Longer Double Support Time Research Articles

Changes in dynamic balance control in adults with obesity across walking speeds

Adults with obesity have gait instability, leading to increased fall risks and decreased physical activity. Whole-body angular momentum (WBAM) is regulated over a gait cycle, essential to avoid a fall. However, how obese adults regulate WBAM during walking is unknown. The current study investigated changes in WBAM about the body’s center of mass (COM) during walking in obese and non-obese adults across different walking speeds. Twenty-eight young adults with obesity and normal weight walked barefoot at a fixed walking speed (FWS, 1.25 m/s) and at five different speeds based on their preferred walking speed (PWS): 50, 75, 100, 125, and 150 % of PWS. Adults with obesity walked slower with shorter step length, wider step width, and longer double support time (p < 0.01). The ranges of frontal- and transverse-plane WBAM were greater in obese adults (p < 0.01). We also found that the range of frontal-plane WBAM did not significantly change with walking speed (p > 0.05), while the range of transverse-plane WBAM increased with walking speed (p < 0.01). The ranges of frontal- and transverse-plane WBAM increased with the mediolateral ground reaction force and mediolateral moment arm (p < 0.01), which may be most affected by lateral foot placement relative to the body’s COM. Our findings suggest that controlling mediolateral stability during walking is more challenging in obese adults, independent of their slow walking speed. Understanding whole-body rotational dynamics observed in obese walking provides an insight into the biomechanical link between obesity and gait instability, which may help find a way to reduce fall risks and increase physical activity.

The effect of obesity on whole-body angular momentum during steady-state walking

BackgroundIndividuals with obesity demonstrate deficits in postural stability, leading to increased fall risks. Controlling whole-body angular momentum is essential for maintaining postural stability during walking and preventing falls. However, it is unknown how obesity impacts whole-body angular momentum during walking. Research purposeTo investigate the change in angular momentum about the body’s COM during walking in individuals with different degrees of obesity. MethodsThirty-eight young adults with different body mass index (BMI) scores walked barefoot at their preferred speed on a treadmill for 2 min. The whole-body angular momentum has been quantified from ground reaction force and moment data to capture the rotational behavior of walking in individuals with obesity without relying solely on placing markers on anatomical landmarks. ResultsWe found that adults with higher BMI scores walked slower with shorter step length, wider step width, and longer double support time (ps<.01). Ranges of the frontal- and transverse-plane angular momentum were greater in adults with higher BMI scores (ps<.01), while no difference was observed between BMI groups in the total sum of changes in whole-body angular momentum in any plane (ps>.05). SignificanceObesity not only decreased walking speed but also limited the ability to control mediolateral stability during walking. Investigating how obesity affects whole-body angular momentum may help better understand why adults with obesity have atypical gait with poor balance, address fall risk factors, and facilitate participation in physical activities.

Gait and Axial Spondyloarthritis: Comparative Gait Analysis Study Using Foot-Worn Inertial Sensors.

BackgroundAxial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice.ObjectiveThis study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate.MethodsA total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms–1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground).ResultsAge, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17).ConclusionsGait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine.Trial RegistrationClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212International Registered Report Identifier (IRRID)RR2-10.1007/s00296-019-04396-4

Effect of High-Heeled Shoes on Balance and Lower-Extremity Biomechanics During Walking in Experienced and Novice High-Heeled Shoe Wearers.

Wearing high-heeled shoes and carrying asymmetrical loads are common in ladies. However, knowledge of the effects of wearing high-heeled shoes on balance and lower-extremity biomechanics in experienced and novice high-heeled shoe wearers is lacking. The study aims to examine the effects of high-heeled shoes and asymmetrical load carrying on joint kinematics and kinetics of the lower extremity during walking as well as balance in experienced and novice high-heeled shoe wearers. Fifteen experienced and 15 novice high-heeled shoes wearers participated in this study. Using a motion analysis system, kinematic and kinetic data were collected while participants walked at their preferred speed in six conditions created from two types of shoes (9-cm high-heeled shoes and flat-heeled shoes) and three weights of symmetrical load (0%, 5%, and 10% of body weight). Stride time and length, step length, double support time, peak joint angles, and joint moments in a sagittal plane were analyzed. Single-leg and tandem-leg stance tests were performed in each condition. Compared with experienced high-heeled shoe wearers, novice high-heeled shoe wearers had longer double support time and shorter stride length during 10% of body weight asymmetrical load walking; walked with greater knee flexion angle, smaller knee range of motion, and smaller ankle dorsiflexor moment; and scored lower in the single-leg and tandem-leg stance tests. Novice high-heeled shoe wearers need to alter their lower-limb joint angles and moments to adjust to high-heeled shoes to achieve balance during gait while carrying an asymmetrical load.

