1
|
Buekers J, Delgado-Ortiz L, Megaritis D, Polhemus A, Breuls S, Buttery SC, Chynkiamis N, Demeyer H, Gimeno-Santos E, Hume E, Koch S, Williams P, Wuyts M, Hopkinson NS, Vogiatzis I, Troosters T, Frei A, Garcia-Aymerich J. Gait differences between COPD and healthy controls: systematic review and meta-analysis. Eur Respir Rev 2024; 33:230253. [PMID: 38657998 PMCID: PMC11040389 DOI: 10.1183/16000617.0253-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Despite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls. METHODS We searched 11 electronic databases, supplemented by Google Scholar searches and manual collation of references, in November 2019 and updated the search in July 2021. Record screening and information extraction were performed independently by one reviewer and checked for accuracy by a second. Meta-analyses were performed in studies not considered at a high risk of bias. RESULTS Searches yielded 21 085 unique records, of which 25 were included in the systematic review (including 1015 people with COPD and 2229 healthy controls). Gait speed was assessed in 17 studies (usual speed: 12; fast speed: three; both speeds: two), step length in nine, step duration in seven, cadence in six, and step width in five. Five studies were considered at a high risk of bias. Low-quality evidence indicated that people with COPD walk more slowly than healthy controls at their usual speed (mean difference (MD) -19 cm·s-1, 95% CI -28 to -11 cm·s-1) and at a fast speed (MD -30 cm·s-1, 95% CI -47 to -13 cm·s-1). Alterations in other gait characteristics were not statistically significant. CONCLUSION Low-quality evidence shows that people with COPD walk more slowly than healthy controls, which could contribute to an increased falls risk. The evidence for alterations in spatial and temporal components of gait was inconclusive. Gait impairment appears to be an important but understudied area in COPD.
Collapse
Affiliation(s)
- Joren Buekers
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sara C Buttery
- National Lung and Heart Institute, Imperial College London, London, UK
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Elena Gimeno-Santos
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Hospital Clinic of Barcelona - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Parris Williams
- National Lung and Heart Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, London, UK
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| |
Collapse
|
2
|
Liu WY, Spruit MA, Delbressine JM, Willems PJ, Yentes JM, Bruijn SM, Franssen FME, Wouters EFM, Meijer K. Alterations in stride-to-stride fluctuations in patients with chronic obstructive pulmonary disease during a self-paced treadmill 6-minute walk test. PLoS One 2024; 19:e0300592. [PMID: 38489297 PMCID: PMC10942081 DOI: 10.1371/journal.pone.0300592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Evaluating variability and stability using measures for nonlinear dynamics may provide additional insight into the structure of the locomotor system, reflecting the neuromuscular system's organization of gait. This is in particular of interest when this system is affected by a respiratory disease and it's extrapulmonary manifestations. This study assessed stride-to-stride fluctuations and gait stability in patients with chronic obstructive pulmonary disease (COPD) during a self-paced, treadmill 6-minute walk test (6MWT) and its association with clinical outcomes. In this cross-sectional study, eighty patients with COPD (age 62±7y; forced expiratory volume in first second 56±19%predicted) and 39 healthy older adults (62±7y) were analyzed. Gait parameters including stride-to-stride fluctuations (coefficient of variation (CoV), predictability (sample entropy) and stability (Local Divergence Exponent (LDE)) were calculated over spatiotemporal parameters and center of mass velocity. Independent t-test, Mann-Whitney U test and ANCOVA analyses were conducted. Correlations were calculated between gait parameters, functional mobility using Timed Up and Go Test, and quadriceps muscle strength using dynamometry. Patients walked slower than healthy older adults. After correction for Speed, patients demonstrated increased CoV in stride length (F(1,116) = 5.658, p = 0.019), and increased stride length predictability (F(1,116) = 3.959, p = 0.049). Moderate correlations were found between mediolateral center of mass velocity LDE and normalized maximum peak torque (ρ = -0.549). This study showed that patients with COPD demonstrate alterations in stride length fluctuations even when adjusted for walking speed, highlighting the potential of nonlinear measures to detect alterations in gait function in patients with COPD. Association with clinical outcomes were moderate to weak, indicating that these clinical test are less discriminative for gait alterations.
Collapse
Affiliation(s)
- Wai-Yan Liu
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Horn, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Paul J. Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jennifer M. Yentes
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, Horn, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Emiel F. M. Wouters
- Department of Research and Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
3
|
Molouki A, Abedi M, Roostayi MM, Khosravi M, Rezaei M. Comparison between patients with COPD and healthy subjects on spatiotemporal, moment and kinematic parameters: A quasi-experimental study. Health Sci Rep 2024; 7:e1784. [PMID: 38186935 PMCID: PMC10766874 DOI: 10.1002/hsr2.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Chronic obstructive respiratory diseases (COPD) not only cause damage to the respiratory system as well as the heart and blood vessels of the patient but also have a direct effect on the condition of the musculoskeletal system. The risk of falling is increasing due to dysfunction of the joints as well as aging, which occurs frequently in this population. Gait deficits are known as an important risk factor for falls. This research aimed to investigate the gait of COPD patients compared to healthy people to gain a better understanding of the reasons for falls. Methods Twenty patients with COPD and 20 age and BMI-matched healthy individuals were included in this study. Sixteen markers were applied to the lower body of the subjects. Spatio-temporal, kinematic, and maximum moment parameters were measured in different phases in three lower body joints, including the hip, knee, and ankle. Results The results showed that all spatio-temporal parameters in patients were significantly lower than in healthy people. The ankle angle in the sagittal plane at initial contact was significantly difference (p = 0.03). As well as, in the frontal plane the hip angle in the mid-stance showed a significant difference (p = 0.02). There was also a significant difference in maximum hip moment in the sagittal plane between the two groups (p = 0.01). Conclusion The larger hip angle of the patients can be related to the balance problems in the mediolateral direction. The moment showed a significant difference in the hip joint. Since the hip muscles are directly in a synergistic relationship with the trunk muscles, it seems the performance of these muscles is likely to be seriously damaged due to respiratory diseases.
Collapse
Affiliation(s)
- Ali Molouki
- Department of physiotherapy, School of Rehabilitation Shahid BeheshtiUniversity of Medical SciencesTehranIran
| | - Mohsen Abedi
- Department of physiotherapy, School of Rehabilitation Shahid BeheshtiUniversity of Medical SciencesTehranIran
- Pulmonary Rehabilitation Research Center (PRRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD)Shahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Mohsen Roostayi
- Department of physiotherapy, School of Rehabilitation Shahid BeheshtiUniversity of Medical SciencesTehranIran
| | - Mobina Khosravi
- Department of physiotherapy, School of Rehabilitation Shahid BeheshtiUniversity of Medical SciencesTehranIran
| | - Mehdi Rezaei
- Department of physiotherapy, School of Rehabilitation Shahid BeheshtiUniversity of Medical SciencesTehranIran
| |
Collapse
|
4
|
Yentes JM, Liu WY, Zhang K, Markvicka E, Rennard SI. Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician. Int J Chron Obstruct Pulmon Dis 2022; 17:2653-2675. [PMID: 36274993 PMCID: PMC9585958 DOI: 10.2147/copd.s339195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.
