Purpose: Frailty is an emerging risk factor for morbidity and mortality in advanced lung disease and lung transplantation. Interventions to reduce frailty in this population have not been tested. We sought to determine the extent to which pulmonary rehabilitation affected frailty characteristics.

Methods: Data from the National Emphysema Treatment Trial were retrospectively analyzed. Frailty was defined as ≥3 of the following: weight loss in past three months, self-reported exhaustion, limited ability to walk one block, slow gait speed, and low maximal inspiratory or expiratory muscle strength. Difficulty with housework or self-care and self-perception of frailty were also examined. Pre- and post- pulmonary rehabilitations measures were compared using McNemar's test.

Results: 1218 patients (61.2% male), with a median FEV₁ of 23% (IQR 19-28%), completed 12 pulmonary rehabilitation sessions and were included in the analyses. At baseline, 16.9% of patients were frail compared to 10.3% following pulmonary rehabilitation (p= 0.0001). Before pulmonary rehabilitation, 55.9% of patients had low maximal respiratory muscle strength, 22.3% had slow gait speed, 6.1% had recent weight loss, 17.1% had exhaustion, and 40.0% had difficulty walking one block. Following rehab those numbers were reduced to: 51.7% for muscle strength (p= 0.0030), 16.6% for gait speed (p= 0.0001), 9.8% for exhaustion (p= 0.0001), and 31.7% for difficulty walking one block (p= 0.0001). Self-perception of frailty following pulmonary rehabilitation improved from 27.3% of patients to 19.6% (p =0.0001). Moreover, fewer patients reported difficulties in self-care, housework, and stair climbing following pulmonary rehabilitation.

Conclusions: Pulmonary rehabilitation significantly reduced frailty status by 39% in patients with lung disease. In addition to improving multiple frailty criteria, pulmonary rehabilitation positively affected activities of daily living and measures of physical function. Additional research is needed to determine how to optimize and/or supplement pulmonary rehabilitation to reduce frailty in a larger percentage of patients with lung disease.

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