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Rahman H, Leutzinger T, Hassan M, Schieber M, Koutakis P, Fuglestad MA, DeSpiegelaere H, Longo GM, Malcolm P, Johanning JM, Casale GP, Pipinos II, Myers SA. Peripheral artery disease causes consistent gait irregularities regardless of the location of leg claudication pain. Ann Phys Rehabil Med 2024; 67:101793. [PMID: 38118246 PMCID: PMC11009086 DOI: 10.1016/j.rehab.2023.101793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND The most common symptom of peripheral artery disease (PAD) is intermittent claudication that involves the calf, thigh, and/or buttock muscles. How the specific location of this leg pain is related to altered gait, however, is unknown. OBJECTIVES We hypothesized that because the location of claudication symptoms uniquely affects different leg muscle groups in people with PAD, this would produce distinctive walking patterns. METHODS A total of 105 participants with PAD and 35 age-matched older volunteers without PAD (CTRL) were recruited. Participants completed walking impairment questionnaires (WIQ), Gardner-Skinner progressive treadmill tests, the six-minute walk test, and we performed an advanced evaluation of the biomechanics of their overground walking. Participants with PAD were categorized into 4 groups according to their stated pain location(s): calf only (C, n = 43); thigh and calf (TC, n = 18); buttock and calf (BC, n = 15); or buttock, thigh, and calf (BTC, n = 29). Outcomes were compared between CTRL, C, TC, BC and BTC groups using a one-way ANOVA with post-hoc comparisons to identify and assess statistically significant differences. RESULTS There were no significant differences between CTRL, C, TC, BC and BTC groups in distances walked or walking speed when either pain-free or experiencing claudication pain. Each participant with PAD had significantly dysfunctional biomechanical gait parameters, even when pain-free, when compared to CTRL (pain-free) walking data. During pain-free walking, out of the 18 gait parameters evaluated, we only identified significant differences in hip power generation during push-off (in C and TC groups) and in knee power absorption during weight acceptance (in TC and BC groups). There were no between-group differences in gait parameters while people with PAD were walking with claudication pain. CONCLUSIONS Our data demonstrate that PAD affects the ischemic lower extremities in a diffuse manner irrespective of the location of claudication symptoms. DATABASE REGISTRATION ClinicalTrials.gov NCT01970332.
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Affiliation(s)
- Hafizur Rahman
- School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX, USA; Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - Todd Leutzinger
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - Molly Schieber
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Matthew A Fuglestad
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Holly DeSpiegelaere
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA
| | - G Matthew Longo
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Philippe Malcolm
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Jason M Johanning
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - George P Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Iraklis I Pipinos
- Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA; Department of Surgery and Research Service, Nebraska-Western Iowa Veterans Affairs Medical Center, Omaha, NE, USA.
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Wiles TM, Mangalam M, Sommerfeld JH, Kim SK, Brink KJ, Charles AE, Grunkemeyer A, Kalaitzi Manifrenti M, Mastorakis S, Stergiou N, Likens AD. NONAN GaitPrint: An IMU gait database of healthy young adults. Sci Data 2023; 10:867. [PMID: 38052819 PMCID: PMC10698035 DOI: 10.1038/s41597-023-02704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
An ongoing thrust of research focused on human gait pertains to identifying individuals based on gait patterns. However, no existing gait database supports modeling efforts to assess gait patterns unique to individuals. Hence, we introduce the Nonlinear Analysis Core (NONAN) GaitPrint database containing whole body kinematics and foot placement during self-paced overground walking on a 200-meter looping indoor track. Noraxon Ultium MotionTM inertial measurement unit (IMU) sensors sampled the motion of 35 healthy young adults (19-35 years old; 18 men and 17 women; mean ± 1 s.d. age: 24.6 ± 2.7 years; height: 1.73 ± 0.78 m; body mass: 72.44 ± 15.04 kg) over 18 4-min trials across two days. Continuous variables include acceleration, velocity, position, and the acceleration, velocity, position, orientation, and rotational velocity of each corresponding body segment, and the angle of each respective joint. The discrete variables include an exhaustive set of gait parameters derived from the spatiotemporal dynamics of foot placement. We technically validate our data using continuous relative phase, Lyapunov exponent, and Hurst exponent-nonlinear metrics quantifying different aspects of healthy human gait.
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Affiliation(s)
- Tyler M Wiles
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Joel H Sommerfeld
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Seung Kyeom Kim
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Kolby J Brink
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Anaelle Emeline Charles
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Alli Grunkemeyer
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Marilena Kalaitzi Manifrenti
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Spyridon Mastorakis
- College of Information Science and Technology, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
- Department of Physical Education and Sport Science, Aristotle University, Thessaloniki, Greece
| | - Aaron D Likens
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA.
