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Saving Time for Patients with Moderate to Severe COPD: Endurance Test Speed Set Using Usual and Fast Walk Speeds.

ABSTRACT: Background: For assessing the effects of interventions on exercise tolerance, the tolerable duration (tlimit) of a high-intensity constant-speed endurance test is recommended. The test intensity is determined by the test speed (stest) which should be individualized to target a tlimit of 3 to 15 minutes. We determined the accuracy of setting the stest to achieve a targeted tlimit of 3 to 15 minutes using the participant's easily measured and non-fatiguing usual (susual) and fast (sfast) walk speeds. Methods: Participants with COPD were asked to walk at their usual and fast walk speeds to establish their susual and sfast. This required that they walk for less than 1 minute. The individualized stest was calculated from a previously developed equation (0.57 x [sfast - susual]) + susual. Participants then completed a constant-speed endurance test, walking at this calculated stest to intolerance, to determine if the resultant tlimit occurred within 3 to 15 minutes. Results: Twenty-nine participants (forced expiratory volume in 1 second [FEV1] standard deviation [SD ]=43 [25] %predicted; FEV1 to forced vital capacity [FVC]ratio= 41 [13]%; susual = 57.3 [10.4] meters per minute (m·min-1 ); sfast = 71.7 [10.7] m·min-1) completed the study. During testing, 24 (83%) participants used supplemental oxygen and 16 (55%) used a walking aid. The derived stest was 65.6 [10.3] m·min-1 with the observed tlimit of 6.0 [5.0] minute. Twenty-four of 29 (83 %) endurance tests were within 3 to 15 minutes. Conclusion: Using the usual and fast walk speeds provides a simple, quick, inexpensive method for clinicians to set an acceptable endurance walk speed.

SUBMITTER: Dolmage TE

PROVIDER: S-EPMC5556864 | biostudies-other | 2014 Sep

REPOSITORIES: biostudies-other

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Saving Time for Patients with Moderate to Severe COPD: Endurance Test Speed Set Using Usual and Fast Walk Speeds.

Dolmage Thomas E TE Rozenberg Dmitry D Malek Nina N Evans Rachael A RA Goldstein Roger S RS

Chronic obstructive pulmonary diseases (Miami, Fla.) 20140925 2

Background: For assessing the effects of interventions on exercise tolerance, the tolerable duration (tlimit) of a high-intensity constant-speed endurance test is recommended. The test intensity is determined by the test speed (stest) which should be individualized to target a tlimit of 3 to 15 minutes. We determined the accuracy of setting the stest to achieve a targeted tlimit of 3 to 15 minutes using the participant's ...[more]

PMID: 28848821

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Project description:New findingsWhat is the central question of the study? Are the changes in force potentials (at the muscle level) related with metabolic changes at speeds above and below the walk-to-run transition? What is the main finding and its importance? The force-length and force-velocity potentials of gastrocnemius medialis during human walking decrease as a function of speed; this decrease is associated with an increase in cumulative EMG activity and in the energy cost of locomotion. Switching from fast walking to running is associated to an increase in the force potentials, supporting the idea that the 'metabolic trigger' that determines the transition from walking to running is ultimately driven by a reduction of the muscle's contractile capacity.AbstractThe aim of this study was to investigate the interplay between the force-length (F-L) and force-velocity (F-V) potentials of gastrocnemius medialis (GM) muscle fascicles, the cumulative muscle activity per distance travelled (CMAPD) of the lower limb muscles (GM, vastus lateralis, biceps femori, tibialis anterior) and net energy cost (Cnet ) during walking and running at speeds above and below the walk-to-run transition speed (walking: 2-8 km h-1 ; running: 6-10 km h-1 ). A strong association was observed between Cnet and CMAPD: both changed significantly with walking speed but were unaffected by speed in running. The F-L and F-V potentials decreased with speed in both gaits and, at 6-8 km h-1 , were significantly larger in running. At low to moderate walking speeds (2-6 km h-1 ), the changes in GM force potentials were not associated with substantial changes in CMAPD (and Cnet ), whereas at walking speeds of 7-8 km h-1 , even small changes in force potentials were associated with steep increases in CMAPD (and Cnet ). These data suggest that: (i) the walk to run transition could be explained by an abrupt increase in Cnet driven by an upregulation of the EMG activity (e.g., in CMAPD) at sustained walking speeds (>7 km h-1 ) and (ii) the reduction in the muscle's ability to produce force (e.g., in the F-L and F-V potentials) contributes to the increase in CMAPD (and Cnet ). Switching to running allows regaining of high force potentials, thus limiting the increase in CMAPD (and Cnet ) that would otherwise occur to sustain the increase in locomotion speed.

Project description:BackgroundGait speed has been found to be associated with cognitive function. However, gait speed is an unspecific measure that may not be informative about gait patterns. The Walk ratio (step length divided by step frequency) can be measured without specialized equipment, and has been suggested as an indicator of central gait control. However, the association with cognitive function is unknown.Research questionIs there a relationship between Walk ratio and cognitive function, and gait speed and cognitive function?MethodsThis was a systematic literature review of studies where spatiotemporal gait parameters was reported in populations with cognitive impairment. The search was performed through PubMed, PEDro, AMED, Cochrane, Embase, MEDLINE, and PsycINFO. The studies had to contain either the Walk ratio, or report average step length and average step frequency. In the latter case, the average step length was divided by the average step frequency. The studies also had to report gait speed and the minimal mental state examination (MMSE). Studies testing patients on treadmills or that did not state the exclusion of patients with neurologic or orthopedic diseases, possible affecting gait ability, were excluded.ResultsA total of 24 studies were included, consisting of 909 patients with cognitive impairment and 4,108 healthy controls. The patient group had a lower Walk ratio (mean difference 0.07, p ≤ 0.001) and gait speed (mean difference 0.26, p ≤ 0.001) than the healthy controls. Using linear regression models, we found an association between the MMSE and the Walk ratio (R2 = 0.29, p < 0.001) and gait speed (R2 = 0.41, p < 0.001) in separate, unadjusted models. In a final model with Walk ratio, gait speed and age, Walk ratio was not significantly associated with MMSE, while gait speed was.SignificanceOur results suggest that preferred gait speed may be preferable to the Walk ratio when assessing older adults with cognitive impairment.

Dataset Information

Saving Time for Patients with Moderate to Severe COPD: Endurance Test Speed Set Using Usual and Fast Walk Speeds.

Publications

Saving Time for Patients with Moderate to Severe COPD: Endurance Test Speed Set Using Usual and Fast Walk Speeds.

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