Elsevier

Gait & Posture

Volume 47, June 2016, Pages 86-91
Gait & Posture

Effects of leg muscle fatigue on gait in patients with Parkinson's disease and controls with high and low levels of daily physical activity

https://doi.org/10.1016/j.gaitpost.2016.04.002Get rights and content

Highlights

  • Patients with PD and healthy individuals seek to improve balance and safety after fatigue.

  • The gait adjustments after muscle fatigue were less pronounced in patients with PD.

  • The physical activity level did not interact with lower limb muscle fatigue.

Abstract

Patients with Parkinson's disease (PD) are more susceptible to muscle fatigue, which can damage their gait. Physical activity can improve muscle condition, which is an important aspect during walking. The aim of this study was to analyze the effects of lower limb muscle fatigue on gait in patients with PD and healthy individuals, grouped according to physical activity level. Twenty Patients with PD (PD group) and 20 matched individuals (control group) were distributed according to physical activity level into four subgroups of ten individuals (active and inactive). Participants performed three walking trials before and after lower limb muscle fatigue, induced by a repeated sit-to-stand task on a chair. Kinematic (stride length, width, duration, velocity and percentage of time in double support) and kinetic (propulsive and breaking anterior–posterior and medio-lateral impulse) gait parameters were analyzed. In both groups, participants increased stride length and velocity and decreased stride duration and braking vertical impulse after lower limb muscle fatigue. The PD groups presented higher step width and percentage of double time support than the control groups before muscle fatigue. The control groups increased step width and decreased percentage of time in double support, while the PD groups did not change these parameters. For physical activity level, active individuals presented longer stride length, greater stride velocity, higher braking and propulsive anterior–posterior impulse and shorter step width than inactive individuals. Groups sought more balance and safety after lower limb muscle fatigue. Physical activity level does not appear to modify the effects of lower limb muscle fatigue during unobstructed walking in individuals with PD or controls.

Introduction

The general increase in human life expectancy coincides with an increase in the number of people with chronic diseases, such as Parkinson's disease (PD). Patients with PD present several motor and non-motor impairments [1], including a higher perception of fatigue than age-matched controls [2]. The exacerbated perception of fatigue is caused by musculoskeletal and neurophysiological impairments associated with PD, particularly resulting from altered norepinephrine and serotonin production due to degeneration of neurons of the raphe nuclei and locus coeruleus [1], [3]. However, little is known about the effects of fatigue on movement in patients with PD. Previous studies indicate that gait is affected by fatigue in an age-dependent manner [4]. Gait adjustments with muscle fatigue are more pronounced in individuals over 40 years of age than in younger individuals. These adjustments appear to be aimed at maintaining adequate control of balance in the fatigued condition [4]. It is conceivable that individuals with PD demonstrate even more pronounced gait adjustments, since patients with PD present deficits in muscle strength and motor control [5].

Muscle fatigue could be expected to affect gait less in individuals with higher physical activity levels, due to their better neuromuscular and cardiovascular condition [6], which influences the process of muscle fatigue development [7]. However, the effects of muscle fatigue on gait in young adults are not dependent on their physical activity level [8]. This might be due to young adults having substantial remaining capacity to deal with the limited balance threat of normal unperturbed gait even with substantial muscle fatigue. Thus, whether this is generalized to older and diseased populations is unknown. Regular physical activity improves functional capacity [9] and walking ability [10] in patients with PD and likely slows down fatigue development, but whether it improves their gait in a fatigued state is unknown.

Therefore, the aim of the present study was to analyze the effects of lower limb muscle fatigue on gait in patients with PD and in healthy individuals, grouped according to physical activity level. We expected that patients with PD would be more affected by lower limb muscle fatigue than healthy controls. In addition, we hypothesized that both groups would improve anterior–posterior and medio-lateral balance control after lower limb muscle fatigue. Furthermore, we hypothesized that there would be an interaction between lower limb muscle fatigue and physical activity level, with greater effects of muscle fatigue on gait parameters in inactive participants of both groups.

Section snippets

Participants

After signing the informed consent, forty subjects participated in the study which had been approved by the local ethics committee (#3083/2011); 20 individuals with PD (PD group), according to the UK Brain Bank Criteria [11], and 20 neurologically healthy matched-individuals (control group). Individuals were included if they met the following inclusion criteria: (i) independently living in the community, able to walk without the use of any aids, not presenting balance or vision disorders (to

Groups characteristics

The characteristics of each group, score in physical activity level and time to fatigue of the lower limb muscles are presented in Table 1. There was no difference between the PD and control groups for physical activity level (active: p < 0.90 and inactive: p < 0.61). For the time to fatigue of the lower limb muscles, the ANOVA indicated main effects of group (F1,36 = 17.34, p < 0.001) and physical activity level (F1,36 = 14.48, p < 0.001), and an interaction between group and physical activity level (F1,36

Discussion

The aim of this study was to analyze the effects of lower limb muscle fatigue on gait in patients with PD and neurologically healthy individuals according to their physical activity level. Lower limb muscle fatigue caused adjustments in gait parameters in both the PD and control groups, which was in agreement in part with our hypothesis. However, in contrast with our expectations, the PD group did not demonstrate stronger effects of lower limb muscle fatigue; instead the gait changes were

Conflict of interest statement

None declared.

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