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1.
Cochrane Database Syst Rev ; 10: CD006185, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33091160

RESUMO

BACKGROUND: Electromechanical- and robot-assisted gait-training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017. OBJECTIVES: Primary • To determine whether electromechanical- and robot-assisted gait training versus normal care improves walking after stroke Secondary • To determine whether electromechanical- and robot-assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched 6 January 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to 6 January 2020); Embase (1980 to 6 January 2020); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 20 November 2019); the Allied and Complementary Medicine Database (AMED; 1985 to 6 January 2020); Web of Science (1899 to 7 January 2020); SPORTDiscus (1949 to 6 January 2020); the Physiotherapy Evidence Database (PEDro; searched 7 January 2020); and the engineering databases COMPENDEX (1972 to 16 January 2020) and Inspec (1969 to 6 January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials. SELECTION CRITERIA: We included all randomised controlled trials and randomised controlled cross-over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical- and robot-assisted gait training versus normal care. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We assessed the quality of evidence using the GRADE approach. The primary outcome was the proportion of participants walking independently at follow-up. MAIN RESULTS: We included in this review update 62 trials involving 2440 participants. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 2.01, 95% confidence interval (CI) 1.51 to 2.69; 38 studies, 1567 participants; P < 0.00001; I² = 0%; high-quality evidence) and increased mean walking velocity (mean difference (MD) 0.06 m/s, 95% CI 0.02 to 0.10; 42 studies, 1600 participants; P = 0.004; I² = 60%; low-quality evidence) but did not improve mean walking capacity (MD 10.9 metres walked in 6 minutes, 95% CI -5.7 to 27.4; 24 studies, 983 participants; P = 0.2; I² = 42%; moderate-quality evidence). Electromechanical-assisted gait training did not increase the risk of loss to the study during intervention nor the risk of death from all causes. Results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variation between trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Post hoc analysis showed that people who are non-ambulatory at the start of the intervention may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk but revealed differences between devices in terms of walking velocity and capacity. AUTHORS' CONCLUSIONS: People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that eight patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase 3 trials undertaken to address specific questions about the most effective frequency and duration of electromechanical-assisted gait training, as well as how long any benefit may last. Future trials should consider time post stroke in their trial design.


Assuntos
Aparelhos Ortopédicos , Robótica/instrumentação , Reabilitação do Acidente Vascular Cerebral/métodos , Caminhada , Idoso , Viés , Causas de Morte , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Intervalos de Confiança , Terapia por Estimulação Elétrica , Desenho de Equipamento , Terapia por Exercício/métodos , Marcha , Humanos , Pessoa de Meia-Idade , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/instrumentação , Velocidade de Caminhada
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4592-4595, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019016

RESUMO

Gait analysis has many potential applications in understanding the activity profiles of individuals in their daily lives, particularly when studying the progression of recovery following injury, or motor deterioration in pathological conditions. One of the many challenges of conducting such analyses in the home environment is the correct and automatic identification of bouts of gait activity. To address this, a novel method for determining bouts of gait from accelerometer data recorded from the shank is presented. This method is fully automated and includes an adaptive thresholding approach which avoids the necessity for identifying subject-specific thresholds. The algorithm was tested on data recorded from 15 healthy subjects during self-selected slow, normal and fast walking speeds ranging from 0.48 ± 0.19 to 1.38 ± 0.33m/s and a single subject with PD walking at their normal walking speed (1.41 ± 0.08m/s) using accelerometers on the shanks. Intra-Class Correlation (ICC) confirmed high levels of agreement between bout onset/offset times and durations estimated using the algorithm, experimentally recorded stopwatch times and manual annotation for the healthy subjects (r=0.975, p <; 0.001; r=0.984, p<; 0.001) and moderate agreement for the PD subject (r=0.663, p<; 0.001). Mean absolute errors between accelerometer-derived and manually-annotated times were calculated, and ranged from 0.91 ± 0.05 s to 1.17 ± 2.26 s for bout onset detection, 0.80 ± 0.23 s to 2.41 ± 3.77 s for offset detection and 1.27 ± 0.13 s to 3.67 ± 4.59 s for bout durations.


