The effect of walking aids on exercise capacity and oxygenation in elderly patients with chronic obstructive pulmonary disease

Background: high walking frames may improve exercise capacity in young patients with chronic obstructive pulmonary disease (COPD). We have assessed the effect of Zimmer, rollator and gutter frames on 6-min walking distance and on arterial oxygenation during exercise in elderly patients with COPD. Methods: 27 out-patients (15 men) aged 70-82 (mean 75) years were recruited. Exclusions comprised: COPD exacerbation or oral steroid use within 6 weeks, confusional state, participation in a pulmonary rehabilitation programme and exercise limitation by other diseases. Subjects completed 6-min walk tests unaided and with the three frames on four separate days in random order 30 min after nebulized salbutamol (5 mg) and ipratropium (0.5 mg) and were accompanied by an investigator blinded to results of all other walk tests undertaken. Oxygen saturation (SaO(2)) was monitored by finger probe during exercise. Grouped t-tests were used to compare distances and reductions in SaO(2). Results: Unaided, the mean (SEM) 6-min walk distance was 210 (16) m and fall in oxygen saturation was 6.0 (1.1)%. Use of a rollator frame did not significantly affect either of these values. Using the Zimmer frame reduced the mean distance to 165 (13) m (t = 5.2, P < 0.001 vs unaided walk) with an SaO(2) fall similar to that recorded during the unaided walk. Using the gutter frame increased the mean distance to 234 (150) m (t = 3.1, P = 0.004 vs unaided walk) and reduced the fall in SaO(2) to 3.7 (0.8)% (t = 2.3, P = 0.03 vs unaided walk). Conclusions: gutter frames improve exercise capacity and SaO(2) during exercise in elderly COPD patients who remain symptomatic on optimal therapy, whereas unwheeled Zimmer frames have a deleterious effect in such patients.