Fast Walking Research Articles

The impact of twisted wind on pedestrian comfort around two non-identical-height buildings in tandem arrangement: a wind tunnel study

Due to the impact of urbanization, an increasing number of buildings are being constructed near hilly terrains because of the limited availability of land resources. The influence of twisted wind profile (TWP) on pedestrian-level wind comfort surrounding two tandem non-identical-height buildings, with a height ratio H1/H2 ranging from 3:1 to 1:0.33, was investigated by wind tunnel experiment with two twist angles (13 ° and 25 °), and compared with the conventional wind profile (CWP). The assessment of thermal comfort was based on Physiologically Equivalent Temperature (PET) using wind velocity measured from the wind tunnel and observation results. Both the mean and gust wind velocities were investigated and compared with wind assessment criteria. The results reveal a significant disparity in the mean and gust wind fields for various H1/H2 under both CWP and TWPs, with the influence of twist being more pronounced for step-up building configuration (H1<H2). The influence of TWPs on the low wind velocity region demonstrated contrasting patterns for buildings with step-up and step-down configurations. The pedestrian level wind environment varies significantly with H1/H2 under CWP and TWPs in the passage between the two tandem buildings, categorized as “Sitting long” for identical-height buildings and modified to “Strolling” and “Walking fast” for step-up building configuration. The twisted wind shifts the “Sitting short” area toward the direction of the approaching twisted wind flow and amplifies the “Strolling” area on the other side. The twisted wind can diminish the thermal comfort surrounding the two tandem structures during summer while enhancing the thermal environment in winter.

Gait Analysis with Wearable Sensors in Isolated REM Sleep Behavior Disorder Associated with Phenoconversion: An Explorative Study.

Gait disturbance is a vital characteristic of motor manifestation in α- synucleinopathies, especially Parkinson's disease. Subtle gait alterations are present in isolated rapid eye movement sleep behavior disorder (iRBD) patients before phenoconversion; it is yet unclear, if gait analysis may predict phenoconversion. To investigate subtle gait alterations and explore whether gait analysis using wearable sensors is associated with phenoconversion of iRBD to α-synucleinopathies. Thirty-one polysomnography-confirmed iRBD patients and 33 healthy controls (HCs) were enrolled at baseline. All participants walked for a minute while wearing 6 inertial sensors on bilateral wrists, ankles, and the trunk (sternal and lumbar region). Three conditions were tested: (i) normal walking, (ii) fast walking, and (iii) dual-task walking. Decreased arm range of motion and increased gait variation (stride length, stride time and stride velocity) discriminate converters from HCs at baseline. After an average of 5.40 years of follow-up, 10 patients converted to neurodegenerative diseases (converters). Cox regression analysis showed higher value of stride length asymmetry under normal walking condition to be associated with an early conversion of iRBD to α- synucleinopathies (adjusted HR 4.468, 95% CI 1.088- 18.349, p = 0.038). Stride length asymmetry is associated with progression to α- synucleinopathies in patients with iRBD. Gait analysis with wearable sensors may be useful for screening, monitoring, and risk stratification for disease-modifying therapy trials in patients with iRBD.

Relationship between metabolic cost, muscle moments and co-contraction during walking and running

BackgroundThe metabolic cost of locomotion is a key factor in walking and running performance. It has been studied by analysing the activation and co-activation of the muscles of the lower limbs. However, these measures do not comprehensively address muscle mechanics, in contrast to approaches using muscle moments and co-contraction. Research questionWhat is the effect of speed and type of locomotion on muscle moments and co-contraction, and their relationship with metabolic cost during walking and running? MethodsEleven recreational athletes (60.5 ± 7.1 kg; 169.0 ± 6.6 cm; 23.6 ± 3.3 years) walked and ran on a treadmill at different speeds, including a similar speed of 1.75 m.s−1. Metabolic cost was estimated from gas exchange measurements. Muscle moments and co-contraction of ankle and knee flexors and extensors during the stance and swing phases were estimated using an electromyographic-driven model. ResultsBoth the slowest and fastest walking speeds had significantly higher metabolic costs than intermediate ones (p < 0.05). The metabolic cost of walking was correlated with plantarflexors moment during swing phase (r = 0.62 at 0.5 m.s−1, r = 0.67 at 1,25 m.s−1), dorsiflexors moment during stance phase (r = 0.65 at 1.25 m.s−1, r = 0.67 at 1.5 and 1.75 m.s−1), and ankle co-contraction during the stance phase (r = 0.63 at 1.25 and 1.75 m.s−1). The metabolic cost of running at 3.25 m.s−1 during the swing phase was correlated with the dorsiflexors moment (r = 0.63), plantarflexors moment (r = 0.61) and ankle co-contraction (r = 0.60). Discussion and conclusionFluctuations in metabolic cost of walking and running could be explained, at least in part, by increased ankle antagonist moments and co-contraction.

