https://doi.org/10.4081/monaldi.2025.3071
Downhill: a new rehabilitation frontier. A systematic review of the literature
Submitted: May 29, 2024
Accepted: November 11, 2024
Published: January 16, 2025
Accepted: November 11, 2024
Abstract Views: 133
PDF: 59
SUPPLEMENTARY MATERIAL: 7
SUPPLEMENTARY MATERIAL: 7
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
In the last few years, we have seen the gradual spread of a new treadmill training modality, which involves walking not on the flat but downhill, also known as "downhill". This review aims to qualitatively assess the efficacy of downhill treatment on different patient populations and outline treatment routes for future efficacy studies. We searched five different databases: MEDLINE, SCOPUS, Web of Science, PEDro, and LILACS for studies to include. Only randomized controlled trials (RCTs) published in English were considered. PEDro scales and Risk of Bias 2 (RoB 2) assessment were used to evaluate the risk of bias. Forty-one RCTs were included, and three articles remained to be analyzed; the included studies showed 110 participants for three RCTs; of these, two were performed on patients diagnosed with chronic obstructive pulmonary disease (COPD), while one was for treating people with multiple sclerosis (MS). The outcome measures used in the studies were the pulmonary function test, the cardiopulmonary exercise test, the 6-Minute Walking Test, and the St. George Respiratory Questionnaire. In patients diagnosed with COPD, downhill training appears effective on functional capacity and symptoms of dyspnea and fatigue, while in people with MS, it increases strength and activity performance when compared to other walking training modalities. RoB 2 tool shows good methodological quality for all studies included in the review; when evaluated with the PEDro scale, all presented a score of 8. Downhill could be such an effective, safe, and feasible eccentric training modality that it can be considered a new rehabilitation strategy that could be implemented for patients with low exercise tolerance.
Durstine JL, Gordon B, Wang Z, Luo X. Chronic disease and the link to physical activity. J Sport Health Sci 2013;2:3-11.
DOI: https://doi.org/10.1016/j.jshs.2012.07.009
Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: why and when. Best Pract Res Clin Rheumatol 2015;29:120-30.
DOI: https://doi.org/10.1016/j.berh.2015.04.022
Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA 2018;320:2020-8.
DOI: https://doi.org/10.1001/jama.2018.14854
Kemps H, Kränkel N, Dörr M, et al. Exercise training for patients with type 2 diabetes and cardiovascular disease: what to pursue and how to do it. A position paper of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019;26:709-27.
DOI: https://doi.org/10.1177/2047487318820420
Linder S, Abu-Omar K, Geidl W, et al. Physical inactivity in healthy, obese, and diabetic adults in Germany: an analysis of related socio-demographic variables. PLoS One 2021;16:e0246634.
DOI: https://doi.org/10.1371/journal.pone.0246634
McCafferty WB, Horvath SM. Specificity of exercise and specificity of training: a subcellular review. Res Q 1977;48:358-71.
DOI: https://doi.org/10.1080/10671315.1977.10615433
Hortobagyi T, Hill JP, Houmard JA, et al. Adaptive responses to muscle lengthening and shortening in humans. J Appl Physiol 1996;80:765-72.
DOI: https://doi.org/10.1152/jappl.1996.80.3.765
Drexel H, Mader A, Saely CH, et al. Downhill hiking improves low-grade inflammation, triglycerides, body weight and glucose tolerance. Sci Rep 2021;11:14503.
DOI: https://doi.org/10.1038/s41598-021-93879-1
Malm C, Sjödin TLB, Sjöberg B, et al. Leukocytes, cytokines, growth factors and hormones in human skeletal muscle and blood after uphill or downhill running. J Physiol 2004;556:983-1000.
DOI: https://doi.org/10.1113/jphysiol.2003.056598
Laursen B, Ekner D, Simonsen EB, et al. Kinetics and energetics during uphill and downhill carrying of different weights. Appl Ergon 2000;31:159-66.
