Gait deficiencies associated with peripheral artery disease are different than chronic obstructive pulmonary disease

Abstract

Objective Previous studies have indicated that patients with peripheral artery disease (PAD), display significant differences in their kinetic and kinematic gait characteristics when compared to healthy, aged-matched controls. The ability of patients with chronic obstructive pulmonary disease (COPD) to ambulate is also limited. These limitations are likely due to pathology-driven muscle morphology and physiology alterations establish in PAD and COP, respectively. Gait changes in PAD were compared to gait changes due to COPD to further understand how altered limb muscle due to disease can alter walking patterns. Both groups were independently compared to healthy controls. It was hypothesized that both patients with PAD and COPD would demonstrate similar differences in gait when compared to healthy controls. Methods Patients with PAD (n =25), patients with COPD (n =16), and healthy older control subjects (n =25) performed five walking trials at self-selected speeds. Sagittal plane joint kinematic and kinetic group means were compared. Results Peak values for hip flexion angle, braking impulse, and propulsive impulse were significantly reduced in patients with symptomatic PAD compared to patients with COPD. After adjusting for walking velocity, significant reductions (p < 0.05) in the peak values for hip flexion angle, dorsiflexor moment, ankle power generation, propulsion force, braking impulse, and propulsive impulse were found in patients with PAD compared to healthy controls. No significant differences were observed between patients with COPD and controls. Conclusions The results of this study demonstrate that while gait patterns are impaired for patients with PAD, this is not apparent for patients with COPD (without PAD). PAD (without COPD) causes changes to the muscle function of the lower limbs that affects gait even when subjects walk from a fully rested state. Altered muscle function in patients with COPD does not have a similar effect.

Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

“…While McCamley et al [25] did not find any significant difference, Yentes et al [22] observed an altered pattern at the ankle level, after correcting for covariates of age, gender and smoking history. In particular, they measured an increased peak ankle power absorption at mid-stance and a lack of increase in peak ankle dorsiflexion moment in fatigued conditions with respect to controls.…”

“…Yentes et al [23] noticed a consistent (−15%) whilst not significant (p = 0.06, t-test) reduction in gait speed. McCamley et al [25] and Yentes et al [22] did not find significant differences between groups, since they matched patients and controls in terms of walking speed, either a-priori or by covariate analysis. In addition, patients with COPD generally tend to reduce their stride (and step) length and cadence [12,23,26,27].…”

“…The respiratory symptoms and neuromuscular deficits of the disease reduce both function and mobility and would suggest strong changes of the walking function, that in COPD was associated with limp, shuttle or other walking abnormalities [45]. Contrary to this hypothesis, patients with COPD demonstrated minimal significant differences in biomechanical gait analysis, gathered results were not coincident, and there were studies [22,24,25] reporting qualitatively normal gait and balance in similar populations. Thus, the results emerging from the existing literature do not allow to draw conclusive traits of the gait patterns in patients with COPD (Table 2).…”

“…The sample size of patients with COPD ranged from 14 to 196 (mean age range: 64-75 years). Three papers [22,23,25] relied on traditional optical motion capture combined with force platforms to collect full-body three-dimensional kinematics and kinetics (joint angles, moments and powers); in the remaining papers, spatiotemporal parameters and dependent variables were obtained by means of electronic walkways [12,26], video analysis [24] or inertial units [27]. All studies required participants to walk at their self-selected walking speed, either over ground (6MWT) or on a treadmill.…”

“…However, as speed is responsible of considerable changes in gait patterns [30], to exclude a possible confounding factor and to better identify COPD-specific characteristics, gait should be evaluated at similar speeds as done in [22,25].…”