Brain plasticity after rehabilitation in a severe case of artery of Percheron stroke assessed with multimodal MR imaging.

Artery of Percheron (AOP) stroke is a rare event. We describe an AOP stroke involving both thalami and the midbrain, resulting in a multifunctional clinical impairment. Intensive inpatient multidisciplinary rehabilitation favored the recovery of motor deficits, together with the improvement of cognitive dysfunctions. MRI assessment in the chronic post-stroke phase showed structural and functional reorganization in response to the extended thalamic tissue damage and absence of revascularization. Thalamo-cortical networks involving frontal and prefrontal regions, as well as parietal areas were disrupted, whereas increased functional thalamo-occipital connectivity was found. This report sheds light on brain reorganization following AOP stroke after rehabilitation..

A prospective study of the effects of carbocysteine lysine salt on frequency of exacerbations in COPD patients treated with or without inhaled steroids.

OBJECTIVE: COPD is one of the major causes of morbidity and mortality worldwide and represents one of the most important issues for public health. Frequent exacerbations induce a faster decline in lung function and poorer quality of life, increase mortality, and have a socio-economic impact with a high burden in terms of resources and healthcare costs. The clinical trials evaluated the effect of mucolytics in COPD and showed that the long-term carbocysteine, associated with bronchodilators, anticholinergics, and steroids, reduces the frequency of exacerbations and improves the quality of life. PATIENTS AND METHODS: The aim of this prospective real-life study was to evaluate the long-term impact on exacerbations (at 1 year) in COPD patients treated with carbocysteine lysine salt (single dose of 2.7 g once a day) in addition to background therapy with or without inhaled steroids. RESULTS: In a total of 155 evaluable patients, our study showed that the addition of a single dose of carbocysteine lysine salt to background therapy determines a statistically significant reduction of the average number of exacerbations vs. the number observed in the previous year (from 1.97±0.10 to 1.03±0.11; p<0.01), irrespective of treatment with or without inhaled steroids. In particular, in patients with ≥2 exacerbations in the previous year, the addition of carbocysteine lysine salt resulted in a statistically significant reduction in the exacerbations rate from 69% to 33% and from 58% to 25%, respectively (p<0.01) in patients with or without inhaled steroids. CONCLUSIONS: In summary, our data highlighted the efficacy of long-term administration of a single daily dose of carbocysteine lysine salt (2.7 g/day) in reducing the number and rate of exacerbations in COPD patients, independently from the use of inhaled steroids.

Facilitators and barriers to adaptive implementation of the Meeting Centers Support Program (MCSP) in three European countries; the process evaluation within the MEETINGDEM study.

ABSTRACTBackground:In the MEETINGDEM project, the Meeting Centers Support Program (MCSP) was adaptively implemented and evaluated in three European countries: Italy, Poland, and the United Kingdom. The aim of this study was to investigate overall and country-specific facilitators and barriers to the implementation of MCSP in these European countries. METHODS: A qualitative multiple case study design was used. Based on the theoretical model of adaptive implementation, a checklist was composed of potential facilitators and barriers to the implementation of MCSP. This checklist was administered among stakeholders involved in the implementation of MCSP to trace the experienced facilitators and barriers. Twenty-eight checklists were completed. RESULTS: Main similarities between countries were related to the presence of suitable staff, management, and a project manager, and the fact that the MCSP is attuned to needs and wishes of people with dementia and informal caregivers. Main differences between countries were related to: communication with potential referrers, setting up an inter-organizational collaboration network, receiving support of national organizations, having clear discharge criteria for the MCSP and continuous PR in the region. CONCLUSION: The results of this study provide insight into generic and country specific factors that can influence the implementation of MCSP in different European countries. This study informs further implementation and dissemination of MCSP in Europe and may also serve as an example for the dissemination and implementation of other effective psychosocial support interventions for people with dementia and their informal caregivers across and beyond Europe.

Not re-inventing the wheel: the adaptive implementation of the meeting centres support programme in four European countries.

