Rollators Increase Walking Distance and Reduce Breathlessness

Systematic Review of Rollators In Those With COPD

What Is A Rollator?  Walkers and rollators are equipment used to help people with mobility issues. A walker is usually built with aluminum supports and does not have wheels. The person has to lift the walker as he/she moves forward. In contrast, a rollator has wheels that does not require lifting.

The front wheels swivel to make turning in small spaces easy. It typically is

There are many types of rollators

3-wheel rollator

equipped with a padded seat and brakes. It is faster than a walker because of the wheels.

The rollator comes with either 3 or 4 wheels. The 3-wheel device is smaller and easier to maneuver than one with 4 wheels.

Study: Dr. A.L. Lee and colleagues from West Park Healthcare Centre in Toronto, Ontario, Canada, reviewed studies evaluating the effects of a rollator in those with COPD. Two reviewers assessed all published studies on the effects of rollator use compared to no aid in individuals with COPD. The article was published on-line in the Journal of Cardiopulmonary Rehabilitation and Prevention (November 8, 2017).

4-wheel rollator

4-wheel rollator with padded seat and hand brakes

Results: A total of seven studies were identified that involved 126 subjects. Use of a rollator increased the distance walked in 6-minutes by an average of 43 feet compared with walking without an aid and also lowered the shortness of breath rating at the end of the 6-minute walk by an average of one unit. However, longer term use did not impact exercise capacity or the person’s quality of life.

Conclusions: The authors concluded that when used in short-term, rollators improved walking distance with a reduction in breathing difficulty.

My Comments: A physical therapist typically evaluates individuals for use of a walker or rollator. Three standard tests are generally used to assess someone’s ability to perform basic physical activities: timed up-and-go; five times sit to stand; and assessment of gait and balance.

The timed up-and-go test is:  When I say “Go,” I want you to:
1. Stand up from the chair.
2. Walk to the line (10 feet away) on the floor at your normal pace.
3. Turn.
4. Walk back to the chair at your normal pace.
5. Sit down again.                                                                                                   The time to do this test is recorded with a stop watch.

If you have difficulty getting around due to weakness, recent falls, or struggle with balance, you should ask your health care professional about a rollator.

Maintenance Pulmonary Rehabilitation in COPD is Beneficial for Two Years

Maintenance Pulmonary Rehabilitation Increases Walking Distance

Background: Whether maintenance pulmonary rehabilitation programs help to sustain the short-term benefits is unclear.

Study: Researchers in Spain studied patients with COPD over 3 years after they completed a standard 8-week pulmonary rehabilitation program. Subjects were randomized (divided by chance) into two groups: those who received maintenance therapy and those in a control group (no maintenance).

Cycle ergometer for maintenance pulmonary rehabilitation

Cycle ergometer

What was the maintenance program?  Patients exercised at home three times a week doing: 15 minutes of chest physiotherapy; 30 minutes of lifting weights (which were bought by patients); and 30 minutes of riding a stationary cycle (provided by the hospitals). A physiotherapist called the patients every 15 days; during the alternate week, patients went to the hospital for a supervised training session.

Patients assigned to maintenance pulmonary rehabilitation did arm training with weights

Woman with COPD doing arm curls with hand weights.

What did the control group do? Patients in the control group were advised to exercise at home without any supervision. They were encouraged to walk or buy a stationary cycle for home use.

The study results were published in the March 1, 2017, issue of the American Journal of Respiratory and Critical Care Medicine (pages 622-629).

Results: For the total of 138 patients, average age was 64 years, and the amount of air exhaled in one second (FEV1) was 34% predicted. There were 68 patients in the treatment group, and 70 in the control group. More than 50% of those who started the study failed to complete the 3 years. Main reasons for stopping were a COPD flare-up (exacerbation), other medical problems (called co-morbidities), and death.

Those in the treatment group improved significantly more than the control group for: 1. distance walked in 6 minutes and 2. the BODE index [B = body mass index (weight and height); O = FEV1; D = breathlessness; E = 6-minute walking distance]. However, there were no differences in health-related quality of life between the two groups.

Conclusions:  The authors concluded that the 3-year maintenance pulmonary rehabilitation program provided improvements in walking distance and the BODE index compared with usual care. These improvements lasted for 2-years; after that, there no longer was a beneficial effect.

My Comments: This study is notable because it has the longest follow-up period of any published randomized trial of maintenance pulmonary rehabilitation. The findings support the benefits of continued exercise following completion of a pulmonary rehabilitation program.

One limitation of the study is that it primarily involved men so that it cannot be assumed that women would experience the same benefits.  However, women may be more compliant than men and are likely to live longer.  

I recommend participation in pulmonary rehabilitation to all of my patients with COPD and strongly encourage maintenance after completing our 12-week program.