title: Validation of Walking Trails for the Urban Training™ of Chronic Obstructive Pulmonary Disease Patients.
abstract: OBJECTIVE
  Accessible interventions to train patients with chronic obstructive pulmonary disease (COPD) are needed. We designed urban trails of different intensities (low, moderate and high) in different types of public spaces (boulevard, beach and park). We aimed to validate the trails' design by assessing the physiological response to unsupervised walking trails of: (1) different intensities in COPD patients, and (2) same intensity from different public spaces in healthy adults.
  
  
  METHODS
  On different days and under standardized conditions, 10 COPD patients walked the three intensity trails designed in a boulevard space, and 10 healthy subjects walked the three intensity trails in three different spaces. We measured physiological response and energy expenditure using a gas analyzer. We compared outcomes across trails intensity and/or spaces using mixed-effects linear regression.
  
  
  RESULTS
  In COPD patients, physiological response and energy expenditure increased significantly according to the trails intensity: mean (SD) peak V̇O2 15.9 (3.5), 17.4 (4.7), and 17.7 (4.4) mL/min/kg (p-trend = 0.02), and MET-min 60 (23), 64 (26), 72 (31) (p-trend<0.01) in low, moderate and high intensity trails, respectively. In healthy subjects there were no differences in physiological response to walking trails of the same intensity across different spaces.
  
  
  CONCLUSIONS
  We validated the trails design for the training of COPD patients by showing that the physiological response to and energy expenditure on unsupervised walking these trails increased according to the predefined trails' intensity and did not change across trails of the same intensity in different public space. Walkable public spaces allow the design of trails that could be used for the training of COPD patients in the community.
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Ane
authors.initials: A
authors.lastname: Arbillaga-Etxarri
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Torrent-Pallicer
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.|FCS Blanquerna, Research Group in Physical Activity and Health (SAFE), Ramon Llull University, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gimeno-Santos
authors.affiliation: Pneumology department, Hospital Clínic of Barcelona, Barcelona, Spain.|August Pi i Sunyer Biomedicine Research Institution (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.|CIBER Respiratory diseases (CIBERES), Bunyola, Illes Balears, Spain.
authors.forename: Anael
authors.initials: A
authors.lastname: Barberan-Garcia
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Delgado
authors.affiliation: Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Respiratory diseases (CIBERES), Bunyola, Illes Balears, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Pneumology department, Hospital del Mar, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Balcells
authors.affiliation: CIBER Respiratory diseases (CIBERES), Bunyola, Illes Balears, Spain.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.|Pneumology department, Hospital del Mar, Barcelona, Spain.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Rodríguez
authors.affiliation: FCS Blanquerna, Research Group in Physical Activity and Health (SAFE), Ramon Llull University, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vilaró
authors.affiliation: International University of Catalunya (UIC), Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Vall-Casas
authors.affiliation: Catalan National Institute of Physical Education (INEFC), Barcelona, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Irurtia
authors.affiliation: Pneumology department, Hospital Clínic of Barcelona, Barcelona, Spain.|August Pi i Sunyer Biomedicine Research Institution (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.|CIBER Respiratory diseases (CIBERES), Bunyola, Illes Balears, Spain.
authors.forename: Robert
authors.initials: R
authors.lastname: Rodriguez-Roisin
authors.affiliation: Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Garcia-Aymerich
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation* / Q000628:therapy; D016138:Walking