Analysis of Voice Biomarkers in Chronic Obstructive Pulmonary Disease: Investigating a New Frontier for Assessing Motivational Profiles for Physical Exercise and Response to Pulmonary Rehabilitation

• Grant number: 25/12387-4
• Support Opportunities: Scholarships in Brazil - Doctorate
• Start date: July 01, 2025
• End date: June 30, 2028
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Renata Gonçalves Mendes
• Grantee: Gustavo Henrique Guimarães Araujo
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Associated research grant: 24/10232-0 - Speaking up for COPD through artificial intelligence in Brazil: Analysis of voice biomarkers for better diagnosis, early identification of exacerbation and assessing the effect of pulmonary rehabilitation, AP.TEM

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is one of the main public health problems in Brazil, with a prevalence ranging from 12% to 15%. A significant portion of cases remains underdiagnosed and without access to specific care. Although the Brazilian Unified Health System (SUS) provides management protocols, there are gaps between the guidelines and their practical implementation. Pulmonary rehabilitation (PR) is one of the main non-pharmacological strategies in COPD care, with well-established benefits in improving functional capacity, quality of life, and reducing exacerbations. However, there is a growing need for new tools to monitor and personalize care, identifying individual needs and priorities. In this context, the application of artificial intelligence (AI) in the analysis of vocal biomarkers emerges as an innovative and promising approach to monitor clinical and behavioral outcomes in individuals with COPD.This project aims to investigate whether vocal biomarkers, analyzed using AI, are capable of distinguishing physical behavior patterns and motivational profiles for exercise in individuals with COPD undergoing a PR program. The study will be conducted in two phases. The first phase consists of a cross-sectional study involving 40 individuals with COPD. Clinical and demographic data will be collected, along with information on physical behavior (via accelerometry using the activPAL3¿® device for 7 days) and motivation (using the Behavioral Regulation in Exercise Questionnaire - 3 and the Basic Psychological Needs in Exercise Scale). Vocal characteristics will be obtained from recordings of sustained vowels and paced speech, and analyzed using AI for features such as frequency, intensity, pitch variability, speech rate, articulation, inhalations, jitter, shimmer, Harmonics-to-Noise Ratio (HNR), and formants.The second phase will consist of a randomized clinical trial involving a 12-week PR program, including physical training, education, and behavior change strategies. Patients will be assessed before and after the program, as well as at 3 and 6 months post-intervention. Assessments will include pulmonary function, disease impact, quality of life (London Chest Activity of Daily Living, Hospital Anxiety and Depression Scale, and EuroQoL-5D-3L), motivation, peripheral muscle strength, physical activity levels, and vocal biomarkers. It is expected that the findings will help determine whether vocal biomarkers are sensitive indicators capable of differentiating clinical and behavioral profiles, thereby supporting the integration of innovative technologies in the monitoring of COPD patients and potentially enhancing the implementation of more individualized strategies within the SUS.