Pediatric Pulmonary Rehab Boosts Function, Quality of Life

Significant gains in exercise capacity, physical strength, and quality of life are achievable through pulmonary rehabilitation (PR) in children with chronic respiratory disease, even when traditional measures of lung function show no improvement, according to new research presented at the 2026 American Thoracic Society International Conference.¹

Exercise Capacity, Strength Rose Despite Stable Spirometry

The single-center cohort study, led by Tauras Vucianis, a third-year medical student at the University of Cincinnati College of Medicine, tracked outcomes among 51 pediatric patients who completed at least 5 sessions of a structured PR program between March 2017 and August 2025. The cohort had a mean age of 14.4 years and was roughly evenly split by sex. Underlying lung disease was classified as obstructive in 45% of participants, restrictive in 39%, and mixed in 6%, as determined by spirometric patterns.

Participants completed a mean of 18.8 sessions, with approximately 9 days between sessions. Despite the heterogeneous patient population and varied diagnoses, outcomes were consistently positive across multiple functional measures.

Exercise capacity, as measured by the 6-minute walk test (6MWT), improved significantly with the average distance increasing from 1234 ft to 1464 ft (P = .0001). Strength-based functional assessments told a similar story: 30-second sit-to-stand repetitions rose from a mean of 13.7 to 17.9 (P = .0002), modified push-up counts nearly doubled from 15.4 to 27.6 (P = .0022), and 8-foot-up-and-go time decreased from 4.48 to 3.88 seconds (P = .0001), reflecting improved agility and lower-body function.

"The key takeaway is that pediatric PR significantly improves how children function and feel, with increased exercise capacity, strength, and quality of life — even when traditional lung function testing doesn't change," Vucianis said in a statement.²

Why Spirometry Isn't the Whole Story

Pulmonary function tests, which measure airflow and lung volumes through spirometry, did not improve significantly following the PR program.¹ This finding, rather than undercutting the program's value, reinforces a growing recognition that clinical benefit in chronic respiratory disease extends well beyond what spirometry captures.

Self-reported quality of life, as measured by the Pediatric Quality of Life Inventory, improved from both the patient and caregiver perspective. Patient-reported scores rose from a mean of 64.95 to 70.74 (P = .027), while parent-reported scores climbed from 60.67 to 68.40 (P = .021). Patient and caregiver satisfaction with the program was described as uniformly high.

"This highlights that meaningful clinical improvement extends beyond spirometry and supports PR as an important component of care for children with chronic respiratory disease," Vucianis said.

The findings carry implications for how outcomes are defined and measured in pediatric respiratory care and for how payers and health systems evaluate the value of PR programs. In the adult population, PR has faced its own access and utilization challenges. Fewer than 2% of fee-for-service Medicare beneficiaries with chronic obstructive pulmonary disease completed a PR program within 90 days of hospitalization, despite evidence linking the therapy to improved survival.³ Barriers including transportation, geography, and lack of referrals from primary care providers have been identified as key drivers of underuse.⁴

A Gap in Pediatric Care

Despite its well-documented benefits in adults, PR remains rare in pediatric settings. Vucianis noted that standardized protocols for children are largely absent, and programs must be individually tailored to account for each patient's age, developmental stage, behavior, and functional capacity—all of which add complexity compared with adult programs. Those factors have historically contributed to a dearth of research in this space and limited availability of pediatric PR programs nationwide.

The study population reflected a range of chronic respiratory diagnoses, underscoring that the benefits of PR are not limited to a single disease type. The program's goal of building patient confidence in self-managing their disease—and sustaining physical activity beyond the formal program—was a defining feature.

"One of the main goals of our program is to increase patients' confidence in the self-management of their disease, and to promote physical activity outside of the medical facility," Vucianis said. "We are always thrilled to hear when our former participants are continuing to implement their own exercise programs long after their PR sessions have ended."

What Researchers Still Need to Know About Pediatric PR

The research team plans to continue building the evidence base for pediatric PR, with forthcoming studies examining the sustainability of PR benefits over time, the impact on additional clinical outcomes, and the optimal timing of PR across different disease stages and patient populations.²

“These findings highlight the holistic benefits of PR for children with chronic respiratory diseases,” they concluded.¹ “Collectively, these results provide a foundation for broader study and implementation of PR in pediatric chronic lung disease management.”

References

1. Vucianis T, Foster KE, Nakamura A, et al. Benefits of pulmonary rehabilitation for pediatric chronic respiratory disease. Presented at: 2026 ATS International Conference; May 15-20, 2026; Orlando, FL.
2. Pediatric pulmonary rehab improves exercise ability, quality of life. News release. American Thoracic Society. May 6, 2026. Accessed May 27, 2026. https://site.thoracic.org/press-releases/pediatric-pulmonary-rehab-improves-exercise-ability-quality-of-life
3. Pulmonary rehabilitation for COPD linked to lower risk of death in FFS Medicare. AJMC^®. May 12, 2020. Accessed May 27, 2026. https://www.ajmc.com/view/pulmonary-rehabilitation-for-copd-linked-to-lower-risk-of-death-in-ffs-medicare
4. Barriers hinder primary care providers from referring patients with COPD to pulmonary rehabilitation. AJMC. January 26, 2022. Accessed May 27, 2026. https://www.ajmc.com/view/barriers-hinder-primary-care-providers-from-referring-patients-with-copd-to-pulmonary-rehabilitation