1
Journal of Parkinson’s Disease xx (20xx) x–xx DOI 10.3233/JPD-140445 IOS Press
3
roo f
2
Walking Economy During Cued Versus Non-Cued Self-Selected Treadmill Walking in Persons with Parkinson’s Disease
4
Paul M. Galloa,b,∗ , Tara L. McIsaaca,c and Carol Ewing Garbera
5
a Teacher’s
6
b Norwalk
uth
7
College, Columbia University, NY, USA Community College, Norwalk, Connecticut c Arizona School of Health, Science, A.T. Still University, Mesa, Arizona
or P
1
22
Keywords: Parkinson disease, walking, physical fitness, exercise, rehabilitation
23
INTRODUCTION
13 14 15 16 17 18 19 20
24 25 26 27 28 29 30
cte
12
rre
11
co
10
Un
9
dA
21
Abstract. Background: Gait impairments related to Parkinson’s disease (PD) include variable step length and decreased walking velocity, which may result in poorer walking economy. Auditory cueing is a common method used to improve gait mechanics in PD that has been shown to worsen walking economy at set treadmill walking speeds. It is unknown if auditory cueing has the same effects on walking economy at self-selected treadmill walking speeds. Objectives: To determine if auditory cueing will affect walking economy at self-selected treadmill walking speeds and at speeds slightly faster and slower than self-selected. Methods: Twenty-two participants with moderate PD performed three, 6-minute bouts of treadmill walking at three speeds (self-selected and ± 0.22 m· sec−1 ). One session used cueing and the other without cueing. Energy expenditure was measured and walking economy was calculated (energy expenditure/power). Results: Poorer walking economy and higher energy expenditure occurred during cued walking at a self-selected and a slightly faster walking speed, but there was no apparent difference at the slightly slower speed. Conclusion: These results suggest that potential gait benefits of auditory cueing may come at an energy cost and poorer walking economy for persons with PD at least at some treadmill walking speeds.
8
Parkinson’s disease (PD) is commonly associated with gait impairment characterized as variable step length and slower walking velocity [1–3]. As a result of altered gait patterns, there may be increased risk of falling [4], difficulties engaging in activities of daily living, and reduced quality of life [5] in persons with PD. ∗ Correspondence
to: Paul M. Gallo, Norwalk Community College, 188 Richards Avenue, Norwalk, Connecticut 06854, Tel.: +203 857 7194; Fax: +203 857 7098; E-mails: [email protected]; [email protected] (T.L. McIsaac); [email protected] (C.E. Garber).
PD-related impairments in walking can cause inefficient gait patterns requiring greater amounts of energy expenditure [6–8]. Studies investigating the effects of gait impairment on energy expenditure during treadmill walking show that persons with PD expend more energy and have higher oxygen uptake compared with age and gender matched healthy adults [6, 8]. More recently, Gallo et al. [8] demonstrated that persons with PD have worse walking economy when compared to age and gender matched healthy people at two set treadmill walking speeds (0.67 and 1.12 m· sec−1 ). Rhythmic auditory cueing often improves step length variability and walking velocity in persons with PD [3, 9, 10], but this comes at an energy cost [8].