Assuntos
Marcha , Caminhada , Acelerometria , Algoritmos , Humanos , Velocidade de Caminhada
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4596-4599, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019017

RESUMO

Walking speed (WS) is recognized as an important dimension of functional health and a candidate endpoint for clinical trials. To be adopted as a powerful outcome measure in clinical assessment, WS should be estimated pervasively and accurately in the real-life context. Although current state of the art points to possible solutions, e.g., by using pairing of wearable sensors with dedicated algorithms, the accuracy and robustness of existing algorithms in challenging situations should be carefully considered. This study highlights the main methodological issues for WS estimation using single inertial sensor fixed on trunk (chest/low back) and data recorded in a sample of stroke patients with impaired mobility.


Assuntos
Marcha , Acidente Vascular Cerebral , Algoritmos , Humanos , Tronco , Velocidade de Caminhada
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3792-3798, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018827

RESUMO

Wearable sensors, such as inertial measurement units (IMU), provide the ability to quantify gait parameters outside of traditional gait laboratory settings. Walking speed has been shown to be associated with morbidity and mortality. Therefore, the ability of a clinician to easily and inexpensively measure gait speed within their clinic or patients' home setting can improve patient management and care. This study highlights multiple methods used to estimate patient walking speeds based only on IMU data and minimal anthropometric data, and identifies the algorithm appearing to be the most robust; one relying on identifying swing phases of gait first.Clinical relevance- Providing a clinician with a simple, inexpensive and reliable protocol for measuring patients' gait speed and other parameters could offer prevention and individualized care.


Assuntos
Velocidade de Caminhada , Dispositivos Eletrônicos Vestíveis , Algoritmos , Marcha , Humanos , Amplitude de Movimento Articular
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3940-3944, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018862

RESUMO

Energy expenditure (EE) estimation is an important factor in tracking personal activity and preventing chronic diseases, such as obesity and diabetes. The challenge is to provide accurate EE estimations in free-living environment through portable and unobtrusive devices. In this paper, we present an experimental study to estimate energy expenditure during sitting, standing and treadmill walking using a smartwatch. We introduce a novel methodology, which aims to improve the EE estimation by first separating sedentary (sitting and standing) and non-sedentary (walking) activities, followed by estimating the walking speeds and then calculating the energy expenditure using advanced machine learning based regression models. Ten young adults participated in the experimental trials. Our results showed that combining activity type and walking speed information with the acceleration counts substantially improved the accuracy of regression models for estimating EE. On average, the activity-based models provided 7% better EE estimation than the traditional acceleration-based models.


Assuntos
Metabolismo Energético , Velocidade de Caminhada , Aceleração , Humanos , Postura Sentada , Caminhada , Adulto Jovem
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1002-1006, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018154

RESUMO

This research focuses on the gait phase recognition using different sEMG and EEG features. Seven healthy volunteers, 23-26 years old, were enrolled in this experiment. Seven phases of gait were divided by three-dimensional trajectory of lower limbs during treadmill walking and classified by Library for Support Vector Machines (LIBSVM). These gait phases include loading response, mid-stance, terminal Stance, pre-swing, initial swing, mid-swing, and terminal swing. Different sEMG and EEG features were assessed in this study. Gait phases of three kinds of walking speed were analyzed. Results showed that the slope sign change (SSC) and mean power frequency (MPF) of sEMG signals and SSC of EEG signals achieved higher accuracy of gait phase recognition than other features, and the accuracy are 95.58% (1.4 km/h), 97.63% (2.0 km/h) and 98.10% (2.6 km/h) respectively. Furthermore, the accuracy of gait phase recognition in the speed of 2.6 km/h is better than other walking speeds.


