Improve Walking Endurance Research Articles

Abstract 3027: Home-based, High-pressure Intermittent Limb Compression Following Lower Extremity Revascularization In Patients With Severe Peripheral Artery Disease: A Pilot Trial

Objective: Many patients who undergo lower extremity revascularization (LER) for peripheral artery disease (PAD) continue to experience mobility impairment despite adequate revascularization. High-pressure intermittent limb compression (HPILC) has been shown to augment leg blood flow and improve walking endurance in symptomatic PAD patients. This pilot trial aimed to examine the feasibility of home-based HPILC for 2 hours daily over 3 consecutive months in patients who underwent LER for PAD. The primary outcome was the change in 6-minute walk distance from baseline to 3-month follow-up. Methods: Three months following LER, 9 participants were randomly assigned to either HPILC (n=5) or a sham (n=4) group. Participants were provided with a portable pneumatic air pump and inflatable cuffs that were wrapped around the feet, ankles, and calves (ArtAssist, ACI Medical). The inflation pressures were 120 mmHg and 30 mmHg in the HPILC and sham devices, respectively. A built-in timer, inaccessible to participants, provided one estimate of treatment compliance. Outcomes were assessed before and after the completion of the 3-month interventions. Results: Among the 9 randomized participants, one individual required reintervention and was withdrawn from the study. Adherence to treatment was 74% for HPILC and 92% for sham. As shown in Figure 1, the change in 6-minute walk distance from baseline tended to be higher in the HPILC group compared to the sham-treated group (HPILC: 35.2±38.7 m vs. Sham: -14.7±25 m, p=0.07). There were no group differences in the secondary outcomes, including the changes in the ankle-brachial index, the toe-brachial index, and the Vascular Quality of Life questionnaire scores. Conclusions: Home-based HPILC following LER for PAD is feasible, well-tolerated, and appears to improve walking performance. These preliminary findings indicate that HPILC may be a useful adjunct therapy to enhance lower extremity functioning in patients recovering from LER.

Repeated Exposure to Mild Intermittent Hypoxia Improves Walking Endurance in OSA Patients for 4 - 8 Weeks Post Therapy

Background: Approximately one billion adults globally are diagnosed with obstructive sleep apnea (OSA). Co-morbidities associated with sleep apnea include hypertension and increased susceptibility to fatigue linked to lower oxygen bioavailability and reduced exercise performance. Previously, we reported that daily exposure to mild intermittent hypoxia (MIH) reduces blood pressure following 3 weeks of treatment. These reductions in pressure could be coupled with improvements in microvascular function, fatigability and exercise performance. Objective: Thus, in the present investigation we explored if daily exposure to MIH improves walking endurance that is sustained for 8 weeks following treatment in individuals with OSA and hypertension (HTN). We also examined if improvements in endurance were correlated to modifications in microvascular function measured using near-infrared spectroscopy. Methods: To achieve this objective, both males and females with severe OSA and hypertension were randomly assigned to receive an MIH intervention (n=9) or Sham MIH (n=10). Half of the individuals in each group were also randomly assigned to nightly CPAP use. Based on the small sample size and the similarity of responses, the groups treated with MIH or sham MIH were combined independent of CPAP use. The MIH protocol consisted of twelve 2-minute hypoxic episodes (PETO2 ~ 50 mmHg), interchanged with 2 minutes of normoxia administered each day for 15 days. PETCO2 was sustained 2 mmHg above baseline throughout the protocol. To evaluate the impact of MIH on microvascular function, oxygen carrying capacity and fatigability, 10 minute walk tests (10 MWT) and vascular occlusion tests coupled with near infrared spectroscopy (NIRS) were performed before therapy, as well as, 5 days, 4 weeks, and 8 weeks after therapy. Results: No significant difference in distance, speed, and performance fatigue was found between the two groups during the 10 MWT before therapy. However, following therapy, the MIH group was able to walk further (p = 0.005), faster (p = 0.005), and were less fatigued (p = 0.009). These improvements were maintained for up to 8 weeks following treatment with MIH but not sham MIH. As anticipated, the total distance travelled was correlated to the performance fatigue index (r = -0.734, p < 0.0001). The Δ in performance fatigue index was correlated to the Δ in the maximal hyperemic response of oxygenated hemoglobin (HbO2) (r = -0.461, p = 0.021) following treatment with MIH. Likewise, the perceived fatigability index was correlated to the Δ in the amplitude of the hyperemic HbO2 response (relative to measures obtained at the end of occlusion) (r = -0.397, p = 0.0494) and the Δ in the time to achieve the maximum HbO2 hyperemic response (r = 0.412, p = 0.041) following treatment with MIH. Conclusion: Our results show that distance, speed and performance fatigue are improved following treatment with MIH and that these improvements are sustained for 8 weeks. Our results also showed that correlations between improved performance, perceived fatigue and microvascular function were evident, providing the impetus to further investigate these relationships. Overall, our findings suggest that MIH may improve muscle endurance, allowing individuals with OSA and HTN to walk faster, longer, and with less fatigue for up to 8 weeks following 15 days of treatment with MIH. I01CX000125, IK6CX002287, R01HL142757, R56HL142757. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Exercise Therapy for Peripheral Artery Disease.

