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Scientific Review

Clinical and Physiological Effects of Rollators in Individuals With Chronic Obstructive Pulmonary Disease


Lee, Annemarie L. PhD, MPhysio; Beauchamp, Marla K. PhD, MSc(PT); Goldstein, Roger S. MB, ChB, FRCP(UK), FRCP(C); Brooks, Dina PhD, MSc, BSc(PT)

Author Information
Journal of Cardiopulmonary Rehabilitation and Prevention: November 2018 - Volume 38 - Issue 6 - p 366-373
doi: 10.1097/HCR.0000000000000280

Rollators are often prescribed for individuals with chronic obstructive pulmonary disease (COPD).1,2 They consist of a frame with handles, a seat, a hand brake, and 3 or 4 wheels.1,2 The rationale for the use of a rollator is to reduce exertional dyspnea during exercise and physical activity.3,4 The underlying mechanism for symptom relief is multifactorial. A forward leaning position stabilizes the upper limb and the rib cage, thereby assisting the accessory respiratory muscles5 as well as reducing work by transferring a portion of the body weight to the rollator.6–8 An increase in maximal voluntary ventilation (MVV) has been described in individuals with COPD when bracing their arms on a rollator, with the hypothesis that this posture improves ventilatory capacity.5,9 In some studies, rollators increased stride length, which improved walking efficiency,10,11 whereas others have noted a reduction in gait speed.12 In the elderly, rollators have been prescribed to improve balance and assist ambulation, with reports of an increased perception of safety,13 especially in the presence of comorbidities such as osteoarthritis or obesity.2,14 Daily use of a rollator, principally for outdoor use, has been reported in 59% of individuals with COPD for whom it was prescribed and assists outdoor walking in those with ambulatory oxygen therapy.15

In COPD, patients are frequently prescribed overground walking exercise (supervised and unsupervised) and undertake field walking tests as a measure of their exercise tolerance, with rollators often used during these activities.16 The effect of rollator use during a field walking test on walking distance and symptoms of dyspnea and fatigue is variable, with several studies reporting improvement3,4,17 but not all studies.11 Increased gait efficiency has also been noted in some11 but not all studies.18 Current indicators for rollator prescription include the need for rests during a field walking test, habitual use of arm bracing during a walking test, supervised walking training, or reports of less dyspnea or achieving an increased walking distance using this aid.19 Given many different indications for rollator use, there is a need to determine the short- and longer-term effects of rollators in individuals with COPD. The aim of this study was to systematically review the effects of rollators in COPD on (1) exercise capacity, (2) symptoms, and (3) health-related quality of life (HRQOL), as well as to comment on any reported physiological changes and the frequency of use. This review was registered with the international database of prospectively registered systematic reviews (PROSPERO; number CRD42016041397) and was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.20



The primary search strategy used the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PubMed, Cochrane Database of Systematic Reviews, and Physiotherapy Evidence Database (PEDro) electronic databases from inception to November 2015, with an updated search in August 2016. The key terms were “COPD/chronic obstructive disease, pulmonary obstructive lung disease,” “rollator/wheeled rollator/wheeled walker,” “exercise capacity/peak exercise capacity/walking distance, gait parameters, health-related quality of life/quality of life, dyspnea/breathlessness, fatigue, physical activity.” The search strategy used for MEDLINE is shown in Appendix 1 (see Supplemental Digital Content 1, available at: and was adapted for use in the other databases. Secondary searches involved hand-searching reference lists from identified articles, citation tracking of included articles, and use of the PubMed-related articles option.


Two investigators reviewed titles and abstracts independently, and potentially relevant articles were identified and retrieved in full text for independent assessment using the inclusion criteria. Inclusion criteria are outlined in Table 1. Any disagreements were resolved by consensus. Abstracts were included if sufficient data could be obtained.

Table 1 - Inclusion Criteria
Participants Diagnosis of COPD (Physician-based and/or lung function), stable state or acute exacerbation
Intervention Rollator with a frame and either 3 or 4 wheels
Comparison Randomized controlled or randomized crossover trials comparing use of a rollator with no aid
Outcomes Exercise capacity (6MWT, ISWT, ESWT, peak exercise capacity); walking distance; cardiovascular parameters (HR, BP, Spo 2); respiratory parameters (TV, MVV, o 2max, RR); gait parameters (walking speed, stride length); measure of physical activity (steps per day); HRQOL (SGRQ, CRQ, SF-36); symptoms (dyspnea, fatigue) and functional measures; frequency of use
Abbreviations: BP, blood pressure; COPD, chronic obstructive pulmonary disease; CRQ, Chronic Respiratory Disease Questionnaire; ESWT, Endurance Shuttle Walk Test; HR, heart rate; HRQOL, health-related quality of life; ISWT, Incremental Shuttle Walk test; MVV, maximum voluntary ventilation; RR, respiratory rate; Spo2, oxygen saturation; SGRQ, St George's Respiratory Questionnaire; SF-36, Short-form 36 questionnaire; TV, tidal volume; o2max, peak oxygen uptake; 6MWT, 6-Minute Walk Test.


