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Matthew K. Seeley, Ryan P. Sandberg, Joshua F. Chacon, Merrill D. Funk, Neil Nokes and Gary W. Mack

Context:

Individuals using traditional axillary crutches to ambulate expend approximately twice as much energy as individuals who perform able-bodied gait. A relatively novel spring-loaded crutch now being marketed may reduce metabolic energy expenditure during crutch ambulation. This idea, however, had not yet been tested.

Objective:

To determine whether the novel spring-loaded crutch reduces oxygen consumption during crutch ambulation, relative to traditional-crutch ambulation. A secondary purpose was to evaluate the design for subject-perceived comfort and ease of use.

Design:

Within-subject.

Setting:

Indoor track.

Participants:

10 able-bodied men and 10 able-bodied women.

Interventions:

The independent variable was crutch design. Each subject ambulated using 3 different crutch designs (traditional, spring-loaded, and modified spring-loaded), in a randomized order.

Main Outcome Measures:

The primary dependent variable was oxygen consumption. Secondary dependent variables were subject-perceived comfort and ease of use, as rated by the subjects using a 100-mm visual analog scale. Dependent variables were compared among the 3 crutch designs using a 1-way repeated-measures ANOVA (α = .05).

Results:

Oxygen consumption during spring-loaded-crutch ambulation (17.88 ± 2.13 mL · kg−1 · min−1) was 6.2% greater (P = .015; effect size [ES] = .50) than during traditional axillary-crutch ambulation (16.84 ± 2.08 mL · kg−1 · min−1). There was no statistically significant difference (P = .068; ES = −.45) for oxygen consumption between spring-loaded-crutch ambulation and ambulation using the modified crutch (17.03 ± 1.61 mL · kg−1 · min−1). Subjects perceived the spring-loaded crutch to be more comfortable (P < .001; ES = .56) than the traditional crutch. There was no difference (P = .159; ES = −.09) between the spring-loaded and traditional crutches for subject-perceived ease of use.

Conclusions:

Compared with traditional axillary crutches, the novel spring-loaded crutch may be more comfortable but does not appear to benefit subjects via reduced metabolic energy expenditure.

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Alison C. Novak and Brenda Brouwer

This study describes and contrasts the kinematics and kinetics of stair ambulation in people with chronic stroke and healthy control subjects. Three-dimensional motion data were collected from 10 persons with stroke (7 males) and 10 sex and age-matched older adults as they ascended and descended an instrumented staircase at self-selected speed with and without a handrail. Ankle, knee and hip joint angle and moment profiles were generated during stance and range of motion and peak moments were contrasted between groups, sides (stroke only) and condition. Cadence was lower in stroke than controls, although the kinematic profiles appeared similar during ascent and decent. Notable differences in joint kinetics were evident as the peak extensor moments were typically lower on the affected side in stroke compared with controls and the less affected side. These differences accounted for the lower magnitude net extensor support moment. The lower affected side hip abductor moments likely limited lateral stability. Handrail use tended to reduce the peak moments on the affected side only leading to more side-to-side differences than occurred without the handrail. The findings reveal differences in task performance between stroke and healthy groups that help inform rehabilitation practice.

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Joaquin U. Gonzales, Jordan Shephard and Neha Dubey

We tested the hypothesis that the intensity of daily ambulation would relate with functional walking capacity in older adults. Forty-three women (n = 25) and men (n = 18) between the ages of 60-78 years wore an accelerometer for measurement of average daily steps and 30-min peak stepping cadence. A 400-m walk test was used to measure walking speed. No sex difference was found for average daily steps (p = .76), average peak cadence (p = .96), or walking speed (p = .89). Daily steps (women: r = .68, p < .01; men: r = .04) and peak cadence (women: r = .81, p < .01; men: r = −.16) were positively correlated with walking speed in women but not in men. After controlling for daily steps, peak cadence remained significantly associated with walking speed in women (partial r = .61, p < .01). Walking intensity during daily ambulation is independently related to functional walking capacity in older adults, albeit this relation may be more significant for women than men.

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Claire Peel and Diane Ballard

The primary purpose of this study was to determine the reproducibility of the 6-min-walk test (6MWT) in older women. A secondary purpose was to document heart rate (HR), blood pressure (BP), and ratings of perceived exertion (RPE) in response to the 6MWT. Twenty-eight women with an average age of 80.0 years (±5.2) participated. They performed 2 trials of the 6MWT on 3 separate days, for a total of 6 trials. Heart rate, BP, RPE, and the total distance walked were recorded for each trial. The results indicated a significant increase from Trial 1 to Trial 2, with no differences between Trials 2–6, F(5, 131) = 7.02, p = .000. HR and BP were consistent across the 6 trials, and RPE was higher for the second trial on the second day of testing, F(5, 131) = 2.72, p = .023. The intraclass correlation coefficient for distance walked was .94. After the initial trial, performance on the 6MWT appears to be stable in older women.

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Suzy Lai Wong, Rachel Colley, Sarah Connor Gorber and Mark Tremblay

Background:

Actical accelerometer thresholds have been derived to enable objective measurement of time spent performing sedentary activity in children and adolescents, but not adults. Thus, the purpose of this study was to determine Actical accelerometer sedentary activity thresholds for adults.

Methods:

Data were available from 3187 participants aged 6 to 79 years from a preliminary partial dataset of the Canadian Health Measures Survey, who wore an Actical for 7 days. Step count data were used to evaluate the use of 50, 100, and 800 counts per min (cpm) as sedentary activity thresholds. Minutes when no steps were recorded were considered minutes of sedentary activity.

