The impact of a home-based pulmonary telerehabilitation program on muscle function and quality of life following acute exacerbations of chronic obstructive pulmonary disease

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Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and is highly prevalent in the aging veteran population. Health care costs in COPD are largely attributable to acute exacerbations of COPD (AECOPD), defined as an increase in shortness of breath, cough, and/or sputum production that is beyond typical day-to-day variability and usually requires a change in medication. In addition to loss of lung function, decreased quality of life, and increased mortality, AECOPD are associated with reduced physical activity, muscle dysfunction, and poorer health-related quality of life. Muscle loss and dysfunction have, in turn, been associated with increased mortality in patients with COPD. Outpatient pulmonary rehabilitation initiated in the immediate post-exacerbation period has been shown to have a positive impact on muscle function, exercise endurance, and health-related quality of life. As such, consensus guidelines recommend the participation in a pulmonary rehabilitation program within three to four weeks of an acute exacerbation of COPD. However, efforts to initiate outpatient pulmonary rehabilitation in the post- exacerbation period are often hindered by lack of physician referral, limited patient access to pulmonary rehabilitation facilities, or low patient motivation. A home-based pulmonary telerehabilitation program initiated at hospital discharge may circumvent these barriers. Pulmonary telerehabilitation programs have been shown to have a high acceptance and adherence rate and lead to improvement in exercise capacity and quality of life in stable COPD. However, data regarding the feasibility and impact of pulmonary telerehabilitation following hospitalization for an AECOPD on physical activity levels, muscle function, exercise capacity, and health- related quality of life are lacking. Our primary hypothesis is that a home-based pulmonary telerehabilitation program initiated at hospital discharge following an AECOPD is feasible in the veteran population and will result in increased physical activity and greater improvement in muscle function, exercise capacity, and health- related quality of life compared to usual care. We will test this hypothesis with the following specific aims: (1) To determine the feasibility of an eight-week home-based pulmonary telerehabilitation program in veterans with moderate to severe COPD initiated in the immediate post-hospitalization period following an AECOPD. (2) To determine physical activity levels and the magnitude and variability in changes of measurements of muscle strength, functional exercise performance, and health-related quality of life following an eight-week home- based pulmonary telerehabilitation program versus usual care initiated in veterans with moderate to severe COPD immediately following hospitalization for an AECOPD. We will randomize (1:1 allocation) 30 male and female veterans hospitalized with an AECOPD to either an eight-week, three sessions per week, home-based pulmonary telerehabilitation program that includes lower extremity endurance exercises with a cycle ergometer and upper and lower extremity strength training with 1:1 supervision via video conferencing with an exercise physiologist as well as a twice-monthly online support group via video conferencing versus usual care. Changes from baseline in physical activity levels, handgrip and quadriceps muscle strength, exercise endurance, and health-related quality of life will be assessed following the pulmonary telerehabilitation program versus usual care. Findings from this project will contribute to the growing field of pulmonary telerehabilitation and will provide critical preliminary data for the design and implementation of a larger, randomized control trial assessing the impact of pulmonary telerehabilitation on long-term clinical outcomes following AECOPD.