Physical strain of walking in people with neuromuscular diseases is high and relates to step activity in daily life
DOI:
https://doi.org/10.2340/jrm.v56.40026Keywords:
neuromuscular disorders, activities of daily living, physical exertion, exercise test, physical therapyAbstract
Objective: To determine the physical strain of walking and assess its relationship with daily steps and intensity of daily activity in people with neuromuscular diseases.
Design: Cross-sectional study.
Subjects/patients: Sixty-one adults with neuromuscular diseases.
Methods: Physical strain of walking, defined as oxygen consumption during comfortable walking relative to peak oxygen uptake. Daily step count and daily time spent in moderate and vigorous physical activity were assessed using accelerometry and heart rate measurements, respectively. Regression analyses assessed the relationships between log daily step count and log daily time spent in moderate and vigorous physical activity, and physical strain of walking.
Results: The mean (standard deviation) physical strain of walking was 73 (20)% Log daily step count and physical strain were negatively associated (β = –0.47). No association was found with log daily time spent in moderate and vigorous physical activity.
Conclusions: The highly increased physical strain of comfortable walking indicates that walking is very demanding for people with neuromuscular diseases and is associated with a reduction in daily step activity. The absence of a relationship between intensity of activities and physical strain indicates that, despite a reduction in daily step activity, strenuous daily activities may still be performed.
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References
Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2012; 2: 1143–1211.
https://doi.org/10.1002/cphy.c110025 DOI: https://doi.org/10.1002/cphy.c110025
Phillips M, Flemming N, Tsintzas K. An exploratory study of physical activity and perceived barriers to exercise in ambulant people with neuromuscular disease compared with unaffected controls. Clin Rehabil 2009; 23: 746–755.
https://doi.org/10.1177/0269215509334838 DOI: https://doi.org/10.1177/0269215509334838
McDonald CM. Physical activity, health impairments, and disability in neuromuscular disease. Am J Phys Med Rehabil 2002; 81: S108–120.
https://doi.org/10.1097/00002060-200211001-00012 DOI: https://doi.org/10.1097/00002060-200211001-00012
Winberg C, Flansbjer UB, Rimmer JH, Lexell J. Relationship between physical activity, knee muscle strength, and gait performance in persons with late effects of polio. PM R 2015; 7: 236–244.
https://doi.org/10.1016/j.pmrj.2014.09.005 DOI: https://doi.org/10.1016/j.pmrj.2014.09.005
Féasson L, Camdessanché JP, El Mandhi L, Calmels P, Millet GY. Fatigue and neuromuscular diseases. Ann Readapt Med Phys 2006; 49: 289–300.
https://doi.org/10.1016/j.annrmp.2006.04.015 DOI: https://doi.org/10.1016/j.annrmp.2006.04.015
Jensen MP, Abresch RT, Carter GT, McDonald CM. Chronic pain in persons with neuromuscular disease. Arch Phys Med Rehabil 2005; 86: 1155–1163.
https://doi.org/10.1016/j.apmr.2004.11.028 DOI: https://doi.org/10.1016/j.apmr.2004.11.028
Andries A, Van Walsem MR, Ørstavik K, Frich JC. Functional ability and physical activity in hereditary neuromuscular diseases. J Neuromuscul Dis 2022; 9: 437–446.
https://doi.org/10.3233/JND-210677 DOI: https://doi.org/10.3233/JND-210677
Winberg C, Brogårdh C, Flansbjer UB, Carlsson G, Rimmer J, Lexell J. Physical activity and the association with self-reported impairments, walking limitations, fear of falling, and incidence of falls in persons with late effects of polio. J Aging Phys Act 2015; 23: 425–432.
https://doi.org/10.1123/japa.2014-0163 DOI: https://doi.org/10.1123/japa.2014-0163
Anens E, Emtner M, Hellström K. Exploratory study of physical activity in persons with Charcot-Marie-Tooth disease. Arch Phys Med Rehabil 2015; 96: 260–268.
https://doi.org/10.1016/j.apmr.2014.09.013 DOI: https://doi.org/10.1016/j.apmr.2014.09.013
Slaman J, Bussmann J, van der Slot WM, Stam HJ, Roebroeck ME, van den Berg-Emons RJ. Transition and Lifespan Research Group South West Nether-lands. Physical strain of walking relates to activity level in adults with cerebral palsy. Arch Phys Med Rehabil 2013; 94: 896–901.
