Effects of a Walking Aid in COPD Patients Receiving Oxygen Therapy

doi:10.1378/chest.06-2108

Chest

Volume 131, Issue 4, April 2007, Pages 1068-1074

https://doi.org/10.1378/chest.06-2108 Get rights and content

Study objectives

To elucidate whether a simple walking aid may improve physical performance in COPD patients with chronic respiratory insufficiency who usually carry their own heavy oxygen canister.

Design

Randomized crossover trial.

Setting

Physiopathology laboratory of three rehabilitation centers.

Patients and interventions

We studied 60 stable COPD patients (mean age, 70.6 ± 7.9 years; FEV₁, 44.8 ± 14.3% of predicted [± SD]) with chronic respiratory insufficiency who randomly performed, on 2 consecutive days, a standardized 6-min walking test using two different modalities: a full-weight oxygen canister transported using a small wheeled cart and pulled by the patient (Aid modality) or full-weight oxygen canister carried on the patient's shoulder (No-Aid modality).

Measurements and results

The distance walked, peak effort dyspnea, and leg fatigue scores as primary outcomes, and other cardiorespiratory parameters as secondary outcomes were recorded during both tests. A significant difference (p < 0.05) between the two tests occurred for all the measured outcomes in favor of the Aid modality. Most importantly, significant changes for distance (+ 43 m, p < 0.001), peak effort dyspnea (− 2.0 points, p < 0.001), leg fatigue (− 1.4 points, p < 0.001), as well as for mean and nadir oxygen saturation and heart rate with the Aid modality (but not with the No-Aid modality) were recorded in the subgroup of patients walking < 300 m at baseline.

Conclusions

This study suggests that a simple walking aid may be helpful in COPD patients receiving long-term oxygen therapy, particularly in those with lower residual exercise capacity.

Section snippets

Patients

Consecutive COPD inpatients who were admitted to a comprehensive pulmonary rehabilitation program from January to December 2005 at the hospital facilities of Villa Pineta (Gaiato-MO), IRCCS San Raffaele (Velletri-Roma), and Clinic Center (Napoli) were recruited. The predetermined recruitment of 20 patients per center was finalized.

Eligible patients had to receive LTOT for at least 6 months before enrollment and be in stable condition with no evidence of acute exacerbation or change in

Sample Characteristics

Sixty COPD patients (mean age, 70.6 years) were included in the study. General characteristics of the study sample are shown in Table 1.

On average, patients had normal body mass index values and normal resting arterial oxygenation under correction with appropriate external Fio₂. Thirty-seven patients walked < 300 m during standard 6MWT (No-Aid modality).

6MWT Distance

Table 2 shows the results of the two walking session modalities in the total sample. Overall, distance walked and symptoms (primary outcomes)

Discussion

This study shows that walking with a wheeled cart is able to improve distance, symptoms, and cardiopulmonary parameters in COPD patients receiving LTOT. These results are of particular relevance among the subgroup of patients who are more disabled.

Although there are still not sufficient data in the literature regarding activities in patients receiving LTOT, a randomized controlled trial¹³ has shown that outdoor walking distance improves in patients receiving portable oxygen with respect to

ACKNOWLEDGMENT

The authors gratefully thank Ms. Shirley Ann Woods for editorial assistance.

References (23)

SolwayS et al.
The short-term effect of a rollator on functional exercise capacity among individuals with severe COPD
Chest
(2002)
SolwayS et al.
A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain
Chest
(2001)
GoldsteinRS et al.
Randomized controlled trial of respiratory rehabilitation
Lancet
(1994)
ProbstV et al.
Mechanisms of improvement in exercise capacity using a rollator in patients with COPD
Chest
(2004)
CelliBR
The clinical use of upper extremity exercise
Clin Chest Med
(1994)
BreslinEH et al.
Correlations between dyspnea, diaphragm, and sternomastoid recruitment during inspiratory resistance breathing in normal subjects
Chest
(1990)
EggermontLH et al.
Walking with a rollator and the level of physical intensity in adults 75 years of age or older
Arch Phys Med Rehabil
(2006)
!! Canadian Respiratory Review Panel. (1998) Guidelines for the treatment of chronic obstructive pulmonary disease...
TroostersT et al.
Pulmonary rehabilitation in chronic obstructive pulmonary disease
Am J Respir Crit Care Med
(2005)
HoneymanP et al.
Effect of a walking aid on disability, oxygenation, and breathlessness in patients with chronic airflow limitation
J Cardiopulm Rehabil
(1996)

WesmillerSW et al.