Two investigators independently assessed the internal validity of the randomized controlled and crossover studies using the Cochrane Risk of Bias tool.21 Data extraction was performed by one investigator using a standardized template, with data checked by a second investigator. Authors of one included study were contacted and responded to provide additional information.19


Meta-analysis was planned for ≥2 studies considered clinically homogenous (similar model of intervention and outcome tools).22 Data were entered using the Review Manager 5.3 computer program (Cochrane Collaboration Information Management System), with outcomes treated as continuous variables. Data reported as mean ±SE or mean ± SD were pooled; data reported as median (interquartile range) were not able to be pooled. For crossover trials, data were analyzed using mean difference, with SE of the difference calculated from the P value or t-statistic.23,24 Weighted mean difference (same metric scale) using a fixed-effects model was selected when estimating the total effect of pooled data for a given follow-up period, with generic inverse variance used for analysis.24 Forest plots were generated to depict results, and heterogeneity was tested according to the overlap in confidence intervals (CIs), interpretation of the χ2 test, and the I2 statistic, with substantial heterogeneity represented by I2 > 50%.24 For meta-analyses, authors of included studies were contacted for additional information where necessary. When study findings could not be combined, a narrative format was used to report results.


An initial search and secondary searches yielded 31 articles, following removal of duplicates. After independent review by 2 researchers, 7 studies, 2 randomized controlled trials,3,19 and 5 crossover trials4,11,25–27 of rollator use met the inclusion criteria (Figure 1). Overall, 124 clinically stable individuals with COPD were included. Two studies reported different information from the same participants.3,4 Two studies explored the impact of integrating rollator use into daily activities over 4 wk19 and 8 wk.3 One study prescribed the rollator in those who had recently completed pulmonary rehabilitation (PR) and were previously naive to rollator use and had a 6-min walk distance (6MWD) of <375 m.3 The second study prescribed a rollator following completion of pulmonary rehabilitation for use during the following tasks: walking activities at home, walking within the home, walking outside, getting to and from the car, walking indoors in a location other than home, and other activities outside the home.19 For use during exercise testing, 4 studies compared the effects of using a rollator with no aid during a 6-Minute Walk Test (6MWT),4,11,25,26 with protocols originating from different sources28–30 and one study explored the immediate effects during a 12-min walk test (12MWT).27 Characteristics of included studies are outlined in Table 2.

Figure 1.
Figure 1.:
Flowchart of the process of a systematic review. Abbreviation: COPD, chronic obstructive pulmonary disease.
Table 2 - Characteristics of Included Studies
Article Study Design n (%) Male/Age, Mean ± SD, y FEV1, L, or % Predicted Circumstances of Rollator Use Intervention Group Control Group
Use of rollator during field walking test
Wesmiller and Hoffman (1994)27 RCX 12 (100)/63 ± 4 0.94 L 12MWT Rollator No aid
Honeyman et al (1996)26 RCX 11 (NR)/71 ± 6 0.71 L 6MWT Rollator No aid
Solway et al (2002)25 RCX 40 (53)/68 ± 1.2 36% predicted 6MWT Rollator No aid
Probst et al (2004)11 RCX 14 (64)/70 ± NRa 45% predicted 6MWT Rollator No aid
Gupta et al (2006)4 RCT 31 (42)/68 ± 8 30 to 36% predicted 6MWT Rollator No aid
Extended rollator use in the community
Gupta et al (2006)3 RCT 31 (42)/68 ± 8 30 to 36% predicted Rollator integrated into daily activities at home (8 wk) Rollator No aid
Ng (2012)31 RCX 19 (58)/72 ± 8 38% predicted Use of the rollator during daily activities involving walking and exercise at home and during maintenance exercise programs Rollator No aid
Abbreviations: FEV1, forced expiratory volume in the first second of expiration; NR, not reported; RCT, randomized controlled trial; RCX, randomized crossover trial; 6MWT, 6-min walk test; 12MWT, 12-min walk test.
aAge data reported as median value.