Knee sleeves improve gait symmetry during fast walking in older adults.

Knee sleeves are commonly used to address knee-related concerns, particularly in older individuals. Although previous studies have demonstrated their efficacy in improving gait and functional outcomes in knees with pathological conditions, the effectiveness of knee sleeves for improving gait characteristics in healthy older adults remains unclear. The harmonic ratio (HR), an index for assessing gait symmetry commonly used to discriminate between individuals with different functional levels, can be used to detect alterations in gait characteristics. This study investigated the effects of knee sleeves on gait symmetry in healthy older adults. Sixteen healthy community-dwelling older adults walked barefoot with and without knee sleeves at normal and fast speeds. Gait symmetry indices (HR and improved HR [iHR]) and spatiotemporal gait parameters were compared under different conditions. A significant interaction between knee condition and walking speed was observed for mean iHR in the anteroposterior direction (p = 0.006). A significant simple main effect of knee condition was found during fast walking, with a larger iHR with knee sleeves than without (p = 0.002). In the condition without knee sleeves, the iHR was significantly lower during fast walking than during normal walking (p = 0.035). Furthermore, a significant main effect of knee condition was observed for the variability of iHR in the anteroposterior direction, with a smaller variability when walking with knee sleeves than when walking without (p = 0.006). These results suggest that knee sleeves may enhance gait symmetry along the anteroposterior direction, particularly during fast walking, where symmetry disruption is more likely than walking at a comfortable pace. A significant reduction in gait symmetry variability also suggests a stabilizing effect on gait dynamics. These findings provide the first evidence supporting the efficacy of knee sleeves for improving gait symmetry. The use of knee sleeves could be a valuable option for restoring disrupted gait symmetry during fast walking, with potential implications for reducing the risk of falls.

Inter-joint coordination with and without dopaminergic medication in Parkinson’s disease: a case-control study

BackgroundHow the joints exactly move and interact and how this reflects PD-related gait abnormalities and the response to dopaminergic treatment is poorly understood. A detailed understanding of these kinematics can inform clinical management and treatment decisions. The aim of the study was to investigate the influence of different gait speeds and medication on/off conditions on inter-joint coordination, as well as kinematic differences throughout the whole gait cycle in well characterized pwPD.Methods29 controls and 29 PD patients during medication on, 8 of them also during medication off walked a straight walking path in slow, preferred and fast walking speeds. Gait data was collected using optical motion capture system. Kinematics of the hip and knee and coordinated hip-knee kinematics were evaluated using Statistical Parametric Mapping (SPM) and cyclograms (angle-angle plots). Values derived from cyclograms were compared using repeated-measures ANOVA for within group, and ttest for between group comparisons.ResultsPD gait differed from controls mainly by lower knee range of motion (ROM). Adaptation to gait speed in PD was mainly achieved by increasing hip ROM. Regularity of gait was worse in PD but only during preferred speed. The ratios of different speed cyclograms were smaller in the PD groups. SPM analyses revealed that PD participants had smaller hip and knee angles during the swing phase, and PD participants reached peak hip flexion later than controls. Withdrawal of medication showed an exacerbation of only a few parameters.ConclusionsOur findings demonstrate the potential of granular kinematic analyses, including > 1 joint, for disease and treatment monitoring in PD. Our approach can be extended to further mobility-limiting conditions and other joint combinations.Trial registrationThe study is registered in the German Clinical Trials Register (DRKS00022998, registered on 04 Sep 2020).

Association Between education and walking speed: counterfactual mediation analysis in favor of a motor reserve hypothesis.

