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PubMed2006

Physical performance in peripheral arterial disease: a slower rate of decline in patients who walk more.

BACKGROUND: Exercise rehabilitation programs increase treadmill walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication. However, it is unknown whether patients with PAD who walk for exercise regularly have less functional decline than those with less walking activity. OBJECTIVE: To determine whether patients with PAD who report that they walk for exercise 3 or more times per week have less annual functional decline than those who walk for exercise less frequently. DESIGN: Prospective cohort study with a median follow-up of 36 months (interquartile range, 24 to 36 months). SETTING: Academic medical center. PARTICIPANTS: 417 men and women with PAD. MEASUREMENTS: Participants were classified at baseline and annually according to the number of times they reportedly walked for exercise each week. Functional assessments (6-minute walk distance, 4-meter walking speed, summary performance score) were measured at baseline and annually. Results were adjusted for age, sex, ethnicity, comorbid conditions, body mass index, ankle-brachial index, education, leg symptoms, cigarette use, geriatric depression score, previous year's level of functioning, and patterns of missing data. RESULTS: Compared with those who exercised less frequently, patients who walked for exercise 3 or more times per week had a significantly smaller average annual decline in 6-minute walking distance (-48.0 feet per year compared with -56.6 feet per year for those who walked 1 to 2 times per week and -79.4 feet per year for nonexercisers; P for trend = 0.037). Patients who walked for exercise at least 3 times per week experienced a smaller average annual decline in the usual-paced 4-meter walking velocity (-0.014 m/s per year compared with -0.022 m/s per year for those who walked 1 to 2 times per week and -0.045 m/s per year for nonexercisers; P = 0.005). Similar findings were observed for the fast-paced 4-meter walk. The subset of asymptomatic patients who walked for exercise 3 or more times per week had annual declines in 6-minute walking performance (P = 0.107), normal-paced walking velocity (P = 0.065), and the summary performance score (P = 0.115); however, these declines were smaller than those observed in asymptomatic participants who walked fewer than 3 times per week. LIMITATIONS: Because this was an observational study, associations reported here cannot be construed as causal relationships. Sample sizes for subgroup analyses were small, which limited statistical power. CONCLUSION: Among patients with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year. Similar trends were observed in the subset of asymptomatic patients with PAD. These findings may be particularly important for the numerous patients with PAD who do not have access to supervised walking exercise programs.

Disability Evaluation↗
PubMed1977

Exercise studies in horses: 2. The cardiac response to exercise in normal horses and in horses with chronic obstructive pulmonary disease.

The relationship of velocity (v) to heart rate (HR)and of kinetic energy (KE) to heart rate, were investigated in 6 normal horses and in 6 horses with chronic obstructive pulmonary, disease (COPD). Radiotelemetry was used to determine the heart rate while subjects were ridden on a 400m track. Velocity was measured by stop-watch between 2 markers 50 m apart at the end of the track. Kinetic energy was calculated from the formula KE =1/2 Mv2, where M = mass of horse, rider, saddle and bridle (KG) and V = velocity (metres per second). In all subjects, the relationship of velocity to heart rate was a linear one at each individual pace (i.e. walk, trot and gallop). There were however significant differences between the v/HR regression curves of each pace. These differences indicated that the increase in velocity per unit increase in heart rate was greater at the trot than at the walk, and greater at the gallop than at the trot. When data for all paces were combined, the relationship log v/log HR was a linear one. The above findings were also true of the relationship of kinetic energy to the heart rate. In horses, which reached maximal heart rate at a relatively low velocity, the v/HR curve became asymptotic. At comparable submaximal velocities, the heart rate of COPD subjects was approximately 20 beats per minute higher than that of normal subjects. This was also true when the term "kinetic energy per units mass" was substituted for velocity.

Animals↗
PubMed2005

Functional roles of lower-limb joint moments while walking in water.

