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The study examined how clinically measured walking capacity contributes to real-world walking performance in persons with Parkinson's disease (PD).Cross-sectional baseline data (n = 82) from a PD clinical trial were analyzed. The 6-Minute Walk Test (6MWT) and 10-Meter Walk Test (10MWT) were used to generate capacity metrics of walking endurance and fast gait speed, respectively. An activity monitor worn for seven days was used to generate performance metrics of mean daily steps and weekly moderate intensity walking minutes. Univariate linear regression analyses were used to examine associations between each capacity and performance measure in the full sample and less and more active subgroups.Walking capacity significantly contributed to daily steps in the full sample (endurance: RWalking capacity contributed to, but explained a relatively small portion of the variance in, real-world walking performance. The contribution was somewhat greater in less active individuals. The study adds support to the idea that clinically measured walking capacity may have limited benefit for understanding real-world walking performance in PD. Factors beyond walking capacity may better account for actual walking behavior.

Walking speed strongly correlates with health outcomes, making accurate assessment essential for clinical evaluations. However, assessments tend to be conducted over short distances, often in a laboratory or clinical setting, and may not capture natural walking behavior. To address this gap, the following questions are investigated in this work: Is walking speed significantly influenced by the continuity and duration of a walking bout? Can preferred walking speed be inferred by grouping walking bouts using duration and continuity?We collected two weeks of continuous data from fifteen healthy young adults using a thigh-worn accelerometer and a heart rate monitor. Walking strides were identified and grouped into walking periods. We quantified the duration and the continuity of each walking period. Continuity is used to parameterize changes in stepping rate related to pauses during a bout of walking. Finally, we analyzed the influence of duration and continuity on estimates of stride speed, and examined how the distribution of walking speed varies depending on different walking modes (defined by duration and continuity).We found that continuity and duration can be used to explain some of the variability in real-world walking speed (p0.001). Speeds estimated from long continuous walks with many strides (42% of all recorded strides) had the lowest standard deviation. Walking speed during these bouts was 1.41msWalking behavior in the real world is largely variable. Features of real-world walks, like duration and continuity, can be used to explain some of the variability observed in walking speed. As such, we recommend using long continuous walks to confidently isolate the preferred walking behavior of an individual.

To examine the effects of community-based resistance training (RT) on physical function for older adults with mobility disability.Four databases (PubM, PubMed, MEDLINE, Ovid, Cumulative Index to Nursing and Allied Health, Web of Science) were searched from inception to February 2, 2021.Randomized controlled trials that examined community-based RT for improving physical function in community-dwelling older adults were included.Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and risk of bias quality assessment.Twenty-four studies (3656 participants; age range, 63-83 years) were included. RT programs ranged from 10 weeks to 18 months in duration. RT was more effective than control in improving 6-minute walk test distance (n=638; mean difference [MD], 16.1m; 95% CI, 12.27-19.94; Plt;.0001), lower extremity strength (n=785; standardized MD, 2.01; 95% CI, 1.27-2.75; Plt;.0001), and usual gait speed (n= 2106; MD, 0.05 m/s, 95% CI, 0.03-0.07; Plt;.001). In sensitivity analyses, benefits were maintained when studies with a high risk of bias were excluded. There was no effect of RT on fast gait speed or Short Physical Performance Battery score compared with control.RT improves walking distance, lower extremity strength, and usual gait speed in older adults with mobility disability. Improvements in physical function could increase independence in activities of daily living for this at-risk population.

This study developed a five-year survival analysis to verify the relationship between the Short Physical Performance Battery (SPPB) and death in older adults residing in nursing homes (NHs). A total of 114 residents of NHs in Northeast Brazil participated in the follow-up. In addition to the SPPB, the older adults answered questions about sociodemographic and health condition information. The relationship between physical performance and mortality was evaluated using the Kaplan Meier survival curves and Cox proportional regression. As a result, 61.40% of the participants presented low performance and 41.22% died. Low physical performance increased the chance of death by 2.77 times in five years (adjusted Hazard Ratio 2.77; 95% CI 1.40-5.50; p0.01). Low SPPB Gait Speed Test also represented a 2.58-fold increased risk of dying (adjusted HR 2.58; 95% CI 1.38-4.83; p0.01). The results of this study showed that low physical performance can predict the mortality of older adults residing in NHs over five years.

Individuals with lower limb amputation exhibit lower residual limb strength compared to their sound limb. Deficits in residual limb knee flexion and extension strength may impact functional performance during tasks relevant to daily living.Does knee flexor and extensor strength in the residual limb impact functional outcome measures, such as walking energetics and performance metrics, in individuals with unilateral transtibial amputation?Fourteen individuals with traumatic unilateral transtibial amputation were recruited for this observational study. Participants completed metabolic testing at three standardized speeds based on leg length, as well maximum isokinetic knee flexion and extension strength for both residual and sound limbs. Participants also completed a series of functional outcome tests, including a two-minute walk test, timed stair ascent test, and four-square step test. Walking energetics (metabolic cost, heart rate, and rating of perceived exertion) and performance metrics were compared to percent deficit of residual limb to sound limb knee flexion and extension muscle strength. A linear regression assessed significant relationships (p 0.05).A significant relationship was observed between percent deficit of knee extension strength and heart rate (p = 0.024) at a fast walking speed. Additionally, percent deficit knee flexion strength related to rating of perceived exertion at slow and moderate walking speeds (p = 0.038, p = 0.024). Percent deficit knee extension strength related to two-minute walk time performance (p = 0.035) and percent deficit knee flexion strength related to timed stair ascent time (p = 0.025).These findings suggest the importance of strength retention of the residual limb knee flexion and extension musculature to improve certain functional outcomes in individuals with unilateral transtibial amputation.

To investigate the association between self-reported walking pace and type 2 diabetes (T2D) incidence and whether it differed by physical activity levels and walking time.There were 162,155 participants (mean age, 57.1 years; 54.9% women) from the UK Biobank prospective study, recruited between 2006 and 2010, included in the study. Walking pace was self-reported and classified as brisk, average, or slow. Total physical activity and walking time were self-reported using the International Physical Activity Questionnaire. Association between walking pace and T2D incidence and the potential moderating role of physical activity and walking time were investigated using Cox proportional hazards models.The median follow-up was 7.4 (interquartile range, 6.7 to 8.2) years. There were 4442 participants in whom T2D developed during the follow-up period. In the fully adjusted model (sociodemographic factors, diet, body mass index, and physical activity), average walking pace (hazard ratio [HR], 1.28; 95% CI, 1.14 to 1.44) and slow walking pace (HR, 1.91; 95% CI, 1.62 to 2.24) were associated with a higher T2D risk compared with brisk walking among women. Among men, average walking pace (HR, 1.28; 95% CI, 1.17 to 1.40) and slow walking pace (HR, 1.73; 95% CI, 1.50 to 1.99) were also associated with higher T2D risk. Compared with slow walkers, brisk walkers have the same diabetes incidence rate 18.6 and 16.0 years later, for women and men, respectively.Average and slow walking pace was associated with a higher risk of incident T2D in both men and women, independent of major confounding factors. The associations were consistent across different physical activity levels and walking time.

