Effect of treadmill training on specific gait parameters in older adults with frailty: case series

Sprint Interval Training on Stationary Air Bike Elicits Cardiorespiratory Adaptations While Being Time-Efficient

ABSTRACT

Moghaddam, M, Cervantes, M, Cheshier, B, and Jacobson, BH. Sprint interval training on stationary air bike elicits cardiorespiratory adaptations while being time-efficient. J Strength Cond Res 37(9): 1795-1801, 2023-Sprint interval training (SIT) refers to a set of brief intermittent exercises that are performed at maximal intensity. This study compared the effects of 2 SIT protocols (e.g., 10-5-SIT and 20-10-SIT) vs. moderate-intensity continuous training (MICT) on cardiovascular adaptations, using stationary air bikes. Thirty-two recreationally active individuals were randomly assigned to the 3 performance groups, such as 10-5-SIT (n = 11), 20-10-SIT (n = 10), and MICT (n = 11), to train 3 days per week for 4 weeks. Moderate-intensity continuous training included 30 minutes of cycling at 75% of maximal heart rate reserve, whereas the SIT protocols consisted of 3 sets of 8 intervals at all-out intensity. The 10-5-SIT and 20-10-SIT were performed with 10-second work:5-second rest and 20-second work:10-second rest, with 2.5- and 5-minute recovery periods between sets, respectively. A ramp protocol was used before and after the intervention via cycle ergometer to assess aerobic performance. Time to exhaustion (TTE), absolute V̇o2max (A-V̇o2max), relative V̇o2max (R-V̇o2max), and metabolic equivalents (METs) were measured and analyzed with 2-way mixed factorial analyses of variance (ANOVAs). In addition, total work (TW) during 12 sessions were recorded and analyzed with 1-way ANOVA. Significant (p < 0.05) differences were found for TW (10-5-SIT: 907.3 ± 332.0, 20-10-SIT: 1230.0 ± 188.1, and MICT: 2263.0 ± 896.9 calories) between groups. A significant main effect of time was observed for 10-5-SIT, 20-10-SIT, and MICT (p < 0.05) in TTE (increased by 7.3, 8.7, and 8.2%), A-V̇o2max (increased by 13.0, 11.8, and 13.6%), R-V̇o2max (increased by 12.6, 12.1, and 14.8%), and METs (increased by 12.7, 12.3, and 14.9%), respectively. Despite less volume and duration, both SIT protocols induced cardiorespiratory adaptations similar to MICT. These findings suggest that performing SIT on a stationary air bike is valuable because of time-efficiency and cardiorespiratory adaptations.

Comparing the Effects of Two Perturbation-Based Balance Training Paradigms in Fall-Prone Older Adults: A Randomized Controlled Trial

INTRODUCTION

There is increasing evidence that perturbation-based balance training (PBT) is highly effective in preventing falls at older age. Different PBT paradigms have been presented so far, yet a systematic comparison of PBT approaches with respect to feasibility and effectiveness is missing. Two different paradigms of PBT seem to be promising for clinical implementation: (1) technology-supported training on a perturbation treadmill (PBTtreadmill); (2) training of dynamic stability mechanisms in the presence of perturbations induced by unstable surfaces (PBTstability). This study aimed to compare both program's feasibility and effectiveness in fall-prone older adults.

METHODS

In this three-armed randomized controlled trial, seventy-one older adults (74.9 ± 6.0 years) with a verified fall risk were randomly assigned into three groups: PBTtreadmill on a motorized treadmill, PBTstability using unstable conditions such as balance pads, and a passive control group (CG). In both intervention groups, participants conducted a 6-week intervention with 3 sessions per week. Effects were assessed in fall risk (Brief-BEST), balance ability (Stepping Threshold Test, center of pressure, limits of stability), leg strength capacity, functional performance (Timed Up and Go Test, Chair-Stand), gait (preferred walking speed), and fear of falling (Short FES-I).