OBJECTIVE: To clarify the functional roles of lower-limb joint moments and their contribution to support and propulsion tasks while walking in water compared with that on land. DESIGN: Sixteen healthy, young subjects walked on land and in water at several different speeds with and without additional loads. BACKGROUND: Walking in water is a major rehabilitation therapy for patients with orthopedic disorders. However, the functional role of lower-limb joint moments while walking in water is still unclear. METHODS: Kinematics, electromyographic activities in biceps femoris and gluteus maximums, and ground reaction forces were measured under the following conditions: walking on land and in water at a self-determined pace, slow walking on land, and fast walking in water with or without additional loads (8 kg). The hip, knee, and ankle joint moments were calculated by inverse dynamics. RESULTS: The contribution of the walking speed increased the hip extension moment, and the additional weight increased the ankle plantar flexion and knee extension moment. CONCLUSIONS: The major functional role was different in each lower-limb joint muscle. That of the muscle group in the ankle is to support the body against gravity, and that of the muscle group involved in hip extension is to contribute to propulsion. In addition, walking in water not only reduced the joint moments but also completely changed the inter-joint coordination. RELEVANCE: It is of value for clinicians to be aware that the greater the viscosity of water produces a greater load on the hip joint when fast walking in water.

Adaptation, Physiological↗
PubMed2003

Locomotor adjustments for circumvention of an obstacle in the travel path.

Independent living requires the navigation of a surrounding environment which is often cluttered with obstacles. When walking around an obstacle in the travel path, safe clearance requires some degree of body-segment reorientation. While body-segmental coordination strategies have been well studied for steering tasks that require moving the body in a new walking direction, it has never been established just what coordination strategies are used in different walking tasks. To address this issue, the current study was designed to investigate the timing of body segment coordination strategies and whole-body anticipatory locomotor adjustments employed when circumventing an obstacle placed in the travel path. Six healthy adults were asked to walk at their natural pace during unobstructed walking, as well as during avoidance to the right or left of a cylindrical obstacle (OBS) located in the travel path. Data analyzed were center of mass (COM) clearance from the OBS, forward velocity, step length and width, yaw angles of the head and trunk, roll angle of the trunk, and medial-lateral COM displacement. Onset of change in these variables from unobstructed walking was calculated as the time from OBS crossing. Avoidance involved two equally used strategies: lead limb close to or away from the OBS during the crossing step. Medial-lateral COM deviations were controlled by changes in step width without changes in trunk roll. There were no differences in the onset times of body segment reorientation for path deviation. These results are in contrast to previous studies on change in travel direction where the head segment initiates the body reorientation. Contrary to a steering task, circumventing an obstacle requires a different coordination for a transient change in COM trajectory with the underlying travel-direction maintained.

Adult↗
PubMed2005

Children use different anticipatory control strategies than adults to circumvent an obstacle in the travel path.

Carrying out the daily activities of work and play requires the ability to integrate available sensory information in order to navigate complex, potentially cluttered, environments. The expression of locomotor adjustment behaviour is still maturing during mid- to late-childhood (Grasso et al. in Neurosci Biobehav Rev 22(4): 533-539, 1998a; McFadyen et al. in Gait Posture 13:7-16, 2001), which raises the question, do children coordinate their body segments differently than adults when circumventing an obstacle in their travel path? Healthy young children (n=5; age 10.3+/-1.5 years) and adults (n=6; age 26.3+/-2.9 years) were asked to walk at their natural pace during unobstructed walking, as well as during the avoidance to the right or left of a cylindrical obstacle located in the travel path 3 m from the initial starting position. Fourteen infrared markers were fixed to participants and tracked using the Optotrak motion analysis system (60 Hz; Northern Digital Inc, Canada). Data analyses included center of mass (COM) clearance from the obstacle, gait speed, angular movement of the head and trunk (yaw, pitch and roll) and medial-lateral (M-L) COM displacement. Onset of change in these variables from unobstructed walking was also calculated as the time from OBS crossing. Although there were no differences in when adults or children altered their M-L COM trajectory, adults reoriented their head and trunk segments at the same time as their COM while children reoriented their head and trunk prior to changing COM direction. A comparison of foot placement data for this task indicated that while adults changed their gait patterns well in advance of obstacle crossing, children initiated M-L adjustments to gait patterns just prior to OBS crossing. Vallis and McFadyen (Exp Brain Res 152 (3):409-414, 2003) indicated that during circumvention of an obstacle, adults coordinate body segments for a single transient change in COM trajectory while maintaining the underlying travel direction. The present data suggest, however, that children partition obstacle avoidance into two tasks, initially steering with proactive movement of the head and trunk segments and finally making adjustments to their gait trajectory, via stride and step width changes, to ensure adequate obstacle clearance just prior to obstacle crossing. This study demonstrates different anticipatory control strategies used by children as compared to adults to circumvent obstacles in the travel path. The different head and trunk anticipatory segmental coordination suggests that children gather visual information differently when circumventing an obstacle in their travel path and are more dependent on visual input to guide their circumvention strategy.