To summarize evidence regarding exercise treatments for lower extremity peripheral artery disease (PAD). Supervised walking exercise is recommended by practice guidelines for PAD. Supervised treadmill exercise improves treadmill walking distance by approximately 180m and 6-min walk distance by 30-35m, compared to control. The Centers for Medicaid and Medicare Services covers 12weeks of supervised exercise, but most people with PAD do not participate. Home-based walking exercise may be more convenient and accessible than supervised exercise. In randomized clinical trials, home-based walking exercise interventions incorporating behavioral methods, such as accountability to a coach, goal-setting, and self-monitoring, improved 6-min walk distance by 40-54m, compared to control. Arm and leg ergometry also improved walking endurance for people with PAD, but efficacy compared to walking exercise remains unclear. Walking exercise is first-line therapy for PAD-related walking impairment and can be effective in either a supervised or a structured home-based setting.

Effects of Walking-Only Intervention on Physical Function, Fall-Related Outcomes, and Health-Related Quality of Life in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

IMPLEMENTATION OF A COMMUNITY WALKING PROGRAM FOR OLDER ADULTS WITH MOBILITY CHALLENGES—WALK-ON!

Abstract Clinical trials in controlled settings show walking interventions improve function and reduce mobility loss in older adults. In the NIA-funded LIFE study, participants with more compromised function derived the most benefit, yet improvements were not sustained. Based on this research, clinicians often prescribe walking for older patients. However, few communities provide accessible opportunities for those with limited function to engage in safe, ability-appropriate, walking. Additionally, no evidence-based National Council on Aging exercise programs emphasize ambulation over longer distances in supervised and social settings. In collaboration with community partners, we developed and initiated Walk On!, a group-based, facilitator-led program designed to improve walking endurance, balance, confidence, and social connectedness in older adults with mobility challenges. In addition to walking, the program incorporates balance, gait, and flexibility components, and follows a safe progression based on individual ability. Sessions take place for one-hour, twice/week, over 12 weeks. The program is currently offered at four sites in Winston-Salem and Charlotte, NC (two churches-one primarily black membership and one primarily white, a YWCA, and a community fitness center). This symposium provides an overview of Walk On! and initial implementation. Both quantitative and qualitative program data on feasibility, satisfaction, and effectiveness for improving physical and psychosocial outcomes will be presented. Based on these early data, we believe there are countless underserved older adults who may be socially isolated due to limited mobility, yet are willing and would benefit from incorporating more ambulation in a safe and accessible environment.