Evaluation of an assistive device for ambulation in oxygen dependent patients with COPD

J Cardiopulm Rehabil

(1994)

Cited by (31)

Management of breathlessness in patients with cancer: ESMO Clinical Practice Guidelines †
2020, ESMO Open
Citation Excerpt :
Mobility aids help to improve both breathlessness and mobility through an increased ventilatory capacity and/or reduced metabolic cost.29 30 Despite the absence of studies in patients with cancer, several randomised crossover studies in breathless patients with COPD demonstrate that use of a rollator improves self-paced walking distance in both indoor31 32 and outdoor environments,33 especially in patients severely limited by breathlessness including those using ambulatory oxygen.34 Using a modern ‘draisine’ (bicycle without pedals) improved indoor walking distance further still, with the same metabolic requirements and breathlessness scores,35 but in outdoor environments with obstacles it had a detrimental effect on mobility compared with unaided walking.33
The impact of carrying supplemental oxygen on exercise capacity and dyspnea in patients with interstitial lung disease
2018, Respiratory Medicine
Citation Excerpt :
The differences we observed in distance covered and dyspnea were not as large as in any of these three studies, but the lung disease was not nearly as severe in our subjects who, on average had mild or mild-moderate ILD (compared with severe or very severe COPD in those studies). In a subgroup analysis [9], Crisafulli and colleagues observed that the most impaired COPD patients appeared to have the most to gain: among the 37 subjects whose baseline walk distance was ≤300 m, dyspnea (4.0 points vs. 6.0 points, p = 0.001) and distance (213 points vs. 256 points, p = 0.001) both improved. In contrast, among the 23 subjects whose walk distance was >300 m, although dyspnea was less when they pulled (versus carried) the trolley, walk distance was not significantly different (pull O2 trolley: 340 m vs. carry O2 trolley: 349 m, p = 0.15) – nor were other parameters, such as nadir SpO2 or drop in SpO2 from baseline.
May patients with interstitial lung disease (ILD) require supplementary oxygen (O₂) therapy to maintain normoxia. However, ambulatory O₂ delivery devices are constraining and cumbersome. The physiologic and symptomatic impact of these devices on ILD patients is unknown.
We conducted a prospective study of 30 clinically stable ILD patients (with varying disease severity), half of whom used O₂ at baseline. Each subject completed two six-minute walk tests (6MWTs); for O₂ users, one walk was completed while wearing a backpack (weight 7.2 pounds) containing a tank with compressed O₂, and for non-users, one walk was completed with a similarly-weighted backpack. For each subject, during the second walk, no backpack was worn; for the second walk, O₂ users received oxygen via a stationary delivery system. For both walks, O₂ non-users wore a portable metabolic system, which measured variables related to respiratory physiology and gas exchange. Borg dyspnea and exertion ratings were recorded after each walk.
Wearing the O₂-containing backpack resulted in decreased distance covered during the 6MWT, and increased dyspnea and perceived exertion among O₂ users. While wearing the weighted backpack, O₂ non-users had a significantly lower peripheral O₂ saturation and distance-saturation product. Compared with carrying O₂ in the backpack, receiving O₂ via the stationary concentrator resulted in the largest improvement in walk distance for the three subjects with greatest impairment at baseline (6MWT ≤ 300 m).
Among ILD patients, carrying portable O₂ versus receiving O₂ via a stationary concentrator results in significantly greater dyspnea and shorter distances covered in timed testing. Patients with the greatest impairment may be affected most. When prescribing O₂, practitioners should alert patients to this effect and help patients decide on the best O₂ delivery mode to meet their needs.
Rehabilitation and supportive therapy in elderly patients with chronic obstructive pulmonary disease
2014, European Journal of Internal Medicine
Citation Excerpt :
The use of wheeled aid walker (e.g. rollator) was proposed to optimize ventilatory capacity and to improve mechanical efficiency of exercise in elderly patients with COPD [82]. Positive gains were obtained in terms of exercise tolerance, dyspnea sensation and leg fatigue on exertion in these patients even when suffering from insufficient gas exchange and chronic hypoxemia [83]. It is likely that this clinical finding may help a substantial reduction of social isolation and a better quality of life when outdoor.
Chronic Obstructive Pulmonary Disease (COPD) very often coexists with cardiovascular, musculoskeletal and metabolic comorbidities. This condition significantly impact on the general health, function, frailty and disability of such patients, and consequently on their prognosis. Indeed, complex and recurrent symptoms of general dysfunction are commonly present and burden on the health status.
