Predictors of walking capacity in peripheral arterial disease patients

OBJECTIVE: To estimate walking capacity in intermittent claudication patients through a prediction model based on clinical characteristics and the walking impairment questionnaire. METHODS: The sample included 133 intermittent claudication patients of both genders aged between 30 and 80 years. Data regarding clinical characteristics, the walking impairment questionnaire and treadmill walking test performance were obtained. Multiple regression modeling was conducted to predict claudication onset distance and total walking distance using clinical characteristics (age, height, mass, body mass index, ankle brachial index lower, gender, history of smoking and co-morbid conditions) and walking impairment questionnaire responses. Comparisons of claudication onset distance and total walking distance measured during treadmill tests and estimated by a regression equation were performed using paired t-tests. RESULTS: Co-morbid conditions (diabetes and coronary artery disease) and questions related to difficulty in walking short distances (walking indoors - such as around your house and walking 5 blocks) and at low speed (walking 1 block at average speed - usual pace) resulted in the development of new prediction models high significant for claudication onset distance and total walking distance (p0.05) were observed. CONCLUSION: The current study demonstrated that walking capacity can be adequately estimated based on co-morbid conditions and responses to the walking impairment questionnaire

Dynamic walking features and improved walking performance in multiple sclerosis patients treated with fampridine (4-aminopyridine)

Background: Impaired walking capacity is a frequent confinement in Multiple Sclerosis (MS). Patients are affected by limitations in coordination, walking speed and the distance they may cover. Also abnormal dynamic walking patterns have been reported, involving continuous deceleration over time. Fampridine (4-aminopyridine), a potassium channel blocker, may improve walking in MS. The objective of the current study was to comprehensively examine dynamic walking characteristics and improved walking capacity in MS patients treated with fampridine. Methods: A sample of N = 35 MS patients (EDSS median: 4) underwent an electronic walking examination prior to (Time 1), and during treatment with fampridine (Time 2). Patients walked back and forth a distance of 25 ft for a maximum period of 6 min (6-minute 25-foot-walk). Besides the total distance covered, average speed on the 25-foot distance and on turns was determined separately for each test minute, at Time 1 and Time 2. Results: Prior to fampridine administration, 27/35 patients (77 %) were able to complete the entire 6 min of walking, while following the administration, 34/35 patients (97 %) managed to walk for 6 min. In this context, walking distance considerably increased and treatment was associated with faster walking and turning across all six test minutes (range of effect sizes: partial eta squared = .34-.72). Importantly, previously reported deceleration across test minutes was consistently observable at Time 1 and Time 2. Discussion: Fampridine administration is associated with improved walking speed and endurance. Regardless of a treatment effect of fampridine, the previously identified, abnormal dynamic walking feature, i.e. the linear decline in walking speed, may represent a robust feature. Conclusions: The dynamic walking feature might hence be considered as a candidate for a new outcome measure in clinical studies involving interventions other than symptomatic treatment, such as immune-modulating medication. Trial registration: DRKS00009228 (German Clinical Trials Register). Date obtained: 25.08.2015

Identifying candidates for targeted gait rehabilitation: better prediction through biomechanics-informed characterization

BACKGROUND: Walking speed has been used to predict the efficacy of gait training; however, poststroke motor impairments are heterogeneous and different biomechanical strategies may underlie the same walking speed. Identifying which individuals will respond best to a particular gait rehabilitation program using walking speed alone may thus be limited. The objective of this study was to determine if, beyond walking speed, participants' baseline ability to generate propulsive force from their paretic limbs (paretic propulsion) influences the improvements in walking speed resulting from a paretic propulsion-targeting gait intervention. METHODS: Twenty seven participants >6 months poststroke underwent a 12-week locomotor training program designed to target deficits in paretic propulsion through the combination of fast walking with functional electrical stimulation to the paretic ankle musculature (FastFES). The relationship between participants' baseline usual walking speed (UWSbaseline), maximum walking speed (MWSbaseline), and paretic propulsion (propbaseline) versus improvements in usual walking speed (∆UWS) and maximum walking speed (∆MWS) were evaluated in moderated regression models. RESULTS: UWSbaseline and MWSbaseline were, respectively, poor predictors of ΔUWS (R 2  = 0.24) and ΔMWS (R 2  = 0.01). Paretic propulsion × walking speed interactions (UWSbaseline × propbaseline and MWSbaseline × propbaseline) were observed in each regression model (R 2 s = 0.61 and 0.49 for ∆UWS and ∆MWS, respectively), revealing that slower individuals with higher utilization of the paretic limb for forward propulsion responded best to FastFES training and were the most likely to achieve clinically important differences. CONCLUSIONS: Characterizing participants based on both their walking speed and ability to generate paretic propulsion is a markedly better approach to predicting walking recovery following targeted gait rehabilitation than using walking speed alone

The walking library: mobilising books, places, readers and reading

The Walking Library, inaugurated in 2012, has functioned as a mobile laboratory and art project for the ongoing exploration of the relationships between environments, books, reading and writing. In this essay, our focus turns to The Walking Library’s function as a library, asking: ‘What sort of library is a walking library? What does a walking library do—for its books and its borrowers and the places through which it moves? And what can it reveal or teach us about libraries, books, reading and environment?’ In a context in which data has become ‘mobile’, we explore the mobility of physical books through the Walking Library’s social and architextural designs and structures. The book on the move is recognised as the material of social bonding. The Walking Library depends upon and promotes the mobility of books through social networks by gifting, lending, borrowing and sharing; it is the social capacity—the social capital—of The Walking Library, and of walking and reading together, which concerns us most here. The Walking Library has offered temporary spaces for sociality, for shared contemplation, poetic spatiality and kinaesthetic comprehension. In doing so, it has generated a heightened sense of books’ sociability, spatiality and mobility through a stronger understanding of the inter-dependencies of reading, walking, time and place

