Predicting Home and Community Walking Activity in People With Stroke

Fulk GD, Reynolds C, Mondal S, Deutsch JE. Predicting home and community walking activity in people with stroke.

Objective

To determine the ability of the 6-minute walk test (6MWT) and other commonly used clinical outcome measures to predict home and community walking activity in high-functioning people with stroke.

Design

Cross-sectional.

Setting

Outpatient physical therapy clinic.

Participants

Participants (N=32) with chronic stroke (n=19; >6mo poststroke) with self-selected gait speed (GS) faster than .40m/s and age-matched healthy participants (n=13).

Interventions

Not applicable.

Main Outcome Measures

Independent variables: 6MWT, self-selected GS, Berg Balance Scale (BBS), lower extremity motor section of the Fugl-Meyer Assessment, and Stroke Impact Scale. Dependent variable: average steps taken per day during a 7-day period, measured using an accelerometer.

Results

6MWT, self-selected GS, and BBS were moderately related to home and community walking activity. The 6MWT was the only predictor of average steps taken per day; it explained 46% of the variance in steps per day.

Conclusions

The 6MWT is a useful outcome measure in higher functioning people with stroke to guide intervention and assess community walking activity.     

Validity of a Functional Dynamic Walking Test for the Elderly

Lark SD, Pasupuleti S. Validity of a functional dynamic walking test for the elderly.

Objective

To determine the validity of a safe, quick, and simple method of measuring dynamic balance in the elderly during gait called the parallel walk test.

Design

Control study.

Setting

Outpatient clinic, community.

Participants

Twenty-seven elderly fallers (age 82±6y) registered at a falls clinic and 34 elderly nonfallers (age 76±7y) were recruited to this study based on Mini Mental State Examination and Barthel Index scores.

Interventions

Subjects were timed as they walked 6m between 2 parallel lines on the floor at 3 different widths (20, 30.5, 38cm) in their own footwear. They were scored for foot placement on the line (1 point) or outside the lines (2 points). Participants also performed a timed 6-m tandem walk test, a 30-second tandem stance, and a 30-second parallel stance.

Main Outcome Measures

Scores and time to complete the parallel walk test and tandem walk test along with the time of standing for tandem and parallel stance. Validity coefficients were calculated for the sensitivity and specificity of the parallel walk test.

Results

All subjects completed the parallel walk test, but few attempted and completed the tandem walk test. The fallers had significantly greater scores at 20 and 30.5cm and took significantly longer to complete the 6m at all widths. The 20-cm width was most discriminatory. The parallel walk test showed a significant correlation with the tandem stance.

Conclusions

All subjects attempted and completed the parallel walk test but not the tandem walk test. The time to completion and scoring accurately measures dynamic balance during gait in elderly fallers. The parallel walk test could be a useful tool in the clinical setting for assessing balance in gait pre- and postintervention.     

Light Touch Cue Through a Cane Improves Pelvic Stability During Walking in Stroke

Boonsinsukh R, Panichareon L, Phansuwan-Pujito P. Light touch cue through a cane improves pelvic stability during walking in stroke.

Objective

To examine the effect of a light touch cue provided through a cane on mediolateral (ML) pelvic stability during walking in subjects poststroke.

Design

Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods.

Setting

Physical therapy clinic, tertiary care center.

Participants

Subacute patients (N=40) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days. The average gait speed with a cane was .13m/s (.05-.29m/s).

Intervention

Using a cane with the force contact and touch contact methods during walking.

Main Outcome Measures

ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration, muscle activation of bilateral tensor fascia latae (TFL), semitendinosus (ST), and vastus medialis (VM) using an electromyography system, and vertical cane force.

Results

The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N, respectively. A light touch cue through a cane was required only when the paretic leg accepted the body weight, and this cue can provide ML pelvic stability (.16g of average pelvic acceleration) during walking to the same degree as the force contact method of cane use. However, significant increases in single-limb support duration with higher activations of TFL, VM, and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion (P<.05).

Conclusions

A light touch cue can be provided during walking through the use of a cane. This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase.     

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study

McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

Objective

To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.