Adult↗
PubMed2003

A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study.

OBJECTIVES: To determine whether a home-based pedometer-driven walking program with arthritis self-management education (Walk +) would increase physical activity, muscle strength, and functional performance in older adults with osteoarthritis (OA) of the knee as opposed to arthritis self-management education alone (EDU). DESIGN: A randomized two-by-three (group-by-time) design with participants assigned to Walk + (n = 17, mean age +/- standard deviation = 69.6 +/- 6.7) or EDU (n = 17, age = 70.8 +/- 4.7). SETTING: Community located in the Baltimore-Washington area. PARTICIPANTS: Thirty-four community-dwelling adults, aged 60 and older with symptomatic knee OA and self-reported functional impairment. INTERVENTIONS: Both groups received 12 hours of the Arthritis Self-Management program over 12 weeks and were followed for an additional 12 weeks. In addition, the Walk + group received individualized instruction in the use of a pedometer, with the goal of increasing their step count by 30% of their baseline step count. MEASUREMENTS: The outcome measures were physical activity (daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac-R3D accelerometer), quadriceps femoris strength (isometric peak torque), and functional performance tasks (100-foot walk-turn-walk, timed stair climb, timed chair rise, and pain status). RESULTS: Daily steps walked showed a significant group-by-time interaction (P =.04) after controlling for age. From baseline to completion of training, a 23% increase in daily steps occurred in the Walk + group and a 15% decrease in the EDU group. Although steps increased in the Walk + group, total activity vector magnitude was maintained, suggesting a more efficient gait. The Walk + group became quicker than the EDU group in the normal-pace walk-turn-walk (P =.04). An isometric strength gain of 21% postintervention was seen in the Walk + group, compared with a loss of 3.5% in the EDU group. CONCLUSION: In older adults with symptomatic knee OA, Walk + appears to increase walking, with improvements in muscle strength and walking performance. The use of a home-based pedometer-driven program to increase physical activity, strength, and function in this population warrants further research.

Aged↗
PubMed2006

Functional decline in patients with and without peripheral arterial disease: predictive value of annual changes in levels of C-reactive protein and D-dimer.

BACKGROUND: Inflammation may be a potential mechanism of aging-related functional decline. We determined whether greater annual increases in levels of high sensitivity C-reactive protein (hsCRP) and D-dimer predicted greater decline in functioning among persons with and without lower extremity peripheral arterial disease (PAD). METHODS: We prospectively studied 296 men and women with PAD and 191 without PAD. Objective measures of functioning, hsCRP, and D-dimer were obtained at baseline and annually for 3 years (mean follow-up = 36.3 +/- 6.4 months). RESULTS: Among PAD participants, greater annual increases in hsCRP were associated with greater annual declines in 6-minute walk performance (-2.63 ft/mg/L, p =.039) but not in other functional outcomes. Higher prior year absolute hsCRP levels were associated with greater declines in 6-minute walk (-2.93 ft/mg/L, p =.022), summary performance score (-0.038/mg/L, p =.017), and rapid paced 4-meter walk (-0.29 cm/s/mg/L, p =.026) during the subsequent year. Among participants without PAD, greater annual increases in hsCRP were associated with greater annual declines in 6-minute walk (-7.47 ft/mg/L, p =.002), usual-pace 4-meter walk (-0.33 cm/s/mg/L, p <.001), fast paced 4-meter walk (-0.56 cm/s/mg/L, p =.003), and the summary performance score (-0.029 mg/L, p <.001). There were no consistent associations between D-dimer levels and functional decline. CONCLUSION: These findings suggest that inflammation may play a role in functional decline in persons with and without PAD.