Harmonic ratios (HRs), recurrence quantification analysis in the antero-posterior direction (RQAThis study aimed to i) assess the internal and external responsiveness to rehabilitation of HR, RQAThe trunk acceleration patterns of 21 pwPD and 21 age- and speed-matched healthy subjects (HSmatched) were acquired during gait using an inertial measurement unit at baseline (T0). pwPD were also assessed after a 4-week rehabilitation period (T1). Each participant's HR in the antero-posterior (HRAt T1, HRWhen using inertial measurement units, HR

The maintenance of stability during walking is critical for successful locomotion. While targeted balance training can improve stability, it is unclear how simply meeting recommended physical activity guidelines may impact dynamic stability in healthy young adults.Examining the differences in the mediolateral margin of stability (ML-MOS) and the variability of the ML-MOS in physically active and inactive young adults across a range of stability-challenging walking tasks METHOD: Twenty-one physically active and twenty inactive young adults completed four experimental walking conditions: (1) Overground Walking, (2) Tandem Walking, (3) Beam Walking, and (4) Stepping-Stones. The ML-MOS and coefficient of variation of the ML-MOS were calculated at each heel strike while participants walked at their preferred walking speed. A two-way mixed-effects ANOVA was conducted to examine the effects of group and condition and their interaction on ML-MOS and ML-MOS variability RESULTS: Neither the ML-MOS nor the variability of the ML-MOS was significantly different between physically active and physically inactive young adults during any experimental walking conditions. A significant main effect of the experimental walking condition was observed, with the ML-MOS decreasing from overground walking to the tandem and beam walking conditions. The ML-MOS also became more variable in the tandem, beam, and stepping-stones conditions than in overground gait.Physical activity status did not influence frontal plane dynamic balance in healthy young adults, even in stability-challenging environments. Conditions that constrain step width, such as tandem and beam walking, are adequate for challenging frontal plane dynamic balance and indicate that trunk kinematics may be adjusted when step width is constrained.

Knee extensor (KE) weakness is commonly exhibited in individuals with knee osteoarthritis (KOA) and may contribute to disability due an increased muscle functional demand and resulting compensatory gait strategies during locomotion. Muscle functional demand is defined as the percentage of maximal strength that is used during a task.The study aim was to quantify KE functional demand in KOA, the impact of walking speed and the relationships with the relative joint contribution to total limb work.Fourteen individuals with symptomatic KOA underwent gait analysis at preferred and faster speeds and isokinetic dynamometry for KE maximum voluntary isometric torque. The KE functional demand as well as the relative and peak joint work and powers were calculated. Paired samples t-test was used to compare functional demand and relative work between speeds and Pearson's correlation was used to assess the relationship between relative work and functional demand values (α = 0.05).The KE functional demand was 36.0 ± 15.7 % for the preferred speed and significantly higher at 49.8 ± 16.1 % for the faster speed, (t(13) = -5.45, p .05). Knee flexion moment was also significantly higher for the faster speed (t(13) = -5.54, p .001). There were significant relationships between fast speed functional demand and relative ankle negative power (r = -0.57) and relative ankle positive work (r = 0.66), (all p .05).The results suggest that as functional demand nears or exceeds 50 % of the muscle capacity individuals with KOA reduce the relative effort at the knee and use an ankle-based compensation strategy to meet task demands.

Background Variability in gait speed is influenced by age and health status. However, no study has investigated the effects of different instructions on gait speed. Research question This study investigated how walking prompts contributed to variability in gait speed. Methods Participants walked on a pressurized walkway. Gait speed variability was assessed using multilevel modeling. Results 61% of the variance in gait speed was due to instruction, while 14% was due to individual differences. Significance Reference values for gait speed across a number of prompts will be highly useful for assessing gait performance in young adults. Further, the instruction given produces a large amount of variability in selected walking speed. This finding urges researchers to maintain consistency when delivering walking instructions.

OBJECTIVES To determine the accuracy of the 5-time stand-to-sit (5TSTS) test for the identification of older adults with reduced gait speed. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 559 community-dwelling older adults were included in the study, divided into groups of women (n=465) and men (n=94). METHODS 5TSTS and gait speed were assessed. Multiple linear regression analysis with adjustment was performed in order to determine the association between 5TSTS and gait speed, followed by the receiver operating characteristic (ROC) curve for the identification of the usefulness of 5TSTS to discriminate older adults with reduced gait speed. Based on the ROC curve, we identified the area under the curve, the sensitivity, specificity, and cutoff points of the 5TSST. Statistical analyses were made using the SPSS software (version 25.0), and a significance level of 5% (P ≤ .05) was adopted. RESULTS The 5TSTS showed correlation with gait speed. Additionally, 5TSTS was able to discriminate reduced gait speed with moderate accuracy (P < .05; AUC between 0.7 and 0.8). For women, the cutoff scores for 5TSTS to identify gait speed

Background Previous studies have compared the functional roles of the individual lower-limb muscles when healthy young and older adults walk at their self-selected speeds. No age-group differences were observed in ankle muscle forces and ankle muscle contributions to support and progression. However, older adults displayed higher gluteus maximus (hip extensor) muscle forces and greater contributions to support during early stance. There are no data that describe the functions of the individual lower-limb muscles in healthy older adults for walking at speeds other than the self-selected speed. Research question How does walking speed affect the functional roles of the individual lower-limb muscles in healthy older adults? Methods Three-dimensional gait data were recorded for 10 healthy young and 10 healthy older adults walking at slow, normal, and fast speeds (0.7 m/s, 1.4 m/s, and 1.7 m/s, respectively). Both groups walked at the same speed at each condition. The experimental data were combined with a full-body musculoskeletal model to calculate and compare muscle forces and muscle contributions to the vertical, fore-aft, and mediolateral ground reaction forces (support, progression, and balance, respectively) in both groups. Results Lower-limb muscle function was similar in young and older adults when both groups walked at the same speed at each condition. The same five muscles - gluteus maximus, gluteus medius, vasti, gastrocnemius, and soleus – contributed most significantly to support, progression, and balance in both groups at all speeds. However, gluteus maximus generated greater support and braking forces during early stance and gastrocnemius contributed less to forward propulsion during late stance at all speeds in the older group. Significance These results provide further insight into the functional roles of the individual lower-limb muscles of older adults during walking and could inform the design of exercise programs aimed at improving support and balance in those at risk of falling.

An increased risk of slow gait speed (GS) has been reported among older adults with decreased muscle strength, coupled with a concomitant increase in body fat known as dynapenic obesity (DO); however, these two conditions together have rarely been studied. The objective of this study was to determine the association between GS and DO in older Mexican ambulatory adults. A cross-sectional study was conducted; body fat percentage, and muscle strength and GS using EWGSOP criteria, were measured in 126 older ambulatory Mexican adults, with a mean age of 71 years old. The association was evaluated using controlled logistic regression models. Among ambulatory older adults with slow GS, the risk of DO was 3.4 times higher than among those without, controlling for age and sex (p0.01). In conclusion, slow GS in ambulatory older adults can be a useful indicator for the early identification of DO.

Older adults with sarcopenic obesity have a higher risk of experiencing mobility difficulty. Additionally, sarcopenia and obesity are closely associated with knee osteoarthritis. This study investigated the associations of sarcopenia, obesity, and in combination of both with walking disability during postoperative rehabilitation in older adults with knee osteoarthritis who underwent total knee replacement.A retrospective cohort study.From a rehabilitation center database, we retrospectively selected and investigated 482 older patients with knee osteoarthritis who had undergone total knee replacement and received postoperative rehabilitation.Sarcopenia was identified in accordance with the diagnostic criteria established by the Asian Working Group for Sarcopenia and obesity was defined as body mass index ≥ 30 kg/mCompared with the reference group, the sarcopenic, obese, and sarcopenic obese groups appeared to have a higher probability of experiencing postoperative walking disability (all P.001). The sarcopenic obese group were likely to have the highest risk of experiencing postoperative walking disability (adjusted hazard ratio = 3.89).Sarcopenia or obesity alone may independently exert negative effects on postoperative gait speed. The participants with sarcopenic obesity were likely to have the highest risk of experiencing walking disability following total knee replacement. The findings may serve as a reference for clinicians developing rehabilitation strategies to optimize walking ability after total knee replacement, especially those preoperatively diagnosed as having sarcopenic obesity.

To determine phenotypic differences between Black and White patients with Parkinson's disease (PD).Patients with PD in a movement disorders clinic were approached to participate. After consent, a battery of tests was completed, including MDS-UPDRS Part III and the motor domains of the NIH Toolbox, Montreal Cognitive Assessment, Single Digit Modality Test, Patient-Reported Outcomes Measurement Information System (PROMIS) measures, Parkinson's Disease Questionnaire (PDQ39), Schwab and England, Epworth Sleepiness Scale, UPSIT smell test, and others.Twenty-four Black PD and 25 White PD patients participated. There were no differences in demographics and MDS-UPDRS Part III scores. White PD participants performed better on the 4-m walk gait speed test (p 0.0005), standing balance test (p 0.001), Montreal Cognitive Assessment (p 0.0005), and Single Digit Modality Test (p 0.005). Black PD participants had lower scores on PROMIS Satisfaction with Participation (p = 0.023), PROMIS Physical Function Mobility (p = 0.007), total PDQ39 (p = 0.008), PDQ39 mobility (p = 0.012), PDQ39 ADL (p = 0.014), PDQ39 cognition (p = 0.023), and PDQ39 body discomfort (p = 0.041) scales.Significant differences were found in motor, non-motor and quality of life scales in Black and White PD participants with similar demographics. Further work will need to be done to identify the underlying reasons and ways to mitigate these disparities.

