Goal:
Strengthen leg muscles (especially quads) without overloading your lungs

Before You Start

  • Talk to your doctor or rehab specialist. Make sure DW is safe for your current condition.
  • Start indoors if possible. A treadmill with a decline setting is ideal for controlling the slope and speed.
  • Warm up. 5 minutes of flat walking before the downhill session helps avoid injury.

How to Do It

Frequency:
2–3 times per week to start, with at least one rest day in between
(Your muscles may be sore for 1–2 days — that’s okay!)

Duration:
Start with 10–20 minutes, depending on your tolerance.

Speed:
Walk at a comfortable pace — no need to rush. Let the decline do the work.

Slope:
Start with a -5% to -7% incline (most treadmills show this). Outdoors? Choose a gentle, steady hill — no steep descents.

Optional: Add a Load

If you’re progressing well, you can try carrying a light chest-weight vest (2–4 kg).
But don’t feel pressure to do this — the study showed bodyweight alone works well.

Stop if You Feel:

  • Chest pain
  • Dizziness
  • Shortness of breath that doesn’t ease with rest
  • Joint pain (especially in knees or hips)

Recovery

  • Expect mild soreness in thighs 24–48 hours later (a sign the muscles worked).
  • Rest and hydrate.
  • Don’t repeat DW too soon — recovery is key to results.

Pro Tip: Track Your Progress

  • Use a log to record how long you walked, how hard it felt (1–10 scale), and any soreness after.
  • Over time, you should notice:
    • Less soreness
    • Stronger legs
    • Better endurance

Camillo, C. A., Osadnik, C. R., Burtin, C., Everaerts, S., Janssens, W., & Troosters, T. (2015). Downhill walking elicits eccentric quadriceps contractile fatigue in people with chronic obstructive pulmonary disease. Chronic Respiratory Disease, 12(3), 198–205. https://doi.org/10.1177/1479972315575717

Burtin, C., Osadnik, C. R., Vandenberk, N., Langer, D., & Troosters, T. (2020). Downhill walking during pulmonary rehabilitation in patients with COPD: A randomized controlled trial. Chest, 158(6), 2421–2431. https://doi.org/10.1016/j.chest.2020.05.611

Mueller, M., Vogt, L., Janzen, A., et al. (2019). Eccentric exercise and pulmonary rehabilitation in patients with COPD: A review. Chest, 156(6), 1019–1027. https://doi.org/10.1016/j.chest.2019.06.021

Kim, D. H., et al. (2018). Influence of downhill walking training on physical condition and quality of life in patients with COPD. Journal of Physical Therapy Science, 30(8), 1076–1081. https://doi.org/10.1589/jpts.30.1076

Camillo, C. A., et al. (2016). Effects of a training program including downhill walking in COPD: A randomized controlled trial. Respiratory Medicine, 118, 24–30. https://doi.org/10.1016/j.rmed.2016.07.006