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Oxygen pulse best predicts energy expenditure during stair ascent and descent in individuals with chronic stroke. Neurol Sci 2022; 43:4349-4354. [DOI: 10.1007/s10072-022-05939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
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Lefeber N, De Buyzer S, Dassen N, De Keersmaecker E, Kerckhofs E, Swinnen E. Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis. Disabil Rehabil 2019; 42:1650-1666. [DOI: 10.1080/09638288.2018.1531943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nina Lefeber
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sam De Buyzer
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikkie Dassen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emma De Keersmaecker
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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Penke K, Scott K, Sinskey Y, Lewek MD. Propulsive Forces Applied to the Body's Center of Mass Affect Metabolic Energetics Poststroke. Arch Phys Med Rehabil 2018; 100:1068-1075. [PMID: 30391412 DOI: 10.1016/j.apmr.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the effect of timing and magnitude of horizontally directed propulsive forces to the center of mass (COM) on the metabolic cost of walking (COW) for individuals poststroke. DESIGN Repeated-measures, within-subject design. SETTING Research laboratory. PARTICIPANTS A total of 9 individuals with chronic hemiparesis poststroke and 7 unimpaired similarly aged controls (N=16). INTERVENTION Individuals walked on a treadmill in 2 separate studies. First, we compared the metabolic COW with an anterior force applied to the COM that (1) coincided with paretic propulsion or (2) was applied throughout the gait cycle. Next, we compared the metabolic COW with anterior (assistive) or posterior (resistive) forces applied during paretic propulsion. MAIN OUTCOME MEASURE Metabolic COW. RESULTS The COW was significantly greater in the Stroke group. Anterior (propulsive) assistance reduced the COW differently based on group. The Stroke group exhibited a 12% reduction in COW when assistance was provided only during paretic propulsion, but not when assistance was provided throughout the gait cycle. In contrast, the Control group demonstrated reduced COW during both anterior assistance conditions. In addition, we observed that resistance during paretic propulsion (simulated hemiparesis for Control group) significantly increased the COW. CONCLUSIONS Systematically manipulating propulsive forces at the body's COM had a profound influence on metabolic cost. The timing of propulsive forces to the COM is important and needs to coincide with paretic terminal stance. Additional internally or externally generated propulsive forces applied to the body's COM poststroke may produce a lower metabolic COW.
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Affiliation(s)
- Kelly Penke
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Korre Scott
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yunna Sinskey
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael D Lewek
- Department of Allied Health Sciences, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Gjovaag T, Mirtaheri P, Starholm IM. Carbohydrate and fat oxidation in persons with lower limb amputation during walking with different speeds. Prosthet Orthot Int 2018; 42:304-310. [PMID: 29119861 DOI: 10.1177/0309364617740237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies suggest that the energy expenditure of healthy persons (control) during walking with the preferred walking speed in steady-state conditions is dominated by fat oxidation. Conversely, carbohydrate and fat oxidation during walking is little investigated in transfemoral amputees. OBJECTIVES To investigate carbohydrate and fat oxidation, energy cost of walking, and percent utilization of maximal aerobic capacity [Formula: see text]during walking. STUDY DESIGN Eight transfemoral amputees and controls walked with their preferred walking speed and speeds 12.5% and 25% slower and faster than their preferred walking speed. METHODS Energy expenditure and fuel utilization were measured using a portable metabolic analyzer. Metabolic values are means ± standard deviation. RESULTS For transfemoral amputees (37.0 ± 10.9 years) and controls (39.0 ± 12.3 years), fat utilization at the preferred walking speed was 44.8% ± 7.2% and 45.0% ± 7.2% of the total energy expenditure, respectively. The preferred walking speed of the transfemoral amputees and controls was close to a metabolic cross-over speed, which is the speed where carbohydrate utilization increases steeply and fat utilization decreases. When walking fast, at 90 m min-1 (preferred walking speed plus 25%), transfemoral amputees utilized 70.7% ± 5.6% of their [Formula: see text], while the controls utilized 30.9% ± 4.5% ( p < 0.001) at the matching speed (control preferred walking speed). At 90 m min-1, carbohydrate utilization was 78% ± 4.7% and 55.2% ± 7.2% of the total energy expenditure for the transfemoral amputees and controls, respectively ( p < 0.01). Compared to the control, energy cost of walking was higher for the transfemoral amputees at all speeds (all comparisons; p < 0.001). CONCLUSION At the preferred walking speed, carbohydrate, not fat, dominates energy expenditure of both transfemoral amputees and controls. For the transfemoral amputees, consequences of fast walking are very high [Formula: see text] utilization and rate of carbohydrate oxidation. Clinical relevance Research on the relationships between physical effort and fuel partitioning during ambulation could provide important insights for exercise-rehabilitation programs for lower limb amputees (LLA). Regular endurance exercise will improve maximal aerobic capacity and enable LLA to walk faster and at the same time expend less energy and improve fat utilization.
