Home-based exercise using remote supervision for adults with chronic respiratory disease

This study aims to assess whether a remotely supervised home-based minimal equipment exercise training program is a feasible and acceptable model of pulmonary rehabilitation for people with chronic respiratory disease. Home-based minimal equipment exercise training program involves twice-weekly sessions for 8 weeks, in groups of 2-4 participants at a time. The sessions are remotely supervised by an experienced exercise physiologist or physiotherapist (via video-conferencing), participants will be able to interact via video-conferencing technology with other group participants and the supervising clinician. Each session, participants will undertake circuit-based training incorporating 7 exercises. Exercises included in the program are sit to stand, air boxing, step up, step to side with lateral raise, bent over row. The total training session duration will be 45minutes; each exercise circuit will be between 15-16minutes in duration (including interval rests) and repeated 3 times, accounting for a total exercise time of 31.5minutes. A 5minute rest period will be undertaken between each circuit. Intensity Moderate-intensity exercise training will be prescribed and progressed according to guidelines, Borg dyspnoea score 3-4 correlating to the equivalent of work rate greater than or equal to 60% VO2peak (Mellerick et al. unpublished). Exercise will be progressed each week to ensure time and load correlate to Borg dyspnoea scores of 3-4 (Gloeckl R et al. Eur Resp Rev, 2013). If unable to progress time due to fatigue or endurance issues, load may be progressed first. Participants ratings of perceived exertion and breathlessness, heart rate and oxygen saturation will be monitored throughout the sessions. Heart rate and oxygen saturation will be measured via an ear probe pulse oximeter worn in a Nonin oximeter bag with cross body strap. All equipment required to undertake the tele-rehabilitation will be supplied by the study investigators for the duration of the rehabilitation period. Home Visit An initial home visit will be completed by an experienced clinician prior to program commencement. The home visit will involve delivery of the intervention kit including equipment and iPad, setting up the exercise circuit and a familiarisation session to ensure appropriate exercise and videoconferencing set-up. The participant will be provided with a participant exercise booklet and instruction manual to assist with videoconferencing set-up and troubleshooting issues. To ensure the safety of the healthcare professional during home visits, the relevant institution Home Visit Assessment Policy will be adhered to as per standard practice. We have previously completed trials involving these processes in delivering telerehabilitation with no risk or harm to participants or clinicians.