Age-Related Longitudinal Changes in Metabolic Energy Expenditure during Walking in Boys with Duchenne Muscular Dystrophy

Objective

The aim of this study was to evaluate age-related changes in metabolic walking energy expenditure in ambulant boys affected by Duchenne muscular dystrophy over a follow-up period of 12 months.

Methods

At baseline (T1) and 12 months later (T2), metabolic walking energy expenditure was assessed during a 6-minute walk test at comfortable speed in 14 ambulant boys with Duchenne (age range: 6.0-12.5 years, mean 8.2). Outcome measures derived from the assessment included the 6-minute comfortable walking distance (m) and net-nondimensional energy cost relative to speed-matched control cost (SMC-EC, %). Statistical comparisons were made using a two-way repeated measures ANOVA (factors: time (T1 versus T2) and age (<8 years of age (yoa) versus ≥8 yoa)).

Results

Over the course of the study, a significant decrease of -28m (−8.2%, p = 0.043) was noted in the walked distance at comfortable speed. Besides, SMC-EC increased with 4.4%, although this change was not significant (p = 0.452). Regarding age groups, boys below 8 yoa showed a smaller annual decrease in the walked distance (−15 m) compared to boys above 8 yoa (−37 m). SMC-EC increased with 10% in the older boys, while in the younger boys it decreased (−2.1%). The main effect of age group on walking distance and SMC-EC however was not significant (p>0.158), and also there were no interaction effects (p>0.248).

Conclusions

The results of our small study suggest that the natural course of walking performance in ambulant boys with Duchenne is characterized by a decrease in comfortable walking distance and an increase in walking energy cost. The rate of energy cost seems to increase with age, while walking distance decreases, which is opposite from the trend in typically developing children.     

Predicting metabolic cost of level walking

Energy expenditure in walking is usually expressed as a function of walking speed. However, this relationship applies only to freely adopted step length-step rate patterns. Both the step length and the step rate must be used to preduct the energy expenditure for any combination of step length and step rate. Evidence on seven subjects indicates that the energy demand for such a combination can be determined by conducting two experiments. In the first, the subject is allowed to freely choose his own walking pattern to achieve a set of prescribed speeds. In the second, the speed is kept constant but the subject is forced to adopt a range of prescribed step rates. The results of the two experiments combined yield enough data to make possible the determination of the energy equation of the pattern, encompassing both "free" and "forced" gaits. Results show that the freely chosen step rate requires the least oxygen consumption at any given speed. Any other forced step rate at the same speed increases the oxygen cost over that required for the "free" step rate.     

Physiological responses to prolonged treadmill walking with external loads

Limited information is available regarding the physiological responses to prolonged load carriage. This study determined the energy cost of prolonged treadmill walking (fixed distance of 12 km) at speeds of 1.10 m.s-1, 1.35 m.s-1, and 1.60 m.s-1, unloaded (clothing mass 5.2 kg) and with external loads of 31.5 and 49.4 kg. Fifteen male subjects performed nine trials in random order over a 6-week period. Oxygen uptake (VO2) was determined at the end of the first 10 min and every 20 min thereafter. A 10-min rest period was allowed following each 50 min of walking. No changes occurred in VO2 over time in the unloaded condition at any speed. The 31.5 and 49.4 kg loads, however, produced significant increases (ranging from 10 to 18%) at the two fastest and at all three speeds, respectively, even at initial exercise intensities less than 30% VO2max. In addition, the 49.4 kg load elicited a significantly higher (P less than 0.05) VO2 than did the 31.5 kg load at all speeds. The measured values of metabolic cost were also compared to those predicted using the formula of Pandolf et al. In trials where VO2 increased significantly over time, predicted values underestimated the actual metabolic cost during the final minute by 10-16%. It is concluded that energy cost during prolonged load carriage is not constant but increases significantly over time even at low relative exercise intensities. It is further concluded that applying the prediction model which estimates energy expenditure from short-term load carriage efforts to prolonged load carriage can result in significant underestimations of the actual energy cost.     