BACKGROUND: Treadmills provide a safe and convenient way to study the gait of people with Parkinson’s disease (PD), but outcome measures derived from treadmill gait may differ from overground walking. OBJECTIVE: To investigate how the relationships between gait metrics and walking speed vary between overground and treadmill walking in people with PD and healthy controls. METHODS: We compared 29 healthy controls to 27 people with PD in the OFF-medication state. Subjects first walked overground on an instrumented gait walkway, then on an instrumented treadmill at 85, 100 and 115% of their overground walking speed. Average stride length and cadence were computed for each subject in both overground and treadmill walking. RESULTS: Stride length and cadence both differed between overground and treadmill walking. Regressions of stride length and cadence on gait speed showed a log-log relationship for both overground and treadmill gait in both PD and control groups. The difference between the PD and control groups during overground gait was maintained for treadmill gait, not only when treadmill speed matched overground speed, but also with ±15% variation in treadmill speed from that value. SIGNIFICANCE: These results show that the impact of PD on stride length and cadence and their relationship to gait speed is preserved in treadmill as compared to overground walking. We conclude that a treadmill protocol is suitable for laboratory use in studies of PD gait therapeutics.

Human gait is a complex task resulting from the interaction of sensory perception, muscle force output, and sensory-motor integration, which declines with the aging process and impacts gait speed in older women.What are the separate and combined impacts of sensory-motor factors on gait speed of older women?Sixty healthy older women (69.3 ± 5.9 years) volunteered for this study. A previous screening using Pearson's correlation selected variables significantly correlated with gait speed: age, plantar tactile perception, lower limb explosive force, and mean velocity (MV) of the center of pressure (CoP). Simple and multivariate regression models were performed with selected variables. The magnitude of evidence was obtained using Bayesian inference, determining posterior probabilities based on our data.Gait speed was negatively correlated with age and positively correlated with plantar tactile perception, MV (Romberg index), and lower limb explosive force. The coefficient of determination (RAge, plantar tactile perception, MV (Romberg index), and lower limb explosive force impact gait speed, whereas the combination of the first three factors has an excellent posterior probability of predicting or affecting gait speed.

Children born very preterm ( 32 weeks' gestation) are at greater risk of motor impairment and executive/attentional dysfunctions than term-born children; however, little is known about how functional tasks, including walking, may be affected by very preterm birth.How does the gait pattern of preschool-age children born 30 weeks compare with term-born controls under a variety of walking conditions?In this prospective cohort study, children born 30 weeks and at term were assessed at 4.5-5 years' corrected age, blinded to birth group. Four walking conditions were assessed using the GAITRite® system: preferred speed, cognitive dual-task, motor dual-task, and tandem walking. Gait variables analysed included speed, cadence, step length, step time, base of support (BOS), and single and double support time. Spatiotemporal variables were compared between groups using linear regression, adjusting for lower-limb length, corrected age at assessment, and number of trials.224 children (112 30 weeks and 112 term-born) were assessed. Gait variables of children born 30 weeks did not differ from their term-born peers when walking at their preferred speed, except for higher BOS variability (mean difference [MD] = 0.19 cm, 95% confidence interval [CI] 0.10, 0.27, p 0.001). Under the motor dual-task condition, children born 30 weeks walked faster (MD= 3.06 cm/s, 95% CI 0.14, 5.97, p = 0.040), with a longer step length (MD= 1.10 cm, 95%CI 0.19, 2.01, p = 0.018), and a wider BOS (MD= 0.37 cm, 95%CI 0.06, 0.67, p = 0.019). In cognitive dual-task and tandem conditions, children born 30 weeks walked with a wider BOS compared with term-born peers (MD= 0.43 cm, 95%CI 0.05, 0.81, p = 0.028; and MD= 0.30 cm, 95%CI 0.09, 0.51, p = 0.005, respectively).This research highlights the need to consider the walking performance of preschool-age children born 30 weeks under challenging conditions, such as dual-task or tandem walking, when assessing gait patterns and planning interventions.

Background Difficulty in activities of daily living (ADL) is common in patients with cardiovascular disease (CVD) and is associated with mortality. Objectives The relationship between gait speed/6-minute walking distance (6MWD) and difficulties in ADL in patients with CVD was explored. Methods The study population consisted of 447 patients with CVD for whom data on gait speed, 6MWD, and difficulty in ADL during outpatient rehabilitation were available. Relationships of gait speed/6MWD and difficulty in ADL were examined using propensity-adjusted logistic regression analysis. Results Both gait speed and 6MWD were significantly related to difficulty in ADL, and the areas under the curves were large. The cutoff values ranged from 0.93 to 1.30 m/s for gait speed and 370 to 500 m for 6MWD, from basic ADL to vigorous activities. Conclusions Both gait speed and 6MWD were used for the estimation of difficulty in ADL in patients with CVD. Gait speed can be measured easily and therefore could be incorporated in busy clinical practice to identify patients at risk for functional decline.

Background The freezing episode (FE) management during gait in Parkinson's disease is inefficient with current medications, neurosurgery, and physical interventions. Knowing the biomechanical change patients suffer preceding FE would be the ultimate goal to measure, predict, and prevent these events. Objective We performed a systematic review to summarize the kinematic, kinetic, electromyographic, and spatio-temporal characteristics of the events that precede the FE during gait in Parkinson's disease. Literature Survey Databases searched included PubMed, Embase, and Cochrane and between 2001 to August 2021. Methodology The present study was a systematic review registered in the PROSPERO database (CRD42021255082). Three reviewers searched and selected studies with methodologies involving biomechanical changes and kinetic, kinematic, electromyography, and spatiotemporal changes before FE in a patient with Parkinson's disease. The relevant articles that show the events preceding FE in patients with PD were identified. We excluded studies that describe or compare methods or algorithms to detect FE. Studies may include participants with all PD severity, time of disease, and age. Synthesis We selected ten articles for final evaluation. The most consistent results indicate a dramatic reduction of movement excursions with (1) decrease in stride length; (2) decreased gait speed; (3) postural instability with the increased double support phase; (4) incoordination of anterior tibial and gastrocnemius; (5) larger amplitude in the EMG of biceps femoris; (6) decreased range of motion in the sagittal plane at the ankle and hip joints; and (7) anterior pelvic tilt. Conclusion FE is characterized by complex motor patterns than normal gait and mismatched gains in the perception and execution of the ongoing movement.