OBJECTIVES: The implementation of new health services is a complex process. This study investigated the first phase of the adaptive implementation of the Dutch Meeting Centres Support Programme (MCSP) for people with dementia and their carers in three European countries (Italy, Poland, the UK) within the JPND-MEETINGDEM project. Anticipated and experienced factors influencing the implementation, and the efficacy of the implementation process, were investigated. Findings were compared with previous research in the Netherlands. METHOD: A qualitative multiple case study design was applied. Checklist on anticipated facilitators and barriers to the implementation and semi-structured interview were completed by stakeholders, respectively at the end and at the beginning of the preparation phase. RESULTS: Overall, few differences between countries were founded. Facilitators for all countries were: added value of MCSP matching needs of the target group, evidence of effectiveness of MCSP, enthusiasm of stakeholders. General barriers were: competition with existing care and welfare organizations and scarce funding. Some countries experienced improved collaborations, others had difficulties finding a socially integrated location for MCSP. The step-by-step implementation method proved efficacious. CONCLUSION: These insights into factors influencing the implementation of MCSP in three European countries and the efficacy of the step-by-step preparation may aid further implementation of MCSP in Europe.

Technology-enhanced multi-domain at home continuum of care program with respect to usual care for people with cognitive impairment: the Ability-TelerehABILITation study protocol for a randomized controlled trial.

BACKGROUND: According to the World Alzheimer Report (Prince, The Global Impact of Dementia: an Analysis of Prevalence, Incidence, Cost and Trends, 2015), 46.8 million people worldwide are nowadays living with dementia. And this number is estimated to approximate 131.5 million by 2050, with an increasing burden on society and families. The lack of medical treatments able to stop or slow down the course of the disease has moved the focus of interest toward the nonpharmacological approach and psychosocial therapies for people with/at risk of dementia, as in the Mild Cognitive Impairment (MCI) condition. The purpose of the present study is to test an individualized home-based multidimensional program aimed at enhancing the continuum of care for MCI and outpatients with dementia in early stage using technology. METHODS: The proposed study is a single blind randomized controlled trial (RCT) involving 30 subjects with MCI and Alzheimer's disease (AD) randomly assigned to the intervention group (Ability group), who will receive the "Ability Program", or to the active control group (ACG), who will receive "Treatment As Usual" (TAU). The protocol provides for three steps of assessment: at the baseline (T_0), after treatment, (T_1) and at follow-up (T_2) with a multidimensional evaluation battery including cognitive functioning, behavioral, functional, and quality of life measures. The Ability Program lasts 6 weeks, comprises tablet-delivered cognitive (5 days/week) and physical activities (7 days/week) combined with a set of devices for the measurement and monitoring from remote of vital and physical health parameters. The TAU equally lasts 6 weeks and includes paper and pencil cognitive activities (5 days/week), with clinician's prescription to perform physical exercise every day and to monitor selected vital parameters. DISCUSSION: Results of this study will inform on the efficacy of a technology-enhanced home care service to preserve cognitive and motor levels of functioning in MCI and AD, in order to slow down their loss of autonomy in daily life. The expected outcome is to ensure the continuity of care from clinical practice to the patient's home, enabling also cost effectiveness and the empowerment of patient and caregiver in the care process, positively impacting on their quality of life. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02746484 (registration date: 12/apr/2016 - retrospectively registered).

Carbocysteine counteracts the effects of cigarette smoke on cell growth and on the SIRT1/FoxO3 axis in bronchial epithelial cells.