Collapse
Affiliation(s)
- Jennifer M Yentes
- Department of Kinesiology & Sport Management, Texas A&M University, College Station, TX, USA
| | - Wai-Yan Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands
| | - Kuan Zhang
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Eric Markvicka
- Department of Electrical & Computer Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
- Department of Mechanical & Materials Engineering, University of Nebraska at Lincoln, Lincoln, NE, USA
| | - Stephen I Rennard
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
5
|
Amiss E, Cottrell M. Evaluation of a Novel Step Training Mobile App Intervention in Cardiopulmonary Rehabilitation: A Single-Arm Prospective Cohort Study. Games Health J 2022; 11:330-336. [PMID: 36067152 DOI: 10.1089/g4h.2021.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To establish the usability, acceptability, safety, and exercise adherence of a step training mobile app. Design: A single-arm prospective cohort study. Setting: Royal Brisbane and Women's Hospital, Australia. Subjects: Twenty-six cardiopulmonary rehabilitation participants. Intervention: Twelve weeks of step training using the mobile app Clock Yourself. Participants used Clock Yourself at home and during cardiopulmonary rehabilitation sessions, prescribed for a total of 15-20 minutes three times a week. Main Measures: The primary outcomes of interest were usability and acceptability and were measured using the System Usability Scale (SUS) and Attitudes to Falls-Related Interventions Scale (AFRIS) questionnaire, respectively. Safety and adherence were measured by self-report and participant diary, respectively. Secondary outcomes measuring changes in stepping, gait, balance, and physical performance included Manual test of Choice Stepping Reaction Time (CSRT-M), Short Physical Performance Battery (SPPB), Gait speed with and without a cognitive dual task (DT) and Timed Up and Go with and without a cognitive DT (TUG and TUGcog). Results: Twenty-one participants completed the study. Clock Yourself was considered highly useable (SUS [median] = 82.5/100; interquartile range [IQR, 67.5-95], equating to an "A" rating [A-F scale]) and acceptable (AFRIS [median] = 38/42 [IQR, 31-41]). Participants practiced Clock Yourself for a median of 18.29 minutes per week and no adverse events were reported. At 12 weeks, mean change in CSRT-M, SPPB, gait speed, DT gait speed, TUG, and TUGcog were all statistically significant (P < 0.01). Conclusion: Twelve weeks of mobile app-based step training was safe and considered usable and acceptable by participants. On average, participants did not meet the prescribed practice dosage. Statistically significant changes were observed in all physical measures; however, results are confounded by participation in cardiopulmonary rehabilitation and lack of control group.
Collapse
Affiliation(s)
- Emilie Amiss
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Michelle Cottrell
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia
| |
Collapse
|
6
|
Zucchelli A, Pancera S, Bianchi LNC, Marengoni A, Lopomo NF. Technologies for the Instrumental Evaluation of Physical Function in Persons Affected by Chronic Obstructive Pulmonary Disease: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176620. [PMID: 36081078 PMCID: PMC9459845 DOI: 10.3390/s22176620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 05/17/2023]
Abstract
Several systems, sensors, and devices are now available for the instrumental evaluation of physical function in persons with Chronic Obstructive Pulmonary Disease (COPD). We aimed to systematically review the literature about such technologies. The literature search was conducted in all major scientific databases, including articles published between January 2001 and April 2022. Studies reporting measures derived from the instrumental assessment of physical function in individuals with COPD were included and were divided into application and validation studies. The quality of validation studies was assessed with the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias tool. From 8752 articles retrieved, 21 application and 4 validation studies were included in the systematic review. Most application studies employed accelerometers, gait analysis systems, instrumented mattresses, or force plates to evaluate walking. Surface electro-myography or near-infrared spectroscopy were employed in four studies. Validation studies were heterogeneous and presented a risk of bias ranging from inadequate to doubtful. A variety of data regarding physical function can be retrieved from technologies used in COPD studies. However, a general lack of standardization and limitations in study design and sample size hinder the implementation of the instrumental evaluation of function in clinical practice.
Collapse
Affiliation(s)
- Alberto Zucchelli
- Department of Information Engineering, Università degli Studi di Brescia, Brescia 25123, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna SE-171 65, Sweden
| | - Simone Pancera
- IRCCS Fondazione Don Carlo Gnocchi, Milan 20148, Italy
- Correspondence: (S.P.); (N.F.L.); Tel.: +39-030-29881 (S.P. & N.F.L.)
| | | | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna SE-171 65, Sweden
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia 25123, Italy
| | - Nicola Francesco Lopomo
- Department of Information Engineering, Università degli Studi di Brescia, Brescia 25123, Italy
- Correspondence: (S.P.); (N.F.L.); Tel.: +39-030-29881 (S.P. & N.F.L.)
| |
Collapse
|
7
|
Pichon R, Van Hove O, Ménard M, Hearing D, Crétual A. Impairment and characteristics of postural control sub-components in people with COPD: a scoping review. Disabil Rehabil 2022:1-16. [PMID: 36000464 DOI: 10.1080/09638288.2022.2107083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).Materials and methods: A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.Results: Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.Conclusions: People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.
Collapse
Affiliation(s)
- Romain Pichon
- Institut de Formation en Pédicurie-Podologie, Ergothérapie et Kinésithérapie (IFPEK), Rennes, France.,M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | | | - Mathieu Ménard
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France.,Institut d'Ostéopathie de Rennes - Bretagne (IO-RB), Bruz, France
| | - Diane Hearing
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | - Armel Crétual
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| |
Collapse
|
8
|
Sutor TW, Fuller DD, Fox EJ. Locomotor-respiratory coupling in ambulatory adults with incomplete spinal cord injury. Spinal Cord Ser Cases 2022; 8:49. [PMID: 35501342 PMCID: PMC9061751 DOI: 10.1038/s41394-022-00515-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Observational, analytical cohort study. OBJECTIVES After incomplete spinal cord injury (iSCI), propriospinal pathways may remain intact enabling coupling between respiration and locomotion. This locomotor-respiratory coupling (LRC) may enable coordination between these two important behaviors and have implications for rehabilitation after iSCI. However, coordination between these behaviors is not well understood and it is unknown if iSCI disrupts LRC. The objective of this study was to compare LRC in ambulatory adults with iSCI to able-bodied controls. SETTING Rehabilitation Research Center, Jacksonville, Florida, United States of America. METHODS Adults with iSCI (4 males, 1 female) and able-bodied controls (2 males, 3 females) walked at their fastest comfortable speed for 6 min over ground, and on a treadmill with bodyweight support (10-20%) and as-needed assistance at a standardized fast speed (controls) or their fastest speed (iSCI) for 6 min. LRC was quantified as the percent of breaths that were coupled with steps at a consistent ratio during the last 4 min of each walking condition. RESULTS Over ground, participants with iSCI demonstrated significantly more LRC than able-bodied controls (72.4 ± 6.4% vs. 59.1% ± 7.5, p = 0.016). During treadmill walking, LRC did not differ between groups (iSCI 67.5 ± 15.8% vs. controls 66.3 ± 4.0%, p > 0.05). CONCLUSIONS Adults with iSCI demonstrated similar or greater LRC compared to able-bodied controls. This suggests that pathways subserving coordination between these behaviors remain intact in this group of individuals who walk independently after iSCI.