Motor-cognitive intervention concepts are promising to counteract residual gait and cognitive impairments in chronic stroke. There is, however, considerable variation in motor-cognitive intervention types, which may lead to different effects. This systematic review strived to summarize and compare the effects of different motor-cognitive intervention concepts on gait and cognitive functions in chronic stroke. The systematic search identified twenty-nine articles, which were allocated to three types of motor-cognitive training concepts; SEQUENTIAL, SIMULTANEOUS-ADDITIONAL, and SIMULTANEOUS-INCORPORATED. Random-effects meta-analyses revealed that motor-cognitive interventions may be better than non-combined training approaches for improving gait function in chronic stroke (e.g. gait speed: g = 0.43, 95 % CI [0.22, 0.64], p < 0.0001). SIMULTANEOUS-INCORPORATED motor-cognitive training seems the most promising concept. As very few articles measured both, spatiotemporal gait parameters and cognitive outcomes, future studies are warranted to investigate the effects of motor-cognitive intervention concepts on gait control and cognitive functions in chronic stroke., Neuroscience & Biobehavioral Reviews, 132, ISSN:0149-7634, ISSN:1873-7528

Gait speed is recognized to correlate to knee kinematic alterations. Clinically, patients with knee diseases tend to walk slowly compared to healthy controls. Hence, gait speed may serve as a confounding factor in the kinematic characteristics of patients during gait compared to healthy controls.Whether and how gait speed affects six degrees of freedom (6DOF) knee kinematics remains unclear. The current study was designed to explore whether and how decreased gait speeds affect 6DOF knee kinematics.Thirty subjects (15 males and 15 females) were recruited for this study. A three-dimensional gait analysis system was used to assess the 6DOF knee kinematics of subjects at gait speeds of 4.0 km/h, 3.5 km/h, 3.0 km/h, 2.5 km/h, 2.0 km/h, 1.5 km/h, and 1.0 km/h. Kinematics of gait cycle (GC) were assessed at all gait speed levels.Decreased adduction angle (0.5-3.2 °, p0.05), increased external rotation (0.6-3.3 °, p0.05) and decreased flexion angle (1.5-17.4 °, p0.05) were found during most GC as gait speed level decreased. Greater anterior tibial translation (0.9-2.6 mm, p0.05), greater proximal translation (0.4-2.4 mm, p0.05) and decreased lateral tibial translation (0.5-3.0 mm, p0.05) were found during most GC as gait speed level decreased. Gender was also found to have great effects on 6DOF knee kinematics (p0.05). Interactions between gender and gait speed were also found (p0.05).Our findings suggest that additional attention should be paid when dealing with kinematic comparisons of GC between controls and patients with significantly different gait speeds or genders than controls. Kinematic alterations induced by gait speed may raise concern for patients with knee diseases who struggle to walk faster than their normal speed. This may enhance our knowledge of the relationship between gait speed and 6DOF knee kinematics.

Background: The Gait Profile Score (GPS) provides a composite measure of the quality of joint movement during walking, but the relationship between this measure and metabolic cost, temporal (e.g. walking speed) and spatial (e.g. stride length) parameters in stroke survivors has not been reported. Research Question: The aims of this study were to compare the GPS (paretic, non-paretic, and overall score) of young stroke survivors to the healthy able-bodied control and determine the relationship between the GPS and metabolic cost, temporal (walking speed, stance time asymmetry) and spatial (stride length, stride width, step length asymmetry) parameters in young stroke survivors to understand whether the quality of walking affects walking performance in stroke survivors. Methods: Thirty-nine young stroke survivors aged between 18 and 65years and 15 healthy age-matched able-bodied controls were recruited from six hospital sites in Wales, UK. Joint range of motion at the pelvis, hip, knee and ankle, and temporal and spatial parameters were measured during walking on level ground at self-selected speed with calculation of the Gait Variable Score and then the GPS. Results: GPS for the paretic leg (9.40° (8.60–10.21) p < 0.001), non-paretic leg (11.42° (10.20–12.63) p < 0.001) and overall score (11.18° (10.26–12.09) p < 0.001)) for stroke survivors were significantly higher than the control (4.25° (3.40–5.10), 5.92° (5.11 (6.73)). All parameters with the exception of step length symmetry ratio correlated moderate to highly with the GPS for the paretic, non-paretic, and/or overall score (ρ =

We aimed to investigate a causal effect of functional sarcopenia status, including poor handgrip strength and slow walking pace, on cardiovascular diseases. This study was an observational cohort study including observational analysis and Mendelian randomization. We studied the UK Biobank prospective cohort (n = 324,486) for observational analysis with poor handgrip strength or self-reported slow walking pace as the exposures, investigating risk of myocardial infarction or mortality. Genetic instruments for the exposures were developed in 337,138 individuals of white British ancestries, and coronary artery disease outcome (60,801 cases/123,504 controls) from the independent CARDIoGRAMplustC4D cohort was studied by two-sample Mendelian randomization. The findings were replicated by one-sample analysis by polygenic risk score analysis within the UK Biobank. Both slow walking pace and poor handgrip strength were significantly associated with higher risks of incident myocardial infarction and mortality, particularly from cardiovascular deaths, in the observational investigation. Genetically predicted poor handgrip strength (odds ratio: 1.128 [1.041 to 1.222]) and slow walking pace (odds ratio: 1.171 [1.022 to 1.342]) showed causal effects on the coronary artery disease risks in the independent cohort. The results were again identified by the one-sample Mendelian randomization, as the higher polygenic risk score for poor handgrip strength and slow walking pace was associated with a higher risk of mortality. In conclusion, this study supports the causal effects of slow walking pace and poor handgrip strength on the risks of cardiovascular disease and mortality. The functional sarcopenia status are targetable causative factors for interventions aiming to reduce risks of cardiovascular disease or mortality.

Risk of pedestrian-vehicle crashes increased with distraction of pedestrians at roadway crossings. Aims of the study included analysing distracted pedestrian crossing behavior, identifying factors that influence pedestrian crossing speed at a midblock crosswalk, and determining the influence of road cross-section (RCS) on pedestrian walking speed. Three cities in Oregon State in the USA were included in the study: Corvallis, Albany, and Eugene. A combination of digital video and researcher field notes were used to obtain the data at each site. A total of 1045 pedestrian crossings from 23 midblock crossings were observed and analysed to determine the association of distraction type, road cross-section, and other in situ factors with pedestrian walking speed. Data analysis was conducted in two stages. First, the effect of each distraction type (looking at a handheld device, talking on a cell phone, wearing headphones, walking in a pair, walking in a group, and other distractions) on the pedestrian walking speed was examined. The results showed that average walking speed was 4.8 ft./s (1.46 m/s). Pedestrians walking with headphones crossed more quickly (0.91 ft./s) (0.28 m/s) than those with no distractions (5.14 ft./s) (1.57 m/s). In addition, talking on a cell phone was not significantly correlated with walking speed. Moreover, the other four distraction types were associated with decreasing the walking speed by 0.29 ft./s (0.09 m/s) to 0.83 ft./s (0.25 m/s). Second, the influence of pedestrian distraction, crosswalk configuration, land use, compliance rate, and pedestrian demographics on the pedestrian walking speed were examined in this study. Findings indicated that distracted pedestrian in two road cross-sections would require more crossing time than an elderly pedestrian. Pedestrian safety is a key concern in transportation research, and improved understanding of the factors contributing to pedestrian fatalities could enable safer roadways to be designed.

Background To be able to use muscluloskeletal models in clinical settings, it is important to understand the effect of walking speed on joint and muscle force estimations in different generic musculoskeletal models. Research question The aim of the current study is to compare estimated joint and muscle forces as a function of walking speed between two standard approaches offered in two different modelling environments (AnyBody and OpenSim). Methods Experimental data of 10 healthy participants were recorded at three different walking speeds (self-selected, 25 % slower, 25 % faster) using a ten-camera motion capture system together with four force plates embedded into a ten-meter walkway. Joint compression forces and muscle forces were calculated with a generic model in AnyBody and OpenSim. Trend analyses, mean absolute error (MAE) and correlation coefficients were used to compare joint compression forces and muscle forces between the two approaches. A one-way and two-way ANOVA with repeated measures were used to compare MAE and trend analysis changes, respectively (α = 0.05, Bonferroni corrected post-hoc tests). Results Trend analyses showed the same speed effect for AnyBody and OpenSim. MAEs increased significantly from slow to fast walking for knee joint compression forces, biceps femoris long head, gluteus maximus, gluteus medius and vastus intermedius. Lower correlation coefficients during slower walking were found for quadriceps muscles, gluteus maximus and biceps femoris compared to normal and faster walking. Significance Lower correlation coefficients during slower walking are assumed to be due to a higher amount of solutions solving the muscle recruitment in musculoskeletal models. This indicates that decreasing walking speed is more prone to speed dependent differences regarding variability, while the absolute error increased with increasing walking speed. To conclude, different modelling environments can react differently to changes in walking speed, but overall results are promising regarding the generalization across different generic musculoskeletal models.