BACKGROUND: Cigarette smoke may accelerate cellular senescence by increasing oxidative stress. Altered proliferation and altered expression of anti-aging factors, including SIRT1 and FoxO3, characterise cellular senescence. The effects of carbocysteine on the SIRT1/FoxO3 axis and on downstream molecular mechanisms in human bronchial epithelial cells exposed to cigarette smoke are largely unknown. AIMS: Aim of this study was to explore whether carbocysteine modulated SIRT1/FoxO3 axis, and downstream molecular mechanisms associated to cellular senescence, in a bronchial epithelial cell line (16-HBE) exposed to cigarette smoke. METHODS: 16HBE cells were stimulated with/without cigarette smoke extracts (CSE) and carbocysteine. Flow cytometry and clonogenic assay were used to assess cell proliferation; western blot analysis was used for assessing nuclear expression of SIRT1 and FoxO3. The nuclear co-localization of SIRT1 and FoxO3 was assessed by fluorescence microscopy. Beta galactosidase (a senescence marker) and SIRT1 activity were assessed by specific staining and colorimetric assays, respectively. ChiP Assay and flow cytometry were used for assessing survivin gene regulation and protein expression, respectively. RESULTS: CSE decreased cell proliferation, the nuclear expression of SIRT1 and FoxO3 and increased beta galactosidase staining. CSE, reduced SIRT1 activity and FoxO3 localization on survivin promoter thus increasing survivin expression. In CSE stimulated bronchial epithelial cells carbocysteine reverted these phenomena by increasing cell proliferation, and SIRT1 and FoxO3 nuclear expression, and by reducing beta galactosidase staining and survivin expression. CONCLUSIONS: The study shows for the first time that carbocysteine may revert some senescence processes induced by oxidative stress due to cigarette smoke exposure.

Muscle function and functional ability improves more in community-dwelling older women with a mixed-strength training programme.

BACKGROUND: Supervised training can reach a limited number of elderly people. OBJECTIVE: To determine the impact of a 1-year mixed-strength training programme on muscle function (MF), functional ability (FA) and physical activity (PA). SETTING: Twice-a-week hospital-based exercise classes and a once-a-week home session. PARTICIPANTS: twenty-eight healthy community-dwelling men and women on the training programme and 20 controls aged over 75 years. METHODS: Training with two multi-gym machines for the lower limbs at 60% of the repetition maximum (1RM). At-home subjects used elastic bands. MEASUREMENTS: Maximum isometric strength of knee extensors (KE), ankle plantar flexors (PF), leg extensor power (LEP), functional reach (FR), chair rise 1 (CR1) and 10 times (CR10), bed rise (BR), six-minute walking test (6MWT), stair climbing (SC), get-up-and-go (GU&G), one-leg standing (1LS). PA was assessed with the Paqap questionnaire. RESULTS: Women were significantly weaker than men at baseline: -47% for KE and -59% for PF. Training induced significant gains in MF and FA in the training females; males improved significantly only in FA. PA levels increased non-significantly (2%) in all of the training group. CONCLUSIONS: Long-term mixed-strength programmes can improve MF and FA in elderly females, and FA in elderly males.

The optimal locomotion on gradients: walking, running or cycling?

On level ground, cycling is more economical than running, which in turn is more economical than walking in the high speed range. This paper investigates whether this ranking still holds when moving on a gradient, where the three modes are expected to be mainly facing the same burden, i.e. to counter gravity. By using data from the literature we have built a theoretical framework to predict the optimal mode as a function of the gradient. Cycling was found to be the mode of choice only below 10-15% gradient, while above it walking was the least expensive locomotion type. Seven amateur bikers were then asked to walk, run and ride on a treadmill at different gradients. The speed was set so as to maintain almost constant the metabolic demand across the different gradients. The results indicate that the "critical slope", i.e. the one above which walking is less expensive than cycling (and running), is about 13-15%. One subject was loaded during bipedal gaits with a bicycle-equivalent mass, to simulate to cross-country cycling situation. The critical slope was close to 20%, due to the higher metabolic cost of loaded walking and running. Part of the findings can be explained by the mechanically different paradigms of the three locomotion types.

Mechanical and metabolic profile of locomotion in adults with childhood-onset GH deficiency.

