Maximum Walking Speed Research Articles

Concurrent validity of the GAITRite electronic walkway and the 10-m walk test for measurement of walking speed after stroke

Background: Walking speed is used to assess functional status, predict recovery, prescribe exercise, and track functional progress after stroke. Determining concurrent validity ensures that results from different tests of walking speed can be compared or used interchangeably. The GAITRite electronic walkway and the 10-m walk test (10MWT) are popular measurement tools of walking speed in the laboratory and in clinical settings, respectively.Research question: Do walking speeds in chronic stroke survivors measured with the 10-m walk test and GAITRite electronic walkway demonstrate concurrent validity?Methods: 77 participants with chronic stroke performed four trials of 10MWT and four trials of GAITRite—two trials at comfortable walking speed and two trials at maximal walking speed. Intraclass correlations [ICC (3,1), absolute agreement] and Bland-Altman plots were used to assess the relationship between gait speed from these two measures.Results: Walking speed showed poor to good absolute agreement between 10MWT and GAITRite for comfortable walking speed [ICC: 0.77 (95% CI: 0.46, 0.89; P < 0.001)] and excellent absolute agreement for maximal walking speed [ICC: 0.94 (95% CI: 0.91, 0.96; P < 0.001)]. Mean difference value (systematic bias) was different from 0 for comfortable walking [10MWT was faster; P < 0.001 (95% CI: 0.05, 0.10)] but not for maximal walking [P = 0.16 (95% CI: −0.01, 0.04)]. Limits of agreement were broad (comfortable walking speed, 0.43; maximal walking speed, 0.37), and there was proportional bias at both speeds whereby participants who walked faster tended to have a faster walking speed during 10MWT vs. GAITRite (comfortable walking speed, R2 = 0.22, P < 0.001; maximal walking speed, R2 = 0.08, P = 0.01).Significance: Systematic bias, proportional bias, and broad limits of agreement suggest that caution should be used when comparing walking speeds from 10MWT and GAITRite. It may not be appropriate to use them interchangeably. Conducting 10MWT and GAITRite tests at maximal walking speeds may allow more accurate comparisons between measures.

Patients 10 years after total hip arthroplasty have the deficits in functional performance, physical activity, and high fall rate compared to healthy adults.

Background Long-term results in muscle strength, physical activity (PA), and functional improvement after total hip arthroplasty (THA) have not been studied. The purpose of this study was to evaluate the deficits in functional performance, PA, and high fall rate in patient 10 years after THA compared to healthy adults. Methods The subjects were 58 patients who underwent primary THA for unilateral hip osteoarthritis 10 years, and 46 healthy adults. Hip abductor strength, balance function (single-leg stance time), Maximal Walking Speed (MWS), fall rate, and PA (IPAQ short ver.) were evaluated. The unpaired t-test and χ2 test were used to assess differences between the groups. Statistical significance was set at p value <0.05. Results Compared to healthy adults, THA patients had 9.5% less hip abductor muscle strength on the operated side, 42.1% shorter single-leg stance time on the operated side, 14.8% slower MWS, 2.0 times less High-PA group, and 2.8 times higher fall rate (p<0.05). Conclusion This study showed that hip abductor muscle strength, gait speed, balance function, and PA were significantly lower in patients 10 years after THA than in healthy adults. Additionally, the fall rate was significantly higher in patients 10 years post-THA than in healthy adults.

Limited Walking Abilities and Impaired Ankle Dorsiflexion Function in Children After Intense Cancer Treatment.

With improved survival rates in pediatric oncology, the detection of adverse side- and late-effects is gaining increased interest. This cross-sectional study investigated walking abilities and ankle dorsiflexion function in children with cancer. Study participants included 16 children with various cancers (4-20 years, patient group) after completion of the intense treatment and 16 age- and gender-matched healthy peers (comparison group). Walking speed (10-meter-walking-test, treadmill test assessing preferred transition speed), walking capacity (2-minute-walk-test), walking balance (Timed-Up-And-Go-Test), active/passive ankle dorsiflexion range of motion (ROM) (goniometer) and ankle dorsiflexion strength (hand-held dynamometer) were comprehensively assessed. Significant lower values in the patient group were found for walking capacity, maximum walking speed, ankle dorsiflexion ROM and strength. No significant differences between the groups were found for preferred walking speed and walking balance. Limited walking abilities and ankle dorsiflexion dysfunctions are prominent in children with cancer; having the potential to impact children's community mobility and physical activity. To provide holistic care, the development of specific supportive strategies such as exercise interventions and its translation into clinical practice needs to be accelerated.