Background Despite strong evidence that walking speed and forward propulsion decline with increasing age, their relationship is still poorly understood. While changes in the ankle and hip mechanics have been described, few studies have reported the effect of ageing on the whole leg’s contribution to propulsion. Research question The aim of this study was to investigate age-related changes in the work performed by the leg on the center of mass (COM) push-off power during walking in adults aged 20–86 years. Specifically, we evaluated how deterioration in COM push-off power relates to changes in ankle and hip kinetics as well as age and walking speed. Methods Motion, ground reaction forces and gastrocnemius muscle activity were recorded in 138 adults during overground walking at self-selected speed. Age-related differences in variables between decades were analyzed with an ANOVA, while the relation between COM push-off power and joint kinetic variables, as well as walking speed and biological age, was evaluated using correlations and multiple regression analysis. Results From the age of 70 years and onwards, COM push-off power was significantly decreased. The decline in COM push-off power was mostly explained by a decline in average ankle push-off power (72 %), and to a lesser extent by peak hip extension moment (3 %). There was no re-distribution of ankle-to-hip push-off power. The decline in COM push-off power seemed more related to walking speed (explaining 54 % of the variance) than biological age (only 4 %). Significance Findings indicate that age-related decline in COM push-off power in able-bodied adults starts from the age of 70 years, which is before changes have been found in kinematics, but still later than generally presumed. This decrease in push-off power was more related to walking speed than biological age, which emphasizes the need to better understand the reason for speed decline in older adults.

Background Investigating cognitive-motor interference on the treadmill allows for better examination of motor adaptation to the dual-task challenges through the information of continuous strides. However, one of the major critiques for conducting dual-task investigation on a treadmill is the use of a constant, fixed walking speed, constraining the natural fluctuations of the speed of human walking, which could be addressed by using the self-paced feature of a feedback-controlled treadmill. Research question Do people use different adaptation and task prioritization strategies during the dual-task treadmill walking at self-paced versus fixed speeds? Methods Eighteen healthy younger participants walked on an instrumented treadmill (1) under two speed conditions: self-paced and fixed-speed, and (2) with and without each of the four different cognitive tasks. Dynamic margins of stability (MOS), step spatiotemporal measures, kinematic variability, and local dynamic stability were computed for each trial. Results Participants had significantly more local instability during self-paced than fixed-speed treadmill walking. The often-reported response of reducing stride time variability during dual-task, fixed-speed walking was not observed during dual-task, self-paced walking. In addition, there were significantly greater dual-task interference effects on stride time variability and local dynamic stability as well as the Paced Auditory Serial Addition Test performance during self-paced walking. Reduced variability in the lower-extremity joint angles, trunk motion and position, and MOS measures were observed both in dual-task, self-paced and fixed-speed walking. Significance Healthy younger adults had different task prioritization and greater dual-task effects on gait stability and cognitive performance during self-paced versus fixed-speed walking. However, similar adaptation strategies, in terms of gait adjustments, were used for the two walking conditions. The results suggest that self-paced treadmill walking is more challenging than the fixed-speed walking and can serve as a better alternative to the overground walking than the fixed-speed walking for the dual-task investigation.

Background Rhythmic Auditory Stimulation (RAS) involves synchronizing footsteps to music or a metronome to improve gait speed and stability in patients with neurological disorders, such as Parkinson’s disease. However, responses to RAS vary across individuals, perhaps because of differences in enjoyment of the music or in musical abilities. Research question Intuitively, musical enjoyment may influence gait responses to RAS, but enjoyment has not been systematically manipulated nor the effects empirically assessed. In addition, differences in beat perception ability are likely to influence gait responses to music, particularly when synchronizing to the beat. Therefore, we asked: how does music enjoyment alter gait, and do gait parameters differ between individuals with good versus poor beat perception ability, specifically when instructed to ‘walk freely’ versus ‘synchronize to the beat’? Method Young adults and older adults walked on a pressure sensor walkway in silence and to music that they had rated as either high or low in enjoyment, as well as a metronome. All stimuli were presented at 15 % faster than baseline cadence. Participants either walked freely to the music or synchronized to the beat. Results Music enjoyment had no significant effects on gait in either younger or older adults. Compared to baseline, younger adults walked faster (by taking longer strides) to music than the metronome, whereas older adults walked faster (by taking more steps per minute) to the metronome than music. When instructed to synchronize vs. walk freely, young adults walked faster, but older adults walked slower. Finally, regardless of instruction type, young adults with poor beat perception took shorter and slower strides to the music, whereas older adults with poor beat perception took slower strides to the music. Significance Beat perception ability, instruction type, and age affect gait more than music enjoyment does, and thus should be considered when optimizing RAS outcomes.

Increasing data suggests that chronic low-grade inflammation plays an important role on development of sarcopenia. The present study was designed to identify the association between fibrinogen, fibrin degradation products (FDP) and sarcopenia risk in hospitalized old patients.A total of 437 patients were enrolled in this cross-sectional study (148 with sarcopenia and 289 without sarcopenia). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Body composition, grip strength and gait speed were performed to participants. Fibrinogen, FDP levels were measured. Logistic regression analyses were carried out to assess the association between fibrinogen and sarcopenia, between FDP and sarcopenia, respectively.Compared to non-sarcopenic patients, fibrinogen and FDP levels were found to be higher in the sarcopenic group (3.07 g/L vs 2.79 g/L, 1.75 μg/mL vs 1.00 μg/mL, respectively, p 0.05). Multiple linear regression analysis showed a significant negative association between fibrinogen and gait speed (β: -0.164, p = 0.008), and muscle strength (β: -0.231, p 0.001). Multivariable logistic regression analysis showed that fibrinogen and FDP were independently associated with sarcopenia (odds ratio 1.32 [95% confidence interval 1.03, 1.70], p = 0.009; odds ratio 1.07 [95% confidence interval 1.01, 1.19], p = 0.049, respectively). ROC curve revealed that the cutoff values of fibrinogen and FDP to predict sarcopenia risk were 2.54 g/L and 1.15 μg/mL, respectively.In hospitalized old patients, serum fibrinogen and FDP levels are elevated in sarcopenia patients than those without sarcopenia. Fibrinogen and FDP are associated with sarcopenia in a concentration-dependent manner.

Background The 400-meter walk test (400MWT) is used to assess cardiovascular and pulmonary fitness or to predict adverse outcomes such as mobility disability. Additionally, short tests of walking such as the 4- or 8-meter walk test are administered to predict mortality, falls and other events. It remains uncertain if and how an integrated measurement of a short distance during 400MWT can replace an additional short distance measurement which would be clinically useful. Research question How do short distance (i.e. segment) measurements of gait speed and walk ratio during a 400MWT of mobility compare to those from an additional 8-meter walk test? Methods A 400MWT and a separate 8-meter walk test were performed by 148 community-dwelling older adults (mean age 80.4 ± 4.4 years) using an instrumented walkway. Results Gait speed and walk ratio (i.e. step length divided by step frequency) of single segments of the 400MWT were strongly associated with gait speed (r ≥ 0.91) and walk ratio (r ≥ 0.93) of an 8-meter walk test with best agreement in the middle part 20-meter walk during the 400MWT. Mean gait speed of all single walks on the instrumented walkway during the 400MWT was faster than the mean gait speed of the total 400MWT. Significance A single walk of the 6th to 10th 20-meter walk during the 400MWT can be used as a substitute to an additional short distance trial. Furthermore, the awareness of being measured is higher on an instrumented walkway and possibly increases the motivation to overperform.