Collapse
Affiliation(s)
- Tommy W Sutor
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
- Brooks Rehabilitation, Jacksonville, FL, USA.
| |
Collapse
|
9
|
Assisting Walking in Patients with Chronic Respiratory Disease Using a Powered Exoskeleton: A Series of N-of-1 Trials. Ann Am Thorac Soc 2022; 19:1230-1232. [PMID: 35348445 DOI: 10.1513/annalsats.202201-045rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
10
|
Rebelo P, Brooks D, Marques A. Measuring intensity during free-living physical activities in people with chronic obstructive pulmonary disease: a systematic literature review. Ann Phys Rehabil Med 2021; 65:101607. [PMID: 34818590 DOI: 10.1016/j.rehab.2021.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Measuring intensity of physical activity (PA) is important to ensure safety and the effectiveness of PA interventions in chronic obstructive pulmonary disease (COPD). OBJECTIVE This systematic review identified which outcomes, outcome measures and instruments have been used to assess single free-living PA-related intensity in people with COPD and compared the intensity level (light, moderate, vigorous) obtained by different outcome measures. METHODS PubMed, Scopus, Web of Science, Cochrane Library and EBSCO were searched for original studies of COPD and assessing single free-living PA-related intensity were included. Agreement was calculated as the number of agreements between 2 measures [same intensity level]/ number of comparisons using both measures*100. RESULTS We included 43 studies (1282 people with COPD, mean age 66 years, 65% men, 49% FEV1%pred) and identified 13 outcomes, 46 outcome measures and 22 instruments. The most-reported outcomes, outcome measures and instruments were dyspnoea with the Borg scale 0-10; cardiac function, via heart rate (HR) using HR monitors; and pulmonary gas exchange, namely oxygen consumption (VO2), using portable gas analysers, respectively. The most frequently assessed PAs were walking and lifting, changing or moving weights/objects. Agreement between the outcome measures ranged from 0 (%VO2peak vs metabolic equivalent of task [MET]; %HRpeak vs Fatigue Borg; MET vs walking speed) to 100% (%HRreserve vs dyspnoea Borg; fatigue and exertion Borg vs walking speed). %VO2peak/reserve elicited the highest intensity. Hence, Borg scores, %HRreserve and MET may underestimate PA-related intensity. CONCLUSIONS Various methodologies are used to assess single free-living PA-related intensity and yield different intensity levels for the same PA. Future studies, further exploring the agreement between the different outcome measures of PA-related intensity and discussing their advantages, disadvantages and applicability in real-world settings, are urgent. These would guide future worldwide recommendations on how to assess single free-living PA-related intensity in COPD, which is essential to optimise PA interventions and ensure patient safety.
Collapse
Affiliation(s)
- Patrícia Rebelo
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; West Park Healthcare Centre, Toronto, ON, Canada
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| |
Collapse
|
11
|
Namazi H. Complexity-based analysis of the correlation between stride interval variability and muscle reaction at different walking speeds. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Fischer G, de Queiroz FB, Berton DC, Schons P, Oliveira HB, Coertjens M, Gruet M, Peyré-Tartaruga LA. Factors influencing self-selected walking speed in fibrotic interstitial lung disease. Sci Rep 2021; 11:12459. [PMID: 34127700 PMCID: PMC8203722 DOI: 10.1038/s41598-021-91734-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
This study aimed to investigate the walking economy and possible factors influencing self-selected walking speed (SSWS) in patients with fibrotic interstitial lung disease (ILD) compared to controls. In this study, 10 patients with ILD (mean age: 63.8 ± 9.2 years, forced expiratory volume in the first second: 56 ± 7% of predicted) and 10 healthy controls underwent resting pulmonary function tests, cardiopulmonary exercise, and submaximal treadmill walking tests at different speeds. The walking economy was assessed by calculating the cost-of-transport (CoT). Dynamic stability was assessed by stride-to-stride fluctuations using video recordings. Patients with ILD showed reduced peak oxygen uptake with a tachypneic breathing pattern and significant oxygen desaturation during exercise. The CoT did not differ between the groups (p = 0.680), but dyspnea and SpO2 were higher and lower, respectively, in patients with ILD at the same relative speeds. SSWS was reduced in ILD patients (2.6 ± 0.9 vs. 4.2 ± 0.4 km h-1 p = 0.001) and did not correspond to the energetically optimal walking speed. Dynamic stability was significantly lower in patients with ILD than in healthy controls, mainly at lower speeds. Patients with ILD presented a similar cost of transport compared to healthy controls; however, they chose lower SSWS despite higher walking energy expenditure. Although walking stability and dyspnea were negatively affected, these factors were not associated with the slower walking speed chosen by individuals with ILD.
Collapse
Affiliation(s)
- Gabriela Fischer
- grid.411237.20000 0001 2188 7235Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, SC Brazil ,grid.414449.80000 0001 0125 3761Programa de Pós-Graduação Em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre/Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil
| | - Francisco B. de Queiroz
- grid.414449.80000 0001 0125 3761Programa de Pós-Graduação Em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre/Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil
| | - Danilo C. Berton
- grid.414449.80000 0001 0125 3761Programa de Pós-Graduação Em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre/Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil
| | - Pedro Schons
- grid.414449.80000 0001 0125 3761Programa de Pós-Graduação Em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre/Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil ,grid.8532.c0000 0001 2200 7498Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, Rua Felizardo, 750, Porto Alegre, RS 90690-200 Brazil ,grid.8532.c0000 0001 2200 7498Programa de Pós-Graduação Em Ciências Do Movimento Humano, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil
| | - Henrique B. Oliveira
- grid.8532.c0000 0001 2200 7498Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, Rua Felizardo, 750, Porto Alegre, RS 90690-200 Brazil ,grid.8532.c0000 0001 2200 7498Programa de Pós-Graduação Em Ciências Do Movimento Humano, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil
| | - Marcelo Coertjens
- grid.414449.80000 0001 0125 3761Programa de Pós-Graduação Em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre/Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil ,grid.8532.c0000 0001 2200 7498Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, Rua Felizardo, 750, Porto Alegre, RS 90690-200 Brazil ,Programa de Pós-Graduação Em Ciências Biomédicas, Universidade Federal Do Delta Do Parnaíba, Parnaíba, PI Brazil
| | - Mathieu Gruet
- grid.12611.350000000088437055Laboratoire IAPS, Université de Toulon, 83041 Toulon, France
| | - Leonardo A. Peyré-Tartaruga
- grid.414449.80000 0001 0125 3761Programa de Pós-Graduação Em Ciências Pneumológicas, Hospital de Clínicas de Porto Alegre/Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil ,grid.8532.c0000 0001 2200 7498Exercise Research Laboratory, Universidade Federal Do Rio Grande Do Sul, Rua Felizardo, 750, Porto Alegre, RS 90690-200 Brazil ,grid.8532.c0000 0001 2200 7498Programa de Pós-Graduação Em Ciências Do Movimento Humano, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS Brazil
| |
Collapse
|
13
|
Fallahtafti F, Gonabadi AM, Samson K, Yentes JM. Margin of Stability May Be Larger and Less Variable during Treadmill Walking Versus Overground. BIOMECHANICS 2021; 1:118-130. [PMID: 34414390 PMCID: PMC8372237 DOI: 10.3390/biomechanics1010009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Margin of stability (MOS) is considered a measure of mechanical gait stability. Due to broad application of treadmills in gait assessment experiments, we aimed to determine if walking on a treadmill vs. overground would affect MOS during three speed-matched conditions. Eight healthy young participants walked on a treadmill and overground at Slow, Preferred, and Fast speed-matched conditions. The mean and variability (standard deviation) of the MOS in anterior-posterior and mediolateral directions at heel contact were calculated. Anterior-posterior and mediolateral mean MOS values decreased with increased speed for both overground and treadmill; although mediolateral mean MOS was always wider on the treadmill compared to overground. Due to lack of optic flow and different proprioceptive inputs during treadmill walking, subjects may employ strategies to increase their lateral stability on treadmill compared to overground. Anterior-posterior MOS variability increased with speed overground, while it did not change on treadmill, which might be due to the fixed speed of treadmill. Whereas, lateral variability on both treadmill and overground was U-shaped. Walking at preferred speed was less variable (may be interpreted as more stable) laterally, compared to fast and slow speeds. Caution should be given when interpreting MOS between modes and speeds of walking. As sagittal plane walking is functionally unstable, this raises the consideration as to the meaningfulness of using MOS as a global measure of gait stability in this direction.
