Effects of downhill walking in pulmonary rehabilitation for patients with COPD: a randomised controlled trial
Carlos Augusto Camillo, Christian Robert Osadnik, Chris Burtin, Stephanie Everaerts, Miek Hornikx, Heleen Demeyer, Matthias Loeckx, Fernanda Machado Rodrigues, Karen Maes, Ghislaine Gayan-Ramirez, Wim Janssens, Thierry Troosters, Carlos Augusto Camillo, Christian Robert Osadnik, Chris Burtin, Stephanie Everaerts, Miek Hornikx, Heleen Demeyer, Matthias Loeckx, Fernanda Machado Rodrigues, Karen Maes, Ghislaine Gayan-Ramirez, Wim Janssens, Thierry Troosters
Abstract
The development of contractile muscle fatigue (CMF) affects training responses in patients with chronic obstructive pulmonary disease (COPD). Downhill walking induces CMF with lower dyspnoea and fatigue than level walking. This study compared the effect of pulmonary rehabilitation (PR) comprising downhill walking training (DT) to PR comprising level walking (conventional training (CT)) in patients with COPD.In this randomised controlled trial, 35 patients (62±8 years; forced expiratory volume in 1 s (FEV1) 50±17% predicted) were randomised to DT or CT. Exercise tolerance (6-minute walk test distance (6MWD); primary outcome), muscle function, symptoms, quality-of-life and physical activity levels were assessed before and after PR. Absolute training changes and the proportion of patients exceeding the 30 m 6MWD minimally important difference (MID) were compared between groups. Quadriceps muscle biopsies were collected after PR in a subset of patients to examine physiological responses to long-term eccentric training.No between-group differences were observed in absolute 6MWD improvement (mean 6MWD change 77±46 m DT versus 56±47 m CT; p=0.45), however 94% of patients in DT exceeded the 6MWD MID compared to 65% in CT (p=0.03). Patients in DT tended to have larger improvements than CT in other outcomes. Muscle biopsy analyses did not differ between groups.PR incorporating downhill walking confers similar magnitudes of effects to PR with conventional walking across clinical outcomes in patients with COPD, however, offers a more reliable stimulus to maximise the achievement of clinically relevant gains in functional exercise tolerance in people with COPD.
Trial registration: ClinicalTrials.gov NCT02113748.
Conflict of interest statement
Conflict of interest: C.A. Camillo has nothing to disclose. Conflict of interest: C.R. Osadnik has nothing to disclose. Conflict of interest: C. Burtin has nothing to disclose. Conflict of interest: S. Everaerts has nothing to disclose. Conflict of interest: M. Hornikx has nothing to disclose. Conflict of interest: H. Demeyer has nothing to disclose. Conflict of interest: M. Loeckx has nothing to disclose. Conflict of interest: F.M. Rodrigues has nothing to disclose. Conflict of interest: K. Maes has nothing to disclose. Conflict of interest: G. Gayan-Ramirez has nothing to disclose. Conflict of interest: W. Janssens reports grants and personal fees from Boehringer Ingelheim, AstraZeneca, GSK and Chiesi, outside the submitted work; and is senior clinical researcher of FWO co-founder of ArtiQ. Conflict of interest: T. Troosters has nothing to disclose.
Copyright ©ERS 2020.
Source: PubMed