We quantified the extent to which the association between education and fast walking speed (FWS) is explained by 17 mediators (cardiovascular risk factors/diseases, comorbidities, health behaviours, socio-professional characteristics, cognition), and examined whether mediators interact with education, in favor of a reserve hypothesis. Cross-sectional analyses are based on Constances (population-based study of French adults 45-69y). 3m-FWS was measured using photoelectric cells. Education was categorized as lower/higher. After multiple imputation of missing values, we used counterfactual mediation models for multiple mediators allowing for education×mediator interactions, to estimate the total effect (TE), total indirect effect (TIE), and mediated interaction (IMD) of lower education on FWS. Analyses are based on 71,222 participants (52.6% women; mean age=57.2y; 27.2% higher education; mean FWS=180.2cm/s). In joint mediation analyses, the TE of lower education was -8.19cm/s (95% confidence interval [CI]=-8.87;-7.51), with a TIE of -5.76cm/s (95%CI=-6.10;-5.41; proportion mediated=70.3%, 95%CI=65.6;75.0). The IMD was negative (-2.52, 95%CI=-3.31;-1.72); 30.8% of the TE and 43.8% of the TIE were attributable to the IMD. Several mediators explain a large part of the association between lower education and slower FWS. The detrimental effect of mediators was more pronounced in participants with lower than in those with higher education, in agreement with a reserve hypothesis.

Atrioventricular Synchrony Delivered by a Dual-Chamber Leadless Pacemaker System.

A dual-chamber leadless pacemaker system has been designed for atrioventricular synchronous pacing using wireless, beat-to-beat, implant-to-implant (i2i) communication between distinct atrial and ventricular leadless pacemakers. The atrioventricular synchrony achieved across various ambulatory scenarios has yet to be systematically evaluated. A prospective, single-arm, unblinded, multicenter, international clinical trial of the leadless pacemaker system was conducted in patients with a conventional dual-chamber pacing indication enrolled from February 2022 to March 2023. Leadless pacemaker systems were implanted, and 12-lead Holter electrocardiographic recordings were collected 3 months after implantation over various postures/activities: sitting, supine, left lateral recumbent, right lateral recumbent, standing, normal walk, and fast walk. An independent Holter core laboratory performed a manual adjudication of the percent of atrioventricular synchronous beats using the standard 300-millisecond PR interval limit. Atrium-to-ventricle and ventricle-to-atrium i2i communication success rates were also assessed. Post hoc summary statistics describing the relationships between atrioventricular synchrony and i2i success, posture/activity, implantation indication, atrioventricular event, and heart rate were calculated. In the evaluable population (n=384 of 464 enrolled [83%]; 61% male; age, 70 years; weight, 82 kg; 60% ejection fraction; 95% of beats evaluable), the mean atrioventricular synchrony of 98% of beats observed across all postures using the standard 300-millisecond limit was greater than both atrial-to-ventricular i2i (94%) and ventricular-to-atrial i2i (94%; P<0.001), exceeding both i2i values in 95% of patients. Atrioventricular synchrony was achieved in >95% of evaluable beats across all postures/activities, implantation indications, atrioventricular paced/sensed event combinations, and heart rate ranges (including >100 bpm). This dual-chamber leadless pacemaker system demonstrated atrioventricular synchrony in 98% of evaluable beats at 3 months after implantation. Atrioventricular synchrony was maintained across postures/activities and remained robust for heart rates >100 bpm.

Dorsiflexion Specific Ankle Robotics to Enhance Motor Learning After Stroke: A Preliminary Report.