DOI: https://doi.org/10.1016/S0003-6870(99)00036-8
Howatson G, Hough P, Pattison J, et al. Trekking poles reduce exercise-induced muscle injury during mountain walking. Med Sci Sports Exerc 2011;43:140-5.
DOI: https://doi.org/10.1249/MSS.0b013e3181e4b649
Maeo S, Yamamoto M, Kanehisa H, Nosaka K. Prevention of downhill walking-induced muscle damage by non-damaging downhill walking. PLoS One 2017;12:e0173909.
DOI: https://doi.org/10.1371/journal.pone.0173909
Ofori-Asenso R, Chin KL, Mazidi M, et al. Global incidence of frailty and prefrailty among community-dwelling older adults: a systematic review and meta-analysis. JAMA Netw Open 2019;2:e198398.
DOI: https://doi.org/10.1001/jamanetworkopen.2019.8398
To TL, Doan TN, Ho WC, Liao WC. Prevalence of frailty among community-dwelling older adults in Asian countries: a systematic review and meta-analysis. Healthcare 2022;10:895.
DOI: https://doi.org/10.3390/healthcare10050895
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community‐dwelling older persons: a systematic review. J Am Geriatr Soc 2012;60:1487-92.
DOI: https://doi.org/10.1111/j.1532-5415.2012.04054.x
WHO. WHO clinical consortium on healthy ageing topic focus: frailty and intrinsic capacity. 2017. Available from: https://www.who.int/publications/i/item/WHO-FWC-ALC-17.2.
Cheng M, Chang S. Frailty as a risk factor for falls among community dwelling people: evidence from a meta‐analysi. J Nurs Scholarsh 2017;49:529-36.
DOI: https://doi.org/10.1111/jnu.12322
Kojima G. Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis. J Geriatr Phys Ther 2018;41:42-8.
DOI: https://doi.org/10.1519/JPT.0000000000000097
McPhee JS, French DP, Jackson D, et al. Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology 2016;17:567-80.
DOI: https://doi.org/10.1007/s10522-016-9641-0
Polese JC, Ada L, Dean CM, et al. Treadmill training is effective for ambulatory adults with stroke: a systematic review. J Physiother 2013;59:73-80.
DOI: https://doi.org/10.1016/S1836-9553(13)70159-0
Robinson AG, Dennett AM, Snowdon DA. Treadmill training may be an effective form of task-specific training for improving mobility in people with Parkinson’s disease and multiple sclerosis: a systematic review and meta-analysis. Physiotherapy 2019;105:174-86.
DOI: https://doi.org/10.1016/j.physio.2018.11.007
Bishnoi A, Lee R, Hu Y, et al. Effect of treadmill training interventions on spatiotemporal gait parameters in older adults with neurological disorders: systematic review and meta-analysis of randomized controlled trials. Int J Environ Res Public Health 2022;19:2824.
DOI: https://doi.org/10.3390/ijerph19052824
Samaei A, Bakhtiary AH, Hajihasani A, et al. Uphill and downhill walking in multiple sclerosis. Int J MS Care 2016;18:34-41.
DOI: https://doi.org/10.7224/1537-2073.2014-072
Camillo CA, Osadnik CR, Burtin C, et al. Effects of downhill walking in pulmonary rehabilitation for patients with COPD: a randomised controlled trial. Eur Respir J 2020;56:2000639.
DOI: https://doi.org/10.1183/13993003.00639-2020
Lindemann U, Schwenk M, Schmitt S, et al. Effect of uphill and downhill walking on walking performance in geriatric patients using a wheeled walker. Z Gerontol Geriatr 2017;50:483-7.
DOI: https://doi.org/10.1007/s00391-016-1156-4
Moher D, Liberati A, Tetzlaff J. Preferred reporting Items for Systemic reviews and Meta-Analyses (PRISMA) 2015 statement. Syst Rev 2015;4:1.