Collapse
Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha; Omaha, NE 68182-0860, United States
- Correspondence: (F.F.); (J.M.Y.)
| | - Arash Mohammadzadeh Gonabadi
- Department of Biomechanics, University of Nebraska at Omaha; Omaha, NE 68182-0860, United States
- Rehabilitation Engineering Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals; Lincoln, NE 68506, United States
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center; Omaha, NE 68198-4375, United States
| | - Jennifer M. Yentes
- Department of Biomechanics, University of Nebraska at Omaha; Omaha, NE 68182-0860, United States
- VA Nebraska-Western Iowa Health Care System, Department of Veterans’ Affiars; Omaha, NE 68105, United States
- Department of Health & Kinesiology, Texas A&M University; College Station, TX 77843, United States
- Correspondence: (F.F.); (J.M.Y.)
| |
Collapse
|
14
|
Yentes JM, Fallahtafti F, Denton W, Rennard SI. COPD Patients Have a Restricted Breathing Pattern That Persists with Increased Metabolic Demands. COPD 2020; 17:245-252. [PMID: 32301362 DOI: 10.1080/15412555.2020.1750578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A healthy respiratory system has variability from breath-to-breath and patients with COPD (PwCOPD) have abnormal variability in breath cycles. The aim of this study was to determine if interbreath-interval and tidal-volume variability, and airflow regularity change as metabolic demands increase (seated, standing, and walking) in PwCOPD as compared to controls. Sixteen PwCOPD (64.3 ± 7.9 yr, 61.3 ± 44.1% FEV1%predicted) and 21 controls (60.2 ± 6.8 yr, 97.5 ± 16.8% FEV1%predicted) sat, stood, and walked at their preferred-pace for five-minutes each while breathing patterns were recorded. The mean, standard deviation, and coefficient of variation of interbreath-intervals and tidal-volume, and the regularity (sample entropy) of airflow were quantified. Results were subjected to ANOVA analysis. Interbreath-interval means were shorter in PwCOPD compared to controls (p = 0.04) and as metabolic demand increased (p < 0.0001), standard deviation was decreased in PwCOPD compared to controls during each condition (p's < 0.002). Mean tidal-volume did decrease as metabolic demand increased across groups (p < 0.0001). Coefficient of variation findings (p = 0.002) indicated PwCOPD decline in tidal-volume variability from sitting to standing to walking; whereas, controls do not. There was an interaction for airflow (p = 0.02) indicating that although, PwCOPD had a more regular airflow across all conditions, control's airflow became more irregular as metabolic demand increased. PwCOPD's airflow was always more regular compared to controls (p = 0.006); although, airflow became more irregular as metabolic demand increased (p < 0.0001). Healthy respiratory systems have variability and irregularity from breath-to-breath decreases with adaptation to demand. PwCOPD have more regular and restricted breathing pattern that may affect their ability to adjust in demanding situations.
Collapse
Affiliation(s)
- Jennifer M Yentes
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska, USA.,Center for Research in Human Movement Variability, University of Nebraska, Omaha, Nebraska, USA
| | | | - William Denton
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska, USA
| | - Stephen I Rennard
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
15
|
Fujiwara S, Sato S, Sugawara A, Nishikawa Y, Koji T, Nishimura Y, Ogasawara K. The Coefficient of Variation of Step Time Can Overestimate Gait Abnormality: Test-Retest Reliability of Gait-Related Parameters Obtained with a Tri-Axial Accelerometer in Healthy Subjects. SENSORS 2020; 20:s20030577. [PMID: 31972959 PMCID: PMC7036754 DOI: 10.3390/s20030577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/18/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022]
Abstract
The aim of this study was to investigate whether variation in gait-related parameters among healthy participants could help detect gait abnormalities. In total, 36 participants (21 men, 15 women; mean age, 35.7 ± 9.9 years) performed a 10-m walk six times while wearing a tri-axial accelerometer fixed at the L3 level. A second walk was performed ≥1 month after the first (mean interval, 49.6 ± 7.6 days). From each 10-m data set, the following nine gait-related parameters were automatically calculated: assessment time, number of steps, stride time, cadence, ground force reaction, step time, coefficient of variation (CV) of step time, velocity, and step length. Six repeated measurement values were averaged for each gait parameter. In addition, for each gait parameter, the difference between the first and second assessments was statistically examined, and the intraclass correlation coefficient (ICC) was calculated with the level of significance set at p < 0.05. Only the CV of step time showed a significant difference between the first and second assessments (p = 0.0188). The CV of step time also showed the lowest ICC, at <0.50 (0.425), among all parameters. Test-retest results of gait assessment using a tri-axial accelerometer showed sufficient reproducibility in terms of the clinical evaluation of all parameters except the CV of step time.
Collapse
Affiliation(s)
- Shunrou Fujiwara
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan; (S.S.); (A.S.); (Y.N.); (T.K.); (K.O.)
- Institute for Open and Transdisciplinary Research Initiative, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
- Correspondence: ; Tel.: +81-19-651-5111
| | - Shinpei Sato
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan; (S.S.); (A.S.); (Y.N.); (T.K.); (K.O.)
| | - Atsushi Sugawara
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan; (S.S.); (A.S.); (Y.N.); (T.K.); (K.O.)
| | - Yasumasa Nishikawa
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan; (S.S.); (A.S.); (Y.N.); (T.K.); (K.O.)
| | - Takahiro Koji
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan; (S.S.); (A.S.); (Y.N.); (T.K.); (K.O.)
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan;
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan; (S.S.); (A.S.); (Y.N.); (T.K.); (K.O.)
| |
Collapse
|
16
|
Wouters EF, Posthuma R, Koopman M, Liu WY, Sillen MJ, Hajian B, Sastry M, Spruit MA, Franssen FM. An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease. Expert Rev Respir Med 2020; 14:149-161. [PMID: 31931636 DOI: 10.1080/17476348.2020.1700796] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Pulmonary rehabilitation (PR) is one of the core components in the management of patients with chronic obstructive pulmonary disease (COPD). In order to achieve the maximal level of independence, autonomy, and functioning of the patient, targeted therapies and interventions based on the identification of physical, emotional and social traits need to be provided by a dedicated, interdisciplinary PR team.Areas covered: The review discusses cardiopulmonary exercise testing in the selection of different modes of training modalities. Neuromuscular electrical stimulation as well as gait assessment and training are discussed as well as add-on therapies as oxygen, noninvasive ventilator support or endoscopic lung volume reduction in selected patients. The potentials of pulsed inhaled nitric oxide in patients with underlying pulmonary hypertension is explored as well as nutritional support. The impact of sleep quality on outcomes of PR is reviewed.Expert opinion: Individualized, comprehensive intervention based on thorough assessment of physical, emotional, and social traits in COPD patients forms a continuous challenge for health-care professionals and PR organizations in order to dynamically implement and adapt these strategies based on dynamic, more optimal understanding of underlying pathophysiological mechanisms.