Sideways walking: preferred is slow,slow is optimal,and optimal is expensive

When humans wish to move sideways, they almost never walk sideways, except for a step or two; they usually turn and walk facing forward. Here, we show that the experimental metabolic cost of walking sideways, per unit distance, is over three times that of forward walking. We explain this high metabolic cost with a simple mathematical model; sideways walking is expensive because it involves repeated starting and stopping. When walking sideways, our subjects preferred a low natural speed, averaging 0.575 m s⁻¹ (0.123 s.d.). Even with no prior practice, this preferred sideways walking speed is close to the metabolically optimal speed, averaging 0.610 m s⁻¹ (0.064 s.d.). Subjects were within 2.4% of their optimal metabolic cost per distance. Thus, we argue that sideways walking is avoided because it is expensive and slow, and it is slow because the optimal speed is low, not because humans cannot move sideways fast.     

The effect of repeated bouts of backward walking on physiologic efficiency

Previous studies have demonstrated an increased energy expenditure with novel tasks. With practice, the energy cost decreases as the body more efficiently recruits motor units. This study examined whether one becomes more efficient after repeated bouts of backward walking. The subjects were 7 healthy subjects between the ages of 23 and 49 years. A backward walking speed was calculated to elicit a VO(2) equal to 60% of the VO(2)max. There were 18 training sessions at the prescribed walking speed 3 d x wk(-1) for 20 min x d(-1). The backward walking speed required to elicit a fixed VO(2) increased between weeks 4 and 6 of the training period. This finding suggests that backward walking is indeed a novel task and that motor learning occurs as a result of practice, leading to a more efficient recruitment of motor units.     

Speed training with body weight unloading improves walking energy cost and maximal speed in 75- to 85-year-old healthy women.

This randomized controlled study was designed to prove the hypothesis that a novel approach to high-speed interval training, based on walking on a treadmill with the use of body weight unloading (BWU), would have improved energy cost and speed of overground walking in healthy older women. Participants were randomly assigned to either the exercise group (n = 11, 79.6 +/- 3.7 yr, mean +/- SD) or the nonintervention control group (n = 11, 77.6 +/- 2.3 yr). During the first 6 wk, the exercise group performed walking interval training on the treadmill with 40% BWU at the maximal walking speed corresponding to an intensity close to heart rate at ventilatory threshold (T(vent) walking speed). Each session consisted of four sets of 5 min of walking (three 1-min periods at T(vent) walking speed, with two 1-min intervals at comfortable walking speed in between each period at T(vent) walking speed) with 1-min interval between each set. Speed was increased session by session until the end of week 6. BWU was then progressively reduced to 10% during the last 6 wk of intervention. After 12 wk, the walking energy cost per unit of distance at all self-selected overground walking speeds (slow, comfortable, and fast) was significantly reduced in the range from 18 to 21%. The exercise group showed a 13% increase in maximal walking speed and a 67% increase in mechanical power output at T(vent) after the training program. The novel "overspeed" training approach has been demonstrated to be effective in improving energy cost and speed of overground walking in healthy older women.     

Influence of higher-grade walking on metabolic demands in young untrained Japanese women

The primary purpose of this study was to document the physiological responses of level walking and running (LW/R) at various speeds, and grade walking (GW) at various grades on a treadmill. Twenty-four young untrained Japanese women performed 2 tests on the specially designed treadmill for a higher grade exercise. The first test was the LW/R with increase of speeds, 33.3, 66.7, 91.7, and 116.7 m.min(-1). The first 3 progressions were for walking and the last progression was for running. The second test was the GW with increase of grades 0, 10, 20, and 30% with the velocity of 33.3 m.min(-1) in all progressions. The different combinations of speeds and grade for the progressions used in this study were selected based on the results of preliminary pilot studies, so that the percent heart rate maximim (%HRmax) was reached at the minimum intensities recommended to allow improving cardiorespiratory fitness by the American College of Sports Medicine (ACSM). Significant (p 相似文献   

