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Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice

McCarthy, Margaret; Jevotovsky, David; Mann, Devin; Veerubhotla, Akhila; Muise, Eleanor; Whiteson, Jonathan; Rizzo, John Ross
PURPOSE/OBJECTIVE:Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity. DESIGN AND METHODS/METHODS:This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings. RESULTS:The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress. CLINICAL RELEVANCE/CONCLUSIONS:If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services. CONCLUSION/CONCLUSIONS:RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.
PMID: 37723623
ISSN: 2048-7940
CID: 5591172

Pulmonary Sequelae of Coronavirus Disease 2019

Whiteson, Jonathan H
Severe acute respiratory syndrome coronavirus 2, the infectious agent that causes coronavirus disease 2019 (COVID-19), can infect multiple organ systems triggering an inflammatory response resulting in abnormalities in cellular and organ function. This can result in multiple symptoms and associated functional limitations. Respiratory symptoms in acute COVID-19 and in post-acute sequelae of COVID-19 (PASC) are common and can range from mild and intermittent to severe and persistent, correlating with functional limitations. Although the long-term pulmonary sequelae of COVID-19 infection and PASC are not known, a considered rehabilitative approach is recommended to yield optimal functional outcomes with a return to pre-morbid functional, avocational, and vocational status.
PMID: 37419533
ISSN: 1558-1381
CID: 5536932

Exercise intolerance associated with impaired oxygen extraction in patients with long COVID

Norweg, Anna; Yao, Lanqiu; Barbuto, Scott; Nordvig, Anna S; Tarpey, Thaddeus; Collins, Eileen; Whiteson, Jonathan; Sweeney, Greg; Haas, Francois; Leddy, John
OBJECTIVE:Chronic mental and physical fatigue and post-exertional malaise are the more debilitating symptoms of long COVID-19. The study objective was to explore factors contributing to exercise intolerance in long COVID-19 to guide development of new therapies. Exercise capacity data of patients referred for a cardiopulmonary exercise test (CPET) and included in a COVID-19 Survivorship Registry at one urban health center were retrospectively analyzed. RESULTS:pulse peak % predicted (of 79 ± 12.9) was reduced, supporting impaired energy metabolism as a mechanism of exercise intolerance in long COVID, n = 59. We further identified blunted rise in heart rate peak during maximal CPET. Our preliminary analyses support therapies that optimize bioenergetics and improve oxygen utilization for treating long COVID-19.
PMID: 37076024
ISSN: 1878-1519
CID: 5464512

Mind-Body Intervention for Dysfunctional Breathing in Chronic Obstructive Pulmonary Disease: Feasibility Study and Lessons Learned

Norweg, Anna Migliore; Wu, Yinxiang; Troxel, Andrea; Whiteson, Jonathan H; Collins, Eileen; Haas, Francois; Skamai, Anne; Goldring, Roberta; Jean-Louis, Girardin; Reibman, Joan; Ehrlich-Jones, Linda; Simon, Naomi
PMID: 36800224
ISSN: 2768-3613
CID: 5435382

Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice

Mccarthy, Margaret; Jevotovsky, David; Mann, Devin; Veerubhotla, Akhila; Muise, Eleanor; Whiteson, Jonathan; Rizzo, John Ross
ISSN: 0278-4807
CID: 5591122

Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Autonomic Dysfunction in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)

Blitshteyn, Svetlana; Whiteson, Jonathan; Abramoff, Benjamin; Azola, Alba; Bartels, Matthew N; Bhavaraju-Sanka, Ratna; Chung, Tae; Fleming, Talya K; Henning, Ellen; Miglis, Mitchell G; Sampsel, Sarah; Silver, Julie K; Tosto, Jenna; Verduzco-Gutierrez, Monica; Putrino, David
PMID: 36169154
ISSN: 1934-1563
CID: 5334282