Assuntos
Marcha , Caminhada , Adulto , Eletroencefalografia , Voluntários Saudáveis , Humanos , Velocidade de Caminhada , Adulto Jovem
7.
J Stroke Cerebrovasc Dis ; 29(10): 105174, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912567

RESUMO

Stroke survivors often face difficulty in community ambulation though they attain steady-state walking in clinical setups. Compliance and unpredictability of the environment may alter the muscle activity and challenge the individual's gait. Successful reintegration into the community requires gait assessment and training in a real-life challenging environment. Little is known about the assessment and training of gait in the community environment under challenging mobility dimensions. Hence, we aimed to study the changes that real-life environmental dimensions have on the activity of selected muscles in hemiparetic lower limb and gait velocity in stroke survivors. METHODS: An observational cross-sectional study was conducted on 16 ambulatory stroke survivors to assess the hemiparetic lower limb muscle activity during walking in real-life environmental dimensions. Participants were made to walk in the community on a walkway consisting of even surface, ramp, stairs, uneven terrain and obstacles. They were also made to manoeuvre through traffic and pick a load while walking for a distance in the walkway. Muscle activity of Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior of the paretic lower limb were continuously recorded while walking using wireless surface electromyography. Gait velocity for the entire walkway and level of perceived difficulty while walking in different dimensions were also measured. Paired t-test was used to compare the percentage Maximum Voluntary Contraction (%MVC) of lower limb muscles between even surface and real-life environment dimensions while walking. One sample t-test was used to compare the gait velocity in real-life dimensions versus gait velocity in even surface measured in an earlier study. RESULTS: There was a significant reduction (p < 0.01) in the activity of all four hemiparetic lower limb muscles while walking under the influence of real-life environmental dimensions compared to even surface. Gait velocity (0.33 ± 0.17 m/s) was significantly lower than that is essential to be a community ambulator. The level of perceived difficulty across all dimensions was reported qualitatively with the highest difficulty reported during stair and obstacle clearance. CONCLUSION: Real-life environmental dimensions lead to the reduction of paretic lower limb muscle activities and gait velocity during walking in community-dwelling stroke survivors. Stroke survivors perceived more difficulty while walking in real-life environment dimensions particularly while negotiating stairs and obstacles. SIGNIFICANCE: Knowledge about the influence of real-life environmental dimensions will help the clinicians to target rehabilitation methods to improve walking adaptability.


Assuntos
Meio Ambiente , Contração Muscular , Músculo Esquelético/inervação , Paresia/fisiopatologia , Acidente Vascular Cerebral/complicações , Velocidade de Caminhada , Atividades Cotidianas , Adulto , Idoso , Estudos Transversais , Eletromiografia , Análise da Marcha , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paresia/diagnóstico , Paresia/etiologia , Paresia/reabilitação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral
8.
Cochrane Database Syst Rev ; 9: CD013019, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32970328

RESUMO

BACKGROUND: Motor imagery (MI) is defined as a mentally rehearsed task in which movement is imagined but is not performed. The approach includes repetitive imagined body movements or rehearsing imagined acts to improve motor performance. OBJECTIVES: To assess the treatment effects of MI for enhancing ability to walk among people following stroke. SEARCH METHODS: We searched the Cochrane Stroke Group registry, CENTRAL, MEDLINE, Embase and seven other databases. We also searched trial registries and reference lists. The last searches were conducted on 24 February 2020. SELECTION CRITERIA: Randomized controlled trials (RCTs) using MI alone or associated with action observation or physical practice to improve gait in individuals after stroke. The critical outcome was the ability to walk, assessed using either a continuous variable (walking speed) or a dichotomous variable (dependence on personal assistance). Important outcomes included walking endurance, motor function, functional mobility, and adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials according to pre-defined inclusion criteria, extracted the data, assessed the risk of bias, and applied the GRADE approach to evaluate the certainty of the evidence. The review authors contacted the study authors for clarification and missing data. MAIN RESULTS: We included 21 studies, involving a total of 762 participants. Participants were in the acute, subacute, or chronic stages of stroke, and had a mean age ranging from 50 to 78 years. All participants presented at least some gait deficit. All studies compared MI training versus other therapies. Most of the included studies used MI associated with physical practice in the experimental groups. The treatment time for the experimental groups ranged from two to eight weeks. There was a high risk of bias for at least one assessed domain in 20 of the 21 included studies. Regarding our critical outcome, there was very low-certainty evidence that MI was more beneficial for improving gait (walking speed) compared to other therapies at the end of the treatment (pooled standardized mean difference (SMD) 0.44; 95% confidence interval (CI) 0.06 to 0.81; P = 0.02; six studies; 191 participants; I² = 38%). We did not include the outcome of dependence on personal assistance in the meta-analysis, because only one study provided information regarding the number of participants that became dependent or independent after interventions. For our important outcomes, there was very low-certainty evidence that MI was no more beneficial than other interventions for improving motor function (pooled mean difference (MD) 2.24, 95% CI -1.20 to 5.69; P = 0.20; three studies; 130 participants; I² = 87%) and functional mobility at the end of the treatment (pooled SMD 0.55, 95% CI -0.45 to 1.56; P = 0.09; four studies; 116 participants; I² = 64.2%). No adverse events were observed in those studies that reported this outcome (seven studies). We were unable to pool data regarding walking endurance and all other outcomes at follow-up. AUTHORS' CONCLUSIONS: We found very low-certainty evidence regarding the short-term benefits of MI on walking speed in individuals who have had a stroke, compared to other therapies. Evidence was insufficient to estimate the effect of MI on the dependence on personal assistance and walking endurance. Compared with other therapies, the evidence indicates that MI does not improve motor function and functional mobility after stroke (very low-certainty evidence). Evidence was also insufficient to estimate the effect of MI on gait, motor function, and functional mobility after stroke compared to placebo or no intervention. Motor Imagery and other therapies used for gait rehabilitation after stroke do not appear to cause significant adverse events.