Predicting metabolic cost of running with and without backpack loads

In the past, a mathematical equation to predict the metabolic cost of standing or walking (Mw) was developed. However, this equation was limited to speeds less than 2.2 m.s-1 and overestimated the metabolic cost of walking or running at higher speeds. The purpose of this study was, therefore, to develop a mathematical model for the metabolic cost of running (Mr), in order to be able to predict the metabolic cost under a wide range of speeds, external loads and grades. Twelve male subjects were tested on a level treadmill under different combinations of speed and external load. Speed varied between 2.2 to 3.2 m.s-1 using 0.2 m.s-1 intervals and external loads between 0-30 kg with 10 kg intervals. Four of the subjects were also tested at 2 and 4% incline while speed and load remained constant (2.4 m.s-1, 20 kg). The model developed is based on Mw and is proportionately linear with external load (L) carried as follows: Mr = Mw-0.5 (1-0.01L)(Mw -15L-850), (watt) The correlation coefficient between predicted and observed values was 0.99 (P less than 0.01) with SER of 7.7%. The accuracy of the model was validated by its ability to predict the metabolic cost of running under different conditions extracted from the literature. A highly significant correlation (r = 0.95, P less than 0.02, SER = 6.5%) was found between our predicted and the reported values. In conclusion, the new equation permits accurate calculation of energy cost of running under a large range of speeds, external loads and inclines.     

The metabolic cost of changing walking speeds is significant,implies lower optimal speeds for shorter distances,and increases daily energy estimates

Humans do not generally walk at constant speed, except perhaps on a treadmill. Normal walking involves starting, stopping and changing speeds, in addition to roughly steady locomotion. Here, we measure the metabolic energy cost of walking when changing speed. Subjects (healthy adults) walked with oscillating speeds on a constant-speed treadmill, alternating between walking slower and faster than the treadmill belt, moving back and forth in the laboratory frame. The metabolic rate for oscillating-speed walking was significantly higher than that for constant-speed walking (6–20% cost increase for ±0.13–0.27 m s⁻¹ speed fluctuations). The metabolic rate increase was correlated with two models: a model based on kinetic energy fluctuations and an inverted pendulum walking model, optimized for oscillating-speed constraints. The cost of changing speeds may have behavioural implications: we predicted that the energy-optimal walking speed is lower for shorter distances. We measured preferred human walking speeds for different walking distances and found people preferred lower walking speeds for shorter distances as predicted. Further, analysing published daily walking-bout distributions, we estimate that the cost of changing speeds is 4–8% of daily walking energy budget.     

Energy cost of treadmill and floor walking at self-selected paces

Oxygen uptake-velocity regression equations were developed for floor and level treadmill walking by having two groups of men, aged 19-29 years (n = 20) and 55-66 years (n = 22), walk at four self-selected paces, from "rather slowly" to "as fast as possible". A two-variable quadratic model relating VO2 (ml X kg-1 X min-1) to velocity (m X s-1) was adopted for prediction purposes. However, age and fatness significantly (P less than 0.05) interacted with treadmill walking speed, while age alone significantly interacted with floor speed. In addition, a significant difference was found between the energy cost of floor and treadmill walking. For example at the normal walking speed of 1.33 m X s-1, the energy cost for the treadmill (age 55-66 years) was 10.58 ml X kg-1 X min-1 and for the floor, 11.04 ml X kg-1 X min-1 (P less than 0.05). Four quadratic equations are therefore presented, one each for floor and treadmill in each of the two age-groups. The percent variance explained was between 87 and 95% for each of these equations.     

Energy cost of balance control during walking decreases with external stabilizer stiffness independent of walking speed

Human walking requires active neuromuscular control to ensure stability in the lateral direction, which inflicts a certain metabolic load. The magnitude of this metabolic load has previously been investigated by means of passive external lateral stabilization via spring-like cords. In the present study, we applied this method to test two hypotheses: (1) the effect of external stabilization on energy cost depends on the stiffness of the stabilizing springs, and (2) the energy cost for balance control, and consequently the effect of external stabilization on energy cost, depends on walking speed. Fourteen healthy young adults walked on a motor driven treadmill without stabilization and with stabilization with four different spring stiffnesses (between 760 and 1820 N m⁻¹) at three walking speeds (70%, 100%, and 130% of preferred speed). Energy cost was calculated from breath-by-breath oxygen consumption. Gait parameters (mean and variability of step width and stride length, and variability of trunk accelerations) were calculated from kinematic data. On average external stabilization led to a decrease in energy cost of 6% (p<0.005) as well as a decrease in step width (24%; p<0.001), step width variability (41%; p<0.001) and variability of medio-lateral trunk acceleration (12.5%; p<0.005). Increasing stabilizer stiffness increased the effects on both energy cost and medio-lateral gait parameters up to a stiffness of 1260 N m⁻¹. Contrary to expectations, the effect of stabilization was independent of walking speed (p=0.111). These results show that active lateral stabilization during walking involves an energetic cost, which is independent of walking speed.     

