After consenting to the study, all the participants will undergo baseline assessments (demographic details, primary and secondary outcome measures). 

Baseline assessments: Demographic details, Six-minute walk test (6MWT), European quality of life (EQ-5D-5L), King’s Brief Interstitial Lung Disease (KBILD), Modified Medical Research Council (mMRC) scale, Dyspnoea-12 (D-12 questionnaire), hand-held dynamometer, hand grip dynamometer, Fatigue Severity Scale (FSS), London Chest Activity of Daily Living (LCADL), six-minute peg board ring test (6PBRT), 30 Sit-to-stand (30 STS), Depression, Anxiety and Stress scale (DASS-21), Health Literacy Survey Questionnaire (HLS-EU-Q47), Pittsburgh Sleep Quality Index (PSQI), Global Physical Activity Questionnaire (GPAQ), Exercise Benefits/Barriers Scale (EBBS), PROMIS scale. 

Randomization:

After baseline assessments, the participants will undergo a randomization process using computer-generated random number tables. The randomization process will include block randomization and the participants will be separated into 12 boxes of six participants each. Allocation concealment will be done using sequentially numbered, opaque sealed envelopes. Participants will be allocated into either intervention group 1 or intervention group 2. The process of randomization would be done by a Professor who is a Ph.D. (VK)

After randomization, participants will be allocated to the study group (n= 36) and the control group (n=36). In intervention group 2, participants will receive home-based pulmonary rehabilitation using a developed and validated educational exercise booklet. 

Intervention group 1: In intervention group 1, participants will receive a 12-week exercise program at home through telerehabilitation. During the hospital visit participants in both groups will be receiving one familiarization session. During the first three months of telerehabilitation, supervised sessions of 30–45-minute/ session along with warm-up and cooldown will be held 2 times per week through an online platform (Zoom/ Teams) along with caregivers for assistance. Participants will be instructed to continue doing the exercises on the other days of the week using the developed exercise video. After 3 months, there will be no progression of exercises. Participants will be instructed to continue their exercises unsupervised using exercise video. The exercises included are aerobic exercises, resistance training and flexibility training. Participants will track their exercise sessions in a logbook during the unsupervised period.

Intervention group 2: The exercise intensity will be individualized according to the patient’s condition. Participants will track their exercise sessions in a logbook during the unsupervised period. Participants in intervention group 2 will be receiving a home-based program through a validated educational booklet and will be asked to perform these exercises at home. This booklet consists of deep breathing exercises, resistance, flexibility, and endurance training. Participants are recommended to perform their exercises 4-5 days per week. Intervention group 2 will receive the same exercise intervention as group 1. Throughout the exercise session phase, participants in both groups will receive weekly motivational calls. The intervention is considered complete if the participant completes at least 50 out of 60 sessions within three months.

Throughout the exercise session phase, participants in both groups will receive weekly motivational calls.

Risk factors: The possible risks in this study are increase in symptoms (breathlessness and fatigue) while doing exercises, muscle soreness and pain. The mitigation strategies will be taught to the participants on managing breathlessness and fatigue by doing relaxation and breathing exercises and giving adequate rest. In case of muscle soreness and pain they will be instructed to do cryotherapy.

Participants will be receiving education on safety precautions, choose appropriate exercise attire, footwear, ventilated and non-slippery environment and also to perform warm-up and cool-down exercises. They will be asked to show the oxygen saturation using pulse oximeter on the screen during video conference sessions. During unsupervised sessions, they will be advised to monitor the saturation while doing exercises.