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Affiliation(s)
- Terje Gjovaag
- 1 Oslo and Akershus University College, Oslo, Norway
| | - Peyman Mirtaheri
- 2 Faculty of Technology, Art and Design, Oslo and Akershus University College, Oslo, Norway
| | - Inger Marie Starholm
- 3 Faculty of Health Sciences, Oslo and Akershus University College, Oslo, Norway
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Polese JC, Ada L, Teixeira-Salmela LF. Relationship between oxygen cost of walking and level of walking disability after stroke: An experimental study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2017; 23. [PMID: 28671315 DOI: 10.1002/pri.1688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/21/2017] [Accepted: 04/07/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Since physical inactivity is the major risk factor for recurrent stroke, it is important to understand how level of disability impacts oxygen uptake by people after stroke. This study investigated the nature of the relationship between level of disability and oxygen cost in people with chronic stroke. METHODS Level of walking disability was measured as comfortable walking speed using the 10-m Walk Test reported in m/s with 55 ambulatory people 2 years after stroke. Oxygen cost was measured during 3 walking tasks: overground walking at comfortable speed, overground walking at fast speed, and stair walking at comfortable speed. Oxygen cost was calculated from oxygen uptake divided by distance covered during walking and reported in ml∙kg-1 ∙m-1 . RESULTS The relationship between level of walking disability and oxygen cost was curvilinear for all 3 walking tasks. One quadratic model accounted for 81% (95% CI [74, 88]) of the variance in oxygen cost during the 3 walking tasks: [Formula: see text] DISCUSSION: The oxygen cost of walking was related the level of walking disability in people with chronic stroke, such that the more disabled the individual, the higher the oxygen cost of walking; with oxygen cost rising sharply as disability became severe. An equation that relates oxygen cost during different walking tasks according to the level of walking disability allows clinicians to determine oxygen cost indirectly without the difficulty of measuring oxygen uptake directly.
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Affiliation(s)
- Janaine C Polese
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia.,Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Department of Physical Therapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Luci F Teixeira-Salmela
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Zukowski LA, Martin JM, Scronce G, Lewek MD, Plummer P. The influence of cognitive load on metabolic cost of transport during overground walking in healthy, young adults. Eur J Appl Physiol 2017; 117:679-686. [PMID: 28243780 DOI: 10.1007/s00421-017-3536-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/03/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Our aim was to examine whether cognitive processing during walking increases the metabolic cost of transport in healthy young adults. METHODS Twenty healthy, young adults completed five conditions: (1) walking at a self-selected speed (spontaneous single-task), (2) seated resting (baseline), (3) performing cognitive task while seated (cognitive single-task), (4) walking while simultaneously performing the cognitive task (dual-task), and (5) single-task walking at a speed that matched the participant's dual-task gait speed (matched single-task). Rate of oxygen consumption (V̇O2) was recorded during all conditions. Gait speed and cost of walking (Cw; oxygen consumed per distance traveled) were recorded during all walking conditions. Reaction time and accuracy of responses in the cognitive task were recorded during all cognitive task conditions. Data from the fifth minute of each 5-min condition were analyzed. RESULTS There was no difference in V̇O2 between the dual-task and matched single-task walking conditions. V̇O2 in the seated cognitive condition was significantly smaller than both walking conditions, but was not significantly different than zero. Cw was significantly greater during the matched single-task walking condition than during the dual-task walking condition. However, the difference in Cw was so small that it is unlikely to be clinically significant (0.008 mLO2/kg/m, 95% CI 0.002-0.014). CONCLUSIONS Cognitive processing while walking may not increase energy demands of walking in healthy young adults. Maintaining non-preferred gait speed (matched speed) overground continuously for 5 min may require attentional resources, and thereby increase metabolic costs relative to walking at habitual speed.
