Efficacy of walking aids on self‐paced outdoor walking in individuals with COPD: A randomized cross‐over trial

Abstract

Background and objective: Walking aids, such as rollator or draisine, improve mobility and functional exercise performance in individuals with chronic obstructive pulmonary disease (COPD) during an indoor 6-min walk test. However, this test does not reflect everyday walking, which is the most frequently reported problematic activity of daily life in individuals with COPD.To date, efficacy of walking aids during selfpaced outdoor walking remains unknown. Therefore, we aimed to determine the efficacy of a rollator and draisine on self-paced outdoor walking in individuals with COPD. Methods: Fifteen individuals with COPD (68% men; age: 63 ± 8 years; forced expiratory volume in 1 s: 40 ± 14% predicted) performed three self-paced outdoor walking tests on two consecutive days: test 1 unaided, and tests 2 and 3 with rollator or draisine in random order. Participants had to walk as long as possible at their own pace. The test ended when participants needed to stop, with a maximum duration of 30 min. Results: The use of rollator resulted in the highest walk distance and time (P < 0.05 vs unaided and draisine). Furthermore, individuals with COPD walked significantly further and longer during an unaided test compared with a draisine aided test (P < 0.05). Moreover, use of draisine resulted in a significantly higher walking speed, fewer strides, greater stride length, and higher step and stride variability (P < 0.05 vs unaided and rollator). Conclusion: To conclude, a rollator improves the selfpaced outdoor walk distance and time in individuals with moderate and advanced COPD and a poor functional exercise capacity, whereas the use of a draisine had a detrimental effect compared with unaided walking.

Management of breathlessness in patients with cancer: ESMO Clinical Practice Guidelines

“…28 Mobility aids 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 indoor 31 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.…”

“…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 All the above studies have been conducted over a short time period and prolonged satisfaction and benefit should not be assumed. If mobility aids are prescribed, a subsequent review is recommended.…”

COPD and exercise: does it make a difference?

“…Dyspnoea is the most disabling symptom for people with COPD and is often the reason that medical attention is sought. Strategies that have been demonstrated to ameliorate dyspnoea, other than participating in supervised exercise training, include adopting a forward-leaning sitting position, pursed lip breathing and the use of a rollator (or four-wheeled walker) to assist with ambulation [ 62 – 64 ]. Together with inspiratory muscle training, these treatments are likely to reduce the sensation of unrewarded inspiration that is perceived as dyspnoea [ 64 ].…”

Year in review 2015: Asthma and chronic obstructive pulmonary disease

“…Although walking aids, such as wheeled walkers, may be used by severely deconditioned COPD patients for mobility independence during exercise testing, there is little formal assessment of their effect on community activities such as outdoor walking. In a novel study, Vaes et al . compared the effect of two‐wheeled mobility devices, the rollator (a four‐wheeled walker) and the draisine (a bicycle without pedals), on self‐paced outdoor walking distance and time in 15 COPD patients with an average age of 63 years.…”