Collapse
Affiliation(s)
- Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands
| | - Maud Koopman
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Wai-Yan Liu
- CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Maurice J Sillen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Bita Hajian
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Manu Sastry
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands
| | - Martijn A Spruit
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| | - Frits M Franssen
- Department of Respiratory Medicine, Maastricht University Medical Center+, The Netherlands.,CIRO+, center of expertise for chronic organ failure, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center Maastricht, The Netherlands
| |
Collapse
|
17
|
Fallahtafti F, Curtze C, Samson K, Yentes JM. Chronic obstructive pulmonary disease patients increase medio-lateral stability and limit changes in antero-posterior stability to curb energy expenditure. Gait Posture 2020; 75:142-148. [PMID: 31683184 PMCID: PMC6889081 DOI: 10.1016/j.gaitpost.2019.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A relationship exists between step width and energy expenditure, yet the contribution of dynamic stability to energy expenditure is not completely understood. Chronic obstructive pulmonary disease (COPD) patients' energy expenditure is increased due to airway obstruction. Further, they have a higher prevalence of falls and balance deficits compared to controls. RESEARCH QUESTION Is dynamic stability different between COPD patients and controls; and is the association between dynamic stability and energy expenditure different between groups? METHODS Seventeen COPD patients (64.3 ± 7.6years) and 23 controls (59.9 ± 6.6years) walked on a treadmill at three speeds: self-selected walking speed (SSWS), -20%SSWS, and +20%SSWS. Mean and variability (standard deviation) of the anterior-posterior (AP) and medio-lateral (ML) margins of stability (MOS) were compared between groups and speed conditions, while controlling for covariates. Additionally, their association to metabolic power was examined. RESULTS The association between stability and power did not significantly differ between groups. However, increased metabolic power was associated with decreased MOS AP mean (p < 0.0001), independent of speed. Increased MOS AP variability (p = 0.01) and increased SSWS (p's < 0.05) were associated with increased metabolic power. The MOS ML mean for COPD patients was greater than that of healthy patients (p = 0.02). MOS AP mean decreased as speed increased and differed by group (p = 0.048). For COPD patients, a plateau was observed at SSWS and did not decrease further at +20%SSWS compared to controls. MOS AP variability (p < 0.0001), MOS ML mean (p < 0.0001), and MOS ML variability (p = 0.003) decreased as speed increased and did not differ by group. SIGNIFICANCE Patients with COPD operate at the upper limit of their metabolic reserve due to an increased cost of breathing. To compensate for their lack of stability, they walked with larger margins of stability in the ML direction, instead of changing the stability margins in the AP direction, due to its association with energy expenditure.
Collapse
Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182-0860, United States.
| | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182-0860, United States.
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, United States.
| | - Jennifer M Yentes
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182-0860, United States.
| |
Collapse
|
18
|
Almeida CNS, Costa RAD, Manso KP, Ferreira JF, Callegari B, Oliveira CC, Neves LMT. Static balance in older adults with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. GERIATRICS, GERONTOLOGY AND AGING 2020. [DOI: 10.5327/z2447-212320201900091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To compare balance between older adults with and without chronic obstructive pulmonary disease (COPD) in tasks involving proprioceptive changes and respiratory muscle load, and to investigate the association between balance, functional capacity, and peripheral and respiratory muscle strength. METHODS: Fourteen older adults with COPD undergoing pulmonary rehabilitation and nine older adults without pulmonary disease were evaluated for static balance on a force platform under four conditions: eyes open, eyes closed, eyes closed on foam, and eyes open with respiratory overload. Differences between groups, among conditions and group/condition interactions, were tested using two-way ANOVA. Associations were explored using Pearson’s correlation coefficient. RESULTS: No differences in the posturographic variables were found in the group/condition interactions (p ≥ 0.23). The COPD group exhibited greater total displacement (F = 8.79, p = 0.003), mediolateral sway (F = 4.01, p = 0.04) and anteroposterior velocity (F = 4.28, p = 0.04) in the group effect analysis. Significant differences were found between eyes closed on foam and other conditions for all posturographic variables: anteroposterior sway (F = 13.39), mediolateral sway (F = 28.58), total displacement (F = 59.4), area (F = 37.68), anteroposterior velocity (F = 26.42), and mediolateral velocity (F = 33.29), in the condition effect analysis (p < 0.001, post-hoc). In the COPD group, significant correlations were found between the Glittre-ADL test, anteroposterior sway (r = 0.68, p = 0.01), and anteroposterior velocity (r = 0.67, p = 0.009); the 6MWT was also correlated with anteroposterior velocity (r = 0.59, p = 0.03). CONCLUSION: Older adults with COPD present balance deficits compared to healthy individuals. The unstable surface caused greater postural instability compared to other conditions in both groups. Impaired balance was associated with reduced physical function and exercise capacity.
Collapse
|
19
|
Liu WY, Schmid KK, Meijer K, Spruit MA, Yentes JM. Subjects With COPD Walk With Less Consistent Organization of Movement Patterns of the Lower Extremity. Respir Care 2019; 65:158-168. [PMID: 31719193 PMCID: PMC7055489 DOI: 10.4187/respcare.06743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The inherent stride-to-stride fluctuations during walking are altered in the aging population and could provide insight into gait impairments and falls in patients with COPD. Stride-to-stride fluctuations are quantified two ways: variability of the fluctuations (eg, standard deviation), and movement patterns within the fluctuations. Our objective was to investigate stride-to-stride fluctuations by evaluating the variability and movement patterns of lower limb joints in subjects with COPD compared to subjects without COPD as control subjects. METHODS In this cross-sectional study, 22 subjects with COPD (age 63 ± 9 y; FEV1 54 ± 19% predicted) and 22 control subjects (age 62 ± 9 y; FEV1 95 ± 18% predicted) walked for 3 min on a treadmill while their gait was recorded. The amount of variability (ie, standard deviation and coefficient of variation) and movement patterns (ie, predictability and consistency in organization) were quantified for the range of motion and joint angle of the hip, knee, and ankle, at 3 walking speeds (ie, self-selected, fast, and slow). General linear mixed models were used for analysis. RESULTS Control subjects had more consistent organization of the hip and knee joint movement patterns compared to subjects with COPD (P = .02 and P = .02, respectively). Further, control subjects adapted to speed changes by demonstrating more consistent organization of movement patterns with faster speeds, whereas subjects with COPD did not. At the fast walking speed, subjects with COPD demonstrated less consistent organization of knee and hip joint movement patterns as compared to control subjects without COPD (P = .03 and P = .005, respectively). The amount of variability did not differ between groups. CONCLUSIONS Although subjects with COPD did not demonstrate decreased amount of variability, their hip and knee joint movement patterns were less consistent in organization during walking. Reduced consistency in organization of movement patterns may be a contributing factor to falls and mobility problems experienced by patients with COPD.