DOI: https://doi.org/10.1186/2046-4053-4-1
Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019;10:ED000142.
DOI: https://doi.org/10.1002/14651858.ED000142
Noyes J, Booth A, Flemming K, et al. Cochrane qualitative and implementation methods group guidance series—paper 3: methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings. J Clin Epidemiol 2018;97:49-58.
DOI: https://doi.org/10.1016/j.jclinepi.2017.06.020
Berardi A, Tofani M, Colalelli F, et al. The psychometric properties of the Italian version of the PEDro Scale. Gazzetta Medica Ital Arch Sci Mediche 2022;181:357-65.
DOI: https://doi.org/10.23736/S0393-3660.22.04593-4
Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366:l4898.
DOI: https://doi.org/10.1136/bmj.l4898
Moezy A, Erfani A, Mazaherinezhad A, Javad Mousavi SA. Downhill walking influence on physical condition and quality of life in patients with COPD: a randomized controlled trial. Med J Islam Repub Iran 2018;32:49.
DOI: https://doi.org/10.14196/mjiri.32.49
Wanta DM, Nagle FJ, Webb P. Metabolic response to graded downhill walking. Med Sci Sports Exerc 1993;25:159-62.
DOI: https://doi.org/10.1249/00005768-199301000-00022
Liefeldt G, Noakes TD, Dennis SC. Oxygen delivery does not limit peak running speed during incremental downhill running to exhaustion. Eur J Appl Physiol Occup Physiol 1992;64:493-6.
DOI: https://doi.org/10.1007/BF00843756
Crisafulli E, D’Abrosca F, Delicati O, et al. Raccomandazioni Italiane sulla pneumologia riabilitativa. Evidenze scientifiche e messaggi clinico-pratici. Available from: https://www.aiporassegna.it/article/view/318. [Article in Italian].
Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation Am J Respir Crit Care Med 2006;173:1390-413.
DOI: https://doi.org/10.1164/rccm.200508-1211ST
Camillo CA, Burtin C, Hornikx M, et al. Physiological responses during downhill walking: a new exercise modality for subjects with chronic obstructive pulmonary disease? Chron Respir Dis 2015;12:155-64.
DOI: https://doi.org/10.1177/1479972315575717
LaStayo P, Marcus R, Dibble L, et al. Eccentric exercise in rehabilitation: safety, feasibility, and application. J Appl Physiol 2014;116:1426-34.
DOI: https://doi.org/10.1152/japplphysiol.00008.2013
Har-Nir I, Frid L, Kalron A. Energy expenditure and perceived effort during uphill and downhill walking in people with multiple sclerosis. Eur J Phys Rehabil Med 2023;59:25-31.
DOI: https://doi.org/10.23736/S1973-9087.22.07682-1
How to Cite
Tamburlani, Matteo, Rossana Cuscito, Alessio D’Angelo, Giovanni Galeoto, Leonardo Papi, Ilaria Ruotolo, Francesca Santini, Annamaria Servadio, Edoardo Tirelli, and Giovanni Sellitto. 2025. “Downhill: A New Rehabilitation Frontier. A Systematic Review of the Literature”. Monaldi Archives for Chest Disease, January. https://doi.org/10.4081/monaldi.2025.3071.
