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Effects of downhill walking in pulmonary rehabilitation for patients with COPD : a randomised controlled trial

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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.
Keywords
Pulmonary and Respiratory Medicine, MUSCLE STRENGTH, ENERGY-COST, EXERCISE, RESPONSES, POSITION, FATIGUE, TESTS, LOAD

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MLA
Camillo, Carlos Augusto, et al. “Effects of Downhill Walking in Pulmonary Rehabilitation for Patients with COPD : A Randomised Controlled Trial.” EUROPEAN RESPIRATORY JOURNAL, vol. 56, no. 3, 2020, doi:10.1183/13993003.00639-2020.
APA
Camillo, C. A., Osadnik, C. R., Burtin, C., Everaerts, S., Hornikx, M., Demeyer, H., … Troosters, T. (2020). Effects of downhill walking in pulmonary rehabilitation for patients with COPD : a randomised controlled trial. EUROPEAN RESPIRATORY JOURNAL, 56(3). https://doi.org/10.1183/13993003.00639-2020
Chicago author-date
Camillo, Carlos Augusto, Christian Robert Osadnik, Chris Burtin, Stephanie Everaerts, Miek Hornikx, Heleen Demeyer, Matthias Loeckx, et al. 2020. “Effects of Downhill Walking in Pulmonary Rehabilitation for Patients with COPD : A Randomised Controlled Trial.” EUROPEAN RESPIRATORY JOURNAL 56 (3). https://doi.org/10.1183/13993003.00639-2020.
Chicago author-date (all authors)
Camillo, Carlos Augusto, Christian Robert Osadnik, Chris Burtin, Stephanie Everaerts, Miek Hornikx, Heleen Demeyer, Matthias Loeckx, Fernanda Machado Rodrigues, Karen Maes, Ghislaine Gayan-Ramirez, Wim Janssens, and Thierry Troosters. 2020. “Effects of Downhill Walking in Pulmonary Rehabilitation for Patients with COPD : A Randomised Controlled Trial.” EUROPEAN RESPIRATORY JOURNAL 56 (3). doi:10.1183/13993003.00639-2020.
Vancouver
1.
Camillo CA, Osadnik CR, Burtin C, Everaerts S, Hornikx M, Demeyer H, et al. Effects of downhill walking in pulmonary rehabilitation for patients with COPD : a randomised controlled trial. EUROPEAN RESPIRATORY JOURNAL. 2020;56(3).
IEEE
[1]
C. A. Camillo et al., “Effects of downhill walking in pulmonary rehabilitation for patients with COPD : a randomised controlled trial,” EUROPEAN RESPIRATORY JOURNAL, vol. 56, no. 3, 2020.
@article{8663319,
  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.},
  articleno    = {2000639},
  author       = {Camillo, Carlos Augusto and Osadnik, Christian Robert and Burtin, Chris and Everaerts, Stephanie and Hornikx, Miek and Demeyer, Heleen and Loeckx, Matthias and Rodrigues, Fernanda Machado and Maes, Karen and Gayan-Ramirez, Ghislaine and Janssens, Wim and Troosters, Thierry},
  issn         = {0903-1936},
  journal      = {EUROPEAN RESPIRATORY JOURNAL},
  keywords     = {Pulmonary and Respiratory Medicine,MUSCLE STRENGTH,ENERGY-COST,EXERCISE,RESPONSES,POSITION,FATIGUE,TESTS,LOAD},
  language     = {eng},
  number       = {3},
  pages        = {12},
  title        = {Effects of downhill walking in pulmonary rehabilitation for patients with COPD : a randomised controlled trial},
  url          = {http://dx.doi.org/10.1183/13993003.00639-2020},
  volume       = {56},
  year         = {2020},
}

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