Effects of obesity and sex on the energetic cost and preferred speed of walking.

The metabolic energy cost of walking is determined, to a large degree, by body mass, but it is not clear how body composition and mass distribution influence this cost. We tested the hypothesis that walking would be most expensive for obese women compared with obese men and normal-weight women and men. Furthermore, we hypothesized that for all groups, preferred walking speed would correspond to the speed that minimized the gross energy cost per distance. We measured body composition, maximal oxygen consumption, and preferred walking speed of 39 (19 class II obese, 20 normal weight) women and men. We also measured oxygen consumption and carbon dioxide production while the subjects walked on a level treadmill at six speeds (0.50-1.75 m/s). Both obesity and sex affected the net metabolic rate (W/kg) of walking. Net metabolic rates of obese subjects were only approximately 10% greater (per kg) than for normal-weight subjects, and net metabolic rates for women were approximately 10% greater than for men. The increase in net metabolic rate at faster walking speeds was greatest in obese women compared with the other groups. Preferred walking speed was not different across groups (1.42 m/s) and was near the speed that minimized gross energy cost per distance. Surprisingly, mass distribution (thigh mass/body mass) was not related to net metabolic rate, but body composition (% fat) was (r2= 0.43). Detailed biomechanical studies of walking are needed to investigate whether obese individuals adopt novel energy saving mechanisms during walking.     

Maximal oxygen uptake during treadmill walking and running at various speeds.

Three groups of male subjects, average fitness (AF, N = 12), high fitness (HF, N = 7) and highly fit competitive race walkers (CRW, N = 3) performed maximal treadmill tests walking at 3.5 and 4.5 mph and running at 4.5, 5.5, 7.0, and 8.5 mph. In addition, the HF group performed a running test at 10.0 mph and the CRW group performed a walking test at 5.5 mph. All maximal oxygen uptake (VO2 max) tests with the exception of the 3.5 mph walking test (modified Balke test) were discontinuous in nature. VO2 max obtained from walking tests was similar regardless of speed within each group. Walking VO2 max was significantly lower than running VO2 max which was found to be similar over a speed range of 4.5 to 8.5 mph in the AF group. Running at 4.5 mph (HF group) and 4.5 and 5.5 mph (CRW group) resulted in lower VO2 max levels than running at speeds greater than or equal to 7.0 mph. Associated physiological variables (heart rate, ventilation, and respiratory exchange ratio) did not demonstrate a discernable pattern with reference to mode of locomotion (walking versus running) or speed. It was concluded that VO2 max elicited during walking is independent of speed and less than VO2 max obtained during running. Running VO2 max was interrelated with speed of running and state of training.     

Comparing predictive validity of four ballistic swing phase models of human walking

It is unclear to what extent ballistic walking models can be used to qualitatively predict the swing phase at comfortable walking speed. Different study findings regarding the accuracy of the predictions of the swing phase kinematics may have been caused by differences in (1) kinematic input, (2) model characteristics (e.g. the number of segments), and (3) evaluation criteria. In the present study, the predictive validity of four ballistic swing phase models was evaluated and compared, that is, (1) the ballistic walking model as originally introduced by Mochon and McMahon, (2) an extended version of this model in which heel-off of the stance leg is added, (3) a double pendulum model, consisting of a two-segment swing leg with a prescribed hip trajectory, and (4) a shank pendulum model consisting of a shank and rigidly attached foot with a prescribed knee trajectory. The predictive validity was evaluated by comparing the outcome of the model simulations with experimentally derived swing phase kinematics of six healthy subjects. In all models, statistically significant differences were found between model output and experimental data. All models underestimated swing time and step length. In addition, statistically significant differences were found between the output of the different models. The present study shows that although qualitative similarities exist between the ballistic models and normal gait at comfortable walking speed, these models cannot adequately predict swing phase kinematics.     

