Tele-Pulmonary Rehabilitation: Global Expert Perspectives on Unresolved Issues

Pulmonary rehabilitation (PR) is a multidisciplinary intervention whose cornerstone is aerobic and resistive exercise training coupled with disease education. Advances in the field of PR have focused on remote delivery to address access to this guideline-driven intervention. A scientific symposium on key unresolved issues facing tele-PR was programmed at the 2025 American Thoracic Society International Conference. This narrative review summarizes presentations by PR experts on synchronous versus asynchronous delivery modes; exercise training using aerobic gym equipment versus minimal equipment; and the primary functional outcome being a measure of exercise capacity versus measures of frailty or physical activity (PA). While synchronous tele-PR may enhance safety, allow real-time feedback during exercise, and foster group camaraderie, asynchronous delivery offers flexibility and individualized engagement with clinicians. Gym equipment may facilitate higher exercise intensity training and progression, but the experienced PR clinician can achieve both with minimal equipment and a clear prescription for ground walking speed, walking duration, or weight additions. Finally, improvement in exercise capacity is a well-established outcome of PR, yet evidence is variable as to whether this benefit translates into increased PA. It will be important to study the concept of frailty to individualize program content. All PR models must provide the core components and lead to the expected outcomes. New tele-PR models must be rigorously evaluated. The goal is to provide equitable access to effective PR to as many people with chronic lung disease as possible. Tele-PR has the potential to improve access, but should not replace center-based PR.