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Imagens, Psicoterapia/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Idoso , Viés , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Velocidade de Caminhada
9.
Geriatr Gerontol Int ; 20(10): 974-979, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32881240

RESUMO

AIM: Heart diseases and social factors are associated with physical frailty, but there are few studies of older people living in the community. Consequently, the aim of this study was to examine the association between heart diseases, social factors and physical frailty in community-dwelling older populations including the oldest-old people. METHODS: The cross-sectional study included 1882 participants of community-dwelling older and oldest-old people. The survey site assessed questionnaires on medical history, social factors, blood samples and physical examination. Physical frailty was based on slow gait speed or weak grip strength. Associations were analyzed using multiple logistic regression with adjustments for covariate factors. RESULTS: Subjects with heart disease had a higher prevalence of physical frailty than those without heart disease. After adjusting the covariate factors, heart diseases were associated with a slow gait speed (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.13-2.32, P = 0.009). Frequency of going outdoors and direct interaction with relatives or friends were associated with a slow gait speed (OR = 0.83, 95% CI 0.75-0.91, P ≤ 0.001 and OR = 0.87, 95% CI 0.81-0.94, P < 0.001), and associated with physical frailty (OR = 0.80, 95% CI 0.72-0.89, P ≤ 0.001 and OR = 0.88, 95% CI 0.82-0.95, P = 0.002). Living alone and frequency of direct interaction with relatives or friends were associated with physical frailty in subjects with heart disease. CONCLUSIONS: Our findings indicate that in community-dwelling older people, heart diseases and social factors were associated with physical frailty. Older people with heart disease, those living alone and the frequency of direct interaction with relatives or friends were associated with physical frailty. Geriatr Gerontol Int 2020; 20: 974-979.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Cardiopatias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Relações Interpessoais , Masculino , Razão de Chances , Prevalência , Apoio Social , Inquéritos e Questionários , Velocidade de Caminhada
10.
Geriatr Gerontol Int ; 20(10): 980-987, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32886834

RESUMO

AIMS: Sarcopenia is a serious problem because of its poor prognosis. Growth differentiation factor 15 (GDF15) is associated with mitochondrial dysfunction, inflammation, insulin resistance and oxidative stress, which may play crucial roles for the development of sarcopenia. We aimed to examine whether serum GDF15 level is associated with muscle mass, strength and lower extremity function in older patients with cardiometabolic disease. METHODS: Serum GDF15 levels were measured in 257 patients with cardiometabolic diseases (including 133 patients with diabetes) who had visited the frailty clinic, using a latex turbidimetric immunoassay. Appendicular skeletal muscle index, handgrip strength, timed-up-and-go test and gait speed were evaluated. Power, speed, balance and total scores based on the sit-to-stand test were calculated to assess lower extremity function. RESULTS: The highest tertile of serum GDF15 was independently associated with low handgrip strength, low gait speed, long timed-up-and-go time and scores of lower extremity function but not an appendicular skeletal muscle index in multiple logistic regression analyses after adjustment for covariates. Patients in the highest tertile of GDF15 were at the risk of having three to nine times lower grip strength, three times lower gait speed, five to six times lower mobility and five to 11 times reduction in lower extremity function as compared with those in the lowest GDF15 tertile dependent on the models. CONCLUSIONS: Elevated serum GDF15 level was independently associated with low muscle strength and lower extremity function in older patients with cardiometabolic disease. Serum GDF15 could be one of the biomarkers for muscle weakness and low physical performance. Geriatr Gerontol Int 2020; 20: 980-987.


