Relationship between temporal-spatial gait parameters, gait kinematics, walking performance, exercise capacity, and physical activity level in peripheral arterial disease.

摘要

OBJECTIVE: Impaired physical function is a feature of patients with peripheral arterial disease (PAD) who present with symptoms of intermittent claudication (PAD-IC). Previous research found that temporal-spatial gait parameters do not discriminate between PAD-IC patients and control subjects during normal and maximal walking even though PAD-IC patients have decreased physical function characteristic of the disease. This study examined the hypothesis that patients with PAD-IC would demonstrate decreased temporal-spatial gait parameters, gait kinematics, walking performance, physiologic responses to exercise, and physical activity level compared with control subjects. The aim was to examine the temporal-spatial gait parameters and gait kinematics of individuals with PAD-IC and to determine the relationship between these variables and walking performance, exercise capacity, and physical activity level in these individuals. METHOD: A cross-sectional study of 28 PAD-IC subjects (IC) and 25 controls (CON) matched for age and mass was conducted in a medical faculty human performance laboratory. IC subjects had a history of PAD, ankle-brachial pressure index (ABI)<0.9 in at least one leg, and a positive Edinburgh Claudication Questionnaire response. Gait characteristics were determined by two-dimensional motion analysis. A graded treadmill test was used to assess walking performance and peak physiologic responses to exercise. Physical activity levels were measured by analysis of 7-day pedometer recording motion. Differences between groups were examined by one-way analysis of covariance. RESULTS: Compared with CON, IC temporal-spatial gait parameters were significantly lower (P<.05), except for single support ipsilateral limb time. IC subjects spent a greater percentage of time in gait support phases, took longer to complete a stride, and had reduced stride length and walking speeds during the gait cycle. IC joint angular kinematics showed significantly reduced displacement of ankle plantar flexion (P=.017), kneerange of motion (P=.021), and hip extension (P=.016) compared with the CON subjects during the gait cycle. All joint minimum and maximum angular velocities and accelerations, walking physiologic responses, and physical activity levels were significantly lower for IC compared with the CON subjects. CONCLUSION: IC subjects walk with a shuffling gait pattern indicated by reduced joint angular displacement, velocities, and accelerations that results in reduced walking performance and physiologic responses and physical activity compared with controls matched for age, mass, and physical activity.