Collapse
Affiliation(s)
- Wai-Yan Liu
- Department of Research and Education, CIRO, Haelen, The Netherlands.,Department of Nutrition and Movement Sciences
| | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Martijn A Spruit
- Department of Research and Education, CIRO, Haelen, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jennifer M Yentes
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska.
| |
Collapse
|
20
|
Nolan CM, Rochester CL. Exercise Training Modalities for People with Chronic Obstructive Pulmonary Disease. COPD 2019; 16:378-389. [PMID: 31684769 DOI: 10.1080/15412555.2019.1637834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Exercise training confers health benefits for people with chronic obstructive pulmonary disease (COPD). This article reviews the evidence for several exercise training modalities shown to be beneficial among individuals with COPD. These modalities include aerobic, resistance, nonlinear periodized, upper limb and balance training, as well as yoga, Tai Chi, inspiratory muscle training, whole body vibration training and neuromuscular electrical stimulation. The literature pertaining to each modality was critically reviewed, and information on the rationale, mechanism(s) of action (where known), benefits, and exercise prescription is described to facilitate easy implementation into clinical practice.
Collapse
Affiliation(s)
- Claire M Nolan
- Harefield Respiratory Research Unit, Royal Brompton and Harefield NHS Foundation Trust, UK.,Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Carolyn L Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| |
Collapse
|
21
|
Gait characteristics and their associations with clinical outcomes in patients with chronic obstructive pulmonary disease. Gait Posture 2019; 74:60-65. [PMID: 31470225 DOI: 10.1016/j.gaitpost.2019.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 05/19/2019] [Accepted: 08/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormalities of spatiotemporal gait parameters are frequently observed in chronic obstructive pulmonary disease (COPD). However, associations of gait parameters with clinical outcomes and their implementation into clinical practice have not been established. RESEARCH QUESTION To investigate gait abnormalities and their association with clinical outcomes of COPD. METHODS This study included 34 male outpatients with COPD and 16 community-dwelling healthy men aged ≥65 years. The subjects underwent a ten-metre walk test wearing an accelerometer. Data on gait speed, step length, cadence, walk ratio, acceleration magnitude, and standard deviation of step time (step time SD) were collected. Forced expiratory volume in 1-second, modified Medical Research Council dyspnoea score, six-minute walk distance (6MWD), quadriceps muscle strength (QMVC), and physical activity (daily steps and time spent in moderate to vigorous physical activity per day) were measured in the COPD group as clinical outcomes of COPD. We tested group differences in gait parameters, associations between gait parameters and COPD clinical outcomes, and predictive capability of gait parameters for reductions in 6MWD, QMVC, and daily steps in COPD. RESULTS All gait parameters except walk ratio deteriorated in COPD. Step time SD and gait speed were significant independent predictors of 6MWD in COPD (B=-0.440, p = 0.001, B = 0.339, p = 0.007, respectively). Step length was a significant independent predictor of QMVC (B=-0.609, p < 0.001) and daily steps (B=-0.453, p = 0.006). Step length was a significant predictor of muscle weakness and physical inactivity, and step time SD was significant in predicting poor 6MWD in COPD. SIGNIFICANCE Significant associations between gait abnormalities measured by an accelerometer and deficits in extra-pulmonary features of COPD were observed. An accelerometer-based gait analysis could be an alternative approach to assessing gait abnormalities and screening of functional decline in COPD.
Collapse
|
22
|
Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD. J Clin Med 2019; 8:jcm8040459. [PMID: 30959769 PMCID: PMC6518247 DOI: 10.3390/jcm8040459] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 03/27/2019] [Accepted: 04/03/2019] [Indexed: 01/23/2023] Open
Abstract
Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what extent, PR affects positively gait characteristics in COPD. In this prospective observational study, 44 COPD patients (aged: 62 ± 7 years; Forced expiratory volume in 1 s 56 ± 20% predicted) performed self-paced, treadmill 6-min-walk tests (Gait Real-time Analysis Interactive Lab) before and after PR, while spatiotemporal parameters and center of mass position were recorded (100 Hz, Vicon Nexus). Standard deviation, coefficient of variation, predictability (sample entropy), and consistency in organization (local divergence exponent) were calculated. Sub-analysis was performed to identify gait differences between good and poor responders (<30 m change in a 6-min-walk distance). Patients demonstrated shorter stride times (p = 0.001) and improved lower-limb muscle function (p < 0.001) following PR. The good responders had a greater increase in stride length (p < 0.001) and a greater decrease in stride time (p < 0.001) compared to the poor responders. Current PR improved stride time in patients, while movement patterns within stride-to-stride fluctuations did not change. Training programs specifically targeting balance issues and gait function may be beneficial in improving gait characteristics in COPD.
Collapse
|
23
|
Yentes JM, Denton W, Samson K, Schmid KK, Wiens C, Rennard SI. Energy efficient physiologic coupling of gait and respiration is altered in chronic obstructive pulmonary disease. Acta Physiol (Oxf) 2019; 225:e13217. [PMID: 30414317 DOI: 10.1111/apha.13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/28/2022]
Abstract
AIMS Coupling between walking and breathing in humans is well established. In healthy systems, the ability to couple and uncouple leads to energy economization. It is unknown if physiologic efficiency is susceptible to alteration, particularly in individuals with airflow obstruction. The aim of this research was to determine if coupling was compromised in a disease characterized by abnormal airflow and dyspnoea, and if this was associated with reduced energy efficiency. METHODS As a model of airflow obstruction, 17 chronic obstructive pulmonary disease (COPD) patients and 23 control subjects were included and walked on a treadmill for 6 minutes at three speeds (preferred speed and ±20% preferred speed) while energy expenditure, breathing, and walking were recorded. Rating of perceived exertion was recorded at the end of each walking trial. The most commonly used frequency ratio (ie, strides:breath) and cross recurrence quantification analysis were used to quantify coupling. Linear regression models were used to determine associations. RESULTS Less complex frequency ratios, simpler ratios, (ie, 1:1 and 3:2) accompanied with stronger coupling were moderately associated with increased energy expenditure in COPD subjects. This was found for all three speeds. CONCLUSION The novel finding was that increased energy expenditure was associated with stronger and less complex coupling. Increased effort is needed when utilizing a frequency ratio of 1:1 or 3:2. The more stable the coupling, the more effort it takes to walk. In contrast to the complex energy efficient coupling of controls, those with airflow obstruction manifested simpler and stronger coupling associated with reduced energy efficiency.
Collapse
Affiliation(s)
| | - William Denton
- Department of Biomechanics University of Nebraska Omaha Nebraska
| | - Kaeli Samson
- Department of Biostatistics University of Nebraska Medical Center Omaha Nebraska
| | - Kendra K. Schmid
- Department of Biostatistics University of Nebraska Medical Center Omaha Nebraska
| | - Casey Wiens
- Department of Biological Sciences University of Southern California Los Angeles California
| | - Stephen I. Rennard
- Early Clinical Development IMED Biotech Unit, AstraZeneca Cambridge UK
- Department of Internal Medicine University of Nebraska Medical Center Omaha Nebraska
| |
Collapse
|
24
|
Antonellis P, Galle S, De Clercq D, Malcolm P. Altering gait variability with an ankle exoskeleton. PLoS One 2018; 13:e0205088. [PMID: 30356309 PMCID: PMC6200209 DOI: 10.1371/journal.pone.0205088] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 09/19/2018] [Indexed: 11/28/2022] Open
Abstract
Exoskeletons can influence human gait. A healthy gait is characterized by a certain amount of variability compared to a non-healthy gait that has more inherent variability; however which exoskeleton assistance parameters are necessary to avoid increasing gait variability or to potentially lower gait variability below that of unassisted walking are unknown. This study investigated the interaction effects of exoskeleton timing and power on gait variability. Ten healthy participants walked on a treadmill with bilateral ankle-foot exoskeletons under ten conditions with different timing (varied from 36% to 54% of the stride) and power (varied from 0.2 to 0.5 W∙kg-1) combinations. We used the largest Lyapunov exponent (LyE) and maximum Floquet multiplier (FM) to evaluate the stride-to-stride fluctuations of the kinematic time series. We found the lowest LyE at the ankle and a significant reduction versus powered-off with exoskeleton power (summed for both legs) of 0.45 W∙kg-1 and actuation timing at 48% of the stride cycle. At the knee, a significant positive effect of power and a negative interaction effect of power and timing were found for LyE. We found significant positive interaction effects of the square of timing and power for LyE at the knee and hip joints. In contrast, the FM at the ankle increased with increasing power and later timing. We found a significant negative effect of power and a positive interaction effect of power and timing for FM at the knee and no significant effects of any of the exoskeleton parameters for FM at the hip. The ability of the exoskeleton to reduce the LyE at the ankle joint offers new possibilities in terms of altering gait variability, which could have applications for using exoskeletons as rehabilitation devices. Further efforts could examine if it is possible to simultaneously reduce the LyE and FM at one or more lower limb joints.
