Pulmonary Rehabilitation Increases Gait Speed in Patients With Chronic Lung Diseases

Abstract

Introduction:Gait speed provides an integrated index of physical performance; changes in gait speed could reflect deterioration in the underlying medical disorder or a response to medical/surgical interventions. Slower gait speeds reflect the overall level of impairment, especially in patients with chronic lung disease.Methods:We retrospectively reviewed the medical files of 119 patients who completed the pulmonary rehabilitation program at the University Medical Center in Lubbock, Texas, and collected demographic, pulmonary function, and 6-minute walk test information. Gait speed was calculated using the 6-minute walk test information.Results:The patients in this study had a mean age of 68.8 ± 10.1 years. Most patients (95) had chronic obstructive pulmonary disease/asthma. The mean forced expiratory volume in the first second of expiration (FEV1) was 1.3 ± 0.7 L (47.2% ± 19.7% predicted). The baseline gait speed was 41 ± 15 m/min before rehabilitation and 47 ± 15 m/min after rehabilitation. Baseline gait speed, body mass index, and FEV1 predicted postrehabilitation gait speed (P < .05 for each variable). Ten patients had a gait speed >60 m/min before rehabilitation; this number increased to 29 postrehabilitation. Using multivariable analysis, it was found that only the baseline gait speed predicted a speed of more than 60 m/min postrehabilitation. Seventy-four patients had an increase in 6-minute walk distance of greater than 30 m.Conclusions:Patients with chronic lung diseases have slow gait speeds. Most patients improve their speed with rehabilitation but do not increase their speed above 60 m/min and remain frail by this criterion. However, the majority of patients increase their walk distance by 30 m, a distance that represents a minimal clinically important distance.

<p>Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review</p>

“…Of four randomised trials, three tested the effectiveness of exercise-based interventions (a hospital-based pedal exercise intervention, 45 pulmonary rehabilitation with or without electrical muscle stimulation, 46 and home-based pulmonary rehabilitation 47 ); one trial tested whether the severity of respiratory disability affected outcomes of centre-or homebased pulmonary rehabilitation. 48 Of 12 cohort studies, most assessed the impact of pulmonary rehabilitation on frailty or frailty components, [49][50][51][52][53][54] three assessed the feasibility or outcomes of geriatric rehabilitation, [55][56][57] and three assessed how baseline characteristics (e.g. dyspnoea severity, exercise tolerance, frailty) affect pulmonary rehabilitation outcomes.…”

“…To maximise outcomes of exercise-based interventions, authors suggested being inclusive of people with lower baseline scores and high potential for improvements. 51,58,66 However, an inclusive stance needed to be balanced with evidence that low exercise tolerance or severe breathlessness can hinder benefit in some circumstances. 48,59 Professional stakeholders acknowledged tensions between lower baseline abilities and judging potential to benefit from services like outpatient pulmonary rehabilitation, especially when completion rates are used as a measure of service "quality".…”

Is it possible to reverse frailty in patients with chronic obstructive pulmonary disease?

“…This means that gait speed increased by at least 0.17 m/s, which is greater than the minimum clinical difference of 0.11 m/s in gait speed for 4MGS ( 56 ). There are also a small number of patients with COPD whose gait speed increases less than the minimum clinical difference value after PR; however, this does not prevent patients from benefiting from PR because it may improve survival outcomes ( 56 , 57 ). In short, these frail COPD patients can benefit from a comprehensive PR program that includes walking as an exercise.…”

Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD

“…Gait assessment may be of clinical value as gait abnormalities have been reported in patients with COPD, including reduced cadence, reduced stride length and increased double support time as compared to healthy subjects [3,4,5,6,7]. Though PR has proven to increase gait speed in patients with COPD [39], a comprehensive analysis of gait characteristics after PR is lacking. In the current study, patients with COPD improved their walk distance during the GRAIL-based 6MWT after PR, which also reached a clinically significant improvement [26].…”