OBJECTIVE: The aim of the present study was to evaluate the energy cost and the mechanical work of locomotion in a group of adults with childhood-onset GH deficiency (GHD). SUBJECTS: Eight males with childhood-onset GHD (mean age+/-s.d.: 31.7+/-3.6 years; mean height: 145.1+/-6.7cm) and six age-, sex- and exercise-matched normal subjects were studied. DESIGN: GHD patients and healthy controls were requested to walk and run in the speed range of 2-11km h(-1). For each condition, simultaneous mechanical and metabolic measurements were taken. METHODS: Oxygen consumption, and mechanical internal and external work of locomotion were evaluated with standard open-circuit respirometry and three-dimensional motion analysis respectively. RESULTS: External work was not significantly different between GHD patients and healthy controls, while internal work was higher for patients at all speeds. In walking, the relationships between both the mechanical energy recovery and the metabolic cost with speed were shifted towards lower speeds in patients. As a consequence, the optimal speed of walking, i.e. the speed at which the cost of locomotion is minimum, was lower for GHD patients. Stride frequency was significantly higher (11.2-11.3%) for GHD patients at all speeds of walking and running. GHD patients were unable to run at speeds higher than 8km h(-1) for the time needed to reach a metabolic steady state. CONCLUSION: It appears that both the mechanics and energetics of locomotion in short-statured adults with childhood-onset GHD are not strikingly different from those of healthy controls, thus demonstrating a substantial 'normality' in this group of GHD patients at metabolically attainable speeds. The 'harmonic' body structure and the adherence to allometric transformations in these patients do not exclude the possibility of a different metabolic role of GH in normally statured adults with childhood-onset GHD and in those with acquired GHD, taking into account the well recognized heterogeneity of the adult GHD syndrome.

Laryngeal movements during the respiratory cycle measured with an endoscopic imaging technique in the conscious horse at rest.

A video-laryngoscopic method, implemented with an algorithm for the correction of the deformation inherent in the endoscope optical system, has been used to measure the dorsoventral diameter (Drg) and the cross-sectional area (CSArg) of the rima glottidis in five healthy workhorses during conscious breathing at rest. Simultaneous recording of the respiratory airflow was also obtained in two horses. Drg measured 82.7 +/- 4.5 mm (mean +/- S.D.) independently of the respiratory phase, and did not differ from the measurement in post-mortem anatomical specimens of the same horses. CSArg ranged from 1130 +/- 117 mm2 (mean +/- S.D.) during the inspiratory phase to 640 +/- 242 mm2 during the expiratory phase; being always narrower than tracheal cross-sectional area, which was 1616 +/- 224 mm2, as determined from anatomical specimens. Both inspiratory and expiratory airflow waves displayed a biphasic pattern. Maximal laryngeal opening occurred in phase with the second inspiratory peak, while during expiration CSArg attained a minimum value during the first expiratory peak which was significantly smaller (P < 0.01) than the area subsequently maintained during the rest of the expiratiory phase. These quantitative measurements of equine laryngeal movements substantiate the important role played by the larynx in regulating upper airway respiratory resistance and the expiratory airflow pattern at rest.

The relationship between mechanical work and energy expenditure of locomotion in horses.

Three-dimensional motion capture and metabolic assessment were performed on four standardbred horses while walking, trotting and galloping on a motorized treadmill at different speeds. The mechanical work was partitioned into the internal work (W(INT)), due to the speed changes of body segments with respect to the body centre of mass, and the external work (W(EXT)), due to the position and speed changes of the body centre of mass with respect to the environment. The estimated total mechanical work (W(TOT)=W(INT)+W(EXT)) increased with speed, while metabolic work (C) remained rather constant. As a consequence, the 'apparent efficiency' (eff(APP)=W(TOT)/C) increased from 10 % (walking) to over 100 % (galloping), setting the highest value to date for terrestrial locomotion. The contribution of elastic structures in the horse's limbs was evaluated by calculating the elastic energy stored and released during a single bounce (W(EL,BOUNCE)), which was approximately 1.23 J kg(-)(1) for trotting and up to 6 J kg(-)(1) for galloping. When taking into account the elastic energy stored by the spine bending and released as W(INT), as suggested in the literature for galloping, W(EL,BOUNCE) was reduced by 0.88 J kg(-)(1). Indirect evidence indicates that force, in addition to mechanical work, is also a determinant of the metabolic energy expenditure in horse locomotion.

