Abstract
Alterations in gait biomechanics are common during early stages of Parkinson’s disease (PD), potentially elevating energy requirements of walking and leading to impaired economy of gait. Although gait economy is traditionally assessed during treadmill walking with simultaneous ox-ygen consumption (VO2) monitoring, treadmill gait mechanics, particularly in PD, may be different from over-ground walking mechanics, possibly providing a distorted picture of true gait economy. Currently, no studies have directly examined the energy cost of over-ground walking in PD patients. The purpose of this study was to test the feasibility of measuring energy expenditure during over-ground walking in mild to moderate PD using portable gas exchange monitoring technology. Additionally, we sought to determine whether energy expenditure, as assessed through VO2 measures, related to disease severity for PD. Seventeen PD patients underwent separate 6-minute walk (6MW) tests both with and without the COSMED K4b2 portable oxygen monitoring system. Gait economy was calculated as measured VO2 during 6MW divided by the predicted VO2 for non-PD age-matched subjects, according to a standard estimation equation utilizing ground speed. Distance covered during the 6MW with the portable system (420 ± 12 meters) was highly correlated (r = 0.96, p 2 peak for normal floor walking, and show impaired gait economy relative to prediction equations. Interestingly, the degree of elevated energy expenditure during gait did not relate to disease severity.
Highlights
IntroductionAlterations in the biomechanics of gait, such as decreased stride length, increased stride length variability and reduced gait speed, are common even in early-stage Parkinson’s Disease (PD) [1,2,3]
Gait impairment is one of the cardinal symptoms of Parkinson’s Disease (PD)
Our results demonstrate that PD patients use extraordinarily high percentage of VO2 peak for normal floor walking, and show impaired gait economy relative to prediction equations
Summary
Alterations in the biomechanics of gait, such as decreased stride length, increased stride length variability and reduced gait speed, are common even in early-stage PD [1,2,3]. PD patients attempt to compensate for short steps by increasing gait cadence, thereby potentially elevating energy requirements of usual pace walking. Increased energy expenditure during walking, manifested as higher oxygen consumption (VO2), reflects inefficient gait or lower economy of gait [4], with activities being performed at a higher percentage of an individual’s maximal or peak aerobic capacity (VO2 peak). The clinical significance is that impaired economy of gait and decreased physiological reserve often lead to increased fatigue and reduced endurance, thereby limiting functional independence and sustainability of activities of daily living (ADLs).
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