IMPORTANCE: Sarcoidosis is a restrictive lung disease marked by granulomatous inflammation affecting multiple organs. Despite its multisystem nature, therapeutic approaches for managing exercise intolerance and fatigue in pulmonary sarcoidosis require further research. OBJECTIVE: Our aim was to compare the effects of one-legged and two-legged cycling exercises on exercise capacity, fatigue, muscle strength, and quality of life in patients with pulmonary sarcoidosis (stages 2 to 4). DESIGN: Randomized controlled trial. SETTING: This randomized controlled trial involved 26 patients, divided equally into one-legged and two-legged cycling groups. PARTICIPANTS: Patients diagnosed with pulmonary sarcoidosis (stages 2 to 4). INTERVENTION: Both groups underwent an 8-week program, with 40-min sessions twice weekly. MAIN OUTCOMES AND MEASURES: Assessments included the 6-Minute Walk Test (6MWT), Incremental Shuttle Walk Test (ISWT), Endurance Shuttle Walk Test (ESWT), Fatigue Assessment Scale (FAS), Multidimensional Fatigue Inventory (MFI), handheld dynamometer tests (quadriceps, tibialis anterior, gastrosoleus), blood lactate analysis, and St. George's Respiratory Questionnaire (SGRQ). RESULTS: Both groups showed significant improvements in fatigue, muscle strength, and quality of life. The one-legged group demonstrated superior results in total SGRQ and SGRQ activity scores (p < 0.05). CONCLUSION: Both exercise protocols effectively enhanced exercise capacity and reduced fatigue in patients with sarcoidosis, with the one-legged approach offering specific advantages for activity-related quality of life.

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