Original article
Rollator Use Does Not Consistently Change the Metabolic Cost of Walking in People With Chronic Obstructive Pulmonary Disease

Presented to the European Respiratory Society, September 24-28, 2011, Amsterdam, The Netherlands.
https://doi.org/10.1016/j.apmr.2012.01.009Get rights and content

Abstract

Hill K, Dolmage TE, Woon LJ, Brooks D, Goldstein RS. Rollator use does not consistently change the metabolic cost of walking in people with chronic obstructive pulmonary disease.

Objectives

To (1) evaluate whether the use of a rollator changed metabolic cost during a controlled walking task, and (2) explore relationships between the difference in dyspnea and metabolic cost associated with rollator use.

Design

Single-group interventional study in which patients completed 2 corridor walks: 1 without and 1 with a rollator, at the same individualized constant speed.

Setting

Rehabilitation hospital.

Participants

Patients with chronic obstructive pulmonary disease (N=15; 10 men; median age [interquartile range; IQR]=69 [12]y; forced expiratory volume in 1 second=42 [20]% predicted).

Intervention

Rollator use.

Main Outcome Measures

Oxygen uptake, converted to metabolic equivalent units (METs), and minute ventilation were measured throughout both tasks using a portable gas analysis system; dyspnea and arterial oxygen saturation (SpO2) were collected on completion.

Results

Median [IQR] walk speed [IQR] was 48 (10)m/min. Walking with a rollator, compared with walking without, reduced dyspnea (median [IQR]=1.0 [1.5] vs 2.0 [2.0]; P=.01) without changing energy expenditure (median [IQR]=2.8 [1.2] vs 3.2 [0.9] METs; P=.65), minute ventilation (median [IQR]=30.3 [9.6] vs 27.7 [9.9]L/min; P=.50), or SpO2 (median [IQR]=92 [8]% vs 94 [10]%; P=.41). The association between the reduction in dyspnea and any difference in energy expenditure related to rollator use was of borderline significance (rs=.50; P=.06). Six of the 8 participants who experienced a reduction in dyspnea also demonstrated a reduction in the metabolic cost of walking.

Conclusions

The mechanism responsible for the amelioration in dyspnea during rollator-assisted walking is multifactorial. A reduction in the metabolic cost of walking may play a part in some, but not all, patients.

Section snippets

Participants

We recruited patients who had been referred to the pulmonary rehabilitation program at our facility or who were under the care of a respirologist due to symptomatic chronic lung disease. Patients were eligible to participate if they were diagnosed with COPD based on a ratio of postbronchodilator forced expiratory volume in 1 second to forced vital capacity less than 0.7,2 were clinically stable at the time of assessment, and had a smoking history greater than or equal to 10 pack years.7

Results

The characteristics of the 15 participants who completed the study are summarized in table 1. Average speed was 48 [10] (range, 35–72)m/min. For the walk undertaken without a rollator, between minutes 4 and 6 of the task, there were no differences in energy expenditure (3.0 [0.9] vs 3.2 [0.8] METs; P=.94) or minute ventilation (26.6 [8.5] vs 27.7 [9.9]L/min; P=.45). Likewise, for the walk undertaken with a rollator, there were no differences in energy expenditure (2.9 [1.1] vs 2.8 [1.2] METs; P

Discussion

The most important finding of this study is that, for the average patient with COPD, rollator use decreased dyspnea on completion of a constant pace walking task without changing energy expenditure, minute ventilation, or SpO2. Although examination of individual responses revealed that many of the participants who reported less dyspnea when using a rollator also experienced a reduction in the metabolic cost of walking, this finding was not consistent. The absence of strong significant

Conclusions

Our data demonstrated that the use of a rollator decreased dyspnea in the absence of a consistent change in energy expenditure, minute ventilation, or SpO2. Among those participants who experienced reductions in dyspnea of at least 1 unit on the Borg scale, a reduction in the metabolic cost of walking was an inconsistent finding. A better understanding of the mechanisms by which rollators improve function will assist clinicians in identifying those patients most likely to benefit from them. Our

References (18)

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Supported by a Canada Research Chair and the National Sanitarium Association Chair in Respiratory Rehabilitation Research.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

In-press corrected proof published online on Apr 1, 2012, at www.archives-pmr.org.

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