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Original Research: COPD |

The Effect of Pulmonary Rehabilitation on Critical Walk Speed in Patients With COPDCritical Walk Speed After Rehabilitation: A Comparison With Self-Paced Walks

Thomas E. Dolmage, MSc; Rachael A. Evans, MD, PhD; Kylie Hill, PhD; Maria Blouin, RRT; Dina Brooks, PhD; Roger S. Goldstein, MD, FCCP
Author and Funding Information

From the Department of Respiratory Medicine (Drs Evans, Brooks, and Goldstein; Mr Dolmage; and Ms Blouin) and Respiratory Diagnostic and Evaluation Services (Dr Goldstein and Mr Dolmage), West Park Healthcare Centre; and the Department of Physical Therapy (Drs Hill, Brooks, and Goldstein) and the Department of Medicine (Drs Evans and Goldstein), University of Toronto, Toronto, ON, Canada; the School of Physiotherapy and Curtin Health Innovation Research Institute (Dr Hill), Curtin University, Bentley, WA, Australia; and the Lung Institute of Western Australia and Centre for Asthma, Allergy and Respiratory Research (Dr Hill), University of Western Australia, Crawley, WA, Australia.

Correspondence to: Roger S. Goldstein, MD, FCCP, 82 Buttonwood Ave, Toronto, ON, Canada M6M 2J5; e-mail: rgoldstein@westpark.org


Funding/Support: This research was conducted with support by an unrestricted grant [D6255L00002] from the Investigator-Sponsored Study Programme of AstraZeneca (Canada). Dr Goldstein is supported by the National Sanitarium Association-University of Toronto Chair in Respiratory Rehabilitation Research. Dr Brooks is supported by the Canada Research Chairs program.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):413-419. doi:10.1378/chest.11-1059
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Background:  Walking is frequently used in the exercise rehabilitation of patients with COPD. Walking ability can be characterized by the two-parameter hyperbolic relationship between endurance and speed. One parameter, critical walk speed (s_critical), represents the maximum speed that can be endured indefinitely. The purpose of this study was to: (1) determine the effect of pulmonary rehabilitation on the critical speed and (2) compare the critical speed with the speed chosen during self-paced walking.

Methods:  We estimated critical speed in patients with COPD before and after rehabilitation. Patients completed four high-intensity constant-speed walk tests to intolerance on a 30-m course. The parameters of the hyperbolic relationship were determined using nonlinear regression of endurance on speed. Participants also completed self-paced walks: (1) for as long as they could, (2) at their “usual” and “fast” speeds, and (3) as a 6-min walk test.

Results:  Twelve participants (FEV1 [SD], 41 [16] % predicted; FEV1/FVC, 41 [12]) completed the study. At baseline, the critical speed (65 [12] m/min) was not significantly different from the self-paced, usual, or 6-min walk speeds (65 [12], 67 [14], and 63 [15] m/min, respectively). There was a significant increase in critical speed (6 [1-10] m/min) and 6-min speed (16 [10-21] m/min) after rehabilitation, without changes in the self-paced, usual, or fast speeds.

Conclusions:  Patients with COPD increase their critical walk speed after pulmonary rehabilitation. The pace chosen during common walk tasks is closely related to critical speed; this relationship is altered after rehabilitation.

Trial registry:  ClinicalTrials.gov; No.: NCT00781183; URL: www.clinicaltrials.gov

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