How do people with COPD walk? A European study on digitally measured real-world gait
Walking activity is reduced in people with chronic obstructive pulmonary disease (COPD), but little is known about their real-world gait characteristics. This study characterised gait in COPD using wearable-derived digital mobility outcomes (DMOs) and compared them across disease severity and with healthy older adults. A total of 549 people with COPD from seven European centres and 19 healthy older adults wore a single wearable device continuously for one week. Walking bouts were identified and 15 gait-related DMOs were aggregated at the weekly level. DMOs were compared across COPD severity, defined by Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades and symptom groups, and with healthy peers. Participants with COPD had a mean±SD age of 68±8 years, 37% were female, and mean post-bronchodilator forced expiratory volume in 1 second was 54±20% predicted. All gait DMOs were normally distributed and showed substantial inter-individual variability (e.g. walking speed 0.83±0.12 m·s⁻¹, range 0.48–1.20 m·s⁻¹). Walking speed and cadence decreased with increasing disease severity (e.g. walking speed 0.88±0.11 to 0.78±0.14 m·s⁻¹ across GOLD grades 1–4, p<0.001; cadence 93±6 to 89±7 steps·min⁻¹ across GOLD A–E, p=0.013). Stride length and stride duration also varied across severity levels, while bout-to-bout variability in walking speed and cadence differed primarily by dyspnoea severity. Compared with healthy older adults (47% women, mean age 71±6 years), people with COPD had significantly lower walking speed and cadence (e.g. walking speed 0.83±0.12 versus 0.90±0.12 m·s⁻¹, p=0.041). In summary, real-world gait DMOs in COPD are normally distributed, worsen with advancing disease, and differ from healthy ageing. Future studies should determine which gait DMOs are responsive to interventions aimed at improving mobility and reducing adverse outcomes.
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