Physical performance in relation to menopause status and physical activity.

The aim of this study was to examine differences in physical performance (muscle power, muscle strength, aerobic capacity, and walking speed) across menopausal stages and potential of leisure physical activity (PA) to modify the impact of menopause on physical performance. In this cross-sectional study, women aged 47 to 55 were randomly selected from the Finnish National Registry and categorized as premenopausal (n = 233), perimenopausal (n = 381), or postmenopausal (n = 299) based on serum concentrations of follicle-stimulating hormone and bleeding diary. Physical performance was measured by knee extension force, handgrip force, vertical jumping height, maximal walking speed, and 6-minute walking distance. PA level was assessed by self-report and categorized as low, moderate, or high. Multivariate linear regression modeling was used for data analysis. After including fat mass, height, PA, and education in the model, the postmenopausal women showed 12.0 N weaker (P < 0.001) handgrip force and 1.1 cm lower (P < 0.001) vertical jumping height than the premenopausal women. There was no significant interaction between menopausal stage and PA on physical performance. The peri- and postmenopausal women with a high PA, however, showed better performance in the maximal knee extension strength and 6-minute walking test, and showed greater lower body muscle power than those with a low PA. Menopause status is associated with muscle strength and power, whereas the association between menopause status and mobility/walking is clearly weaker. A high leisure PA level provides more capacity to counteract the potential negative influence of menopausal factors on muscle function.

Relationships among subjective patient-reported outcome, quality of life, and objective gait characteristics using wearable foot inertial-sensor assessment in foot-ankle patients.

This study aimed to determine the relationships between subjective validated patient-reported outcomes and health-related quality of life, to objective gait characteristics in patients with foot-ankle conditions. Objective gait characteristics were obtained using a wearable foot inertial-sensor device as well as by assessing the relationships between spatiotemporal or gait parameters by analyzing the inter-metric correlations. Fifty-two patients with foot-ankle conditions (37 women/15 men, aged 21-75years) were included in this study. Clinical assessments, including evaluations of validated patient-reported outcomes using visual analog scale foot and ankle score, health-related quality of life using validated Short Form-36, and gait characteristics using a wearable foot inertial-sensor device, were performed and recorded for each patient. A significant negative correlation was observed between the physical component summary (PCS) and maximal cadence (r = - 0.308, P = 0.025). Significant positive correlations were noted between mean walking speed and mean cadence (r = 0.776, P < 0.001) and between maximal walking speed and mean step length (r = 0.498, P < 0.001). Significant negative correlations were found between the mean cadence and mean step length (r = - 0.491, P < 0.001) and between maximal cadence and mean step length (r = - 0.355, P = 0.009). Cadence is an important objective spatiotemporal parameter to assess in foot and ankle patients as it relates well to outcome, with a significantly negatively correlation to subjectively reported PCS in health-related quality of life. Based on inter-metric relationships, an increased cadence might be used to maintain walking speed as a compensatory mechanism in patients with foot-ankle conditions.

Relationship between the occurrence of falls by season and physical functions of community-dwelling old-old people living in cold, snowy areas.

To investigate the functional characteristics of older adults who experienced a fall in the winter season and other seasons. Participants were 403 older adults enrolled in the project "Population-Based and Inspiring Potential Activity for Old-old Inhabitants," and were living in cold, snowy regions in Japan. They were aged ≥75 years, and 41.9% (n = 169) were men. Sociodemographic characteristics, and physical, psycho-cognitive and social factors were surveyed. By experiences of falls, they were divided into three groups: the non-fall group, the fall in non-winter group and the fall in winter group. Each factor was compared with a χ2 -test, Student's t-test and Mann-Whitney U-test. Logistic regression analysis was carried out. spss version 25 was used for the statistical analysis. The level of significance was set at 5%. No differences were confirmed between the non-fall and fall in winter groups. In contrast, the maximum walking speed in the fall in non-winter group was significantly slower than the non-fall group, even with adjustment by variables, such as age, sex and self-efficacy. When considering intervention methods for health promotion, it is necessary to consider not only the presence or absence of falls, but also the seasons of falls. Geriatr Gerontol Int 2019; 19: 124-129.

