Assessment of exercise provides important prognostic information about pulmonary arterial hypertension patients. Researchers from the UK have recently published a review of current digital alternatives to traditional outcome measures.
The 6-minute walk test (6MWT) is a key tool for monitoring pulmonary arterial hypertension, but since care is often centralized, patients may only do it once or twice a year. Digital alternatives could allow more frequent, home-based monitoring.
What’s been tried:
- Continuous actigraphy (e.g. daily step counts via wearables) — useful at the population level, but too variable for tracking individual patients reliably, including seasonal fluctuations unrelated to disease.
- Digital 6MWT via smartphone apps — proven safe, accurate, and well-accepted by patients. Various approaches exist: indoors vs. outdoors, GPS vs. accelerometer, fixed vs. free course, app-only vs. app paired with a smartwatch or ECG sensor.
- Adding physiological data (heart rate, cardiac effort) from wearables improves the richness and interpretability of results.
Key challenges:
- Patient adherence drops off significantly over time (15–48% dropout in trials)
- Data quality and technical artefacts are difficult to manage at scale
- No validated “minimal clinically important difference” yet for digital tests
- Missing data (e.g. patients not wearing devices when unwell) is an underexplored problem
Bottom line: The digital 6MWT is feasible and promising, but more work is needed to prove it can reliably track disease progression and treatment response over time before it’s ready for routine clinical use. AI may eventually help, but is still in early stages.
Read more at this link on Current Opinions in Pulmonary Medicine
Citation
Appenzeller P, Jeffery D, Toshner M. Remote exercise assessment in pulmonary hypertension. Curr Opin Pulm Med. 2026 May 7. doi: 10.1097/MCP.0000000000001277. Epub ahead of print. PMID: 42093162.