Effects of Obesity and Fall Risk on Gait and Posture of Community- Dwelling Older Adults

Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BMI>30 kg/m2) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults (age 74.0±7.6 years, range of 56-90 years) living independently in a community participated in this study. Participants' history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the prior year were classified as fallers. Each individual was assessed for postural stability during quiet stance and gait stability during 10 meters walking. Fall risk parameters of postural sway (COP area, velocity, path-length) were measured utilizing a standard forceplate coupled with an accelerometer affixed at the sternum. Additionally, parameters of gait stability (walking velocity, double support time, and double support time variability) were assessed utilizing an accelerometer affixed at the participant's sternum. Gait and postural stability analyses indicate that obese older adults who fell have significantly altered gait pattern (longer double support time and greater variability) exhibiting a loss of automaticity in walking and, postural instability as compared to their counterparts (i.e., higher sway area and path length, and higher sway velocity) further increasing the risk of a fall given a perturbation. Body weight/BMI is a risk factor for falls in older adults as measured by gait and postural stability parameters.

Differential associations between dual-task walking abilities and usual gait patterns in healthy older adults—Results from the Baltimore Longitudinal Study of Aging

BackgroundIt is well established that facing a cognitive challenge while carrying out a motor task interferes with the motor task performance, and in general the ability of handling a dual-task declines progressively with aging. However, the reasons for this decline have not been fully elucidated. Understanding the association between usual-walking gait patterns and dual-task walking performance may provide new insights into the mechanisms that lead to gait deterioration in normal aging and its link to motor and cognitive function. Research questionOur aim was to assess usual gait parameters in kinematics and kinetics to understand how these parameters are related with a specific task in dual-task walking. MethodsWe hypothesized that difficulty in dual-task walking would be associated with gait deteriorations as reflected in range of motion and mechanical work expenditure. We tested this hypothesis by quantifying the gait of 383 participants in the Baltimore Longitudinal Study of Aging (68% of whom successfully completed the dual-task walk, 21% failed the motor task, and 11% failed the cognitive task). ResultsCompared to successful performers, participants who failed the single motor task had slower gait speed, shorter stride length, higher cadence, and lower range of motion in the knee and ankle joints (p < 0.05, for all), while the participants who failed the cognitive task while walking had longer double support time (p = 0.003), and greater knee absorptive mechanical work (p = 0. 001) and lower ankle generative mechanical work (p < 0. 001). SignificanceThese results suggest that dual-task walking may be useful for monitoring subtle and diverse gait deteriorations in aging and possibly for designing interventions for maintaining and regaining proper gait patterns in older adults.

Differential Gait Patterns by History of Falls and Knee Pain Status in Healthy Older Adults: Results From the Baltimore Longitudinal Study of Aging.

Consideration of knee pain can be crucial for identifying fall-related gait patterns. While walking, gait parameters at usual speed were examined in persons with different falls and knee pain status. A total of 439 adults aged 60-92 years participated in this study. Persons with a history of falls had a wider stride width (p = .036) and longer double support time (p = .034) than nonfallers. In the absence of knee pain, fallers had longer double support time than nonfallers (p = .012), but no differences in double support time by history of falls were observed in participants with knee pain. With slower gait speed, fallers with knee pain have narrower stride width and larger hip range of motion (p = .027 and p = .001, respectively). Results suggest the importance of considering knee pain in fall studies for better understanding the fall-related differential gait mechanisms and for designing fall prevention intervention strategies.

Fear of falling and gait parameters in older adults with and without fall history.

