Fast-paced Gait Speed Research Articles

Relationship between quadriceps femoris echotexture biomarkers and muscle strength and physical function in older adults with heart failure with preserved ejection fraction

BackgroundMuscle wasting is pronounced in patients with heart failure with preserved ejection fraction (HFpEF). The quadriceps femoris echotexture biomarkers assessed by ultrasound (US) have not been studied in these patients. ObjectiveTo describe echotexture biomarkers assessed by the US and to assess their relationship with sex, age, body mass index (BMI), self-reported outcomes, muscle strength and physical function in older adults with HFpEF. MethodsA cross-sectional study was conducted. Patients 70 years and older with HFpEF were included. The sex, age, BMI, and self-reported outcomes were collected. The US assessed muscle and subcutaneous fat tissue contrast, correlation, energy, homogeneity, and entropy at rest and maximal voluntary isometrical contraction (MVIC). The six-minute walk test (6MWT), the short physical performance battery (SPPB), the timed up and go test (TUG), the usual pace gait speed test (UGS), and the fast pace gait speed test (FGS) were used to assess physical function. The five-repetitions sit-to-stand test (5-STS) was performed to assess muscle strength. Bivariant Pearson correlations and subsequent multivariate linear regression analyses were conducted. ResultsSeventy-two older adults with HFpEF [81.06 years, 29.13 BMI, and 55.60% females] were recruited. In women, relaxed and MVIC muscle energy and entropy explained 35.40% of the TUG variance; relaxed muscle entropy and MVIC muscle energy shared 24.00% of the UGS variance; relaxed and MVIC muscle entropy, MVIC muscle contrast and MVIC muscle energy explained 32.60% of the FGS variance, adjusted all the models by age and BMI. ConclusionsEchotexture biomarkers are related to women's muscle strength and physical function, especially muscle energy, contrast, and entropy. Echotexture biomarkers assessed by the US could facilitate the management of older adults with HFpEF, monitor its progression and assess the effectiveness of treatments on the musculoskeletal structure. Trial registrationNCT03909919. April 10, 2019. Retrospectively registered.

Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial

To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n=58) or TR (n=56). HBR comprised at least five physical therapy sessions over 10weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12weeks, with a non-inferiority margin of 0.10m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02m/s; 95%CrI, -0.05 to 0.10m/s; week-24 difference, 0.01m/s; 95%CrI, -0.07 to 0.10m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.

Predictors of Clinically Meaningful Gait Speed Response to Caloric Restriction Among Older Adults Participating in Weight Loss Interventions.

The purpose of this study was to examine whether select baseline characteristics influenced the likelihood of an overweight/obese, older adult experiencing a clinically meaningful gait speed response (±0.05 m/s) to caloric restriction (CR). Individual level data from 1 188 older adults participating in 8, 5/6-month, weight loss interventions were pooled, with treatment arms collapsed into CR (n = 667) or no CR (NoCR; n = 521) categories. Exercise assignment was equally distributed across groups (CR: 65.3% vs NoCR: 65.4%) and did not interact with CR (p = .88). Poisson risk ratios (95% confidence interval [CI]) were used to examine whether CR assignment interacted with select baseline characteristic subgroups: age (≥65 years), sex (female/male), race (Black/White), body mass index (BMI; ≥35 kg/m2), comorbidity (diabetes, hypertension, cardiovascular disease) status (yes/no), gait speed (<1.0 m/s), or inflammatory burden (C-reactive protein ≥3 mg/L, interleukin-6 ≥2.5 pg/mL) to influence achievement of ±0.05 m/s fast-paced gait speed change. Main effects were also examined. The study sample (69.5% female, 80.1% White) was 67.6 ± 5.3 years old with a BMI of 33.8 ± 4.4 kg/m2. Average weight loss achieved in the CR versus NoCR group was -8.3 ± 5.9% versus -1.1 ± 3.8%; p < .01. No main effect of CR was observed on the likelihood of achieving a clinically meaningful gait speed improvement (risk ratio [RR]: 1.09 [95% CI: 0.93, 1.27]) or gait speed decrement (RR: 0.77 [95% CI: 0.57, 1.04]). Interaction effects were nonsignificant across all subgroups. The proportion of individuals experiencing a clinically meaningful gait speed change was similar for CR and NoCR conditions. This finding is consistent across several baseline subgroupings.

