Addressing Gaps in Pulmonary Rehabilitation: Evaluation of a Virtual Platform for Patients with COPD (Preprint)

<sec> <title>BACKGROUND</title> Traditional brick-and-mortar pulmonary rehabilitation (PR) programs remain substantially underutilized, with only 2.7% of Medicare beneficiaries completing PR within 12 months following a COPD exacerbation hospitalization. Given the critical role of PR in improving exercise tolerance, quality of life, and reducing readmissions, innovative delivery models are needed to address these this massive utilization gap. Virtual PR platforms have emerged as a potential solution, offering scalable, and home-based rehabilitation </sec> <sec> <title>OBJECTIVE</title> To evaluate the impact of a novel virtual pulmonary rehabilitation program on functional, psychosocial, and cardiometabolic outcomes among adults with COPD. </sec> <sec> <title>METHODS</title> This retrospective observational study analyzed outcomes among patients enrolled in a structured, multidisciplinary virtual PR program between 2022–2024. Participants completed individualized exercise and education sessions remotely, supported by respiratory therapists and health coaches. Baseline and post-program measures were compared using Cohen’s d to assess effect sizes across clinical domains. Primary outcomes included changes in maximum metabolic equivalents (METs), Duke Activity Status Index (DASI), and Patient Health Questionnaire-9 (PHQ-9) scores. Other measures included changes in blood pressure (systolic and diastolic), smoking status, and prevalence of hypertension. </sec> <sec> <title>RESULTS</title> Among 2,444 patients completing the program, the largest effect size improvements were observed in maximum METs achieved, DASI and PHQ9. The program was also associated with decreased smoking rates and a lower prevalence of hypertension post-intervention. Notably, 91% of the studied population self-identified as “fixed income” underscoring the potential for virtual PR to extend access to patients with lower incomes in the US </sec> <sec> <title>CONCLUSIONS</title> Virtual pulmonary rehabilitation appears to be a promising and potentially more scalable alternative to traditional center-based PR for patients with COPD. Significant improvements in exercise capacity, mood, and cardiovascular parameters suggest clinical benefit, while reductions in smoking and hypertension further highlight potential for broader health impact. Given the high proportion of participants on fixed incomes, virtual PR may represent an effective strategy to expand access and equity in chronic respiratory care delivery across the United States. </sec> <sec> <title>CLINICALTRIAL</title> N/A </sec>