Remote monitoring technologies are increasingly used to assess physical activity and cardiopulmonary haemodynamics in patients with pulmonary arterial hypertension (PAH), yet the seasonal stability of these parameters remains poorly defined. In this study, patients with PAH underwent continuous remote monitoring using implantable cardiac monitors, pulmonary artery pressure sensors, smartwatches, and structured hospital-based walk tests to assess active and passive physical activity and haemodynamic parameters throughout the year. Passively collected physical activity data demonstrated significant seasonal variation, with the lowest levels in winter and peak activity during summer. In contrast, no seasonal variability was observed in structured exercise tests (incremental shuttle walk test, 6-minute walk test) or remote measures of pulmonary artery pressure, cardiac output, heart rate, or heart rate variability. Furthermore, national clinical trial recruitment data revealed seasonal fluctuations, with reduced enrolment in April and December. These findings underscore the importance of accounting for environmental and temporal factors when interpreting passively collected physical activity data and designing clinical trials that incorporate remote digital endpoints.

The authors have declared no competing interest.

NCT04078243

MRC Exp Med MR/W026279/1 EPSRC EP/Z531297/1

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Feasibility of Novel Clinical Trial Infrastructure, Design and Technology for Early Phase Studies in Patients with Pulmonary Hypertension (FIT- PH, NCT04078243, REC 19/YH/0354 - Yorkshire & The Humber - Sheffield Research Ethics Committee). ASPIRE registry (REC: 22/EE/0011, East of England - Cambridge East Research Ethics Committee) database

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All data produced in the present study are available upon reasonable request to the authors