Effect of Stride Management Assist Gait Training for Poststroke Hemiplegia: A Single Center, Open-Label, Randomized Controlled Trial

BackgroundPoststroke gait disorders negatively impact activities of daily living. Rehabilitation for stroke patients is aimed at improving their walking ability, balance, and quality of life. Robot-assisted gait training (RAGT) is associated with an increased number of task-specific exercises, which may benefit poststroke motor learning. We investigated the effects of RAGT using Stride Management Assist (SMA, which increases walk ratio by inducing hip-joint flexion and extension) in subacute stroke patients with hemiplegia. MethodsWe conducted a single center, open-label randomized controlled trial in hemiplegia patients who experienced a first ever stroke and were admitted to the convalescent rehabilitation ward. A total of 41 were divided into the control (20 patients) and experimental group (21 patients). A 10-day, conventional gait training program was carried out for the control group; and RAGT with SMA was used for the experimental group. The maximum walking speed and other gait parameters were compared preintervention and postintervention. The intergroup differences in the improvement ratio were compared using an intention-to-treat analysis. ResultsTen-day intervention was completed by 36 patients. There was no difference between the 2 groups regarding gait parameters at intervention initiation. The improvement ratio of the maximum walking speed was significantly higher for the experimental group. Significant improvements were observed postintervention for maximum walking speed, paralysis-side step length, symmetry, and cadence in the experimental group. No adverse events attributable to the SMA were observed. ConclusionsTen days of RAGT with the SMA was effective for improving gait disorders of subacute stroke patients.

Effect of kinesthetic illusion induced by visual stimulation on ankle dorsiflexion dysfunction in a stroke patient: ABAB single-case design

ABSTRACTThe purpose of this study was to investigate the effect of simultaneous intervention with the kinesthetic illusion induced by visual stimulation (KiNvis) and voluntary exercise on ankle dorsiflexion dysfunction in a patient with right-sided stroke hemiparesis. Within an ABAB single-case design, we conducted two phases each lasting five days. Phase A represented the baseline during which only voluntary ankle dorsiflexion (VAD) was performed. Phase B involved simultaneous performance of VAD and KiNvis. We measured the angle of ankle joint dorsiflexion (AJD), and the 10 m maximum walking speed (10MWS). AJD and 10MWS were significantly improved in phase B.

Home-Based, Moderate-Intensity Exercise Training Using a Metronome Improves the Breathing Pattern and Oxygen Saturation During Exercise in Patients With COPD.

One of the well-known but less-investigated effects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) is the change in breathing pattern toward a more efficient one (higher tidal volume [VT], lower breathing frequency). Evidence suggests this change can be obtained only with supervised, high-intensity exercise training (ExTr). However, some patients either do not have such programs available or are unable to exercise at higher intensity. We evaluated the effects of a 12-wk, moderate-intensity, home-monitored ExTr program using a metronome on the breathing pattern, oxygen saturation (SpO2), and dyspnea during exercise in patients with COPD. Twenty-one patients with COPD (7 female, aged 64-85 yr) performed spirometry, incremental, and endurance walking tests (at 60% of maximal walking speed) on a treadmill before and after training. During the endurance test, patients were equipped with an instrument that continuously monitored ventilation ((Equation is included in full-text article.)E), breathing pattern, and SpO2. Patients trained at home for 12 wk, 30 min/d for at least 4 d/wk at moderate intensity. A metronome paced the walking speed. Sixteen patients completed the program. After training, a significant change was observed in breathing pattern (lower (Equation is included in full-text article.)E and (Equation is included in full-text article.)E/VT ratio; P < .001), a higher SpO2 (P < .001), and a lower dyspnea perception at the same work intensity (P < .01). The (Equation is included in full-text article.)E/VT ratio and SpO2 during exercise were significantly related (r = 0.56, P = .001). A change in breathing pattern towards more efficient ventilation can be obtained with a moderate, home-monitored ExTr program with a pace that is controlled by a metronome. Decreased (Equation is included in full-text article.)E/VT was associated with an improved SpO2 during exercise.

