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People With COPD Who Respond to Ground-Based Walking Training Are Characterized by Lower Pre-training Exercise Capacity and Better Lung Function and Have Greater Progression in Walking Training Distance

Ho, Jian Ping BSc (Physiotherapy); Alison, Jennifer A. PhD; Ng, L. W. Cindy PhD; Wootton, Sally L. PhD; McKeough, Zoe J. PhD; Jenkins, Sue C. PhD; Eastwood, Peter R. PhD; Hillman, David R. MBBS; Jenkins, Christine PhD; Spencer, Lissa M. PhD; Cavalheri, Vinicius PhD; Hill, Kylie PhD, BSc

Journal of Cardiopulmonary Rehabilitation and Prevention: September 2019 - Volume 39 - Issue 5 - p 338–343
doi: 10.1097/HCR.0000000000000421
Pulmonary Rehabilitation
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Purpose: To investigate the characteristics that distinguish responders from nonresponders to ground-based walking training (GBWT) in people with chronic obstructive pulmonary disease (COPD).

Methods: An analysis was undertaken of data collected during a trial of GBWT in people with COPD. Responders to GBWT were defined in 2 ways: (1) improved time on the endurance shuttle walk test of ≥190 sec (criterion A); or (2) improved ability to walk, perceived by the participant to be at least “moderate” (criterion B). Differences in participant characteristics, pre-training exercise capacity, health-related quality of life, and the improvement in the distance walked during the training program were examined between responders and nonresponders.

Results: Of the 95 participants randomized to GBWT (age 69 ± 8 yr, forced expiratory volume in 1 sec [FEV1] % predicted = 43% ± 15%), data were available for analysis on 78 and 73 patients by criterion A and criterion B, respectively. According to criterion A, 32 (41%) participants were responders. The odds of being a responder increased with increasing FEV1 % predicted (OR = 1.2; 95% CI, 1.0-1.5, for every 5% increase) and increased with decreasing pre-training incremental shuttle walk distance (OR = 1.4; 95% CI, 1.0-1.8, for every 50-m decrement). According to criterion B, 42 (58%) participants were responders. There were no differences in characteristics or pre-training measures between the responders and nonresponders. For both criteria, responders demonstrated greater change in the distance walked during the training program (P < .05).

Conclusion: Responders to GBWT had lower pre-training exercise capacity, had better lung function, and demonstrated greater change in the distance walked during the training program.

This study investigated the characteristics of responders and nonresponders to ground-based walking training (GBWT) in people with chronic obstructive pulmonary disease. Responders to GBWT were characterized by having a lower pre-training exercise capacity and less airflow obstruction and demonstrated greater change in the walking distance during the training program.

School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Western Australia, Australia (Ms Ho and Drs Jenkins, Eastwood, Cavalheri, and Hill); Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia (Drs Alison, Wootton, and McKeough); Sydney Local Health District, New South Wales, Australia (Drs Alison and Spencer); Physiotherapy Department, Singapore General Hospital, Singapore (Dr Ng); Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, New South Wales, Australia (Dr Wootton); Institute for Respiratory Health (Drs Jenkins, Eastwood, Cavalheri, and Hill), Physiotherapy Department (Dr Jenkins), and Department of Pulmonary Physiology & Sleep Medicine (Drs Eastwood and Hillman), Sir Charles Gairdner Hospital, Western Australia, Australia; Centre for Sleep Science, School of Anatomy, Physiology & Human Biology, University of Western Australia, Western Australia, Australia (Dr Eastwood); and Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia (Dr Jenkins).

Correspondence: Jennifer A. Alison, PhD, Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW 2141, Australia (jennifer.alison@sydney.edu.au).

All authors declare no conflicts of interest.

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