Aged↗
PubMed1996

A six-minute walk test for assessing exercise tolerance in severely ill children.

OBJECTIVES: The primary objective of this study was to compare exercise tolerance, heart rate, and oxyhemoglobin saturation (Sao2) between a traditional progressive maximal exercise test and a self-paced, 6-minute walk test in severely ill children. STUDY DESIGN: Seventeen patients (9 to 19 years of age) performed a progressive maximal exercise test on a cycle ergometer and a self-paced, 6-minute walk test as part of the evaluation for possible heart, lung, or combined heart and lung transplantation. Physical work capacity and peak oxygen uptake were measured during the progressive cycle test. The walk test was performed in a hospital corridor, with patients trying to cover as much distance as possible in 6 minutes at their own pace. Oxyhemoglobin saturation and heart rate were monitored continuously by pulse oximetry and compared between the two tests. RESULTS: The distance walked in 6 minutes correlated with peak oxygen uptake (r = 0.70, p < 0.01) and physical work capacity (r = 0.64, p < 0.005). The minimum (Min) Sao2 on the bike test correlated significantly with Min Sao2 on the walk test (r = 0.82, p < 0.001), with 11 of 17 patients having a lower Min Sao2 on the walk test than the bike test (mean Min Sao2, 84% and 86%, respectively). The peak heart rate did not correlate significantly between the bike and walk tests (r = 0.25), although significantly lower (p < 0.01) values were observed on the walk (148 beats/min) than bike (169 beats/min) test. CONCLUSIONS: The results suggest that the 6-minute self-paced walk test may provide an alternative method for assessing functional capacity in severely ill children, and that Sao2 measured during progressive exercise testing on a cycle ergometer may not reflect the degree of oxyhemoglobin desaturation during self-paced walking in some patients with severe cardiopulmonary disease.

Adolescent↗
PubMed1992

Development of a shuttle walking test of disability in patients with chronic airways obstruction.

BACKGROUND: The aim was to develop a standardised and externally paced field walking test, incorporating an incremental and progressive structure, to assess functional capacity in patients with chronic airways obstruction. METHODS: The usefulness of two different shuttle walking test protocols was examined in two separate groups of patients. The initial 10 level protocol (group A, n = 10) and a subsequent, modified, 12 level protocol (group B, n = 10) differed in the number of increments and in the speeds of walking. Patients performed three shuttle walking tests one week apart. Then the performance of patients (group C, n = 15) in the six minute walking test was compared with that in the second (modified) shuttle walking test protocol. Heart rate was recorded during all the exercise tests with a short range telemetry device. RESULTS: The 12 level modified protocol provided a measure of functional capacity in patients with a wide range of disability and was reproducible after just one practice walk; the mean difference between trial 2 v 3 was -2.0 (95% CI -21.9 to 17.9) m. There was a significant relation between the distance walked in the six minute walking test and the shuttle walking test (rho = 0.68) but the six minute walking test appeared to overestimate the extent of disability in some patients. The shuttle test provoked a graded cardiovascular response not evident in the six minute test. Moreover, the maximal heart rates attained were significantly higher for the shuttle walking test than for the six minute test. CONCLUSIONS: The shuttle walking test constitutes a standardised incremental field walking test that provokes a symptom limited maximal performance. It provides an objective measurement of disability and allows direct comparison of patients' performance.

Aged↗
PubMed1999

The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease.