Background Due to the high infectivity and seriousness of coronavirus disease, people’s daily activities were restricted in countries worldwide; governments implemented lockdown measures and advised individuals to perform self-restraint in terms of leaving the house. However, there have been few scientific reports on the effects of such behavioral restrictions on walking parameters. Research question Did behavioral restrictions during the state of emergency in Japan effect walking parameters in daily life outdoor walking? Methods In this retrospective cohort study, four walking parameters, namely, the average number of steps taken, walking speed, step length, and cadence, were measured using a smartphone application among 3901 participants (mean age ± standard deviation: 60.3 ± 28.9 years) from March 2 to June 15 in both 2019 and 2020. Repeated-measures two-way analysis of variance was used to compare the walking parameters between the two years. Results The number of steps significantly decreased (p

Background Enhancing propulsion during walking is often a focus in physical therapy for those with impaired gait. However, there is no consensus in the literature for assessing braking and propulsion. Both are typically measured from the anterior-posterior ground reaction force (AP-GRF). While normalization of AP-GRF force by bodyweight is commonly done in the analysis, different methods for AP-GRF time axis normalization are used. Research question Does walking speed affect propulsion and/or braking, and how do different methods for calculating propulsion and braking impact the conclusion, in both healthy adults and those with lower limb impairment? Methods We investigated three different analysis methods for assessing propulsion. 1. BW-TimeIntegration: Bodyweight (BW) normalized time integration of AP-GRF (units of BW s). 2. BW-%StanceIntegration: BW normalized AP-GRF is resampled to percent stance phase prior to integration (units of BW %Stance). 3. BW-Peak: BW normalized peak force (units of BW). We applied these methods to two data sets. One data set included AP-GRFs from trials of slow, self-selected, and fast walking speeds for 203 healthy controls (HCs); a second data set included subjects with lower limb orthopedic injuries. Results Using the BW-TimeIntegration method, we found no effect of walking speed on propulsion for HCs. Time integration over the longer stance phase of slower walking balanced the lower magnitude AP-GRFs of slower walking, resulting in a time-integrated impulse that was the same regardless of walking speed. In contrast, the other two methods that are not time integration methods found that propulsion increased with walking speed. Similarly, in the gait pathology data set, differences in results were found depending on the analysis method used. Significance For many gait studies concerning propulsion and/or braking, the impulse measure used should be related to the body’s change of momentum, necessitating an analysis method with a time integration of the AP-GRF.

Measuring daily physical activity and exercise capacity is recommended in the routine care of patients with chronic obstructive pulmonary disease (COPD). The 4-m gait speed (4mGS) is simple and effective in stratifying patients according to exercise performance, dyspnea, health status, and prognosis. We assessed the reliability of the 4mGS as a clinical marker by examining its association with established clinical indicators among hospitalized patients with COPD.This retrospective study included 78 patients hospitalized with COPD (mean age: 76.3 ± 0.9 years; males, n = 69) between January 2016 and June 2018 who were assessed using the 4mGS and divided into slow (0.8 m/s) and normal (≥0.8 m/s) 4mGS groups. Clinical characteristics were compared, including death during the observation period, time to first exacerbation, and long-term oxygen therapy requirement.There were strong relationships between 4mGS performance, the 6-min walk test (R = 0.70; p 0.0001), and the modified Medical Research Council dyspnea scale (R = 0.68; p 0.0001) among the 78 patients. The slow 4mGS group had a higher frequency of death during the observation period (p = 0.0095) and a greater requirement for long-term oxygen therapy (p = 0.0063). The 4mGS correlated with inspiratory capacity (IC) and IC/total lung capacity ratios, which are respiratory failure indicators.The 4mGS is a simple and easy method of assessing the physical condition as well as estimating the prognosis of patients with COPD, and may serve as a useful marker in home medical treatment or clinical settings.

Background The measurement of step count and distance covered are of interest in healthcare and rehabilitation medicine, so fitness trackers and smartwatches have incorporated these metrics. In 2014, the introduction of new brands of these devices peaked, although the highest number of new devices was introduced in 2015. Even though Mi Band Xiaomi was among the top 5 regarding sales, it is not at the top of the fitness bands considered in research articles. Research question this study aimed to assess the validity of Xiaomi Mi Band 2.0, 3.0 and 4.0 for recording steps and distance covered. Method The data were recorded from 26 elderly adults (71.2 ± 3.2 years old; 169.3 ± 5.8 height; 72.1 ± 9.2 weight), who covered the maximum distance possible at walking speed in a delimited outdoor space following different trajectories to compare data with the criterion measure, using three wristband devices (Xiaomi Mi Band versions 2.0, 3.0. and 4.0.). Results In step count, the average bias was small ( 0.76; t=0.30). However, Xiaomi Mi Band 4.0 obtained questionable validity (ICC = 0.76) for distance estimation. Significance The accuracy of Mi Band Xiaomi 2.0., 3.0. and 4.0. may be considered as good to count the number of steps for physical activity monitoring, whereas distance estimation is considered questionable.

Both gait speed and gait endurance directly impact independence and community engagement for individuals with Parkinson's disease (PD). However, factors accounting for variability in gait speed and gait endurance performance are unclear. The purpose of this study was to investigate whether key factors associated with gait speed in individuals with PD also predicted gait endurance.Community dwelling ambulatory individuals with PD were recruited for a single session. Key measures included 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) and key factors: age, disease severity [Movement Disorders Society United Parkinson's Disease Rating Scale (motor scale only) (MDS-UPDRS motor)], plantar flexor strength [Calf Raise Senior (CRS)], fatigue [Fatigue Severity Scale (FSS)], cognition [Montreal Cognitive Assessment (MoCA)], and balance [Four Square Step Test (FSST)]. Multiple linear regression analyses were conducted to determine clinical relationships.Seventy-two individuals with PD (mean (standard deviation) (age = 70.83 (7.91) years; 50 males; MDS-UPDRS motor = 30.67 (13.50)) completed all assessments. The model predicting gait speed was significant, F(6, 65) = 15.143, p.001, accounting for 54 % of the variance. Of the predictor variables age, MDS-UPDRS motor, CRS, MoCA and FSST scores were significant predictors. The model predicting gait endurance was significant, F(6, 65) = 15.608, p.001, accounting for 55 % of the variance. Of the predictor variables, age, MDS-UPDRS motor scale, and CRS scores were significant predictors.Gait speed and gait endurance are similarly influenced by age, motor impairment, and plantarflexion strength. However, cognition and balance were predictors only of gait speed, which may suggest unique task differences exist between gait speed and gait endurance.

OBJECTIVE To study gait function among individuals with spina bifida (SB) aged 50 years or older. DESIGN A cross-sectional study conducted in 2017. SETTING Home-dwelling participants from all regions in Norway. PARTICIPANTS Individuals between the ages of 51 and 76 years (N=26; 16 women) categorized as independent walkers (n=9), walkers with aids (n=10) and nonwalkers (n=7). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Questionnaire, pain assessment, anthropometry, Falls Efficacy Scale International (FES-I), objective gait analysis, 6-minute walk test (6MWT), and timed Up and Go (TUG). RESULTS Walking speed correlated with SB severity (ρ=-.59; P=.008). Individuals who walked slower than 0.81 m/s had a higher body mass index (BMI) than those who walked faster (P=.008). Independent walkers walked slower than healthy age-matched walkers (P=.046); spatiotemporal variables showed that this was owing to shorter steps rather than cadence. The mean TUG was 10.6±2.6 seconds in independent walkers and 20.2±6.5 in walkers with aids (P

Background This study was performed to test the hypothesis that low quadriceps isometric strength (QIS) is associated with greater risk of mortality and has the additive prognostic significance to the severity of heart failure (HF) and gait speed in older patients with HF. Methods A retrospective cohort study was performed in 1273 patients ≥ 60 years of age with HF (mean age 75 ± 8 years, 59.1% men); all of whom were evaluated during hospitalization for usual gait speed and maximal QIS. The QIS was expressed relative to body mass (% BM). The endpoint was all-cause mortality. Results Over a median follow-up period of 1.59 years (interquartile range, 0.58 to 3.42 years), 224 patients died. The cutoff value based on the Youden index for the QIS discriminating those at high risk of mortality was 36.2% BM for overall, and we defined less than this cutoff point of QIS as low QIS. After adjustment for the HF risk score, the hazard ratio in low QIS was 1.55 for overall (95% confidence interval [CI], 1.17-2.06). The addition of low QIS to the HF risk score and gait speed was associated with significant increases in both net reclassification improvement (NRI, 0.239 for overall; 95% CI, 0.096-0.381) and integrated discrimination improvement (IDI, 0.004 for overall; 95% CI, 0.001-0.009) for all-cause mortality. Conclusion Low QIS was strongly associated with poor prognosis and showed complementary prognostic predictive capability to the HF risk score and gait speed in older patients with HF.