Mechanical and metabolic determinants of the preferred step width in human walking

We studied the selection of preferred step width in human walking by measuring mechanical and metabolic costs as a function of experimentally manipulated step width (0.00-0.45L, as a fraction of leg length L). We estimated mechanical costs from individual limb external mechanical work and metabolic costs using open circuit respirometry. The mechanical and metabolic costs both increased substantially (54 and 45%, respectively) for widths greater than the preferred value (0.15-0.45L) and with step width squared (R(2) = 0.91 and 0.83, respectively). As predicted by a three-dimensional model of walking mechanics, the increases in these costs appear to be a result of the mechanical work required for redirecting the centre of mass velocity during the transition between single stance phases (step-to-step transition costs). The metabolic cost for steps narrower than preferred (0.10-0.00L) increased by 8%, which was probably as a result of the added cost of moving the swing leg laterally in order to avoid the stance leg (lateral limb swing cost). Trade-offs between the step-to-step transition and lateral limb swing costs resulted in a minimum metabolic cost at a step width of 0.12L, which is not significantly different from foot width (0.11L) or the preferred step width (0.13L). Humans appear to prefer a step width that minimizes metabolic cost.     

Acceleration versus heart rate for estimating energy expenditure and speed during locomotion in animals: tests with an easy model species, Homo sapiens

An important element in the measurement of energy budgets of free-living animals is the estimation of energy costs during locomotion. Using humans as a particularly tractable model species, we conducted treadmill experiments to test the validity of tri-axial accelerometry loggers, designed for use with animals in the field, to estimate rate of oxygen consumption (VO2: an indirect measure of metabolic rate) and speed during locomotion. The predictive power of overall dynamic body acceleration (ODBA) obtained from loggers attached to different parts of the body was compared to that of heart rate (fH). When subject identity was included in the statistical analysis, ODBA was a good, though slightly poorer, predictor of VO2 and speed during locomotion on the flat (mean of two-part regressions: R2=0.91 and 0.91, from a logger placed on the neck) and VO2 during gradient walking (single regression: R2=0.77 from a logger placed on the upper back) than was fH (R2=0.96, 0.94, 0.86, respectively). For locomotion on the flat, ODBA was still a good predictor when subject identity was replaced by subject mass and height (morphometrics typically obtainable from animals in the field; R2=0.92 and 0.89) and a slightly better overall predictor than fH (R2=0.92 and 0.85). For gradient walking, ODBA predicted VO2 more accurately than before (R2=0.83) and considerably better than did fH (R2=0.77). ODBA and fH combined were the most powerful predictor of VO2 and speed during locomotion. However, ODBA alone appears to be a good predictor and suitable for use in the field in particular, given that accelerometry traces also provide information on the timing, frequency and duration of locomotion events, and also the gait being used.     

Metabolic responses to Wii Fit™ video games at different game levels

The Wii Fit? is a form of interactive gaming designed to elicit health and fitness benefits to replace sedentary gaming. This study was designed to determine the effectiveness of Wii Fit? fitness games. The purpose of the study was to determine the %VO2max and energy expenditure from different Wii Fit? games at different levels including the step and hula games. Eight healthy young women completed a preliminary trial to determine VO2max and later played the Wii Fit? during 2 separate counterbalanced trials. During each session, subjects played levels of Wii Fit? games for 10 minutes each level. One session involved beginning and intermediate hula, and the other session involved beginning and intermediate steps. The VO2 was measured continuously via metabolic cart, and rating of perceived exertion (RPE) was assessed at the end of each game level. The lowest %VO2max, kcal·min, and RPE occurred during the beginning step game and the highest values occurred during the intermediate hula game. Respiratory exchange ratio was significantly higher in the intermediate hula than beginning hula game but was not significantly different between step game levels. The intermediate hula and step games produced the greatest energy expenditure with an equivalent effect of a walking speed of >5.63 km·h (>3.5 miles·h). This is the first study to determine the percentage of VO2max and caloric expenditure elicited by different Wii Fit? video games at different game levels in adults. Findings suggest that the Wii Fit? can be used as an effective activity for promoting physical health in this population.     