The isometric knee extension strength threshold for maintaining walking speed and step length in older male inpatients

To clarify the minimum knee extension muscle strength needed to maintain walking speed and step length in older male inpatients. The participants were 786 male inpatients of ≥65 years of age without cerebrovascular disorder, orthopedic disease, malignancy, or dementia. We investigated the participants' isometric knee extension muscle force (kgf/kg), maximum walking speed (m/s) and step length, based on their medical records. The relationship of walking speed and step length to isometric knee extension muscle force was fitted to linear and nonlinear models, and the respective R2 values were compared. Next, the muscle force data were divided into two groups, and two linear functions were calculated. Then, the muscle force value that minimized the sum of the residual sum of squares of the two linear function expressions was obtained. The R2 values of each equation in the nonlinear model were higher than those in the linear model. Among all participants, the muscle force values that minimized the sum of the residual sum of squares for walking speed and step length were 0.33 kgf/kg and 0.43 kgf/kg, respectively. Among participants of ≤74 years of age, the muscle force value that minimized the sum of the residual sum of squares was 0.30 kgf/kg for both walking speed and step length, whereas the values were 0.32 kgf/kg and 0.43 kgf/kg, respectively, in participants of ≥75 years of age. Walking speed and step length were significantly decreased in male inpatients of 65-74 years of age when the isometric knee extension force values for both were <0.30 kgf/kg. In contrast, among male inpatients of ≥75 years of age, these values were significantly decreased when the respective isometric knee extension muscle force values were <0.32 kgf/kg and <0.43 kgf/kg.

OR-030 Influences of Four Weeks Intermittent Hypoxic Training on Aerobic Ability of High-Level Race Walking Athletes

OR-030 Influences of Four Weeks Intermittent Hypoxic Training on Aerobic Ability of High-Level Race Walking Athletes

Association of Activities of Daily Living With Load During Step Ascent Motion in Nursing Home-Residing Elderly Individuals: An Observational Study.

This study aimed to examine the association of independence in activities of daily living with the loads during step ascent motion and other motor functions in 32 nursing home-residing elderly individuals. Independence in activities of daily living was assessed by using the Functional Independence Measure. The loads at the upper (i.e., pulling up) and lower (i.e., pushing up) levels during the step ascent task was measured on a step ascent platform. Hip extensor, knee extensor, plantar flexor muscle, and quadriceps setting strengths; lower extremity agility using the stepping test; and hip and knee joint pain severities were measured. One-legged stance and functional reach distance for balance and maximal walking speed, timed up-and-go time, five-chair-stand time, and step ascent time were also measured to assess mobility. Stepwise regression analysis revealed that the load at pushing up during step ascent motion and timed up-and-go time were significant and independent determinants of Functional Independence Measure score. Functional Independence Measure score decreased with decreased load at pushing up and increased timed up-and-go time. The study results suggest that depending on task specificity, both one step up task's push-up peak load during step ascent motion and timed up-and-go can partially explain activities of daily living's Functional Independence Measure score in nursing home-residing elderly individuals. Lower extremity muscle strength, agility, pain, or balance measures did not add to the prediction.

Better preoperative physical performance reduces the odds of complication severity and discharge to care facility after abdominal cancer resection in people over the age of 70 – A prospective cohort study