Design

Parallel group, posttest only.

Setting

Inpatient rehabilitation center.

Participants

Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).

Interventions

Locomotor treadmill training with partial BWS or traditional gait training methods.

Main Outcome Measures

Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.

Results

Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.

Conclusions

Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.     

Metabolic and Biomechanical Effects of Velocity and Weight Support Using a Lower-Body Positive Pressure Device During Walking

Grabowski AM. Metabolic and biomechanical effects of velocity and weight support using a lower-body positive pressure device during walking.

Objectives

To determine how changes in velocity and weight support affect metabolic power and ground reaction forces (GRFs) during walking using a lower-body positive pressure (LBPP) device. To find specific velocity and weight combinations that require similar aerobic demands but different peak GRFs.

Design

Repeated measures.

Setting

University research laboratory.

Participants

Healthy volunteer subjects (N=10).

Interventions

Subjects walked 1.00, 1.25, and 1.50m/s on a force-measuring treadmill at normal weight (1.0 body weight [BW]) and at several fractions of BW (.25, .50, .75, .85 BW). The treadmill was enclosed within an LBPP apparatus that supported BW.

Main Outcome Measures

Metabolic power, GRFs, and stride kinematics.

Results

At faster velocities, peak GRFs and metabolic demands were greater. In contrast, walking at lower fractions of BW attenuated peak GRFs and reduced metabolic demand compared with normal weight walking. Many combinations of velocity and BW resulted in similar aerobic demands, yet walking faster with weight support lowered peak GRFs compared with normal weight walking.

Conclusions

Manipulating velocity and weight using an LBPP device during treadmill walking can reduce force yet maintain cardiorespiratory demand. Thus, LBPP treadmill training devices could be highly effective for rehabilitation after orthopedic injury and/or orthopedic procedures.     

Change of Strength and Rate of Rise of Tension Relate to Functional Arm Recovery After Stroke

Renner CIE, Bungert-Kahl P, Hummelsheim H. Change of strength and rate of rise of tension relate to functional arm recovery after stroke.

Objective

To examine the relationship between individual strength parameters and functional motor ability over time during rehabilitation in stroke patients.

Design

A multiple-baseline experiment with assessment at inclusion and after 3 and 6 weeks.

Setting

Secondary-care rehabilitation center.

Participants

A convenience sample of 16 subacute stroke patients.

Interventions

Not applicable.

Main Outcome Measures

Maximal voluntary force and rate of rise of tension of hand grip, wrist extension, and elbow flexion and extension were recorded at all 3 times. At the same time, functional motor assessments were evaluated by the Action Research Arm Test (ARAT), Box and Block test, and Rivermead Test.

Results

We found no correlation between maximal voluntary force increases of various muscle contractions measurements. Neither the increase of grip strength nor that of wrist extension force correlated with improvement in ARAT score. Yet the improvement in the rate of rise of tension of hand grip (Spearman rho=.91) and of wrist extension (Spearman rho=.73) correlated with the improvement of the ARAT score and explained 77% of the variance of the ARAT.

Conclusions

The change in the rate of rise of tension of the hand grip has a better predictive value for the functional recovery compared to the change in maximal voluntary force in patients with moderate arm and hand weakness after stroke. The rate of rise of tension of hand grip seems an adequate quantifiable parameter to detect small improvements during functional recovery.     

Changes in Walking Activity and Endurance Following Rehabilitation for People With Parkinson Disease

White DK, Wagenaar RC, Ellis TD, Tickle-Degnen L. Changes in walking activity and endurance following rehabilitation for people with Parkinson disease.

Objective

To investigate changes in walking activity and endurance after interdisciplinary rehabilitation in people with Parkinson disease (PD).

Design

Randomized controlled trial.

Setting

Clinic, home, and community.

Participants

Mild to moderate PD (Hoehn and Yahr stage 2-3).

Interventions

Three experimental conditions lasting 6 weeks in duration: (1) no active rehabilitation; (2) 3.0 hours of interdisciplinary rehabilitation a week; or (3) 4.5 hours of interdisciplinary rehabilitation a week. Participants had stable medication regimes during the study.

