Abstract
BackgroundGait disorders of Parkinson’s disease (PD) are characterized by the breakdown of the temporal organization of stride duration variability that was tightly associated to dynamic instability in PD. Activating the upper body during walking, Nordic Walking (NW) may be used as an external cueing to improve spatiotemporal parameters of gait, such as stride length or gait variability, in PD. The aim of this study was to evaluate the beneficial effects of NW on temporal organization of gait variability and spatiotemporal gait variables in PD.MethodsFourteen mild to moderate PD participants and ten age-matched healthy subjects performed 2 × 12 min overground walking sessions (with and without pole in a randomized order) at a comfortable speed. Gait speed, cadence, step length and temporal organization (i.e. long-range autocorrelations; LRA) of stride duration variability were studied on 512 consecutive gait cycles using a unidimensional accelerometer placed on the malleola of the most affected side in PD patients and of the dominant side in healthy controls. The presence of LRA was determined using the Rescaled Range Analysis (Hurst exponent) and the Power Spectral Density (α exponent). To assess NW and disease influences on gait, paired t-tests, Z-score and a two-way (pathological condition x walking condition) ANOVA repeated measure were used.ResultsLeading to significant improvement of LRA, NW enhances step length and reduces gait cadence without any change in gait speed in PD. Interestingly, LRA and step length collected from the NW session are similar to that of the healthy population.ConclusionThis cross-sectional controlled study demonstrates that NW may constitute a powerful way to struggle against the randomness of PD gait and the typical gait hypokinesia. Involving a voluntary intersegmental coordination, such improvement could also be due to the upper body rhythmic movements acting as rhythmical external cue to bypass their defective basal ganglia circuitries.Ethics committee’s reference numberB403201318916Trial registrationNCT02419768
Highlights
Gait disorders of Parkinson’s disease (PD) are characterized by the breakdown of the temporal organization of stride duration variability that was tightly associated to dynamic instability in PD
The randomness of PD gait was recently emphasized by subtle deterioration of the temporal organization of gait variability, using the long-range autocorrelations (LRA) assessment [6]
LRA and step length collected from the Nordic Walking (NW) session are similar to that of the healthy population
Summary
Gait disorders of Parkinson’s disease (PD) are characterized by the breakdown of the temporal organization of stride duration variability that was tightly associated to dynamic instability in PD. As a result of such impairment, a reduced gait speed, shorter stride length, reduced arm swing and a random walking pattern (i.e. increased gait variability) are typical features of PD gait [1,2,3,4,5]. From the specific temporal point of view, the inability to produce a steady gait rhythm, which result in more random stride-to-stride variability, is one of the primary temporal gait disorders and can indicate a sensitive marker of a higher fall risk in PD [5, 6]. The randomness of PD gait was recently emphasized by subtle deterioration of the temporal organization of gait variability, using the long-range autocorrelations (LRA) assessment [6]. Deviations from an optimal level of variability in either the direction of randomness or the over-regularity are thought to reflect the loss of the adaptive capabilities of the system [8]
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