Downhill: a new rehabilitation frontier. A systematic review of the literature

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 outl...

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Main Authors: Matteo Tamburlani, Rossana Cuscito, Alessio D’Angelo, Giovanni Galeoto, Leonardo Papi, Ilaria Ruotolo, Francesca Santini, Annamaria Servadio, Edoardo Tirelli, Giovanni Sellitto
Format: Article
Language:English
Published: PAGEPress Publications 2025-01-01
Series:Monaldi Archives for Chest Disease
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Online Access:https://www.monaldi-archives.org/macd/article/view/3071
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author Matteo Tamburlani
Rossana Cuscito
Alessio D’Angelo
Giovanni Galeoto
Leonardo Papi
Ilaria Ruotolo
Francesca Santini
Annamaria Servadio
Edoardo Tirelli
Giovanni Sellitto
author_facet Matteo Tamburlani
Rossana Cuscito
Alessio D’Angelo
Giovanni Galeoto
Leonardo Papi
Ilaria Ruotolo
Francesca Santini
Annamaria Servadio
Edoardo Tirelli
Giovanni Sellitto
author_sort Matteo Tamburlani
collection DOAJ
description 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.
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spelling doaj-art-65fc2dac135d4cc0a7a966306afee36f2025-08-20T01:49:20ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642025-01-0110.4081/monaldi.2025.3071Downhill: a new rehabilitation frontier. A systematic review of the literatureMatteo Tamburlani0https://orcid.org/0009-0004-1624-930XRossana Cuscito1Alessio D’Angelo2Giovanni Galeoto3Leonardo Papi4Ilaria Ruotolo5Francesca Santini6Annamaria Servadio7Edoardo Tirelli8Giovanni Sellitto9Local Health Board Rome 2, RomeTor Vergata University, RomeTor Vergata University, RomeDepartment of Human Neurosciences, Sapienza University, RomeTor Vergata University, RomeDepartment of Human Neurosciences, Sapienza University, RomeTor Vergata University, RomeLocal Health Board Rome 2, RomeTor Vergata University, RomeDepartment of Human Neurosciences, Sapienza University, Rome 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. https://www.monaldi-archives.org/macd/article/view/3071Downhill walktreadmillrehabilitationphysiotherapyaerobic training
spellingShingle Matteo Tamburlani
Rossana Cuscito
Alessio D’Angelo
Giovanni Galeoto
Leonardo Papi
Ilaria Ruotolo
Francesca Santini
Annamaria Servadio
Edoardo Tirelli
Giovanni Sellitto
Downhill: a new rehabilitation frontier. A systematic review of the literature
Monaldi Archives for Chest Disease
Downhill walk
treadmill
rehabilitation
physiotherapy
aerobic training
title Downhill: a new rehabilitation frontier. A systematic review of the literature
title_full Downhill: a new rehabilitation frontier. A systematic review of the literature
title_fullStr Downhill: a new rehabilitation frontier. A systematic review of the literature
title_full_unstemmed Downhill: a new rehabilitation frontier. A systematic review of the literature
title_short Downhill: a new rehabilitation frontier. A systematic review of the literature
title_sort downhill a new rehabilitation frontier a systematic review of the literature
topic Downhill walk
treadmill
rehabilitation
physiotherapy
aerobic training
url https://www.monaldi-archives.org/macd/article/view/3071
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