Main Outcome Measures

Walking activity was estimated with an activity monitor (AM) (time spent walking and number of 10-second walking periods) in the home and community settings over a 24-hour period. Walking endurance was measured in the clinic with the two-minute walk test (2MWT). Linear contrast analyses were applied to examine changes in walking activity and endurance after higher doses of rehabilitation, and 2-way analysis of variance models with interaction were applied to examine the effect of high and low baseline walking levels on changes.

Results

The 2MWT was completed by 108 people with PD (mean age, 66.53y; with PD, 6.59y), and AM data were used from 74 of these people (mean age, 66.7y; with PD, 5.8y). Improvement in AM measures and the 2MWT did not significantly change across increasing dosages of interdisciplinary rehabilitation. Higher doses of rehabilitation resulted in significant improvements in the 2MWT for subjects with low baseline walking endurance (P=.001), and in AM measures for subjects with high baseline walking activity (P<.02).

Conclusions

Interdisciplinary rehabilitation can improve walking activity and endurance depending on baseline walking levels.     

Life-Space Mobility of Middle-Aged and Older Adults at Various Stages of Usage of Power Mobility Devices

Auger C, Demers L, Gélinas I, Miller WC, Jutai JW, Noreau L. Life-space mobility of middle-aged and older adults at various stages of usage of power mobility devices.

Objective

To examine whether the impact of power mobility devices (PMDs) varies as a function of stage of usage and to explore key factors associated with greater life-space mobility for middle-aged and older adults.

Design

Multicohort study with respondents grouped as a function of stage of PMD usage (reference group with mobility impairments, n=42; initial users, 1-6mo, n=35; long-term users, 12-18mo, n=39). Cohorts were compared with respect to life-space mobility in a continuum of environments ranging from home to outside town, using analysis of variance and chi-square tests. Baseline personal, assistive device, intervention, and environmental factors associated with life-space mobility were explored with age-adjusted linear regression models.

Setting

Four Canadian rehabilitation centers.

Participants

Random sample of middle-aged and older adults (N=116; 50-89y) living in the community or residential care.

Intervention

Procurement of a powered wheelchair or scooter.

Main Outcome Measure

Life-Space Assessment composite score.

Results

Cohort comparisons showed higher frequency of outings for PMD users in the neighborhood (P<.001) and around home (P<.05) and significantly greater Life-Space Assessment composite scores for initial and long-term users than for the reference group (P<.05). Factors such as sex, the nature of activities, and device type explained variances in Life-Space Assessment composite score ranging from 15.9% to 18.0% (P<.006).

Conclusions

Life-space mobility increases after PMD use and remains stable across the stages of initial and long-term use. To appreciate the impact of PMDs, clinicians should consider the environment and a combination of personal and device factors that are associated with the range of life-space mobility in the first 18 months after procurement.     

Incomplete Bladder Emptying in Patients With Stroke: Is Detrusor External Sphincter Dyssynergia a Potential Cause?

Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC. Incomplete bladder emptying in patients with stroke: is detrusor external sphincter dyssynergia a potential cause?

Objectives

To delineate the frequency, clinical risk factors, and urodynamic mechanisms of incomplete bladder emptying (IBE) among patients with recent stroke.

Design

Retrospective study.

Setting

Inpatient setting in the rehabilitation ward of a university hospital.

Participants

All patients with acute stroke admitted for rehabilitation between January and December 2005, excluding those with a history of lower-urinary tract symptoms and urologic diseases. Eighty-two patients (42 women and 40 men; mean age, 65.5y) were included.

Interventions

Not applicable.

Main Outcome Measures

We measured postvoid residual (PVRs) by catheterization or by using an ultrasonic bladder scanner. Twenty-five patients (30.5%) had IBE with PVRs greater than 100mL on 2 consecutive days. Patients with IBE were evaluated by a urologist and subsequently underwent urodynamic studies.