The quality assessment for each study is presented in Table 3. There was a high risk of bias with participants, with only 2 studies including a blinded assessor.3,4 Randomization sequence was adequately described in 2 studies,19,25 although allocation concealment was largely unclear. All studies included a complete reporting of results.

Table 3 - Risk of Bias Assessment
Study Randomization Sequence Allocation Concealment Blinding Incomplete Data Selective Reporting Other Biases
Participants Therapists Outcome Assessors
Use of rollator during field walking tests
Wesmiller and Hoffman (1994)27 Unclear Unclear High High High Low Low NR
Honeyman et al (1996)26 Unclear Unclear High High High Low Low NR
Solway et al (2002)25 Low Unclear High High Unclear Low Low NR
Probst et al (2004)11 Unclear Unclear High High High Low Low NR
Gupta et al (2006)4 Unclear Unclear Unclear High Low Low Low NR
Extended rollator use in the community
Gupta et al (2006)3 Unclear Unclear High Unclear Low Low Low NR
Ng (2014)19 Low Unclear Unclear Unclear Unclear Low Low NR
Abbreviation: NR, not reported.


Meta-analysis of 3 studies showed that a rollator increased the 6MWD by 13 m (95% CI, 5-22) (Figure 2). Similar findings with a median improvement of 46 m (P = .04) were reported by Probst et al.11 In contrast, there was no significant improvement in 12-min walking distance with a rollator27 (Table 4). Those with a 6MWD of <300 m had a significant improvement with a rollator compared with no aid (mean difference = 22.2; P =.02), but use of a rollator in those with a 6MWD of >300 m had no significant effect (mean difference = −9.9 m; P = .1).25

Figure 2.
Figure 2.:
Forest plot comparing rollator use versus no walking aid on 6MWD and dyspnea levels at end-6MWT. Abbreviations: 6MWD, 6-min walk distance; 6MWT, 6-Minute Walk Test.
Table 4 - Outcome Measures and Differences Between Groups
Study Follow-up Period Outcome Measures Between Group Differences
Use of rollators during field walking tests
Wesmiller and Hoffman (1994)27 Immediately post-12MWT 12MWD, m No significant difference in walking distance with a rollator (434.6 m vs control 388.3 m, P = NS)
Honeyman et al (1996)26 Immediately post-6MWT 6MWD, m; Spo 2, %; Borg rating of dyspnea at completion of the 6MWT Significant increase in 6MWD with a rollator compared with no aid (259 m vs 226 m, P < .005)
Reduced dyspnea at the conclusion of the 6MWT with a rollator compared with no aid (4.7 vs 3.4, P < .005); less desaturation with a rollator (5% vs 7.2%, P < .05)
Solway et al (2002)25 Immediately post-6MWT 6MWD, m; Borg rating of dyspnea at completion of the 6MWT; Spo 2,%; HR, beats/min; RR, breaths/min; stride length; walking speed, m/min No significant difference in 6MWD with a rollator (P = .30); those with 6MWD <300 m had a significant improvement in walking distance with a rollator (242.5 m) vs no aid (220.3 m) (P = .02), whereas those with 6MWD >300 m had no change in their walking distance with a rollator (384.4 m) vs no aid (394.3 m) (P = .1)
Reduced dyspnea at end-6MWT with a rollator compared with no aid (2.7 vs 1.8, P < .001); significantly less dyspnea in both those with 6MWD <300 m (Borg scale dyspnea 1.8 points with a rollator vs 3.2 with no aid, P < .001) and those with 6MWD >300 m (with a rollator 1.7 points vs 2.2 with no aid, P = .03)
Lower HR with a rollator (102 vs 106, P = .02) but no difference in oxygen desaturation or RR; no difference between those with 6MWD >300 m or <300 m
Reduced walking speed with a rollator (54.4 vs 56.1 m/min, P = .007), no difference in stride length; no difference between subgroups of those with 6MWD >300 m compared with those who walked <300 m
Probst et al (2004)11 Immediately post-6MWT 6MWD, m; walking speed, m/sec; o 2peak, L/min; TV, L; MVV, L/min; RR, breaths/min; Spo 2, %; HR, beats/min; Borg rating of dyspnea at completion of the 6MWT Significant increase in 6MWD with a rollator = 462 m (424, 477)a vs no aid = 416 m (396, 435)a
Higher walking speed with a rollator = 1.28 m/sec (1.17, 1.32)a vs no aid = 1.15 m/sec (1.1, 1.2)a
Significant increase in o 2peak with a rollator = 0.9 L/min (0.65, 1.2)a vs no aid = 1.0 L/min (0.85, 1.25)a; TV = 0.98 L (0.92, 1.43) vs no aid = 0.92 L (0.81, 1.37)a and MVV = 60 L/min (36, 65)a vs no aid = 55 L/min (36, 65)a
No difference in Spo 2, HR, RR, dyspnea, or fatigue between conditions
Gupta et al (2006)4 Immediately post-6MWT 6MWD, m; Borg rating of dyspnea at completion of the 6MWT Significant increase in 6WMD with a rollator compared with no aid (292 m vs 263 m)
Reduced dyspnea at the conclusion of the 6MWT with a rollator compared with no aid (3.7 vs 4.6)
Extended rollator use in the community
Gupta et al (2006)3 4 wk; 8 wk CRQ; 6MWD Nonsignificant increase in 6MWD with a rollator at 4 wk (296 m vs 275 m) and 8 wk (283 m vs 259 m) (P = .5)
Nonsignificant reduction in dyspnea with a rollator at 4 wk (4.0 vs 4.5) and 8 wk (3.7 vs 4.4)
Ng (2012)31 4 wk CRQ; PA No difference in domains of the CRQ (dyspnea, fatigue, emotional function, or mastery) between groups
Increase in numbers of daily steps with a rollator (mean difference = 732; 95% CI, 139-1325)
Significant increase in time spent doing moderate-intensity activity (mean difference = 9 min; 95% CI, 1-17) with a rollator
No difference in the amount of time spent walking with a rollator vs control (mean difference = 7 min; 95% CI, −1 to 16); no difference in the amount of time spent standing, sitting, or lying between groups
Abbreviations: CRQ, Chronic Respiratory Disease Questionnaire; HR, heart rate; MVV, maximal voluntary ventilation; NS, nonsignificant; PA, physical activity; RR, respiratory rate; Spo2, peripheral oxygen saturation; TV, tidal volume; o2peak, peak oxygen uptake; 6MWD, 6-min walk distance; 6MWT, 6-Minute Walk Test; 12MWD, 12-min walk distance; 12MWT, 12-Minute Walk Test.
aData reported as median (interquartile range).

