Comparisons of Knee Extensor Functional Demand During Gait by Age, Physical Activity Level, and the Impact of Acute Exercise and Walking Speed

Muscle Torque-Velocity Relationships and Fatigue With Reduced Knee Joint Range of Motion in Young and Older Adults

The purpose of this study was to evaluate the influence of knee joint range of motion (RoM) on the torque-velocity relationship and fatigue in the knee extensor muscles of 7 young (median = 26 y) and 7 older (68 y) adults. Each leg was assigned a RoM (35° or 75°) over which to perform a torque-velocity protocol (maximal isokinetic contractions, 60-300°·s-1) and a fatigue protocol (120 maximal contractions at 120°·s-1, 0.5 Hz). Six older participants were unable to reach 300°·s-1 over 35°. Therefore, the velocity eliciting 75% of peak torque at 60°·s-1 (V75, °·s-1) was calculated for each RoM from a fit of individual torque-velocity curves (60-240°·s-1), and ΔV75 (35°-75°) was determined. Fatigue (final torque/initial torque) was used to calculate Δfatigue (35°-75°). ΔV75 was not different from 0 in young (-28.3°·s-1 [-158.6 to 55.7], median [range], P = .091) or older (-18.5°·s-1 [-95.0 to 23.9], P = .128), with no difference by age (P = .710). In contrast, fatigue was greater for 75° in young (Δfatigue = 25.9% [17.5-30.3], P = .018) and older (17.2% [11.9-52.9], P = .018), with no effect of age (P = .710). These data indicate that, regardless of age, RoM did not alter the torque-velocity relationship between 60 and 240°·s-1, and fatigue was greater with a larger RoM.

Sit-to-Stand Power Is a Stronger Predictor of Gait Speed than Knee Extension Strength

With a growing aging population, the routine assessment of physical function may become a critical component of clinical practice. The purpose of this cross-sectional study is to compare two common assessments of muscular function: (1) isometric knee extension strength (KES) and (2) sit-to-stand (STS) muscle power tests, in predicting objective physical function (i.e., gait speed) in aging adults. 84 adults (56% female, mean (SD) age = 66.6 (9.4) years) had their relative KES, STS power, usual gait speed (UGS), and fast gait speed (FGS) assessed. Multiple linear regression examined the associations between KES, STS power, and gait outcomes. When entered in separate models, KES and STS power were both independently associated with UGS and FGS (Std. β = 0.35-0.44 and 0.42-0.55 for KES and STS power, respectively). When entered in the same model, STS power was associated with UGS and FGS (Std. β = 0.37 [95%CI: 0.15, 0.58] and 0.51 [95%CI: 0.31, 0.70], respectively), while KES was only associated with FGS (Std. β = 0.25 [95%CI: 0.02, 0.48]). STS power seems to be a valid indicator of function in aging adults. Its feasibility as a screening tool for "low" function in the primary care setting should be explored.

Improving muscle capacity utilization with a 12-week strengthening program for females with symptomatic knee osteoarthritis

BACKGROUND

Strengthening exercise improves symptoms in knee osteoarthritis (OA), but it remains unclear if biomechanical mechanisms contribute to this improvement. Muscle capacity utilization, which reflects the proportion of maximum capacity required to complete tasks, may provide insight into how strengthening exercise improves clinical outcomes in painful knee OA.

PURPOSE

The purpose of this secondary analysis was to determine if a 12-week strengthening intervention reduced muscle capacity utilization during walking, squat and lunge tasks in females with painful knee OA.

METHODS

Data from 28 females (age 59.6 ± 6.2 years old; body mass index 29.1 ± 4.7 kg/m2) with clinical knee OA were included. Participants completed a strengthening intervention 3 times per week for 12 weeks. Knee extensor isometric torque was measured on a commercial dynamometer; peak values from three exertions were averaged. Peak KFM was extracted and averaged from five walking trials. Mean KFM was extracted and averaged from three trials for each of static lunges and squats. Muscle capacity utilization was the ratio of mean peak KFM to peak extensor torque for walking; and mean KFM to peak extensor torque for squats and lunges. Paired t-tests determined differences between peak extensor torque, peak KFM and muscle capacity utilization from pre to post intervention (p < 0.05).