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx

BackgroundMultimodal agility-based exercise training (MAT) is a group-based exercise training framework for persons with multiple sclerosis (pwMS) with a potential to impact fatigue and fatigability. In a mixed-methods design, this study evaluated the feasibility of implementing MAT in an inpatient rehabilitation setting and the feasibility of a randomized controlled trial (RCT) study protocol with ‘traditional’ strength and endurance training (SET) as an active control condition. Secondarily, preliminary outcome data was acquired.MethodsPwMS with low to moderate disability and self-reported fatigue were randomly allocated to either MAT or SET when starting inpatient rehabilitation (4–6 weeks). The MAT-participants exercised in a group following a MAT-manual (sessions were gym- (5x/week) and pool-based (3x/week)). SET-participants exercised individually 5x/week on a cycle ergometer, and 3x/week on strength training machines. Feasibility assessments focused on processes, resources, management, time, and scientific domains. Assessed clinical outcomes at admission and discharge included perceived fatigue, motor and cognitive fatigability, cognitive performance, motor function, and balance confidence. Perceived fatigue was reassessed 1, 4, and 12 weeks after discharge. Feasibility was determined regarding predetermined progression criteria.ResultsTwenty-two participants were randomized. Both groups performed the minimum number of sessions (> 18), and retention was adequate (73–91%). SET-participants performed more sessions than MAT-participants (30.8 vs. 22.7) and stayed longer in the facility (34.2 vs. 31.6 days). Non-eligibility of admitted pwMS was high (74% non-eligible), mainly due to high EDSS and inability to attend pool-based sessions. Consequently, recruitment (1.8/month) was slower than the predetermined progression criterium. Baseline assessments took longer than required (only 50% completed within 3 days). Short-term fatigue reduction was similar for both groups. Motor fatigability also improved in both groups, whereas cognitive fatigability deteriorated. In MAT, average improvement in walking endurance (43.9 m) exceeded minimal important change values for individuals (> 26.9 m).ConclusionsProgressing to a definitive RCT necessitates adaptation of eligibility criteria. In the present design it will also be difficult to attain similar dosing of interventions. A multicenter RCT focused only on gym-based MAT might be another option to assess the effect of MAT. The primary outcome measure should be able to measure change in perceived fatigue more robustly.Trial registrationGerman Clinical Trials Register: DRKS00023943, date of registration: 23 September 2021.

Efficacy of Tai Chi on lower limb function of Parkinson's disease patients: A systematic review and meta-analysis.

At present, the effect of Tai Chi (TC) on lower limb function in patients with Parkinson's disease (PD) is controversial. Therefore, we conducted a meta-analysis on the influence of TC on lower limb function in PD patients. According to the PRISMA guidelines, seven databases were searched. Randomized controlled trials (RCTS) were selected and screened according to inclusion and exclusion criteria. We assessed the quality of the studies using the Cochrane Risk of Bias tool and then extracted the characteristics of the included studies. The random effect model was adopted, and heterogeneity was measured by I 2 statistic. A total of 441 articles were screened, and 10 high-quality RCTs were with a total of 532 patients with PD met Our inclusion criteria. Meta-analysis showed that compared To control groups TC improved several outcomes. TC significantly improved motor function (SMD = -0.70; 95% CI = -0.95, -0.45; p < 0.001; I 2 = 35%), although The results were not statistically significant for The subgroup analysis of TC duration (SMD = -0.70; 95% CI = -0.95, -0.45; p = 0.88; I 2 = 0%;). TC significantly improved balance function (SMD = 0.89; 95% CI = 0.51, 1.27; p < 0.001; I 2 = 54%), functional walking capacity (SMD = -1.24; 95% CI = -2.40, -0.09; p = 0.04; I 2 = 95%), and gait velocity (SMD = 0.48; 95% CI = -0.02, 0.94; p = 0.04; I 2 = 78%), But Did Not improve endurance (SMD = 0.31; 95% CI = -0.12, 0.75; p = 0.16; I 2 = 0%), step length (SMD = 0.01; 95% CI = -0.34, 0.37; p = 0.94; I 2 = 29%), and cadence (SMD = 0.06; 95% CI = -0.25, 0.36; p = 0.70; I 2 = 0%). TC has beneficial effects on motor function, balance function, functional walking ability, and gait velocity, but does not improve walking endurance, stride length, and cadence.

Visual Feedback and Virtual Reality in Gait Rehabilitation of Hemiparetic Children and Teenagers after Acquired Brain Injury: A Pilot Study

Hemiparesis as a term refers to a neurological disorder that can be extremely variable, especially with regard to walking abilities. Few works have assessed the use of virtual reality and biofeedback in children and adolescents with hemiparesis. The aim of this study is to provide insights about the rehabilitation of hemiparetic children and teenagers with visual biofeedback in a virtual reality environment. Six hemiparetic subjects (mean age 13.13 years, age range (7-18), 4 males) received 20 personalized rehabilitation GRAIL (Gait Real-time Analysis Interactive Lab) sessions plus 20 sessions of traditional physiotherapy. After an initial evaluation of rehabilitation needs, training focused on gait pattern correction (GP), walking endurance (WE), or gross motor functions (GMFs). All subjects were assessed for their gait analysis by GRAIL, the Gross Motor Function Measure (GMFM), and the 6-Minute Walking Test (6MWT) before and after rehabilitation. All subjects reached their rehabilitation goals, save for one who showed reduced collaboration. In addition, 4 subjects reached a better GP, 3 subjects reported improvements in WE, and 2 subjects improved in GMF. This personalized training with visual biofeedback delivered in a VR setting appears to be effective in modifying motor control and improving gait pattern, in addition to resistance and functional activities, in subjects with hemiparesis.