Respiratory mechanics during exhaustive submaximal exercise at high altitude in healthy humans.

1. The present investigation was conducted to test the hypothesis that the respiratory system is stressed more during exhaustive exercise in chronic hypoxia than in normoxia. 2. Four healthy male subjects (aged 33-35 years) exercised on a cycle ergometer at 75% of the local maximum oxygen consumption (Vo2,max) until exhaustion, at sea level (SL) and after a 1 month stay at 5050 m (HA). 3. Airflow at the mouth (V), oesophageal (Po) and gastric (Pg) pressures were measured at rest, during exercise and recovery. Minute ventilation (VE), respiratory power (Wresp), respiratory frequency (f) and transdiaphragmatic pressure (Pdi) were calculated from the measured variables. 4. The subjects' mechanical power output of cycling at HA was 23.7% lower than at SL. In spite of this reduction, time to exhaustion at HA was 55.3% less than at SL. VE increased slightly during exercise at SL, but showed a marked increase at HA, and at the end of exercise at HA was 47.3% higher than at SL. 5. Respiratory power increased more at HA than at SL (77.3% higher at the end of exercise) due to the increase in f needed to sustain the high VE. 6. Gastric pressure swings were negative at the end of HA exercise but always positive at SL. The Pai:Po ratio reached values below 1 at HA but never at SL. 7. These data seem to indicate that the respiratory system is stressed more during submaximal exercise at HA than at SL. We suggest that the exceedingly high VE demand, requiring an excessive Wresp, may lead to fatigue of the diaphragm.

Work tolerance and physiological responses to thermal environment wearing protective NBC clothing.

Six young, healthy male subjects performed a series of experiments in a climatic chamber in different environmental conditions wearing protective ventilated NBC clothing. Ambient temperature, TA, ranged from -20 to 35 degrees C, relative humidity, RH, from 20 to 85%, and air velocity, VA, from 0 center dot 1 to 5 center dot 0 ms-1. In addition, thermal radiation, measured by the temperature of the globothermometer, TG, was artificially increased in some experiments. A total of 32 experiments were performed. The subject had to exercise on a bicycle ergometer at a mechanical power of 60 W for 120 min. Heart rate, HR, oxygen uptake, VO2, skin temperature, Tsk, and rectal temperature, Tre, were measured during the experiments together with the temperature of the space between skin and garment, Tmu. Sweat loss was determined as the difference of the body weight before and after the experiment. Tmu was well correlated with the chamber environmental parameters. During heat exposure work duration began to decrease progressively from a Tmu > 30 degrees C, reducing to 40 min at the highest thermal load. About the same value of Tmu marked the departure of HR, VO2, Tsk and Tre from the values measured during the same work load in neutral conditions. Also, during cold exposure at -20 degrees C work duration was reduced below 1 h, but the limit appeared to be the cold at the extremities. From these findings it appears that Tmu is a good indicator of the thermal load and is related to the environmental condition by the equation: Tmu = 9 center dot 93 + 0 center dot 56 TA + 0 center dot 023 TG + 0 center dot 14 RH (T in degrees C, RH in %). For better comfort and performance Tmu should be monitored whenever a subject has to work wearing an NBC garment and the ventilating system must be adequate to fulfil the needs imposed on the subject by an adverse environment, in particular a high relative humidity.

The effects of locomotor-respiratory coupling on the pattern of breathing in horses.

