Many people who suffer from chronic shortness of breath tend to live sedentary lives – sitting or laying down for significant blocks of time each day. Over time, this behavior pattern leads to reduced cardiovascular fitness, degraded muscle function, bone mass loss, and has been shown in previous studies to increase the likelihood of exacerbation events (shortness of breath attacks significant enough to require an emergency room visit and/or hospitalization).
Therefore, for COPD patients and people who live with persistent breathlessness, respiratory care professionals highly recommend starting and maintaining a daily physical activity program that involves activities that require more walking and standing than sitting or laying.
To kick start this higher level of physical activity in moderate to severe COPD patients, pulmonologists can prescribe pulmonary rehabilitation. This treatment option has been shown in many studies to improve exercise capacity, reduce shortness of breath, reduce hospitalizations and improve overall patient quality of life.
However, 99% of COPD patients in the U.S. cannot gain entry to a pulmonary rehab program given the limited number of available outpatient programs and the restrictive reimbursement rules that govern admission (similar issues exist in many countries around the globe).
Further, for the lucky few who do gain entry, pulmonary rehab programs typically only last 8-12 weeks and the benefits gained during rehab only persistent long-term if the exercise, breathing technique and nutrition recommendations continue to be practiced post-rehab. Unfortunately, many COPD patients who successfully complete a pulmonary rehab program do not continue the practices and principles gained during rehab and therefore lose the conditioning benefits within one year.
As our readers know, we are strong advocates for pulmonary rehabilitation and believe COPD patients should demand their pulmonologist refer them to a program in their local area. We also believe that it is feasible for many COPD patients to start and maintain an at-home rehab-style program on their own if they can’t gain entry to a program in their area or if they have already completed a program and are on their own at this point. We created the Breathe Better for Life program based on the principles of pulmonary rehabilitation for this very purpose. To learn more, visit www.breathebetterforlife.com.
That said, given the overall low level of daily physical activity among COPD patients in general, pulmonology researchers continue to search for additional ideas beyond pulmonary rehabilitation that will help COPD patients achieve and maintain a higher level of daily physical activity for the long-term. To that end, a new Austrian research study published this month online ahead of print in the journal Respiratory Research examined a new and interesting option – Nordic Walking.
In particular, the researchers desired to know whether a 12 week Nordic Walking program would provide lasting conditioning benefits and increase daily activity levels of the COPD patients participating in the study. (Breyer MK, et al. Nordic Walking improves daily physical activities in COPD: a randomized controlled trial. Respiratory Research. 2010, 11:112 doi: 10.1186/1465-9921-11-112. epub ahead of print)
What is Nordic Walking, you ask? Simply put, it is an exercise technique that involves walking outdoors utilizing poles that look a lot like ski poles but have been modified to provide shock absorption and slip resistance. According to the research team, the specialized walking poles increase walking speed and muscle use.
In the study, the research team selected 60 COPD patients and divided them into two groups of 30 - a Control group who received “usual care” (meaning they received no exercise intervention), and a Walking group who participated in a 12 week Nordic Walking program. The Nordic Walking program involved walking outdoors at a brisk pace with the specialized poles for 1 hour, 3 days a week over the 12 week period.
The study subjects’ level of daily activity, movement intensity, exercise capacity and perceived breathlessness among other measures were all established at the outset of the study. Then at the end of the 12 week training period for the Walking group, these measures were taken again for both the Control group and the Walking group to determine the effectiveness of the training program itself. To determine whether there were lasting benefits from the Nordic Walking program, the researchers again measured the COPD patients on these same measures at 3 months and 6 months after the training program ended.
The study results showed significant improvements in the Nordic Walking group with regard to movement intensity, daily activity level, exercise capacity and perceived breathlessness. These improvements were evident at the end of the 12 week training program and were largely still present at the 3 month and 6 month post-training evaluation checkpoints.
For example, the Walking group’s mean time spent each day either walking or standing at the end of the 12 week training program increased by over 50% compared to readings taken at the beginning of the study, and the higher level of daily activity was still around 50% higher than baseline when measured again 6 months after the training program completed. The research team noted one likely reason for the maintained higher level of daily activity of the Walking group at 6 months post-training program was that 63% of the Walking group continued their Nordic Walking program on their own after the official training program ended.
In contrast to these results, the Control group saw the mean time they spent walking or standing drop by about 10% from their readings at the beginning of the study to their readings at the end of the study. Overall, the Walking group was approximately 70% more active each day than the Control group at the 6-month post-training program evaluation checkpoint.
By way of further example, at the end of the 3-month training period the Nordic Walking group members were able to walk 17% further in the 6-minute walk test (the main diagnostic tool used by the researchers to measure exercise capacity) compared to their baseline results at the outset of the study. At 6 months after the training program ended, the Nordic Walking group’s mean 6-minute walk distance was still 13% higher than it had been at baseline. By comparison, the Control group members’ 6-minute walk distance declined 3% at the 9 month evaluation checkpoint (6 months after the Walking group completed its 12 week training program) compared to their mean baseline results.
The paper’s authors concluded, “Nordic Walking has proven to be a simple, safe, and effective physical training modality for patients with COPD. Indeed, this is the first study demonstrating that Nordic Walking is feasible in patients with COPD and can improve COPD patients’ daily physical activity levels. In addition to the positive short-term effects of Nordic Walking on the physical exercise performance and daily symptoms of COPD patients, Nordic Walking created a long term effect on the training results even after an un-coached observation period of six months.”
So, Nordic Walking may be an interesting method for improving daily activity among COPD patients. It certainly seems like the combination of outdoor walking and the use of the specialized walking poles might at a minimum spice up a basic walking program and thereby make it a more interesting form of exercise to continue for a longer period of time.
No comments:
Post a Comment