Effects of long-term, home-based, virtual cycling after COPD exacerbation - results from the randomised controlled COPDtoParis trial.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with functional decline, reduced quality of life, and high rates of readmission and mortality. Although exercise is recommended following AECOPD, long-term adherence and maintenance of benefits remain challenging. Home-based, technology-supported exercise modalities may offer accessible alternatives, but evidence on long-term effectiveness remains limited. Objective: To evaluate the effectiveness of a long-term, home-based, virtual cycling intervention on physical performance, physical activity, lung function, functional mobility, frailty, symptoms, health-related quality of life (HRQoL), and hospital readmission in people with COPD following AECOPD. Methods: This single-centre, parallel-group, cluster randomised controlled trial recruited patients hospitalised with AECOPD. Participants were randomised in teams to 12 months of home-based virtual cycling or standard care. The intervention consisted of team-based cycling on pedal trainers guided by pre-recorded route videos. The primary outcome was the five-repetition sit-to-stand test (5RSTS). Secondary outcomes included physical performance, lung function, physical activity measured by leg-mounted triaxial accelerometers, dyspnoea, frailty, functional mobility, and HRQoL. Outcomes were assessed at baseline, 6 weeks, 6 months, and 12 months using linear mixed models. Results: Forty participants were randomised (21 intervention, 19 control). Physical and respiratory outcomes remained largely stable over time with no significant between-group differences. At 12 months, the intervention group reported higher self-rated health and functional mobility compared with controls in secondary outcomes. Sedentary time remained high in both groups, and readmission and mortality rates were similar. Conclusion: In older, multimorbid individuals recovering from AECOPD, long-term home-based virtual cycling did not improve physical performance, activity levels, or lung function, but was associated with higher self-perceived health and functional mobility at 12 months. However, given attrition and limited power, these findings should be cautiously interpreted. Low-threshold, technology-supported exercise may offer patient-centred benefits in populations with limited exercise reserve but research with sufficient power is needed.