At-Home Exercise Program is Safe for People Recovering from Pulmonary Embolism
A preliminary clinical trial, funded in part by a KL2 Career Development Award from the UR CTSI, shows that an early at-home rehabilitation exercise program is safe for patients who are recovering from pulmonary embolisms—blockages in the arteries that send blood to the lungs. Published in the European Respiratory Journal, the study is a first step toward understanding if at-home rehab can improve outcomes and health equity among pulmonary embolism patients.
Many patients recovering from a pulmonary embolism fear that exercise or activity may be dangerous, so they avoid it, which sets them up for worse outcomes. They also get little direction from their doctors on the matter.
“Right now there's no standard medical recommendations on how patients should increase activity after acute pulmonary embolism,” said former KL2 scholar Daniel Lachant, DO, who led the study and is currently an assistant professor of Pulmonary Diseases and Critical Care at URMC. “In-person rehabilitation facilities certainly couldn't accommodate an influx of these patients, so incorporating technology is the way to help patients recover after acute pulmonary embolism.”
To help patients get moving, Lachant and a team of collaborators created an eight-week, at-home rehab exercise program. By eliminating transportation burdens and reducing cost, the team hopes the program will make rehab more accessible for all patients, which may ultimately improve health equity.
Twenty-one patients with intermediate and high-risk pulmonary embolism participated in a preliminary trial to test the rehab program. Roughly half were randomly assigned to the rehab program and received explicit web-based exercise instructions with heart rate goals. The other half were assigned to receive generic encouraging messages as a control.
One week after patients were treated for pulmonary embolism and discharged, they came back to the hospital for baseline testing. All participants completed a six-minute walk test while wearing a heart rate monitor and received counseling about the benefits and safety of exercise.
All participants were sent home with a heart rate monitor and exercise videos created in collaboration with the Pulmonary Hypertension Association. Lachant and his team monitored patients’ normal activity at home for two weeks and patients filled out a questionnaire about their quality of life.
Once the baseline was established, patients received daily health messages over the course of eight weeks. The control group received generic messages about their health, such as a reminder to take their medication and wear their heart monitor if they exercised. On the other hand, the rehab group received messages with explicit exercise directions. For example, their message might instruct them to walk for five minutes, followed by five minutes of rest, and repeat three times.
After the eight-week intervention, they completed the same assessments they had taken at baseline. Seven out of ten participants in the rehab group reported improved quality of life and stamina, compared to one in nine in the control group. However, both groups clocked a similar number and duration of exercise sessions.
These results suggest that providing a combination of the in-office education, at-home exercise videos, and—most important—the heart monitor, allayed patients’ fears and helped them get moving earlier. Getting back to being active earlier, Lachant believes, may be key to patients’ recovery.
Lachant and his team will continue to track patients’ progress, checking in after three months and a year, to see how well they have recovered and if their recovery is sustained. They also hope to refine and expand on this study by incorporating rural medical centers and allowing patients to choose an observation only option.
In the meantime, Lachant is leading a multi-center clinical trial funded by the United Therapeutics Corporation to test the same at-home rehab program among patients with pulmonary arterial hypertension (high blood pressure in the arteries that feed the lungs). In this study, Lachant will measure participants’ cardiac effort (the number of heart beats required for a person to walk a given distance), which is a new, more reliable, and sensitive metric he developed with KL2 funding.
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The project described above was supported by the University of Rochester CTSA award number KL2 TR001999 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Susanne Pritchard Pallo | 6/24/2024
