By Elie Donath, MD, MPH

If you work in pulmonary rehabilitation, you’ve probably noticed it already: more and more patients are showing up wearing some kind of device on their wrist, finger, or chest. Some may be enthusiastic about it or some may be skeptical; but, often, they’re wondering whether these numbers mean anything at all. It becomes worth asking, “Is any of this actually helpful?”

Pulmonary rehab has always been about far more than just exercise routines. It’s a form of comprehensive care that encompasses aerobic and resistance training, education, behavioral changes, and confidence building. For patients with chronic respiratory diseases like COPD or asthma, their inactivity is rarely a matter of just motivation. It’s often rooted in triggering symptoms, loss of independence, and deconditioning. Wearables enter that trying landscape with a simple promise to improve visibility.

Shifting From Snapshots to Patterns

Traditionally we assess physical function through a variety of means, including physical exams, lab work, vital signs, questionnaires, and observed performance. These are valuable, but they are only snapshots. Wearables offer something slightly different — longitudinal data from real life. They track heart rate, respiratory rate, steps, mood, sleep patterns, oxygen saturation, activity intensity, and more. Unlike recall-based questionnaires, activity monitors provide a more direct and objective picture of daily physical activity (this matters a great deal in a population where inactivity is associated with a wide variety of adverse outcomes). These tools allow behavioral and physiologic patterns outside the clinic to become visible to both patients and clinicians. That shift — from intermittent observation to continuous trend monitoring — has the potential to change how we think about clinical trajectories and patient stability, decline, or recovery.

In pulmonary rehab, that could look like noticing a gradual decline in pulse oximetry and/or daily step count prior to the onset of a full-blown asthma/COPD exacerbation, identifying fragmented sleep patterns that could point towards nocturnal respiratory symptoms, and monitoring whether activity gains achieved during rehab are maintained after discharge. None of these replace clinical evaluation. But they add important texture to the overall picture.

Motivation and Behavior Change

One of the most promising roles for wearables in pulmonary rehab isn’t diagnostic — its behavioral. Behavioral modification strategies integrated with daily monitoring and feedback increasingly are being paired with pulmonary rehab protocols. This permits the relationship between effort and outcome to become more tangible, and for some patients that visibility can be truly empowering. The device becomes a tool for reflection, and that’s where behavior change can really begin.

The Integration Challenge

Obviously, more data doesn’t necessarily translate into better care. Important issues that still require further resolution include data ownership, interoperability, workflow integration, trust, and reimbursement.

For pulmonary rehab teams, the most immediate issue is likely workflow. Wearables generate dense data streams; and deciding what should be reviewed, when it should be reviewed, and by whom requires intentional structure (not every metric needs a clinical response but, invariably, they will produce some number that really shouldn’t be ignored).

Accuracy also deserves attention. Some devices are FDA-cleared for specific medical purposes, but many consumer devices are not. So while a step count trend may be useful, a random spot oxygen reading from a consumer watch may be less reliable. It’s thus important to emphasize that wearables can generate hypotheses but they do not replace actual clinical assessment.

There’s also an emotional component. Alerts and false positives often provoke needless anxiety. In a population already closely attuned to their respiratory patterns, these numbers can amplify worry if not framed appropriately; and that could possibly exacerbate underlying symptoms.

Trust, Literacy, and Equity

Adoption of wearable technology hinges on trust. Patients need clarity on who owns their data, how its stored, and who has access. They also need digital literacy support, as some will require assistance navigating apps, syncing devices, and interpreting numerical outputs/ranges. There is also a “digital divide” in that unequal access exists to technology/connectivity, and chronic respiratory diseases disproportionately affect individuals with socioeconomic barriers.

The Evidence Landscape

Our field is still defining how these devices are being utilized and which outcomes (functional capacity, adherence, physical activity levels, quality of life, etc.) are most impacted. On a health system level, reimbursement models for remote monitoring are also still being defined; and return on investment is murky. Cybersecurity, data integration, and staff training require significant upfront investments; and long-term savings depend on whether earlier interventions can reduce resource utilization.

The Foundation Remains the Same

Pulmonary rehab has always centered on helping patients rebuild confidence and reengage with daily life. Wearables do not alter that foundation — they add to it. They provide another lens through which to understand patterns of activity and behavior outside clinical walls. At the same time, it’s important to recognize they only become meaningful when interpreted within a therapeutic relationship grounded in trust and understanding. A device may be able to count steps — but it cannot normalize the experience of being breathless or coach coping strategies in real-time or help celebrate when a patient accomplishes their first walk around the block in months. That remains our work as providers. And our hope is that it may quietly strengthen what our field already does best: converting data into insights and insights into action.

Take-Home Points

• Wearables offer real-world trend data that can support behavioral changes and early recognition of a decline in chronic respiratory diseases
• These data often require context and interpretation by skilled professionals
• Successful integration depends on workflow design, digital literacy, equitable access and patient trust

Dr. Elie Donath is an assistant professor of medicine at the University of Vermont Medical Center with interests in digital health, wearable technologies, and data-driven approaches to improving patient care. His work focuses on integrating emerging technologies into clinical practice to enhance monitoring, outcomes, and patient engagement.

REFERENCES:

Ginsburg GS, Picard RW, Friend SH, Drazen JM. Wearable digital health technologies in clinical care. N Engl J Med. 2024;390:1118-1127.

Oliveira TRA, Fernandes ATNSF, Santino TA, Menescal FEPS, Nogueira PAMS. Effects of using wearable devices to monitoring physical activity in pulmonary rehabilitation programs for chronic respiratory diseases: A systematic review protocol. PLoS ONE. 2024;19(7):e0308109.