Gait patterns in COPD: the Rotterdam Study

Abstract

Gait disturbances in patients with chronic obstructive pulmonary disease (COPD) may lead to disability and falls. As studies assessing gait kinematics in COPD are sparse, we investigated associations of COPD with various gait domains and explored a potential link with falling.Gait was measured within the prospective, population-based Rotterdam Study (age ⩾55 years) using an electronic walkway and summarised into seven gait domains: Rhythm, Variability, Phases, Pace, Tandem, Turning and Base of Support. Rhythm is a temporal gait aspect that includes cadence and reflects how quickly steps are taken.Persons with COPD (n=196) exhibited worse Rhythm (−0.21 SD, 95% CI −0.36-−0.06 SD) compared with persons with normal lung function (n=898), independent of age, sex, height, education, smoking or analgesic use, especially when dyspnoea and severe airflow limitation or frequent exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D: −0.83 SD, 95% CI −1.25-−0.41 SD) were present. A lower forced expiratory volume in 1 s was associated with worse Rhythm and Pace, including lower cadence and gait velocity, respectively. Importantly, fallers with COPD had significantly worse Rhythm than nonfallers with COPD.This study demonstrates that persons with COPD exhibit worse Rhythm, especially fallers with COPD. The degree of Rhythm deterioration was associated with the degree of airflow limitation, symptoms and frequency of exacerbations. @ERSpublications This study comprehensively investigates, in a large, population-based cohort, the gait pattern in COPD http://ow.ly/HQbc3

Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review

“…A general pattern in patient with COPD is the reduction of stride length and cadence [ dence and speed were positively related with FEV1/FVC, and that their deterioration was associated with the degree of airflow limitation, symptoms and frequency of exacerbations [12]. Abnormalities in stride time were also observed during 6MWT, partially explaining the lower distance covered by patients with COPD in the test [27].…”

“…McCamley et al [25] and Yentes et al [22] did not find significant differences between groups, since they matched patients and controls in terms of walking speed, either a-priori or by covariate analysis. In addition, patients with COPD generally tend to reduce their stride (and step) length and cadence [12,23,26,27].…”

“…The sample size of patients with COPD ranged from 14 to 196 (mean age range: 64-75 years). Three papers [22,23,25] relied on traditional optical motion capture combined with force platforms to collect full-body three-dimensional kinematics and kinetics (joint angles, moments and powers); in the remaining papers, spatiotemporal parameters and dependent variables were obtained by means of electronic walkways [12,26], video analysis [24] or inertial units [27]. All studies required participants to walk at their self-selected walking speed, either over ground (6MWT) or on a treadmill.…”

“…As a consequence of such balance deficits, patients with COPD fall frequently [10][11][12][13]. This is a major health concern, since falling represents one of the main causes of pain, inactivity, disability, loss of functional independence and death in the elderly [14].…”

“…Gait changes are often too subtle to be detected only by clinical observations, and clinical gait analysis may be the best tool to predict fall onsets [12]. Thus, the assessment of kinematic and kinetic gait parameters enables to detect and qualify specific abnormalities and sudden sensorimotor postural deficiencies in patients with COPD, and in turn can contribute to prevent the consequences of falls [7].…”