RESULTS

Fifty-one participants completed the study. Training adherence was 91% for PBTtreadmill and 87% for PBTstability, while no severe adverse events occurred. An analysis of covariance with an intention-to-treat approach revealed statistically significant group effects in favor of PBTstability in the Brief-BEST (p = 0.009, η2 = 0.131) and the limits of stability (p = 0.020, η2 = 0.110) and in favor of PBTtreadmill in the Stepping Threshold Test (p < 0.001, η2 = 0.395). The other outcomes demonstrated no significant group effects.

CONCLUSION

Both training paradigms demonstrated high feasibility and were effective in improving specific motor performances in the fall-prone population and these effects were task specific. PBTtreadmill showed higher improvements in reactive balance, which might have been promoted by the unpredictable nature of the included perturbations and the similarity to the tested surface perturbation paradigm. PBTstability showed more wide-ranging effects on balance ability. Consequently, both paradigms improved fall risk-associated measures. The advantages of both formats should be evaluated in light of individual needs and preferences. Larger studies are needed to investigate the effects of these paradigms on real-life fall rates.

Muscle activation and rating of perceived exertion of typically developing children during DRY and aquatic treadmill walking

Aquatic treadmill gait training is a poorly understood rehabilitation method that alters bodyweight support, increases lower limb resistance, and assists with postural stability. This training could be an attractive tool for clinical populations with balance control issues or limited weight-bearing prescriptions for the lower limb. As a first step, the purpose of this study was to quantify differences in mean muscle activity of the tibialis anterior, rectus femoris, medial gastrocnemius, and semitendinosus, and perceived exertion (RPE) in typically developing children (7:8 M:F, age = 11.3 ± 4.1 years, 1.46 ± 0.18 m, and 44.2 ± 16.8 kg) during dry and aquatic treadmill walking at 75 %, 100 %, and 125 % self-selected speed. We hypothesized that the greatest mean muscle activity, normalized to percent maximum voluntary contraction and averaged across all strides, would be observed during 125 % dry treadmill walking and that aquatic treadmill walking would produce lower RPE. Overall, aquatic treadmill walking reduced mean medial gastrocnemius activity by 50.2 % (padj < 0.001), increased mean rectus femoris activity at least 32.8 % (padj < 0.006), and produced 78.0 % (padj = 0.007) greater RPE compared to dry treadmill walking. This study provides normative pediatric data for future aquatic treadmill walking studies in clinical populations to help inform gait rehabilitation protocols.

Low composite functional movement screen score associated with decline of gait stability in young adults

Background

The functional movement screen (FMS)^TM is a screening tool used to evaluate fundamental motor function. A score of 14 for the composite total FMS score (TFMS) is generally used as the cut-off point (≤14/21). In addition, gait analysis is used to evaluate fundamental motor function in humans. Thus, evaluating the fundamental motor function using the FMS^TM test and gait analysis at various speeds can provide further understanding of any decline in gait stability. In this study, we aimed to investigate the association between gait ability and fundamental movement patterns in young adults according to the cut-off point.

Methods

A total of 439 participants (male: 203, female: 236) successfully completed the FMS test and a 1 min treadmill test; the participants were classified into two groups: low TFMS (≤14) and high TFMS (>14).

Results

The low TFMS group exhibited slower and shortened walking patterns and worsen gait variability than the high TFMS group. The coefficient of variance (CV) for the double support phase at a faster speed (male) and the stride length at a slower speed (female) were classifiers between the two groups. In addition, the low TFMS group demonstrated insufficient gait adaptation at the preferred and faster speeds based on the CV of the double support phase and gait asymmetry. Lower TFMS is associated with a decline in gait ability. Therefore, participants with a lower TFMS and poor gait ability may require intervention programs to prevent risk of future injury and to enhance motor function.

How gait influences frailty models and health-related outcomes in clinical-based and population-based studies: a systematic review

Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.