Collapse
Affiliation(s)
- Prokopios Antonellis
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
| | - Samuel Galle
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Dirk De Clercq
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Philippe Malcolm
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
| |
Collapse
|
25
|
Heraud N, Alexandre F, Gueugnon M, Davy C, Tremey E, Oliver N, Varray A. Impact of Chronic Obstructive Pulmonary Disease on Cognitive and Motor Performances in Dual-Task Walking. COPD 2018; 15:277-282. [PMID: 29799281 DOI: 10.1080/15412555.2018.1469607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
When two tasks are performed simultaneously, they compete for attentional resources, resulting in a performance decrement in one or both tasks. Patients with attention disorders have a reduced ability to perform several tasks simultaneously (e.g., talking while walking), which increases the fall risk and frailty. This study assessed the cognitive and motor performances of patients with COPD and healthy controls within a dual-task walking paradigm. A subobjective was to assess the impact of a pulmonary rehabilitation program on the dual-task performances in COPD. Twenty-five patients with COPD and 20 controls performed a cognitive task (subtraction) and a 15-m walking test separately (single-task; ST) and jointly (dual-task; DT). In addition, a subsample of 10 patients performed the same evaluations 5 weeks later after a pulmonary rehabilitation program following current recommendations. Cognitive and gait performances in ST showed no differences between patients with COPD and controls (all p > 0.05). However, COPD patients exhibited a greater increase in gait variability than controls in DT (4.07 ± 1.46% vs. 2.17 ± 0.7%, p < 0.001). The pulmonary rehabilitation program had no effect on the dual-task impairment for the subsample of patients (p = 0.87). This study provides evidence of insufficient attentional resources to successfully deal with DT in patients with COPD, and this was expressed through an exaggerated increase in gait variability in DT walking. Given the high risk of falls and disability associated with altered gait variability, dual-task training interventions should be considered in pulmonary rehabilitation programs.
Collapse
Affiliation(s)
- Nelly Heraud
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - François Alexandre
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Mathieu Gueugnon
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Corentin Davy
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Emilie Tremey
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Nicolas Oliver
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France
| | - Alain Varray
- a Cliniques du Souffle , Service Recherche , Groupe 5 Sante, Lodeve , France.,b Euromov, University of Montpellier , Montpellier , France
| |
Collapse
|
26
|
van Buul AR, Kasteleyn MJ, Chavannes NH, Taube C. Physical activity in the morning and afternoon is lower in patients with chronic obstructive pulmonary disease with morning symptoms. Respir Res 2018; 19:49. [PMID: 29587841 PMCID: PMC5870529 DOI: 10.1186/s12931-018-0749-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) experience symptoms that vary over the day. Symptoms at the start of the day might influence physical activity during the rest of the day. Therefore, physical activity during the course of the day was studied in patients with low and high morning symptom scores. Methods This cross-sectional observational study included patients with moderate to very severe COPD. Morning symptoms were evaluated with the PRO-morning COPD Symptoms Questionnaire (range 0–60); the median score was used to create two groups (low and high morning symptom scores). Physical activity was examined with an accelerometer. Activity parameters during the night, morning, afternoon and evening were compared between patients with low and high morning symptom scores using independent t-tests or Mann-Whitney U tests. Results Seventy nine patients were included. Patients were aged (mean ± SD) 65.6 ± 8.8 years with a mean forced expiratory volume in 1 s of 55 ± 17%predicted. Patients with low morning symptom scores (score < 17.0) took more steps in the afternoon (p = 0.015) and morning (p = 0.030). There were no significant differences during the evening and night. Conclusion Patients with high morning symptom scores took significantly fewer steps in the morning and afternoon than those with low morning symptom scores. Prospective studies are needed to prove causality between morning symptoms and physical activity during different parts of the day. Electronic supplementary material The online version of this article (10.1186/s12931-018-0749-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Amanda R van Buul
- Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, Postzone C2-R, Postbus 9600, 2300, RC, Leiden, The Netherlands.
| | - Marise J Kasteleyn
- Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, Postzone C2-R, Postbus 9600, 2300, RC, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, postzone V-0p, Postbus 9600, 2300, RC, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, postzone V-0p, Postbus 9600, 2300, RC, Leiden, The Netherlands
| | - Christian Taube
- Department of Pulmonology, Leiden University Medical Center, Albinusdreef 2, Postzone C2-R, Postbus 9600, 2300, RC, Leiden, The Netherlands.,Department of Pulmonary Medicine, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Tüschener Weg 40, 45239, Essen, Germany
| |
Collapse
|
27
|
Zago M, Sforza C, Bonardi DR, Guffanti EE, Galli M. Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review. Gait Posture 2018; 61:408-415. [PMID: 29462775 DOI: 10.1016/j.gaitpost.2018.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/18/2018] [Accepted: 02/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait instability is a major fall-risk factor in patients with chronic obstructive pulmonary disease (COPD). Clinical gait analysis is a reliable tool to predict fall onsets. However, controversy still exists on gait impairments associated with COPD. RESEARCH QUESTION Thus, the aims of this review were to evaluate the current understanding of spatiotemporal, kinematic and kinetic gait features in patients with COPD. METHODS In line with PRISMA guidelines, a systematic literature search was performed throughout Web of Science, PubMed Medline, Scopus, PEDro and Scielo databases. We considered observational cross-sectional studies evaluating gait features in patients with COPD as their primary outcome. Risk of bias and applicability of these papers were assessed according to the QUADAS-2 tool. RESULTS Seven articles, cross-sectional studies published from 2011 to 2017, met the inclusion criteria. Sample size of patients with COPD ranged 14-196 (mean age range: 64-75 years). The main reported gait abnormalities were reduced step length and cadence, and altered variability of spatiotemporal parameters. Only subtle biomechanical changes were reported at the ankle level. SIGNIFICANCE A convincing mechanistic link between such gait impairments and falls in patients with COPD is still lacking. The paucity of studies, small sample sizes, gender and disease status pooling were the main risk of biases affecting the results uncertainty. Two research directions emerged: stricter cohorts characterization in terms of COPD phenotype and longitudinal studies. Quantitative assessment of gait would identify abnormalities and sensorimotor postural deficiencies that in turn may lead to better falling prevention strategies in COPD.
