Spatio-temporal gait disorder and gait fatigue index in a six-minute walk test in women with fibromyalgia

Association of Moderate-to-Vigorous Physical Activity, Sedentary Time, Fat Percentage, and Physical Fitness with Gait Parameters in Women with Fibromyalgia: The Al-Ándalus Project

Gait impairments have been found in women with fibromyalgia, reducing the physical activity possibilities in this population and leading to a negative correlation with fibromyalgia impact. The aim of this study was to analyze the individual and independent associations of moderate-to-vigorous physical activity (MVPA), sedentary time, fat percentage, and physical fitness with gait parameters in women with fibromyalgia. A total of 84 women with fibromyalgia were included. MVPA and sedentary time were assessed with accelerometry, fat percentage with bioimpedance analysis, and physical fitness with field-based fitness tests. Gait was assessed during a "6 min walk test" and categorized in velocity, cadence, step length, step cycle duration, unipedal stance phase, and bipedal stance phase. Individual relationships were analyzed by partial correlations and independent relationships by linear regressions, adjusting by age and height. MVPA, sedentary time, fat percentage, and physical fitness were correlated with most gait parameters (rpartial between |0.842| and |0.219|; p ≤ 0.05). Physical fitness was independently associated with all gait parameters (β between |0.346| and |0.761|; p ≤ 0.002). In addition, MVPA was independently associated with velocity and step length (β = 0.241 and 0.292; both p = 0.004), and fat percentage was associated with bipedal stance phase (β = 0.242; p = 0.049). Good levels of MVPA, physical fitness, and adequate weight balance are associated with improved gait parameters in women with fibromyalgia.

Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study

BACKGROUND

The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance.

OBJECTIVE

The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods.

METHODS

People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test.

RESULTS

The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI -2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and -77.6 (95% CI -107.7 to -61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points.

CONCLUSIONS

In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment.

Reference equations for the six-minute walking distance in obese Chinese subjects more than 40 years old

BACKGROUND

Studies have shown that the reference equations for the six-minute walking distance (6MWD), which were mainly derived from healthy, normal-weight people, are not suitable for individuals with obesity. The main purpose of this study was to establish reference equations for the 6MWD in obese Chinese subjects.

METHODS

In our study, a total of 214 individuals with obesity performed the six-minute walking tests (6MWTs) according to the American thoracic society (ATS) guidelines, and the longer 6MWD was used for further analysis. The reference equations for the 6MWD were developed using stepwise multiple regression analysis. The newly established equations for the 6MWD were compared to the existing prediction equations.

RESULTS

The mean 6MWD for the cohort was 523 ± 56 m. We found that the reliability of two 6MWTs was good. Age and BMI were identified as independent factors, and explained 31% and 27% of the variance in the 6MWD for the male and female participants, respectively. Thus, the reference equations reported in the previous studies did not accurately predict the 6MWD in our subjects.

CONCLUSION

Our study was the first to describe the 6MWD in obese Chinese subjects and to propose new predictive equations. These established equations can improve the assessment of the health of obese Chinese patients whose exercise capacity is affected by the disease.

LEVEL OF EVIDENCE

III, Cohort study.

Predicting Fatigue in Long Duration Mountain Events with a Single Sensor and Deep Learning Model

AIM

To determine whether an AI model and single sensor measuring acceleration and ECG could model cognitive and physical fatigue for a self-paced trail run.

METHODS

A field-based protocol of continuous fatigue repeated hourly induced physical (~45 min) and cognitive (~10 min) fatigue on one healthy participant. The physical load was a 3.8 km, 200 m vertical gain, trail run, with acceleration and electrocardiogram (ECG) data collected using a single sensor. Cognitive load was a Multi Attribute Test Battery (MATB) and separate assessment battery included the Finger Tap Test (FTT), Stroop, Trail Making A and B, Spatial Memory, Paced Visual Serial Addition Test (PVSAT), and a vertical jump. A fatigue prediction model was implemented using a Convolutional Neural Network (CNN).

