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Title:	Validation of walking trails for the urban training of chronic obstructive pulmonary disease patients
Author:	Arbillaga-Etxarri, Ane; Torrent-Pallicer, Jaume; Gimeno-Santos, Elena; Barberan-Garcia, Anael; Delgado, Anna; Balcells, Eva; Rodríguez, Diego A.; Vilaró, Jordi; Vall Casas, Pere; Irurtia, Alfredo; Rodriguez-Roisin, Robert; Garcia-Aymerich, Judith; Urban Training Study Group
Notes:	Purpose: Accessible interventions to train patients with chronic obstructive pulmonary disease (COPD) are needed. We designed urban trails of different intensities (low, moderate and high) in different types of public spaces (boulevard, beach and park). We aimed to validate the trails’ design by assessing the physiological response to unsupervised walking trails of: (1) different intensities in COPD patients, and (2) same intensity from different public spaces in healthy adults. Methods: On different days and under standardized conditions, 10 COPD patients walked the three intensity trails designed in a boulevard space, and 10 healthy subjects walked the three intensity trails in three different spaces. We measured physiological response and energy expenditure using a gas analyzer. We compared outcomes across trails intensity and/or spaces using mixed-effects linear regression. Results: In COPD patients, physiological response and energy expenditure increased significantly according to the trails intensity: mean (SD) peak O2 15.9 (3.5), 17.4 (4.7), and 17.7 (4.4) mL/min/kg (p-trend = 0.02), and MET-min 60 (23), 64 (26), 72 (31) (p-trend<0.01) in low, moderate and high intensity trails, respectively. In healthy subjects there were no differences in physiological response to walking trails of the same intensity across different spaces. Conclusions: We validated the trails design for the training of COPD patients by showing that the physiological response to and energy expenditure on unsupervised walking these trails increased according to the predefined trails’ intensity and did not change across trails of the same intensity in different public space. Walkable public spaces allow the design of trails that could be used for the training of COPD patients in the community.
Subject(s):	-Pulmons--Malalties obstructives -Caminades (Exercici) -Bioenergètica -Dispnea -Fatiga -Exercici -Cor--Circulació -Oxigen -Pulmones -- Enfermedades obstructivas -Caminar (Ejercicio) -Bioenergética -Disnea -Fatiga -Ejercicio físico -Ritmo cardíaco -Oxígeno -Chronic obstructive pulmonary disease -Walking -Bioenergetics -Dyspnea -Fatigue -Physical activity -Heart rate -Oxygen -61
Rights:	© 2016 Arbillaga-Etxarri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/
Document type:	Article Article - Accepted version
Published by:	Public Library of Science
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