Results:

The use of higher cpm thresholds resulted in a greater percentage of sedentary minutes being correctly classified as sedentary. The percentage of minutes that were incorrectly classified as sedentary was substantially higher when using a threshold of 800 cpm compared with 50 or 100 cpm. Results were similar for children, adolescents, and adults.

Conclusions:

These findings suggest that a threshold of 100 cpm is appropriate for classifying sedentary activity of adults when using the Actical. As such, wear periods with minutes registering less than 100 cpm would be classified as time spent performing sedentary activity.

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Christie L. Ward, Rudy J. Valentine and Ellen M. Evans

Adiposity, lean mass, and physical activity (PA) are known to influence physical function in older adults, although the independent influences are not completely characterized. Older adults (N = 156, M age = 68.9 ± 6.7 yr, 85 men) were assessed for body composition via dual-energy X-ray absorptiometry, PA by accelerometer, and physical function via timed up-and-go (UP&GO), 30-s chair stand, 6-min walk (6-min WALK), and Star-Excursion Balance Test. In the absence of percentage-body-fat by PA interactions (p > .05), main effects existed such that a higher percentage body fat was associated with poorer performance in UP&GO, 30-s chair stand, and 6-min WALK (p < .05). No significant main effects were found for PA and functional performance. Adiposity explains 4.6–11.4% in physical functional variance (p < .05). Preventing increases in adiposity with age may help older adults maintain functional independence.

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Linda C. Campanelli

Functional mobility is generally considered a major contributor to maintaining quality of life at any age. There are several overviews of physiological aging relative to physical functioning and/or mobility in the recent literature. This paper reiterates the need for continued exercise (at all levels) throughout one’s lifetime, specifically to enhance quality of life and functional independence. Implications for professionals and program development are included. Tailored exercises for both ambulatory and nonambulatory older adults to maintain flexibility, gait, and bed mobility are described.

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Travis Saunders, Nerissa Campbell, Timothy Jason, Gail Dechman, Paul Hernandez, Kara Thompson and Chris M. Blanchard

Background:

Although individual studies have reported on the number of steps/day taken by individuals with chronic obstructive pulmonary disease (COPD), this evidence has not been systematically reviewed or synthesized.

Methods:

MEDLINE and PsycINFO were searched for studies reporting objectively-measured steps/day and percent predicted forced expiratory volume in 1 second (FEV1%) in patients with COPD. Meta-analyses were used to estimate steps/day across studies, while metaregression was used to estimate between-study variance based on clinical and demographic factors (year and location of study, activity monitor brand, number of days wearing the monitor, whether participants were about to enter pulmonary rehabilitation, 6-minute walk distance (6MWD), FEV1%, age, and sex).

Results:

38 studies including 2621 participants met inclusion criteria. The pooled mean estimate was 4579 steps/day (95% CI:4310 to 5208) for individuals with COPD. Only 6MWD, FEV1% and whether patients were about to undergo pulmonary rehabilitation explained a significant portion of the variance (P < 0.1) in univariate meta-regression. In a multivariate model including the above risk factors, only FEV1% was associated with steps/day after adjustment for other covariates.

Conclusions:

These results indicate that patients with COPD achieve extremely low levels of physical activity as assessed by steps/day, and that severity of airflow obstruction is associated with activity level.

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Michael Sanders, Anton E. Bowden, Spencer Baker, Ryan Jensen, McKenzie Nichols and Matthew K. Seeley

were applied, manual muscle tests were performed to ensure proper sensor placement. The sensors were then secured with elastic tape. Data Collection We collected 5 ambulation trials for 8 different trial types. The 8 different trials types consisted of a trial type for each leg (involved—right and

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Matthew K. Seeley, Iain Hunter, Thomas Bateman, Adam Roggia, Brad J. Larson and David O. Draper

Context:

A novel spring-loaded-crutch design may provide patients additional forward velocity, relative to traditional axillary crutches; however, this idea has not yet been evaluated.

Objective:

To quantify elastic potential energy stored by spring-loaded crutches during crutch–ground contact and determine whether this energy increases forward velocity for patients during crutch ambulation. Because elastic potential energy is likely stored by the spring-loaded crutch during ambulation, the authors hypothesized that subjects would exhibit greater peak instantaneous forward velocity during crutch–ground contact and increased preferred ambulation speed during spring-loaded-crutch ambulation, relative to traditional-crutch ambulation.

Design:

Within-subject.

Setting:

Biomechanics laboratory.

Participants:

10 healthy men and 10 healthy women.

Interventions:

The independent variable was crutch type: Subjects used spring-loaded and traditional axillary crutches to ambulate at standardized and preferred speeds.

Main Outcome Measures:

The primary dependent variables were peak instantaneous forward velocity and preferred ambulation speed; these variables were quantified using high-speed videography and an optoelectronic timing device, respectively. Between-crutches differences for the dependent variables were evaluated using paired t tests (α = .05). Elastic potential energy stored by the spring-loaded crutches during crutch–ground contact was also quantified via videography.

Results:

Peak forward velocity during crutch–ground contact was 5% greater (P < .001) for spring-loaded-crutch ambulation than for traditional-crutch ambulation. Preferred ambulation speed, however, did not significantly differ (P = .538) between crutch types. The spring-loaded crutches stored an average of 2.50 ± 1.96 J of elastic potential energy during crutch–ground contact.

Conclusions:

The spring-loaded crutches appear to have provided subjects with additional peak instantaneous forward velocity. This increased velocity, however, was relatively small and did not increase preferred ambulation speed.