Control of lateral weight transfer is associated with walking speed in individuals post-stroke

Restoring functional gait speed is an important goal for rehabilitation post-stroke. During walking, transferring of one’s body weight between the limbs and maintaining balance stability are necessary for independent functional gait. Although it is documented that individuals post-stroke commonly have difficulties with performing weight transfer onto their paretic limbs, it remains to be determined if these deficits contributed to slower walking speeds. The primary purpose of this study was to compare the weight transfer characteristics between slow and fast post-stroke ambulators. Participants (N = 36) with chronic post-stroke hemiparesis walked at their comfortable and maximal walking speeds on a treadmill. Participants were stratified into 2 groups based on their comfortable walking speeds (≥0.8 m/s or <0.8 m/s). Minimum body center of mass (COM) to center of pressure (COP) distance, weight transfer timing, step width, lateral foot placement relative to the COM, hip moment, peak vertical and anterior ground reaction forces, and changes in walking speed were analyzed. Results showed that slow walkers walked with a delayed and deficient weight transfer to the paretic limb, lower hip abductor moment, and more lateral paretic limb foot placement relative to the COM compared to fast walkers. In addition, propulsive force and walking speed capacity was related to lateral weight transfer ability. These findings demonstrated that deficits in lateral weight transfer and stability could potentially be one of the limiting factors underlying comfortable walking speeds and a determinant of chronic stroke survivors’ ability to increase walking speed.     

A Simple Exoskeleton That Assists Plantarflexion Can Reduce the Metabolic Cost of Human Walking

Background

Even though walking can be sustained for great distances, considerable energy is required for plantarflexion around the instant of opposite leg heel contact. Different groups attempted to reduce metabolic cost with exoskeletons but none could achieve a reduction beyond the level of walking without exoskeleton, possibly because there is no consensus on the optimal actuation timing. The main research question of our study was whether it is possible to obtain a higher reduction in metabolic cost by tuning the actuation timing.

Methodology/Principal Findings

We measured metabolic cost by means of respiratory gas analysis. Test subjects walked with a simple pneumatic exoskeleton that assists plantarflexion with different actuation timings. We found that the exoskeleton can reduce metabolic cost by 0.18±0.06 W kg⁻¹ or 6±2% (standard error of the mean) (p = 0.019) below the cost of walking without exoskeleton if actuation starts just before opposite leg heel contact.

Conclusions/Significance

The optimum timing that we found concurs with the prediction from a mathematical model of walking. While the present exoskeleton was not ambulant, measurements of joint kinetics reveal that the required power could be recycled from knee extension deceleration work that occurs naturally during walking. This demonstrates that it is theoretically possible to build future ambulant exoskeletons that reduce metabolic cost, without power supply restrictions.     

Mechanical and metabolic requirements for active lateral stabilization in human walking

Walking appears to be passively unstable in the lateral direction, requiring active feedback control for stability. The central nervous system may control stability by adjusting medio-lateral foot placement, but potentially with a metabolic cost. This cost increases with narrow steps and may affect the preferred step width. We hypothesized that external stabilization of the body would reduce the active control needed, thereby decreasing metabolic cost and preferred step width. To test these hypotheses, we provided external lateral stabilization, using springs pulling bilaterally from the waist, to human subjects walking on a force treadmill at 1.25 m/s. Ten subjects walked, with and without stabilization, at a prescribed step width of zero and also at their preferred step width. We measured metabolic cost using indirect calorimetry, and step width from force treadmill data. We found that at the prescribed zero step width, external stabilization resulted in a 33% decrease in step width variability (root-mean-square) and a 9.2% decrease in metabolic cost. In the preferred step width conditions, external stabilization caused subjects to prefer a 47% narrower step width, with a 32% decrease in step width variability and a 5.7% decrease in metabolic cost. These results suggest that (a). human walking requires active lateral stabilization, (b). body lateral motion is partially stabilized via medio-lateral foot placement, (c). active stabilization exacts a modest metabolic cost, and (d). humans avoid narrow step widths because they are less stable.