Robotics in Pulmonary Rehabilitation: Current Evidence and Recommendations
Robotics currently have no established role in pulmonary rehabilitation for COPD or asthma, as they remain investigational technologies without sufficient evidence to support their use over proven rehabilitation modalities. 1
Current Status of Robotic Applications
The American Thoracic Society and European Respiratory Society acknowledge that technologies, including robotics, are being adapted and tested to support exercise training, education, exacerbation management, and physical activity monitoring in pulmonary rehabilitation contexts. 1 However, these remain investigational rather than established interventions, with an insufficient evidence base compared to traditional rehabilitation approaches. 1
No randomized controlled trials or high-quality evidence currently support the use of robotics as a component of pulmonary rehabilitation programs for patients with chronic respiratory diseases. 1
Evidence-Based Alternatives That Should Be Used Instead
Proven Exercise Training Modalities
Rather than experimental robotic interventions, clinicians should implement the following evidence-based approaches that demonstrate robust improvements in dyspnea, exercise capacity, and quality of life:
Interval training, strength training, upper limb training, and transcutaneous neuromuscular electrical stimulation have increased evidence for efficacy as part of pulmonary rehabilitation. 2
Lower-extremity exercise training at higher intensity produces greater physiologic benefits for COPD patients. 3
Strength training combined with endurance training increases muscle strength and muscle mass. 3
Upper extremity training improves arm function and reduces ventilatory requirements during arm activities. 3
Technology-Assisted Alternatives With Evidence
If technology is desired to enhance accessibility or monitoring, technology-assisted telerehabilitation represents a more evidence-based technological approach than robotics. 1
Technology-assisted exercise training can remotely monitor home-based endurance programs with good compliance and significant clinical improvements. 3, 4
These approaches may reduce primary care contacts for respiratory issues and potentially decrease acute exacerbations and hospitalizations. 3
Home-based exercise training that is appropriately resourced has proven effective in reducing dyspnea and increasing exercise performance. 2, 1
Core Components That Must Be Delivered
Pulmonary rehabilitation is defined as a comprehensive intervention based on thorough patient assessment followed by patient-tailored therapies that include exercise training, education, and behavior change. 2
Any technology, including robotics, must deliver all core components of pulmonary rehabilitation to be considered appropriate:
- Exercise training (endurance, strength, upper and lower extremity) 3
- Patient education and self-management training 3
- Behavioral support and psychological interventions 3
- Nutritional assessment and support when indicated 3
Program Duration and Intensity
Exercise training should be conducted for 6-12 weeks, with longer programs (12 weeks) producing greater sustained benefits. 3
Programs should include both upper and lower extremity training components at appropriate intensity to achieve physiological benefits. 3
Maintenance strategies following initial rehabilitation are necessary, as benefits decline gradually over 12-18 months without maintenance. 3
Critical Pitfalls to Avoid
Do not substitute experimental robotic technology for comprehensive pulmonary rehabilitation that includes all core components—exercise training, education, behavioral support, and nutritional assessment. 1
Avoid using technology as a standalone intervention without the multidisciplinary team approach that addresses the complex needs of patients with COPD and multiple comorbidities. 1
Do not assume technology improves outcomes simply because it is novel; the ATS/ERS emphasizes that technologies are still being tested and lack the robust evidence base of traditional approaches. 1
Failing to include both upper and lower extremity training components is a common pitfall that reduces program effectiveness. 3
Not providing adequate exercise intensity to achieve physiological benefits undermines the rehabilitation program. 3
When Technology May Be Considered
Technology-assisted approaches may be deployed for patients who cannot access center-based programs due to transportation barriers, rural location, or mobility limitations, but must deliver all core components of pulmonary rehabilitation. 1
Integrated care principles should guide management of COPD patients with comorbidities, with pulmonary rehabilitation as a core component using established modalities rather than unproven robotic interventions. 1