Gait energetic efficiency in older adults with and without knee pain: results from the Baltimore Longitudinal Study of Aging

Abstract

With aging, customary gait patterns change and energetic efficiency declines, but the relationship between these alterations is not well understood. If gait characteristics that develop with aging explain part of the decline in energetic efficiency that occur in most aging individuals, then efforts to modify these characteristics could delay or prevent mobility limitation. This study characterizes gait patterns in older persons with and without knee pain and tests the hypothesis that changes in gait characteristics due to knee pain are associated with increased energetic cost of walking in older adults. Study participants were 364 men and 170 women aged 60 to 96 years enrolled in the Baltimore Longitudinal Study of Aging (BLSA), of whom 86 had prevalent knee pain. Gait patterns were assessed at participant self-selected usual pace in the gait laboratory, and the energetic cost of walking was assessed by indirect calorimetry during self-selected usual pace walking over 2.5 min in a tiled corridor using a portable equipment. Participants with knee pain were less energetically efficient than those without pain (oxygen consumption 0.97 vs. 0.88 ml/(10 m·100 kg); p=0.002) and had slower gait speed and smaller range of motion (ROM) at the hip and knee joints (p<0.05, for all). Slower gait speed and lower knee ROM in participants with knee pain and longer double support time and higher ankle ROM in participants without knee pain were associated with lower energetic efficiency (p<0.05, for all). Slower gait speed and lower knee ROM were correlates of knee pain and were found to mediate the association between age and oxygen consumption. Although knee pain is associated with a higher energetic cost of walking, gait characteristics associated with energetic efficiency differ by pain status which suggests that compensatory strategies both in the presence and absence of pain may impact gait efficiency.

Differential Gait Patterns by History of Falls and Knee Pain Status in Healthy Older Adults: Results From the Baltimore Longitudinal Study of Aging

“…Without considering knee pain status, previous studies have found fallers to have prolonged double support duration, shorter stride length, increased variability, and lower strength than nonfallers (Espy, Yang, Bhatt, & Pai, 2010; Lord et al, 1996; Moreland et al, 2004; Verghese et al, 2009). Older adults with knee pain share spatiotemporal gait adaptations with older adult fallers (Barton, Levinger, Webster, & Menz, 2011; Kitayuguchi et al, 2015; Ko et al, 2015). We found an interaction between history of falls and knee pain in double support time, which may suggest that knee pain can modify compensatory strategies in recent fallers.…”

“…Gait speed was negatively associated with ankle ROM only in participants without knee pain (G1 and G2). This can be a compensational role of the ankle in slower speed gait that is evident only in participants without knee pain (Ko et al, 2015). …”

“…Specifically, knee pain, which effects approximately a quarter of older adults (McAlindon, Snow, Cooper, & Dieppe, 1992; O’Reilly, Muir, & Doherty, 1996) and increases with age (Peat, McCarney, & Croft, 2001), was associated with slower gait speed, longer double support time, and smaller range of motion (ROM) in hip and knee joints while walking (Bindawas, 2016; Kitayuguchi et al, 2015; Ko, Simonsick, & Ferrucci, 2015; Tas et al, 2014). Knee pain during walking is also related with older age, overweight, abnormal gait patterns, and knee osteoarthritis (Chang et al, 2016; Grodzinsky, Levenston, Jin, & Frank, 2000; Miranda, Viikari-Juntura, Martikainen, & Riihimaki, 2002).…”

Support of Joint Function, Range of Motion, and Physical Activity Levels by Consumption of a Water-Soluble Egg Membrane Hydrolyzate

“… 18 Decreased joint ROM is associated with compensatory strategies. 19 In addition, obesity adds biomechanical stress on weight-bearing joints, contributing to postural dysfunction, abnormal gait, and increased stiffness along the upper and lower back, all contributing to chronic pain and further loss of physical functionality. 20 Nondisease-related factors contributing to a decline in joint function and mobility include occupational stress, 21 where additional factors affecting musculoskeletal mobility include mental stress-related muscular tension, 22 which over time can contribute to chronic reduction of mobility, typically of the neck and back.…”

Association between gait characteristics and endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease

“…Slow gait speed is associated with increased risk of all-causemortality (Studenski et al 2011), frailty and independence (Liu et al 2016), impaired gait efficiency (Ko et al 2015), and increased risk of disability (Liu et al 2016;Stephan et al 2015), hospitalization (Liu et al 2016;Stephan et al 2015), and placement in longterm care (Cawthon et al 2009;Vermeulen et al 2011). Slow gait speed, as defined by a velocity slower than 0.8 m/s, is highly prevalent in men and women above age 65.…”