Insole modification as a plantar pressure distributor in diabetic polyneuropathy

73 years old, male, referred from Internal Medicine department with diagnose Diabetic Polyneuropathy. The patient felt numbness at both feet since about 8 years ago and also complain about shortened walking distance because of fatigue. From the physical examination we found that has muscle weakness at left leg. From the foot examination there were decreased vibration and light touch sensation, anhidrosis, hyperkeratosis at his feet. There were also charcot arthropathy and decreased of foot fat pad. Foot pressure examination was high. The treatment goal for this patient is to wear comfortable footwear, improving walking endurance, and preventing future ulceration. The insole was needed to decrease plantar pressure during ambulation. Recommended rehabilitation treatment involves interaction between the health care team and the patient to achieve rehabilitation goals.

Ergonomics Design and Assistance Strategy of A-Suit.

Concerning the biomechanics and energy consumption of the lower limbs, a soft exoskeleton for the powered plantar flexion of the ankle, named A-Suit, was developed to improve walking endurance in the lower limbs and reduce metabolic consumption. The method of ergonomics design was used based on the biological structures of the lower limbs. A profile of auxiliary forces was constructed according to the biological force of the Achilles tendon, and an iterative learning control was applied to shadow this auxiliary profile by iteratively modifying the traction displacements of drive units. During the evaluation of the performance experiments, four subjects wore the A-Suit and walked on a treadmill at different speeds and over different inclines. Average heart rate was taken as the evaluation index of metabolic consumption. When subjects walked at a moderate speed of 1.25 m/s, the average heart rate Hav under the Power-ON condition was 7.25 ± 1.32% (mean ± SEM) and 14.40 ± 2.63% less than the condition of No-suit and Power-OFF. Meanwhile, the additional mass of A-Suit led to a maximum Hav increase of 7.83 ± 1.44%. The overall reduction in Hav with Power-ON over the different inclines was 6.93 ± 1.84% and 13.4 ± 1.93% compared with that of the No-Suit and Power-OFF condition. This analysis offers interesting insights into the viability of using this technology for human augmentation and assistance for medical and other purposes.

A Comparative Study to Check the Effectiveness of Task Oriented Activity on Walking Speed in Sub-Acute Stroke Patients

Stroke which is also known as cerebrovascular accident (CVA) is a leading cause of impairment and disability in the world. There are many factors that affect the functional independence in post stroke people in which gait impairment plays a significant role. The purpose of stroke rehabilitation is to help patients to achieve as high level of functional independence as possible within their particular impairments. It is found that Task oriented activity has been shown to be an effective intervention to improve mobility. However, little is known about the impact of this intervention on the walking speed. The objective of study is to determine the combined effects of task oriented activity with conventional physiotherapy over conventional physiotherapy alone on walking speed in subjects with sub-acute stroke. This was a comparative study where pre and post design were used. Thirty (30) subjects with sub-acute stroke were taken considering the selection criteria; where Experimental group (Group-A) received task oriented activities and conventional physiotherapy and Control group (Group-B) received Conventional physiotherapy with 15 subjects in each group. Six minutes walk test (MWT) was used to assess the walking endurance and Functional ambulation categories (FAC) was used to evaluate the level of dependency of subjects in performing functional activities. Statistical analysis was done by using paired ‘t’ tests which showed significant improvement as the mean value of Group A (experimental group) mean 6MWT increase from -0.517 to -17.582, mean FAC increase from -1.288 to -3.055 but when intergroup analysis was done, its result was significant only in 6MWT were P= 0.046. task oriented activity after stroke could significantly improve walking endurance but not much significant on the level of dependency of the subject in performing functional activities.