Effect on symptoms of dyspnea and fatigue

Meta-analysis of data from 3 pooled studies4,25,26 showed that rollator use was associated with a lower Borg dyspnea score at the end of the 6MWT with a mean difference of 0.97 (95% CI, 0.63-1.32) (Figure 2). Rollator use reduced dyspnea in those with a 6MWD of <300 m (mean difference = 1.4; P <.001) and a 6MWD of >300 m (mean difference = 0.5 points; P = .03).25 There were no reports on fatigue or rating of perceived exertion with rollator using during field walking tests.

Cardiorespiratory parameters

One study noted that short-term rollator use was associated with an increased peak oxygen uptake11 and an increased ventilatory capacity, tidal volume, and MVV. Rollator use in this study resulted in a faster walking speed of 76.8 m/min.11 Another study noted a lower heart rate (HR) during the 6MWT, with walking speed of 54.4 m/min.25 Rollator use reduced oxygen desaturation in 1 study26 and had no effect in 2 others.11,25

Gait parameters

Walking speed was reduced in one study25 and increased in another11 (Table 4), with no changes in stride length being observed.


Effects of rollator on functional exercise and symptoms

Only one study reported on functional exercise capacity. Although it was greater with a rollator after 4 and 8 wk, this difference was not significant.3 After 8 wk of use, dyspnea scores at end-6MWT remained less with a rollator than with no aid3 (Table 4).

Effect on HRQOL

Two studies explored the effect of using a rollator within the community upon HRQOL according to the Chronic Respiratory Disease Questionnaire.3,19 Data were pooled for the domains of dyspnea, fatigue, emotional function, and mastery (Figure 3). Use of a rollator did not affect any of these domains of HRQOL compared with no aid after 4 or 8 wk.

Figure 3.
Figure 3.:
Forest plot of comparison of 4 wk of rollator use versus no rollator use on Chronic Respiratory Disease Questionnaire Dyspnea, Fatigue, Emotional function, and Mastery in COPD. Abbreviations: COPD, chronic obstructive pulmonary disease; SE, standard error.

Physical activity

Only one study examined the effect of a rollator use on physical activity.19 Its use increased the number of daily steps compared with no aid (mean difference = 732 steps; 95% CI, 139-1325). It also increased the amount of time undertaking moderate-intensity physical activity (9 min; 95% CI, 1-17).19 There was no difference in the amount of time spent walking (Table 4).