Symptomatic COPD patients, even with chronic and complex comorbidities or with different degree of severity, may benefit from rehabilitation including exercise and maintenance of physical activity, in order to reducing symptoms and restoring the highest possible level of independent function.
This review will focus on the associated and relevant clinical problems of these patients at the onset of disability, methods of assessment and useful non-pharmacological treatments for caring and supporting them.
Exercise training modalities and strategies to improve exercise performance in patients with respiratory disease
2014, Revista Portuguesa de Pneumologia
Pulmonary rehabilitation is an evidence-based, multidisciplinary, comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and whose daily living activities are often restricted.
Pulmonary rehabilitation programs are designed to improve the physical and emotional condition of people with chronic respiratory disease and to promote long-term adherence to health-enhancing behavior.
Exercise training is at the core of pulmonary rehabilitation (PR) programs. The benefits of exercise training include decreased dyspnea, improved health-related quality of life, fewer days of hospitalization, and decreased health-care utilization.
To gain PR benefits, patients should be able to complete an exercise training program, preferably with high intensity exercise, and it is likely that these benefits will translate into a change from a pattern of a sedentary lifestyle to a physically active lifestyle.
Chronic respiratory patients, namely COPD patients, have a low exercise tolerance due to multiple factors, such as dynamic hyperinflation and peripheral muscle dysfunction.
In this article, the authors describe a variety of modalities and strategies to overcome exercise limitations and improve the effects of exercise training.
A reabilitação pulmonar é uma intervenção abrangente, multidisciplinar e baseada em evidências, para doentes com doenças respiratórias crónicas que são sintomáticas e cujas actividades da vida diária são frequentemente limitadas.
Os programas de reabilitação pulmonar estão concebidos para melhorar a condição física e emocional de pessoas com doenças respiratórias crónicas e promover a adesão a longo prazo a comportamentos benéficos para a saúde.
O exercício físico está no cerne dos programas de reabilitação pulmonar (RP). Os benefícios do exercício físico incluem redução da dispneia, melhor qualidade de vida em termos de saúde, menos dias de hospitalização, e utilização reduzida dos cuidados de saúde.
Para obter os benefícios da RP, os doentes deverão ser capazes de completar um programa de exercício físico, de preferência com exercícios de alta intensidade, e é provável que esses benefícios se traduzam numa mudança de um padrão de estilo de vida sedentário para um estilo de vida fisicamente activo.
Doentes com doenças respiratórias crónicas, nomeadamente com DPOC, têm uma baixa tolerância ao exercício devido a uma diversidade de factores, como a hiperinsuflação dinâmica e a disfunção muscular periférica.
Neste artigo, os autores descrevem uma variedade de modalidades e estratégias para superar as limitações de exercício e melhorar os efeitos do treino físico.
The effects of a "new" walking aid on exercise performance in patients with COPD: A randomized crossover trial
2012, Chest
Generally, the use of a rollator improves mobility in patients with COPD. Nevertheless, not all patients benefit from its use, and many patients feel embarrassed about using it. Therefore, other walking aids are worthwhile to consider. We compared the direct effects of a “new” ambulation aid (a modern draisine) with the effects of a rollator on 6-min walk distance (6MWD) in patients with COPD.
Twenty-one patients with COPD performed two 6-min walk tests (6MWTs) during prerehabilitation assessment (best 6MWD: 369 ± 88 m). Additionally, two extra 6MWTs were performed on two consecutive days in random order: one time with a rollator and one time with a modern draisine. Walking pattern (n = 21) was determined using an accelerometer, and metabolic requirements (n = 10) were assessed using a mobile oxycon.
Walking with the modern draisine resulted in a higher 6MWD compared with walking with the rollator (466 ± 189 m vs 383 ± 85 m). Moreover, patients had fewer strides (245 ± 61 vs 300 ± 49) and a greater stride length (1.89 ± 0.73 m vs 1.27 ± 0.14 m) using the modern draisine compared with the rollator (all P ≤ .001). Oxygen uptake, ventilation, heart rate, oxygen saturation, and Borg symptom scores were comparable between both walking aids. Ten percent of the patients felt embarrassed using the modern draisine compared with 19% for the rollator, and a significantly smaller proportion of patients would use the modern draisine in daily life.
