Long-Term Benefits of Tailored Exercise in Severe Sarcoidosis: A Case Report

Background: We studied the effects of a supervised, structured exercise program in a severe sarcoidosis patient. Methods: After being clinically stable for two years, a 52-year-old woman (stage IV, American Thoracic Society) who originally had irreversible lung fibrosis, pulmonary arterial hypertension (PAH), mild mitral insufficiency, and atrial dilatation, and was candidate for lung transplant, performed a combined high-intensity interval, high load resistance, and inspiratory muscle training for 4.5 years, and was tested (cardiopulmonary exercise testing and dual X-ray absorptiometry) every six months. Results: Cardiorespiratory fitness (CRF) and maximal pulmonary ventilation increased by 44% and 60%, respectively. Ventilatory efficiency also improved (decrease in the ventilatory equivalent for oxygen by 32% and 14% at the ventilatory threshold and respiratory compensation point, respectively). She improved New York Heart Association (NYHA) class (from III to II), and cardiac alterations as well as PAH reversed so that she was not in need of lung transplantation anymore. Likewise, she suffered no more episodes of hemoptysis. Bone health was overall maintained despite the post-menopausal status and the corticoid treatment. Conclusions: A long-term combined exercise intervention safely contributed—at least partly—to improve CRF and NYHA class in a patient with severe sarcoidosis, suggesting a potential coadjuvant effect to attenuate clinical manifestations.