Benzo, R

Abstract Rationale Despite its effectiveness at improving outcomes in patients with COPD, pulmonary rehabilitation (PR) attrition rates are high, often exceeding 50%. Fully remote programs, like home-based PR (HBPR), face additional challenges engaging patients in real-world settings. With the growing adoption of wearables, sensor-derived behavioral measures, like sleep patterns, may identify patients most likely to benefit from remote PR. This study evaluated whether incorporating baseline sleep measures from a wrist-worn activity monitor in machine learning (ML) models improved the prediction of 12-week engagement with HBPR in patients with COPD. Methods Among participants (n = 124), the following sleep measures were collected for 1 week before HBPR: sleep duration (min), standard deviation of sleep duration, wake-after-sleep-onset (WASO) (min), standard deviation of WASO, number of awakenings, length of awakenings (min), activity counts, movement index, movement fragmentation index, and sleep fragmentation index. Sleep measures were processed (1) using a previously validated Tudor-Locke algorithm and (2) applying partial least squares-discriminant analysis (PLS-DA) to generate a single latent variable (Composite Sleep Health Score) for inclusion in models. Engagement was defined as completion of one or more recommended activities per week for the full program duration (12 weeks). To determine if the inclusion of objective sleep measures improved the prediction of HBPR engagement, nested model comparisons for parametric (logistic regression and SVM) and non-parametric (decision tree and naïve bayes) ML models were performed. A sensitivity analysis (SA) replaced the Composite Sleep Health Score with sleep regularity (duration and WASO) measures only. Results In models adjusted for age, sex, Charlson Comorbidity Index, current smoker status, modified Medical Research Council (mMRC), and forced expiratory volume in 1 second (FEV1), the inclusion of the Composite Sleep Health Score significantly improved the prediction of 12-week engagement only in SVM models (AUC 0.755; p = 0.007). Specificity (18.2%) and accuracy (68.5%) also improved by 27.3% and 7.3%, respectively. The Composite Sleep Health Score and mMRC scores ranked most frequently as the variables of highest importance. Identical trends were observed in the SA. Conclusion Although preliminary, these findings support additional investigation into the use of wearable-derived sleep measures to improve screening for HBPR eligibility, identifying patients who will clinically benefit from fully remote PR. Building on these primary findings, future researchers should carefully select variables for model inclusion and initiate new hypotheses elucidating the link between objective sleep measures and HBPR outcomes in COPD patients. This abstract is funded by: NIH R56 HL173214, NIH R01 HL140486, and the Robert D. and Patricia E. Kern Center for the Science of Health Delivery

Abstract Importance Conventional Pulmonary Rehabilitation (PR) after a hospital admission for a COPD exacerbation reduces remission and improves quality of life and survival, but only 2% of hospitalized patients complete PR. New feasible and effective strategies for increasing adherence to rehabilitation in the post hospitalization period are needed. Objective Determine the effect of patient’s choice on adherence to rehabilitation and outcomes. Design, Setting, and Participants: Individuals discharged after a COPD-related hospitalization were randomized to home rehabilitation with health coaching (HRwHC) or the choicethe choice of conventional PR or HRwHC. Intervention The HRwHC program was asynchronous and included weekly health coaching calls for 12 weeks and remote monitoring of lifestyle activities including daily exercises, and steps measured by an activity tracker, the compliance with 24-minute daily exercise routine and a daily wellbeing assessment. Participants in the choice arm that elected for conventional PR were facilitated by the study team to attend the nearest PR center. Main Outcomes and Measures The primary outcomes were adherence and effect on health-related quality of life measured by the Chronic Respiratory Questionnaire. Secondarily Physical activity was measured with Actigraph®GX3T a validated triaxial accelerometry. Results Among 1905 potential participants identified, 296 were randomized (uptake 14%). Reasons for declining include No interest in research 556 (29%), Already in PR or in other monitoring or research program 125 (6.5%), too much going/still recovering 650 (34%), Felt not needed (content with care) 208 (11%), Hospice 12 (0.6%), Technology barrier 64 (3%). Arm baseline measures were not different between arms. Among participants in the choice group, 1 of 148 (0.6%) elected HRwHC instead of PR. Because all patients received the same intervention (except one), outcomes at 3 months showed no difference, result are presented as one group before -after analysis. Among 295 patients that chose or were randomized to HRwHC, adherence (completion) was 59%. CRQ physical and Emotional Summary as well as all individuals’ domains improved significantly and beyond the MCID at 3 months Table 1A. CRQ improvement was maintained at 6- and 12-months Table 1B-C. Linear mixed models for repeated measures confirmed the significant sustained improvement over one year after adjusting to age, FEV1%, Charlson comorbidity index (p < 0.001 for all three time point 3-6-12 months). Conclusions and Relevance Home rehabilitation may represent the preferred choice after a COPD-related hospital admission. HRwHC sustainably improved quality of life over one year making a feasible and effective rehabilitation option and opportunity for primary palliative care. This abstract is funded by: NIH

Abstract Background Daily physical activity (PA) is the strongest predictor of survival and is associated with the risk of hospitalization, poor quality of life 1-3 in people living with Chronic Obstructive Pulmonary Disease COPD.2 However, symptoms of breathlessness, functional limitations, and poor exercise tolerance may make it difficult to meet the conventional physical activity guidelines of 150 minutes of moderate intensity. There is a knowledge gap in the granular amount and intensity of daily PA that may provide a survival benefit for people living with COPD: specifically in light PA (1.5-3METs) and moderate (3-6 METs) PA, which are the intensities most achievable in moderate-severe disease. We aimed to determine whether different intensities of daily physical activity, accurately measured by a gold-standard activity monitor, were associated with a survival benefit in a large cohort of people living with moderate to severe COPD followed for six years. Methods Participants wore the Actigraph® GT3X-BT, a tri-axial wrist accelerometer, for 7 days. Survival at 72 months was assessed through the National Death Index Inquiry by Accurint® and confirmed by records. Analysis Participants in this cohort were randomly assigned to a training data set (70%) and 30% to a validation set. Classification and regression tree (CART) models were generated using the training data set. Bootstrapping with 3,000 iterations was conducted. 872 patients were part of this study: mean age 69+ 8, 54% female, mMRC score, (scale 0-4) was 2.6 + 0.8 and FEV1% was 46% +19. The mean follow-up was 42+ 21 months with a range of 1-72 months. At the end of the follow up 67.3% were alive, 32.7% were deceased. The bootstrapped CART analysis modeled cut points associated with survival as follows: 296 minutes for light PA, 17 minutes for moderate PA; and 3243 steps after adjusting for age, sex, FEV1% and mMRC score. Consistent with the 17 minutes of moderate PA providing 58% survival benefits, we also found that two 10-minute Freedson bouts of activity per day (2x10 min of PA in moderate intensity) the same provided the same survival benefit1. Cox models are presented in Table 1 Conclusion This report is the first to document the survival benefit of light physical activity in patients with COPD. In the context of most patients with moderate-severe COPD not able to achieve PA guidelines, our results represent a breath of fresh air, suggesting that simple and meaningful (to the patient) light activities may provide a survival benefit. This abstract is funded by: NIH