Background Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory arthritis that impacts biomechanical features of gait. This systematic review describes the effects of JIA on gait motion parameters and walking performance. Methods Six databases were searched (PubMed/Medline, Cochrane, the EBSCOHost database SPORTDiscus, Web of Science, and Embase). Studies were restricted to children with any subtype of JIA who were assessed for gait motion features (kinematic, kinetic, temporalspatial) or walking performance (velocity or distance covered); could include intervention or treatment exposure with measures of gait and gait speed; could involve comparison of gait in JIA to healthy controls. Quality of evidence was assessed using the GRADE system. This systematic review was registered at PROSPERO (CRD42018109582) Results The search yielded 625 papers, 23 of which described biomechanical features of gait and/or assessed walking performance. Twenty studies measured walking velocity and walking ability using simple field tests or laboratory methods. Eleven studies measured temporalspatial parameters such as cadence, step length, stride length, step width, single and double support time. Nine studies evaluated kinetic measurements including joint power, flexion and extension and joint moments. Nine studies evaluated kinematic parameters including range of motion, pelvic tilt, center of motion and trunk sway. Conclusions Key features of gait in children with JIA include slower gait velocity, shortened step length, decreased range of motion at the hip, knee and ankle with trend towards flexion, decreased joint power, anteriorly tilted pelvis and trunk with shifted center of motion. There is a potential to ameliorate JIA-related gait changes with exercise and/or pharmaceutical interventions.

Background Measuring gait function has become an essential tool in the assessment of mobility in aging populations for both, clinicians and researchers. A variety of systems exist that assess gait parameters such as gait cycle time, gait speed or duration of relative gait phases. Due to different measurement principles such as inertial or pressure sensors, accurate detection of spatiotemporal events may vary between systems. Research question To compare the absolute agreement and consistency in spatiotemporal gait parameters among five different clinical gait analysis systems using different sensor technologies. Methods We compared two devices using inertial sensors (GaitUp & Mobility Lab), two devices using pressure sensor systems (GAITRite & Zebris) as well as one optical system (OptoGait). Twelve older adults walked at self-selected speed through a walkway integrating all of the above systems. Basic spatiotemporal parameters (gait cycle time, cadence, gait speed and stride length) as well as measures of relative phase (stance phase, swing phase, double stance phase, single limb support) were extracted from all systems. We used Intraclass Correlation Coefficients as measures of agreement and consistency. Results High agreement and consistency between all systems was found for basic spatiotemporal parameters, whereas parameters of relative phase showed poorer agreement and consistency. Overground measurement (GAITRite & OptoGait) showed generally higher agreement with each other as compared to inertial sensor-based systems. Significance Our results indicate that accurate detection of both, the heel-strike and toe-off event are crucial for reliable results. Systematic errors in the detection of one or both events may only have a small impact on basic spatiotemporal outcomes as errors remain consistent from step to step. Relative phase parameters on the other hand may be affected to a much larger extent as these differences lead to a systematic increase or reduction of relative phase durations.

Walking at a brisk pace is widely recommended to promote health. When partners walk together, walking activity is increased and maintained due to enhanced social support and accountability, but at least one person must adjust their gait speed. Decreased gait speed could compromise health benefits, which may be especially relevant for the aging population.Do adults change gait speed when walking with their romantic partner, relative to walking alone, and is the change in speed affected by age or pathway conditions?Participants were 141 individuals from 72 romantic couples; age range 25-79 years. The three couple conditions were walking alone, walking with their partner, and walking while holding hands with their partner. The two pathway conditions were clear pathway and pathway with obstacles. Gait speed was modeled as a function of the couple conditions, pathway conditions, and covariates (gender, age, relationship duration, and physical activity) using mixed-effects (3-level) regression.In both pathway conditions, both partners reduced speed when walking together (p0.001), and reduced speed further while holding hands (p0.001), when compared to walking alone. These effects were unchanged when covariates were included in the model. Further, speed was slower on the obstructed pathway for all participants, but the magnitude of slowing was greater with increasing age (p0.001) and in females (p=0.03).Across the adult lifespan, when walking together, both partners decreased gait speed by a clinically meaningful amount (≥0.05 m/s). While walking with a partner may increase walking activity due to social support, reduced speed when walking together may unintentionally reduce health benefits and gait quality in both partners. Future research should identify how health is impacted by the trade-off between increased walking activity and reduced gait speed when romantic partners walk together.

BACKGROUND: Gait speed is an important measure of health status for older adults and individuals with neurological conditions. Literature reports that measurements made by people are not as accurate as automatic timers. RESEARCH QUESTION: Is the GaitBox (GB), a device to measure walking speed (WS) automatically and accurately, a valid approach to walking speed measurement in a clinical setting? METHODS: Two prospective validation studies were completed comparing the GB to human timers (HT) and the Sprint Timing System (STS). Subjects were recruited from convenience samples of healthy older adults (S1, N=35, 72.4 ± 7.4 years of age) and individuals with Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), or unknown / no diagnosis (S2, N=44, 35.3 ± 13.5 years of age). Subjects completed 4 timed walks. The GB, HT, and STS simultaneously measured WS across a 4 m or 10 m course. Protocol followed an adapted version of the NIH Walk Test. Subjects were instructed to walk at a normal pace. Validity and reliability were determined using Pearson correlations, absolute mean differences, Intraclass Correlation Coefficients (ICC’s) and Bland-Altman plots. RESULTS: WS measured in both studies demonstrated strong correlations between GB and STS (r=0.98-0.99, p

Background The postural control in cerebral palsy (CP) is often deficient and manifests in a variety of impairments. Consequently, maintaining balance and controlling posture is impeded and results in an increased cost of locomotion and higher risk of falls. The margin of stability is an established measure to quantify dynamic stability during gait. It can be facilitated to analyze impaired control mechanisms, but it is unknown if and how people with CP manage to control the margin of stability during a more demanding motor task, such as running. Research question How do people with cerebral palsy regulate dynamic stability during walking and running? Methods Children and adolescents with bilateral cerebral palsy (N = 117; 50 female, 67 male; age 11.0 ± 3.2) were retrospectively included. All underwent instrumented 3D gait analysis, walking and running barefoot at a self-selected gait speed. People with CP were compared to a control group of N = 25 typically developed (TD). Repeated measures ANOVAs were computed to analyze group differences and multiple linear regressions to identify predictors for the medio-lateral margin of stability. Results The medio-lateral margin of stability was significantly higher in the CP group and was statistically unchanged during running. Different adaptions when running were particularly observed in the lateral trunk lean and step width, which remained high in CP, whereas the TD increased the trunk lean and reduced their step width. Step width was the main predictor for the medio-lateral margin of stability in both gait conditions. Significance Young people with cerebral palsy manage to maintain their medio-lateral margin of stability during walking and running, however, with significantly higher safety margins compared to typically developed. This conservative strategy may reflect an adaption to motor and postural control impairments.

The Urban Street Segment Chapter of the Highway Capacity Manual (HCM) includes a methodology for evaluating the level of service urban street segments provide to automobile users. The methodology does not account for pedestrian activity at un-signalized midblock crosswalk on an urban street segment. Pedestrian activity at un-signalized midblock crosswalk on urban street segments causes friction conditions between automobiles and pedestrians. As a consequence, the average time it takes vehicles to travel along the segment is increased. Increasing segment running time decreases both the travel speed of automobiles and the level of service provided to automobile users. There is an inverse relationship between the delay incurred by interrupted vehicles and the speeds at which pedestrians walk while crossing at midblock. To account for this delay, there is a need to investigate pedestrian walking speeds at un-signalized midblock crosswalks. This study measured pedestrian walking speeds by age-group at two un-signalized midblock crosswalks on urban street segments. The first objective of this paper is to perform statistical analyses to examine the measured free-flow pedestrian walking speeds. The second objective is to demonstrate how the findings of this study can be incorporated into the Urban Street Segment Analysis Chapter of the HCM. Pedestrian walking speeds were recorded and analyzed for 2937 pedestrians. The results show teenagers walk at an average speed of 1.45 m/s, young adults walk at an average speed of 1.55 m/s, middle age pedestrians walk at a speed of 1.45 m/s, older pedestrians walk at speed of 1.09 m/s, and elderly or physically disabled pedestrians walk at a speed of 1.04 m/s.