Barriers and enablers to walking in individuals with intermittent claudication: a systematic review to conceptualize a relevant and patient-centered program

Background: Walking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population. Aim: To systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC. Methods: A systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework. Results: Eighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention. Conclusions: This review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418

Relation of modifiable neighborhood attributes to walking

Abstract Background There is a paucity of research examining associations between walking and environmental attributes that are more modifiable in the short term, such as car parking availability, access to transit, neighborhood traffic, walkways and trails, and sidewalks. Methods Adults were recruited between April 2004 and September 2006 in the Minneapolis-St Paul metropolitan area and in Montgomery County, Maryland using similar research designs in the two locations. Self-reported and objective environmental measures were calculated for participants\u27 neighborhoods. Self-reported physical activity was collected through the long form of the International Physical Activity Questionnaire (IPAQ-LF). Generalized estimating equations were used to examine adjusted associations between environmental measures and transport and overall walking. Results Participants (n = 887) averaged 47 years of age (SD = 13.65) and reported 67 min/week (SD = 121.21) of transport walking and 159 min/week (SD = 187.85) of non-occupational walking. Perceived car parking difficulty was positively related to higher levels of transport walking (OR 1.41, 95%CI: 1.18, 1.69) and overall walking (OR 1.18, 95%CI: 1.02, 1.37). Self-reported ease of walking to a transit stop was negatively associated with transport walking (OR 0.86, 95%CI: 0.76, 0.97), but this relationship was moderated by perceived access to destinations. Walking to transit also was related to non-occupational walking (OR 0.85, 95%CI: 0.73, 0.99). Conclusions Parking difficulty and perceived ease of access to transit are modifiable neighborhood characteristics associated with self-reported walking

Exploring potential of crowdsourced geographic information in studies of active travel and health: Strava data and cycling behaviour

In development of sustainable transportation and green city, policymakers encourage people to commute by cycling and walking instead of motor vehicles in cities. One the one hand, cycling and walking enables decrease in air pollution emissions. On the other hand, cycling and walking offer health benefits by increasing people’s physical activity. Earlier studies on investigating spatial patterns of active travel (cycling and walking) are limited by lacks of spatially fine-grained data. In recent years, with the development of information and communications technology, GPS-enabled devices are popular and portable. With smart phones or smart watches, people are able to record their cycling or walking GPS traces when they are moving. A large number of cyclists and pedestrians upload their GPS traces to sport social media to share their historical traces with other people. Those sport social media thus become a potential source for spatially fine-grained cycling and walking data. Very recently, Strava Metro offer aggregated cycling and walking data with high spatial granularity. Strava Metro aggregated a large amount of cycling and walking GPS traces of Strava users to streets or intersections across a city. Accordingly, as a kind of crowdsourced geographic information, the aggregated data is useful for investigating spatial patterns of cycling and walking activities, and thus is of high potential in understanding cycling or walking behavior at a large spatial scale. This study is a start of demonstrating usefulness of Strava Metro data for exploring cycling or walking patterns at a large scal

Pedestrian speeds on stairs: an initial step for a simulation model

In order to predict a pedestrian’s walking speed on stairs from his/her characteristics of and those of the stairs, the relationship between the walking speed of a pedestrian on stairs and his/her characteristics, and the relationship between the pedestrians’ walking speeds on stairs and the stair-gradients were investigated. It is suggested that Leg Extensor Power shows a strong correlation to walking speeds of elderly people on stairs, the stair-gradient has a linear relationship with horizontal walking speeds on stairs, and Leg Extensor Power could be used to represent a unique walking speed of an elderly pedestrian on stairs

Forms of early walking

Children in the first weeks of independent locomotion display a wide variety of walking forms. The walking forms differ in mechanical strategy and concern with balance. Three extreme walking forms are presented: the Twister, who uses trunk twist, the Faller, who uses gravity, and the Stepper, who remains balanced as much as possible. Each walking form is presented as a ''d-space'', a mathematical format combining continuous and discrete aspects, developed to express the sequence and pattern of a movement without the inappropriate precision of a physical trajectory. The three d-spaces represent analyses of three extreme modes of early walking. They are used to generate the variety of early walking forms and to predict mixtures of mechanical strategies as children mature and converge to more similar walking forms over the first few months of independent locomotion. (C) 1995 Academic Press Limite

Comparing Evaluation Methods for Encumbrance and Walking on Interaction with Touchscreen Mobile Devices

In this paper, two walking evaluation methods were compared to evaluate the effects of encumbrance while the preferred walking speed (PWS) is controlled. Users frequently carry cumbersome objects (e.g. shopping bags) and use mobile devices at the same time which can cause interaction difficulties and erroneous input. The two methods used to control the PWS were: walking on a treadmill and walking around a predefined route on the ground while following a pacesetter. The results from our target acquisition experiment showed that for ground walking at 100% of PWS, accuracy dropped to 36% when carrying a bag in the dominant hand while accuracy reduced to 34% for holding a box under the dominant arm. We also discuss the advantages and limitations of each evaluation method when examining encumbrance and suggest treadmill walking is not the most suitable approach to use if walking speed is an important factor in future mobile studies