Assuntos
Doenças Cardiovasculares/sangue , Diabetes Mellitus/sangue , Fator 15 de Diferenciação de Crescimento/sangue , Extremidade Inferior/fisiopatologia , Força Muscular/fisiologia , Sarcopenia/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus/fisiopatologia , Feminino , Fragilidade , Força da Mão , Humanos , Masculino , Músculo Esquelético/fisiopatologia , Sarcopenia/fisiopatologia , Estudos de Tempo e Movimento , Velocidade de Caminhada/fisiologia
11.
Stroke ; 51(9): 2639-2648, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811378

RESUMO

BACKGROUND AND PURPOSE: We investigated the effect of higher therapeutic exercise doses on walking during inpatient rehabilitation, typically commencing 1 to 4 weeks poststroke. METHODS: This phase II, blinded-assessor, randomized controlled trial recruited from 6 Canadian inpatient rehabilitation units, between 2014 and 2018. Subjects (n=75; 25/group) were randomized into: control (usual care) physical therapy: typically, 1 hour, 5 days/week; Determining Optimal Post-Stroke Exercise (DOSE1): 1 hour, 5 days/week, more than double the intensity of Control (based on aerobic minutes and walking steps); and DOSE2: 2 hours, 5 days/week, more than quadruple the intensity of Control, each for 4 weeks duration. The primary outcome, walking endurance at completion of the 4-week intervention (post-evaluation), was compared across these groups using linear regression. Secondary outcomes at post-evaluation, and longitudinal outcomes at 6 and 12-month evaluations, were also analyzed. RESULTS: Both DOSE1 (mean change 61 m [95% CI, 9-113], P=0.02) and DOSE2 (mean change 58 m, 6-110, P=0.03) demonstrated greater walking endurance compared with Control at the post-evaluation. Significant improvements were also observed with DOSE2 in gait speed (5-m walk), and both DOSE groups in quality of life (EQ-5D-5 L) compared with Control. Longitudinal analyses revealed that improvements in walking endurance from the DOSE intervention were retained during the 1-year follow-up period over usual care. CONCLUSIONS: This study provides the first preliminary evidence that patients with stroke can improve their walking recovery and quality of life with higher doses of aerobic and stepping activity within a critical time period for neurological recovery. Furthermore, walking endurance benefits achieved from a 4-week intervention are retained over the first-year poststroke. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01915368.


Assuntos
Terapia por Exercício/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Caminhada , Adulto , Idoso , Exercício Físico , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Resistência Física , Qualidade de Vida , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Resultado do Tratamento , Velocidade de Caminhada
12.
PLoS One ; 15(8): e0237449, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817696

RESUMO

Sex differences in human locomotion are of interest in a broad variety of interdisciplinary applications. Although kinematic sex differences have been studied for many years, the underlying reasons behind several noted differences, such as pelvis and torso range of motion, are still not well understood. Walking speed and body size in particular represent confounding influences that hinder our ability to determine causal factors. The purpose of this study was to investigate sex differences in whole body gait kinematics across a range of controlled, non-dimensional walking and running speeds. We hypothesized that as task demand (i.e. gait speed) increased, the influences of modifiable factors would decrease, leading to a kinematic motion pattern convergence between sexes. Motion capture data from forty-eight healthy young adults (24 M, 24 F) wearing controlled footwear was captured at three walking and three running Froude speeds. Spatiotemporal metrics, center of mass displacement, and joint/segment ranges of motion were compared between sexes using 2x6 mixed-model ANOVAs. Three dimensional time-series waveforms were also used to describe the time-varying behavior of select joint angles. When controlling for size, sex differences in spatiotemporal metrics and center of mass displacement disappeared. However, contrary to our hypothesis, sagittal plane ankle, frontal plane pelvis, and transverse plane pelvis and torso range of motion all displayed sex differences that persisted or increased with gait speed. Overall, most spatiotemporal sex differences appear to be related to size and self-selection of gait speeds, while in contrast, sex differences in joint motion may be more inherent and ubiquitous than previously thought. Discussion on potential causal factors is presented.