BACKGROUND: The purpose of this study was to develop an externally controlled, constant paced field walking test to assess endurance capacity in patients with chronic obstructive pulmonary disease (COPD). There were four objectives: (1) to develop a protocol; (2) to compare treadmill and shuttle walk tests of endurance capacity; (3) to examine the repeatability of the endurance shuttle walk test; and (4) to compare the sensitivity to pulmonary rehabilitation of endurance and incremental shuttle walk tests. METHODS: The test was designed to complement the incremental shuttle walk test (ISWT) using the same 10 m shuttle course and an audio signal to control pace. The intensity of the field endurance test was related to a percentage of each patient's maximum field exercise performance assessed by the ISWT. A number of cassette tapes were pre-recorded with a range of audio signal frequencies to dictate walking speeds between 1.80 and 6.00 km/h. In the first limb of the study 10 patients with COPD (mean (SD) forced expiratory volume in one second (FEV1) 1.0 (0.36) 1, 35% predicted) performed three endurance shuttle walk tests (ESWTs) and three treadmill endurance tests. The walking speeds were calculated to elicit 75%, 85%, and 95% of each patient's maximum ISWT performance for the field tests and measured peak oxygen consumption for the treadmill tests. In a separate group of patients the repeatability of the ESWT at an intensity of 85% of the ISWT performance was evaluated. Finally, the ESWT (at the 85% intensity) and the ISWT were performed at the start of a five week control period and at the start and end of a seven week pulmonary rehabilitation programme in 21 patients with COPD (mean FEV1 0.80 (0.18) 1). RESULTS: The mean (SE) times achieved during the ESWT were 13.1 (2.3), 10.2 (2.5), and 5.3 (1.7) min for the walks at 75%, 85%, and 95% intensities, respectively. Patients tended to walk for longer on the treadmill than during the field tests at all intensities, but there were no significant differences between the end of test heart rates or Borg ratings of breathlessness or perceived exertion. Following one practice ESWT at the 85% intensity, the mean difference and limits of agreement (2SD) between tests 2 and 3 was +15 (42) s (p > 0.05). There was no significant change in performance on either test following the five week control period prior to rehabilitation. Following rehabilitation the ESWT duration increased by 160 (24)% and the ISWT distance increased by 32 (11)% (effect sizes 2.90 and 0.41, respectively). CONCLUSIONS: The ESWT was simple to perform, acceptable to all patients, and exhibited good repeatability after one practice walk. The test showed major improvement following rehabilitation and was more sensitive to change than the field test of maximal capacity.

Exercise Test↗
PubMed2001

Functional status and self-rated health in 2,262 nonagenarians: the Danish 1905 Cohort Survey.

OBJECTIVES: To describe the functional capacity and self-rated health of a large cohort of nonagenarians. DESIGN: A cross-sectional survey of all Danes born in 1905 (92-93 years of age), carried out August to October 1998. SETTING: Participants' homes. PARTICIPANTS: Two thousand two hundred and sixty-two nonagenarians, corresponding to a participation rate of 63% (of these, 20% participated by proxy). MEASUREMENTS: Activities of daily living (ADLs) and self-rated health were assessed by interview. Five items from Katz's ADLs (bathing, dressing, transfer, toileting, and eating) were used to construct a three-level five-item ADL scale (not disabled (no disabilities), moderately disabled (1-2 disabilities), severely disabled (3-5 disabilities)). From responses to a more extensive list of questions on ADLs (26 items), we identified scales of strength and agility by means of factor analysis. Furthermore, a 26-item ADL scale was made. Physical performance tests (chair stand, timed walk, lifting a 2.7 kg box, maximum grip-strength, and flexibility tests) were performed among nonproxy responders. RESULTS: According to the five-item ADL scale, 50% of the men and 41% of the women were categorized as not disabled, while 19% and 22%, respectively, were categorized as severely disabled. The five-item ADL scale correlated highly with the 26-item ADL scale (r = 0.83). The ADL scales showed moderate-to-good correlation with each other (r = 0.74-0.83), and with the physical performance tests (r = 0.31-0.58). Only 3.7% of the women and 6.3% of the men walked (normal pace) with a speed of at least 1 meter per second, which is the minimum walking speed required to cross signaled intersections in Denmark. A total of 56% considered their health to be excellent or good. Of the participants, 74% were always or almost always satisfied with their lives, even though only 45% reported that they "felt well enough to do what they wanted." The analyses showed that no single ADL item seemed to be of particular importance for how the participants rated their health. CONCLUSION: The Danish 1905 cohort survey is the largest and the only nationwide survey of a whole birth-cohort of nonagenarians. A total of 2,262 fairly nonselected nonagenarians participated. The level of both self-reported disability and functional limitations measured by physical performance tests among nonagenarians was high. Despite their lower mortality, women were more disabled than men and did not perform as well as men in the physical performance tests. Nevertheless, the majority of the participants considered their health to be good and were satisfied with their lives.

