University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
Medical Service, VA Puget Sound Health Care System, USA; University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA.
Respir Med. 2023 Nov;218:107397. doi: 10.1016/j.rmed.2023.107397. Epub 2023 Aug 26.
Alternatives to center-based pulmonary rehabilitation are needed to improve patient access to this important therapy. A critical challenge to overcome is how to maximize safety of unsupervised exercise for at-risk patients. We investigated if a novel remote monitoring-enabled mobile health (mHealth) program is safe, feasible, and effective for patients who experience exercise-induced hemoglobin desaturation.
An interstitial lung disease (ILD) commonly associated with pronounced exercise desaturation was investigated - the rare, female-predominant ILD lymphangioleiomyomatosis (LAM). Over a 12-week program, hemoglobin saturation (SpO) was continuously recorded during all home exercise sessions. Intervention effects were assessed with 6-min walk test (6MWT), maximal cardiopulmonary exercise test (CPET), lower extremity computerized dynamometry, pulmonary function tests, and health-related quality of life (QoL) surveys. Safety was assessed by blood biomarkers of systemic inflammation and cardiac wall stress, and incidence of adverse events.
Fifteen LAM patients enrolled and 14 completed the intervention, with high adherence to aerobic (87 ± 15%) and strength (87 ± 12%) training components. An innovative characterization of exercise training SpO revealed that while mild-to-moderate desaturation was common during home workouts, participants were able to self-adjust exercise intensity and supplemental oxygen levels to maintain recommended exercise parameters. Significant improvements included 6MWT distance (+36 ± 34 m, p = 0.003), CPET time (p = 0.04), muscular endurance (p = 0.008), QoL (p = 0.009 to 0.03), and fatigue (p = 0.001 to 0.03). Patient acceptability and satisfaction indicators were high, blood biomarkers remained stable (p > 0.05), and no study-related adverse events occurred.
A remote monitoring-enabled home exercise program is a safe, feasible, and effective approach even for patients who experience exercise desaturation.
为改善患者接受这一重要治疗的机会，需要替代以中心为基础的肺康复。克服的一个关键挑战是如何最大限度地提高高危患者的非监督运动的安全性。我们研究了一种新的远程监测功能的移动健康（mHealth）程序对于经历运动诱导的血红蛋白去饱和的患者是否安全、可行和有效。
研究了一种与明显运动去饱和相关的间质性肺疾病（ILD） - 罕见的、女性为主的ILD淋巴管平滑肌瘤病（LAM）。在 12 周的计划中，血红蛋白饱和度（SpO）在所有家庭运动期间连续记录。干预效果通过 6 分钟步行测试（6MWT）、最大心肺运动测试（CPET）、下肢计算机动态测力、肺功能测试和健康相关生活质量（QoL）调查进行评估。安全性通过全身炎症和心脏壁应力的血液生物标志物以及不良事件的发生率进行评估。
15 名 LAM 患者入组，14 名完成干预，有氧（87±15%）和力量（87±12%）训练成分的依从性很高。对运动训练 SpO 的创新特征分析表明，虽然在家锻炼时轻度至中度去饱和很常见，但参与者能够自我调整运动强度和补充氧气水平以维持推荐的运动参数。显著改善包括 6MWT 距离（+36±34 m，p=0.003）、CPET 时间（p=0.04）、肌肉耐力（p=0.008）、QoL（p=0.009 至 0.03）和疲劳（p=0.001 至 0.03）。患者的接受度和满意度指标较高，血液生物标志物保持稳定（p>0.05），且无研究相关不良事件发生。
即使对于经历运动去饱和的患者，远程监测功能的家庭运动计划也是一种安全、可行和有效的方法。
