Gait Monitoring and Walk Distance Estimation With an Accelerometer During 6-Minute Walk Test

BACKGROUND

The 6-min walk test (6MWT) encompasses potential and untapped information related to exercise capacity. However, this test does not yield any information about gait pattern. Recently, we used a ventilatory polygraph to reveal respiratory adaptation during the 6MWT with subjects having high or low body mass index (BMI). In this study, we aimed to determine gait parameters with the same device, which integrates an accelerometer.

METHODS

Using a 30-m corridor, steps and U-turns were detected with a custom-made algorithm, compared to video recordings as a reference method, and analyzed offline. From the vertical acceleration signal, we were able to determine cadence and step length, and we could calculate the total distance covered in 6 min (6MWD). We then compared these variables between subjects with low BMI (n = 13 subjects) or high BMI (n = 29 subjects).

RESULTS

Steps and U-turn detection correlated with video results (r = 0.99, P < .001 for both). The 6MWD calculation was also in line with classical measurements (r = 0.99, P < .001). High BMI subjects had a significantly lower 6MWD, cadence, and step length than controls (P < .001 for each). Walking speed was more closely correlated with step length (r = 0.92) than with cadence (r = 0.64) for both groups.

CONCLUSION

Our results demonstrated that a ventilatory polygraph with an embedded accelerometer can be used to detect steps and U-turns, and to calculate 6MWD. This method is sufficiently sensitive to characterize significant BMI-dependent differences in gait pattern during a 6MWT and appears to be a promising tool for routine clinical use.

New Respiratory Inductive Plethysmography (RIP) Method for Evaluating Ventilatory Adaptation during Mild Physical Activities

The pneumotachometer is currently the most accepted device to measure tidal breathing, however, it requires the use of a mouthpiece and thus alteration of spontaneous ventilation is implied. Respiratory inductive plethysmography (RIP), which includes two belts, one thoracic and one abdominal, is able to determine spontaneous tidal breathing without the use of a facemask or mouthpiece, however, there are a number of as yet unresolved issues. In this study we aimed to describe and validate a new RIP method, relying on a combination of thoracic RIP and nasal pressure signals taking into account that exercise-induced body movements can easily contaminate RIP thoracic signals by generating tissue motion artifacts. A custom-made time domain algorithm that relies on the elimination of low amplitude artifacts was applied to the raw thoracic RIP signal. Determining this tidal ventilation allowed comparisons between the RIP signal and simultaneously-recorded airflow signals from a calibrated pneumotachometer (PT). We assessed 206 comparisons from 30 volunteers who were asked to breathe spontaneously at rest and during walking on the spot. Comparisons between RIP signals processed by our algorithm and PT showed highly significant correlations for tidal volume (Vt), inspiratory (Ti) and expiratory times (Te). Moreover, bias calculated using the Bland and Altman method were reasonably low for Vt and Ti (0.04 L and 0.02 s, respectively), and acceptable for Te (<0.1 s) and the intercept from regression relationships (0.01 L, 0.06 s, 0.17 s respectively). The Ti/Ttot and Vt/Ti ratios obtained with the two methods were also statistically correlated. We conclude that our methodology (filtering by our algorithm and calibrating with our calibration procedure) for thoracic RIP renders this technique sufficiently accurate to evaluate tidal ventilation variation at rest and during mild to moderate physical activity.

Body Mass Index-Dependent Ventilatory Parameters From Respiratory Inductive Plethysmography During 6-Minute Walk Test

BACKGROUND

Walking is part of obesity management. Assessment of ventilatory impairments and consequences for gait induced by obesity could be clinically helpful. We aimed to develop a method to accurately monitor ventilation with respiratory inductive plethysmography (RIP) in subjects with high body mass indices (BMIs) during a 6-min walk test (6MWT).

METHODS

25 volunteers were divided into 2 groups based on BMI (<25 or >30 kg/m2) and performed a 6MWT with a calibrated RIP. Ventilatory parameters (tidal volume [V(T)], inspiratory [T(I)] and expiratory [T(E)] times, V(T)/T(I) ratio, and T(I)/Ttot ratio) were determined after processing RIP signals with a custom-made algorithm designed to discriminate tissue motion artifacts and respiratory cycles in the time domain. Six-min walk distance and average speed by minute were collected.

RESULTS

The number of artifacts removed by the algorithm used for artifact removal was higher for high-BMI subjects and was correlated to their individual values (r = 0.66, P < .001). Six-min walk distance was lower for the group with a higher BMI (P = .001). ANOVA revealed effects of exercise for V(T), T(I), and T(E) (P < .001) and also BMI effects in the course of the 6MWT for V(T), T(I), T(E), V(T)/T(I), and T(I)/Ttot (P < .001 for each of them).

CONCLUSIONS

This respiratory monitoring method is sufficiently sensitive to point out differences between rest and exercise as well as locomotor and ventilatory differences relative to BMI during the 6MWT. Thus, this system gives useful information from the 6MWT for clinicians who want to assess respiratory patterns of patients during this commonly used test.