***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND OBJECTIVE It is unclear whether the severity of functional limitation result ing from IPF affects the response to pulmonary rehabilitation . The aim of this study was to compare the outcomes of rehabilitation in patients with IPF , who were grouped according to the Medical Research Council ( MRC ) dyspnoea scale . METHODS Sixty-five subjects ( 46 , 71 % men ) with stable IPF were enrolled in an 8-week pulmonary rehabilitation programme .  Subjects with MRC dyspnoea grade s 2 , 3 and 4 undertook a supervised outpatient programme , whereas subjects with MRC dyspnoea grade 5 participated in an unsupervised , home-based programme , with review every 2 weeks . The outcome measures included functional exercise capacity ( 6MWD ) , health status ( Medical Outcomes Study Short Form 36 ( SF-36 ) ) and dyspnoea ( transition dyspnoea index ) , which were measured at baseline and immediately after the programme . Hospitalizations for respiratory exacerbations were compared for the 12 months preceding and following the programme . RESULTS The number of subjects with MRC dyspnoea grade s 2 , 3 , 4 and 5 were 16 ( 25 % ) , 17 ( 26 % ) , 17 ( 26 % ) and 15 ( 23 % ) , respectively . There were differences between these groups in the magnitude of change in 6MWD , SF-36 and transition dyspnoea index ( all P < 0.05 ) . Specifically , subjects with MRC dyspnoea grade 2 or 3 demonstrated clinical ly and statistically significant improvements in 6MWD and SF-36 following rehabilitation ( all P < 0.05 ) . In contrast , for all measures , subjects with MRC dyspnoea grade 4 or 5 showed little or no improvement , or deteriorated following rehabilitation . Hospitalizations were reduced following rehabilitation only in subjects with MRC dyspnoea grade 2 , 3 or 4 ( P<0.05 ) . CONCLUSIONS The response to pulmonary rehabilitation in subjects with IPF varies depending on the MRC grade of dyspnoea , with little benefit being observed in subjects with severe functional limitation BACKGROUND Idiopathic pulmonary fibrosis ( IPF ) is a chronic , progressive and fatal interstitial lung disease associated with cardiovascular impairments which compromise exercise tolerance and worsen prognosis . AIM To examine the effect of participating in supervised exercise training ( ET ) program on cardiovascular function in patients with IPF . DESIGN A r and omized controlled study . SETTING Outpatient hospital . POPULATION Thirty-two IPF patients ( 68±8 years ) . METHODS An ET group ( N.=15 ) participated in a 12-week twice a week 60-minute supervised exercise program while a control group ( N.=17 ) received usual care . At baseline and after the 12-week intervention all patients underwent resting echocardiography , cardiopulmonary exercise testing and N-terminal pro-brain natriuretic peptide ( NT-proBNP ) assessment s. RESULTS The ET group significantly improved peak values of exercise cardiovascular indexes while the control group showed a trend of deterioration in the outcomes . The mean difference between the groups ( 95 % CI ) for circulatory power was 638 mLO2/kg/min/mmHg ( 95 % CI : 197 - 1080 ) ( P=0.006 ) , cardiac power output 0.3 W ( 95 % CI : 0.1 to 0.6 ) ( P=0.041 ) , and stroke work 312 mL/beat/mmHg ( 95 % CI : 52 - 573 ) ( P=0.02 ) . No significant differences between groups were detected in most echocardiography measures and NT-proBNP . Changes in exercise cardiovascular indexes showed significant correlation with improvements in functional capacity , dyspnea and quality of life among ET group . CONCLUSIONS Participation in supervised ET program  can improve exercise cardiovascular function in patients with IPF , however resting cardiac evaluations seem to be less sensitive to detect such changes . CLINICAL REHABILITATION IMPACT These findings underscore the utility of supervised ET for cardiovascular enhancement which may also be clinical ly beneficial in reducing the cardiovascular morbidity and mortality in IPF patients RATIONALE The 6-minute-walk test ( 6MWT ) is a practical and clinical ly meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases . Performance characteristics in patients with idiopathic pulmonary fibrosis ( IPF ) have not been systematic ally evaluated . OBJECTIVES To assess the reliability , validity , and responsiveness of the 6MWT and estimate the minimal clinical ly important difference ( MCID ) in patients with IPF . METHODS The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b ( n = 822 ) .  Six-minute walk distance ( 6MWD )  and other parameters were measured at baseline and at 24-week intervals using a st and ardized protocol . Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function , dyspnea , and health-related quality of life . Both distribution-based and anchor-based methods were used to estimate the MCID . MEASUREMENTS AND MAIN RESULTS Comparison of two proximal measures of 6MWD ( mean interval , 24 d ) demonstrated good reliability ( coefficient = 0.83 ; P < 0.001 ) . 6MWD was weakly correlated with measures of physiologic function and health-related quality of life ; however , values were consistently and significantly lower for patients with the poorest functional status , suggesting good construct validity . Importantly , change in 6MWD was highly predictive of mortality ; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year ( hazard ratio , 4.27 ; 95 % confidence interval , 2.57- 7.10 ; P < 0.001 ) . The estimated MCID was 24 - 45 m. CONCLUSIONS The 6MWT is a reliable , valid , and responsive measure of disease status and a valid endpoint for clinical trials in IPF INTRODUCTION : Pulmonary rehabilitation is effective for patients with COPD , but its benefit is less clearly established in idiopathic pulmonary fibrosis ( IPF ) , especially in regard to levels of physical activity and health-related quality of life . The objectives were to determine whether pulmonary rehabilitation increased physical activity as assessed by the International Physical Activity Question naire ( IPAQ ) , and improved quality of life and symptoms as assessed by the St George respiratory