Effects of pulmonary rehabilitation on gait characteristics in patients with COPD

Abstract

Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what extent, PR affects positively gait characteristics in COPD. In this prospective observational study, 44 COPD patients (aged: 62 ± 7 years; Forced expiratory volume in 1 s 56 ± 20% predicted) performed self-paced, treadmill 6-min-walk tests (Gait Real-time Analysis Interactive Lab) before and after PR, while spatiotemporal parameters and center of mass position were recorded (100 Hz, Vicon Nexus). Standard deviation, coefficient of variation, predictability (sample entropy), and consistency in organization (local divergence exponent) were calculated. Sub-analysis was performed to identify gait differences between good and poor responders (<30 m change in a 6-min-walk distance). Patients demonstrated shorter stride times (p = 0.001) and improved lower-limb muscle function (p < 0.001) following PR. The good responders had a greater increase in stride length (p < 0.001) and a greater decrease in stride time (p < 0.001) compared to the poor responders. Current PR improved stride time in patients, while movement patterns within stride-to-stride fluctuations did not change. Training programs specifically targeting balance issues and gait function may be beneficial in improving gait characteristics in COPD.