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Affiliation(s)
- Lisa A Zukowski
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant 3020, CB# 7135, Chapel Hill, NC, 27599, USA
| | - Jasmine M Martin
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant 3020, CB# 7135, Chapel Hill, NC, 27599, USA
| | - Gabrielle Scronce
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael D Lewek
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant 3020, CB# 7135, Chapel Hill, NC, 27599, USA.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Prudence Plummer
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant 3020, CB# 7135, Chapel Hill, NC, 27599, USA. .,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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How strongly is aerobic capacity correlated with walking speed and distance after stroke? Systematic review and meta-analysis. Phys Ther 2015; 95:835-53. [PMID: 25573761 DOI: 10.2522/ptj.20140081] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 12/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Restoration of walking capacity, as reflected by walking speed and walking distance, is a primary goal after stroke. Peak aerobic capacity (peak oxygen consumption [V̇o₂peak]) is suggested to be correlated with walking capacity after stroke. Although the strength of this correlation is unclear, physical therapy programs often target walking capacity by means of aerobic training. PURPOSE The purpose of this systematic review was to summarize the available evidence on the correlation between V̇o₂peak and walking capacity. DATA SOURCES The databases MEDLINE, CINAHL, EMBASE, Cochrane Library, and SPORTDiscus were searched up to May 2014. STUDY SELECTION Cross-sectional studies reporting correlation coefficients between V̇o₂peak and walking capacity in stroke were included, along with longitudinal studies reporting these correlation coefficients at baseline. DATA EXTRACTION The methodological quality of the studies was assessed using a checklist of 27 items for observational research. Information on study design, stroke severity and recovery, and assessments and outcome of V̇o₂peak and walking capacity, as well as the reported correlation coefficients, were extracted. DATA SYNTHESIS Thirteen studies involving 454 participants were included. Meta-analyses showed combined correlation coefficients (rɱ) for V̇o₂peak and walking speed and for V̇o₂peak and walking distance of .42 (95% credibility interval=.31, .54) and .52 (95% credibility interval=.42, .62), respectively. LIMITATIONS The studies included in the present review had small sample sizes and low methodological quality. Clinical and methodological diversity challenged the comparability of the included studies, despite statistical homogeneity. Relevant data of 3 studies could not be retrieved. CONCLUSIONS The strength of the correlation of V̇o₂peak with walking speed was low and moderate for V̇o₂peak and walking distance, respectively, indicating that other factors, besides V̇o₂peak, determine walking capacity after stroke.
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High metabolic cost and low energy expenditure for typical motor activities among individuals in the chronic phase after stroke. J Neurol Phys Ther 2015; 38:226-32. [PMID: 25198864 DOI: 10.1097/npt.0000000000000053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Energy variables, such as metabolic cost (MC) and energy expenditure (EE), are important characteristics of motor activities that can influence daily activity and have implications for health. In individuals poststroke, these variables have previously been described only for walking. Our goal was to characterize the MC and EE of typical motor activities among individuals in the chronic phase poststroke and compare them with those of able-bodied individuals. METHODS Eleven individuals with poststroke and 8 able-bodied individuals participated in this study. Four activities were tested: sit-to-walk-to-sit, walking over an obstacle course, walking at a comfortable speed, and reaching for an object while in a standing position. Each activity was performed repeatedly for 8 minutes, while oxygen consumption was recorded. The MC of the activities was calculated by dividing the mean oxygen consumption by walking speed or the number of repetitions. The EE was represented by metabolic equivalents. RESULTS There was a significant interaction effect of group and activity on MC and EE (P = 0.001 and P = 0.007, respectively). In the participants poststroke, the MC of mobility activities ranged from 0.24 (0.06) to 0.3 (0.06) mL/kg/m, and the MC of the standing activity was 0.1 (0.03) mL/kg/repetition. The MC was higher for the participants poststroke than for the able-bodied participants (P < 0.001). The EE of the participants poststroke ranged from 1.96 (0.4) to 3.83 (0.6) metabolic equivalents and was lower compared with the able-bodied participants (P = 0.001). DISCUSSION AND CONCLUSIONS Individuals poststroke have high MC and low EE across various motor activities. These findings suggest that rehabilitation programs need to specifically address the energetic domain.Video Abstract available. See Video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A75) for more insights from the authors.
