Creating a digital approach for promoting physical activity in pediatric pulmonary hypertension: A framework for future interventions

Abstract

Children with pulmonary hypertension (PH) often demonstrate limited exercise capacity. Data support exercise as an effective nonpharmacologic intervention among adults with PH. However, data on exercise training in children and adolescents are limited, and characteristics of the optimal exercise program in pediatric PH have not been identified. Exercise programs may have multiple targets, including muscle deficits which are associated with exercise limitations in both adult and pediatric PH. Wearable accelerometer sensors measure physical activity volume and intensity in the naturalistic setting and can facilitate near continuous data transfer and bidirectional communication between patients and the study team when paired with informatics tools during exercise interventions. To address the knowledge gaps in exercise training in pediatric PH, we designed a prospective, single arm, nonrandomized pilot study to determine feasibility and preliminary estimates of efficacy of a 16-week home exercise intervention, targeting lower extremity muscle mass and enriched by wearable mobile health technology. The exercIse Training in pulmONary hypertEnsion (iTONE) trial includes (1) semistructured exercise prescriptions tailored to the participant's baseline level of activity and access to resources; (2) interval goal setting fostering self-efficacy; (3) real time monitoring of activity via wearable devices; (4) a digital platform enabling communication and feedback between participant and study team; (5) multiple avenues to assess participant safety. This pilot intervention will provide information on the digital infrastructure needed to conduct home-based exercise interventions in PH and will generate important preliminary data on the effect of exercise interventions in youth with chronic cardiorespiratory conditions to power larger studies in the future.

Keywords: actigraphy; exercise; informatics; pediatric pulmonary hypertension; physical activity.

Figure 1

Study schematic. An exercise intervention, guided by Social Cognitive Theory and enriched by mobile health technology, could increase physical activity and enhance skeletal muscle mass and strength, leading to better exercise performance, functional status, and quality of life in youth with PH and other cardiac diseases.

Figure 2

Activity tracker and informatics tools. When worn, the heart rate monitor communicates with the smartwatch via Bluetooth, and the participant heart rate is visible on the watch screen. When the watch face is docked and connected to the home data hub (disc shaped object) via a USB port and the hub is connected to the participant's home Wi‐Fi modem via an ethernet cord, heart rate and activity data are uploaded to a cloud‐based database. Activity intensity cutpoints are applied and daily activity summaries are transferred to the center's database via an automated API connection. Participant feedback can be provided via text messaging. A URL‐based ChatBot enables communication between the participant and study team.