Frequency of use

One study separated frequent (minimum use of 3 times per week) from infrequent rollator users.3 Duration of use was 25 to 60 d among 10 frequent users (n = 10) and 5 to 15 d among 8 infrequent users. Frequent users had higher levels of mastery and lower levels of fatigue over the 8 wk than infrequent users.


When used in the short-term, rollators increased 6MWD and reduced dyspnea. Lack of daily use, with 44% of participants using a rollator <3 times per week,3 limits meaningful conclusions regarding its effect on exercise capacity or HRQOL over the longer-term. The effects of rollator use on HR, oxygenation, respiratory rate, and walking speed were variable.

Improvements in mastery and fatigue have been reported among both indoor and outdoor users,3,15 as have increased confidence and greater stability when walking among both frequent and infrequent users.3 However, the studies included in this review evaluating the long-term effects were influenced by actual rather than recommended use. The infrequent practice in one study may account for the lack of a positive effect on exercise capacity or HRQOL.3 Although the second study had a documented frequency of 3 times per wk, the time frame (4 wk) may be too short to realize the benefits.19 Alternatively, difficulty in transferring a rollator to and from a car19 and a limited ability to use indoors at home due to space constraints15 may have imposed some barriers to regular practice.

In contrast, rollator use ≥3 times per week, improved the time spent in moderate-intensity physical activity.19 This change is likely to be attributable to an increased pace of walking rather than a change in stride length.31 The extent of functional limitation due to dyspnea may also be important, with patients designated Modified Medical Research Council (MMRC) class ≥3 experiencing a greater increase in their number of steps per day than those at MMRC class 2.19 In addition to the benefits achieved by the adopted forward leaning posture, being equipped with a seat promotes more opportunities for rests and recovery of symptoms. Despite this, the lack of change in time spent walking suggests that although fear was reduced,19 the rollator does not empower individuals to be more active. However, a rollator may be a useful training adjunct to walking training in clinical practice, enabling those with marked functional limitation an opportunity to increase their walking pace and gain clinical benefit.

When used during a field walking test (6MWT), rollators significantly improved functional exercise capacity by an amount approaching the minimal clinically important difference (MCID) of 25 m suggested for COPD, while the reduction in dyspnea on exertion did reach the MCID for all participants.32,33 This effect was greater in those with baseline walking distances below 300 m,25 while the reduction in dyspnea on exertion did reach the MCID in all participants.33 The need to rest during an unaided 6MWT was predictive of an improved 6MWD and reduced perception of dyspnea when a rollator was used.25 These observations may help inform the decision whether to prescribe a rollator for an individual with COPD and substantial limitations in functional ability.

The exact mechanism beyond the reduction in dyspnea is unclear, with respiratory physiological effects ranging from an increased oxidative capacity and improved ventilation11 to variable effects on oxygenation11,25,26 to no effect on HR or respiratory rate.11,25 The favorable length-tension relationship of the diaphragm may reduce the work of breathing5,25,26 and may account for reduced dyspnea. However, this has not translated into improvements in oxygenation or breathing rate, which have been previously observed.18 In studies including patients of a similar FEV1% (percent forced expiratory volume in the first second of expiration) predicted, the degree of airflow limitation is unlikely to be the reason. Although only one study commented on the occurrence of rests during the test and their duration, the slower walking speed and lower HR lend support that resting during a 6MWT is another possible explanation.25

The effects of a rollator on walking speed were inconsistent11,25 despite studies using similar standardized protocols for the 6MWT. It might be because the improvement in walking associated with the forward lean position might be offset by the increased work associated with pushing the rollator on all but smooth surfaces.6,7,9,13 It may be influenced by the occurrence of rests during a 6MWT, with one study noting rest periods.25


The review was limited by the limited information related to adherence to the rollator prescription even among those identified as frequent users.3 Greater consistencies in reporting prescription adherence among future studies will further enhance interpretation of the clinical effects of using a rollator over the short- and long-term. Information on randomization and concealment was limited, which might have encouraged a risk of bias. Only one study evaluated the important outcome of rollator use on step count and moderate-intensity physical activity.


Short-term use of a rollator improves walking distance and reduces dyspnea. There is insufficient information on rollator adherence to draw conclusions regarding its longer-term impact on exercise capacity or HRQOL. The impact of rollator use on daily activity levels remains to be explored.


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chronic obstructive pulmonary disease; exercise capacity; health-related quality of life; rollators

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