1. To investigate the effect of locomotor activity on the pattern of breathing in quadrupeds, ventilatory response was studied in four healthy horses during horizontal and inclined (7%) treadmill exercise at different velocities (1.4-6.9 m s(-1)) and during chemical stimulation with a rebreathing method. Stride frequency (f(s)) and locomotor-respiratory coupling (LRC) were also simultaneously determined by means of video recordings synchronized with respiratory events. 2. Tidal volume (V(T)) was positively correlated with pulmonary ventilation (V(E)) but significantly different linear regression equations were found between the experimental conditions (P < 0.0001), since the chemical hyperventilation was mainly due to increases in V(T), whereas the major contribution to exercise hyperpnoea came from changes in respiratory frequency (f(R)). 3. The average f(R) at each exercise level was not significantly different from f(S), although there was not always a tight 1:1 LRC. At constant speeds, f(S) was independent of the treadmill slope and hence the greater V(E) during inclined exercise was due to increased V(T). 4. At any ventilatory level, the differences in breathing patterns between locomotion and rebreathing or locomotion at different slopes derived from different set points of the inspiratory off-switch mechanism. 5. The percentage of single breaths entrained with locomotor rhythm rose progressively and significantly with treadmill speed (P < 0.0001) up to a 1:1 LRC and was significantly affected by treadmill slope (P < 0.001). 6. A LRC of 1:1 was systematically observed at canter (10 out of 10 trials) and sometimes at trot (5 out of 14) and it entailed (i) a 4- to 5-fold reduction in both V(T) and f(R) variability, and (ii) a gait-specific phase locking of inspiratory onset during the locomotor cycle. 7. It is concluded that different patterns of breathing are employed during locomotion and rebreathing due to the interference between locomotor and respiratory functions, which may play a role in the optimization and control of exercise ventilation in horses.

Metabolic and mechanical aspects of foot landing type, forefoot and rearfoot strike, in human running.

The study was undertaken to assess the metabolic and the mechanical aspects of two different foot strike patterns in running, i.e. forefoot and rearfoot striking (FFS and RFS), and to understand whether there is some advantage for a runner to use one or the other of the two landing styles. Eight subjects performed two series of runs (FFS and RFS) on a treadmill at an average speed of 2.50, 2.78, 3.06, 3.33, 3.61, 3.89, 4.17 m s-1. Step frequency, oxygen uptake, mechanical work, and its two components, external and internal, were measured. No differences were found for step frequency, mechanical internal work per unit time and oxygen uptake, while external and total mechanical work per unit time were significantly higher, 7-12%, for FFS. The higher external work was the result of an increase of the work performed against both gravitational and inertial forces. As the energy expenditure was the same it has been speculated that a higher storage and release of energy takes place in the elastic structures of the lower leg with FFS. In a different series of experiments on six subjects contact time, time of deceleration and time of acceleration were measured by means of a video camera while running on the treadmill at 2.50, 3.33 and 4.17 m s-1, both FFS and RFS. Time of deceleration is similar for FFS and RFS, but contact time and time of acceleration are shorter, respectively 12 and 25%, for FFS.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of stride frequency on mechanical power and energy expenditure of walking.

The energetics and mechanics of walking were investigated at different speeds, both at the freely chosen stride frequency (FCSF) and at imposed ones (up to +/- 40% of FCSF). Metabolic energy expenditure was minimized at FCSF for each speed. Motion analysis allowed to calculate: the mechanical internal work rate (Wint), needed to move the segments with respect to the body center of mass (bcm); the external work rate (Wext), necessary to move bcm in the environment; and the total work rate (Wtot), equal to Wint+Wext. Wtot explains the metabolic optimization only at high speeds, while Wext, differently from previously reported, displays minima which better predict FCSF at all speeds (exception made for 1.39 m.s-1). This is probably caused by an overestimation of Wint due to a more ballistic movement of the limbs at low speeds (and low frequencies). The tendency of Wext to increase at high frequencies is due to a persistent minimal vertical excursion of bcm (about 0.02 m, the "locomotory dead space"). While the match between mechanics and energetics (at FCSF and imposed frequencies) occurs to a certain extent, it could be improved by removing the methodological assumptions about the energy transfer between segments and by the possibility to account for the coactivation of antagonist muscles.

Mechanical determinants of the minimum energy cost of gradient running in humans.

