Hip flexor muscle dysfunction during walking at self-selected and fast speed in patients with aortoiliac peripheral arterial disease

Kakihana, Takaaki; Ito, Osamu; Sekiguchi, Yoshinori; Ito, Daisuke; Gotō, Hitoshi; Akamatsu, Daijirou; Matsumoto, Yasuharu; Kohzuki, Masahiro

doi:10.1016/j.jvs.2017.03.421

Cited by 7 publications

(15 citation statements)

References 42 publications

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“…34 The other two studies highlighted a gait impairment in patients with PAD, using a walkway embedded with a force plate. 35,36 Moreover, in a study of 374 patients with PAD, the correlation between poor strength/mobility and lower limb ischemia was found in women, but not men, probably because of their higher baseline strength. 37 It is important to note that in a total of 11 studies associating low muscle strength and/or function and/or quality and PAD, none used the term sarcopenia.…”

Section: Resultsmentioning

confidence: 99%

Sarcopenia and peripheral arterial disease: a systematic review

Pizzimenti

Meyer

Charles

et al. 2020

J cachexia sarcopenia muscle

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Background Patients with lower extremity peripheral arterial disease (PAD) and sarcopenia are a population at risk requiring specific and targeted care. The aim of this review is to gather all relevant studies associating sarcopenia and PAD and to identify the underlying pathophysiological mechanisms as well as potential therapeutic strategies to improve skeletal muscle function. Methods A systematic review was carried out following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results Data extraction allowed the evaluation of 140 publications; 87 met the inclusion criteria; of which 79 were included in the final review, reporting sufficient data for epidemiological and diagnostic criteria, mechanical analysis, and therapeutic approaches. Epidemiological analysis and diagnostic criteria were based on 18 studies following 2362 PAD patients [31.39% (SD 7.61) women], aged 72.42 (SD 2.84); sarcopenia was present in 34.63% (SD 12.86) of the patients. Mechanical and pathway analysis were based on five animal studies and 29 clinical reports, showing significantly altered muscle strength and function in 1352 PAD patients [26.49% (SD 17.32) women], aged 67.67 (SD 5.14) years; impaired muscle histology in 192 PAD patients (9.2% (SD 11.22) women), aged 64.3 (SD 0.99) years; +58.63% (SD 25.48) of oxidative stress in 69 PAD patients [16.96% (SD 8.10) women], aged 63.17 (SD 1.43) years; mitochondriopathy in 153 PAD patients [29.39% (SD 28.27) women], aged 63.50 (SD 1.83) years; +15.58% (SD 7.41) of inflammation in 900 PAD patients [40.77% (SD 3.71) women], aged 74.88 (SD 2.76) years; and altered signalling pathways in 51 PAD patients [34.45% (SD 32.23) women], aged 72.25 (SD 5.25) years. Therapeutic approaches analysis was based on seven animal studies and 21 clinical reports. In total, 884 patients followed an exercise therapy, and 18 received an angiogenesis treatment; 30.84% (SD 17.74) were women. Mean ages of patients studied were 66.85 (SD 3.96). Conclusions Sarcopenia and lower extremity PAD have musculoskeletal consequences that directly impair patients' quality of life and prognosis. Although PAD is primarily a vascular disease, all etiological factors of sarcopenia identified so far are present in PAD. Indeed, both sarcopenia and PAD are accompanied by oxidative stress, skeletal muscle mitochondrial impairments, inflammation, inhibition of specific pathways regulating muscle synthesis or protection (i.e. IGF-1, RISK, and SAFE), and activation of molecules associated with muscle degradation. To date, besides revascularization, the best therapeutic strategy includes exercise, but approaches targeting the underlying mechanisms still deserve further studies.

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Section: Resultsmentioning

confidence: 99%

Sarcopenia and peripheral arterial disease: a systematic review

Pizzimenti

Meyer

Charles

et al. 2020

J cachexia sarcopenia muscle

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show abstract

“…Similar reductions in the peak knee extensor (predominantly the quadriceps muscles) torque during early stance were reported in patients with PAD, walking at self-selected speed with and without claudication pain compared to healthy controls. 32,33,46,47 These differences correspond to less eccentric muscle activity (i.e., reduced knee extensor torque), and they remained significant while walking at a fast speed and before IC onset. 46 Likewise, there were significant reductions in ankle dorsiflexor (predominantly tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles) torque in patients with PAD during early stance while walking with and without pain at self-selected speed and without pain at fast speed as compared to healthy controls.…”

Section: Methods Of Biomechanical Assessmentmentioning

confidence: 93%

“…32,33,46,47 These differences correspond to less eccentric muscle activity (i.e., reduced knee extensor torque), and they remained significant while walking at a fast speed and before IC onset. 46 Likewise, there were significant reductions in ankle dorsiflexor (predominantly tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles) torque in patients with PAD during early stance while walking with and without pain at self-selected speed and without pain at fast speed as compared to healthy controls. 32,46 Some studies did not find a significant difference in the ankle dorsiflexor torque compared to healthy controls.…”

Section: Methods Of Biomechanical Assessmentmentioning

confidence: 93%

“…During the early stance phase, peak hip extensor torque was significantly reduced during self-selected 33,39,45–47 and fast overground walking 46 in patients with PAD. This implies decreased concentric contractions of the hip extensors (gluteal muscles).…”

Section: Methods Of Biomechanical Assessmentmentioning

confidence: 93%

“…During push-off, patients with PAD showed reduced peak hip flexor (predominantly iliopsoas muscles) torque during pain-free and pain-induced walking at self-selected speed 33 and pain-free walking at fast speed. 46 Additionally, compared with healthy individuals, reduced peak ankle plantar flexor (predominantly soleus and gastrocnemius muscles) torque was found in patients with PAD. 32,33,39,45 These reductions are consistent with reduced concentric muscle activity at the ankle and hip during push-off.…”

Section: Methods Of Biomechanical Assessmentmentioning

confidence: 93%

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A biomechanical perspective on walking in patients with peripheral artery disease

et al. 2023

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The most common symptom of peripheral artery disease (PAD) is intermittent claudication, which consists of debilitating leg pain during walking. In clinical settings, the presence of PAD is often noninvasively evaluated using the ankle–brachial index and imaging of the arterial supply. Furthermore, various questionnaires and functional tests are commonly used to measure the severity and negative effect of PAD on quality of life. However, these evaluations only provide information on vascular insufficiency and severity of the disease, but not regarding the complex mechanisms underlying walking impairments in patients with PAD. Biomechanical analyses using motion capture and ground reaction force measurements can provide insight into the underlying mechanisms to walking impairments in PAD. This review analyzes the application of biomechanics tools to identify gait impairments and their clinical implications on rehabilitation of patients with PAD. A total of 18 published journal articles focused on gait biomechanics in patients with PAD were studied. This narriative review shows that the gait of patients with PAD is impaired from the first steps that a patient takes and deteriorates further after the onset of claudication leg pain. These results point toward impaired muscle function across the ankle, knee, and hip joints during walking. Gait analysis helps understand the mechanisms operating in PAD and could also facilitate earlier diagnosis, better treatment, and slower progression of PAD.

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