IntroductionReduced functional reserve in older people, combined with the surgical stress, may increase the likelihood of adverse postoperative outcomes. The objective of this study was to examine the associations between preoperative physical performance and severity of postoperative complications, length of stay (LoS), and discharge destination in older people after abdominal cancer surgery. MethodsBetween December 2015 and December 2017, a prospective cohort study examined 197 individuals ≥ 70 years of age awaiting abdominal cancer surgery. Measures of physical performance (walking distance, functional leg strength, grip strength, inspiratory muscle strength, gait speed) and self-reported physical activity were conducted preoperatively, and postoperative outcomes were collected within 30 days of surgery. ResultsFifty-four percent experienced at least one postoperative complication at 30-day follow-up, including 10% with severe complications. In the multivariable analysis, better walking distance, functional leg strength, grip strength, inspiratory muscle strength, and gait speed were associated with reduced odds of higher complication severity. Better preoperative inspiratory muscle strength was associated with shorter LoS in hospital, and better preoperative physical activity level, walking distance, grip strength, and maximal walking speed reduced the odds of being postoperatively discharged to further care rather than to home. ConclusionThe results emphasize the importance of acknowledging the physical fitness of the older individual rather than chronological age. Objectively measured physical performance is an important addition to conventional risk assessments in preoperative care. This will help to identify patients at high risk and in need of an alternative preoperative pathway, which might include personalized preoperative exercise.

MRI Markers and Functional Performance in Patients With CIS and MS: A Cross-Sectional Study.

Introduction: Brain atrophy is a widely accepted marker of disease severity with association to clinical disability in multiple sclerosis (MS). It is unclear to which extent this association reflects common age effects on both atrophy and function.Objective: To explore how functional performance in gait, upper extremities and cognition is associated with brain atrophy in patients with Clinically Isolated Syndrome (CIS) and relapsing-remitting MS (RRMS), controlling for effects of age and sex.Methods: In 27 patients with CIS, 59 with RRMS (EDSS ≤3) and 63 healthy controls (HC), 3T MRI were analyzed for T2 lesion count (T2C), volume (T2V) and brain volumes [normalized brain volume (NBV), gray matter volume (NGMV), white matter volume (NWMV), thalamic volume (NThalV)]. Functional performance was measured with short maximum walking speed (SMSW speed), 9-hole peg test (9HPT) and symbol digit modalities test (SDMT). Linear regression models were created for functional variables with stepwise inclusion of age, sex and MR imaging markers.Results: CIS differed from HC only in T2C and T2V. RRMS differed from HC in NBV, NGMV and NThalV, T2C and T2V, but not in NWMV. A strong association with age was seen in HC, CIS and RRMS groups for NBV (r = −0.5 to −0.6) and NGMV (r = −0.6 to −0.8). Associations with age were seen in HC and RRMS but not CIS for NThalV (r = −0.3; r = −0.5), T2C (rs = 0.3; rs = 0.2) and T2V (rs = 0.3; rs = 0.3). No effect of age was seen on NWMV. Correlations of functional performance with age in RRMS were seen for SMSW speed, 9HPTand SDMT (r = −0.27 to −0.46). Regression analyses yielded significant models only in the RRMS group for 9HPT, SMSW speed and EDSS. These included NBV, NGMV, NThalV, NWMV, logT2V, age and sex as predictors. NThalV was the only MRI variable predicting a functional measure (9HPTr) with a higher standardized beta than age and sex (R2 = 0.36, p < 1e-04).Conclusion: Thalamic atrophy was a stronger predictor of hand function (9HPT) in RRMS, than age and sex. This underlines the clinical relevance of thalamic atrophy and the relevance of hand function as a clinical marker even in mildly disabled patients.

Altered joint kinetic strategies of healthy older adults and individuals with Parkinson’s disease to walk at faster speeds

Individuals with Parkinson’s disease (PD) exhibit poorer walking performance compared to healthy, age-matched adults. Lower extremity joint kinetics may provide insight into this performance deficit but are currently lacking in the PD literature, especially across multiple speeds. The primary purpose of this study was to compare joint kinetics between individuals with PD and healthy older adults at both comfortable and maximal walking speeds. Secondarily, we quantified relationships between joint kinetics and walking speeds within each group. Biomechanical gait analyses were conducted for 13 individuals with PD and 12 age-matched controls during comfortable (CWS) and maximal (MWS) speed walking. Relative contributions to total positive work from the hip, knee, and ankle were compared across groups and speeds. Within each group, relationships between relative joint work and CWS and MWS were also quantified. Significant group by speed interactions indicated that healthy older adults increased hip and decreased ankle relative work at MWS compared to CWS whereas relative work at all joints in PD group remained stable across speeds. In the older group, positive relationships were observed between relative hip work and MWS. In the PD group, negative relationships were observed between relative hip work and CWS and MWS. Healthy older adults disproportionately increased mechanical contributions from the hip at MWS compared to CWS. Individuals with PD did not exhibit similar disproportionate scaling of joint kinetics across speed conditions. Inability to appropriately scale joint kinetics in PD may represent an inflexible neuromuscular system in PD, which may limit walking performance in this population.