ISSN 1877-7171/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
53 54 55 56 57 58 59 60 61 62 63
64
65
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94
MATERIALS AND METHODS
roo f
52
Participant recruitment
Men and women 50–80 years of age of all races and ethnicities were recruited from a laboratory database, an online clinical trials management system, by webbased advertisements, and word of mouth. Inclusion criteria were: stable idiopathic PD diagnosed by a neurologist, Hoehn and Yahr (H&Y) stage 2.0–3.0, and a stable medication regimen without adjustment for the previous three months. Volunteers were excluded from this study if they had physician-documented or self-reported history of autonomic dysfunction, a history of freezing gait, dementia or cognitive impairment, a Mini-Mental State Examination (MSSE) score
Journal of Parkinson’s Disease xx (20xx) x–xx DOI 10.3233/JPD-140445 IOS Press
3
roo f
2
Walking Economy During Cued Versus Non-Cued Self-Selected Treadmill Walking in Persons with Parkinson’s Disease
4
Paul M. Galloa,b,∗ , Tara L. McIsaaca,c and Carol Ewing Garbera
5
a Teacher’s
6
b Norwalk
uth
7
College, Columbia University, NY, USA Community College, Norwalk, Connecticut c Arizona School of Health, Science, A.T. Still University, Mesa, Arizona
or P
1
22
Keywords: Parkinson disease, walking, physical fitness, exercise, rehabilitation
23
INTRODUCTION
13 14 15 16 17 18 19 20
24 25 26 27 28 29 30
cte
12
rre
11
co
10
Un
9
dA
21
Abstract. Background: Gait impairments related to Parkinson’s disease (PD) include variable step length and decreased walking velocity, which may result in poorer walking economy. Auditory cueing is a common method used to improve gait mechanics in PD that has been shown to worsen walking economy at set treadmill walking speeds. It is unknown if auditory cueing has the same effects on walking economy at self-selected treadmill walking speeds. Objectives: To determine if auditory cueing will affect walking economy at self-selected treadmill walking speeds and at speeds slightly faster and slower than self-selected. Methods: Twenty-two participants with moderate PD performed three, 6-minute bouts of treadmill walking at three speeds (self-selected and ± 0.22 m· sec−1 ). One session used cueing and the other without cueing. Energy expenditure was measured and walking economy was calculated (energy expenditure/power). Results: Poorer walking economy and higher energy expenditure occurred during cued walking at a self-selected and a slightly faster walking speed, but there was no apparent difference at the slightly slower speed. Conclusion: These results suggest that potential gait benefits of auditory cueing may come at an energy cost and poorer walking economy for persons with PD at least at some treadmill walking speeds.
8
Parkinson’s disease (PD) is commonly associated with gait impairment characterized as variable step length and slower walking velocity [1–3]. As a result of altered gait patterns, there may be increased risk of falling [4], difficulties engaging in activities of daily living, and reduced quality of life [5] in persons with PD. ∗ Correspondence
to: Paul M. Gallo, Norwalk Community College, 188 Richards Avenue, Norwalk, Connecticut 06854, Tel.: +203 857 7194; Fax: +203 857 7098; E-mails: [email protected]; [email protected] (T.L. McIsaac); [email protected] (C.E. Garber).
PD-related impairments in walking can cause inefficient gait patterns requiring greater amounts of energy expenditure [6–8]. Studies investigating the effects of gait impairment on energy expenditure during treadmill walking show that persons with PD expend more energy and have higher oxygen uptake compared with age and gender matched healthy adults [6, 8]. More recently, Gallo et al. [8] demonstrated that persons with PD have worse walking economy when compared to age and gender matched healthy people at two set treadmill walking speeds (0.67 and 1.12 m· sec−1 ). Rhythmic auditory cueing often improves step length variability and walking velocity in persons with PD [3, 9, 10], but this comes at an energy cost [8].
ISSN 1877-7171/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved
31 32 33 34 35 36 37 38 39 40 41 42 43 44 45
53 54 55 56 57 58 59 60 61 62 63
64
65
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94
MATERIALS AND METHODS
roo f
52
Participant recruitment
Men and women 50–80 years of age of all races and ethnicities were recruited from a laboratory database, an online clinical trials management system, by webbased advertisements, and word of mouth. Inclusion criteria were: stable idiopathic PD diagnosed by a neurologist, Hoehn and Yahr (H&Y) stage 2.0–3.0, and a stable medication regimen without adjustment for the previous three months. Volunteers were excluded from this study if they had physician-documented or self-reported history of autonomic dysfunction, a history of freezing gait, dementia or cognitive impairment, a Mini-Mental State Examination (MSSE) score
