Original articleRollator Use Does Not Consistently Change the Metabolic Cost of Walking in People With Chronic Obstructive Pulmonary Disease
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
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Management of breathlessness in patients with cancer: ESMO Clinical Practice Guidelines †
2020, ESMO OpenCitation Excerpt :A follow-on effect was not studied.28 Mobility aids help to improve both breathlessness and mobility through an increased ventilatory capacity and/or reduced metabolic cost.29 30 Despite the absence of studies in patients with cancer, several randomised crossover studies in breathless patients with COPD demonstrate that use of a rollator improves self-paced walking distance in both indoor31 32 and outdoor environments,33 especially in patients severely limited by breathlessness including those using ambulatory oxygen.34
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2014, Clinics in Chest MedicineCitation Excerpt :The mechanisms underpinning these improvements are likely to be multifactorial and include an increased capacity to use the accessory muscles of respiration when the arms are fixed, as well as the greater pressure-generating capacity of the inspiratory muscles in the forward lean position.27,28 Further, it may relate to a reduction in the metabolic cost of walking.29 Taken together, these factors serve to optimize the capacity of the respiratory system to meet the ventilatory demands imposed during walking-based exercise and offset the sensation of dyspnea.30
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2012, ChestCitation Excerpt :The use of a rollator (ie, wheeled walker) has been shown to confer gains in 6MWD and reduce dyspnea on exertion.101 Such changes appear to be the consequence of the forward lean position and fixation of the arms, serving to optimize ventilatory capacity as well as improved mechanical efficiency.102,103 Although those who need to rest during a 6-min walk test are most likely to benefit from the use of a rollator,101 whether these devices enhance exercise training among those with the greatest functional limitations is unknown.
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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.