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Bashir AZ. Exploring telehealth interventions to monitor rehabilitation in patients with peripheral artery disease. SAGE Open Med 2023; 11:20503121231175542. [PMID: 37223670 PMCID: PMC10201137 DOI: 10.1177/20503121231175542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
Peripheral artery disease is a manifestation of systemic atherosclerosis, and these patients often have claudication pain in the legs during activity. This leads to generally adopting an inactive lifestyle; hence, even small changes in physical activity could reduce the risk of an adverse cardiovascular event. For patients with peripheral artery disease compliance with non-invasive interventions like assistive devices and long-term exercise therapy is important for improved health outcomes. Benefits to patients can only be measured if patients with peripheral artery disease adhere to the intervention and barriers are identified with improved solutions. The effect of mobile health including pedometers and smartphone technological applications in motivating the patient to continue adhering to the intervention and persist in physical activity is a new venture to be explored.
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Affiliation(s)
- Ayisha Z Bashir
- Department of Cardiology, the University of Nebraska
Medical Center, Child Health Research Institute, Children’s Hospital and Medical Center,
Omaha, NE, USA
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Fallahtafti F, Salamifar Z, Hassan M, Rahman H, Pipinos I, Myers SA. Joint Angle Variability Is Altered in Patients with Peripheral Artery Disease after Six Months of Exercise Intervention. ENTROPY (BASEL, SWITZERLAND) 2022; 24:1422. [PMID: 37420442 PMCID: PMC9602135 DOI: 10.3390/e24101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/23/2022] [Accepted: 10/01/2022] [Indexed: 07/09/2023]
Abstract
Supervised exercise therapy (SET) is a conservative non-operative treatment strategy for improving walking performance in patients with peripheral artery disease (PAD). Gait variability is altered in patients with PAD, but the effect of SET on gait variability is unknown. Forty-three claudicating patients with PAD underwent gait analysis before and immediately after a 6-month SET program. Nonlinear gait variability was assessed using sample entropy, and the largest Lyapunov exponent of the ankle, knee, and hip joint angle time series. Linear mean and variability of the range of motion time series for these three joint angles were also calculated. Two-factor repeated measure analysis of variance determined the effect of the intervention and joint location on linear and nonlinear dependent variables. After SET, walking regularity decreased, while the stability remained unaffected. Ankle nonlinear variability had increased values compared with the knee and hip joints. Linear measures did not change following SET, except for knee angle, in which the magnitude of variations increased after the intervention. A six-month SET program produced changes in gait variability toward the direction of healthy controls, which indicates that in general, SET improved walking performance in individuals with PAD.
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Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
| | - Zahra Salamifar
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Hafizur Rahman
- School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA
| | - Iraklis Pipinos
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 6160, USA
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
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The Effects of High-Speed Resistance Training on Health Outcomes in Independent Older Adults: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095390. [PMID: 35564788 PMCID: PMC9099943 DOI: 10.3390/ijerph19095390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/14/2022]
Abstract
Human ageing involves several physiological impairments—in particular, a decrease in sensorimotor function and changes in the nervous system reduce muscle strength, power, balance, and functional capacity performance. Preventive strategies are essential to ensure the quality of life of the elderly. High-speed resistance training (HSRT) may be an effective approach to muscle power development in this population, with significant short-term effects on neural adaptations and muscle power production. Therefore, the present study intends to analyze and systematize the studies focused on HSRT interventions and their effects on health outcomes in independent older adults. Four electronic databases (PubMed, Web of Science, EBSCO, and Scielo) were used for the purposes of searching randomized controlled trials that measured at least one key outcome measure focusing on velocity-based training and health outcomes in older adults on 7 March 2022 and identified 1950 studies. At the end of the process, fourteen studies were included in this systematic review and ten studies were included in the quantitative analysis. The main results showed that HSRT interventions would improve health measures, mostly cognitive function (large effects, p = 0.001, SMD = 0.94), neuromuscular function (moderate effects, p = 0.003, SMD = 0.70), and physical function (moderate effects, p = 0.04, SMD = 0.55 and p = 0.009, SMD = −0.59). Additionally, the results suggested that interventions with ten weeks or more, performed three times a week, provide significant improvements in neuromuscular function. In this sense, HSRT is effective for improving overall health outcomes in older adults. Future studies should include proper follow-ups (e.g., minimum six months) to assess the durability of HSRT intervention effects on all health-related variables.
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Muscle forces and power are significantly reduced during walking in patients with peripheral artery disease. J Biomech 2022; 135:111024. [PMID: 35248803 PMCID: PMC9064980 DOI: 10.1016/j.jbiomech.2022.111024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/21/2022]
Abstract
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.
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