Archives of Physical Medicine and Rehabilitation · Jul 30, 2026

Remotely Monitored, Home-based Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: Results of a Randomized Controlled Trial

By Child CE, Ho LA, Borders E et al.

OBJECTIVE: In patients with idiopathic pulmonary fibrosis (IPF) on background antifibrotic therapy, we tested a home-based approach to pulmonary rehabilitation (PR) supported with remotely measured physiological variables. DESIGN: A randomized controlled trial with assessments during and after: run-in (0-4wks), intervention (5-16wks), and postintervention (17-20wks) periods. SETTING: Recruitment: Hospital-based interstitial lung disease care centers and the greater IPF community of the region. Rehabilitation setting: an entirely home-based environment. PARTICIPANTS: Twenty-nine of the N=32 enrolled patients with IPF met criteria during run-in for randomization to intervention ("I" n=15) and control ("C" n=14) arms. INTERVENTIONS: Arm I received a 12-week asynchronously remotely monitored, exercise-focused home PR intervention. Arm C received monitoring only. Smartphone-linked, Bluetooth-enabled monitoring devices included accelerometer activity/heart rate monitor and medical-grade fingertip pulse oximeter. MAIN OUTCOME MEASURES: Primary: change from run-in for daily average moderate-to-vigorous physical activity minutes. Feasibility was assessed as rates of completion, adherence, and adverse events. Key secondary: 6-minute walk distance, VO₂max, quality of life (QoL) psychometrics, plasma brain natriuretic peptide, exercise oxygen saturation, and perceived usability of the remote monitoring platform. RESULTS: Program completion was 100% and workout adherence for I was 92%. Primary outcome moderate-to-vigorous physical activity increased by 28% for I but decreased by 35% for C (P=.001 group*time interaction), with an improvement in I (Δ=49±19min/wk) almost double the reported minimal clinically important difference for IPF. Within group effects were observed for several secondary endpoints in I, including increased 6-minute walk distance, decreased (brain natriuretic peptide), and preserved VO₂max and QoL. No adverse events occurred, and intervention usability/satisfaction indicators were high. CONCLUSIONS: For patients with IPF on maintained background antifibrotic therapy, an entirely home-based, remote monitoring-enabled PR program is feasible and produces meaningful increase in moderate-to-vigorous physical activity. Benefits may additionally include improving exercise tolerance and mitigating deterioration of QoL in this challenging, progressive disease.

doi.org/10.1016/j.apmr.2026.07.019PubMed 42532213Interventions