Copyright (c) 2025 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- E.M. Clini, P. Siddu, L. Trianni, R. Graziosi, E. Crisafulli, M.T. Nobile, Activity and analysis of costs in a dedicated weaning centre , Monaldi Archives for Chest Disease: Vol. 69 No. 2 (2008): Pulmonary series
- The Rehabilitation Complexity Scale for respiratory patients Italian network, The ability of the Rehabilitation Complexity Scale (RCS) to capture disability in respiratory patients admitted for in-hospital rehabilitation , Monaldi Archives for Chest Disease: Early Access
- Erick Chan, Francesco Giallauria, Carlo Vigorito, Neil A. Smart, Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis , Monaldi Archives for Chest Disease: Vol. 86 No. 1-2 (2016): Cardiac series
- Marinella Sommaruga, Roberto Tramarin, Gianluigi Balestroni, Ornella Bettinardi, Maria Antonella Cauteruccio, Massimo Miglioretti, Marco Monti, Ombretta Omodeo, Antonia Pierobon, Paola Vaghi, ISYDE-Ψ* First step of the implementation of guidelines for psychology activities in cardiac rehabilitation and prevention *Italian SurveY on CarDiac REhabilitation – Psychology , Monaldi Archives for Chest Disease: Vol. 64 No. 1 (2005): Cardiac series
- Claudio F. Donner, Sandro Amaducci, Elena Bacci, Sandra Baldacci, Maria L. Bartoli, Gianfranco M. Beghi, Alida Benfante, Sara Brighindi, Lucio Casali, Daniela Castiglia, Mario Cazzola, Alessandro Celi, Silvana Cianchetti, Giorgio Colombo, Claudia Crimi, Federico L. Dente, Giuseppe Di Maria, Annalisa Di Maria, Manuela Latorre, Federico Lavorini, Sara Maio, Claudia Mannini, Riccardo Messina, Pier Luigi Paggiaro, Patrizia Pignatti, David Price, Nicola Scichilone, Marzia Simoni, Antonio Spanevello, Martina Stagno d’Alcontres, Shawna Tan, Roberto Torchio, Giovanni Viegi, Dina Visca, Emiel F.M. Wouters, Shaylynn Yu Hui Xin, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Raffaele Griffo, Francesco Fattirolli, Pier Luigi Temporelli, Roberto Tramarin, Italian survey on CArdiac RehabilitatiOn and Secondary prevention after cardiac revascularization: ICAROS study. A survey from the italian cardiac rehabilitation network: rationale and design , Monaldi Archives for Chest Disease: Vol. 70 No. 3 (2008): Cardiac series
- Ombretta Omodeo, Elena Fiabane, Ines Giorgi, Claudia Grandis, Alessandra Gualco, Monica Ceresa, Psychological needs and mental health in women aged ≥ 65 years after cardiac surgery: an exploratory study , Monaldi Archives for Chest Disease: Vol. 80 No. 1 (2013): Cardiac series
- Karina Vieira da Costa, Iara Tainá Cordeiro de Souza, João Victor dos Santos Felix, Celso Brendo Furtado Brandão, Vanessa Michelle de Souza Fernandes, Andressa Bomfim Lugon Favero, Maria Lucrécia de Aquino Gouveia, Dyego Tavares de Lima, José Heriston de Morais Lima, Rafaela Pedrosa, Tatiana Onofre, Geraldo Eduardo Guedes de Brito, Eduardo Eriko Tenorio de França, Efficacy of a rehabilitation protocol on pulmonary and respiratory muscle function and ultrasound evaluation of diaphragm and quadriceps femoris in patients with post-COVID-19 syndrome: a series of cases , Monaldi Archives for Chest Disease: Vol. 93 No. 1 (2023)
- Michele Vitacca, Piero Ceriana, Bruno Balbi , Claudio Bruschi, Maria Aliani, Mauro Maniscalco, Francesco Fanfulla, Aldo Diasparra, Luigino Rizzello, Daniela Sereni, Antonio Spanevello, The respiratory rehabilitation Maugeri network service reconfiguration after 1 year of COVID-19 , Monaldi Archives for Chest Disease: Vol. 91 No. 4 (2021)
- Giuseppe Calsamiglia, Federica Camera, Antonio Mazza, Paola Villa, Francesca Gigli Berzolari, Roberto Tramarin, Franco Cobelli, A new test (VITTORIO Test) for functional fitness assessment in rehabilitation after cardiac surgery , Monaldi Archives for Chest Disease: Vol. 64 No. 1 (2005): Cardiac series
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