question naire for IPF ( SGRQ-I ) and the Borg dyspnea index ( BDI ) . METHODS : Subjects who met current criteria for IPF were r and omized to a 3-month pulmonary rehabilitation program ( n = 11 ) or to a control group ( n = 10 ) . The rehabilitation group participated in twice-weekly , 90-min exercise sessions ( 24 total sessions ) . The control group maintained its preceding , normal physical activity . All subjects underwent 6-min walk tests to assess the postexertion BDI . The SGRQ-I and a 5-point self- assessment of health were completed at baseline , after 3 months of intervention or observation , and after 3-month follow-up . All subjects completed the IPAQ weekly . RESULTS : Subjects in the rehabilitation group maintained significantly higher levels of physical activity throughout the 3-month rehabilitation program ( rehabilitation : 51,364 ± 57,713 [ mean ± SD ] metabolic equivalent of task-minutes ; control : 20,832 ± 37,155 , P = .027 by 2-tailed Mann-Whitney test ) . SGRQ-I symptom domain scores improved considerably by −9 ± 22 in the rehabilitation group , whereas in the control group they worsened ( 16 ± 12 rehabilitation compared with control , P = .013 by 2-tailed Mann-Whitney test ) . During the 3-month follow-up , self-reported physical activity levels in the rehabilitation group were 14,428 ± 8,884 metabolic equivalent of task-minutes and in the control group 16,923 ± 32,620 ( P = .17 by 2-tailed Mann-Whitney test ) , demonstrating substantial reversal of activity in the rehabilitation group . BDI scores after 6-min walk tests did not change significantly . CONCLUSIONS : A 3-month rehabilitation program significantly improved symptoms ( SGRQ-I ) and physical activity levels ( IPAQ ) in subjects with IPF while they participated actively in the program . ( Clinical Trials.gov registration NCT01118221 . BACKGROUND AND OBJECTIVE Although pulmonary rehabilitation is effective for patients with COPD , its efficacy in patients with IPF is unknown . The purpose of this study was to evaluate the effects of pulmonary rehabilitation in IPF . METHODS Thirty patients diagnosed with IPF , according to the consensus statement , were r and omly assigned to the rehabilitation group or the control group . The pulmonary rehabilitation mainly consisted of a 10-week programme of exercise training .  Pulmonary function , blood gas analysis , 6MWD , dyspnoea rating with the baseline dyspnoea index and health-related quality of life score on the St George 's Respiratory Question naire were evaluated at baseline and after the programme . RESULTS Assessment of efficacy was carried out on 13 patients who completed the programme and 15 patients in the control group . There were no significant effects of the programme on measures of pulmonary function , values of arterial blood gas analysis or dyspnoea rating . Although there were some differences in the baseline 6MWD and total health-related quality of life score which were not statistically significant , marked improvements were observed in the 6MWD ( mean difference 46.3 m ( 95 % CI : 8.3 - 84.4 ) , P < 0.05 ) and the total health-related quality of life score ( -6.1 ( 95 % CI : -11.7 to -0.5 ) , P < 0.05 ) . CONCLUSIONS Pulmonary rehabilitation improves both exercise capacity and health-related quality of life in patients with IPF INTRODUCTION Idiopathic pulmonary fibrosis ( IPF ) is a severe chronic lung disease . Pulmonary rehabilitation could improve the quality of life of patients with this condition . METHODS We prospect ively evaluated the impact of an 8-week home-based pulmonary rehabilitation programme over 10 months in stable patients suffering from IPF . Exercise capacity , pulmonary function , dyspnoea and quality of life were analyzed before and after the rehabilitation programme . RESULTS Seventeen patients were included and 13 completed the study . Mean functional vital capacity ( FVC ) was 2.15±0.79L and mean diffusing capacity for carbon monoxide ( DLCO ) was 7.81±3.99mL/min/mmHg . Six patients were treated with low dose oral steroids ( 20mg/day of prednisone ) with or without immunosuppressive treatments ; six were taking part in therapeutic trials . Mean endurance time ( 7.4±9.1 min vs. 14.1±12.1 min ; P=0.01 ) , number of steps per minute on a stepper ( 322±97 vs. 456±163 ; P=0.026 ) , six-minute walk distance relative to heart rate ( HR ) ( 11±6 vs. 17±12 ; P=0.006 ) , exercise dyspnoea ( P=0.026 ) , sensation of physical limitation on the SF-36 ( 25%±26 vs. 49%±38 ; P=0.047 ) and four out of seven visual analogue scales were significantly improved after rehabilitation . In contrast , no significant difference was observed in resting pulmonary function or in other items on quality of life question naires . CONCLUSION A home-based programme of pulmonary rehabilitation is feasible in IPF patients . It significantly improved endurance parameters and physical limitation in this patient group without changing pulmonary function Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective The aim of this study was to investigate the effects of a home-based pulmonary rehabilitation program on the functional outcome parameters in patients with idiopathic pulmonary fibrosis ( IPF ) . Design A prospect i ve study . Patients Seventeen patients diagnosed with IPF . Methods A home-based pulmonary rehabilitation program was carried out in 17 IPF patients for 12 weeks . Dyspnea severity during daily life activities ( Medical Research Council Scale ) , pulmonary function ( pulmonary function test ) , exercise capacity ( 6-minute walking test , 6MWD ) , and general health related quality of life ( Medical Outcomes Short Form-36 ) were evaluated . Results A significant decrease in perceived dyspnea ( p = 0.003 ) and leg fatigue ( p < 0.05 ) severities , and an increase in the 6MWD ( p = 0.04 ) and general health related quality of life scores ( health perception , 
    Output:
    
Conclusion : In patients with IPF  , pulmonary rehabilitation showed short-term effects in enhancing exercise capacity and health-related quality of life , while it had no detectable effects at long-term follow-up