A mobile health technology enabled home-based intervention to treat frailty in adult lung transplant candidates: A pilot study.

BACKGROUND: Frailty is prevalent in lung transplant candidates (LTC) and is associated with waitlist delisting or death. We performed a pilot study to assess the safety and feasibility of a home-based, mobile health technology-facilitated intervention to treat frailty in LTC. METHODS: We performed an 8-week, nonrandomized, home-based exercise and nutrition intervention in LTC with Short Physical Performance Battery (SPPB) frailty scores of ≤11. The intervention utilized a customized, mobile device application ("app") enabling monitoring and progression of the intervention in real time. We aimed to evaluate key process measures. Secondarily, we tested whether the intervention could improve frailty scores quantified by the SPPB and Fried Frailty Phenotype (FFP). RESULTS: A total of 15 subjects enrolled were 63 ± 5.7 years old; oxygen requirements ranged from 3 to 15LPM. Thirteen subjects completed the intervention. Over 108 subject-weeks, there were no adverse events. Subjects found the app engaging and easy to work with. SPPB frailty improved in 7 (54%) and FFP improved in 8 (62%). There was a strong trend toward improved frailty scores (SPPB change 1.0 ± 1.9; P = .08; FFP change -0.6 ± 1.0; P = .07). CONCLUSION: In this pilot study, we found that a home-based prehabilitation program that leverages mobile health technology to target frailty in LTC is well received, safe, and capable of improving physical frailty scores.

Moving Pulmonary Rehabilitation Into the Home: A CLINICAL REVIEW.

Pulmonary rehabilitation (PR) is the standard of care for persons with chronic, symptomatic lung disease. The availability of PR is limited, particularly in rural areas. In addition, barriers to PR include the lack of transportation, patient inconvenience, inadequate insurance coverage, and cost. Technology has the potential to overcome several barriers to PR by enhancing the availability and uptake of PR principles through the development of technology-supported, home-based PR programs. For technology-supported, home-based PR, or telehealth PR, to be effective, key components of traditional PR must be present including appropriate individualized exercise prescription, self-management education, outcome measurements, and patient support. This clinical review summarizes the current practice of PR, describes limitations to the availability of PR, describes key principles that technology should feature to ensure best practices are met, and proposes current and future technology options as an emerging strategy for home delivery of PR and its components.

Pulmonary rehabilitation exercise prescription in chronic obstructive lung disease: US survey and review of guidelines and clinical practices.

Chronic obstructive pulmonary disease is a common, progressive disorder associated with disabling symptoms, skeletal muscle dysfunction, and substantial morbidity and mortality. Current national guidelines recommend pulmonary rehabilitation (PR) to improve dyspnea, functional capacity, and quality of life. Many PR exercise programs are based on guidelines from the American College of Sports Medicine. Recommendations have also been published by the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Thoracic Society. Translating exercise science into effective training and clinical care requires interpretation and the use of diverse national PR guidelines and recommendations. Pulmonary rehabilitation clinicians often vary in their education and background, with most nurses and respiratory care practitioners lacking formal training in exercise physiology. Patients often have comorbidities that may further complicate exercise provision and prescription. This article describes the results of an informal, nonscientific survey of the American Association of Cardiovascular and Pulmonary Rehabilitation members exploring current PR exercise prescription practices as a basis for discussion and reviews current national exercise recommendations for chronic obstructive pulmonary disease. Further, it describes areas of uncertainty regarding exercise prescription in PR and suggests strategies for providing effective exercise training, given the diversity of guidelines, clinician preparedness, and patient complexity.

Pulmonary rehabilitation in interstitial lung disease: benefits and predictors of response.

BACKGROUND: Data examining the role of pulmonary rehabilitation (PR) in interstitial lung disease (ILD) are limited. We tested the hypothesis that PR can improve functional status and dyspnea in a large group of patients with ILD, and that certain baseline patient variables can predict this improvement. METHODS: Data from patients who were referred to PR with a diagnosis of ILD were included. Baseline and post-PR variables were recorded, and changes in 6-min walk test (6MWT) distance and dyspnea were evaluated. The impact of baseline variables on change in 6MWT distance and dyspnea were analyzed. RESULTS: A statistically significant difference was seen in both the change in Borg score and 6MWT distance after PR (p < 0.0001). These changes were consistent with previously established clinically significant differences. Baseline 6MWT distance was a significant predictor of change in 6MWT distance (p < 0.0001), with increasing baseline 6MWT distance predicting a smaller improvement after PR. CONCLUSIONS: These results suggest that PR should be considered as a standard of care for patients with ILD.