Exercise and Oxygen for People with Interstitial Lung Disease

Interstitial Lung Disease (ILD) is a group of diseases that cause progressive damage to the lungs, resulting in difficulty breathing, decreased functional ability and reduced quality of life. Pulmonary rehabilitation is recommended, with guidelines for exercise based on research in people with Chronic Obstructive Pulmonary Disease (COPD). However, individuals with ILD often require more oxygen support with exercise, and have a significantly worse prognosis. ILD is less common than COPD, resulting in a gap of meaningful rehabilitation research exploring this chronic disease.

 

NIRS probe on leg muscle

NIRS probe on leg muscle.

Lisa Wickerson, lecturer in the Department of Physical Therapy, is working with her colleagues  to fill this gap.

“I work with individuals with ILD in the Lung Transplant Program at Toronto General Hospital, where the world’s first single and double lung transplants took place. Toronto General has a rich history of being leaders in lung transplant innovation. With medical and surgical advancements,  guidelines have expanded as to who is eligible for a lung transplant” says Wickerson. “This has had implications for rehabilitation, because we are seeing a more diverse range of individuals undergoing transplantation in terms of age, acuity, co-existing medical issues and functional ability. My role as a physiotherapist is to prescribe exercise programs pre-transplant to increase fitness for surgery, and I found that there was little rehabilitation research on the ILD  population.  Working in a lung transplant program provides a unique opportunity, as ILD is the most common referral for lung transplant at our centre, so I work with a higher proportion of individuals with ILD than most traditional pulmonary rehabilitation programs. I realized I could not wait for this work to be done: I needed to start doing this research myself.”

Wickerson has dedicated her PhD research to just that, searching for safe and effective ways for people with ILD to exercise. Working together with Dr. Darlene Reid (Primary Investigator) and Dr. Sunita Mathur (Co-Investigator), their study has been funded by the Ontario Respiratory Society, and seeks to understand oxygen levels in the muscle during exercise. “Right now, we measure oxygen levels using a pulse oximeter to know if people have enough oxygen in their blood to deliver to their working muscles during exercise. However, this does not tell us what is occurring in the muscles themselves, where the oxygen is being taken up and used” explains Wickerson.

This study will use optical technology in a controlled exercise environment to better understand oxygen levels within the muscle. The study will test three groups of people: a healthy age and gender matched control group, a group of people with severe ILD who are waiting for transplant and require continuous oxygen, and a group of people with mild to moderate ILD who do not need oxygen support. All three groups will perform the same exercise wearing Near Infrared Spectroscopy (NIRS) probes on their arm and leg muscles, which will measure the oxygenation level of the haemoglobin locally.

“This testing is a preliminary step in improving our ability to prescribe exercise and oxygen for people with ILD” says Wickerson, who has also received Fellowships from the Ontario Respiratory Society for the last three years. “Our research will help inform more effective rehabilitation practices for the ILD population with the aim of enhancing their physical function and quality of life.”