Gait analysis in chronic heart failure

The calf as a locus of impaired walking capacity

Fausto A. Panizzolo, Andrew J. Maiorana, Louise H. Naylor, Lawrence Dembo, David G. Lloyd, Daniel J. Green, Jonas Rubenson

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Reduced walking capacity, a hallmark of chronic heart failure (CHF), is strongly correlated with hospitalization and morbidity. The aim of this work was to perform a detailed biomechanical gait analysis to better identify mechanisms underlying reduced walking capacity in CHF. Inverse dynamic analyses were conducted in CHF patients and age- and exercise level-matched control subjects on an instrumented treadmill at self-selected treadmill walking speeds and at speeds representing +20% and -20% of the subjects' preferred speed. Surprisingly, no difference in preferred speed was observed between groups, possibly explained by an optimization of the mechanical cost of transport in both groups (the mechanical cost to travel a given distance; J/kg/m). The majority of limb kinematics and kinetics were also similar between groups, with the exception of greater ankle dorsiflexion angles during stance in CHF. Nevertheless, over two times greater ankle plantarflexion work during stance and per distance traveled is required for a given triceps surae muscle volume in CHF patients. This, together with a greater reliance on the ankle compared to the hip to power walking in CHF patients, especially at faster speeds, may contribute to the earlier onset of fatigue in CHF patients. This observation also helps explain the high correlation between triceps surae muscle volume and exercise capacity that has previously been reported in CHF. Considering the key role played by the plantarflexors in powering walking and their association with exercise capacity, our findings strongly suggest that exercise-based rehabilitation in CHF should not omit the ankle muscle group.

Original languageEnglish (US)
Pages (from-to)3719-3725
Number of pages7
JournalJournal of Biomechanics
Volume47
Issue number15
DOIs
StatePublished - Nov 28 2014

Fingerprint

Gait analysis
Gait
Walking
Heart Failure
Ankle
Muscle
Exercise equipment
Exercise
Muscles
Costs and Cost Analysis
Exercise Therapy
Biomechanical Phenomena
Patient rehabilitation
Fatigue
Hip
Costs
Kinematics
Hospitalization
Extremities
Fatigue of materials

All Science Journal Classification (ASJC) codes

  • Biophysics
  • Orthopedics and Sports Medicine
  • Biomedical Engineering
  • Rehabilitation

Cite this

Panizzolo, F. A., Maiorana, A. J., Naylor, L. H., Dembo, L., Lloyd, D. G., Green, D. J., & Rubenson, J. (2014). Gait analysis in chronic heart failure: The calf as a locus of impaired walking capacity. Journal of Biomechanics, 47(15), 3719-3725. https://doi.org/10.1016/j.jbiomech.2014.09.015
Panizzolo, Fausto A. ; Maiorana, Andrew J. ; Naylor, Louise H. ; Dembo, Lawrence ; Lloyd, David G. ; Green, Daniel J. ; Rubenson, Jonas. / Gait analysis in chronic heart failure : The calf as a locus of impaired walking capacity. In: Journal of Biomechanics. 2014 ; Vol. 47, No. 15. pp. 3719-3725.
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Panizzolo, FA, Maiorana, AJ, Naylor, LH, Dembo, L, Lloyd, DG, Green, DJ & Rubenson, J 2014, 'Gait analysis in chronic heart failure: The calf as a locus of impaired walking capacity', Journal of Biomechanics, vol. 47, no. 15, pp. 3719-3725. https://doi.org/10.1016/j.jbiomech.2014.09.015

Gait analysis in chronic heart failure : The calf as a locus of impaired walking capacity. / Panizzolo, Fausto A.; Maiorana, Andrew J.; Naylor, Louise H.; Dembo, Lawrence; Lloyd, David G.; Green, Daniel J.; Rubenson, Jonas.

In: Journal of Biomechanics, Vol. 47, No. 15, 28.11.2014, p. 3719-3725.

Research output: Contribution to journalArticle

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T2 - The calf as a locus of impaired walking capacity

AU - Panizzolo, Fausto A.

AU - Maiorana, Andrew J.

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AU - Dembo, Lawrence

AU - Lloyd, David G.

AU - Green, Daniel J.

AU - Rubenson, Jonas

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AB - Reduced walking capacity, a hallmark of chronic heart failure (CHF), is strongly correlated with hospitalization and morbidity. The aim of this work was to perform a detailed biomechanical gait analysis to better identify mechanisms underlying reduced walking capacity in CHF. Inverse dynamic analyses were conducted in CHF patients and age- and exercise level-matched control subjects on an instrumented treadmill at self-selected treadmill walking speeds and at speeds representing +20% and -20% of the subjects' preferred speed. Surprisingly, no difference in preferred speed was observed between groups, possibly explained by an optimization of the mechanical cost of transport in both groups (the mechanical cost to travel a given distance; J/kg/m). The majority of limb kinematics and kinetics were also similar between groups, with the exception of greater ankle dorsiflexion angles during stance in CHF. Nevertheless, over two times greater ankle plantarflexion work during stance and per distance traveled is required for a given triceps surae muscle volume in CHF patients. This, together with a greater reliance on the ankle compared to the hip to power walking in CHF patients, especially at faster speeds, may contribute to the earlier onset of fatigue in CHF patients. This observation also helps explain the high correlation between triceps surae muscle volume and exercise capacity that has previously been reported in CHF. Considering the key role played by the plantarflexors in powering walking and their association with exercise capacity, our findings strongly suggest that exercise-based rehabilitation in CHF should not omit the ankle muscle group.

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Panizzolo FA, Maiorana AJ, Naylor LH, Dembo L, Lloyd DG, Green DJ et al. Gait analysis in chronic heart failure: The calf as a locus of impaired walking capacity. Journal of Biomechanics. 2014 Nov 28;47(15):3719-3725. https://doi.org/10.1016/j.jbiomech.2014.09.015