Results

The presence of IBE was significantly associated with urinary tract infection (P<.001) and aphasia (P=.046). The presence of IBE was not related to sex, stroke location, nature of stroke (hemorrhagic or ischemic), history of diabetes mellitus, or previous stroke. Urodynamic studies done on 22 patients with IBE revealed acontractile detrusor in 8 patients (36%) and detrusor underactivity in 3 (14%). Eleven patients (50%) had detrusor-external sphincter dyssynergia (DESD) combined with normative detrusor function (5 patients) or detrusor hyperactivity (6 patients); all but 1 of these patients had a supratentorial lesion. The presence of DESD was associated with a longer onset-to-evaluation interval (P=.008) and spasticity of the stroke-affected lower limb (P=.002). Diabetes mellitus was associated with the presence of acontractile detrusor or detrusor underactivity (P=.03).

Conclusions

IBE is common among patients with stroke and is caused by decreased detrusor contractility or DESD. Spasticity of the external urethral sphincter is a possible pathophysiologic mechanism of DESD.     

The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke

Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.

Objective

To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.

Design

Comparative gait analysis.

Setting

University-based aquatic therapy center.

Participants

Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal and kinematic gait parameters.

Results

The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.

Conclusions

The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking.     

Reliability of Ambulatory Walking Activity in Patients With Hematologic Malignancies

Knols RH, de Bruin ED, Aufdemkampe G, Uebelhart D, Aaronson NK. Reliability of ambulatory walking activity in patients with hematologic malignancies.

Objectives

To determine the relative and absolute reliability of the assessment of ambulatory walking activity during 2 consecutive weeks in patients with hematologic malignancies recovering at home from their medical treatment and to compare the physical activity level of hematologic cancer patients after high-dose chemotherapy with healthy subjects.

Design

Test-retest study of 2 consecutive 7-day recordings using the microprocessor-based step accelerometer 3 (SAM3).

Setting

Home and community.

Participants

Patients (n=23) with hematologic malignancies recovering from high-dose chemotherapy and healthy controls (n=30).

Interventions

Not applicable.

Main Outcome Measures

The intraclass correlation coefficient (ICC_3,1) and its 95% confidence interval (CI), SE of measurement procedure and its 95% CI, the smallest detectable difference (SDD), the coefficient of variation (CV), and t tests for the variables total steps and peak activity.

Results

The day-to-day and week-to-week CVs for walking activity and peak activity were 35.17% and 13.17% and 18.61% and 6.90%, respectively. For relative reliability, the ICCs for 2 consecutive 7-day recordings including the 95% CI for total steps and peak activity were 0.90 (95% CI, 0.75-0.98) and 0.85 (95% CI, 0.66-0.94), respectively. The absolute reliability for total steps and peak activity including the SE of measurement procedure and the 95% CI were 564 (95% CI, ±1106) and 2.42 steps (95% CI, ±4.74), respectively, for 2 consecutive 7-day recordings. The week-to-week SDD was 1564 for total steps and 6.70 for peak activity. The 7-day mean for total step activity was 5355 for the patients with hematologic malignancies and 6364 for healthy subjects (P<0.05).

Conclusions

The results of this study indicate that there is good relative reliability for the assessment of 2 consecutive 7-day recordings of ambulatory walking activity, and it showed that the SDD derived from this sample may be useful in detecting changes in daily walking activity in hematologic cancer patients who are recovering from intensive medical treatment. The study also documented compromised levels of ambulatory walking activity among hematologic cancer patients recovering from high-dose chemotherapy as compared with healthy controls.     

Effects of resistance training on lower-extremity impairments in older people with hip fracture

Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M, Kiviranta I, Sipilä S. Effects of resistance training on lower-extremity impairments in older people with hip fracture.

Objective

To study the effects of resistance training on muscle strength parameters, mobility, and balance.

Design

Randomized controlled trial.

Setting

Research laboratory and senior gym.

Participants

Population-based sample of eligible 60- to 85-year-old community-dwelling men and women 0.5 to 7.0 years after hip fracture. Forty-six people had no contraindications and were willing to participate in the exercise trial.

Intervention

Twelve-week intensive progressive strength-power training (n=24), aiming to reduce asymmetric deficit in leg muscle strength and power, or no intervention (n=22).

