Early mobilization with walking aids following hospital admission with acute exacerbation of chronic obstructive pulmonary disease

Objective: We hypothesized that early ambulation with a gutter frame (GF) in elderly patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may reduce physical disability and allow earlier discharge. Design: Blinded, randomized parallel groups trial. Subjects: One hundred and ten consecutive AECOPD inpatients. Interventions: Participants were recruited two days post admission and randomly allocated to four groups: GF with supplemental oxygen (GFSO), GF with supplemental air (GFSA), rollator with supplemental air (RSA) and rollator with supplemental oxygen (RSO) (air/oxygen was double-blinded to patients and investigators). Patients exercised three times daily (maximum of 15 minutes per session) with a physiotherapist or nurse. Outcome measures: Physical disability measured by Barthel Index and perceived respiratory effort by Borg Scale. Results: After intervention no significant difference was observed between the four groups in length of hospital stay (F = 0.78; p = 0.50), changes in mean Barthel score (F = 2.08; p = 0.11) and Borg score (F = 0.35; p = 0.79). However, improvement in Barthel score (mean 1.22 combined gutter frame group air/oxygen) was greater than the combined rollator group (mean 0.55; p = 0.003). Baseline Barthel score and nurses’ assessment of compliance were associated with improvement in Barthel score (p < 0.0001 and p < 0.002). Barthel score was predicted by use of gutter frame (F = 6.17; p = 0.01), not by use of rollator. Use of air/oxygen group was not related to improvement in Barthel score. Conclusion: Short-term exercise therapy with gutter frame after AECOPD admission reduces physical disability in older patients but does not affect length of hospital stay. Use of supplemental oxygen during exercise has no additional benefits.