Smartphone App-Guided Pulmonary Rehabilitation in Chronic Respiratory Diseases: Randomized Controlled Trial

Abstract

Background: Pulmonary rehabilitation improves exercise capacity, dyspnea, quality of life, and survival in patients with chronic respiratory disease. However, center-based pulmonary rehabilitation programs remain unavailable in many health care facilities due to several barriers. To address this, we developed a smartphone app that enabled individuals to perform pulmonary rehabilitation at home.

Objective: We aimed to evaluate the efficacy of smartphone app-guided pulmonary rehabilitation in improving exercise capacity in individuals with chronic respiratory diseases.

Methods: This was a multicenter prospective, single-blind, randomized controlled trial conducted in 2022. A total of 100 participants with chronic respiratory disease, including chronic obstructive pulmonary disease, asthma, and lung cancer, were recruited, with equal distribution (50:50) between the intervention group and the control group. The intervention group followed a 12-week app-guided rehabilitation program, while the control group received standard outpatient treatment. The primary outcome was the 6-minute walk test distance (6MWD) after the 12-week rehabilitation period. Secondary outcomes included quality of life questionnaires and health care usage.

Results: Among the 100 participants included, 88 completed the follow-up visit (41 in the intervention group and 47 in the control group). Their median age was 68.0 years, and 72 (81.8%) were men. Most participants (n=70, 79.5%) had a smoking history, with a median of 40.0 pack-years. Their forced expiratory volume in 1 second was a median of 63.0% (IQR 50.5-71.5). Most participants (n=85, 96.6%) had chronic obstructive pulmonary disease. After the 12-week rehabilitation program, 6MWD was not different between the intervention and control group (median 490.0, IQR 468.8-556.3 vs 485.0, IQR 440.0-527.3 m). Assuming a clinically minimal effective change of 25 meters in 6MWD, only 7 out of 41 participants among the intervention group achieved the minimal clinically important differences after the rehabilitation program. Quality of life questionnaire scores, including the St George's Respiratory Questionnaire and Hospital Anxiety and Depression Scale, did not differ between groups. In addition, none of the participants experienced hospitalization or emergency room visits during the study period. Regarding the service satisfaction questionnaire, more than 3-quarters of the intervention group (34/41) rated their scores as ≥17/20.

Conclusions: In this study, smartphone app-guided pulmonary rehabilitation failed to improve exercise capacity and quality of life in patients with chronic respiratory diseases. However, the results indicated that older adults with chronic respiratory conditions can safely use smartphone app-guided pulmonary rehabilitation. Thus, smartphone app-guided pulmonary rehabilitation may be a feasible option for older adults with chronic respiratory disease.

Keywords: COPD; apps; chronic respiratory diseases; lungs; mHealth; pulmonary rehabilitation; randomized controlled trial; respiratory; smartphones; walking.

Figure 1.. Screenshots of the Redpill Breath app. Shown are the following: (A) opening screen; (B) account creation; (C) the 6-minute walk test, which displays step counts and test time; (D) walking distance and timer for walking exercises; (E) completion of walking exercise, which displays walking distance, heart rate, oxygen saturation, and rating of perceived exertion scale evaluated after exercise; (F) exercise level change; (G) instruction videos for muscle training exercise program; (H) completion of muscle training exercise; and (I) exercise report, which displays exercise completion rate per week and day.

Figure 2.. Study flowchart.