Smartphone App–Based Music-Facilitated Pulmonary Rehabilitation Program Integrating Rhythm-Guided Walking and Singing for Patients With Chronic Obstructive Pulmonary Disease: Multicenter Randomized Controlled Trial

Background: Pulmonary rehabilitation (PR) is a cornerstone for the management of chronic obstructive pulmonary disease (COPD), yet global uptake remains low due to geographic and resource barriers. Digital health technologies, specifically smartphone apps, offer a promising platform for delivering accessible home-based PR. In addition, music-assisted interventions not only offer unique physiological and psychological benefits but may also serve as an innovative approach to enhancing patient engagement and improving the effectiveness of rehabilitation in home settings. Objective: This study aimed to evaluate the effectiveness of a smartphone app-based, music-facilitated multicomponent PR program (integrating rhythm-guided walking [RW] and singing) for improving exercise capacity and other clinical outcomes in patients with COPD compared with usual care (UC). Methods: This 3-arm, parallel-group, multicenter randomized controlled trial included 70 participants in China. Participants were randomized into a multimodule training (MT) group, which included a multicomponent PR program integrating RW and singing training (n=25); a RW group, which included RW training (n=23); or a UC group (n=22). The MT and RW groups received 12-week asynchronous home-based training via a smartphone app, and all arms received structured patient education. The primary outcome was the distance achieved in the incremental shuttle walking test (ISWT) at 12 weeks. The secondary outcomes included dyspnea, quality of life, and pulmonary function. Results: The modified intention-to-treat principle was used to analyze the 70 study patients. At 12 weeks, the ISWT distance was significantly greater in the MT group than in the UC group (mean difference [MD] 56.35 m, 95% CI 6.66-106.04 m; P=.03; Cohen d=0.30). Significant improvements were observed in the MT group compared with the UC group in the modified Medical Research Council dyspnea scale (mMRC) score (MD -0.44, 95% CI -0.80 to -0.08; P=.02), COPD Assessment Test score (MD -3.23, 95% CI -6.18 to -0.29; P=.03), Hospital Anxiety and Depression Scale-anxiety subscale score (MD -2.31, 95% CI -3.99 to -0.63; P=.008), and inspiratory capacity (MD 15.98% predicted, 95% CI 4.76 to 27.21; P=.01). However, no significant differences were found between the RW and UC groups in primary or secondary outcomes. Compared with RW, MT was significantly better at decreasing the mMRC score (P=.03). Conclusions: The findings of this study demonstrate that our smartphone app-based music-facilitated multicomponent PR program (including tempo-guided walking and singing) caused clinically meaningful improvements in exercise capacity among patients with COPD compared to UC. Moreover, secondary outcomes, including dyspnea, quality of life, psychological status, and inspiratory capacity, showed better improvements with MT than with UC.