Changes in Gait Variables in Patients with Intermittent Claudication

Improved gait parameters following surgical revascularization in patients with intermittent claudication

Objective

Intermittent claudication (IC) is known to be associated with impaired gait parameters, with a higher incidence of falls and higher oxygen consumption due to uneconomic walking. However, the influence of arterial disobliteration in patients with IC on their gait pattern has rarely been investigated to date. The aim of this study was to examine the gait patterns before and after inflow revascularization by surgical disobliteration of pelvic and inguinal arteries (ie, common iliac artery, external iliac artery, common femoral artery, profound femoral artery, superficial femoral artery) in IC patients. Successful surgical disobliteration of inflow arteries (improvement of ankle brachial pressure index of ≥0.2 and patent common iliac, external iliac, common femoral, profound femoral, and superficial femoral arteries) is known to improve the painless walking distance for patients with IC due to peripheral arterial disease; however, its influence on gait parameters is unclear. We hypothesized that the gait parameters would also improve after surgery. Improved gait parameters can lead to a more economic walking process, lower oxygen consumption, a lower risk of falls, and a higher quality of life.

Methods

In a single-center, exploratory, longitudinal study, we examined the gait parameters of 20 IC inpatients of our hospital before and after surgical disobliteration of pelvic and inguinal arteries. Spatiotemporal parameters such as range of motion of the hip and knee joint, stance phase, cadence, and foot rotation were obtained using the Diers 4Dmotion Lab (Diers International). The gait parameters were obtained under painful walking conditions preoperatively and with the patients walking pain free at the same speed postoperatively.

Results

A total of 20 patients were examined. Surgical revascularization led to a higher walking cadence (mean, plus 7.88 steps; 95.5 steps/min vs 87.6 steps/min; P = .024), an increased range of motion of the hip joint (mean, plus 2.0°; 35.1° vs 33.1°; P = .038), and improved foot rotation (mean, plus 2.0°; 11.0° vs 9.0°; P = .02). Regarding other parameters such as step length, stance phase, and step duration, smaller differences were detected in this study.

Conclusions

In this exploratory study, we found that surgical revascularization of pelvic and inguinal arteries in IC patients improved certain gait parameters. Further studies with larger patient numbers are needed to confirm these data and provide more evidence on this subject.

Effects of nordic walking training on gait and exercise tolerance in male ischemic heart disease patients

This technique-focused observational study explores the impact of a 6-week Nordic Walking (NW) program on physiological and biomechanical aspects in ischemic heart disease (IHD) patients. Twelve male IHD patients (66.2 ± 5.2 years, 12.2 ± 7.5 years of disease duration) were evaluated pre- and post-training for (i) gait parameters, (ii) exercise tolerance using electrocardiographic (ECG) stress test, (iii) a 6-min walk test (6MWT). The NW training, adhering to IHD patient guidelines, involved a 100-m walk at a self-selected, preferred speed without sticks, with classic NW sticks and mechatronic sticks. A mechatronic measuring system, specifically engineered for measuring, diagnosing and monitoring the patient's gait, was integrated into mechatronic sticks. Post-training, significant enhancements were observed in ECG stress test duration, metabolic equivalency, and 6MWT distance, irrespective of the stick type. However, no significant changes were noted in spatiotemporal parameters concerning the measured side, stick utilisation, or type. The results suggest that NW training boosts exercise capacity and refines gait mechanics in male IHD patients. However, the improvement in exercise capacity was not linked to changes in gait mechanics from NW training but rather to the movement during NW gait. Hence, the key to enhancing exercise capacity in IHD patients is the movement during NW gait, not the quality of gait mechanics.

Relationship Between Physical Performance and Peripheral Arterial Diseases in Different Age Groups of Chinese Community-Dwelling Older Adults

Aims: This study aimed to examine the relationship between physical performance and peripheral artery disease (PAD) in different age groups of Chinese older adults.

Methods: We enrolled 1357 relatively healthy ≥ 65 years old participants of Chinese ethnicity. We classified the participants into two age categories, the pre-old group (65–74 years,n =968) and the old group (≥ 75 years,n =389). We assessed the cross-sectional association of the ankle–brachial index (ABI), which is used for the classification of patients with PAD (ABI ≤ 0.9). Physical performance mainly focused on muscle strength, mobility, and balance, which were measured via hand grip, 4 m walking speed, and the Timed Up and Go Test.

Results: A total of 125 (9.2%) patients met the diagnostic criteria and were defined as having PAD. After multivariate adjustment, we found that grip strength and 4 m walking speed were correlated negatively with PAD (odds ratio (OR)=0.953, 95% confidence interval (CI)=0.919–0.989; OR=0.296, 95% CI=0.093–0.945) in pre-old participants, whereas balance (OR=1.058, 95% CI=1.007–1.112) was correlated positively with PAD only in older participants.