Fear of falling (FOF) is associated with spatial and temporal gait parameters in older adults. FOF is prevalent among older adults, both those with and without fall history. It is still unclear whether the relationships between FOF and gait parameters are affected by fall history. The aim of the present study was to compare gait parameters by the presence of FOF and fall history. A total of 3575 older adults (mean age 71.7years, 49.7% female) met the inclusion criteria for the present study. We assessed the presence of fall history and FOF by face-to-face interview, and gait parameters (gait speed, stride length, step rate, double support time and variation of stride length) at a comfortable speed using a computerized electronic walkway. Prevalences of fall history and FOF were as follows: non-fallers without FOF 52.6% (n=1881); fallers without FOF 6.3% (n=227); non-fallers with FOF 34.4% (n=1229); and fallers with FOF 6.7% (n=238). Analysis of covariance showed significant differences among the four groups in all gait variables even after adjusting for age, sex and number of medications used. It should be noted that non-fallers with FOF showed significantly slower gait speed, shorter stride length and longer double support time than did non-fallers without FOF (P<0.001). The present results suggest that spatial and temporal gait parameters are influenced by FOF, even in the absence of fall history. The assessment of FOF might be helpful for better understanding of age-related changes in gait control. Geriatr Gerontol Int 2017; 17: 2455-2459.

Cerebral Amyloid Deposition Is Associated with Gait Parameters in the Mayo Clinic Study of Aging.

To determine the cross-sectional association between cerebral amyloid-beta (Aβ) deposition and gait. Cross-sectional. Population-based cohort study in Olmsted County, MN. Cognitively normal individuals (n = 611), aged 50 to 69 years, enrolled in the Mayo Clinic Study of Aging with concurrent PiB-PET imaging and gait assessment. Participants with a history of stroke, alcoholism, Parkinson's disease, subdural hematoma, traumatic brain injury, or normal pressure hydrocephalus were excluded. PiB-PET SUVR was measured in prefrontal, orbitofrontal, parietal, temporal, anterior cingulate, posterior cingulate, and motor-specific regions of interest (ROIs). Gait parameters (speed, cadence, stride length, double support time, and intra-individual stance time variability) were measured using GAITRite® instrumentation. Linear regression models were adjusted for age, sex, body mass index, education, APOE ε4 allele, Charlson comorbidity index, and depression. In secondary analyses, we additionally adjusted for neurodegeneration (hippocampal volume, FDG PET SUVR, and cortical thickness) in AD-associated regions. In fully adjusted models including neuroimaging measures of neurodegeneration, higher PiB-PET SUVR across all ROIs was associated with slower gait speed (P < .05 except for the parietal ROI), lower cadence and longer double support time (P ≤ .05 except for the motor ROI), and greater stance time variability (P < .05). In sex-stratified analyses, the association between higher PiB-PET SUVR across all ROIs and measures of gait was only present among women. PiB-PET SUVR across ROIs, independent of general measures of AD-associated neurodegeneration, is associated with poorer performance on multiple gait parameters among cognitively normal women, aged 50 to 69 years. Longitudinal studies are needed to determine whether Aβ predicts gait decline in both women and men.

Center of pressure and total force analyses for amputees walking with a backpack load over four surfaces

Understanding how load carriage affects walking is important for people with a lower extremity amputation who may use different strategies to accommodate to the additional weight. Nine unilateral traumatic transtibial amputees (K4-level) walked over four surfaces (level-ground, uneven ground, incline, decline) with and without a 24.5 kg backpack. Center of pressure (COP) and total force were analyzed from F-Scan insole pressure sensor data. COP parameters were greater on the intact limb than on the prosthetic limb, which was likely a compensation for the loss of ankle control. Double support time (DST) was greater when walking with a backpack. Although longer DST is often considered a strategy to enhance stability and/or reduce loading forces, changes in DST were only moderately correlated with changes in peak force. High functioning transtibial amputees were able to accommodate to a standard backpack load and to maintain COP progression, even when walking over different surfaces.

Gait energetic efficiency in older adults with and without knee pain: results from the Baltimore Longitudinal Study of Aging.

