How can digital technology be safely and effectively incorporated into pulmonary rehabilitation for adults with chronic respiratory diseases such as chronic obstructive pulmonary disease, asthma, interstitial lung disease, and post‑COVID‑19 sequelae?

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Last updated: February 21, 2026 • View editorial policy

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Digital Technology in Pulmonary Rehabilitation

Primary Recommendation

The American Thoracic Society strongly recommends offering patients with chronic respiratory disease the choice between center-based pulmonary rehabilitation or telerehabilitation, as both delivery models achieve equivalent clinical outcomes with moderate-quality evidence. 1

Evidence-Based Framework for Implementation

When to Offer Digital/Telerehabilitation

  • Offer telerehabilitation as an equivalent alternative to center-based programs for adults with stable COPD, interstitial lung disease, and pulmonary hypertension when patients face barriers to traditional programs 1

  • Primary barriers justifying digital delivery include transportation challenges, rural geographic location, mobility limitations, and competing time demands 1, 2

  • Telerehabilitation demonstrates equivalent outcomes to center-based programs for exercise capacity (6-minute walk distance), health-related quality of life, and dyspnea reduction with moderate-quality evidence 2

Essential Components That Must Be Included

Digital pulmonary rehabilitation is not simply remote exercise monitoring—it must replicate the comprehensive nature of traditional programs:

  • Structured, progressive, individually-tailored exercise training with clear progression protocols 3

  • COPD self-management education integrated alongside exercise components 3

  • Patient-tailored behavioral change strategies and motivational support 3

  • Multidisciplinary team coordination involving healthcare professionals from multiple disciplines 3

  • Outcome measurement and patient assessment throughout the program 1

Clinical Algorithm for Patient Selection

Step 1: Assess eligibility for any pulmonary rehabilitation

  • All symptomatic adults with COPD (strong recommendation), interstitial lung disease (strong recommendation), or pulmonary hypertension (conditional recommendation) should be offered PR 1

Step 2: Determine delivery model

  • If patient can access center-based PR → offer choice between center-based or telerehabilitation 1
  • If transportation, geography, or time constraints exist → prioritize telerehabilitation 2

Step 3: Screen for digital readiness before deploying technology-based PR

  • Verify patient has necessary equipment (smartphone/tablet/computer) and reliable internet connection 2
  • Confirm patient possesses technical skills or has support person available 2
  • Exclude patients with significant vision, hearing, or balance impairments that compromise safety 2
  • Note that 31% of COPD patients in the UK have never accessed the internet; factors associated with lower telehealth use include older age, lower household income, Black race, Latinx ethnicity, and female sex 2

Step 4: Ensure adequate program duration

  • Programs should run at least 6-12 weeks with 2-3 sessions per week regardless of delivery method 2

Critical Limitations and Caveats

What Digital Technology Cannot Replace

  • Center-based pulmonary rehabilitation retains the strongest evidence for reducing mortality (OR 0.28; 95% CI 0.10-0.84) and hospital admissions (OR 0.22; 95% CI 0.08-0.58), particularly after COPD exacerbations 2

  • Technology should deliver all core components, not serve as standalone exercise monitoring or mobility assistance 3, 4

  • Avoid using inspiratory muscle training devices alone without comprehensive exercise training, as evidence does not support routine ventilatory muscle training as a standalone intervention 3

Quality Assurance Requirements

  • Programs with lower-intensity remote supervision require robust service-audit and benchmarking processes to ensure efficacy, as some telerehabilitation models may result in less intensive supervision 2

  • Only program models tested in clinical trials should be implemented, as characteristics of patients most likely to succeed in each model are not yet fully known 2

Safety Profile and Patient Experience

  • No direct reported evidence of undesirable effects for patients undertaking telerehabilitation; qualitative evidence suggests patients view it favorably 2

  • Patients and healthcare providers acknowledged the pivot to virtual PR as positive during COVID-19, though both groups were mindful of implementation challenges 5

  • Service satisfaction is high, with more than three-quarters of intervention group participants rating smartphone app-guided PR scores as ≥17/20 6

Emerging Technologies: Current Status

Virtual Reality and Robotics

  • Virtual reality can be used as an adjunct to conventional pulmonary rehabilitation but must not replace comprehensive center-based or telerehabilitation programs 2

  • Robotic applications and advanced digital technologies are "currently being adapted and tested" but do not yet have the robust evidence base of traditional pulmonary rehabilitation 3

  • Until robotic mobility assistance demonstrates outcomes equivalent to standard programs in rigorous trials, clinicians should offer patients a choice between center-based pulmonary rehabilitation and telerehabilitation 4

Smartphone Applications

  • A 2025 randomized controlled trial found smartphone app-guided pulmonary rehabilitation failed to improve exercise capacity (6-minute walk distance) or quality of life compared to standard care, though it was safe and feasible for older adults 6

  • Only 7 out of 41 participants achieved the minimal clinically important difference of 25 meters in 6-minute walk distance after a 12-week app-guided program 6

Maintenance Rehabilitation

  • After completing initial pulmonary rehabilitation, consider offering supervised maintenance PR (conditional recommendation, low-quality evidence) to sustain benefits 1, 4

  • Digital platforms may facilitate maintenance programs for patients who cannot access ongoing center-based sessions 3

Common Pitfalls to Avoid

  • Do not substitute technology for comprehensive assessment and multidisciplinary care—technology must deliver education, behavioral support, and nutritional assessment alongside exercise 3

  • Do not assume all patients have digital literacy or access—screen carefully for equipment, internet reliability, and technical skills before enrollment 2

  • Do not deploy telerehabilitation without addressing special populations—patients requiring close physiological monitoring, those with severe hemodynamic impairment, or those with vestibular/balance issues may not be appropriate candidates 2

  • Do not implement unvalidated digital tools—the evidence base for many emerging technologies (robotics, VR, standalone apps) remains insufficient compared to established telerehabilitation models 2, 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Robot Technology in Pulmonary Rehabilitation

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Guideline

Robotic Applications in Pulmonary Rehabilitation

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Guideline

Guideline Recommendations for Technology Use in Pulmonary Rehabilitation

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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