Objective To assess effects of 15 exoskeleton-assisted gait training sessions, reflected by the muscle strength of the lower limbs and by walking speed immediately after the training sessions and at the 6-week follow-up. Design Single-group longitudinal preliminary study. Setting Individuals with multiple sclerosis (MS) at a hospital neurology ward. Participants Participants (N=14) included women and men aged from 36-61 years, with Expanded Disability Status Scale scores from 5.0-6.5. Interventions Exoskeleton-assisted walk training. Main Outcome Measures Primary outcomes included dynamometric knee extensor and flexor strength (Biodex Pro4), postural balance, and center of pressure displacements (Zebris FMD-S). Secondary outcomes included walking speed measured with the timed 25-foot walk test and fatigue (Fatigue Severity Scale). Assessments were performed 4 times, that is, prior to the start of the program (T0), at the end of the physiotherapy without an exoskeleton (T1), at the end of the exoskeleton-assisted training (T2), and at 6-week follow-up (T3). Results At the end of exoskeleton-assisted gait training there was a statistically significant improvement in peak torque of knee extensor muscles compared with the period of exercise without an exoskeleton. No statistically significant change was identified in the value of peak torque of knee flexors at T1. Likewise, the assessment at T2 showed the change in peak torque of knee flexors was not significant. The participants presented significantly faster walking speed after exoskeleton-assisted gait training compared with T0 and T1. No improvement was found in body balance. The subjects reported lower fatigue after exoskeleton-assisted gait training; however, the differences between the assessments at T1 and T0 as well as at T2 and T1 were statistically insignificant. Conclusions Individuals with MS and severe gait impairment participating in exoskeleton-assisted gait training achieved significant improvement in lower-limb muscle strength and increase in walking speed, yet the effect was not long-lasting.

Background Backward walking and fast walking have distinctive gait patterns in adults; however, there is minimal literature describing these gait modifications in typically developing children. Additionally, most of previous research focused on overground backward walking, but not on a treadmill. Research question How do typically developing children adapt their gait patterns, including spatiotemporal parameters, joint kinematics, and muscle activation, to changes in direction and speed during treadmill walking? Methods We recruited 19 children (10 M/9 F) aged 6–12 years. Treadmill conditions included forward and backward walking at three speeds: slow (75 % of normal speed), normal speed, and fast (125 % of normal speed). Subjects completed a 2-minute trial under each condition. Spatiotemporal, kinematic, kinetic and electromyography data were collected and analyzed. Correlations between forward and time-reversed backward walking were calculated for joint angles and vertical ground reaction force. Results During backward walking, children (a) decreased step lengths and increased step widths and foot clearance, (b) decreased peak hip and knee flexion and increased peak ankle dorsiflexion, and (c) increased muscle activity at the vastus lateralis, rectus femoris, and tibialis anterior. At faster speeds, children increased step lengths and inconsistently increased overall muscle activity. Both the hip and knee showed high correlation between forward and time-reversed backward walking, while correlation at the ankle was low. Significance Overall, children adapt their gait to changes in direction and speed of treadmill walking in similar ways to adults. However, notable differences emerged in that children limited their ankle range of motion. Our results suggest that, while many aspects of gait are mature enough by this age to adapt to backward walking on a treadmill, neuromuscular control at the ankle may still be lacking in children while walking backward on a treadmill.

Background Gait initiation in level walking is suggested to take three steps before reaching steady-state walking speed. In sloped gait, it is not clear if the general recommendation of level gait can be used. Research question The aim of this study was to investigate (1) if steady-state walking speed is reached within four steps in sloped gait, and (2) to what extent the number of initial steps cause differences in step length, cadence and ground reaction force (GRF). Methods Fourteen healthy participants walked on an instrumented ramp at inclinations of 0°, ±6°, ±12°, and ±18°, covering slight (clinical application) to steep (hiking and mountaineering) slopes. The starting position on the ramp was adjusted to collect each of the first to fourth step using a 12 infrared-camera motion capture system and two force plates. For each slope condition steady-state walking speed was determined using the ratio of the braking and propulsion impulse (ratio pap; p b r a k i n g p p r o p u l s i o n ) and the resultant Centre of Mass (CoM) speed (velCoM). Statistical differences between steps were calculated by using a Friedman ANOVA and pairwise post-hoc Wilcoxon tests. Results In all inclinations, ≥90 % (uphill) and ≥95 % (downhill) of steady-state speed regarding ratio pap and maximum velCoM was reached with the 3rd step. In the level and uphill condition the 4th step showed a slight decrease in velCoM. In uphill and downhill condition, the acceleration was mainly generated due to the increase in cadence with significant increases between the 1st and 2nd step as well as between the 2nd and 3rd step. A significant increase in step length was only observed in the uphill conditions. Significance Steady-state walking speed was reached with the 3rd step and thus, walkways which allow for two initial steps seem to be appropriate for uphill and downhill gait analysis for inclinations up to ±18°.

OBJECTIVE: Adults with radiographic knee OA (rKOA) are at increased risk of mortality and walking difficulty may modify this relation. Little is known about specific aspects of walking difficulty that increase mortality risk. We investigated the association of walking speed (objective measure of walking difficulty) with mortality and examined the threshold that best discriminated this risk in adults with rKOA. METHODS: Participants with rKOA from the Johnston County Osteoarthritis Project (JoCoOA, longitudinal population-based cohort), Osteoarthritis Initiative and Multicenter Osteoarthritis Study (OAI and MOST, cohorts of individuals with or at high risk of knee OA) were included. Baseline speed was measured via 2.4-meter (m) walk test (short-distance) in JoCoOA and 20-m walk test (standard-distance) in OAI and MOST. To examine the association of walking speed with mortality risk over nine years, hazard ratios (aHR) and 95% confidence intervals (CI) were calculated from Cox regression models adjusted for potential confounders., A Maximal Likelihood Ratio Chi-square Approach was utilized to identify an optimal threshold of walking speed predictive of mortality. RESULTS: Deaths after 9 years of follow-up occurred in 23.3% (290/1244) of JoCoOA and 5.9% (249/4215) of OAI+MOST. Walking 0.2 meters/second slower during short- and standard-distance walk tests was associated with 23% (aHR[95%CI]; 1.23[1.10, 1.39]) and 25% (1.25[1.09, 1.43]) higher mortality risk, respectively. Walking

Background Walking in water (WW) is frequently used as an aquatic exercise in rehabilitation programs for the elderly. Understanding gait characteristics of WW is of primary importance to effectively design specific water-based rehabilitation programs. Moreover, as walking speed in water is reduced with a possible effect on gait parameters, the age- and environment-related changes during WW have to be investigated considering the effects of instantaneous walking speed. Research question: how do gait kinematic characteristics differ in healthy elderly between WW and on land walking condition (LW)? Do elderly show different walking patterns compared to young adults? Can these kinematic changes be accounted only by the different environment/age or are they also related to walking speed? Methods Nine healthy elderly participants (73.5 ± 5.8 years) were acquired during walking in WW and LW at two different speeds. Kinematic parameters were assessed with waterproofed inertial magnetic sensors using a validated protocol. The influence of environment, age and walking speed on gait parameters was investigated with linear mixed models. Results Shorter stride distances and longer stride durations were observed in WW compared to LW. In the sagittal plane, hip and knee joint showed larger flexion in WW (>10deg over the whole stride and ∼28deg at foot strike, respectively). Furthermore, lower walking speeds and stride distances were observed in elderly compared to young adults. In the sagittal plane, a slightly more flexed hip joint and a less plantarflexed ankle joint (∼9 deg) were observed in the elderly. Significance: The results showed the importance of assessing the walking speed during WW, as gait parameters can vary not only for the effect environment but also due to different walking speeds.