Is ground walking better than cycling for COPD patients in pulmonary rehab programs?

A new research study published in the Journal of Physiotherapy revealed that COPD patients who “ground walked” (i.e. walking on the ground, not a treadmill) as part of a pulmonary rehabilitation exercise program reported significantly higher walking endurance capacity than COPD patients who cycled.

In many pulmonary rehab programs, stationary cycles are used for aerobic exercise due to space constraints (not many facilities have large indoor walking areas) and due to concerns about patient falls (many moderate to severe COPD patients have difficulty keeping their balance due to poor leg strength). In addition, a number of programs use treadmills as a substitute for indoor ground walking. A debate has gone back and forth over time as to which method is optimal. While this study does not resolve that debate, it does show that indoor ground walking should be considered as an additional form of aerobic exercise in pulmonary rehab programs.

The Australian research team that led the study divided 32 COPD patients into two groups. One group performed indoor ground walks 30-45 minutes 3 days a week for 8 weeks. The other group participated in indoor stationary cycle training for the same 30-45 minutes, 3 days a week during the 8 week study. The researchers evaluated exercise performance differences between the two groups on a variety of measures at the outset of the study (otherwise known as baseline measurements) and the end of the study. (Leung RW, et al. Ground walk training improves functional exercise capacity more than cycle training in people with chronic obstructive pulmonary disease (COPD): a randomised trial. J Physiother. 2010; 56(2):105-12).

The results of the study showed no significant differences between improvements in physical conditioning between the ground-walk group and the cycle group on most of the evaluated measures (including improving peak walking capacity, peak and endurance cycle capacity and quality of life).

However, in an endurance capacity test known as the endurance shuttle walk test (ESWT) the ground-walk group’s improvement between the baseline ESWT and the end of study ESWT was notably better than the cycle group’s improvement. In fact, the ground-walk group improvement exceeded the cycle group improvement by 279 seconds (or approximately 4.5 minutes).

The endurance shuttle walk test has two different components. First, patients are asked to walk a defined distance as fast as they reasonably can and a baseline measure of their speed/pace is recorded. This component of the test is known as an Incremental Shuttle Walk Test (ISWT). Then, in the second component of the ESWT, a patient is asked to walk at 75% to 95% of the maximum speed/pace exhibited in the ISWT for as long as they can before they need to stop and rest. During the ESWT, the patients are prompted to keep pace in the 75%-95% range by researchers.

Based on this outcome the research team concluded, “This study provides evidence for ground walking as a mode of exercise training in pulmonary rehabilitation programs.”