Pulmonary Rehabilitation Program in Patients With Post-Tuberculosis Lung Disease

Persistent impairment after successfully treated pulmonary tuberculosis is increasingly recognized as an important source of chronic respiratory morbidity. Patients may experience dyspnea, exercise intolerance, fatigue, impaired mobility, and reduced health-related quality of life. Preliminary retrospective data from 37 patients suggested that structured pulmonary rehabilitation may improve the 6-minute walk distance, Timed Up and Go performance, dyspnea, perceived exertion, quality of life, and selected inflammatory indices. However, retrospective allocation and the absence of a longer follow-up limit causal interpretation.

The present study is designed as a prospective, assessor-blinded, parallel-group randomized controlled trial. It will assess both the immediate response to an individualized rehabilitation program and the maintenance of benefit three months after the supervised program has ended. The intervention combines aerobic training, resistance training, breathing exercises, education, and individualized symptom-management strategies. The control group will receive usual post-tuberculosis medical care and general physical-activity advice without a structured supervised pulmonary rehabilitation program during the study period.

• Individualized Pulmonary Rehabilitation Program (Behavioral): The intervention consists of an 8-week individualized outpatient pulmonary rehabilitation program, delivered through three supervised sessions per week, with each session lasting approximately 60 minutes. Each session will include: 5-10 minutes of warm-up and mobility exercises; 20-30 minutes of individualized aerobic training, such as walking, treadmill exercise, or cycle ergometry; resistance exercises targeting the major upper- and lower-limb muscle groups; breathing exercises, including diaphragmatic breathing, pursed-lip breathing, and thoracic expansion exercises; airway-clearance techniques when clinically indicated; education regarding symptom monitoring, energy conservation, physical activity, treatment adherence, and healthy lifestyle; an individualized home exercise program on non-supervised days. Exercise intensity and progression will be individualized according to baseline functional capacity, symptoms, Borg CR10 score, heart rate, oxygen saturation, comorbidities, and
• Standard Post-Tuberculosis Care (Other): Standard Post-Tuberculosis Care

Primary outcomes

• Change From Baseline in EUROHIS-QOL-8 Total Score [Baseline, Week 8, and Week 20.]: Generic quality of life will be assessed using the EUROHIS-QOL-8 questionnaire. The questionnaire contains eight items scored from 1 to 5. The total score ranges from 8 to 40, with higher scores indicating better quality of life. A positive change indicates improvement.
• Change From Baseline in St George's Respiratory Questionnaire Total Score at Week 20 [Baseline to Week 20, corresponding to three months after completion of the 8-week pulmonary rehabilitation program.]: Respiratory health-related quality of life will be assessed using the St George's Respiratory Questionnaire (SGRQ). The total score ranges from 0 to 100, with higher scores indicating greater impairment. The outcome will be calculated as the Week 20 score minus the baseline score. A negative change indicates an improvement in respiratory health-related quality of life.

Other outcomes

• Change From Baseline in Six-Minute Walk Distance [Baseline, Week 8, and Week 20]: Functional exercise capacity will be assessed using the 6-Minute Walk Test. The total distance walked in six minutes will be recorded in meters. A greater walking distance indicates better functional exercise capacity.
• Change From Baseline in Timed Up and Go Test Performance [Baseline, Week 8, and Week 20.]: Functional mobility will be assessed using the Timed Up and Go test. The time required for the participant to stand up from a chair, walk 3 meters, turn, return to the chair, and sit down will be recorded in seconds. A shorter completion time indicates better functional mobility.
• Change From Baseline in Modified Medical Research Council Dyspnea Grade [Baseline, Week 8, and Week 20.]: Dyspnea during daily activities will be assessed using the modified Medical Research Council scale. Scores range from 0 to 4, with higher scores indicating greater dyspnea-related functional limitation. A reduction in score indicates improvement.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* • Age 18 years or older.

  * Documented history of pulmonary tuberculosis with anti-tuberculosis treatment completed according to national standards.
  * No clinical evidence of active or relapsed tuberculosis at enrollment; microbiological reassessment will be performed when clinically indicated.
  * Persistent respiratory symptoms, exercise limitation, or functional impairment considered attributable to post-tuberculosis lung disease.
  * Clinical stability for at least 4 weeks before randomization, with no acute respiratory infection or acute exacerbation requiring treatment change.
  * Ability to walk independently, with or without a usual assistive device, and to perform the study assessments.
  * Ability to understand the study procedures and provide written informed consent.

Exclusion Criteria:

* • Suspected or confirmed active, recurrent, or drug-resistant tuberculosis requiring treatment or isolation.

  * Acute respiratory infection or acute cardiopulmonary decompensation within 4 weeks before enrollment.
  * Unstable angina, recent myocardial infarction, uncontrolled arrhythmia, decompensated heart failure, severe uncontrolled hypertension, or another contraindication to exercise testing/training.
  * Severe neurological, musculoskeletal, or cognitive impairment that prevents safe participation or valid outcome assessment.
  * Current participation in another structured pulmonary rehabilitation or supervised exercise program.
  * Planned major surgery or another condition likely to prevent completion of the 20-week follow-up.
  * Any condition judged by the investigator to make participation unsafe or to substantially interfere with interpretation of the outcomes.