With aging, customary gait patterns change and energetic efficiency declines, but the relationship between these alterations is not well understood. If gait characteristics that develop with aging explain part of the decline in energetic efficiency that occur in most aging individuals, then efforts to modify these characteristics could delay or prevent mobility limitation. This study characterizes gait patterns in older persons with and without knee pain and tests the hypothesis that changes in gait characteristics due to knee pain are associated with increased energetic cost of walking in older adults. Study participants were 364 men and 170 women aged 60 to 96 years enrolled in the Baltimore Longitudinal Study of Aging (BLSA), of whom 86 had prevalent knee pain. Gait patterns were assessed at participant self-selected usual pace in the gait laboratory, and the energetic cost of walking was assessed by indirect calorimetry during self-selected usual pace walking over 2.5 min in a tiled corridor using a portable equipment. Participants with knee pain were less energetically efficient than those without pain (oxygen consumption 0.97 vs. 0.88 ml/(10 m · 100 kg); p = 0.002) and had slower gait speed and smaller range of motion (ROM) at the hip and knee joints (p < 0.05, for all). Slower gait speed and lower knee ROM in participants with knee pain and longer double support time and higher ankle ROM in participants without knee pain were associated with lower energetic efficiency (p < 0.05, for all). Slower gait speed and lower knee ROM were correlates of knee pain and were found to mediate the association between age and oxygen consumption. Although knee pain is associated with a higher energetic cost of walking, gait characteristics associated with energetic efficiency differ by pain status which suggests that compensatory strategies both in the presence and absence of pain may impact gait efficiency.

Gait Analysis of the Lower Limb in Patients with Rheumatoid Arthritis: A Systematic Review

In rheumatoid arthritis (RA), signs and symptoms of feet and ankle are common. To evaluate the dynamic function of feet and ankles, namely walking, a variety of gait studies have been published. In this systematic review, we provide a systematic overview of the available gait studies in RA, give a clinimetrical assignment, and review the general conclusions regarding gait in RA. A systematic literature search within the databases PubMed, CINAHL, sportdiscus, Embase, and Scopus was described and performed and delivered 78 original gait studies that were included for further data extraction. The clinimetrical quality of the 78 included RA gait studies measured according a tailored QUADAS item list and proposed clinimetrical criteria by Terwee and coworkers are moderate. General conclusions regarding the walking abnormalities of RA patients point to a slower walk, longer double support time, and avoidance of extreme positions. Frequently found static features in RA are hallux valgus, pes planovalgus, and hind foot abnormalities. Gait studies in RA patients show moderate clinimetrical properties, but are a challenging way of expressing walking disability. Future gait research should focus on more uniformity in methodology. When this need is satisfied, more clinical applicable conclusions can be drawn.

Quantitative Measures of Gait Characteristics Indicate Prevalence of Underlying Subclinical Structural Brain Abnormalities in High-Functioning Older Adults

Abnormal gait in high-functioning older adults may indicate underlying subtle structural brain abnormalities. We tested the hypothesis that temporal and spatial parameters of gait, including speed, stride length and double support time, are cross-sectionally associated with white matter hyperintensity, subcortical infarcts or brain atrophy on brain MRI. We examined 321 men and women (mean age = 78.3) participating to the Cardiovascular Health Study who were free of dementia or stroke at the time of the gait assessment. Analyses were set with gait as independent variable and brain MRIs as dependent variables. Gait measures were determined from the footfalls recorded on a 4-meter-long instrumented walking surface, the GaitMat II. Brain MRIs were examined for the presence of white matter hyperintensity (WMG, graded from 0 to 9), brain infarcts (predominantly subcortical) and ventricular enlargement (graded from 0 to 9). Slower gait, shorter stride length and longer double support times were associated with greater prevalence of white matter grade ≧3 (p = 0.02), and at least 1 brain infarct (p = 0.04) independent of age. In multivariate logistic regression models adjusted for demographics and clinical cardiovascular diseases, those with gait speed <1.02 m/s were more likely to have WMG ≧3 and at least 1 brain infarct, compared with those with faster gait – odds ratio (OR): 2.85, 95% confidence interval (95% CI): 1.35, 6.02, and OR: 2.09, 95% CI: 1.04, 4.19. Shorter stride length was also associated with greater probability of having at least 1 brain infarct (gait stride <0.88 vs. >1.10 m: OR: 3.20, 95% CI: 1.49, 6.88), while longer double support times were associated with a greater probability of having WMG ≧3 (double support time >0.19 vs. <0.14 s: OR: 2.3, 95% CI: 1.1, 4.7) independent of demographics and clinical cardiovascular diseases. Gait parameters were not significantly associated with ventricular grade. In summary, in this group of high-functioning older adults, poorer gait speed, shorter stride and longer double support time are associated with high white matter disease and subclinical strokes.