Robot-assisted training using Hybrid Assistive Limb® for cerebral palsy

PurposeThe Hybrid Assistive Limb® (HAL®, CYBERDYNE) is a wearable robot that provides assistance to a patient while they are walking, standing, and performing leg movements based on the wearer’s intended movement. The effect of robot-assisted training using HAL® for cerebral palsy (CP) is unknown. Therefore, we assessed the effect of robot-assisted training using HAL® on patients with CP, and compared walking and gross motor abilities between pre-intervention and post-intervention. MethodsSix subjects with CP were included (mean age: 16.8 years; range: 13–24 years; Gross Motor Function Classification System levels II–IV: n = 1, 4, 1). Robot-assisted training using HAL® were performed 2–4 sessions per week, 20 min per session, within a 4 weeks period, 12 times in total. Outcome measures included gait speed, step length, cadence, single-leg support per gait cycle, hip and knee joint angle in stance, and swing phase per gait cycle, 6-minute walking distance (6 MD), physiological cost index (PCI), knee-extension strength, and Gross Motor Function Measure (GMFM). ResultsThere were significant increases in self-selected walking speed (SWS), cadence during SWS and maximum walking speed (MWS), single-leg support per gait cycle, hip joint angle in the swing phase, 6 MD, and GMFM. In contrast, gait speed during MWS, step length during SWS and MWS, hip and knee joint angle in the stance phase, knee joint angle in the swing phase, PCI, and knee-extension strength generally improved, but not significantly. ConclusionRobot-assisted training using HAL® may improve walking and gross motor abilities of patients with CP.

The Functional Utilization of Propulsive Capacity During Human Walking.

Aging and many gait pathologies are characterized by reduced propulsive forces and ankle moment and power generation during trailing leg push-off in walking. Despite those changes, we posit that many individuals retain an underutilized reserve for enhancing push-off intensity during walking that may be missed using conventional dynamometry. By using a maximum ramped impeding force protocol and maximum speed walking, we gained mechanistic insight into the factors that govern push-off intensity and the available capacity thereof during walking in young subjects. We discovered in part that young subjects walking at their preferred speed retain a reserve capacity for exerting larger propulsive forces of 49%, peak ankle power of 43%, and peak ankle moment of 22% during push-off-the latter overlooked by maximum isometric dynamometry. We also provide evidence that these reserve capacities are governed at least in part by the neuromechanical behavior of the plantarflexor muscles, at least with regard to ankle moment generation. We envision that a similar paradigm used to quantify propulsive reserves in older adults or people with gait pathology would empower the more discriminate and personalized prescription of gait interventions seeking to improve push-off intensity and thus walking performance.

P31. Gait disturbance in patients with orthostatic tremor

Introduction Orthostatic tremor (OT) is a rare disorder of unclear etiology characterized by a 13–18 Hz tremor of the legs while standing with resolving symptoms during sitting or walking. OT is associated with other movement disorders such as parkinsonism, essential tremor or cerebellar disorders. Although gait disturbances are frequently described in these diseases, there is no systemic analysis of the gait disorder linked to OT. Therefore, the aim of this study is to investigate the gait performance of patients with OT assessed by a standardized sensorimotor and cognitive walking paradigm. Methods Patients with a diagnosis of primary OT were screened and included in this study after informed consent. Gait performance was investigated during 8 different walking conditions using a pressure-sensitive sensor carpet (GAITRite®). Patients walked at preferred, slow and maximum walking speeds (PS, SS, MS), during head reclination and eyes closed conditions (HR, EC) as well as calculatory, semantic and motoric dual task conditions (DTC, DTS, DTM). The gait performance of patients was compared to age-matched healthy subjects. Gait parameters were assessed by a multivariate analysis of variance. Results Eighteen patients with a diagnosis of primary OT with a mean age of 70.4 ± 5.9 years were included in the study. In all walking conditions gait velocity (p Discussion Although OT symptoms diminish during walking, we identified constant impairments of locomotion control. The gait disturbance was characterized by an increased level of a cautious gait (slow, small-stepped, increased double support phases and BOS). Moreover, we identified disturbance of gait stability (increased CV) and interlimb coordination (left-right asymmetry). The specific alterations were found in conditions with increased sensory feedback control as well as attentional cognitive gait control. This implies an impaired integration of sensory feedback, possibly due to a dysfunction of midline cerebellar structures, as cerebellar dysfunction in OT was frequently described.

