Gait pattern alterations in older adults associated with type 2 diabetes in the absence of peripheral neuropathy—Results from the Baltimore Longitudinal Study of Aging

Abstract

Diabetes may impact gait mechanics before onset of frank neuropathies and other associated threats to mobility. This study aims to characterize gait pattern alterations of type 2 diabetic adults without peripheral neuropathy during walking at maximum speed (fast-walking) as well as at self-selected speed (usual-walking). One-hundred and eighty-six participants aged 60 to 87 from the Baltimore Longitudinal Study of Aging (BLSA) able to walk unassisted and without peripheral neuropathy were classified as non-diabetic (N = 160) or having type 2 diabetes (N=26). Gait parameters from the fast-walking and usual-walking tests were compared between participants with and without type 2 diabetes. Participants with diabetes had a shorter stride length for fast-walking (p = 0.033) and a longer percentage of the gait cycle with the knee in 1st flexion for both fast- and usual-walking (p = 0.033, and 0.040, respectively) than non-diabetic participants. Participants with diabetes exhibited a smaller hip range of motion in the sagittal plane during usual-walking compared to non-diabetics (p = 0.049). During fast-walking, participants with diabetes used lower ankle generative mechanical work expenditure (MWE) and higher knee absorptive MWE compared to non-diabetic persons (p = 0.021, and 0.018, respectively). These findings suggest that individuals with type 2 diabetes without overt peripheral neuropathy exhibit altered and less efficient gait patterns than non-diabetic persons. These alterations are more apparent during walking at a maximum speed indicating that maximum gait testing may be useful for identifying early threats to mobility limitations in older adults with type 2 diabetes.

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life

“…This study also showed significant associations between muscle strength and mobility and between reduced quality of life and both muscle strength and mobility in diabetics. Similarly, Ko et al (2011) observed an association of gait pattern alterations with type 2 diabetes (HbA1c = 6.86 %) in older adults (70 years) without peripheral neuropathy. Therefore, preservation of functional capacity should be specifically ↓ heart rate at rest (high-intensity group) ↓ % body fat in both training groups; ↑ VO 2peak in both training groups (25 vs. 17 %, higher in high-intensity group); ↑ peak power output only in high-intensity group (11 %); ↓ HbA1c only in high-intensity group(0.9 %); ↓ insulin resistance (HOMA) in both groups; No adverse effects mentioned Kim et al (2014) HbA1c glycated hemoglobin A1c, OGTT oral glucose tolerance test, AUC area under the curve, 1 RM one maximum repetition (maximal dynamic strength), W max maximal power at cycle ergometer, RT resistance training, ET endurance training, CT combined resistance and endurance training, HR heart rate, HR max maximal heart rate, HRR heart rate reserve, VO 2max maximal oxygen uptake, VO 2 R reserve oxygen uptake, CHD chronic heart failure addressed in aging diabetic patients because in contrast to other chronic conditions, diabetes care is dependent on the patients' ability to perform self-care tasks (Abdelhafiz and Sinclair 2011).…”

“…Indeed, diabetes complications such as peripheral vascular disease and peripheral neuropathy are associated with poor gait ability, impaired balance, and increased risk of falls (Ko et al 2011;Powell et al 2006;Wray et al 2005;Oliveira et al 2012;Vinik et al 2015).…”

Physical Function and Disability in Older Adults with Diabetes

“…18 Similar results on slower gait speed among older adults with diabetes in comparison to nondiabetic persons have been found in other studies, with altered and less efficient gait patterns in those with diabetes. [19][20][21] Fewer studies have explored the longitudinal association between diabetes and physical performance. In the EPESE study, diabetes at baseline predicted increased risk of decline in physical performance by 10% to 60% over the 4 years of followup, independently of demographics and prevalent chronic conditions.…”

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

“…The procedure for the gait analysis performed in the BLSA gait laboratory has been described previously (Ko et al 2011b). Briefly, participants were instrumented with 20 reflective markers placed at anatomical landmarks: anterior and posterior superior iliac spines, medial and lateral knees, medial and lateral ankles, toe (second metatarsal head), heel, and lateral wands over the mid-femur and mid-tibia.…”

“…Changes in gait characteristics that occur with aging and/or pathology have been intensively studied, but whether these changes account for impaired energetic efficiency, that is a higher energetic cost of walking, remains unknown (Inzitari et al 2007;Kerrigan et al 1998;Ko et al 2011b). Prior studies have shown that older persons with slower habitual gait speed tend to consume more oxygen to walk the same distance than persons who walk faster, suggesting that at the same time as aerobic capacity declines with age, the energetic requirement needed for customary normal gait speed increases (Fiser et al 2010).…”