Robotics has emerged as a promising avenue for gait retraining of persons with chronic hemiparetic gait and footdrop, yet there is a gap regarding the biomechanical adaptations that occur with locomotor learning. We developed an ankle exoskeleton (AMBLE) enabling dorsiflexion assist-as-needed across gait cycle sub-events to train and study the biomechanics of motor learning stroke. This single-armed, non-controlled study investigates effects of nine hours (9 weeks × 2 sessions/week) locomotor task-specific ankle robotics training on gait biomechanics and functional mobility in persons with chronic hemiparetic gait and foot drop. Subjects include N = 16 participants (8 male, 8 female) age 53 ± 12 years with mean 11 ± 8 years since stroke. All baseline and post-training outcomes including optical motion capture for 3-D gait biomechanics are conducted during unassisted (no robot) over-ground walking conditions. Robotics training with AMBLE produced significant kinematic improvements in ankle peak dorsiflexion angular velocity (°/s, + 44 [49%], p < 0.05), heel-first foot strikes (%steps, + 14 [15%], p < 0.01) toe-off angle (°, + 83[162%], p < 0.05), and paretic knee flexion (°, + 20 [30%], p < 0.05). Improvements in gait temporal-spatial parameters include increased paretic step length (cm, + 12 [20%], p< 0.05), reduced paretic swing duration (%GC, -3[6%], p < 0.05), and trend toward improved step length symmetry (-16 [11%], p = 0.08). Functional improvements include 10-meter comfortable (m/s, + 13 [16%], p < 0.01) and fastest (m/s, + 13 [15%], p<0.01) walking velocities, 6-minute timed walk distance (m, + 16 [19%], p < 0.01) and Dynamic Gait Index scores (+15 [15%], p < 0.01). Subjects' perceived improvements surpassed the minimal clinically important difference on the Stroke Impact Scale (SIS) mobility subscale (+11 [19%], p < 0.05). AMBLE training improves paretic ankle neuromotor control, paretic knee flexion, and gait temporal-distance parameters during unassisted over-ground walking in persons with chronic stroke and foot drop. This locomotor learning indexed by an increase in volitional autonomous (non-robotic) control of paretic ankle across training translated to improvements in functional mobility outcomes. Larger randomized clinical trials are needed to investigate the effectiveness of task-specific ankle robotics, and precise training characteristics to durably improve gait, balance, and home and community-based functional mobility for persons with hemiparetic gait and foot drop. NCT04594837.

Factors Associated with Overweight/Obesity among Rural Secondary School Children in Bangladesh

Background &amp; Objective: Unhealthy dietary patterns in combination with a sedentary lifestyle could be contributing to some major health issues worldwide. Obesity in children and adolescents can have short- and long-term adverse health consequences including early mortality. Although previously limited to urban areas, with the rapid adoption of urban lifestyle by the rural people the problem is now ubiquitous. It is difficult to develop a policy for promoting health and reducing obesity among adolescents living in rural regions since there is a lack of information on the factors that contribute to this problem. The present study was, therefore undertaken to evaluate the factors influencing overweight and obesity among rural adolescents. Methods: This cross-sectional study was done based on data collected by students of Rajshahi Medical College as part of their RFST (Rural Field-site Training) in 2019 from a rural area of Rajshahi, Bangladesh. A total of 535 students from two rural secondary schools participated in the study. Every alternate student of those schools from class VI-X was then included in the study as a respondent. The weight and height of the selected students were first taken followed by data collection on variables of interest. Using weight and height data, the body mass index (BMI) of the respondents was first determined and was plotted on a growth chart (recommended by CDC, Atlanta) to find the percentile. Then the nutritional status of the individual respondents was determined based on their percentile status and was classified as underweight, normal, overweight, or obese. Results: Almost one-fifth (18.2%) of the respondents was found overweight or obese. Upon comparing respondents’ demographic characteristics, food and exercise behaviour between overweight &amp; obese and normal &amp; underweight groups, the former group was found younger than the latter group. Respondents’ socioeconomic status (SES) was associated with their nutritional status with overweight &amp; obese adolescents being significantly higher in the Middle- and rich SES group (78.4%) than in the poor and lower middle-class (61.4%). Neither dietary nor exercise behaviour was associated with the nutritional status of the respondents. Although the majority (84.2%) of normal &amp; underweight adolescents preferred low to medium-calorie snacks, overweight and obese adolescents were more likely to choose high-calorie snacks. Fast walking and running were the more common forms of exercise behaviour and of longer duration among the overweight &amp; obese cohort than those among normal &amp; underweight cohorts. Conclusion: The study concluded that the period of early adolescence is vulnerable to developing obesity. Adolescents belonging to middle and well-off SES are more prone to be overweight or obese than those belonging to lower middle &amp; poor SES. However, exercise, physical activity, and dietary habits of adolescents do not influence their nutritional status. Ibrahim Card Med J 2023; 13 (1&amp;2): 19-25