The effects of cycling using lower limb active passive trainers in people with neurological conditions: a systematic review

Background Active passive trainers are frequently used as a safe, feasible way for people with neurological disabilities to exercise. However, evidence regarding their efficacy is limited. The aim of this study was to review the literature investigating the effects of lower limb active passive trainer cycling, with or without functional electrical stimulation, on spasticity, cardiovascular fitness, function and quality of life in people with neurological conditions Methods Five electronic databases were searched from inception to June 2021. Studies included: randomised controlled trials using lower limb active passive trainers as a cycling intervention; participants with neurological conditions, such as multiple sclerosis, spinal cord injury, stroke and Parkinson's disease; and at least one outcome related to spasticity, cardiovascular fitness, physical function or quality of life. Results A total of 12 articles were included (n=423 participants, 52% male). Of these, six used functional electrical stimulation-assisted active passive trainer interventions, and the remaining six used active passive trainer interventions alone. A meta-analysis demonstrated statistically significant improvement in walking endurance; however, this only included stroke studies (6-Minute Walk Test performance, P&lt;0.00001). No statistically significant improvement in walking speed was found (P=0.31). A significant improvement in spasticity was reported by three studies (two using the active passive trainer intervention alone, one using the active passive trainer with functional electrical stimulation). One study reported improvement in quality of life. Few studies considered cardiovascular fitness. Conclusions The included studies featured heterogeneous designs, outcome measures, exercise prescriptions and participant disability levels, which made comparison difficult. Active passive trainer interventions appear to improve walking endurance in people with stroke; however, the effect on other outcomes and in other conditions remains unclear. It also remains uncertain as to whether functional electrical stimulation-assisted cycling is more beneficial than active passive trainer cycling alone.

The effect of intermittent vs. continuous walking on distance to fatigue in persons with multiple sclerosis

Purpose Previous studies provided evidence that persons with Multiple Sclerosis (pwMS) who walk intermittently experience less fatigue and walk longer distances than when walking continuously. However, total distance pwMS can walk in either condition is unknown. We examined time and distance to fatigability in pwMS comparing intermittent walking (IW) to continuous walking (CW). Materials and Methods 18 pwMS, with Expanded Disability Status Scale median of 4.75 [range = 2–6.5, IQR = 2.5] participated in this randomized crossover study. The IW condition consisted of alternating 30 s treadmill walking and 30 s seated rests. The CW condition consisted of treadmill walking without breaks. Treadmill speed (TS) was determined by an overground 2-min walk test. Walking fatigability was determined by participants walking on the treadmill, until gait fatigue was noted by patient or examiners. Total time and distance to gait fatigue, and subjective fatigue as measured by the Visual analog scale of fatigue were recorded. Results Participants had significantly longer duration and distance to fatigue in the IW condition than the CW condition (ps ≤ 0.037). No difference in VASF scores between the two conditions were noted. Conclusion In this sample, IW allowed pwMS to perform a greater volume of walking and can be an option to improve walking endurance in this population. IMPLICATIONS FOR REHABILITATION Multiple sclerosis (MS) is a disease that progressively impacts walking, resulting in a decrease in the maximum distance that a person with MS can walk. Intermittent walking has been shown to improve 6-min walk test performance in persons with MS (pwMS) compared to continuous walking, but its effects on longer and shorter walks is not known. The use of distance to fatigue should be considered a viable option for measuring walking fatigability in pwMS as it does not exclude persons based on their ability to complete a 6-min walk, nor would it be too easy for persons with pwMS with mild disability. By using distance to fatigue as an outcome measure, this study provides evidence that intermittent walking results in less fatigability regardless of walking ability. PwMS, regardless of their walking ability, can walk longer distances intermittently than continuously, suggesting that clinical treatment of walking fatigability in pwMS should utilize intermittent rather than continuous walking training.

Combining a supervised and home-based task-oriented circuit training improves walking endurance in patients with multiple sclerosis. The MS_TOCT randomized-controlled trial

