***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 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 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 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 Patients with idiopathic pulmonary fibrosis ( IPF ) have severely limited exercise capacity due to dyspnea , hypoxemia , and abnormal lung mechanics . This pilot study was design ed to determine whether pulmonary rehabilitation were efficacious in improving the 6-min walk test ( 6-MWT ) distance , exercise oxygen uptake , respiratory muscle strength [ maximum inspiratory pressure ( MIP ) ] , and dyspnea in patients with IPF . Underlying physiological mechanisms and effects of the intervention were investigated . Methods Subjects were r and omly assigned to a 3-month  pulmonary rehabilitation program ( n = 11 ) or to a control group ( n = 10 ) . All subjects initially underwent the 6-MWT and constant load exercise gas exchange studies . Results Subjects in the rehabilitation group increased treadmill exercise [ metabolic equivalent of task-minutes ] over the first 14 sessions . Beneficial effects on physical function result ed in those who completed rehabilitation . Subjects who completed the program increased cycle ergometer time and maintained exercise oxygen consumption ( exercise VO2 ) at the baseline level over 3 months , while the control group suffered a significant decrease in exercise VO2 . Rehabilitation subjects also increased their MIP . Plasma lactate doubled and brain natriuretic peptide levels increased significantly after exercise , as did the plasma amino acids glutamic acid , arginine , histidine , and methionine . These changes were associated with significant decreases in arterial oxygen saturation and increases in 15-F2t-isoprostanes after exercise . Conclusions Pulmonary rehabilitation effectively maintained exercise oxygen uptake over 3 months and lengthened constant load exercise time in patients with moderately severe IPF . Exercise endurance on cycle ergometry testing was limited by dyspnea and severe hypoxemia associated with systemic oxidant stress OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Pulmonary rehabilitation improves outcomes in patients with interstitial lung disease ( ILD ) , however it is unclear whether these effects are long last 
    Output:
    
Dyspnea scores improved after aerobic and breathing exercises .
HRQL also improved after aerobic exercise training alone or combined with breathing exercises .
Aerobic training alone or combined with IMT or breathing exercises improved exercise capacity .
Conclusions Breathing exercises appears to complement exercise training towards improved dyspnea and HRQL in patients with IPF