Conclusion: Our study further confirmed the association between physical performance and PAD in community-dwelling older Chinese adults. Muscle strength and mobility correlated negatively with PAD, and balance was positively associated with PAD in older participants. These findings might help with better early screening and management of PAD.

Do Mechatronic Poles Change the Gait Technique of Nordic Walking in Patients with Ischemic Heart Disease?

The study aimed to compare the technique of normal gait with the Nordic walking (NW) gait with classical and mechatronic poles in patients with ischemic heart disease. It was assumed that equipping classical NW poles with sensors enabling biomechanical gait analysis would not cause a change in the gait pattern. The study involved 12 men suffering from ischemic heart disease (age: 66.2 ± 5.2 years, body height: 173.8 ± 6.74 cm; body mass: 87.3 ± 10.89 kg; disease duration: 12.2 ± 7.5 years). The MyoMOTION 3D inertial motion capture system (Noraxon Inc., Scottsdale, AZ, USA) was used to collect biomechanical variables of gait (spatiotemporal and kinematic parameters). The subject's task was to cover the 100 m distance with three types of gait-walking without poles (normal gait), walking with classical poles to NW, and walking with mechatronic poles from the so-called preferred velocity. Parameters were measured on the right and left sides of the body. The data were analyzed using two-way repeated measures analysis of variance with the between-subject factor "body side." Friedman's test was used when necessary. For most kinematic parameters, with the exception of knee flexion-extension (p = 0.474) and shoulder flexion-extension (p = 0.094), significant differences were found between normal and walking with poles for both the left and right side of the body and no differences due to the type of pole. Differences between the left and right movement ranges were identified only for the ankle inversion-eversion parameter (gait without poles p = 0.047; gait with classical poles p = 0.013). In the case of spatiotemporal parameters, a reduction in the cadence step value using mechatronic poles and the stance phase using classical poles compared to normal walking was observed. There was also an increase in the values for step length and step time regardless of the type of poles, stride length, and swing phase when using classical poles and stride time when using mechatronic poles. The differences between the right and left sides of the measurement occurred when walking with both types of poles for single support (gait with classical poles p = 0.003; gait with mechatronic poles p = 0.030), stance phase (gait with classical poles p = 0.028; gait with mechatronic poles p = 0.017) and swing phase (gait with classical poles p = 0.028; gait with mechatronic poles p = 0.017). Mechatronic poles can be used in the study of the biomechanics of gait in real-time with feedback on its regularity because no statistically significant differences were found between the NW gait with classical and mechatronic poles in the studied men with ischemic heart disease.

A biomechanical perspective on walking in patients with peripheral artery disease

The most common symptom of peripheral artery disease (PAD) is intermittent claudication, which consists of debilitating leg pain during walking. In clinical settings, the presence of PAD is often noninvasively evaluated using the ankle-brachial index and imaging of the arterial supply. Furthermore, various questionnaires and functional tests are commonly used to measure the severity and negative effect of PAD on quality of life. However, these evaluations only provide information on vascular insufficiency and severity of the disease, but not regarding the complex mechanisms underlying walking impairments in patients with PAD. Biomechanical analyses using motion capture and ground reaction force measurements can provide insight into the underlying mechanisms to walking impairments in PAD. This review analyzes the application of biomechanics tools to identify gait impairments and their clinical implications on rehabilitation of patients with PAD. A total of 18 published journal articles focused on gait biomechanics in patients with PAD were studied. This narriative review shows that the gait of patients with PAD is impaired from the first steps that a patient takes and deteriorates further after the onset of claudication leg pain. These results point toward impaired muscle function across the ankle, knee, and hip joints during walking. Gait analysis helps understand the mechanisms operating in PAD and could also facilitate earlier diagnosis, better treatment, and slower progression of PAD.

No Influence of Mechatronic Poles on the Movement Pattern of Professional Nordic Walkers

This study compared selected temporal and kinematic parameters of normal gait and Nordic Walking (NW) performed with classic and mechatronic poles (classic poles equipped with sensors). It was assumed that equipping NW poles with sensors for biomechanical gait analysis would not impair the NW walking technique. Six professional NW instructors and athletes, including three women, participated in the study. The MyoMotion MR3 motion analysis system was used to collect gait kinematic variables. The subject's task was to cover a 100-m distance with three types of gait: a gait without poles, a gait with classic NW poles, and a gait with mechatronic poles at the preferred speed. Parameters were measured both on the right and left sides of the body. No significant differences were found between gait types for three temporal parameters: step cadence, step, and stride time. For the other variables, all the differences identified were between free-walking and walking with poles, with no differences between standard and mechatronic poles. For nine kinematic parameters, differences between free-walking and walking with poles for both the left and right sides were found, while no differences were due to the pole type. All temporal parameters were characterized by symmetry, while among kinematic parameters, only two were asymmetrical (shoulder abduction-adduction in walking with regular poles and elbow flexion-extension in walking without poles). Equipping classic NW poles with additional signaling and measuring devices (mechatronic poles) does not impair the NW technique, making it possible to use them in further studies of gait biomechanics.

