Long-term exercise maintenance via telerehabilitation for people with COPD. Feasibility, effectiveness, benefits and challenges

Background and aims: The availability of pulmonary rehabilitation (PR) and exercise maintenance programs for people with chronic obstructive pulmonary disease (COPD) is low, despite being beneficial and recommended. Telerehabilitation can support the delivery of such programs to patients’ homes. However, there is little knowledge of its benefits for people with COPD. This thesis aimed to investigate feasibility, effectiveness, benefits and challenges of a long-term exercise maintenance program via telerehabilitation in COPD. Methods: An innovative 2-year telerehabilitation intervention comprising of treadmill exercise at home, telemonitoring by a physiotherapist via videoconferencing, and self-management via a website was investigated in a pilot study and an international randomized control trial. Results: No adverse events related to the intervention occurred. After one year, 6-minutes walking distance was improved. Physical capacity, lung capacity, symptom level, and quality of life were maintained over the long-term. Participants were satisfied with the intervention and found the technology user-friendly. Satisfaction was supported by experienced health benefits, increased self-efficacy and emotional safety. Discussion and conclusions: Long-term exercise maintenance in COPD via telerehabilitation is safe and feasible. Results are encouraging and suggest that telerehabilitation can prevent deterioration in lung function, symptom burden and health-related quality of life, and maintain functional walking capacity over the long-term. Telerehabilitation can overcome geographical distance, provide specialist access in areas where this is not available, and provide regularity of follow-up by the same healthcare personnel over a longer period. Challenges included maintenance of motivation for exercise, and challenges with transport of equipment and teaching in how to use the technology in the participants’ homes. Long-term telerehabilitation could be offered as an alternative or supplement to centre-based PR