https://doi.org/10.1016/j.apmr.2012.11.005 DOI: https://doi.org/10.1016/j.apmr.2012.11.005
Oorschot S, Brehm MA, Daams J, Nollet F, Voorn EL. Efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases: a systematic review and meta-analysis. Ann Phys Rehabil Med 2023; 66: 101637.
https://doi.org/10.1016/j.rehab.2022.101637 DOI: https://doi.org/10.1016/j.rehab.2022.101637
Wiesinger GF, Quittan M, Nuhr M, Volc-Platzer B, Ebenbichler G, Zehetgruber M, et al. Aerobic capacity in adult dermatomyositis/polymyositis patients and healthy controls. Arch Phys Med Rehabil 2000; 81: 1–5.
https://doi.org/10.1016/s0003-9993(00)90212-0 DOI: https://doi.org/10.1016/S0003-9993(00)90212-0
Brehm MA, Nollet F, Harlaar J. Energy demands of walking in persons with postpoliomyelitis syndrome: relationship with muscle strength and reproduci-bility. Arch Phys Med Rehabil 2006; 87: 136–140.
https://doi.org/10.1016/j.apmr.2005.08.123 DOI: https://doi.org/10.1016/j.apmr.2005.08.123
Gait Analysis: Normal and pathological function. J Sports Sci Med 2010; 9: 353.
Ploeger HE, Bus SA, Nollet F, Brehm MA. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait Posture 2017; 58: 146–153.
https://doi.org/10.1016/j.gaitpost.2017.07.107 DOI: https://doi.org/10.1016/j.gaitpost.2017.07.107
Brehm MA, Verduijn S, Bon J, Bredt N, Nollet F. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 732–737.
https://doi.org/10.2340/16501977-2264 DOI: https://doi.org/10.2340/16501977-2264
Nollet F, Beelen A, Sargeant AJ, de Visser M, Lankhorst GJ, de Jong BA. Submaximal exercise capacity and maximal power output in polio subjects. Arch Phys Med Rehabil 2001; 82: 1678–1685.
https://doi.org/10.1053/apmr.2001.27390 DOI: https://doi.org/10.1053/apmr.2001.27390
Blokland I, Gravesteijn A, Busse M, Groot F, van Bennekom C, van Dieen J, et al. The relationship between relative aerobic load, energy cost, and speed of walking in individuals post-stroke. Gait Posture 2021; 89: 193–199.
https://doi.org/10.1016/j.gaitpost.2021.07.012 DOI: https://doi.org/10.1016/j.gaitpost.2021.07.012
Wezenberg D, van der Woude LH, Faber WX, de Haan A, Houdijk H. Relation between aerobic capacity and walking ability in older adults with a lower-limb amputation. Arch Phys Med Rehabil 2013; 94: 1714–1720.
https://doi.org/10.1016/j.apmr.2013.02.016 DOI: https://doi.org/10.1016/j.apmr.2013.02.016
Apabhai S, Gorman GS, Sutton L, Elson JL, Plötz T, Turnbull DM, et al. Habitual physical activity in mitochondrial disease. PLoS One 2011; 6: e22294.
https://doi.org/10.1371/journal.pone.0022294 DOI: https://doi.org/10.1371/journal.pone.0022294
Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54: 1451–1462.
https://doi.org/10.1136/bjsports-2020-102955 DOI: https://doi.org/10.1136/bjsports-2020-102955
MacIntosh BR, Murias JM, Keir DA, Weir JM. What is moderate to vigorous exercise intensity? Front Physiol 2021; 12: 682233.
https://doi.org/10.3389/fphys.2021.682233 DOI: https://doi.org/10.3389/fphys.2021.682233
Winberg C, Flansbjer UB, Carlsson G, Rimmer J, Lexell J. Physical activity in persons with late effects of polio: a descriptive study. Disabil Health J 2014; 7: 302–308.
https://doi.org/10.1016/j.dhjo.2014.02.003 DOI: https://doi.org/10.1016/j.dhjo.2014.02.003
Andersen LK, Vissing J. Habitual physical activity in patients with myasthenia gravis assessed by accelerometry and questionnaire. J Neuromuscul Dis 2022; 9: 161–169.
https://doi.org/10.3233/JND-210693 DOI: https://doi.org/10.3233/JND-210693
Ramdharry GM, Pollard AJ, Grant R, Dewar EL, Laurá M, Moore SA, et al. A study of physical activity comparing people with Charcot-Marie-Tooth dise-ase to normal control subjects. Disabil Rehabil 2017; 39: 1753–1758.
