Digital Delivery of Pulmonary Rehabilitation in Copd: Access, Adherence, and Implementation in Clinical Practice

Digital models of pulmonary rehabilitation are increasingly used to address long-standing access gaps in chronic obstructive pulmonary disease (COPD), yet their value depends on more than technological novelty. This structured narrative review aimed to synthesize current evidence on digital delivery of pulmonary rehabilitation and physical activity support in COPD, with particular emphasis on access, adherence, safety, patient experience, and implementation. The review was based on a curated full-text PDF library and a PubMed-centered search strategy focused on COPD, pulmonary rehabilitation, exercise, telemedicine, mobile applications, and wearable-supported physical activity coaching. The included literature comprised guideline documents, systematic reviews, randomized and comparative trials, maintenance studies, qualitative work, and implementation-focused evaluations. Across the current evidence base, supervised tele-pulmonary rehabilitation and supported online or home-based models generally produced outcomes comparable to center-based pulmonary rehabilitation for functional capacity, symptoms, and quality of life, while app-only models showed more variable results. The most consistent advantages of digital delivery were improved access, better completion in some programs, and support for maintaining physical activity after formal rehabilitation. However, digital readiness, onboarding burden, adherence decay, and heterogeneity of outcomes remain important barriers. Digital pulmonary rehabilitation is therefore best understood as a delivery strategy that can widen access and sustain engagement when core rehabilitation components are preserved and implementation is carefully designed.