Utilisation of cardiopulmonary exercise testing for tailored pulmonary rehabilitation in people with interstitial lung diseases: A systematic review

Objective To systematically evaluate the effects of cardiopulmonary exercise test-derived, tailored pulmonary rehabilitation on cardiopulmonary outcomes in individuals with interstitial lung diseases. Data sources MEDLINE, Embase, CINAHL Ultimate, SPORTDiscus, CENTRAL, and the Cochrane Library were searched from inception up to 4th September 2025. Reference lists of the included studies were hand-searched for additional sources. Review methods Reporting followed PRISMA 2020 guidelines. Studies of any design published in English and involving participants with interstitial lung disease were eligible. Due to intervention heterogeneity, meta-analysis was not conducted. Results Eleven studies comprising 321 participants were included, with sample sizes ranging from 1 to 52. Designs encompassed single-cohort interventions ( n = 4), comparative interventional studies ( n = 3), randomised controlled trials ( n = 3), and one case report. Pulmonary rehabilitation interventions included aerobic, interval, and resistance training, delivered over study durations ranging from 4 weeks to 4.5 years. Cardiopulmonary exercise testing outcomes included peak oxygen uptake; peak work rate; peak minute ventilation; maximum heart rate, and rate of perceived exertion. All studies assessing peak oxygen uptake and peak work rate reported improvements. Peak minute ventilation improvements were reported in six of seven studies. No serious adverse events were reported. Conclusion Tailored pulmonary rehabilitation via cardiopulmonary exercise test metrics appears to enhance peak oxygen uptake and peak work rate in individuals with interstitial lung disease. Findings support its potential efficacy; however, future research should prioritise standardised methods, consistent reporting, and longer follow-up durations to inform clinical practice.