RESULTS

When the fatigue test battery results were compared for sensitivity to the protocol load, FTT right hand (R² 0.71) and Jump Height (R² 0.78) were the most sensitive while the other tests were less sensitive (R² values Stroop 0.49, Trail Making A 0.29, Trail Making B 0.05, PVSAT 0.03, spatial memory 0.003). The best prediction results were achieved with a rolling average of 200 predictions (102.4 s), during set activity types, mean absolute error for 'walk up' (MAE200 12.5%), and range of absolute error for 'run down' (RAE200 16.7%).

CONCLUSIONS

We were able to measure cognitive and physical fatigue using a single wearable sensor during a practical field protocol, including contextual factors in conjunction with a neural network model. This research has practical application to fatigue research in the field.

Physical activity in the treatment of fibromyalgia

International treatment recommendations for fibromyalgia (FM) highlight the importance of adapted physical activity (APA) combined with patient education. Cognitive and behavioral therapies as well as an interdisciplinary approach can be proposed for more complex or severe clinical situations, with a biopsychosocial vision of rehabilitation. To personalize the rehabilitation's therapeutic approach, a clinician can use simple and validated instruments for measuring physical performance that will highlight levels of physical conditioning, which range from low to very low in FM patients. Several systematic reviews and meta-analyses have found strong evidence that supervised aerobic and resistance-training programs reduce the pain intensity and significantly improve the quality of life and the physical and psychological functioning of female FM subjects. These therapeutic approaches appear safe and promising in terms of cost-effectiveness and should be the subject of more randomized controlled trials among male FM subjects and adolescents.

Impact of cognitive tasks on biomechanical and kinematic parameters of gait in women with fibromyalgia: A cross-sectional study

BACKGROUND

Fibromyalgia (FM) is a chronic disease whose symptoms may cause altered walking pattern, which is important given the relevance of walking in daily life activities. These activities use to require the ability to perform both a motor and a cognitive task simultaneously. The main aim of the current study was to evaluate the impact of performing a simultaneous cognitive task in the gait pattern of women with FM.

METHODS

A total of 36 women recruited from a local association took part in this cross-sectional study. The time required to complete the 10-meters-walking-test and kinematic outcomes including number of steps, cadence, trunk tilt and ranges of motion were analyzed under single (motor task only) and dual task (motor and cognitive tasks simultaneously) conditions. The secondary task consisted in counting aloud backward in rows of two.

RESULTS

Results showed a significant increment in the time required to complete the test (p < 0.01) when participants performed the motor and cognitive tasks at the same time. Moreover, relevant changes in kinematic parameters such as increment of number of steps (p < 0.01), cadence (p < 0.01), trunk tilt (p < 0.01) and both hip (p < 0.01) and knee (p = 0.03) ranges of motion were also observed.

CONCLUSION

Adding a cognitive task to a primary motor task affects the walking motor pattern in women with FM, making it more stable and safer walking pattern when the attention is focused on two simultaneous tasks.

Effects of Transcranial Direct Current Stimulation for Treatment of Primary Dysmenorrhea: Preliminary Results of a Randomized Sham-Controlled Trial

Objective

The aim of this trial was to investigate the effects of five consecutive sessions of anodal transcranial direct current stimulation (tDCS) over the motor cortex (M1) on pain, mood, and physical performance in patients with primary dysmenorrhea (PDM).

Design

This is a double-blind randomized controlled trial.

Subjects

Twenty-two participants with PDM according to the No. 345-PDM Consensus Guideline were included.

Methods

Eleven active treatment and 11 sham stimulation patients received five applications over a one-week period. The primary outcome measures were pain evaluated by numeric rating scale (NRS) and McGill Questionnaire score. Secondary outcomes measures were responses to the Positive and Negative Affect Schedule (PANAS), Hamilton Anxiety Scale (HAM-A), grip strength, and six-minute walk test (6MWT). Baseline data were performed during the first menstrual cycle, and during the second menstrual cycle, participants were conducted to tDCS treatment, and postintervention data were collected.