Assuntos
Velocidade de Caminhada , Adulto , Fenômenos Biomecânicos , Tamanho Corporal , Feminino , Humanos , Articulações/fisiologia , Masculino , Amplitude de Movimento Articular , Caracteres Sexuais
13.
Arch Osteoporos ; 15(1): 132, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32812073

RESUMO

The osteoporosis self-assessment tool was more accurate than hand grip strength, gait speed, and calf circumference in predicting osteoporosis in women. Hand grip strength was more accurate than the osteoporosis self-assessment tool, gait speed, and calf circumference in predicting osteoporosis in men. PURPOSE: The osteoporosis self-assessment tool, functional assessment, and anthropometric measurement are different techniques to identify those at risk of osteoporosis. This study aimed to compare the performance of these techniques in predicting osteoporosis. METHODS: In this cross-sectional, hospital-based study including 1109 participants, the bone mineral density of the spine and hips was evaluated using the dual-energy X-ray absorptiometry. The Osteoporosis Self-Assessment Tool was used as a simple clinical risk assessment tool to screen for osteoporosis. Gait speed and hand grip strength were used as functional assessments to predict osteoporosis. Calf circumference was used as an anthropometric measurement to predict osteoporosis risk. RESULTS: In women, the Osteoporosis Self-Assessment Tool was better than hand grip strength, gait speed, and calf circumference in predicting osteoporosis. In contrast, in men, hand grip strength was better than the Osteoporosis Self-Assessment Tool, gait speed, and calf circumference. CONCLUSION: The application of simple, cost-effective techniques for the identification of osteoporosis risk will be beneficial for both screening and patient care when dual-energy X-ray absorptiometry is not available. We suggest that the Osteoporosis Self-Assessment Tool can be used to identify the risk of osteoporosis in women and hand grip strength measurement can be used for men.


Assuntos
Absorciometria de Fóton/métodos , Antropometria , Densidade Óssea/fisiologia , Força da Mão , Programas de Rastreamento/métodos , Osteoporose/diagnóstico por imagem , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Autoavaliação Diagnóstica , Feminino , Marcha/fisiologia , Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Autoavaliação , Coluna Vertebral/diagnóstico por imagem , Velocidade de Caminhada
14.
Artigo em Inglês | MEDLINE | ID: mdl-32635202

RESUMO

This study aimed to identify classifier variables by considering both gait and physical fitness for identifying adults aged over 75 years and global cognitive function declines in older adults. The participants included 735 adults aged 65-89 years who were asked to walk at three different speeds (slower, preferred, and faster) while wearing inertial measurement units embedded in shoe-type data loggers and to perform nine physical fitness tests. The variability in the stance phase as well as the strength, balance, and functional endurance showed a strong dependence on the age being over 75 years. The cognitive function was evaluated by the Mini-Mental State Examination; a longer stance phase at a slower walking speed and decreased grip strength and five times sit-to-stand were associated with cognitive function. These findings may be useful for determining the decline in physical performance of older adults. A longer stance phase and decreased grip strength and five times sit-to-stand may be factors that help distinguish declines in cognitive function from normal age-related declines.


