Promoting Exercise Training Remotely

Abstract

There has been increased incentivization to develop remote exercise training programs for those living with chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD). Remote programs offer patients an opportunity to overcome barriers to accessing traditional in-person programs, such as pulmonary rehabilitation (PR). Methods to deliver exercise training remotely range in complexity and types of technological modalities, including phone calls, real-time video conferencing, web- and app-based platforms, video games, and virtual reality (VR). There are a number of studies demonstrating the effectiveness of these programs on exercise capacity, dyspnea, and health-related quality of life (HRQL). However, there is great variation in these programs, making it difficult to assess findings across studies. Other aspects that contribute to the effectiveness of these programs include stakeholder perceptions, such as motivation and willingness to engage, and adherence. Finally, while the intent of these remote programs is to overcome barriers to access, they may inadvertently exacerbate access disparities. Future program development efforts should focus on standardizing how remote exercise training is delivered, engaging stakeholders early on to develop patient-centered programs that patients will want to use, and understanding the heterogeneous preferences and needs of those living with chronic respiratory disease in order to facilitate engagement with these programs.

Safety, feasibility and effectiveness of the remotely delivered Pulmonary Hypertension and Home-Based (PHAHB) physical activity intervention

“…There was a significant improvement in the 30-second STS score (p=0.000) between baseline and post-training (Figure 2). The average increase was 8.32 3.95 (SD) reps (range [12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The difference in both the STS and 6MWD performance score between baseline and post-training were calculated and were found to be positively correlated (r =0.75).…”

“…The use of telehealth in conjunction with wearable technology, and evidence-based behavioural change techniques, provides a low-cost and scalable solution to exercise training promotion in PH, that is likely to be sustainable and foster long-term behaviour change. Research of remote programmes in other chronic respiratory diseases appears to be largely beneficial in improving clinical outcomes [ 15 ]. To our knowledge, no previous research has examined the feasibility and effectiveness of a home-based physical activity intervention that is delivered entirely remotely in PH patients.…”

“…Research of remote programs in other chronic respiratory diseases appears to be largely beneficial in improving clinical outcomes [15]. To our knowledge, no previous research has examined the feasibility and effectiveness of a home-based physical activity intervention that is delivered entirely remotely in PH patients.…”

Role of digital health in pulmonary rehabilitation and beyond: shaping the future

“…Digital technologies offer the potential to overcome barriers to accessing PR services (such as travel, transport and location), by increasing coverage in more isolated areas and enabling closer monitoring of patients [1,25]. However, they may also aggravate the existing access disparities, due to the need of digital technology and appropriate infrastructures, including internet access [7,94]. Recent studies have found that, while digital technologies are ubiquitous in daily lives of most patients with CRDs, particularly mobile phones [95][96][97], only a limited number of patients have access to the internet and/or are confident in using it [95][96][97][98], which may create a problem of inequitable access to intervention enrolment.…”

“…However, it is acknowledged that digital interventions are not a "one size fits all" approach [25], and there is a need to better understand the characteristics of patients who can benefit most from digital health. Digital home-based programmes may be more suitable for patients with good connectivity and digital self-efficacy, while centre-based programmes may be a better alternative for those who lack the resources or are uncomfortable using technology [94]. The assessment of patients' suitability for digitally enabled interventions may be facilitated by the use of tools such as the 8-item Dutch Blended Physiotherapy Checklist [101].…”