Main Outcome Measures

Isometric knee extension torque (KET) and leg extension power (LEP) measured in the weaker and stronger leg and the asymmetric deficit ([weak/sum both legs] × 100%), 10-m walking speed, dynamic balance test, and self-reported outdoor mobility.

Results

KET increased in both legs (P<.021), LEP tended to increase in the weaker leg (P=.071), and asymmetric LEP deficit decreased (P=.010) after training compared with the control group. LEP of the stronger leg, asymmetric KET deficit, walking speed, and balance performance were not significantly affected by training. Self-reported ability to walk outdoors improved after training. The compliance to the training was over 90%, and few adverse events (n=4; mainly musculoskeletal) were likely to be caused by the training.

Conclusions

Intensive resistance training is feasible for people with a hip fracture and improved muscle strength and power. More intensive training especially for the weaker leg may be needed to obtain more marked effects on asymmetric deficit, mobility, and balance. Also, the timing and duration of training program should be considered. (ISRCTN identifier ISRCTN34271567.)     

Timed Walking Tests Correlate With Daily Step Activity In Persons With Stroke

Mudge S, Stott NS. Timed walking tests correlate with daily step activity in persons with stroke.

Objectives

To examine the relationship among 4 clinical measures of walking ability and the outputs of the StepWatch Activity Monitor in participants with stroke.

Design

Correlational study.

Setting

Clinic and participants' usual environments.

Participants

Fifty participants more than 6 months after stroke were recruited. All participants were able to walk independently, but with some residual difficulty.

Interventions

Not applicable.

Main Outcome Measures

Rivermead Mobility Index (RMI), Rivermead Motor Assessment (RMA), six-minute walk test (6MWT), ten-meter walk test (10MWT), StepWatch outputs (based on daily step counts and stepping rates).

Results

The correlations between the RMA and all StepWatch outputs were low (ρ=0.36-0.48; P<.05), as were most for the RMI (ρ=0.31-0.52; P<.05). The 10MWT and 6MWT had moderate to high correlations (ρ=0.51-0.73; P<.01) with most StepWatch outputs. Multiple regression showed that the 6MWT was the only significant predictor for most StepWatch outputs, accounting for between 38% and 54% of the variance. Age and the RMI were further significant predictors of 1 and 2 outputs, respectively.

Conclusions

The 6MWT has the strongest relationship with the StepWatch outputs and may be a better test than the 10MWT to predict usual walking performance. However, it should be remembered that the 6MWT explains only half the variability in usual walking performance. Thus, activity monitoring captures aspects of walking performance not captured by other clinical tests and should be considered as an additional outcome measure in stroke rehabilitation.     

Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation

Horn SD, Deutscher D, Smout RJ, DeJong G, Putman K. Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation.

Objective

To describe racial differences in patient characteristics, nontherapy ancillaries, physical therapy (PT), occupational therapy (OT), and functional outcomes at discharge in stroke rehabilitation.

Design

Multicenter prospective observational cohort study of poststroke rehabilitation.

Setting

Six U.S. inpatient rehabilitation facilities.

Participants

Black and white patients (n=732), subdivided in case-mix subgroups (CMGs): CMGs 104 to 107 for moderate strokes (n=397), and CMGs 108 to 114 for severe strokes (n= 335).

Interventions

Not applicable.

Main Outcome Measure

FIM.

Results

Significant black-white differences in multiple patient characteristics and intensity of rehabilitation care were identified. White subjects took longer from stroke onset to rehabilitation admission and were more ambulatory prior to stroke. Black subjects had more diabetes. For patients with moderate stroke, black subjects were younger, were more likely to be women, and had more hypertension and obesity with body mass index greater than or equal to 30. For patients with severe stroke, black subjects were less sick and had higher admission FIM scores. White subjects received more minutes a day of OT, although black subjects had significantly longer median PT and OT session duration. No black-white differences in unadjusted stroke rehabilitation outcomes were found.

Conclusions

Reasons for differences in rehabilitation care between black and white subjects should be investigated to understand clinicians' choice of treatments by race. However, we did not find black-white differences in unadjusted stroke rehabilitation outcomes.     

