Impact of pulmonary rehabilitation on aerobic capacity and exploratory muscle strength outcomes in idiopathic pulmonary fibrosis: a systematic review and meta-analysis

Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease characterised by exertional dyspnoea, intolerance to daily life activities, and dysfunction of skeletal muscle, which collectively exacerbate disability and elevate mortality risk. This systematic review aims to evaluate the impact of pulmonary rehabilitation (PR) programmes on aerobic capacity and peripheral muscle strength in individuals with IPF. A systematic literature search was conducted up to April 2025 using the MEDLINE, EMBASE, CINAHL, LILACS, and Google Scholar databases. The risk of bias was assessed using the RoB2 tool, and the GRADE approach was applied to determine the certainty of the evidence. Nine randomised controlled trials were included. PR significantly improved aerobic capacity, increasing the six-minute walk test (6MWT) distance by 34.4 metres (95% CI 22.00–46.84, p < 0.00001) after the programme, peak work rate (PWR) by 9.9 watts (95% CI 6.39–13.49, p < 0.00001), and exercise time by 138.3 s (95% CI 72.81–203.85, p < 0.0001). Changes in peak oxygen consumption (VO₂ peak) were not statistically significant (mean difference 6.42 ml/kg/min; 95% CI −0.04–12.87; p = 0.05). Regarding muscle strength, only one study assessed this outcome, and its results did not reach statistical significance. Pulmonary rehabilitation improves aerobic capacity in patients with IPF, achieving the minimal clinically important difference (MCID) in 6MWT distance at the end of the programme, but this is not maintained during follow-up. Evidence on peripheral muscle strength is limited and exploratory, precluding firm conclusions.