Remote rehabilitation programs prove excellent option for people with chronic respiratory problems

Astoundingly, 1 in 3 Australians live with a chronic respiratory condition.¹ Chronic obstructive pulmonary disease (COPD)—a group of lung conditions that includes emphysema, chronic bronchitis and chronic asthma—accounts for half of the total burden for respiratory disease. Regular exercise is a key contributor to wellbeing and staying out of hospital but access to supported exercise programs (‘pulmonary rehabilitation’) is a critical problem nationally and globally. Only around 5% of Australians who would benefit have ever accessed a program. 

By combining digital technologies, the power of community support and access to a best-practice exercise program from home, Professor Anne Holland and Associate Professor Narelle Cox from Monash University have demonstrated a remote rehabilitation model that is both cost and clinically effective. The trial, known as REACH, is now referenced in global guidelines for treating people with COPD.

REACH ran in metropolitan and rural locations in Victoria, with some participants located more than 400km from the supervising physiotherapist. The team delivered exercise equipment, including bikes, to people’s doors and participants met online with clinicians for group exercise sessions using simple technology. 

“For the very disabled population—who are often very breathless, often from low socioeconomic circumstances—the burden of getting to rehabilitation programs is too much. This REACH trial is our most technologically advanced remote model,” said Professor Holland.

More than 8 out of 10 people completed the program, higher than in-centre options. People completing the program had significantly lower healthcare costs in the 12 months following the program. 

According to Associate Professor Cox, the flexibility and convenience from saving time and money and the social connection motivated participants.

“I learned a lot about sheep farming, as our regional trial site was in western Victoria. And so did our city patients who talked about it a lot,” laughed Dr Cox. 

“But seriously, a lot of the patients said being part of a group was great. They got to know others experiencing the same challenges, and they were inspired by others exercising in the same way that they were trying to.” she said.

Professor Holland and Associate Professor Cox have dedicated their careers to achieving better outcomes for people with COPD, driven by the frustration of seeing unrealised potential for change.

“People with lung disease get a pretty raw deal. They not only have to deal with a debilitating condition and very distressing breathlessness, but they also have to deal with substantial stigma from society and a lack of services, said Professor Holland.

“One of the big highlights for me is that there were people in the trial that had knocked back rehabilitation many, many times over,” said Associate Professor Cox.

Their innovative approach has not only proven effective but has also paved the way for a new standard of care. Almost half of the pulmonary rehabilitation programs around Australia are delivering services remotely, representing a huge shift in practice.

Next steps

The next step is to drive more widespread clinical implementation of remotely delivered models of pulmonary rehabilitation. Professor Holland and Associate Professor Cox are working with collaborators internationally to define the characteristics of patients most likely to succeed with telerehabilitation and working with clinicians and patients to develop resources to support implementation in practice.

They are also investigating less equipment-intense models of rehabilitation and new methods to accurately assess exercise capacity remotely.

“That is the missing piece of the puzzle that would enable a pulmonary rehabilitation program (assessment and intervention) to be delivered remotely, irrespective of patient location,” said Professor Holland.

Chief Investigators: Professor Anne Holland and Associate Professor Narelle Cox 

Administering institution: Monash University

Team list: Professor Christine McDonald, Professor Ajay Mahal, Professor Jennifer Alison, Dr Angela Burge, Ms Janet Bondarenko, Associate Professor Paul O'Halloran

Grant information: Project Grant (2016–2020), $719,745.07.