Objective monitoring of adherence with home exercise training during pulmonary rehabilitation for chronic obstructive pulmonary disease

Objectives

Outpatient pulmonary rehabilitation relies on the patient completing bouts of unsupervised exercise at home. The aim of this study was to monitor adherence with a home walking programme using activity monitors.

Design

The sensitivity and reliability of five activity monitors were initially established at speeds at which patients are advised to walk. Thereafter, 18 patients with established chronic obstructive pulmonary disease attending pulmonary rehabilitation were recruited. All patients were required to wear a small device around their waist for two, 7-day periods during the 7-week course of rehabilitation. During this time, patients also completed a home diary card. Adherence was monitored by frequency, duration and intensity of walks.

Setting

Pulmonary Rehabilitation Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.

Results

The activity monitors were able to clearly discriminate varying walking speeds and were reproducible at each pre-selected speed (P < 0.05). However, between-monitor comparison was not reproducible at the pre-determined speeds. Individually prescribed walking speeds for home training ranged from 1.76 to 4.83 km/hour. As a group, only two patients failed to achieve 100% of total adherence. Adherence for the individual components varied widely.

Conclusion

Activity monitor technology appears to be able to discriminate individually prescribed walking speeds that allow home walking programmes to be monitored.     

Exploratory Study on Oxygen Consumption On-kinetics During Treadmill Walking in Women With Systemic Lupus Erythematosus

Keyser RE, Rus V, Mikdashi JA, Handwerger BS. Exploratory study on oxygen consumption on-kinetics during treadmill walking in women with systemic lupus erythematosus.

Objective

To determine whether oxygen consumption (V˙o₂) on-kinetics differed between groups of women with systemic lupus erythematosus (SLE) and sedentary but otherwise healthy controls.

Design

Exploratory case-control study.

Setting

Medical school exercise physiology laboratory.

Participants

Convenience samples of women with SLE (n=12) and sedentary but otherwise healthy controls (n=10).

Intervention

None.

Main Outcome Measures

V˙o₂ on-kinetics indices including time to steady state, rate constant, mean response time (MRT), transition constant, and oxygen deficit measured during bouts of treadmill walking at intensities of 3 and 5 metabolic equivalents (METs).

Results

Time to steady state and oxygen deficit were increased and rate constant was decreased in the women with SLE compared with controls. At the 5-MET energy demand, the transition constant was lower and MRT was longer in the women with SLE than in controls. For a similar relative energy expenditure that was slightly lower than the anaerobic threshold, the transition constant was higher in controls than in women with SLE.

Conclusion

V˙o₂ on-kinetics was prolonged in women with SLE. The prolongation was concomitant with an increase in oxygen deficit and may underlie performance fatigability in women with SLE.     

Effects of Weight-Bearing Versus Nonweight-Bearing Exercise on Function, Walking Speed, and Position Sense in Participants With Knee Osteoarthritis: A Randomized Controlled Trial

Jan M-H, Lin C-H, Lin Y-F, Lin J-J, Lin D-H. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial.

Objective

To investigate whether weight-bearing (WB) exercise enhances functional capacity to a greater extent than nonweight-bearing (NWB) exercise in participants with knee osteoarthritis.

Design

Randomized controlled trial.

Setting

Kinesiology laboratory.

Participants

Participants (N=106) were randomly assigned to WB exercise, NWB exercise, or a control group (no exercise).

Intervention

WB exercise and NWB exercise groups underwent an 8-week knee extension-flexion exercise program.

Main Outcome Measures

Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale, walking speed, muscle torque, and knee reposition error were assessed before and after intervention.

Results

Equally significant improvements were apparent for all outcomes after WB exercise and NWB exercise, except for reposition error, for which improvement was greater in the WB exercise group. In contrast, there were no improvements in the control group.

Conclusions

Simple knee flexion and extension exercises (WB and NWB) performed over 8 weeks resulted in significant improvement in the WOMAC function scale and knee strength compared with the control group. NWB exercise alone may be sufficient enough to improve function and muscle strength. The additional benefit of WB exercise was improved position sense, which may enhance complex walking tasks (walking on figure of 8 route and spongy surface).