Treadmill-walking impairs visual function in early glaucoma and elderly controls

Abstract Aims Impaired vision is an additional risk factor in elderly for falls. We investigated the hypothesis that treadmill (TM) walking affects visual function in both healthy elderly and those with early-moderate visual dysfunction due to glaucoma. Methods Thirty healthy controls (HC) aged 64–83 years and 18 glaucoma patients (GLA) aged 62–82 years participated in this cross-sectional study. The impact of TM-walking on visual function was assessed binocularly for (i) best-corrected visual acuity (BCVA) with and without crowding effect, (ii) contrast sensitivity (CS), and (iii) and visual field (mean deviation, VF-MD). Visual function was tested while participants were standing or during TM-walking for 2 speed conditions: (i) fast walking at their preferred speed and (ii) walking at a fixed speed of 3.5 km/h. Results GLA, most with early-moderate VF loss, performed equally well as HC. Independent of GROUP, an impact of SPEED on visual functions was statistically evident with large statistical effect size for (i) both types of BCVA with a mean loss of 0.02–0.05 logMAR (η2 = 0.41) and (ii) VF-MD with mean loss of 1 dB (η2 = 0.70), but not for CS. Conclusions Here, we introduce a paradigm for the assessment of visual function during walking. We provide proof-of-concept that our approach allows for the identification of walking induced visual function loss, i.e., a deterioration of BCVA and VF-sensitivity during TM-walking in both groups. It is therefore of promise for the investigation of the relation of vision impairment and mobility, ultimately the increased frequency of falls in advanced glaucoma.

Physiological Characteristics of Surgical Patients With Obesity in Response to the 6-Min Walk Test

ABSTRACT Background: Overall health and fitness contribute to surgical experience and recovery. The aim of this study was to describe an array of physiological characteristics in a presurgical patient cohort with obesity as a function of their sustained walking speed. Methods: We performed a prospective single-center cohort study in Wollongong Hospital, Australia from 2016 to 2018. Patients (N = 293) with severe obesity completed a 6-min walk test and were classified as either slow or fast walkers according to the cut point of 0.9 m·s−1 (2 mph). These groups were compared for anthropometry, comorbidities, respiratory and cardiovascular physiology, blood biomarkers, patient-centered outcomes, and perception of effort. Results: Slow walkers (n = 115; age 65 [63 to 67] years; mean [95% confidence interval]) and fast walkers (n = 178; age 54 [52 to 56]; P &amp;lt; 0.05) were not different in body weight but were different for body mass index (slow 43.2 [42.0 to 44.4] versus fast 41.1 [40.5 to 41.8]; P &amp;lt; 0.05). Cardiovascular disease and renal disease were more prevalent in slow walkers. Respiratory physiology reflective of restrictive lung disease (force vial capacity [L] slow 2.61 [2.45 to 2.77] versus fast 3.34 [3.19 to 3.47]; P &amp;lt; 0.05) was more common in slow walkers, who also reported higher dyspnea ratings. Resting cardiovascular characteristics were not different, although N-terminal pro-B-type natriuretic peptide levels were higher in the slow group (P &amp;lt; 0.05). Quality of recovery at postoperative day 30 was higher in the fast walking group. Conclusion: In this Australian cohort, patients with obesity undergoing nonbariatric surgery differed in their physiological profiles according to walking speed. This study supports the need to appreciate the physical fitness of patients beyond simplified body weight and classification of obesity in the perioperative period.

Effect of prebiotic fiber on physical function and gut microbiota in adults, mostly women, with knee osteoarthritis and obesity: a randomized controlled trial.

Obesity is a primary risk factor for knee osteoarthritis (OA). Prebiotics enhance beneficial gut microbes and can reduce body fat and inflammation. Our objective was to examine if a 6-month prebiotic intervention improved physical function in adults with knee osteoarthritis and obesity. We also measured knee pain, body composition, quality of life, gut microbiota, inflammatory markers, and serum metabolomics. Adults (n = 54, mostly women) with co-morbid obesity (BMI > 30kg/m2) and unilateral/bilateral knee OA were randomly assigned to prebiotic (oligofructose-enriched inulin; 16g/day; n = 31) or isocaloric placebo (maltodextrin; n = 21) for 6months. Performance based-tests, knee pain, quality of life, serum metabolomics and inflammatory markers, and fecal microbiota and short-chain fatty acids were assessed. Significant between group differences were detected for the change in timed-up-and-go test, 40m fast paced walk test, and hand grip strength test from baseline that favored prebiotic over placebo. Prebiotic also reduced trunk fat mass (kg) at 6months and trunk fat (%) at 3months compared to placebo. There was a trend (p = 0.059) for reduced knee pain at 6months with prebiotic versus placebo. In gut microbiota analysis, a total of 37 amplicon sequence variants differed between groups. Bifidobacterium abundance was positively correlated with distance walked in the 6-min walk test and hand grip strength. At 6months, there was a significant separation of serum metabolites between groups with upregulation of phenylalanine and tyrosine metabolism with prebiotic. Prebiotics may hold promise for conservative management of knee osteoarthritis in adults with obesity and larger trials are warranted. Clinicaltrials.gov/study/NCT04172688.

