One Week of Pre-Program Actigraphy Identifies Dropout Risk in Home-Based Pulmonary Rehabilitation for COPD
Year: 2026
Type: conference-paper
Abstract: Background: Home-based pulmonary rehabilitation (HBPR) can expand access for people with chronic obstructive pulmonary disease (COPD), but program dropout remains common and difficult to predict. We examined whether one week of pre-program wrist actigraphy could yield simple, interpretable activity–sleep phenotypes that prospectively signal dropout risk and non-adherence.Methods: In a randomized 12-week HBPR trial with remote monitoring and weekly coaching, 140 adults with COPD (median age 69.6 years [IQR: 64.2-76.7]) wore an ActiGraph wGT3X-BT accelerometer on their non-dominant wrist for one week before program start. Two features summarized baseline activity and sleep: Peak 1-min Cadence (free-living peak ambulatory intensity) and Movement Index (sleep restlessness). Latent phenotypes were derived using k-means clustering with silhouette-guided model selection. Associations between phenotypes and (1) time-to-dropout (Cox proportional hazards) and (2) weekly exercise completion among active weeks (linear mixed-effects) were estimated with adjustment for clinical and study covariates; cluster effects were tested for robustness via label-permutation likelihood-ratio tests.Results: A two-cluster solution produced stable phenotypes. Compared with Cluster 0 (n = 117), Cluster 1 (n = 23) had lower peak cadence (median 50.1 vs 57.5 steps/min) and more restless sleep (Movement Index 22.1 vs 11.2). Cluster 1 was associated with higher dropout (HR = 2.32, 95% CI 1.32–4.09; p = 0.003) and fewer exercises per active week (β = −1.64, 95% CI −3.19 to −0.08; p = 0.039).Conclusion: A two-feature actigraphy phenotype characterized by lower peak ambulatory intensity with more restless sleep identified HBPR participants at increased risk of dropout and lower week-to-week adherence. These findings suggest that pre-program physical activity and sleep behaviors may provide a parsimonious, interpretable signal of HBPR dropout risk.
Institution: Mayo Clinic
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7202279342