Activities of Daily Living↗
PubMed2005

Effects of home exercises on motor performance in patients with Parkinson's disease.

OBJECTIVE: To investigate the effect of home exercises on the motor performance of patients with Parkinson's disease. DESIGN: A prospective blinded study with allocation of patients into their groups by alternate weeks. SETTING: A University Hospital neurology and physiotherapy department. SUBJECTS: Recruited from a movement disorders outpatient clinic of Cerrahpasa School of Medicine diagnosed with Parkinson's disease, classified as Hoehn and Yahr Grades I, II and III. INTERVENTIONS: Patients who fulfilled the inclusion criteria were recruited to the study. Each patient was evaluated at the end of first and second month after the baseline evaluation. Patients were divided into two groups. Those in the first and third week were put in the exercise group and second and fourth week in the control group. Patients in the exercise group (n = 15) were given a schedule of exercises to undertake at home; the others (n = 15) did not receive this instruction. MEASURES: Ten- and 20-m walking test, first pace length, pace number in 10 m, walking around a chair, Nine Hole Peg Board (NHPB) test. RESULTS: Following the home exercise programme, patients in the exercise group showed improvement in walking 10 and 20 m, time elapsed to complete walking around a chair and length of the first pace length, and in the motor performance of both hands (p < 0.001). CONCLUSIONS: A home-based rehabilitation programme for patients with Parkinson's disease helped to improve motor performance compared to patients who did not take advantage of a regular, professionally designed exercise programme.

Aged↗
PubMed1993

Self-selected exercise intensity of habitual walkers.

This study assessed self-selected exercise intensity of habitual walkers. Twenty-nine healthy adults (22 females, 7 males; age (mean +/- SD) = 34.9 +/- 8.6 yr) performed a typical exercise walk while walking speed was measured by an unseen observer. On a subsequent occasion, the subjects walked at the same pace on a treadmill while several variables related to exercise intensity were measured. The mean self-selected walking pace was 1.78 +/- 0.19 m.s-1. Mean percents of VO2max and HRmax elicited by the treadmill exercise were 52 +/- 11% and 70 +/- 9%, respectively. Mean MET level was 5.2 +/- 1.2, and ratings of perceived exertion (RPE) averaged 10.9 +/- 1.6. Based on reported frequency and duration of walking, weekly energy expenditure in exercise walking was estimated to be 1127 +/- 783 kcal.wk-1. These data suggest that the self-selected exercise intensity of healthy, habitual exercise walkers meets the American College Sports Medicine's recommendation for improvement of cardiorespiratory fitness. These data further suggest that, in this population, the average weekly energy expended through walking reaches a level associated with improvements in health and longevity.

Adult↗
PubMed2006

Walking with a rollator and the level of physical intensity in adults 75 years of age or older.

