Normative data on spontaneous stride velocity, stride length, and walking activity in a non-controlled environment.

BACKGROUND: Normative data are necessary for validation of new outcome measures. Recently, the 95th centile of stride speed was qualified by the European Medicines Agency as a valid secondary outcome for clinical trials in subjects with Duchenne muscular dystrophy. This study aims to obtain normative data on spontaneous stride velocity and length in a non-controlled environment and their evolution after 12 months. METHOD: Ninety-one healthy volunteers (50 females, 41 males), with a mean age of 16 years and 2 months, were recruited and assessed at baseline and 12 months later. The 4-stair climb, 6-min walk test, 10-m walk test and rise from floor assessments were performed. Stride length, stride velocity, and the distance walked per hour were studied in an everyday setting for one month after each evaluation. RESULTS: Of the 91 subjects assessed, 82 provided more than 50 h of recordings at baseline; and 73 subjects provided the same at the end of the year. We observed significant positive correlations of the stride length with age and height of participants, and a significant increase of the median stride length in children after the period. In this group, the 95th centile stride velocity was not correlated with age and was stable after one year. All measures but the 10MWT were stable in adults after a one-year period. CONCLUSION: This study provides with data on the influence of age, height, and gender on stride velocity and length as well as accounting for natural changes after one year in controls.

Effects of twelve weeks of aerobic or strength training in addition to standard care in Parkinson's disease: a controlled study.

BACKGROUND: Physical exercise in addition to standard care (SC) in patients with Parkinson's disease (PD) is now a common practice in many care units. However, exercises can cover a wide range of interventions, and the specific effects of different interventions still deserve to be further investigated. AIM: The aim of this study was to compare the effects of 12 weeks of two different types of physical exercises with SC in patients suffering from PD. DESIGN: Pseudo-randomized controlled trial. SETTING: University laboratory for outcomes, University Hospital Centre for interventions. POPULATION: Fifty-two outpatients suffering from mild to moderate PD at baseline. METHODS: Participants were allocated to three groups: the strength training (ST) group performed individualized upper and lower limbs strength training, the aerobic training (AE) group performed tailored gradual aerobic cycling, and the third group received SC. The effects of the interventions on body function were assessed by measuring isokinetic concentric peak torque for knee extension and flexion, peak oxygen consumption (VO2peak) and peak work load (PWL) during an incremental maximal cycling test. Changes in mobility were evaluated from spatial-temporal gait features measured by mean of an accelerometer system and the Six-Minute Walk Distance (6MWD) Test. We used questionnaires to estimate health-related quality of life and habitual physical activity. RESULTS: No significant changes in any outcome measures occurred in the SC group. More than 80% of the participants adequately completed the AE and the ST interventions. The ST group significantly improved all peak torque measures (P≤0.01), except knee extension in the least affected side (P=0.13). This group also improved the PWL (P=0.009) and 6mwd (P=0.03). The AE group improved the VO2peak (P=0.02) and PWL (P<0.001). CONCLUSIONS: Physical fitness in patients with PD rapidly improved in compliance with training specificities, but better fitness hardly translated into better mobility and health-related quality of life. CLINICAL REHABILITATION IMPACT: Physiotherapists can efficiently propose physical conditioning to patients with mild to moderate PD, but these interventions are insufficient to improve gait and participation. Notwithstanding, ST is an efficient intervention for improving walking capacity.

Contribution of a Trunk Accelerometer System to the Characterization of Gait in Patients With Mild-to-Moderate Parkinson's Disease.

OBJECTIVE: Gait disturbances like shuffling and short steps are obvious at visual observation in patients with advanced Parkinson's disease (PD). However, quantitative methods are increasingly used to evaluate the wide range of gait abnormalities that may occur over the disease course. The goal of this study was to test the ability of a trunk accelerometer system to quantify the effects of PD on several gait features when walking at self-selected speed. METHODS: We recruited 96 subjects split into three age-matched groups: 32 healthy controls (HC), 32 PD patients at Hoehn and Yahr stage < II (PD-1), and 32 patients at Hoehn and Yahr stage II-III (PD-2). The following outcomes were extracted from the signals of the triaxial accelerometer worn on the lower back: stride length, cadence, regularity index, symmetry index, and mechanical powers yielded in the cranial-caudal, anteroposterior, and medial-lateral directions. Walking speed was measured using a stopwatch. RESULTS: Besides other gait features, the PD-1 and the PD-2 groups showed significantly reduced stride length normalized to height (p < 0.02) and symmetry index (p < 0.009) in comparison to the HC. Regularity index was the only feature significantly decreased in the PD-2 group as compared with the two other groups (p < 0.01). The clinical relevance of this finding was supported by significant correlations with mobility and gait scales (r is around -0.3; p < 0.05). CONCLUSION: Gait quantified by a trunk accelerometer may provide clinically useful information for the screening and follow-up of PD patients.

Effects of 3 months of short sessions of controlled whole body vibrations on the risk of falls among nursing home residents.

BACKGROUND: Fatigue, lack of motivation and low compliance can be observed in nursing home residents during the practice of physical activity. Because exercises should not be too vigorous, whole body vibration could potentially be an effective alternative. The objective of this randomized controlled trial was to assess the impact of 3-month training by whole body vibration on the risk of falls among nursing home residents. METHODS: Patients were randomized into two groups: the whole body vibration group which received 3 training sessions every week composed of 5 series of only 15 seconds of vibrations at 30 Hz frequency and a control group with normal daily life for the whole study period. The impact of this training on the risk of falls was assessed blindly by three tests: the Tinetti Test, the Timed Up and Go test and a quantitative evaluation of a 10-second walk performed with a tri-axial accelerometer. RESULTS: 62 subjects (47 women and 15 men; mean age 83.2 ± 7.99 years) were recruited for the study. No significant change in the studied parameters was observed between the treated (n=31) and the control group (n=31) after 3 months of training by controlled whole-body-vibrations. Actually, the Tinetti test increased of + 0.93 ± 3.14 points in the treated group against + 0.88 ± 2.33 points in the control group (p = 0.89 when adjusted). The Timed Up and Go test showed a median evolution of - 1.14 (- 4.75-3.73) seconds in the treated group against + 0.41 (- 3.57- 2.41) seconds in the control group (p = 0.06). For the quantitative evaluation of the walk, no significant change was observed between the treated and the control group in single task as well as in dual task conditions. CONCLUSIONS: The whole body vibration training performed with the exposition settings such as those used in this research was feasible but seems to have no impact on the risk of falls among nursing home residents. Further investigations, in which, for example, the exposure parameters would be changed, seem necessary. TRIAL REGISTRATION NUMBER: NCT01759680.