- Design
- Assessor-blinded, multicentre randomised controlled trial, 16 weeks
- Population
- 51 patients aged 6 to 20 with post-infectious bronchiolitis obliterans
- Primary outcome
- Peak oxygen uptake and ventilatory threshold on cardiopulmonary exercise testing
- Effect
- Peak VO2 +3.39 mL/kg/min (P = 0.04); time to VT1 +1.05 min (P = 0.04)
A multicentre, assessor-blinded trial randomised 51 people aged 6 to 20 with post-infectious bronchiolitis obliterans to a 16-week home programme of two real-time, remotely supervised 40-minute high-intensity interval sessions a week, or to general physical activity advice. Mean age was 13.3 years and baseline FEV1 z-score was -3.56.
Peak oxygen uptake improved by a mean difference of 3.39 mL/kg/min (P = 0.04), time to first ventilatory threshold by 1.05 minutes (P = 0.04), and 30-second sit-to-stand repetitions by 2.21 (P = 0.04). Lung function, strength, BMI and quality-of-life scores did not differ.
The benefits are modest, with p-values close to the threshold, among 51 participants, and the trial did not show benefit for lung function or symptoms. It adds feasibility evidence for supervised remote exercise in a group with little data.
- Encourage regular physical activity in children with bronchiolitis obliterans, with a supervised programme where available
- Expect improvements in fitness rather than in lung function
- Screen for exertional hypoxaemia before intensive exercise
- Remote supervision may help where specialist centres are far away
Why it matters
Exercise training is established in other chronic lung diseases but untested in this condition, which often follows childhood infection.
Don't overread it
A 51-patient trial with p-values close to 0.05 needs confirmation, and there was no lung function benefit.
The statistics, in plain English
Three results with p-values of 0.04 from 51 people are fragile: several outcomes were tested, and a few chance differences are expected. The effect on peak oxygen uptake, about 3.4 mL/kg/min on a baseline of 36.8, is meaningful in fitness terms.
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