Association between Gait Variability and Gait-Ability Decline in Elderly Women with Subthreshold Insomnia Stage

This study investigates the gait characteristics of elderly women, aged more than 65 years, with subthreshold insomnia stage at various walking speeds. A total of 392 participants (insomnia: 202 and controls: 190) wearing shoe-type inertial measurement units completed walking tests on a treadmill for a duration of 1 min at slower, preferred, and faster speeds. The insomnia group indicated lower pace parameters (range of Cohen's d: 0.283-0.499) and the single support phase (Cohen's d: 0.237), greater gait variability (range of Cohen's d: 0.217-0.506), and bilateral coordination (range of Cohen's d: 0.254-0.319), compared with their age-matched controls; the coefficient of variance (CV) of the stance phase at the faster speed condition was a crucial variable for distinguishing between insomnia and control groups. In addition, the insomnia group demonstrated insufficient gait adaptation at the slower and preferred speeds, as indicated by the CVs of the stride length, stride time, and step time. In particular, participants with worsened insomnia symptoms or sleep problems showed that these worse gait patterns may increase the potential risk of falling in elderly women. Thus, elderly women with subthreshold insomnia stage need to improve their sleep quality to enhance their physical functions.

Gait Characteristics Based on Shoe-Type Inertial Measurement Units in Healthy Young Adults during Treadmill Walking

This study investigated the gait characteristics of healthy young adults using shoe-type inertial measurement units (IMU) during treadmill walking. A total of 1478 participants were tested. Principal component analyses (PCA) were conducted to determine which principal components (PC_s) best defined the characteristics of healthy young adults. A non-hierarchical cluster analysis was conducted to evaluate the essential gait ability, according to the results of the PC₁ score. One-way repeated analysis of variance with the Bonferroni correction was used to compare gait performances in the cluster groups. PCA outcomes indicated 76.9% variance for PC₁–PC₆, where PC₁ (gait variability (GV): 18.5%), PC₂ (pace: 17.8%), PC₃ (rhythm and phase: 13.9%), and PC₄ (bilateral coordination: 11.2%) were the gait-related factors. All of the pace, rhythm, GV, and variables for bilateral coordination classified the gait ability in the cluster groups. We suggest that the treadmill walking task may be reliable to evaluate the gait performances, which may provide insight into understanding the decline of gait ability. The presented results are considered meaningful for understanding the gait patterns of healthy adults and may prove useful as reference outcomes for future gait analyses.

Effectiveness of a Treadmill Training Programme in Improving the Postural Balance on Institutionalized Older Adults

Background

Institutionalized older adults have increased gait and balance impairment compared with community-dwelling older adults. The use of the treadmill for the rehabilitation process has been studied in different groups, but not in the institutionalized elderly.

Objectives

The objective of this study was to assess the effects of a treadmill walking workout program on the postural balance of institutionalized older adults.

Methods

Postural balance was assessed by the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), gait speed, and Timed Up and Go Test (TUG) on 37 institutionalized older adults (23 in the intervention group and 14 in the control group). Training consisted of a 20-minute treadmill walking workout carried out twice a week for 10 weeks. Measurements were obtained before and after 10 weeks and with 1 month of follow-up for the intervention group. For the control group, the data were obtained before and after the training period.

Results

Significant improvement occurred in all motor function parameters (BBS: p < 0.01; gait speed: p < 0.01; gait speed: p < 0.01; gait speed: p < 0.01; gait speed:

Conclusions

The present results permit us to conclude that a treadmill walking program had positive effects on the postural balance of institutionalized older adults.

Methods for Gait Analysis During Obstacle Avoidance Task

In this study, we present algorithms developed for gait analysis, but suitable for many other signal processing tasks. A novel general-purpose algorithm for extremum estimation of quasi-periodic noisy signals is proposed. This algorithm is both flexible and robust, and allows custom adjustments to detect a predetermined wave pattern while being immune to signal noise and variability. A method for signal segmentation was also developed for analyzing kinematic data recorded while performing on obstacle avoidance task. The segmentation allows detecting preparation and recovery phases related to obstacle avoidance. A simple kernel-based clustering method was used for classification of unsupervised data containing features of steps within the walking trial and discriminating abnormal from regular steps. Moreover, a novel algorithm for missing data approximation and adaptive signal filtering is also presented. This algorithm allows restoring faulty data with high accuracy based on the surrounding information. In addition, a predictive machine learning technique is proposed for supervised multiclass labeling with non-standard label structure.