BackgroundBalance and mobility impairments are widespread in patients with Multiple Sclerosis (PwMS), even at an early stage. They can contribute to disability, physical deconditioning and reduced quality of life. Task-oriented is a training modality that may promote walking abilities and conditioning. However, the effects usually are short-lasting and exercising at home can have several barriers. This randomized controlled trial aimed to test the effectiveness of the combination of a 2-weeks in-person, supervised task-oriented circuit training (TOCT), followed by a 12-weeks home-based task-oriented program with monthly in-person visits. Methods36 PwMS with EDSS 4–5.5 and unassisted walking have been randomly assigned to 10 supervised TOCT sessions over two weeks (Phase 1) followed by a 12-weeks home-based task-oriented program (Phase 2) or a delayed-treatment group. At the end of Phase 2, the delayed-treatment group (usual care) received the same TOCT protocol. Phase 1 was composed of six gait-based workstations and treadmill training, whereas Phase 2 was based on progressive task-oriented tasks practice at home with monthly visits to adjust activities levels. Six Minute Walk Test (6MWT), Timed 25-foot walk test (T25FW), Timed Up and Go test (TUG), Dynamic Gait Index (DGI), Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Walking Scale – 12 (MSWS-12), Multiple Sclerosis Impact Scale–29 (MSIS-29) and resting muscle oxygen consumption (rmVO2) were assessed as outcome measures at baseline, after Phase 1 and after Phase 2. Retention was tested on the whole sample at a 12-weeks follow-up. ResultsThe entire sample completed the 2-weeks TOCT, whereas adherence was good for the 12-weeks home-based task-oriented program (6.2/10). The mean repetitions and level of difficulty of each task significantly increased after every timepoint. A superiority of task-oriented program was verified for 6MWT (F, 2,88 = 7.80; p<0.001) on usual care after the 12-weeks home-based program. Moreover, between-group differences were highlighted at the same point, even for T25FW, TUG and MSWS-12. RmVO2 and fatigue were significantly improved only in the experimental group. Positive effects on 6MWT were retained 12 weeks after the end of the protocol (p<0.001) in the whole sample. ConclusionsThe combination of a supervised and self-managed task-oriented program enhances walking endurance with positive effects on walking ability, fatigue and resting muscle oxygen consumption in PwMS with unassisted walking. These preliminary results reflected how this intervention was effective for impairment and activity improvements; moreover, it was cardiorespiratory stressful and possibly reduced deconditioning.

Bursting TENS increases walking endurance more than continuous TENS in middle-aged adults

The application of transcutaneous electrical nerve stimulation (TENS) can improve motor performance in both healthy individuals and those who present with clinically detectable sensory impairments. The purpose of our study was to compare the influence of continuous and intermittent TENS applied to the anterior thigh and tibialis anterior muscles on walking endurance and kinematics in healthy, middle-aged adults. Twenty-seven participants completed 4 trials of the 6-min walk test: Baseline, Continuous TENS (0.2 ms pulses at 50 Hz), Fast burst TENS (seven 0.15 ms pulses in 5 Hz bursts), and Slow burst TENS (seven 0.15 ms pulses in 0.5 Hz bursts). Linear mixed-effects models revealed that participants walked further (p ≤ 0.046) during all three TENS trials compared with Baseline (560 ± 76 m) and that they walked even further during both burst TENS trials (576 ± 83 m and 576 ± 83 m) compared with Continuous TENS (566 ± 79 m). Increases in walking speed were predicted by increases in stride length (p < 0.001) and stride frequency (p < 0.001) with toe-off angle being the only significant predictor (p ≤ 0.013) of both kinematic variables for the increase in walking speed. Bursting TENS was more effective than Continuous TENS at improving walking endurance in middle-aged, healthy adults.

A case of improved walking endurance after brain tumor resection due to exercise therapy focusing on hip adductor muscle action in the loading-response phase

A case of improved walking endurance after brain tumor resection due to exercise therapy focusing on hip adductor muscle action in the loading-response phase

Effects of an additional resistance training intervention in hemodialysis patients performing long-term ergometer exercise during dialysis.

[Purpose] To verify the effect of a 12-week additional resistance training intervention in patients on hemodialysis who had been performing supine ergometer exercises alone during dialysis. [Participants and Methods] Overall, 18 patients undergoing hemodialysis were included. A 12-week intervention with additional resistance training was conducted in hemodialysis patients who had been performing supine ergometer exercise for 30 min during dialysis for over >3 months. Physical function before and after the period of bicycle ergometer exercise alone and before and during the additional intervention was compared. Resistance training consisted of 1–3 sets per day of five different exercises for the large muscle groups of the upper and lower limbs. [Results] The results of the 6-min walk test improved significantly after the additional intervention. The average driving distance in the supine ergometer exercise during the additional intervention was identified as an associated factor. [Conclusion] The addition of the resistance training to long-term supine ergometer exercisers improved walking endurance. When supine ergometer exercise alone does not change physical function, the additional use of resistance training subsequently may have a positive effect on walking endurance.

