***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Interstitial lung disease ( ILD ) is characterised by exertional dyspnoea , exercise limitation and reduced quality of life . The role of exercise training in this diverse patient group is unclear . The aims of this study were to establish the safety of exercise training in ILD ; its effects on exercise capacity , dyspnoea and quality of life ; and whether patients with idiopathic pulmonary fibrosis ( IPF ) had similar responses to those with other types of ILD . Methods : 57 subjects with ILD ( 34 IPF ) were r and omised to receive 8 weeks of supervised exercise training or weekly telephone support . The 6 min walk distance ( 6MWD ) , incremental exercise test , modified Medical Research Council ( MRC ) dyspnoea score and Chronic Respiratory Disease Question naire ( CRDQ ) were performed at baseline , following intervention and at 6 months . Results : 80 % of subjects completed the exercise programme and no adverse events were recorded . The 6MWD increased following training ( mean difference to control 35 m , 95 % CI 6 to 64 m ) . A significant reduction in MRC score was observed ( 0.7 points , 95 % CI 0.1 to 1.3 ) along with improvements in dyspnoea ( p = 0.04 ) and fatigue ( p<0.01 ) on the CRDQ . There was no change in peak oxygen uptake ;  however , exercise training  reduced heart rate at maximum isoworkload ( p = 0.01 ) . There were no significant differences in response between those with and without IPF . After 6 months there were no differences between the training and control group for any outcome variable . Conclusions : Exercise training improves exercise capacity and symptoms in patients with ILD , but these benefits are not sustained 6 months following intervention . Trial registration number : 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 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 : Idiopathic pulmonary fibrosis ( IPF ) is a chronic , devastating , interstitial lung disease , with few therapeutic options . IPF is characterized by pulmonary restriction , dyspnea , hypoxemia , exercise intolerance and poor quality of life ( QOL ) . Objectives : We aim ed to examine the effect of exercise training ( ET ) on clinical outcomes in IPF patients . Methods : A r and omized controlled study included thirty-two IPF patients ( aged 68 ± 8 years ) who were allocated either to the ET group ( n = 15 ) , participating in a 12-week , twice-weekly 60-min supervised ET-based pulmonary rehabilitation program  , or to  a control group ( n = 17 ) continuing with regular medical treatment alone . Cardiopulmonary exercise test , 6-min walking distance ( 6MWD ) test , 30-second chair-st and test , pulmonary function tests , dyspnea and QOL were assessed at baseline and at the end of the 12-week intervention . Results : Significant differences were observed between the ET and the control groups in raw mean deltas ( Δ = post- - pre-intervention ) : Δ6MWD , 81 m , p < 0.001 ; ΔVO2 peak , 2.6 ml/kg/min , p = 0.002 ; Δwork rate , 22 W , p < 0.001 ; Δanaerobic threshold , 3.1 ml/kg/min , p < 0.001 , and ΔFVC % predicted , 6 % , p = 0.038 . Dyspnea , QOL and 30-second chair-st and were also improved significantly following the program . Conclusions : ET  improves exercise tolerance , functional capacity , pulmonary function , dyspnea and QOL in patients with IPF , suggesting a short-term treatment efficacy for clinical improvement , and should be considered the st and ard care for 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 BACKGROUND Idiopathic pulmonary fibrosis is a progressive and fatal lung disease with inevitable loss of lung function . The CAPACITY programme ( studies 004 and 006 ) was design ed to confirm the results of a phase 2 study that suggested that pirfenidone , a novel antifibrotic and anti-inflammatory drug , reduces deterioration in lung function in patients with idiopathic pulmonary fibrosis . METHODS In two concurrent trials ( 004 and 006 ) , patients ( aged 40 - 80 years ) with idiopathic pulmonary fibrosis were r and omly assigned to oral pirfenidone or placebo for a minimum of 72 weeks in 110 centres in Australia , Europe , and North America . In study 004 , patients were assigned in a 2:1:2 ratio to pirfenidone 2403 mg/day , pirfenidone 1197 mg/day , or placebo ; in study 006 , patients were assigned in a 1:1 ratio to pirfenidone 2403 mg/day or placebo . The r and omisation code ( permuted block design ) was computer generated and stratified by region . All study personnel were masked to treatment group assignment until after final data base lock 
    Output:
    
A recent systematic review showed significant improvements in 6-min walking distance , peak aerobic capacity , reduced dyspnea and improved quality of life .