Telerehabilitation Using Fitness Application in Patients with Severe Cystic Fibrosis Awaiting Lung Transplant: A Pilot Study

Abstract

Purpose. The purpose of this study was to pilot a home-based pulmonary rehabilitation (PR) program administered via a telemedicine approach using a combination of fitness application and self-selected activity in lung transplant candidates with cystic fibrosis (CF). Methods. We recruited adult patients with CF. The main outcome was adherence, measured by number of sessions completed in 12 weeks. Secondary outcomes were adverse events, six-minute walk distance (6MWD), and dyspnea. Participants were provided a personalized exercise program and equipment including a fitness application that provided exercise videos, recorded exercise time, and corresponding heart rate. We reviewed data daily and provided text messages with feedback. We compared our study outcomes to a retrospective data set of CF patients who participated in a 24-session outpatient hospital-based PR program. Data presented as $\text{mean}\pm \text{standard}\text{deviation}$ . Results. Eleven patients participated in the home PR program, 45% female, age $33\pm 7\text{years}$ , FEV1 $27\pm 5\%$ predicted. Sessions completed were $19\pm 12$ home-based PR vs. $9\pm 4$ hospital-based PR, $p=.03$ . Fifty percent of the home-based group completed ≥24 sessions in 12 weeks versus 0% of the hospital-based patients ( $p=.03$ ). There were no adverse events during exercise. Completers of the home-based program demonstrated a clinically meaningful lower decline in 6 MWD than noncompleters (6MWD $-7\pm 15$ vs. $-86\pm 108\text{meters}$ ). Only one participant performed a post 6 MWD in the hospital-based PR. Conclusion. Patients with severe CF demonstrated adherence to home PR delivered using fitness application and self-selected activity with no adverse events. This program style may be a viable solution for telerehabilitation in severe CF and is particularly relevant in the COVID era.