The metabolic cost and the mechanical work of running at different speeds and gradients were measured on five human subjects. The mechanical work was partitioned into the internal work (Wint) due to the speed changes of body segments with respect to the body centre of mass and the external work (Wext) due to the position and speed changes of the body centre of mass in the environment. Wext was further divided into a positive part (W+ext) and a negative part (W-ext), associated with the energy increases and decreases, respectively, over the stride period. For all constant speeds, the most economical gradient was -10.6 +/-0.5% (S.D., N = 5) with a metabolic cost of 146.8 +/- 3.8 ml O2 kg-1 km-1. At each gradient, there was a unique W+ext/W-ext ratio (which was 1 in level running), irrespective of speed, with a tendency for W-ext and W+ext to disappear above a gradient of +30% and below a gradient of -30%, respectively. Wint was constant within each speed from a gradient of -15% to level running. This was the result of a nearly constant stride frequency at all negative gradients. The constancy of Wint within this gradient range implies that Wint has no role in determining the optimum gradient. The metabolic cost C was predicted from the mechanical experimental data according to the following equation: [formula: see text] where eff- (0.80), eff+ (0.18) and effi (0.30) are the efficiencies of W-ext, W+ext and Wint, respectively, and el- and el+ represent the amounts of stored and released elastic energy, which are assumed to be 55J step-1. The predicted C versus gradient curve coincides with the curve obtained from metabolic measurements. We conclude that W+ext/W-ext partitioning and the eff+/eff- ratio, i.e. the different efficiency of the muscles during acceleration and braking, explain the metabolic optimum gradient for running of about -10%.

The transition between walking and running in humans: metabolic and mechanical aspects at different gradients.

Five subjects walked and ran at overlapping speeds and different gradients on a motorized treadmill. At each gradient the speed was obtained at which walking and running have the same metabolic cost (Sm) and the speed of spontaneous (Ss) transition between the two gaits was measured. Ss was found to be statistically lower than Sm at all gradients, the difference being in the range of 0.5-0.9 km h-1. The motion analysis of walking reveals that at all gradients and at increasing speed: (1) the percentage of recovery, an index of mechanical energy saving related to the pendulum-like characteristic of walking, decreases; (2) the lower limb spread reaches a limit in walking; and consequently (3) both the stride frequency and the internal mechanical work, due to limb acceleration in relation to the body centre of mass, increase much more in walking than in running. Switching to a run, although implying a higher frequency, makes the internal work decrease as a result of the lower limb spread. In this paper several influences, such as the 'ratings of perceived exertion' (RPE), on the choice of beginning to run when it is more economical to walk, are discussed. A tentative hypothesis on the determinants of Ss, which is emphasized to be a speed which has to be studied in detail but is generally avoided in locomotion, is based on a comfort criterion from peripheric afferences and is reflected by the fact that at Ss a running stride costs as much as a walking stride.(ABSTRACT TRUNCATED AT 250 WORDS)

Pygmy locomotion.

The hypothesis that Pygmies may differ from Caucasians in some aspects of the mechanics of locomotion was tested. A total of 13 Pygmies and 7 Caucasians were asked to walk and run on a treadmill at 4-12 km.h-1. Simultaneous metabolic measurements and three-dimensional motion analysis were performed allowing the energy expenditure and the mechanical external and internal work to be calculated. In Pygmies the metabolic energy cost was higher during walking at all speeds (P < 0.05), but tended to be lower during running (NS). The stride frequency and the internal mechanical work were higher for Pygmies at all walking (P < 0.05) and running (NS) speeds although the external mechanical work was similar. The total mechanical work for Pygmies was higher during walking (P < 0.05), but not during running and the efficiency of locomotion was similar in all subjects and speeds. The higher cost of walking in Pygmies is consistent with the allometric prediction for smaller subjects. The major determinants of the higher cost of walking was the difference in stride frequency (+9.45, SD 0.44% for Pygmies), which affected the mechanical internal work. This explains the observed higher total mechanical work of walking in Pygmies, even when the external component was the same. Most of the differences between Pygmies and Caucasians, observed during walking, tended to disappear when the speed was normalized as the Froude number. However, this was not the case for running. Thus, whereas the tested hypothesis must be rejected for walking, the data from running, do indeed suggest that Pygmies may differ in some aspects of the mechanics of locomotion.