Virtual Pulmonary Rehabilitation an Accessible Solution for Patients With COPD on Oxygen

Virtual pulmonary rehabilitation (PR) was safe, feasible, and effective for patients with chronic obstructive pulmonary disease (COPD) on oxygen.1

"Virtual pulmonary rehabilitation allows for increased access to these programs, which benefit people with COPD, regardless of their supplemental oxygen use. In our study, 99% of participants participated safely without any adverse effect, and participants in both groups had improvements in clinical outcomes," investigator Russell Buhr, MD, PhD, a pulmonologist at the University of California, Los Angeles, said in a statement.2 "Our findings demonstrate the need to increase use of virtual pulmonary rehabilitation programs to help improve the quality of life for people with COPD. By evaluating each patient's situation and incorporating virtually accessible programs, we can offer more individualized care for patients."

Buhr and colleagues conducted a retrospective review of all patients with COPD who enrolled and completed a virtual PR program through Kivo Health, a telehealth PR company, from October 2022 to November 2023. Participants were referred by treating pulmonologists and had to be on less than 5 liters of oxygen. Investigators conducted baseline pulmonary function testing and COPD diagnosis at baseline.1

Experienced respiratory therapists and exercise physiologists from American Association of Cardiovascular and Pulmonary Rehabilitation certified programs developed the virtual PR program, which program lasted 8 weeks, with 16 semiweekly sessions of 90 minutes each. The program began with a 1:1 intake appointment to create an individualized exercise plan of moderate-to-high-intensity aerobic exercise that progressively increased over time. A respiratory therapist led classes in small groups of 2–5 patients via a 2-way audiovisual platform, while patients used pulse oximeter wristwatches for real-time monitoring of heart rate and oxygen levels. Investigators tracked intensity through heart rate and modified Borg scores. The training program also included resistance training with bands and discussions on key pulmonary rehabilitation topics.

A total of 167 patients with complete data (of 173 eligible) were included, with 107 requiring exertional oxygen and 60 not. Patients in the oxygen group had more advanced COPD based on GOLD stage and higher baseline CAT scores, but groups were otherwise demographically similar. Median program attendance was 88%, with no significant difference between groups; only smoking status was associated with attendance. Adverse events occurred in 2 participants (1%), with 1 symptomatic bradycardia (oxygen group) and 1 asymptomatic hypertension (nonoxygen group). Overall, 83% completed the program (≥50% session attendance), and completion was significantly lower among current smokers (75% vs 93%, P = .004).1

Following PR, all functional outcomes showed statistically significant improvement. Among all patients, the CAT score improved by 2.9 points, Medical Research Council (mMRC) dyspnea scale by 0.5 points, Patient Health Questionnaire-9 (PHQ-9) by 1.4 points, and 1-minute sit-to-stand (1MSTS) by 4.4 repetitions (P < .001 for all); seven patients previously unable to perform any 1MSTS repetitions completed the test at program end. No significant between-group differences were seen for improvement in CAT, PHQ-9, or 1MSTS; however, the oxygen group improved by 0.3 fewer points in mMRC (P = .052).1

“While larger trials are needed to confirm our findings, this offers hope for reducing health disparities in COPD and contributes to the growing literature on virtual PR to help individualize treatment decisions moving forward,” Buhr and colleagues concluded.1

REFERENCES

1. Filizola H, Kumar A, Buhr RG, Schwab Jensen K. Outcomes of virtual pulmonary rehabilitation in oxygen-dependent COPD patients. Chronic Obstr Pulm Dis. 2025; 12(2): 184-189. doi: doi: 10.15326/jcopdf.2024.0572.

2. Virtual pulmonary rehabilitation programs are safe, effective for people with COPD. News release. COPD Foundation. May 1, 2025. https://www.copdfoundation.org/About-Us/Press-Room/Press-Releases/Article/2208/Virtual-pulmonary-rehabilitation-programs-are-safe-effective-for-people-with-CO.aspx