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Is Afghan walking sessions integration of interest for
COPD patients rehabilitation?
Pauline Triballier∗1, Pierre-Yves De Mullenheim1, B´en´edicte Noury-Desvaux1, and
Florian Congnard†1
1Institute of Physical Education and Sports Sciences (IFEPSA) – Catholic University of the West
(UCO) – France
R´esum´e
Context: Chronic Obstructive Pulmonary Disease (COPD) is characterized by progres-
sive and non-reversible airflow limitation. Recommendations for exercise training in patients
with COPD consist of combining endurance, strength and inspiratory muscle training pro-
grams. Pulmonary rehabilitation improves exercise tolerance, reduces respiratory symptoms
and increases patient’s quality of life (QoL) (Gloeckl, Marinov & Pitta, 2013). Meditation
and breathing control activities have also shown benefits (Yudhawati & Rasjid Hs, 2019).
The Afghan walk (Stiegler, 2004) is a physical activity that combines an aerobic effort, a
meditative state and a rhythmic breathing technique based on the subject’s footstep. The
main respiratory pattern consist of an inspiratory phase during 3 footsteps, keeping inflated
lungs during a fourth and then an expiratory phase during 3 footsteps, ending with keeping
deflated lungs during a last footstep, before starting a new cycle. Despite of the many sup-
posed benefits associated with this activity, to our knowledge, there is no scientific evidence
supporting the interest of conducting this activity in COPD patients.
The aim of this study was to assess the effects of implementing Afghan walking sessions
in a respiratory rehabilitation program on functional capacity, ventilatory parameters and
QoL in COPD patients.
Methods: Thirty patients with COPD (GOLD score: 2.7±1) gave their written informed
consent to participate in the study. After having completed an evaluation of anthropometric
characteristics, respiratory function, functional capacity (6-MWT) and QoL (SF-36) exami-
nations, participants were randomly allocated to either a control group or an experimental
group. For all participants, the 4-weeks respiratory rehabilitation program was composed
of daily cycloergometer sessions, strength-training and stretching sessions. In addition, each
week, 5 treadmill walking sessions were added to the control group (CTRL) while the ex-
perimental group (EXP) completed 3 Afghan walking sessions, completed by 2 treadmill
walking sessions. Ventilatory, functional and QoL assessments were repeated at the end of
the program in both groups. Descriptive analysis and a Linear Mixed Model (LMM) were
used to assess the impact of each rehabilitation program.
Results: Compared to CTRL, EXP had higher improvements in vital capacity (VC: -
0.3% vs. +7.5%) forced vital capacity (FVC: 0% vs. +13.7%), forced expiratory volume
∗Intervenant
†Auteur correspondant: fcongna2@uco.fr
sciencesconf.org:acaps2021:355080
in 1 second (FEV1: -4% vs. +14.9%) and inspiratory and expiratory capacities (-0.8% vs.
+11% and +4.1% vs. +8.7%). The LMM tended to show significant effects of Afghan walk-
ing sessions on VC, FVC and FEV1. Both groups improved 6-MWT distance (+13.9% vs.
+11.9%). The lower benefit observed for EXP could be explained by lower walking speed and
travelled distance during Afghan walking sessions compared to treadmill sessions. Finally,
QoL was not improved in CTRL and EXP. This surprising result could be related to biased
responses linked to pre-program quarantine week.
Conclusion: Afghan walking could be a usefull activity in COPD patient’s rehabilitation.
Further analyzes are required to confirm this assumption.
References:
Gloeckl, R., Marinov, B., & Pitta, F. (2013). Practical recommendations for exercise train-
ing in patients with COPD. European Respiratory Review, 22(128), 178–186.
Stiegler, E. G. (2004). R´eg´en´eration par la marche afghane: La respiration au service de la
sant´e. Les ´editions Tr´edaniel.
Mots-Cl´es: Afghan Walk, COPD, pulmonary disease, rehabilitation