COPD – Home Rehabilitation


Chronic Obstructive Pulmonary Disease And Home Rehabilitation

The Mobile Phone’s Crucial Role

29 Aug 2008   

A home coaching programme using an ordinary mobile phone has led to major improvements in the stamina of patients with chronic obstructive pulmonary disease (COPD), and significantly reduced hospital admissions.

This is the encouraging conclusion of a pilot study due to be published in the forthcoming issue of the European Respiratory Journal (ERJ), the peer-reviewed publication of the European Respiratory Society (ERS), and led by Han-Pin Kuo of Taiwan. An ingenious piece of software installed on patients’ mobile phones encouraged them to do daily walking in time to music, at a rhythm matched to their lung capacity. Simultaneously, the training parameters and respiratory data were recorded and transmitted to the medical team. This remotely supervised home coaching system, which is effective, simple and low cost, could prove useful in the management of other chronic conditions, such as diabetes.

Physical activity is the cornerstone of respiratory rehabilitation for patients with COPD. Indeed, several studies have shown it to be one of the best ways to improve muscle function and reduce chronic respiratory symptoms, particularly difficulty in breathing (dyspnoea). To be effective, however, training programmes require not only strict compliance, but also regular monitoring of performance. Most such programmes are currently run at hospitals, and the need to make regular visits places a significant damper on patients’ motivation. Therefore, participation remains limited, and performance is seriously reduced.

An original solution has been found by Han-Pin Kuo (Dept of Thoracic Medicine, Chang-Guang Memorial Hospital, Taipei, Taiwan) and his team, through the use of this groundbreaking home coaching programme. Designed to help patients with stable COPD, it requires them to do daily walking in time to music installed on their mobile phone by means of simple software. The rhythm was preset at 80% of the patient’s maximum respiratory capacity, which had previously been identified using the so-called “incremental shuttle walking test”, and then adjusted monthly.

At the same time, the main data of interest to doctors (in particular duration of walking and intensity of symptoms) were transmitted by the device on a daily basis to a dedicated website.

Spectacular results within a year

For this original pilot study, Kuo and his colleagues included 48 patients aged between 40 and 80 and suffering from moderate to severe COPD. While all subjects received a leaflet and DVD with advice on an endurance walking training programme, half of them also received a mobile phone with the special software.

For the first three months of the study, both groups (i.e. those with the mobile phones and those without) were seen once a month by doctors for various tests, including a walking test, a quality of life test and spirometry. To strengthen their motivation, all subjects also benefited from frequent telephone contact with the medical team. During the second phase, the patients were seen only once every three months and the phone calls were stopped. The one-year results now published in the ERJ are spectacular. While 22 of the 24 subjects (92%) in the group given musical coaching by mobile phone did the walking exercise daily, only nine subjects in the other group (38%) were able to manage it!

Drastic reduction in hospital admissions

As the Taiwanese team reports in the article, the sustained training based on the mobile phone software brought great benefits for lung function, providing an increase in inspiratory capacity from the third month of training. It also led to a reduction in healthcare consumption.

This simple coaching programme significantly reduced the number of unscheduled visits to the doctor (only two in the “mobile phone” group compared to ten in the other) and the number of hospital admissions. The difference here is even more striking: only two subjects from the first group had to be admitted, compared to 22 in the control group.

“We are seeing benefits on the same scale as those obtained by hospital programmes with good patient compliance”, notes Dr Kuo. He believes a number of factors explain the success of the mobile phone coaching.

Firstly, walking speed is very precisely controlled by the rhythm of the music, which is set individually to an endurance level appropriate to each subject (too high a level would be harmful). The device records the daily duration of exercise, which gives a good indication of the patient’s general state. Sudden changes in duration can be seen by the doctor, who can intervene quickly to prevent deterioration in the patient’s condition.

And the system’s simplicity in itself ensures long-term compliance and, thus, continuing benefits.

Low cost

The software used by the Taiwanese team is compatible with most current models of mobile phone. The authors also point out that the data are transmitted using a very common standard (GPRS or General Packet Radio Service). Therefore, the method can easily be generalised. Han-Pin Kuo also emphasised the device’s low cost of approximately ten US dollars per patient per month, which makes it very competitive.

To validate the technique further, the Taipei team has launched a larger-scale study within Taiwan.

If the benefits are confirmed, this mobile phone-based coaching system could be used for many other chronic conditions requiring physical rehabilitation.

There is, however, one important parameter that needs improvement: the range of music. In the pilot study, the patients could only choose from four segments of classical music. In the new study, they will be able to change as soon as they get bored, on condition, of course, that they keep to the rhythm selected by the medical team.

Title Of The Original Article
Efficacy of a cell phone-based exercise programme for COPD

The European Respiratory Journal is the peer-reviewed scientific publication of the European Respiratory Society (more than 8,000 specialists in lung diseases and respiratory medicine in Europe, the United States and Australia).

European Respiratory Journal The European Respiratory Society (ERS)

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