Validation of Walking Trails for the Urban Training^TM of Chronic Obstructive Pulmonary Disease Patients

<div><p>Purpose</p><p>Accessible interventions to train patients with chronic obstructive pulmonary disease (COPD) are needed. We designed urban trails of different intensities (low, moderate and high) in different types of public spaces (boulevard, beach and park). We aimed to validate the trails’ design by assessing the physiological response to unsupervised walking trails of: (1) different intensities in COPD patients, and (2) same intensity from different public spaces in healthy adults.</p><p>Methods</p><p>On different days and under standardized conditions, 10 COPD patients walked the three intensity trails designed in a boulevard space, and 10 healthy subjects walked the three intensity trails in three different spaces. We measured physiological response and energy expenditure using a gas analyzer. We compared outcomes across trails intensity and/or spaces using mixed-effects linear regression.</p><p>Results</p><p>In COPD patients, physiological response and energy expenditure increased significantly according to the trails intensity: mean (SD) peak <math><mrow><mrow>V</mrow><mo>˙</mo></mrow></math>O₂ 15.9 (3.5), 17.4 (4.7), and 17.7 (4.4) mL/min/kg (p-trend = 0.02), and MET-min 60 (23), 64 (26), 72 (31) (p-trend<0.01) in low, moderate and high intensity trails, respectively. In healthy subjects there were no differences in physiological response to walking trails of the same intensity across different spaces.</p><p>Conclusions</p><p>We validated the trails design for the training of COPD patients by showing that the physiological response to and energy expenditure on unsupervised walking these trails increased according to the predefined trails’ intensity and did not change across trails of the same intensity in different public space. Walkable public spaces allow the design of trails that could be used for the training of COPD patients in the community.</p></div

Clinical and functional characteristics of COPD patients at first hospital admission (Spain, 2004–2006).

<p>Abbreviation<i>: mMRC</i>, Modified Medical Research Council; Number (%) is given, unless otherwise indicated.</p><p>*Chronic cough with phlegm;</p>†<p>Scores range from 0 (no health impairment) to 100 (maximum impairment).</p

Associations between cumulative lifetime occupational exposure and clinical and functional outcome.

<p>Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; MMRC, Modified Medical Research Council; SGRQ, St George’s Respiratory Questionnaire.</p><p>Multivariate logistic or linear regression models, adjusted for sex, age, age 2, weight, smoking status, and pack-years smoked. Referral category for all comparisons includes participants with no history of high exposure to biological dust, mineral dust, or gases/fumes (n = 110; see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0088426#pone-0088426-t002" target="_blank">Table 2</a>).</p><p>* As compared to MMRC dyspnea scale 0, 1 or 2.</p>†<p>As compared to GOLD Stage.</p

Associations between lifetime occupational exposures and DLCO, stratified according to smoking history.

<p>Linear regression models adjusted for sex, age, age2, weight and pack-years smoked. The reference category for all comparisons included participants with no history of high exposure to biological dust, mineral dust, or gases/fumes (n = 110; see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0088426#pone-0088426-t002" target="_blank">Table 2</a>).</p