OBJECTIVE: To determine whether walking with a rollator by persons 75 years of age or older is of sufficient intensity to improve aerobic fitness. DESIGN: A cross-sectional cohort study. SETTING: University movement laboratory. PARTICIPANTS: Fifteen subjects 75 years of age or older (mean age, 83.7 y) who could only walk by using a rollator. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: During 6 minutes of self-paced treadmill walking using a rollator at a mean walking speed of 0.6 m/s, oxygen uptake (Vo2), carbon dioxide production, and heart rate were determined. Respiratory exchange ratio (RER) and energy expenditure were calculated. The energy expenditure was expressed as the number of metabolic equivalents (METS), the percentage of estimated maximal Vo2 (Vo2max), the percentage of estimated Vo2max reserve, and the percentage of estimated maximal heart rate. RESULTS: Mean Vo2 was .718 L/min. Mean RER was .93 (95% confidence interval [CI], .89-.97). Thirteen participants showed an RER below 1.0, which indicates a negligible contribution of anaerobic expenditure. Walking with a rollator required a mean of 2.8 (95% CI, 2.4-3.2) METS, 71.9% of Vo2max (95% CI, 65.2%-78.6%), 50.5% (95% CI, 39.4%-61.5%) of Vo2 reserve, and 75.2% (95% CI, 67.6%-82.8%) of estimated maximal heart rate. CONCLUSIONS: For people 75 years of age or older, walking with a rollator is an activity of moderate to high level of intensity, with the capacity of improving aerobic fitness.

Aged↗
PubMed1999

Walking speed on parquetry and carpet after stroke: effect of surface and retest reliability.

OBJECTIVE: At the transition stage from rehabilitation to home this study aimed to (1) investigate the effect of floor surface (carpet and parquetry) on walking speed; (2) investigate whether there was a difference between these surfaces as stroke patients voluntarily increased from comfortable to fast pace; (3) investigate whether walking speed on parquetry was a predictor of walking speed on carpet at the two paces; (4) investigate whether walking speed at a comfortable pace was a predictor of walking speed at a fast pace on the two surfaces; and (5) quantify systematic and random error in repeated measurements for fast-paced walking trials. DESIGN: Subjects walked 10 metres at comfortable and fast paces on carpet and parquetry on two consecutive days. SETTING: Inpatient rehabilitation centre. SUBJECTS: Twenty-four stroke patients. MAIN OUTCOME MEASURE: Walking speed. RESULTS: Two-way analysis of variance confirmed that patients walked more slowly on carpet than parquetry (F(1,23) = 5.3, p <0.05) at both paces; the interaction effect was not significant (p >0.05). Walking speed on parquetry was a strong predictor of walking speed on carpet at a comfortable (r = 0.92), and fast pace (r = 0.97). Walking speed at comfortable pace was a moderately strong predictor of walking speed at fast pace on parquetry (r = 0.84), and on carpet (r = 0.88). Random error in repeated measurements was higher when walking fast on carpet (7.21 m/min) and parquetry (8.32 m/min) than when walking at a comfortable pace on carpet (4.63 m/min) and parquetry (3.48 m/min). Systematic error was negligible (p <0.05). CONCLUSION: Carpet surface was more challenging than parquetry surface, as evidenced by the systematic decrease in walking speed. This may have been due to lack of familiarity. Relative to the wide range of scores in the group, stroke patients showed consistency of walking speed across both surfaces. Likewise, stroke patients retained their relative position in the group as they changed from a comfortable to a fast walking pace. The difference in random error between comfortable and fast-paced trials highlights the need to quantify error in the repeated measurement situation according to specific test conditions.

Activities of Daily Living↗
PubMed1998

"Value" of improved treadmill exercise capacity: lessons from a study of rate responsive pacing.