The mean difference in 6MWD between a modern draisine and a rollator seems clinically relevant, with the same metabolic requirements and symptom Borg scores. Therefore, this “new” ambulation aid could be a good alternative to the rollator to improve functional exercise performance in patients with COPD.
The Netherlands National Trial Registry; No.: NTR1542; URL: www.trialregister.nl
Impact of different types of walking aids on the physiological energy cost during gait for elderly individuals with several pathologies and dependent on a technical aid for walking
2010, Annals of Physical and Rehabilitation Medicine
In elderly individuals balance disorders and muscle weakness can lead to prescribing a walker. There are several different models. According to the very poor effort tolerance in this population, the energy cost necessary to operate walking technical aids should be taken into account when making a choice.
Compare two types of walker in regards to energy cost produced during gait in weakened elderly individuals.
Thirty subjects over the age of 65 (six men and 24 women, mean age 81.9 years) were admitted in geriatrics care. They all required a walker and performed the same 10-m course with a fixed walker, then with a model bearing front wheels. The walking speed (S) was computed, heart rate at rest (HRrest) and maximum heart rate (HRmax) were recorded during the test. The physiological cost index (PCI = HRmax − HRrest/S) was calculated. Finally a timed get-up-and-go (TGUG) test was performed with each of these technical aids.
With a rollator walker, HRmax was lower (P < 0.05) and S higher (P < 0.001). It was 2.01 with a fixed walker versus 1.23 with a rollator walker (P < 0.01). We found this speed difference during the TGUG test (72.26 sec vs. 82.93 sec, P = 0.001).
There are very little studies on the evaluation of physiological energy cost produced during gait with a walker. The characteristics of our population did not allow us to conduct our test without a technical aid. The use of a fixed walker leads to a major increase in gait PCI, probably due to the required repeated efforts for lifting the walker. This model must be avoided in case of cardiac or respiratory disorders.
Les troubles de l’équilibre et la faiblesse musculaire de la personne âgée peuvent conduire à la prescription d’un déambulateur. Il en existe plusieurs modèles. Compte tenu de la mauvaise tolérance à l’effort de cette population, le coût énergétique lié à l’utilisation de l’aide technique de marche devrait entrer en compte dans son choix.
Comparer le coût énergétique de la marche de personnes âgées fragiles avec deux modèles de déambulateur.
Trente sujets de plus de 65 ans (six hommes et 24 femmes, 81,9 âge moyen) admis en soins de suite gériatriques et nécessitant l’utilisation du déambulateur ont réalisé le même parcours de 10 m avec un cadre de marche fixe, puis un modèle avec roulettes antérieures. La vitesse de marche (V) était calculée, les fréquences cardiaques de repos (FCR) et maximales (FCM) étaient enregistrées pendant l’épreuve. L’indice de coût physiologique (ICP = FCM − FCR/V) était calculé. Enfin un timed get up and go test était réalisé avec chacune des aides techniques.
Avec un rollator, la fréquence cardiaque maximale est inférieure (p < 0,05) et la vitesse supérieure (p < 0,001). L’ICP est de 2,01 avec un cadre fixe contre 1,23 avec un cadre à roulette (p < 0,01). On retrouve cette différence de vitesse au get up and go (72,26 seondes contre 82,93 secondes, p = 0,001).
On compte peu de travaux portant sur l’évaluation du coût énergétique de la marche avec déambulateur. Les caractéristiques de notre population ne nous ont pas permis de réaliser une épreuve sans aide technique. L’utilisation du cadre fixe entraîne une élévation importante du coût physiologique du déplacement, sans doute du fait des efforts répétés de soulèvements qu’il nécessite. Ce modèle doit être évité en cas de problèmes cardiaques ou respiratoires.

View all citing articles on Scopus

: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

View full text

Chest

Original ResearchCOPDEffects of a Walking Aid in COPD Patients Receiving Oxygen Therapy

Study objectives

Design

Setting

Patients and interventions

Measurements and results

Conclusions

Section snippets

Patients

Sample Characteristics

6MWT Distance

Discussion

ACKNOWLEDGMENT

Chest

Chest

Lancet

Chest

Clin Chest Med

Chest

Arch Phys Med Rehabil

Pulmonary rehabilitation in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Effect of a walking aid on disability, oxygenation, and breathlessness in patients with chronic airflow limitation

J Cardiopulm Rehabil

Evaluation of an assistive device for ambulation in oxygen dependent patients with COPD

J Cardiopulm Rehabil

Original Research
COPD
Effects of a Walking Aid in COPD Patients Receiving Oxygen Therapy