Effects of Physical Rehabilitation on Spatiotemporal Gait Parameters and Ground Reaction Forces of Patients with Intermittent Claudication.

Wioletta Dziubek,Katarzyna Kropielnicka,Katarzyna Barska,Andrzej Szuba,Ryszard Jasiński,Rafał Paszkowski,Katarzyna Bulińska,Anna Rachwalik,Małgorzata Stefańska,Marek Woźniewski

doi:10.3390/jcm9092826

Abstract

Chronic ischemia of the lower extremities often presents as intermittent claudication characterized by lower limb pain which subsides after a short break. This study aimed to provide an assessment of the spatiotemporal parameters of gait and ground reaction forces in patients with PAD participating in three forms of supervised physical training. A total of 80 subjects completed a three-month supervised physical rehabilitation program with three sessions per week. The subjects were assigned to one of three programs: group 1—standard walking training on a treadmill (TT); group 2—Nordic walking (NW) training; group 3—strength and endurance training comprised of NW with isokinetic resistance training (NW + ISO). Gait biomechanics tests (kinematic and kinetic parameters of gait) and a six-minute walk test were carried out before and after three months of physical training. Nordic walking training led to the greatest improvements in the gait pattern of patients with PAD and a significant increase in the absolute claudication distance and total gait distance. Combined training (NW + ISO) by strengthening the muscles of the lower extremities increased the amplitude of the general center of gravity oscillation to the greatest extent. Treadmill training had little effect on the gait pattern. Nordic walking training should be included in the rehabilitation of patients with PAD as a form of gait training, which can be conducted under supervised or unsupervised conditions.

Highlights

Atherosclerosis is the most common cause of peripheral arterial disease (PAD) of the lower extremities, resulting in chronic leg ischemia
Chronic ischemia of the lower extremities often presents as intermittent claudication of the calf or the whole leg, characterized by pain after walking a certain distance which subsides after a short break [1,2]
The criteria for inclusion in the rehabilitation program were as follows: aged above 40 years, chronic lower limb ischemia (PAD IIa and IIb according to Fontaine’s classification), claudication distance stable for at least the last 3 months, ankle-brachial index (ABI) lower than 0.9, and written consent to participate in the program

Summary

Introduction

Atherosclerosis is the most common cause of peripheral arterial disease (PAD) of the lower extremities, resulting in chronic leg ischemia. Prolonged ischemia and recurring pain cause a significant reduction in muscle strength, which eventually leads to decreased muscle mass and metabolic changes in their structure [3]. Histopathology studies have demonstrated a reduction in the number of fast-twitch fibres and motor units in patients with PAD, which decreases muscle strength and endurance. In PAD patients, the involvement of particular gait phases changes as the swing phase is reduced and stance phase is prolonged [8], which is probably due to weakness in the ankle and knee muscles [4,9,10]

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