Collapse
Affiliation(s)
- Matteo Zago
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133, Milano, Italy; Fondazione Istituto Farmacologico Filippo Serpero, Viale Luigi Majno 40, 20122, Milano, Italy.
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133, Milano, Italy; Institute of Molecular Bioimaging and Physiology, National Research Council, Segrate, Italy.
| | - Daniela Rita Bonardi
- Istituto Nazionale di Riposo e Cura per Anziani IRCCS CASATENOVO, Via Monteregio 13, 23880 Casatenovo, Lecco, Italy.
| | - Enrico Eugenio Guffanti
- Istituto Nazionale di Riposo e Cura per Anziani IRCCS CASATENOVO, Via Monteregio 13, 23880 Casatenovo, Lecco, Italy.
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy; IRCCS San Raffaele Pisana, Roma, Italy.
| |
Collapse
|
28
|
Liu WY, Spruit MA, Delbressine JM, Willems PJ, Franssen FME, Wouters EFM, Meijer K. Spatiotemporal gait characteristics in patients with COPD during the Gait Real-time Analysis Interactive Lab-based 6-minute walk test. PLoS One 2017; 12:e0190099. [PMID: 29284059 PMCID: PMC5746246 DOI: 10.1371/journal.pone.0190099] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background and aim Overground gait assessment is limited by the analysis of multiple strides or both spatiotemporal gait characteristics, while fixed speed treadmill walking restricts natural gait speed variations. The Gait Real-time Analysis Interactive Lab (GRAIL)-based 6-minute walk test (6MWT) enables 3D motion analysis and self-paced treadmill walking, and could provide insight in gait alterations in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to compare spatiotemporal gait characteristics between patients with COPD and healthy elderly during the GRAIL-based 6MWT. Materials and methods Eighty COPD patients (60% male; 62±7 years; FEV1:56±19% predicted) and 38 healthy elderly (63% male; 62±6 years; FEV1:119±17% predicted) performed two GRAIL-based 6MWTs. Mean differences and coefficient of variation of spatiotemporal gait characteristics were calculated using the trial with the largest walk distance. Sub-analyses were conducted to account for walking speed differences between groups, and muscle strength and COPD severity within the patient group. Results COPD patients showed increased temporal gait characteristics, decreased stride and step lengths, and increased gait variability compared to healthy elderly (p<0.01). Stride length variability remained increased in COPD after correction for walking speed (MD:0.98%, CI:0.36–1.61, p = 0.003). Reduced quadriceps strength did not translate into altered gait characteristics, while COPD severity is associated with stride time (left MD:-0.02s, CI:-0.04–0.01, p = 0.003; right MD:-0.02s, CI:-0.04–0.01, p = 0.003). Discussion COPD patients performed the GRAIL-based 6MWT differently compared to healthy elderly. Further research should use other variability measures to investigate gait characteristics in COPD, to assess subtle alterations in gait and to enable development of rehabilitation strategies to improve gait, and possibly balance and fall risk in COPD. Other lower limb muscle groups should be considered when investigating gait alterations in COPD. Conclusion COPD patients have different gait characteristics compared to healthy elderly. Independent of walking speed, COPD patients demonstrate increased stride length variability during the GRAIL-based 6MWT compared to healthy elderly.
Collapse
Affiliation(s)
- Wai-Yan Liu
- Department of Research and Education, CIRO, Horn, the Netherlands
- Department of Human Movement Science, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
- * E-mail:
| | - Martijn A. Spruit
- Department of Research and Education, CIRO, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | | | - Paul J. Willems
- Department of Human Movement Science, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Frits M. E. Franssen
- Department of Research and Education, CIRO, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Emiel F. M. Wouters
- Department of Research and Education, CIRO, Horn, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Kenneth Meijer
- Department of Human Movement Science, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| |
Collapse
|
29
|
McCamley J, Denton W, Lyden E, Yentes JM. Measuring Coupling of Rhythmical Time Series Using Cross Sample Entropy and Cross Recurrence Quantification Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:7960467. [PMID: 29201135 PMCID: PMC5671691 DOI: 10.1155/2017/7960467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/11/2017] [Accepted: 08/20/2017] [Indexed: 11/18/2022]
Abstract
The aim of this investigation was to compare and contrast the use of cross sample entropy (xSE) and cross recurrence quantification analysis (cRQA) measures for the assessment of coupling of rhythmical patterns. Measures were assessed using simulated signals with regular, chaotic, and random fluctuations in frequency, amplitude, and a combination of both. Biological data were studied as models of normal and abnormal locomotor-respiratory coupling. Nine signal types were generated for seven frequency ratios. Fifteen patients with COPD (abnormal coupling) and twenty-one healthy controls (normal coupling) walked on a treadmill at three speeds while breathing and walking were recorded. xSE and the cRQA measures of percent determinism, maximum line, mean line, and entropy were quantified for both the simulated and experimental data. In the simulated data, xSE, percent determinism, and entropy were influenced by the frequency manipulation. The 1 : 1 frequency ratio was different than other frequency ratios for almost all measures and/or manipulations. The patients with COPD used a 2 : 3 ratio more often and xSE, percent determinism, maximum line, mean line, and cRQA entropy were able to discriminate between the groups. Analysis of the effects of walking speed indicated that all measures were able to discriminate between speeds.
Collapse
Affiliation(s)
- John McCamley
- MORE Foundation, 18444 N. 25th Ave, Suite 110, Phoenix, AZ 85023, USA
| | - William Denton
- Center for Research in Human Movement Variability, University of Nebraska Omaha, 6160 University Drive, Omaha, NE 68182-0860, USA
| | - Elizabeth Lyden
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE 68198-4355, USA
| | - Jennifer M. Yentes
- Center for Research in Human Movement Variability, University of Nebraska Omaha, 6160 University Drive, Omaha, NE 68182-0860, USA
| |
Collapse
|
30
|
Jin Y, Chen C, Cao Z, Sun B, Lo IL, Liu TM, Zheng J, Sun S, Shi Y, Zhang XD. Entropy change of biological dynamics in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2997-3005. [PMID: 29066881 PMCID: PMC5644543 DOI: 10.2147/copd.s140636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this century, the rapid development of large data storage technologies, mobile network technology, and portable medical devices makes it possible to measure, record, store, and track analysis of large amount of data in human physiological signals. Entropy is a key metric for quantifying the irregularity contained in physiological signals. In this review, we focus on how entropy changes in various physiological signals in COPD. Our review concludes that the entropy change relies on the types of physiological signals under investigation. For major physiological signals related to respiratory diseases, such as airflow, heart rate variability, and gait variability, the entropy of a patient with COPD is lower than that of a healthy person. However, in case of hormone secretion and respiratory sound, the entropy of a patient is higher than that of a healthy person. For mechanomyogram signal, the entropy increases with the increased severity of COPD. This result should give valuable guidance for the use of entropy for physiological signals measured by wearable medical device as well as for further research on entropy in COPD.
Collapse
Affiliation(s)
- Yu Jin
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Chang Chen
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Zhixin Cao
- Beijing Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou
| | - Iek Long Lo
- Department of Geriatrics, Centro Hospital Conde de Sao Januario, Macau
| | - Tzu-Ming Liu
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Shixue Sun
- Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Yan Shi
- School of Automation Science and Electrical Engineering, Beihang University, Beijing, China
| | | |
Collapse
|