Selected Spatiotemporal and Joint Angle Parameters in Normal Gait and Nordic Walking with Classical and Mechatronic Poles in Aspects of Sex Differences

Introduction

The aim of this study was to compare selected spatiotemporal parameters and changes in the range of motion in the joints of lower and upper limbs during normal gait and during Nordic walking performed with classical and mechatronic poles of females and males.

Methods

The study involved 19 physical education students (11 males and 8 females). The MyoMotion research motion analysis system was used to collect gait kinematic variables. The subject task was to cover a 100 m distance in a straight line with three types of gait: gait without poles, gait with classical poles, and gait with mechatronic poles at preferred velocity. Parameters were measured both on the right (RT) and on the left side (LT) of the body. The data was analyzed using two-way repeated measures ANOVA with the between-subject factor "sex." Friedman's test was used when necessary.

Results

The most significant differences in spatiotemporal parameters between males and females were revealed in gait with the classical and mechatronic pole (stance phase LT and RT, load response LT and RT, single support LT and RT, preswing LT and RT, swing phase LT and RT, double stance LT and RT, and step length LT), the least in gait without a pole (stance phase RT, load response LT, single support LT, preswing RT, and swing phase RT); whereas, the most significant differences in kinematic parameters were revealed in gait without poles (shoulder rotation RT, wrist radial-ulnar LT, hip flexion-extension LT and RT, knee flexion-extension LT and RT, ankle inversion-eversion LT, and ankle abduction-adduction LT and RT), the least in gait with mechatronic poles (knee flexion-extension LT and RT, ankle dorsiflexion-plantarflexion LT, ankle inversion-eversion LT, and ankle abduction-adduction LT and RT).

Conclusion

Statistical analysis revealed many differences in spatiotemporal and kinematic parameters in normal gait, as well as in gait with the classical and mechatronic poles, which allows the conclusion that the gait of females and males should be analyzed separately.

Muscle forces and power are significantly reduced during walking in patients with peripheral artery disease

Patients with peripheral artery disease (PAD) have significantly reduced lower extremity muscle strength compared with healthy individuals as measured during isolated, single plane joint motion by isometric and isokinetic strength dynamometers. Alterations to the force contribution of muscles during walking caused by PAD are not well understood. Therefore, this study used simulations with PAD biomechanics data to understand lower extremity muscle functions in patients with PAD during walking and to compare that with healthy older individuals. A total of 12 patients with PAD and 10 age-matched healthy older controls walked across a 10-meter pathway with reflective markers on their lower limbs. Marker coordinates and ground reaction forces were recorded and exported to OpenSim software to perform gait simulations. Walking velocity, joint angles, muscle force, muscle power, and metabolic rate were calculated and compared between patients with PAD and healthy older controls. Our results suggest that patients with PAD walked slower with less hip extension during propulsion. Significant force and power reductions were observed in knee extensors during weight acceptance and in plantar flexors and hip flexors during propulsion in patients with PAD. The estimated metabolic rate of walking during stance was not different between patients with PAD and controls. This study is the first to analyze lower limb muscular responses during walking in patients with PAD using the OpenSim simulation software. The simulation results of this study identified important information about alterations to muscle force and power during walking in those with PAD.

Ankle-Brachial Index Is a Good Determinant of Lower Limb Muscular Strength but Not of the Gait Pattern in PAD Patients

The aim of this study was to evaluate the relationship of the ankle-brachial index (ABI) level with kinetic and kinematic parameters of the gait pattern and force-velocity parameters generated by lower limb muscles. Methods: The study group consisted of 65 patients with peripheral arterial disease (PAD). The ABI value, kinetic and kinematic parameters of gait and force-velocity parameters of knee and ankle extensors and flexors were determined in all subjects. The values obtained for right and left limbs as well as the limbs with higher and lower ABI were compared. Results: Regardless of the method of analysis, the values of the gait’s kinematic and kinetic parameters of both lower limbs did not differ significantly. However, significant differences were noted in the values of peak torque, work and power of the extensor muscles of the knee and the flexor muscles of the ankle with the higher and lower ABI. Conclusion: This study demonstrated that a higher degree of ischemia worsened the level of strength, endurance, and performance of ankle flexors and extensors of the knee joint. ABI is not related to the gait pattern. The above-mentioned relationship should be taken into account in the rehabilitation process and methodological assessment.