Smart Telehealth Exercise Intervention to Reduce COPD Readmissions

Surya Bhatt

Dr. Surya Bhatt’s research focuses on clinical and translational studies in chronic obstructive pulmonary disease (COPD), and he emphasizes how few centers offer support for research in the areas of exercise medicine in chronic lung disease. Bhatt, an assistant professor of medicine, runs an ongoing study in reducing hospital readmission in patients with COPD. His REACT pilot research focuses on utilizing smart technology–based exercise interventions to reduce hospital readmissions.

“Twenty percent of COPD patients get readmitted within one month of discharge from the hospital,” Bhatt explains. “There’s a big CMS [Centers for Medicare & Medicaid Services] initiative to reduce readmission rates, and our initial results have been promising in reducing COPD readmissions. I’m early in my career and this pilot grant will be extremely helpful in obtaining the preliminary data to plan a randomized controlled trial. I am excited about the expertise and resources I will have access to as part of this grant.”

His research strategy is to use neuromuscular electrostimulation to the quadricep muscles early during an acute exacerbation of COPD. At their follow-up visit two weeks later, patients will be given a smart phone to enable two-way videoconferencing for exercise sessions including aerobics, core body strengthening, breathing exercises and balance. Sessions will also address topics such as smoking cessation and how to use an inhaler. The exercise sessions will last 30–45 minutes three times a week for three months. The primary outcome is the 30-day readmission rate after discharge from the hospital, and secondary outcomes include change in functional outcomes at the end of the trial.

“We’re looking at how modulating muscle function reduces readmission,” Bhatt says. “We hypothesize that this intervention will benefit by reducing systemic inflammation.”

The pilot is a model for a larger trial moving forward and will include muscle biopsies. Any patient hospitalized with an acute exacerbation of COPD is eligible. The only exclusion is people with a pacemaker or significant comorbidities such as severe heart failure.

“It is a great opportunity to test the hypotheses we have to impact readmission rates,” Bhatt says. “This is a really exciting area of research.”

Surya P. Bhatt, MD, is the Medical Director of the Pulmonary Function and Exercise Physiology Lab and an assistant professor in the Division of Pulmonary, Allergy and Critical Care Medicine at the UAB School of Medicine.