Smart steps forward: the role of wearables in long-term rehabilitation after lung transplantation

Abstract

Physical inactivity is a modifiable and widespread risk factor in chronic disease populations, including those with obstructive pulmonary disease and recipients of lung transplantation (LT). While LT restores respiratory function, full physical recovery remains elusive. Muscle weakness and reduced exercise tolerance are common and often worsened by immunosuppressive therapies, immobility and nutritional deficits.1 Notably, prolonged sedentary behaviour is independently associated with long-term morbidity and mortality,1 2 even among patients meeting activity recommendations.3 The COVID-19 pandemic accelerated telemedicine integration into clinical practice, expanding opportunities for telerehabilitation and digital health interventions. In this context, consumer-grade wearable devices, like Fitbit wristbands (Fitbit, Google Alphabet, California, USA), originally designed for fitness tracking, are increasingly being evaluated as therapeutic tools in chronic disease populations.4 Against this backdrop, the randomised controlled trial by Breuls et al ,5 recently published in Thorax, is timely. It explores the use of wearable-based, long-term telecoaching in a high-risk, deconditioned post-LT population with low baseline activity levels. This marks a crucial shift from traditional short-term, centre-based rehabilitation to sustained, behaviourally driven, patient-centred care, addressing the persistent deconditioning that often characterises long-term recovery.1 6 Wearable technologies are emerging as scalable,7 low-cost tools that support behavioural interventions4 through real-time feedback,7 individualised coaching, social connectivity and remote monitoring (figure …