Effects of walking speeds on lower extremity kinematic synergy in toe vertical position control: An experimental study.

This study aimed to investigate whether lower limb joints mutually compensate for each other, resulting in motor synergy that suppresses toe vertical position fluctuation, and whether walking speeds affect lower limb synergy. Seventeen male university students walked at slow (0.85 ± 0.04 m/s), medium (1.43 ± 0.05 m/s) and fast (1.99 ± 0.06 m/s) speeds on a 15-m walkway while lower limb kinematic data were collected. Uncontrolled manifold analysis was used to quantify the strength of synergy. Two-way (speed × phase) repeated-measures analysis of variance was used to analyze all dependent variables. A significant speed-by-phase interaction was observed in the synergy index (SI) (P < .001). At slow walking speeds, subjects had greater SI during mid-swing (P < .001), while at fast walking speeds, they had greater SI during early-swing (P < .001). During the entire swing phase, fast walking exhibited lower SI values than medium (P = .005) and slow walking (P = .027). Kinematic synergy plays a crucial role in controlling toe vertical position during the swing phase, and fast walking exhibits less synergy than medium and slow walking. These findings contribute to a better understanding of the role of kinematic synergy in gait stability and have implications for the development of interventions aimed at improving gait stability and reducing the risk of falls.

PERCEPTUAL AND HAEMODYNAMIC RESPONSES DURING MODERATE-SPEED WALKING ARE INCREASED BY BLOOD FLOW RESTRICTION IN OLDER ADULTS, BUT DO NOT EXCEED UNRESTRICTED FAST WALKING

INTRODUCTION &amp; AIMS Moderate-speed blood flow restriction (BFR) walking is an efficient exercise modality for older adults who cannot tolerate vigorous activity. However, limited data exist to guide the prescription of this exercise. This study examined the impact of different walking speeds and BFR cuff pressures on perceptual and haemodynamic responses, and compared these to unrestricted fast walking. METHODS Fifteen older adults (67-77 years) performed 10 sessions of 10-minute treadmill walking. In the first session, participants walked “as quickly as possible” to calculate mean fast walk speed. The following nine randomised sessions included moderate-speed walking with 50, 60 or 70% fast walk speed and 0%, 40 or 60% arterial occlusion pressure (AOP). Ratings of perceived discomfort (RPD) and exertion (RPE) were obtained, and blood pressure was assessed to calculate mean arterial pressure (MAP) and pulse pressure (PP). Perceptual scores were examined with Friedman ANOVA and Wilcoxon signed ranks tests, while MAP and PP were examined using linear mixed models (participants as random effects and speed, AOP or condition as fixed effects). RESULTS Higher RPD was observed using 60% AOP, followed by 40%, and 0% (p&amp;lt;0.001). RPE was higher for the fast walk (5.1±0.8 AU) than all other sessions (1.1±0.4 to 2.9±1.4 AU; p&amp;lt;0.001). MAP and PP were increased with higher AOP and walking speeds (p≤0.043). However, MAP (87.2±8.8 to 102.7±15.6 mmHg) and PP (66.3±14.4 to 80.3±21.7 mmHg) from moderate-speed BFR sessions did not significantly exceed measurements during the fast walk trial (MAP=100.1±13.6 mmHg, PP=89.0±22.5 mmHg). CONCLUSION Walking with BFR at 40% and 60% AOP increased limb discomfort and haemodynamic demands. Importantly, these responses did not exceed unrestricted fast walking, which caused the highest RPE. This study suggests a dose-response relationship of BFR cuff pressure with limb discomfort and haemodynamics, though these responses were not exacerbated more than unrestricted fast walking.

Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson’s disease. A secondary analysis from a randomized controlled trial

BackgroundIn the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson’s disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort.MethodsClimb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2–3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test.ResultsCompared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking.ConclusionsSport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson’s disease.Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020)

Longitudinal cognitive decline characterizes the profile of non-PD-manifest GBA1 mutation carriers

With disease-modifying treatment for Parkinson’s disease (PD) associated with variants in the glucocerebrosidase gene (GBA1) under way, the challenge to design clinical trials with non-PD-manifest GBA mutation carriers (GBA1NMC) comes within close reach. To delineate trajectories of motor and non-motor markers as well as serum neurofilament light (sNfL) levels and to evaluate clinical endpoints as outcomes for clinical trials in GBA1NMC, longitudinal data of 56 GBA1NMC carriers and 112 age- and sex-matched GBA1 wildtype participants (GBA1wildtype) with up to 9 years of follow-up was analyzed using linear mixed-effects models (LMEM) and Kaplan–Meier survival analysis of clinical endpoints for motor and cognitive function. GBA1NMC showed worse performance in Pegboard, 20 m fast walking, global cognition as well as in executive and memory function at baseline. Longitudinally, LMEM revealed a higher annual increase of the MDS-UPDRS III bradykinesia subscore in GBA1NMC compared to GBA1wildtype, but comparable trajectories of all other motor and non-motor markers as well as sNfL. Kaplan–Meier survival analysis showed a significantly earlier progression to clinical endpoints of cognitive decline in GBA1NMC. Incidence of PD was significantly higher in GBA1NMC. In conclusion, our study extends data on GBA1NMC indicating early cognitive decline as a potentially characteristic feature. Comprehensive longitudinal assessments of cognitive function are crucial to delineate the evolution of early changes in GBA1NMC enabling a more accurate stratification and allow for a more precise definition of trial design and sample size.

Prediction of walking speed one year following hip fracture based on pre-fracture assessments of mobility and physical activity

BackgroundOlder people with hip fracture are often medically frail, and many do not regain their walking ability and level of physical activity. The aim of this study was to examine the relationship between pre-fracture recalled mobility, fear of falling, physical activity, walking habits and walking speed one year after hip fracture.MethodsThe study had a longitudinal design. Measurements were performed 3–5 days postoperatively (baseline) and at one year after the hip fracture. The measurements at baseline were all subjective outcome measures recalled from pre-fracture: The New Mobility Scale (NMS), the ‘Walking Habits’ questionnaire, The University of California, Los Angeles (UCLA) Activity Scale, Fear of Falling International (FES-I) and demographic variables. At one year 4-meter walking speed, which was a part of the Short Physical Performance Battery (SPPB) was assessed.ResultsAt baseline 207 participants were included and 151 were assessed after one year. Their age was mean (SD) 82.7 (8.3) years (range 65–99 years). Those with the fastest walking speed at one year had a pre-fracture habit of regular walks with a duration of ≥ 30 min and/or a frequency of regular walks of 5–7 days a week. Age (p =.020), number of comorbidities (p <.001), recalled NMS (p <.001), and recalled UCLA Activity Scale (p =.007) were identified as predictors of walking speed at one year. The total model explained 54% of the variance in walking speed.ConclusionsDuration and frequency of regular walks before the hip fracture play a role in walking speed recovery one year following the fracture. Subjective outcome measures of mobility and physical activity, recalled from pre-fracture can predict walking speed at one year. They are gentle on the old and medically frail patients in the acute phase after hip fracture, as well as clinically less time consuming.

Long-Term Effects of a 6-Week Power-Based Resistance Training and Fast Walking Interval Training Program on Physical Function, Muscle Power, Disability, and Frailty in Pre-Frail and Frail Older Adults

Introduction: Concurrent training has been shown to be a beneficial approach to improve overall health status in older adults. However, little is known about the adaptations of this type of training in the long term (i.e., after cessation of exercise), even less in older people affected by frailty syndrome. Therefore, this study aimed (i) to assess the effects of a 6-week concurrent training program composed of power-oriented resistance training and fast walking interval training on physical function, muscle power, disability in activities of daily living and frailty in pre-frail and frail older people, and (ii) to assess the effects of a 6-month detraining period on these outcomes. Methods: A total of 59 pre-frail and frail older adults (>75 years old; Frailty Phenotype >1) were allocated into intervention (INT; n = 32; 81.8 years; 21 women) or control (CON; n = 27; 82.5 years; 19 women) groups. Primary outcomes of this study were Short Physical Performance Battery (SPPB), relative sit-to-stand (STS) power, Barthel index, Lawton scale and Frailty Phenotype. Assessments were performed at baseline (PRE), after the concurrent training programme (POST) and after 6 months of follow-up (DET) in both groups. Mixed model repeated measures ANOVA with Bonferroni’s post hoc tests was used. Results: Immediately after the intervention (∆ = POST-PRE), INT improved SPPB (∆ = 3.0 points; p < 0.001), relative STS power (∆ = 0.87 W·kg−1; p < 0.001) and reduced their frailty levels (∆ = −1.42 criteria; p < 0.001), while no changes were observed in CON. After 6 months of detraining (∆ = DET-PRE), INT showed higher SPPB (∆ = 2.2 points; p < 0.001), higher relative STS power (∆ = 0.73 W·kg−1; p < 0.001) and lower frailty (∆ = −1.24 criteria; p < 0.001) values than those reported at baseline, which were significantly different than those reported by CON. Both, Barthel index and Lawton scale values were not modified during the study in either group. Conclusions: The 6-week concurrent training program improved physical function, muscle power and reduced frailty in pre-frail and frail older people and these improvements were maintained above baseline levels after 6 months of detraining. However, due to the individual variability found, future studies of long-term responders versus non-responders in frail populations are required.