Association of Sex or Race With the Effect of Weight Loss on Physical Function

Consideration of differential treatment effects among subgroups in clinical trial research is a topic of increasing interest. This is an especially salient issue for weight loss trials. To determine whether stratification by sex and race is associated with meaningful differences in physical function response to weight loss among older adults. This pooled analysis used individual-level data from 8 completed randomized clinical trials of weight loss conducted at Wake Forest University or Wake Forest School of Medicine, Winston-Salem, North Carolina. Data were housed within the Wake Forest Older Americans Independence Center data repository and provided complete exposure, outcome, and covariate information. Data were collected from November 1996 to March 30, 2017, and analyzed from August 15, 2019, to June 10, 2020. Treatment arms within each study were collapsed into caloric restriction (CR [n = 734]) and non-CR (n = 583) categories based on whether caloric restriction was specified in the original study protocol. Objectively measured 6-month change in weight, fast-paced gait speed (meters per second), and Short Physical Performance Battery (SPPB) score. A total of 1317 adults (mean [SD] age, 67.7 [5.4] years; 920 [69.9%] female; 275 [20.9%] Black) with overweight or obesity (mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 33.9 [4.4]) were included at baseline. Six-month weight change achieved among those randomized to CR was -7.7% (95% CI, -8.3% to -7.2%), with no difference noted by sex; however, White individuals lost more weight than Black individuals assigned to CR (-9.0% [95% CI, -9.6% to -8.4%] vs -6.0% [95% CI, -6.9% to 5.2%]; P < .001), and all CR groups lost a significantly greater amount from baseline compared with non-CR groups (Black participants in CR vs non-CR groups, -5.3% [95% CI, -6.4% to -4.1%; P < .001]; White participants in CR vs non-CR groups, -7.2% [95% CI, -7.8% to -6.6%; P < .001]). Women experienced greater weight loss-associated improvement in SPPB score (CR group, 0.35 [95% CI, 0.18-0.52]; non-CR group, 0.08 [95% CI, -0.11 to 0.27]) compared with men (CR group, 0.23 [95% CI, 0.00-0.46]; non-CR group, 0.34 [95% CI, 0.09-0.58]; P = .03). Black participants experienced greater weight loss-associated improvement in gait speed (CR group, 0.08 [95% CI, 0.05-0.10] m/s; non-CR group, 0.02 [95% CI, -0.01 to 0.05] m/s) compared with White participants (CR group, 0.07 [95% CI, 0.06-0.09] m/s; non-CR group, 0.06 [95% CI, 0.04-0.08] m/s; P = .02). The association of weight loss on physical function in older adults appears to differ by sex and race. These findings affirm the need to consider biological variables in clinical trial design.

High intensity interval training combined with L-citrulline supplementation: Effects on physical performance in healthy older adults.

The aim of this study was to evaluate the effect of citrulline (CIT) supplementation combined to high intensity interval training (HIIT) on physical performance in healthy older adults. This study is a secondary analysis from a double-blind, randomized trial. Among the participants (sedentary & inactive older adults aged over 65 yrs), 44 were non obese (BMI <30 kg/m2) and completed the intervention: Placebo + HIIT (PLA; n = 21) or CIT + HIIT (n = 23). All participants ingested either 10 g of CIT supplementation/day or placebo and followed HIIT sessions (30 min/session; cycle: 30 s > 85% of maximal heart rate (HR) and Borg scale >17/20 + 1:50 min at 65% HR and Borg scale between 13 and 16) on an elliptical device 3 times per week over a 12-week period. Body composition, muscle strength, muscle power, functional capacities (unipodal balance; self-paced and fast Timed Up and Go (nTUG; fTUG); chair test; step tests; 4-meter walking test; 6-minute walking test); dietary intake, energy expenditure and biological markers were measured pre and post-intervention. A repeated-measure analysis of variance was used to estimate time (HIIT intervention), group (PLA vs. CIT) and time*group effects. The decrease in BMI (p = 0.02) and android fat mass (p = 0.05) were significantly greater in the HIIT+CIT group than in the HIIT+PLA group. Finally, a greater increase in self-paced gait speed (nTUG) (p = 0.02) and fast-paced gait speed (fTUG) (p = 0.03) were also observed in the HIIT+CIT group than in the HIIT+PLA group. CIT supplementation combined to HIIT is more effective in improving functional capacities and body composition in healthy older adults than HIIT alone.

