A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation

Claire E Child; Morgan L Kelly; Haley Sizelove; Marissa Garvin; Julia Guilliams; Paul Kim; Haotian D Cai; SiWei Luo; Kevin J McQuade; Erik R Swenson; Amanda T Wise; Ylinne T Lynch; Lawrence A Ho; Mary Beth Brown

doi:10.1016/j.rmed.2023.107397

A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation

Respir Med. 2023 Nov:218:107397. doi: 10.1016/j.rmed.2023.107397. Epub 2023 Aug 26.

Authors

Claire E Child¹, Morgan L Kelly², Haley Sizelove³, Marissa Garvin⁴, Julia Guilliams⁵, Paul Kim⁶, Haotian D Cai⁷, SiWei Luo⁸, Kevin J McQuade⁹, Erik R Swenson¹⁰, Amanda T Wise¹¹, Ylinne T Lynch¹², Lawrence A Ho¹³, Mary Beth Brown¹⁴

Affiliations

¹ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: cechild@uw.edu.
² University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: mlkelly@usc.edu.
³ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: h.sizelove2014@gmail.com.
⁴ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: mgarvin27@gmail.com.
⁵ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: juliag12@uw.edu.
⁶ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: paulkim1995@gmail.com.
⁷ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: hdcai3@uw.edu.
⁸ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: siweil@uw.edu.
⁹ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: kmcquade@uw.edu.
¹⁰ Medical Service, VA Puget Sound Health Care System, USA; University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA. Electronic address: Erik.Swenson@va.gov.
¹¹ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: amandatwisedo@gmail.com.
¹² University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA. Electronic address: lynchy@uw.edu.
¹³ University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA. Electronic address: laho@uw.edu.
¹⁴ University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA. Electronic address: mbbrown1@uw.edu.

PMID: 37640274
DOI: 10.1016/j.rmed.2023.107397

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers
Exercise Test
Exercise Therapy / adverse effects
Exercise Tolerance
Female
Hemoglobins
Humans
Lung Diseases, Interstitial*
Prescriptions
Quality of Life*

Substances

Biomarkers
Hemoglobins