These findings support a role for telehealth to boost access to pulmonary rehabilitation after chronic obstructive pulmonary disease exacerbations.

Pulmonary rehabilitation improves outcomes for patients with chronic obstructive pulmonary disease (COPD), but only a small minority complete traditional rehabilitation programs. In this study, 120 patients (mean age, 64 years) with at least one COPD-related hospitalisation or emergency department (ED) visit in the past year were randomised to receive telerehabilitation (30-minute exercise sessions three to five times weekly, monitored virtually by a physiotherapist), unsupervised treadmill training (an initial in-person training visit followed by an individualised exercise plan) or usual care. Patients were followed for two years.

With adjustment for imbalances in baseline characteristics, the telerehabilitation group and the unsupervised training group had fewer hospitalisations or ED visits per person-year than did the control group (1.18 for telerehabilitation, 1.14 for unsupervised and 1.88 for controls), corresponding to a relative reduction of more than 30% with either intervention.

At two years, patients in both intervention groups experienced improvements in symptom scores and in six-minute walk duration, whereas six-minute walk duration declined in the control group. Mortality was similar in all groups.

Comment: These findings suggest that exercise training at home – with or without remote supervision – can result in clinically relevant improvements in symptoms and exercise tolerance for patients who lack access to formal programs. Whether the improvement is comparable to what would have been achieved with in-person pulmonary rehabilitation is an open question.

Rahul B. Ganatra, MD, MPH, Instructor in Medicine, Harvard Medical School; Director of Continuing Medical Education for the Medical Service, VA Boston Healthcare System, Boston, USA.

Zanaboni P, et al. Long-term telerehabilitation or unsupervised training at home for patients with chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med 2023; 207: 865-875.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.