People with chronic obstructive pulmonary disease (COPD) suffer from shortness of breath that limits their physical activity. Other symptoms include wheezing, coughing, and an unpleasant awareness of breathing difficulty known as dyspnea. Standard care treatment includes medication and physical rehabilitation focused on breathing exercises. 

Lin & Yeh [Clinical Rehabilitation] conducted a randomized controlled trial to test if a mindful walking program improves exercise capacity and reduces perceived difficulty in breathing among older adults with COPD compared to a standard care control.

The researchers randomly assigned 84 older adult Taiwanese clinic patients (average age=72 years; 97% male) with mild-to-severe COPD to mindful walking added to treatment-as-usual or treatment-as-usual only. Participants in the mindful walking group engaged in mindful walking 5 days a week for 8 weeks.

The 35-minute daily mindful walking program included 5 minutes of meditation with focused diaphragmatic breathing, 5 minutes of stretching, 20 minutes of walking with controlled breathing, and a 5-minute cool down with gradually decelerating walking. 

Controlled breathing while walking involved 3-second inhalations using diaphragmatic breathing and 6-second exhalations through pursed lips. Participants were trained on mindful walking on the first day of the program, then did their daily walking independently at home.

Treatment-as-usual included standard care medical education focused on medication, diet, and smoking cessation as well as a monthly telephone medical consultation. 

Participants were evaluated at baseline, week 4 and 8 of treatment, and at 12-week follow-up after study end on walking distance within 10 minutes, perceived difficulty in breathing, heart rate variability, and interoceptive awareness.

Perceived difficulty in breathing was measured on a 10-point scale, with low scores indicating the absence of symptoms and the highest score indicating severe shortness of breath accompanied by panic. The interoceptive awareness measure included subscales on emotional awareness, attentional regulation, body listening, and noticing.   

The results showed that the mindful walking group significantly increased distance walked in 10 minutes, whereas the control group decreased distance walked. The mindful walking group increased distance walked by an average of 29 meters, a clinically meaningful increase, while the control group decreased distance walked by an average of 8 meters.

This between-group difference was significant at 4, 8, and 12 weeks. Mindful walkers reported significantly less difficulty in breathing than controls. 

This study shows that a mindful walking program can increase walking distance and decrease perceived breathing difficulties in COPD patients compared to a clinical treatment-as-usual.

The study is limited by the absence of an active control group, especially one that includes walking without mindfulness training. It is unclear how much benefit was gained from the mindfulness component relative to the physical demands of daily walking.

Reference:

Lin, F.-L., & Yeh, M.-L. (2021). Walking and mindfulness improve the exercise capacity of patients with chronic obstructive pulmonary disease: A randomised controlled trial. Clinical Rehabilitation. 

Link to study