Adherence and Exercise Capacity Improvements of Patients With Adult Congenital Heart Disease Participating in Cardiac Rehabilitation

Sheng, S Peter; Feinberg, Jodi L; Bostrom, John A; Tang, Ying; Sweeney, Greg; Pierre, Alicia; Katz, Edward S; Whiteson, Jonathan H; Haas, François; Dodson, John A; Halpern, Dan G
Background As the number of adults with congenital heart disease increases because of therapeutic advances, cardiac rehabilitation (CR) is increasingly being used in this population after cardiac procedures or for reduced exercise tolerance. We aim to describe the adherence and exercise capacity improvements of patients with adult congenital heart disease (ACHD) in CR. Methods and Results This retrospective study included patients with ACHD in CR at New York University Langone Rusk Rehabilitation from 2013 to 2020. We collected data on patient characteristics, number of sessions attended, and functional testing results. Pre-CR and post-CR metabolic equivalent task, exercise time, and maximal oxygen uptake were assessed. In total, 89 patients with ACHD (mean age, 39.0 years; 54.0% women) participated in CR. Referral indications were reduced exercise tolerance for 42.7% and post-cardiac procedure (transcatheter or surgical) for the remainder. Mean number of sessions attended was 24.2, and 42 participants (47.2%) completed all 36 CR sessions. Among participants who completed the program as well as pre-CR and post-CR functional testing, metabolic equivalent task increased by 1.3 (95% CI, 0.7-1.9; baseline mean, 8.1), exercise time increased by 66.4 seconds (95% CI, 21.4-111.4 seconds; baseline mean, 536.1 seconds), and maximal oxygen uptake increased by 2.5 mL/kg per minute (95% CI, 0.7-4.2 mL/kg per minute; baseline mean, 20.2 mL/kg per minute). Conclusions On average, patients with ACHD who completed CR experienced improvements in exercise capacity. Efforts to increase adherence would allow more patients with ACHD to benefit.
PMID: 35929458
ISSN: 2047-9980
CID: 5288322

Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Cardiovascular Complications in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)

Whiteson, Jonathan; Azola, Alba; Barry, John T; Bartels, Matthew N; Blitshteyn, Svetlana; Fleming, Talya K; McCauley, Mark D; Neal, Jacqueline D; Pillarisetti, Jayasree; Sampsel, Sarah; Silver, Julie K; Terzic, Carmen M; Tosto, Jenna; Verduzco-Gutierrez, Monica; Putrino, David
PMID: 35657351
ISSN: 1934-1563
CID: 5236212

Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial

Dodson, John A; Schoenthaler, Antoinette; Sweeney, Greg; Fonceva, Ana; Pierre, Alicia; Whiteson, Jonathan; George, Barbara; Marzo, Kevin; Drewes, Wendy; Rerisi, Elizabeth; Mathew, Reena; Aljayyousi, Haneen; Chaudhry, Sarwat I; Hajduk, Alexandra M; Gill, Thomas M; Estrin, Deborah; Kovell, Lara; Jennings, Lee A; Adhikari, Samrachana
BACKGROUND:Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults' uptake, and efficacy data are currently lacking. OBJECTIVE:This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. METHODS:RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ≥65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). RESULTS:As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. CONCLUSIONS:The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. TRIAL REGISTRATION/ NCT03978130; INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)/UNASSIGNED:DERR1-10.2196/32163.
PMID: 35238793
ISSN: 1929-0748
CID: 5174552

Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Breathing Discomfort and Respiratory Sequelae in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)

Maley, Jason H; Alba, George A; Barry, John T; Bartels, Matthew N; Fleming, Talya K; Oleson, Christina V; Rydberg, Leslie; Sampsel, Sarah; Silver, Julie K; Sipes, Sabrina; Verduzco Gutierrez, Monica; Wood, Jamie; Zibrak, Joseph D; Whiteson, Jonathan
PMID: 34902224
ISSN: 1934-1563
CID: 5109642