Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 15, 2021
Date Accepted: Jun 16, 2021
Home-based exercise program in patients with combined advanced chronic cardiac and pulmonary diseases: an exploratory study
ABSTRACT
Background:
As chronic cardiac and pulmonary diseases often co-exist, there is a need for combined physical home-based rehabilitation programs, specifically addressing elderly patients with advanced disease stages.
Objective:
The primary objective was to evaluate completion- and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. Secondary endpoints include patient satisfaction, adverse events, and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life.
Methods:
Participants received a goal-oriented, home-based exercise program, using a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other functions such as short instruction videos on how to perform specific exercises. Participants received weekly coaching by a physio- and occupational therapist via video communication.
Results:
Ten patients with advanced combined cardiopulmonary disease participated (median age 71 (IQR 63-75), 50% male). 90% completed the 8-week program. Median adherence to the exercise prescription was 75 (IQR 37-88)%, but declined significantly when dividing the program into 2-weekly periods (first 2 weeks 86 (IQR 51-100)%; final 2 weeks 57 (IQR 8-75)%; P=.03). Participants were highly satisfied with the program (median CSQ score 29 (IQR 26-32); median PDQ score 103 (IQR 92-108)), however four participants experienced the use of the activity tracker as troublesome. Patient specific complaints scores declined indicating functional improvement (median 7.5 (IQR 6.1-8.9) to 5.7 (IQR 3.8-6.7); P=.01). Other program efficacy metrics showed a trend towards improvement.
Conclusions:
Home-based cardiopulmonary telerehabilitation in patients with severe combined cardiopulmonary disease is feasible in terms of high completion- and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some participants reported difficulties with the technology, addressing the importance of integration of behavior change techniques, using appropriate technology. Clinical Trial: Netherlands Trial Register, NL9182
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