Gait Abnormalities and the Risk of Falls in CKD

BACKGROUND AND OBJECTIVES

Older adults with CKD are at high risk of falls and disability. It is not known whether gait abnormalities contribute to this risk.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Quantitative and clinical gait assessments were performed in 330 nondisabled community-dwelling adults aged ≥65 years. CKD was defined as an eGFR <60 ml/min per 1.73 m². Cox proportional hazards models were created to examine fall risk.

RESULTS

A total of 41% (n=134) of participants had CKD. In addition to slower gait speed, participants with CKD had gait cycle abnormalities including shorter stride length and greater time in the stance and double-support phases. Among people with CKD, lower eGFR was independently associated with the severity of gait cycle abnormalities (per 10 ml/min per 1.73 m² lower eGFR: 3.6 cm [95% confidence interval (95% CI), 1.4 to 5.8] shorter stride length; 0.7% [95% CI, 0.3 to 1.0] less time in swing phase; 1.1% [95% CI, 0.5 to 1.7] greater time in double-support phase); these abnormalities mediated the association of lower eGFR with slower gait speed. On clinical gait exam, consistent with the quantitative abnormalities, short steps and marked swaying or loss of balance were more common among participants with CKD, yet most had no identifiable gait phenotype. A gait phenotype defined by any of these abnormal signs was associated with higher risk of falls among participants with CKD: compared with people without CKD and without the gait phenotype, the adjusted hazard ratio was 1.72 (95% CI, 1.06 to 2.81) for those with CKD and the phenotype; in comparison, the adjusted hazard ratio was 0.71 (95% CI, 0.40 to 1.25) for people with CKD but without the phenotype (P value for interaction of CKD status and gait phenotype =0.01).

CONCLUSIONS

CKD in older adults is associated with quantitative gait abnormalities, which clinically manifest in a gait phenotype that is associated with fall risk.

The correlates of slow gait and its relation with social network among older adults in Singapore

OBJECTIVES

This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status.

METHODS

Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample.

RESULTS

The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score.

CONCLUSION

Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

The Multifeature Gait Score: An accurate way to assess gait quality

PURPOSE

This study introduces a novel way to accurately assess gait quality. This new method called Multifeature Gait Score (MGS) is based on the computation of multiple parameters characterizing six aspects of gait (temporal, amplitude, variability, regularity, symmetry and complexity) quantified with one inertial sensor. According to the aspects described, parameters were aggregated into partial scores to indicate the altered aspect in the case of abnormal patterns. In order to evaluate the overall gait quality, partial scores were averaged to a global score.

METHODS

The MGS was computed for 3 groups namely: healthy adult (10 subjects), sedentary elderly (11 subjects) and active elderly (20 subjects). Data were gathered from an inertial sensor located at the lumbar region during two sessions of 12m walking.

RESULTS

The results based on ANOVA and Tukey tests showed that the partial scores with the exception of those which describe the symmetry aspect were able to discriminate between groups (p<0.05). This significant difference was also confirmed by the global score which shows a significantly lower value for the sedentary elderly group (3.58 ±1.15) compared to the healthy adults (5.19 ±0.84) and active elderly (4.82 ±1.26). In addition, the intersession repeatability of the elaborated global score was excellent (ICC = 0.93, % SEM = 10.81).

CONCLUSION

The results obtained support the reliability and the relevance of the MGS as a novel method to characterize gait quality.

High-Technology Based Gait Assessment in Frail People: Associations between Spatio-Temporal and Three-Dimensional Gait Characteristics with Frailty Status across Four Different Frailty Measures

OBJECTIVE

We analyzed associations between a battery of gait characteristics and frailty status across four different frailty instruments in old patients.

DESIGN

Cross-sectional study.

SETTING

Geriatric wards of a general hospital.

PARTICIPANTS

123 hospitalized patients aged ≥65 years.