Spatial task-related brain activity and its association with preferred and fast pace gait speed in older adults

Task-related brain activity is associated with preferred pace gait speed in older adults. Whether similar regional brain activity relates to fast pace gait speed has yet to be determined, but may provide insight into neural substrate important for walking under various conditions. This study measured regional blood-oxygen-level dependent (BOLD) changes using functional magnetic resonance imaging (fMRI) in response to a spatial Simon/Stroop task in community-dwelling older adults (N = 20, 63–80y). Preferred pace, fast pace, and dual-task gait speeds (picking up objects at preferred pace; fast walking over obstacles) were measured across a 7-meter course. Time to complete a fast pace 400 m walk test was also recorded. Partial correlations were used for all analyses after adjusting for age. Accuracy on incongruent trials of the spatial task was positively correlated with all fast walking conditions (all p < 0.01), but not preferred pace walking conditions. BOLD signal change in the left middle frontal gyrus during the spatial task was associated with preferred pace gait speed (r = 0.51, p = 0.02) and fast walking over obstacles (r = 0.53, p = 0.01). Interestingly, BOLD signal change in the bilateral precuneus was associated with fast pace gait speed (r = 0.58, p < 0.01), fast walking over obstacles (r = 0.48, p = 0.03), and 400 m walk time (r=−0.49, p = 0.02). These results find preferred and fast pace gait speed are associated with different regional task-related brain activity, with activation in the precuneus related with greater performance during fast pace walking.

Dynamic balance and instrumented gait variables are independent predictors of falls following stroke

BackgroundFalls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12 months following rehabilitation discharge.MethodsA prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63 years; median 24 days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars.ResultsOver 12 months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P < 0.001–0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P < 0.040; IQR-odds ratio(OR) = 1.37–7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P = 0.001–0.018; IQR-OR = 5.28–10.29).ConclusionsReduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.

Motor Imagery during Action Observation of Locomotor Tasks Improves Rehabilitation Outcome in Older Adults after Total Hip Arthroplasty

This study aimed at determining whether the combination of action observation and motor imagery (AO + MI) of locomotor tasks could positively affect rehabilitation outcome after hip replacement surgery. Of initially 405 screened participants, 21 were randomly split into intervention group (N = 10; mean age = 64 y; AO + MI of locomotor tasks: 30 min/day in the hospital, then 3×/week in their homes for two months) and control group (N = 11, mean age = 63 y, active controls). The functional outcomes (Timed Up and Go, TUG; Four Step Square Test, FSST; and single- and dual-task gait and postural control) were measured before (PRE) and 2 months after surgery (POST). Significant interactions indicated better rehabilitation outcome for the intervention group as compared to the control group: at POST, the intervention group revealed faster TUG (p = 0.042), FSST (p = 0.004), and dual-task fast-paced gait speed (p = 0.022), reduced swing-time variability (p = 0.005), and enhanced cognitive performance during dual tasks while walking or balancing (p < 0.05). In contrast, no changes were observed for body sway parameters (p ≥ 0.229). These results demonstrate that AO + MI is efficient to improve motor-cognitive performance after hip surgery. Moreover, only parameters associated with locomotor activities improved whereas balance skills that were not part of the AO + MI intervention were not affected, demonstrating the specificity of training intervention. Overall, utilizing AO + MI during rehabilitation is advised, especially when physical practice is limited.

