Study Shows Staying Active Through Regular Exercise Significantly Reduces Risk Of Death With Those With ILD

Research has shown that reduced physical activity and lower exercise capacity — as shown by the six-minute walk test, decreased peak oxygen uptake and other measures — are associated with a higher mortality risk in people with interstitial lung disease (ILD). Pulmonary rehabilitation, including different types of exercise therapy, is recommended for people with ILD, with documented benefits on quality of life and mortality. But there are still some gaps in the understanding of the relationship between exercise and ILD and to what extent exercise can affect the course of the disease and the deaths that it causes.

Those gaps led a group of researchers from Korea to evaluate the association between exercise maintenance and mortality in individuals with ILD using a longitudinal, large population-based database. The results of the study were published Aug. 13, 2025, in Therapeutic Advances in Respiratory Disease.

First author Bo-Guen Kim, M.D., Ph.D., of Kangbuk Samsung Hospital and the Sungkyunkwan University School of Medicine in Seoul, Republic of Korea, and colleagues conducted the retrospective cohort study utilizing the Korean National Health Insurance claims-based database.

A total of 3,850 people with ILD who underwent two consecutive health screening examinations were included in the study. According to Kim, the study measured changes in exercise habits between the two assessments, classifying participants as exercisers (including both maintainers and nonmaintainers) or nonexercisers. Analyses were adjusted for variables such as age, sex, body mass index (BMI), smoking status, alcohol consumption, socioeconomic status, residential area and comorbidities. During a follow-up period of 7.2 years on average, the death rate was lower among exercisers compared to nonexercisers (341.28 versus 401.81 deaths per 10,000 person-years.)

“After adjusting for other factors, the analysis showed that exercisers had a significantly lower risk of death, with an 18% reduction,” the researchers wrote. The decrease in death risk was 22% for those who kept up with regular exercise and 15% in the “exercise nonmaintainers” group.

“Our analysis adds robust evidence for the relationship between exercise habits and ILD prognosis; beyond merely showing exercise as a predictor of mortality in individuals with ILD, our study findings emphasize that adherence to exercise could provide more benefits in individuals with ILD over a long-term period of the natural disease course,” wrote Kim and the other authors.

Their subgroup analyses revealed some nuances. Among those with idiopathic pulmonary fibrosis (IPF), which accounts for approximately a third of IDL cases, the benefit of exercise was evident for up to seven years after follow-up. After that, it disappeared. Kim and colleagues said the reason is not fully explainable, but they noted that the risk of lung cancer and acute exacerbation in IPF increases as the duration of IPF increases, which may affect mortality regardless of exercise capacity.

They also noted that individuals with a lower BMI and higher economic status had a reduced risk of mortality compared to their counterparts. They noted that other research has shown that previous studies that adipose tissue releases proinflammatory cytokines that perhaps contribute to the progression of pulmonary fibrosis. Economic status has an array of consequences that may modify the interaction exercise and mortality, they noted, including access to exercise resources, health literacy, comorbidity burden and healthcare utilization.