Results

The intervention provided significant improvements on NRS in active tDCS, shown as an interaction between group intervention vs pre/postintervention vs days of menstrual cycle (Wald x2 = 10.54, P = 0.005), main effect of days of menstrual cycle (Wald x2 = 25.42, P &lt; 0.001), and pre/postintervention (Wald x2 = 6.97, P = 0.008). McGill showed an interaction effect between pre/postintervention and group of stimulation (Wald x2 = 18.45, P = 0.001), with a large reduction in active tDCS (P &lt; 0.001, d = 0.75). Psychological and functional outcomes did not differ between groups or pre/postintervention.

Conclusions

tDCS could provide pain relief in subjects with PDM. These results provide some preliminary evidence for the potential role of tDCS as a contributor to the management of symptoms of PDM.

Gender differences in patients with fibromyalgia: a gait analysis

This study analysed the spatio-temporal parameters, asymmetry, variability and bilateral coordination of gait in women and men with fibromyalgia and healthy subjects walking at their usual velocity and at a faster walking velocity. Fifty-five women and 12 men with fibromyalgia were analysed. A healthy group of 44 women and 17 men was analysed as the control group. A GAITRite system was used to obtain the spatio-temporal gait parameters for the participants when walking at their usual velocity and at a faster velocity. Coefficients of variation, bilateral coordination and gait asymmetry indexes were calculated. All groups exhibited a significant increase (p &lt; 0.001) in spatio-temporal parameters when walking fast. The fibromyalgia groups showed increased bilateral coordination, asymmetry and variability of stance phase when walking fast. The fibromyalgia women showed significant spatio-temporal, variability and bilateral coordination of gait differences compared with the healthy women. The fibromyalgia men reported significant differences in velocity, cadence, stride length, swing time variability and stance gait asymmetry indices compared with the healthy men. No significant differences were observed between the men and women in the fibromyalgia groups. The findings of the present study did not support gender-specific differences in walking variables and indices in FM patients. The differences found between both genders of FM patients and healthy subjects in walking indices at fast velocities could be a useful tool for diagnoses and evaluation of male and female patients with FM during short-term fast walking tests.

Reference Equations for the Six-Minute Walk Distance in the Healthy Chinese Han Population, Aged 18-30 Years

Background

The six-minute walk test (6MWT) is a safe, simple, inexpensive tool for evaluating the functional exercise capacity. However, there is a lack of standard reference equations for the six-minute walk distance (6MWD) in the healthy Chinese Han population with an age of 18–30 years. The aims of the present study were as follows: 1) to measure the anthropometric data and the walking distance in a sample of healthy Chinese Han population, aged 18–30 years; 2) to construct reference equations for the 6MWD; 3) to compare the measured 6MWD of our cohort with previously published equations.

Methods

The anthropometric data, demographic, lung function and the walking distance of Chinese Han population, aged 18–30 years, were prospectively measured using a standardized protocol. Informed consent was obtained from each participant and the approval was obtained from the ethics committee of Wenzhou People’s Hospital. The 6MWT was performed twice and the longer 6MWD was used for further analysis.

Results

A total of 355 subjects (176 female and 179 male) completed the 6MWT, and the average walking distance was 627.3 ± 52.88 m. The walking distance was achieved by females compared with males (607.4 ± 51.00 m vs. 646.9 ± 47.15 m; p < 0.0001) and active subjects compared with non-active subjects (646.1 ± 48.27 m vs. 611.6 ± 51.52 m; p < 0.0001). Univariate analysis showed age, height, body mass index, resting blood pressure, heart rate and blood pressure after the walk test and difference in heart rate before and after the walk test were significantly correlated with the 6MWD. Stepwise multiple regression analysis showed that height and difference in heart rate before and after the walk test were independent predictors associated with the 6MWD. The reference equations from Caucasian, Canadian and Chilean populations tend to overestimate the walking distance in our subjects, while Brazilian and Arabian equations tend to underestimate the walking distance. There was no significant difference in the walking distance between Korean equations and the current study.

Conclusion

In summary, height and difference in heart rate before and after the walk test were the most significant predictors of the 6MWD, and the regression equations could explain approximately 38% and 31% of the distance variance in the female and male groups, respectively.