Assuntos
Cognição , Marcha , Aptidão Física , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Humanos , Masculino , Caminhada , Velocidade de Caminhada
15.
Clin Interv Aging ; 15: 879-886, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32606628

RESUMO

Background: The SARC-F questionnaire has been developed as a rapid diagnostic test that can be used to screen for sarcopenia. Aim: To investigate the reliability and validity of the Vietnamese version of SARC-F as a screening tool for sarcopenia in older patients in Vietnam. Methods: A cross-sectional study was conducted in older people attending the outpatient clinics of the National Geriatric Hospital in Vietnam. Muscle mass (using dual-energy X-ray absorptiometry), handgrip strength and gait speed were assessed. SARC-F was validated against the three standard criteria for sarcopenia: the Foundation for the National Institutes of Health (FNIH), Asia Working Group for Sarcopenia (AWGS 2019) and European Working Group on Sarcopenia in Older People (EWGSOP2). Results: There were 764 participants (mean age 71.5 ± 8.9 years). The Vietnamese SARC-F questionnaire had a good internal consistency (Cronbach's alpha 0.85). The prevalence of sarcopenia was 49.2% according to SARC-F and 48.3%, 61.1% and 52.6% according to FNIH, AWGS 2019 and EWGSOP2, respectively. The sensitivity and specificity of SARC-F in identifying sarcopenia were 67.1% and 66.7% (for FINH), 66.7% and 67.1% (for AWGS 2019), and 64.9% and 68.2% (for EWGSOP2). The AUCs of SARC-F were 0.71-0.72 against the three sarcopenia criteria. Conclusion: The Vietnamese version of SARC-F questionnaire has acceptable diagnostic value for sarcopenia. SARC-F could be used as an initial screening for sarcopenia in hospital clinics.


Assuntos
Avaliação Geriátrica/métodos , Força da Mão , Músculo Esquelético/patologia , Sarcopenia/diagnóstico , Inquéritos e Questionários/normas , Velocidade de Caminhada , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Vietnã
16.
PLoS One ; 15(7): e0235277, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628686

RESUMO

BACKGROUND AND AIMS: The aim of this study was to investigate the association between walking speed and cardiovascular disease (CVD) risk among community-dwelling middle-aged and elderly populations in Taiwan. METHODS: This was a cross-sectional and community-based study with 400 participants aged 50 years and over recruited from a community health promotion project in 2014 in Guishan district, Taoyuan city. We excluded 91 people, and a total of 309 participants were eligible for analysis. The statistical methods used in this study were one-way ANOVA and the Chi-square test, Pearson's correlation test and logistic regression model. RESULTS: In total, 309 participants (98 males and 211 females) aged 50 to 74 (62.05 ± 6.21) years without a CVD history were enrolled in this study. The walking speed gradually decreased from the low CVD risk group to the high CVD risk group (p < 0.05). A significant inverse association between walking speed and CVD risk was confirmed with a Pearson's correlation coefficient of-0.143 (p < 0.05) in middle-aged people, but this significant inverse association was not shown in elderly people. The multivariate logistic regression model for predicting CVD risk and walking speed with an adjusted odds ratio (OR) was 0.127 (95% CI = 0.021-0.771) in middle-aged people with adjustment for sex, age, waist circumference (WC), hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (p < 0.05). CONCLUSION: Our study clearly shows that slow walking speed is associated with an increased risk of CVD in middle-aged people rather than in elderly people.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Velocidade de Caminhada/fisiologia , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Hiperlipidemias/diagnóstico , Hiperlipidemias/fisiopatologia , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Vida Independente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Fatores de Risco , Inquéritos e Questionários , Taiwan/epidemiologia , Circunferência da Cintura
18.
Artigo em Inglês | MEDLINE | ID: mdl-32599778

RESUMO

Background: Evidence on the association between physical performance and multimorbidity is scarce in Asia. This study aimed to identify multimorbidity patterns and their association with physical performance among older Chinese adults. Methods: Individuals aged ≥60 years from the China Health and Retirement Longitudinal Study 2011-2015 (N = 10,112) were included. Physical performance was measured by maximum grip strength (kg) and average gait speed (m/s) categorized as fast (>0.8 m/s), median (>0.6-0.8 m/s), and slow (≤0.6 m/s). Multimorbidity patterns were explored using exploratory factor analysis. Generalized estimating equation was conducted. Results: Four multimorbidity patterns were identified: cardio-metabolic, respiratory, mental-sensory, and visceral-arthritic. An increased number of chronic conditions was associated with decreased normalized grip strength (NGS). Additionally, the highest quartile of factor scores for cardio-metabolic (ß = -0.06; 95% Confidence interval (CI) = -0.07, -0.05), respiratory (ß = -0.03; 95% CI = -0.05, -0.02), mental-sensory (ß = -0.04; 95% CI = -0.05, -0.03), and visceral-arthritic (ß = -0.04; 95% CI = -0.05, -0.02) patterns were associated with lower NGS compared with the lowest quartile. Participants with ≥4 chronic conditions were 2.06 times more likely to have a slow gait speed. Furthermore, the odds ratios for the highest quartile of factor scores of four patterns with slow gait speed compared with the lowest quartile ranged from 1.26-2.01. Conclusion: Multimorbidity was related to worse physical performance, and multimorbidity patterns were differentially associated with physical performance. A shift of focus from single conditions to the requirements of a complex multimorbid population was needed for research, clinical guidelines, and health-care services. Grip strength and gait speed could be targeted to routinely measure clinical performance among older adults with multimorbidity, especially mental-sensory disorders, in clinical settings.