Identification of serum microRNA alterations associated with long-term exercise-induced motor improvements in patients with Parkinson disease.

Long-term physical exercise has been shown to benefit patients with Parkinson disease (PD), but there is a lack of evidence regarding the underlying mechanism. A better understanding of how such benefits are induced by exercise might contribute to the development of therapeutic targets for improving the motor function in individuals with PD. The purpose of this study was therefore to investigate the possible association between exercise-induced motor improvements and the changes in serum microRNA (miRNA) levels of PD patients through small RNA sequencing for the first time. Thirteen PD patients completed our 3-month home-and-community-based exercise program, while 6 patients were assigned to the control group. Motor functions were measured, and small RNA sequencing with data analysis was performed on serum miRNAs both before and after the program. The results were further validated by quantitative real-time polymerase chain reaction. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were then conducted to determine the role of differentially expressed miRNAs. The 3-month home-and-community-based exercise program induced significant motor improvements in PD patients in terms of Unified Parkinson's Disease Rating Scale activities of daily living and Motor Subscale (P < .05), comfortable walking speed (P = .003), fast walking speed (P = .028), Six-Minute Walk Test (P = .004), Berg Balance Scale (P = .039), and Timed Up and Go (P = .002). A total of 11 miRNAs (10 upregulated and one downregulated) were identified to be remarkably differentially expressed after intervention in the exercise group, but not in the control group. The results of miRNA sequencing were further validated by quantitative real-time polymerase chain reaction. It was found that the targets of altered miRNAs were mostly enriched in the mitogen-activated protein kinase, Wnt, and Hippo signaling pathways and the GO annotations mainly included binding, catalytic activity, and transcription regulator activity. The exercise-induced motor improvements were possibly associated with changes in circulating miRNA levels in PD patients. These miRNAs, as well as the most enriched pathways and GO terms, may play a critical role in the mechanism of exercise-induced benefits in PD and serve as novel treatment targets for the disease, although further investigations are needed.

The impact of pediatric obesity on biomechanical differences across the gait cycle at three walking speeds

BackgroundObesity impacts a child's ability to walk with resulting biomechanical adaptations; however, existing research has not comprehensively compared differences across the gait cycle. We examined differences in lower extremity biomechanics across the gait cycle between children with and without obesity at three walking speeds. MethodsFull gait cycles of age-matched children with obesity (N = 10; BMI: 25.7 ± 4.2 kg/m2) and without obesity (N = 10; BMI: 17.0 ± 1.9 kg/m2) were analyzed at slow, normal, and fast walking speeds. Main and interaction effects of group and speed across hip, knee, and ankle joint angles and moments in sagittal, frontal, and transverse planes were analyzed using one-dimensional statistical parametric mapping. FindingsCompared to children without obesity, children with obesity had greater hip adduction during mid-stance, while also producing greater hip extensor moments during early stance phase, abductor moments throughout most of stance, and hip external rotator moments during late stance. Children with obesity recorded greater knee flexor, knee extensor and knee internal rotator moments during early stance, and knee external rotator moments in late stance than children without obesity; children with obesity also demonstrated greater ankle plantarflexor moments throughout mid and late stance. Interaction effects existed within joint kinetics data; children with obesity produced greater hip extensor moments at initial contact and toe-off when walking at fast compared to normal walking speed. InterpretationWhile few kinematic differences existed between the two groups, children with obesity exhibited greater moments at the hip, knee, and ankle during critical periods of controlling and stabilizing mass.