Effects of Rhythmic Auditory Stimulation on Distance Walked and Dyspnea in Individuals with COPD

Introduction/Rationale: Rhythmic auditory stimulation (RAS) uses the physiologic effects of auditory rhythm to facilitate movement such as gait. RAS is the process of linking music or metronome accentuated cues with movement to elicit a neurological response to retrain the brain and affect behavior. There is a strong sensorimotor coupling that takes place between the brain and the motor system that occurs without cognitive learning efforts (i.e. patient will walk to the tempo). Music also has a distractive property. Dyspnea is the most common symptom reported by patients with Chronic Obstructive Pulmonary Disease (COPD) during physical activity. The purpose of this study was to compare 6-minute walk distances (6-MWD) and perceived dyspnea in patients with COPD under three different walking conditions: walking while listening to RAS enhanced music, walking while listening to music as recorded by the artist and, walking with no music. We hypothesized that individuals with COPD would walk further during the 6-MWT while listening to RAS enhanced music as compared to the 6-MWT distance with no music or distance walked while listening to music as recorded by the artist. An additional aim of this study was to use accelerometer-derived data in the same cohort of individuals to explore amount of time spent sedentary, as well, as factors that may contribute to sedentary behavior. Sedentary behavior has been identified as an independent risk factor for illness, poor health outcomes. Efforts to quantify physical activity have led to new vantages on how physical activity may vary among special populations. Patients with COPD are amongst the least active. Understanding the relationship between sedentary behavior and clinical outcomes in this patient population is critical to improving management and therapy for patients with COPD. Methods: Patients with COPD were recruited at Hines VA Hospital to perform three, 6-MWT in a random order. One walk was conducted while listening to rhythmically enhanced music (RAS walk), one while listening to music as recorded by the artist and one with no music. Usual walking speed was determined by counting the number of steps that a patient walked in 60 seconds. The tempo of the music selection was matched as closely as possible with the patient’s usual walking speed. The tempo of the music for the RAS walk was increased 5-10 beats higher and the bass of the music was enhanced. Patients had a choice from a list of pre-modified songs for the walks. Patients wore Bose® stereo earphones during the walks. At the end of study protocol participants were given a given the Actigraph® GT3X to wear for seven days to quantify physical acticity during free-living. Results: Twenty-five patients with COPD were enrolled. Patients were older (age=71+5 yr), with moderate to severe COPD (FEV % predicted of 47+15.0%), with a 56+27 yr of smoking. Patients walked 103+8 steps/min during the 60 second usual speed walk. During the three six-minute walks, patients walked with 451+81 m with no music, 451+80m with music as recorded, and 463+72 m with RAS enhanced music. Patients walked longer with RAS enhanced music when compared to no music (p =.015) and music as recorded (p =.033). There was no difference in walking distance between no music and music without rhythm enhancement condition. Although patients walked greater distance during the RAS walk, there was no difference in perceived dyspnea at the end of the three walks (scale 0=no dyspnea and 10=maximal dyspnea; no music=2.7+1.7, music as recorded=2.4+1.8, and RAS music=2.5+1.6). Actigraph® GT3X analysis showed that this same cohort spent 44 minutes of each hour recorded sedentary (73.9 ± 9.3%). On average, the patients spent 15 minutes (24.6 ± 9.2%) of each hour recorded in light activity, 1 minute (1.4 ± 1.2%) in moderate activity and no time in vigorous activity. The mean step count for any given hour the accelerometer was worn was 292 ± 108 steps. There were no associations between anxiety, depression, self-efficacy, quality of life and ST. Lastly, there were no differences in ST or percent time spent in light, moderate or vigorous activities between current smokers and non-smokers or based on BMI or COPD GOLD status. Conclusion. These findings suggest that RAS music may be a useful tool to increase walking distance and distract from dyspnea in patients with COPD. Older adult veteran patients with COPD display high levels of sedentary time that are accumulated in larger bouts of time. These results emphasize the complexity of sedentary behavior in COPD patients which is most likely affected by an interaction of both physical and psychological factors