The effect of short-term health promotion intervention on motor function in community-dwelling older adults.

Slow walking speed as one indicator of physical frailty has been found to be associated with deterioration of the health status. Although many reports have shown that exercise training improves motor function, it is unclear whether a group-based and short-term health promotion intervention will improve motor function in older adults. This study aimed to examine the effectiveness of a short-term health promotion intervention on motor function in community-dwelling older adults. A 6-month middle-term and moderate-intensity programme (MTMIP) and a 6-week short-term high-intensity programme (STHIP) were conducted. There were 28 and 29 subjects selected for the MTMIP and STHIP, respectively. The difference in motor function test outcomes was compared by assessment of comfortable walking speed, maximal walking speed, a sit-to-stand test (STS), and a timed up-and-go test (TUG). Comfortable walking speed, maximum walking speed, STS and TUG were significantly improved at end of the programme in the STHIP group (p = 0.02, p = 0.03, p < 0.001 and p = 0.002). Multiple regression analysis revealed that implementation of STHIP had a significant effect on end-of-programme comfortable walking speed (β = 0.19, p = 0.006, 95% CI 0.06 to 0.32). It was assumed that the training content of the STHIP, with its emphasis on high intensity and physical performance, was the main factor in improved walking speed. Our results demonstrated the effectiveness of STHIP on motor function. These findings could help support development of more effective intervention methods in community-dwelling older adults.

Training with Hybrid Assistive Limb for walking function after total knee arthroplasty

BackgroundThe Hybrid Assistive Limb (HAL, CYBERDYNE) is a wearable robot that provides assistance to patients while walking, standing, and performing leg movements based on the intended movement of the wearer. We aimed to assess the effect of HAL training on the walking ability, range of motion (ROM), and muscle strength of patients after total knee arthroplasty (TKA) for osteoarthritis and rheumatoid arthritis, and to compare the functional status after HAL training to the conventional training methods after surgery.MethodsNine patients (10 knees) underwent HAL training (mean age 74.1 ± 5.7 years; height 150.4 ± 6.5 cm; weight 61.2 ± 8.9 kg), whereas 10 patients (11 knees) underwent conventional rehabilitation (mean age 78.4 ± 8.0 years; height 150.5 ± 10.0 cm; weight 59.1 ± 9.8 kg). Patients underwent HAL training during 10 to 12 (average 14.4 min a session) sessions over a 4-week period, 1 week after TKA. There was no significant difference in the total physical therapy time including HAL training between the HAL and control groups. Gait speed, step length, ROM, and muscle strength were evaluated.ResultsThe nine patients completed the HAL training sessions without adverse events. The walking speed and step length in the self-selected walking speed condition, and the walking speed in the maximum walking speed condition were greater in the HAL group than in the control group at 4 and 8 weeks (P < 0.05). The step length in the maximum walking speed condition was greater in the HAL group than in the control group at 2, 4, and 8 weeks (P < 0.05). The extension lag and knee pain were lower in the HAL group than in the control group at 2 weeks (P < 0.05). The muscle strength of knee extension in the HAL group was greater than that in the control group at 8 weeks (P < 0.05).ConclusionHAL training after TKA can improve the walking ability, ROM, and muscle strength compared to conventional physical therapy for up to 8 weeks after TKA. Since the recovery of walking ability was earlier in the HAL group than in the control group and adverse events were not observed in this pilot study, HAL training after TKA can be considered a safe and effective rehabilitation intervention.Trial registrationUMIN, UMIN000017623. Registered 19 May 2015