Investigation of Walking Training With Different Slope Types in COPD Patients

Chronic obstructive pulmonary disease (COPD) is a disease that continues to generate a great deal of research and this research must continue, both because it is not completely curable and because of the large patient population. The importance and benefits of exercise training in COPD patients are clear. One of the most preferred types of exercise training is the so-called aerobic exercise training, which typically takes the form of walking. A typical walking training does not use a slope or may include an uphill slope. However, recently there have been publications about downhill walking and its benefits in COPD. Walking on a level, uphill, and downhill slope may have the potential to result in different gains by using different muscle groups more. Therefore, this study aimed to compare the effects of walking training on exercise capacity, respiratory functions, muscle strength, and functional status in COPD patients with three different slope types: level, uphill, and downhill.

The convenience sampling method will be used as the sampling method in the research. The pre-study sample size was calculated as 42 when the power rate was a minimum 80%, the alpha error rate was 0.05, and the effect size was 0.25 in the analyses performed with the G\*Power 3.1.9.4 program. When the estimated rate of patients who could be lost to follow-up was taken as 20%, it was found that at least 51 patients should be included in the study.

There will be three groups in the study: downhill walking, uphill walking, and level walking. The downhill walking and uphill walking groups will be included as the study group and the level walking group will be included as the control group. Participants will be distributed equally to the three groups. Patients will be assigned to these groups by block randomization method using https://www.randomizer.org/ website.

All three groups will be administered a 6-minute walking test at baseline, and participants will be subjected to a common 8-week, twice-weekly treadmill walking training program in which the speed is determined and increased according to the average speed they walk in this test, and in addition to this, the duration is also increased. One session of the training program will consist of warming up, loading, and cooling down on the treadmill.

During the training, the slope of the treadmill will be adjusted to +10 degrees for uphill walking, -10 degrees for downhill walking, and 0 degrees for level walking and will be kept constant for 8 weeks. A special wooden wedge apparatus will be made under the normal treadmill to give -10 downhill slope.

Primary outcome measurements will be made at baseline and at the end of week 8.

Eligibility Criteria:
Inclusion Criteria:

* Being diagnosed with COPD (A, B, E groups according to GOLD assessment)
* Ambulate on your own
* Not having any contraindications for exercise
* To be mentally appropriate (score 24 points and above in the mini mental test)

Exclusion Criteria:

* Being in GOLD 4 stage in spirometric evaluation
* Presence of hypoxemia
* Participation in another pulmonary rehabilitation program within the last 6 months
* Having an exacerbation in the last 1 month
* Being diagnosed with additional respiratory disease (asthma, bronchiectasis, etc.)
* Having had pulmonary surgery
* Having an orthopedic, neurological or cardiac disease that affects exercise
* Having uncontrolled hypertension or diabetes
* Presence of malignancy