OBJECTIVES: To compare the value of a series of cardiovascular measurements in patients with symptomatic disease receiving an effective treatment (rate responsive pacing). PATIENTS: 12 pacemaker dependent patients with VVIR units. INTERVENTIONS: Single blind crossover between VVI and VVIR. OUTCOME MEASURES: Exercise capacity was assessed by treadmill tests (modified Bruce protocol and a fixed workload protocol) with respiratory gas analysis. Self paced corridor walk tests were also undertaken. Quality of life (QOL) was assessed by questionnaire. Daily activity was measured in the patients' homes using shoe and belt pedometers. RESULTS: Treadmill tests and QOL questionnaires correctly identified the clinical benefit associated with VVIR. The modified Bruce protocol was superior to the fixed workload protocol as it was better tailored to the fairly well preserved exercise capacity of the patients. Symptom scores, but not walking times, were improved with VVIR during corridor walk tests. VVIR did not improve daily activity measured using either the belt or shoe pedometers. CONCLUSIONS: VVIR pacing improved some but not all measures of exercise capacity. This finding illustrates the difficulty of selecting an instrument to measure symptomatic improvement in clinical research; and raises the question, what is the best way of measuring exercise capacity?

Activities of Daily Living↗
PubMed1997

Physiological comparison of walking among bilateral above-knee amputee and able-bodied subjects, and a model to account for the differences in metabolic cost.

OBJECTIVE: To compare the metabolic cost for prosthetic ambulation among persons with bilateral above-knee amputation with that for able-bodied ambulation, and to test a model that differentiates the metabolic cost of walking into three components. DESIGN: Cross-sectional comparison. SETTING: Community-dwelling subjects studied at an academic medical center. PARTICIPANTS: Five bilateral above-knee amputee subjects with mean (+/-SD) age of 22 +/- 3 years, and five able-bodied control subjects matched for gender, height, weight, and age. INTERVENTION: Subjects performed 6-minute bouts of walking at three paced speeds and their chosen walking speed with oxygen uptake being determined during the last 2 minutes of each bout. MAIN OUTCOME MEASURES: Chosen walking speed and oxygen uptake during each walking condition. RESULTS: The chosen walking speed was 21% slower and induced aerobic demands 49% higher for the amputee subjects. Across specified paced speeds, aerobic demands were 55% to 83% higher for the amputee subjects than for the able-bodied subjects. The described model suggests that the higher metabolic costs for the amputee subjects resulted from greater demands for maintenance of balance and posture and for performing the walking movement. CONCLUSIONS: Prosthetic ambulation by young healthy persons with bilateral above-knee amputation induces significantly greater metabolic demands than walking by able-bodied individuals. Although the chosen walking speed of persons with bilateral above-knee amputation is slower, the reduction in speed is insufficient to equalize their metabolic cost with that of able-bodied individuals walking at their chosen walking speed.

Adult↗
PubMed1997

Determination of the optimal walking speed for neural relaxation in healthy elderly women using electromyogram and electroencephalogram analyses.

The purpose of this study was to determine the walking speed which has the greatest influence on neural relaxation in healthy elderly women as determined by electromyogram (EMG) and electroencephalogram (EEG) analyses. Seven elderly female volunteers [mean age 68.5 (SD 3.95) years] served as subjects for this study. The EMG signals were recorded from the gastrocnemius (MG), soleus (SL) and tibialis anterior (TA) muscles while walking on a treadmill, starting at 40 m.min-1 and increasing 6 m.min-1 incrementally for 10 min. The turning point of muscle activities (by integrated EMG. iEMGtp) was determined as the walking speed at the point at which the mean rate of change of iEMG (MG + SL + TA) abruptly increased. After the determination of iEMGtp. the treadmill was set at three constant speeds, one corresponding to the speed for the iEMGtp and two others 20% higher or lower than that for the iEMGtp. The subjects then walked for 20 min at each of these speeds on 3 separate days and their EEG power spectrum data were obtained for frequencies from the 8 to 13 Hz (z-wave component, AWC). The mean of iEMGtp for our subjects was at a mean walking speed of 64.7 (SD 7.9) m.min-1. Considering the subjects' age and height, iEMGtp was somewhat faster than their expected self-paced normal walking speed. There were no differences between the mean AWC values of the subjects prior to exercising at each of the three speeds. The mean AWC values after exercise were significantly (P < 0.01) greater than before. The extent of the increase in AWC at iEMGtp was greater than those at slower speeds. Our data would suggest that walking exercise at the speed which corresponds with EMG evidence of iEMGtp may induce the most significant relaxing effects in elderly women.

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