RESULTS & SIGNIFICANCE

Peak extensor torque increased at follow up (p = 0.02). Peak KFM during walking decreased (p = 0.005). Muscle capacity utilization during walking (p = 0.008) and squat (p = 0.002) decreased. Mean KFM and muscle capacity utilization during lunge remained unchanged from pre to post intervention. The reduction in muscle capacity utilization at follow up indicates the strengthening intervention produced a decrease in proportion of the maximal capacity a participant used to complete walking and squat tasks. Strengthening both increases maximal muscle capacity and decreases the net moment required during daily tasks in knee OA.

Age-related changes in gait biomechanics and their impact on the metabolic cost of walking: Report from a National Institute on Aging workshop

Changes in old age that contribute to the complex issue of an increased metabolic cost of walking (mass-specific energy cost per unit distance traveled) in older adults appear to center at least in part on changes in gait biomechanics. However, age-related changes in energy metabolism, neuromuscular function and connective tissue properties also likely contribute to this problem, of which the consequences are poor mobility and increased risk of inactivity-related disease and disability. The U.S. National Institute on Aging convened a workshop in September 2021 with an interdisciplinary group of scientists to address the gaps in research related to the mechanisms and consequences of changes in mobility in old age. The goal of the workshop was to identify promising ways to move the field forward toward improving gait performance, decreasing energy cost, and enhancing mobility for older adults. This report summarizes the workshop and brings multidisciplinary insight into the known and potential causes and consequences of age-related changes in gait biomechanics. We highlight how gait mechanics and energy cost change with aging, the potential neuromuscular mechanisms and role of connective tissue in these changes, and cutting-edge interventions and technologies that may be used to measure and improve gait and mobility in older adults. Key gaps in the literature that warrant targeted research in the future are identified and discussed.

Knee extensor functional demand in individuals with knee osteoarthritis

BACKGROUND

Knee extensor (KE) weakness is commonly exhibited in individuals with knee osteoarthritis (KOA) and may contribute to disability due an increased muscle functional demand and resulting compensatory gait strategies during locomotion. Muscle functional demand is defined as the percentage of maximal strength that is used during a task.

RESEARCH QUESTION

The study aim was to quantify KE functional demand in KOA, the impact of walking speed and the relationships with the relative joint contribution to total limb work.

METHODS

Fourteen individuals with symptomatic KOA underwent gait analysis at preferred and faster speeds and isokinetic dynamometry for KE maximum voluntary isometric torque. The KE functional demand as well as the relative and peak joint work and powers were calculated. Paired samples t-test was used to compare functional demand and relative work between speeds and Pearson's correlation was used to assess the relationship between relative work and functional demand values (α = 0.05).

RESULTS

The KE functional demand was 36.0 ± 15.7 % for the preferred speed and significantly higher at 49.8 ± 16.1 % for the faster speed, (t(13) = -5.45, p .05). Knee flexion moment was also significantly higher for the faster speed (t(13) = -5.54, p .001). There were significant relationships between fast speed functional demand and relative ankle negative power (r = -0.57) and relative ankle positive work (r = 0.66), (all p .05).

SIGNIFICANCE

The results suggest that as functional demand nears or exceeds 50 % of the muscle capacity individuals with KOA reduce the relative effort at the knee and use an ankle-based compensation strategy to meet task demands.

The relationship between muscle capacity utilization during gait and pain in people with symptomatic knee osteoarthritis

BACKGROUND

Muscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities.

RESEARCH QUESTION

Is pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific?

METHODS

Twenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m², gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences.

RESULTS

Pain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively).

SIGNIFICANCE

Muscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.