https://doi.org/10.1080/09638288.2016.1211180 DOI: https://doi.org/10.1080/09638288.2016.1211180
Knak KL, Sheikh AM, Witting N, Vissing J. Physical activity in myotonic dystrophy type 1. J Neurol 2020; 267: 1679–1686.
https://doi.org/10.1007/s00415-020-09758-8 DOI: https://doi.org/10.1007/s00415-020-09758-8
Oorschot S, Brehm MA, van Groenestijn AC, Koopman FS, Verhamme C, Eftimov F, et al. Efficacy of a physical activity programme combining individu-alized aerobic exercise and coaching to improve physical fitness in neuromuscular diseases (I’M FINE): study protocol of a randomized controlled trial. BMC Neurol 2020; 20: 184.
https://doi.org/10.1186/s12883-020-01725-0 DOI: https://doi.org/10.1186/s12883-020-01725-0
Ferguson B. ACSM’s Guidelines for exercise testing and prescription. 9th ed. J Can Chiropr Assoc 2014; 58: 328.
Compston A. Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty’s Stat-ionery Office: 1942; pp. 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O’Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 Figures. Brain 2010; 133: 2838–2844.
https://doi.org/10.1093/brain/awq270 DOI: https://doi.org/10.1093/brain/awq270
Rietjens GJ, Kuipers H, Kester AD, Keizer HA. Validation of a computerized metabolic measurement system (Oxycon-Pro) during low and high intensity exercise. Int J Sports Med 2001; 22: 291–294.
https://doi.org/10.1055/s-2001-14342 DOI: https://doi.org/10.1055/s-2001-14342
Dallmeijer AJ, Brehm MA. Physical strain of comfortable walking in children with mild cerebral palsy. Disabil Rehabil 2011; 33: 1351–1357.
https://doi.org/10.3109/09638288.2010.531374 DOI: https://doi.org/10.3109/09638288.2010.531374
Brehm MA, Ploeger HE, Nollet F. Self-reported functional ambulation is related to physical mobility status in polio survivors: a cross-sectional observat-ional study. Ann Phys Rehabil Med 2021; 64: 101428.
https://doi.org/10.1016/j.rehab.2020.06.007 DOI: https://doi.org/10.1016/j.rehab.2020.06.007
Horemans HL, Bussmann JB, Beelen A, Stam HJ, Nollet F. Walking in postpoliomyelitis syndrome: the relationships between time-scored tests, walking in daily life and perceived mobility problems. J Rehabil Med 2005; 37: 142–146.
https://doi.org/10.1080/16501970410021526 DOI: https://doi.org/10.1080/16501970410021526
van der Steeg GE, Takken T. Reference values for maximum oxygen uptake relative to body mass in Dutch/Flemish subjects aged 6–65 years: the LowLands Fitness Registry. Eur J Appl Physiol 2021; 121: 1189–1196.
https://doi.org/10.1007/s00421-021-04596-6 DOI: https://doi.org/10.1007/s00421-021-04596-6
Waters RL, Lunsford BR, Perry J, Byrd R. Energy–speed relationship of walking: standard tables. J Orthop Res 1988; 6: 215–222.
https://doi.org/10.1002/jor.1100060208 DOI: https://doi.org/10.1002/jor.1100060208
Menotti F, Felici F, Damiani A, Mangiola F, Vannicelli R, Macaluso A. Charcot-Marie-Tooth 1A patients with low level of impairment have a higher energy cost of walking than healthy individuals. Neuromuscul Disord 2011; 21: 52–57.
https://doi.org/10.1016/j.nmd.2010.09.008 DOI: https://doi.org/10.1016/j.nmd.2010.09.008
Waterval NFJ, Brehm MA, Harlaar J, Nollet F. Description of orthotic properties and effect evaluation of ankle–foot orthoses in non-spastic calf muscle weakness. J Rehabil Med 202018; 52: jrm00026.
https://doi.org/10.2340/16501977–2642 DOI: https://doi.org/10.2340/16501977-2642
Shephard RJ. Tests of maximum oxygen intake: a critical review. Sports Med 1984; 1: 99–124.
https://doi.org/10.2165/00007256-198401020-00002 DOI: https://doi.org/10.2165/00007256-198401020-00002
Ngueleu AM, Barthod C, Best KL, Routhier F, Otis M, Batcho CS. Criterion validity of ActiGraph monitor-ing devices for step counting and distance measurement in adults and older adults: a systematic re-view. J Neuroeng Rehabil 2022; 19: 112.
https://doi.org/10.1186/s12984-022-01085-5 DOI: https://doi.org/10.1186/s12984-022-01085-5
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