Standing balance post total knee arthroplasty: sensitivity to change analysis from four to twelve weeks in 466 patients

Little is known about how static standing balance changes post total knee arthroplasty (TKA). The primary aim of this study was to examine the sensitivity to change and redundancy of center of pressure (COP) variables post-TKA. The secondary aim was to compare the sensitivity of these measures to standard clinical assessments of one repetition maximum knee extension strength and fast pace gait speed. 466 participants performed instrumented double-limb standing balance tests with eyes open at 4 and 12 weeks post-TKA. Measures of COP standard deviation, amplitude, root mean square (RMS), path length, detrended fluctuation analysis (DFA) and signal frequency content for the medial-lateral (ML) and anterior-posterior (AP) axes were examined. Significant decreases in total path length, ML variables related to sway velocity and AP signal complexity and frequency were observed. Inter-session Cohen's d effect size (ES) revealed the strongest effect was for high velocity ML path length, with a 12% decrease in this rapid sway. This variable, along with AP mean instantaneous frequency and AP DFA, were the only ones significantly different with effect sizes >0.20 and non-redundant (Spearman's rho <0.75). The ES of COP-derived variables (maximum=0.45) were lower than gait speed (1.40) and knee extensor strength (1.54). Increased high velocity ML sway is present at four compared to 12 weeks post-TKA. This augmented rapid sway may provide increased challenges to the postural control system at a time coinciding with reduced strength levels, which could have implications for physical function during activities of daily living.

Gait assessment using the Microsoft Xbox One Kinect: Concurrent validity and inter-day reliability of spatiotemporal and kinematic variables

The revised Xbox One Kinect, also known as the Microsoft Kinect V2 for Windows, includes enhanced hardware which may improve its utility as a gait assessment tool. This study examined the concurrent validity and inter-day reliability of spatiotemporal and kinematic gait parameters estimated using the Kinect V2 automated body tracking system and a criterion reference three-dimensional motion analysis (3DMA) marker-based camera system. Thirty healthy adults performed two testing sessions consisting of comfortable and fast paced walking trials. Spatiotemporal outcome measures related to gait speed, speed variability, step length, width and time, foot swing velocity and medial–lateral and vertical pelvis displacement were examined. Kinematic outcome measures including ankle flexion, knee flexion and adduction and hip flexion were examined. To assess the agreement between Kinect and 3DMA systems, Bland–Altman plots, relative agreement (Pearson's correlation) and overall agreement (concordance correlation coefficients) were determined. Reliability was assessed using intraclass correlation coefficients, Cronbach's alpha and standard error of measurement. The spatiotemporal measurements had consistently excellent (r≥0.75) concurrent validity, with the exception of modest validity for medial–lateral pelvis sway (r=0.45–0.46) and fast paced gait speed variability (r=0.73). In contrast kinematic validity was consistently poor to modest, with all associations between the systems weak (r<0.50). In those measures with acceptable validity, the inter-day reliability was similar between systems. In conclusion, while the Kinect V2 body tracking may not accurately obtain lower body kinematic data, it shows great potential as a tool for measuring spatiotemporal aspects of gait.

The Influence of Cervical Spine Flexion-Rotation Range-of-Motion Asymmetry on Postural Stability in Older Adults

Cross-sectional design. The purpose of this study was to isolate the contribution of cervical spine range-of-motion (ROM) asymmetry to postural control in a group of older adults with neck pain. Previous research has suggested that the upper cervical spine plays an important role in postural stability. However, it remains unclear whether the upper cervical spine rotation ROM asymmetry is associated with postural stability. Using the cervical range-of-motion device to assess upper cervical spine ROM via the cervical flexion-rotation test, we classified 54 older adults with neck pain (30 females; mean [standard deviation] age, 66 [5] yr) into the (1) symmetrical group (SYM; n = 20; ≤5° side-to-side difference) or (2) asymmetrical group (ASYM; n = 34; >5° difference). Standing postural control was characterized by the center-of-pressure (CoP) movements measured using a Balance Board. Other measures included habitual, fast-paced gait speed and neck pain. Both groups were compared on the various measures using Welch t tests. Although the ASYM group had 26% greater anteroposterior postural sway than the SYM (P < 0.01), both groups did not differ on postural sway velocity, gait speed, and neck pain intensity. Analyzing the frequency content of the postural sway using wavelet analysis (a modern, nonlinear signal processing method) shed further light: the standing postural sway in the ASYM group was skewed toward lower frequency movement (ultralow [< 0.10Hz] frequency content, anteroposterior: 6.7% in ASYM, 4.7% in SYM, P = 0.01; medial-lateral: 4.2% in ASYM, 3.4% in SYM, P = 0.045). The ASYM group seemed to have compensated for their altered somatosensory input to achieve similar functional levels as the SYM group. Given what is known about the association between ultralow frequency postural sway and visual input, we speculated that the postural strategy adopted by the ASYM group was adaptive and that this group may be relying on the visual system to achieve these compensations.