MEASUREMENTS

Spatio-temporal and three-dimensional gait characteristics were assessed by an electronic walkway and a shoe-mounted, inertial sensor-based mobile gait analysis system. Frailty status was assessed by the frailty phenotype (FP), Clinical Frailty Scale (CFS), frailty index (FI), and frailty index based on a comprehensive geriatric assessment (FI-CGA).

RESULTS

A reduction in walking speed (FP, FI, FI-CGA), stride length (FP, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FI-CGA) and greater stride length variability (FP, CFS, FI, FI-CGA), stride time variability (FP, FI), double support time (FP, FI), and stride width (CFA, FI-CGA) were associated with frailty status across the four frailty instruments (all P < 0.05, respectively). Walking speed (FP, CFS, FI, FI-CGA), stride length (FP, CFS, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FP, FI), stride length variability (CFS, FI, FI-CGA), stride time variability (FI), double support time (FP), and stride width (FP, CFS, FI) were related with frailty severity across the four frailty instruments independent of age and sex (all P adjusted < 0.05, respectively).

CONCLUSIONS

Gait changes in frail patients include more than solely a reduction in walking speed.

Health benefits of cycle ergometer training for older adults over 70: a review

As the number of older adults continues to increase worldwide, more attention is being paid to geriatric health care needs, and successful ageing is becoming an important topic in the medical literature. A preventive approach to the care of older adults is thus a priority in our aging societies. The purpose of this study was to update evidence for the health benefits of cycle ergometer training for older adults over 70. We searched online electronic databases up to September 2014 for original observational and intervention studies on the relationship between cycle ergometer training and health among older patients over 70. Twenty-five studies examined interventions aimed specifically at promoting cycling for older adults over 70. These studies reported a positive effect on the prevention of cardiovascular disease, and a significant improvement in metabolic responses. Improving functional status, muscle strength and cognitive performance are also well established. Overall, this review demonstrates a positive effect of cycle ergometer training with functional benefits and positive health outcomes for older adults over 70. Based on this evidence, clinicians can now encourage older adults to profit from the health benefits of cycle ergometer training to be able to pursue their daily activities independently.

Frailty and technology: a systematic review of gait analysis in those with frailty

BACKGROUND

New technologies for gait assessment are emerging and have provided new avenues for accurately measuring gait characteristics in home and clinic. However, potential meaningful clinical gait parameters beyond speed have received little attention in frailty research.

OBJECTIVE

To study gait characteristics in different frailty status groups for identifying the most useful parameters and assessment protocols for frailty diagnosis.

METHODS

We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Age Line. Articles were selected according to the following criteria: (1) population: individuals defined as frail, prefrail, or transitioning to frail, and (2) outcome measures: quantitative gait variables as obtained by biomechanical analysis. Effect sizes (d) were calculated for the ability of parameters to discriminate between different frailty status groups.

RESULTS

Eleven publications met inclusion criteria. Frailty definitions, gait protocols and parameters were inconsistent, which made comparison of outcomes difficult. Effect sizes were calculated only for the three studies which compared at least two different frailty status groups. Gait speed shows the highest effect size to discriminate between frailty subgroups, in particular during habitual walking (d = 0.76-6.17). Gait variability also discriminates between different frailty status groups in particular during fast walking. Prominent parameters related to prefrailty are reduced cadence (d = 1.43) and increased step width variability (d = 0.64), whereas frailty (vs. prefrail status) is characterized by reduced step length during habitual walking (d = 1.32) and increased double support during fast walking (d = 0.78). Interestingly, one study suggested that dual-task walking speed can be used to predict prospective frailty development.

CONCLUSION

Gait characteristics in people with frailty are insufficiently analyzed in the literature and represent a major area for innovation. Despite the paucity of work, current results suggest that parameters beyond speed could be helpful in identifying different categories of frailty. Increased gait variability might reflect a multisystem reduction and may be useful in identifying frailty. In addition, a demanding task such as fast walking or adding a cognitive distractor might enhance the sensitivity and specificity of frailty risk prediction and classification, and is recommended for frailty assessment using gait analysis.