A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation - 31/10/23
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Abstract |
Rationale |
Alternatives to center-based pulmonary rehabilitation are needed to improve patient access to this important therapy. A critical challenge to overcome is how to maximize safety of unsupervised exercise for at-risk patients. We investigated if a novel remote monitoring-enabled mobile health (mHealth) program is safe, feasible, and effective for patients who experience exercise-induced hemoglobin desaturation.
Methods |
An interstitial lung disease (ILD) commonly associated with pronounced exercise desaturation was investigated - the rare, female-predominant ILD lymphangioleiomyomatosis (LAM). Over a 12-week program, hemoglobin saturation (SpO2) was continuously recorded during all home exercise sessions. Intervention effects were assessed with 6-min walk test (6MWT), maximal cardiopulmonary exercise test (CPET), lower extremity computerized dynamometry, pulmonary function tests, and health-related quality of life (QoL) surveys. Safety was assessed by blood biomarkers of systemic inflammation and cardiac wall stress, and incidence of adverse events.
Results |
Fifteen LAM patients enrolled and 14 completed the intervention, with high adherence to aerobic (87 ± 15%) and strength (87 ± 12%) training components. An innovative characterization of exercise training SpO2 revealed that while mild-to-moderate desaturation was common during home workouts, participants were able to self-adjust exercise intensity and supplemental oxygen levels to maintain recommended exercise parameters. Significant improvements included 6MWT distance (+36 ± 34 m, p = 0.003), CPET time (p = 0.04), muscular endurance (p = 0.008), QoL (p = 0.009 to 0.03), and fatigue (p = 0.001 to 0.03). Patient acceptability and satisfaction indicators were high, blood biomarkers remained stable (p > 0.05), and no study-related adverse events occurred.
Conclusion |
A remote monitoring-enabled home exercise program is a safe, feasible, and effective approach even for patients who experience exercise desaturation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Patients with interstitial lung disease can safely exercise using remote monitoring. |
• | Home exercise program adherence, acceptability and satisfaction were high. |
• | Patients can self-adjust intensity and oxygen delivery to follow target parameters. |
• | Mild-to-moderate desaturation is common during workouts, without evidence of harm. |
Plan
☆ | This work was funded by a Patient Benefit Grant (LAM0130PB07-18) from The LAM Foundation. Funders provided no input or contributions in the development of the research and manuscript. |
☆☆ | This article has an online supplement, which is accessible from this issue's table of contents online. |
Vol 218
Article 107397- novembre 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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