Assuntos
Doença Crônica , Multimorbidade , Desempenho Físico Funcional , Idoso , Ásia , Feminino , Humanos , Pessoa de Meia-Idade , Velocidade de Caminhada
19.
Maturitas ; 138: 51-57, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32631588

RESUMO

BACKGROUND: Motoric Cognitive Risk syndrome (MCR), which combines Subjective Cognitive Complaint (SCC) and slow gait speed in individuals free of dementia and gait disability, is associated with cardiovascular risk factors and diseases as well as incident cognitive impairment. Little information on MCR exists in the Canadian population. This study aims to examine these associations in community-dwelling elderly people living in Quebec, which is a Canadian province. METHODS: Data was collected from the"Nutrition as a determinant of successful aging: The Quebec longitudinal study" (NuAge), which is a Quebec population-based observational cohort study with 3 years of follow-up. A subset of 1113 participants (age 73.8 ±â€¯4.1 and 51.9% female; 63.5% of the initial NuAge sample) was selected. MCR, cardiovascular risk factors and disease were recorded at baseline. Incident cognitive impairment was considered if the Modified Mini-Mental State Examination (3MS) score was ≤79/100 at subsequent annual visits. RESULTS: The prevalence of MCR was 4.2% at baseline and was significantly associated with diabetes (P < 0.032), cerebrovascular disease (P < 0.043) and incident cognitive impairment (P ≤ 0.001). The overall incidence of cognitive impairment during the 3-year follow-up period was 4.6%. A greater decrease of the 3MS score was observed in participants with MCR compared to those without MCR, at each annual assessment (P ≤ 0.001). CONCLUSION: MCR was associated with diabetes and cerebrovascular diseases at baseline, and incident cognitive impairment in NuAge study participants.


Assuntos
Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Diabetes Mellitus/epidemiologia , Idoso , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Incidência , Vida Independente , Masculino , Testes Neuropsicológicos , Prevalência , Quebeque/epidemiologia , Fatores de Risco , Síndrome , Velocidade de Caminhada
20.
Medicine (Baltimore) ; 99(27): e21042, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629729

RESUMO

BACKGROUND: This systematic review protocol will appraise the effectiveness and safety of electrical stimulation (ES) for limb spasticity (LS) in children with stroke. METHODS: Cochrane Library, EMBASE, PUBMED, PsycINFO, Scopus, OpenGrey, CINAHL, ACMD, CNKI, and WANGFANG will be systematically retrieved for randomized controlled trials (RCTs) testing the effectiveness of ES compared with other interventions on LS in children with stroke. Two independent authors will evaluate eligibility using predefined criteria and will perform data extraction and study quality appraisal of eligible trials. Primary outcomes include gait velocity, and limb spasticity status. Limb function, quality of life, pain intensity, and adverse events will be assessed as secondary outcomes. We will perform data analysis using RevMan 5.3 software. RESULTS: This systematic review will summarize the most recent evidence to assess the effectiveness and safety of ES for LS in children with stroke. CONCLUSIONS: The results of this study may help to determine whether ES is effective or not for LS in children with stroke. STUDY REGISTRATION: INPLASY202050115.


Assuntos
Terapia por Estimulação Elétrica/métodos , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Criança , Terapia por Estimulação Elétrica/efeitos adversos , Humanos , Espasticidade Muscular/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento , Velocidade de Caminhada/fisiologia
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