TOPLINE

Patients with idiopathic pulmonary fibrosis (IPF) who trained with one-leg cycling during pulmonary rehabilitation improved their exercise endurance time by 10.5 minutes more than those who trained with conventional two-leg cycling.

METHODOLOGY

• Researchers conducted a prospective randomized trial to assess whether cycling with one leg at a time improved exercise tolerance more than conventional two-leg cycling training in patients with IPF enrolled in pulmonary rehabilitation.
• They included 40 participants with stable IPF (mean age, 73 years) who were randomly assigned to one-leg training (one-leg group, n = 20) or two-leg training (two-leg group, n = 20) on a stationary cycle.
• Training sessions ran three times weekly for 6-8 weeks and lasted 30 minutes each; intensity and duration were increased progressively based on participants' tolerance. Supplemental oxygen was provided to keep blood oxygen saturation at 92% or higher.
• The one-leg group cycled for 15 minutes with each leg, switching mid-session, whereas the two-leg group cycled with both legs at the same time.
• The primary outcome was the time until exercise could no longer be tolerated, measured during constant-power endurance tests done before training, midway through training, and at the end of pulmonary rehabilitation.

TAKEAWAY

• Baseline endurance time was 6.5 minutes in both groups. Endurance time increased significantly in both groups, but the one-leg group improved more (21.8 minutes; 95% CI, 16.0-27.6) than the two-leg group (11.3 minutes; 95% CI, 5.8-16.8). The between-group difference was 10.5 minutes (95% CI, 3.4-17.6), favoring one-leg training.
• Each leg in the two-leg group worked at a lower estimated power than the working leg in the one-leg group (P < .001).
• After training, both groups showed a lower heart rate throughout the constant-power test.
• Peak power and 6-minute walk distance improved in both groups, and peak oxygen uptake rose only in the one-leg group, but none of the differences between groups were significant.

IN PRACTICE

"Overall, the study provides proof of the concept that peripheral muscle specific targeted aerobic training can improve whole body exercise performance in individuals with IPF whose physical activity is affected by dyspnoea. Muscle specific training can easily be incorporated into PR [pulmonary rehabilitation] and should be considered in conjunction with the other components of rehabilitation," the authors wrote.

SOURCE

The study was led by Thomas E. Dolmage, Respiratory Evaluation Services, West Park Healthcare Centre, University Health Network, Toronto, Ontario, Canada. It was published online on September 15, 2026, in Thorax.

LIMITATIONS

Participants could not be blinded to their group assignment during training. COVID-related staffing disruptions also compromised blinding of the assessors of the primary outcome. Moreover, the trial enrolled a relatively small number of patients.

DISCLOSURES

The study was supported by a grant from the Physicians' Services Incorporated Foundation. One author was partly funded by the Leicester National Institute for Health and Care Research Biomedical Research Centre Respiratory Theme. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.