To What Extent is Walking Ability Associated with Participation in People after Stroke?

ObjectivesThis study aims to 1) identify the relation between walking ability and participation after stroke and 2) explore whether change in walking ability is associated with change in participation over time in community living-people after stroke. Materials and MethodsFifty-two people after stroke were assessed at baseline and after a 6-week gait training intervention. People were included between two weeks and six months after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation was used to measure participation. Assessment of walking ability included the six-minute walking test for walking endurance, Timed-up & Go test for functional mobility, Mini Balance Evaluation Systems Test for dynamic balance, and total duration of walking activity per day to measure walking activity. ResultsAt baseline, six-minute walking test, Timed-up & Go test, and Mini Balance Evaluation Systems Test were univariately associated with participation (P < 0.001). Backward multiple regression analysis showed that the Mini Balance Evaluation Systems Test independently explained 55.7% of the variance in participation at baseline. Over time, only change in the six-minute walking test was positively associated with change in participation (R2 = 0.087, P = 0.040). ConclusionsCross-sectional associations showed that walking ability, and especially dynamic balance, contributes to participation after stroke. Dynamic balance, as underlying variable for walking, was an important independently related factor to participation after stroke which needs attention during rehabilitation. Longitudinally, improvement in walking endurance was significantly associated with improvement in participation, which indicates the relevance of training walking endurance to improve participation after stroke.

O-TS003. The combined effect of Repetitive Transcranial Magnetic Stimulation (RTMS) and treadmill training on walking endurance and balance in people with Parkinson’s Disease (PD) – A randomised PLACEBO-CONTROLLED trial

Introduction. Reduced walking endurance and balance is common among patients with PD. Treadmill training and rTMS have been shown to be effective in improving walking performance in patients with PD, but effects were modest and short-lived. Long-term effect of combined rTMS and treadmill training on walking endurance and balance performance in patients with PD is not known. Methods. 34 participants with PD were randomised into 2 groups. Participants received 12 sessions of either 25 Hz rTMS and treadmill training (25 Hz-TT) or sham rTMS and treadmill training (1 Hz-TT) conducted over 3 weeks. For 25 Hz-TT group, 600 TMS stimuli at 80% resting motor threshold were delivered to leg area of motor cortex of each hemisphere. Two- minute walk test (2MWT) and mini-Balance Evaluation System Test (mini-BEST) were used to evaluate the efficacy of interventions on walking tolerance and balance performance. Participants were tested before, after, 1 month and 3 months after intervention ended. Two- way repeated measure ANOVA was used to evaluate the outcome data. SPSS 23.0 was used for all statistical analysis. Results. Significant interaction effect was found in mini-BEST (F (3,32) = 3.247, p = 0.041). Post-hoc analysis shows that only 25-Hz group improved mini-BEST at Post (p = 0.001), 1-month (p = 0.006) and 3-month post intervention (p = 0.036). Between-group analysis of change from baseline showed that 25 Hz-TT had a greater change than sham-TT (by 1.96, p = 0.01) in improving mini-BEST. Both 25 Hz-TT and sham-TT groups improved 2MWT at all measurement time points (p < 0.001). Conclusion. Our results showed that combining 25-Hz rTMS with treadmill training improved walking endurance and balance performance in people with PD in both short-and long-term.

Case Study of a Chronic Stroke Patient with Lower Limb Spasticity Who Showed Improvement in Walking Endurance after a Physical Therapy Intervention with Botulinum Therapy and Functional Electrical Stimulation

〔目的〕慢性期脳卒中患者の一症例に対するボツリヌス療法とfunctional electrical stimulation（FES）を併用した中長期的な介入経過を報告することであった．〔対象と方法〕対象は既往に重度の右麻痺と，modified Ashworth Scaleで3の下肢痙縮を認めた39歳女性であった．24ヵ月の経過中に，複数回のボツリヌス療法とFESを併用した介入を実施した．歩行持久性の指標に6-minute walk test（6MWT）を評価した．〔結果〕平均介入時間は10.3時間／月であった．介入前後の6MWTは162 m，275 mであった．〔結語〕ボツリヌス療法とFESを併用した中長期的な介入は，慢性期脳卒中患者の歩行持久性の向上に寄与する可能性が示唆された．