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Deutsch JE, Guarrera-Bowlby P, Myslinski MJ, Kafri M. Is There Evidence That Active Videogames Increase Energy Expenditure and Exercise Intensity for People Poststroke and with Cerebral Palsy? Games Health J 2014; 4:31-7. [PMID: 26181678 DOI: 10.1089/g4h.2014.0082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article asked and answered the question of whether there was evidence to support the use of videogames for promotion of wellness and fitness for people poststroke and those with cerebral palsy (CP). A literature search of PubMed, CINAHL, and PEDro using a population, intervention, and outcome (PIO) approach and the key words "stroke (or CP) AND video games (and synonyms) AND energy expenditure (EE) (and synonyms)" was conducted. It yielded two relevant references for people poststroke and five references for people with CP. The literature extraction and synthesis by the categories of the PIO indicated that most studies used only the population of interest, except two that compared the EE with that of healthy controls. The main finding is that both people poststroke (moderate severity) and people with CP (mild severity) can achieve moderate EE playing Wii(™) (Nintendo, Kyoto, Japan), PlayStation(®) (Sony, Tokyo, Japan), and Kinect(™) (Microsoft, Redmond, WA) games. Adults with CP of mild severity played the videogames at vigorous levels, whereas those with severe CP played them at low levels. There appears to be an interaction between development and severity that influences the exercise intensity measured by EE. The findings suggests that videogames are a gateway for wellness promotion.
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Affiliation(s)
- Judith E Deutsch
- 1 Rivers Lab, Rutgers University , Newark, New Jersey, USA.,2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Phyllis Guarrera-Bowlby
- 1 Rivers Lab, Rutgers University , Newark, New Jersey, USA.,2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Mary Jane Myslinski
- 2 Department of Rehabilitation and Movement Sciences, Rutgers University , Newark, New Jersey, USA
| | - Michal Kafri
- 3 Program in Physical Therapy, University of Haifa , Haifa, Israel
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Reisman DS, Binder-MacLeod S, Farquhar WB. Changes in metabolic cost of transport following locomotor training poststroke. Top Stroke Rehabil 2013; 20:161-70. [PMID: 23611857 DOI: 10.1310/tsr2002-161] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The energy cost of transport is higher for persons with stroke compared with neurologically intact subjects, and this has a negative impact on ambulatory activity and function. Whether the high energy cost of walking after stroke is influenced by gait training interventions is generally not considered. OBJECTIVE To examine changes in the energy cost of transport with a gait training intervention after stroke and to identify whether energy cost changes independent of changes in walking speed. METHODS Persons with chronic (≯6 months) stroke participated in an intervention combining fast walking and functional electrical stimulation of the ankle dorsi-and plantarflexor muscles. Oxygen consumption, walking speed, and endurance were measured pre and post training. Energy and caloric cost of transport were calculated at self-selected and absolute speeds at each time point. RESULTS Eleven subjects (age 61.8 ± 8 years) participated. Self-selected and fastest walking speed and 6-minute walk test distance improved after the intervention (F = 67.5, P < .001; F = 40.9, P < .001; F = 20.2, P = .001, respectively). Energy and caloric cost of transport at self-selected speed improved (F = 8.63, P = .015, and F = 7.87, P = .019, respectively) but did not change at an absolute speed pre-to postintervention. CONCLUSIONS Energy and caloric cost of transport at self-selected walking speeds improved pre to post training but were unaffected at an absolute walking speed, suggesting that the improved energy cost of transport was through improvements in the subject's self-selected walking speed. These results illustrate that improvements in walking speed following an intervention are an important mechanism by which the energy cost of transport can be reduced post stroke.
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Affiliation(s)
- Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Entin PL, Gest C, Trancik S, Richard Coast J. Fuel oxidation in relation to walking speed: influence of gradient and external load. Eur J Appl Physiol 2010; 110:515-21. [DOI: 10.1007/s00421-010-1523-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2010] [Indexed: 11/29/2022]
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