Association between seated postural control and gait speed in knee osteoarthritis

The purpose of this study was to evaluate, in patients with knee osteoarthritis, whether seated postural control is a multivariate predictor of gait speed, after adjusting for the effects of conventional knee impairments. Sixty-seven patients with knee osteoarthritis awaiting total knee replacement participated. To measure seated postural control, patients sat on a balance board, and the centre-of-pressure (COP) measures calculated in the anterior–posterior (AP) and medio-lateral (ML) directions were standard deviation (SD) and mean frequency (MF). Isometric knee extensor strength was measured using an isokinetic dynamometer; knee flexion range-of-motion, an extendable goniometer; and knee pain intensity, a numeric pain rating scale. Fast-pace gait speed was assessed by the 10-m walk test and a poor gait speed was defined at a cutoff value of 1.0m/s. At the univariate level, the seated COP measures, with the exception of AP–MF, discriminated between patients with and without poor gait speed; however, only ML–MF retained its predictive value in multivariable analyses adjusted for demographic, anthropometric, and knee impairment measures. These findings suggest that seated postural control may be an important correlate of physical function in patients with knee OA and that greater emphasis in the assessment of trunk control may be warranted in this population.

Relationship Between Perceived and Measured Changes in Walking After Stroke

Examining participant-perceived change in walking provides insight into whether changes were meaningful for participants. This study examined the relationships between change scores in standardized walking outcomes and ratings of perceived change following exercise poststroke. Self- and fast-paced gait speed and Six-Minute Walk Test (6MWT) distance were assessed in 22 participants (age 67 ± 10.3 years, 1.8 ± 0.9 years poststroke) before and after a 3-month exercise program. Perceived changes were evaluated using a 15-point Likert scale. Correlation analyses between measured and perceived changes were performed. Subgroups of low and high baseline scores were compared for differences in measured and perceived changes. Six-Minute Walk Test change was correlated with perceived change (ρ = 0.52, P = 0.01), greater 6MWT change was demonstrated among participants who perceived improvement compared to those who did not (difference 34.4 m, 95% CI: 17.2-51.6, P = 0.04). After controlling for measured change, participants with low baseline 6MWT distances perceived less change than those who walked high distances at baseline (P = 0.006) even when relative change was equivalent. A global rating scale using meaningful and context-specific questions was used to determine the relationship between measured and participant-perceived changes in 6MWT distance. A meaningful difference in 6MWT change was observed between participants who did and those who did not perceive improvement. Individuals with lower baseline scores may require larger changes in walking distance to perceive that a change has occurred. This study contributes to a growing body of evidence about the relationships between perceived and measured changes in function and is a step in determining thresholds for perceived change in walking after stroke.

Associations of knee extensor strength and standing balance with physical function in knee osteoarthritis

Knee extensor strength is an important correlate of physical function in patients with knee osteoarthritis; however, it remains unclear whether standing balance is also a correlate. The purpose of this study was to evaluate the cross-sectional associations of knee extensor strength, standing balance, and their interaction with physical function. One hundred four older adults with end-stage knee osteoarthritis awaiting a total knee replacement (mean ± SD age 67 ± 8 years) participated. Isometric knee extensor strength was measured using an isokinetic dynamometer. Standing balance performance was measured by the center of pressure displacement during quiet standing on a balance board. Physical function was measured by the self-report Short Form 36 (SF-36) questionnaire and by the 10-meter fast-pace gait speed test. After adjustment for demographic and knee pain variables, we detected significant knee strength by standing balance interaction terms for both SF-36 physical function and fast-pace gait speed. Interrogation of the interaction revealed that standing balance in the anteroposterior plane was positively related to physical function among patients with lower knee extensor strength. Conversely, among patients with higher knee extensor strength, the standing balance-physical function associations were, or tended to be, negative. These findings suggest that although standing balance was related to physical function in patients with knee osteoarthritis, this relationship was complex and dependent on knee extensor strength level. These results are of importance in developing intervention strategies and refining theoretical models, but they call for further study.