Patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), have unique risks for adverse health events during exercise training outside of a medically supervised setting. Traditionally, patients with ILD have been referred to supervised, center-based pulmonary rehabilitation programs for the availability of supplemental oxygen, assistance with oxygen titration, and direct supervision during exercise. However, center-based programs may not be as accessible as home-based programs and may not be preferred by all patients with LAM.

A multidisciplinary panel of experts in LAM and ILD participated in a two-round modified Delphi study and ranked their level of agreement for statements related to safety and risk mitigation during exercise training in LAM.

Findings from the study, led by investigators at the University of Washington and funded by a research grant from The LAM Foundation were recently published in CHEST. The purpose of the study was to investigate what preparticipation screening steps are essential to determine whether a patient with lymphangioleiomyomatosis (LAM) is medically appropriate to participate in an unsupervised exercise program.

A LAM-specific remote exercise preparticipation screening tool was developed from the consensus statements and agreed upon by the full panel. The panel provides a list of recommendations and a consensus LAM-specific exercise preparticipation screening tool for provider use prior to patient enrollment in the LAMFit remote exercise program:

• An in-person clinical exercise test is indicated to screen for exercise-induced hypoxemia and prescribe supplemental oxygen therapy as needed prior to initiating a remote exercise program.
• Patients with recent pneumothorax should wait to start an exercise program for at least 4 weeks until after resolution of pneumothorax and clearance by a physician.
• Patients with high cardiovascular risk for event during exercise, severe resting pulmonary hypertension, or risk for falls may be more appropriate for referral to exercise under supervision in a rehabilitation center.

The full publication can be accessed here https://doi.org/10.1016/j.chest.2024.06.3803,