Neurological Sciences

, Volume 33, Issue 4, pp 779–784 | Cite as

Energy cost of spontaneous walking in Parkinson’s disease patients

  • Martina A. Maggioni
  • Arsenio Veicsteinas
  • Susanna Rampichini
  • Emiliano Cè
  • Raffaello Nemni
  • Giulio Riboldazzi
  • Giampiero Merati
Original Article

Abstract

In healthy subjects, comfortable walking minimizes the energy cost (Ec) of locomotion. In Parkinson’s disease (PD) patients walking is slower than in healthy subjects: this may increase Ec. Our aims were to analyze gait and Ec in PD patients during walking, particularly at self-selected speed, and the possible pathological, mechanical, and cardiorespiratory limitations. Fourteen mild-to-moderate PD and 14 control subjects were enrolled. Subjects underwent 5-min walking tests at two speeds: self-selected and as-fast-as-possible speeds. Cardiopulmonary and gait parameters (heart rate, ventilation, gas exchanges, step count) were recorded. Velocity was reduced in PD compared to control subjects at both speeds (P < 0.05), and PD patients had shorter strides (P < 0.05) at both speeds and reduced cadence (P = 0.01) at fastest speed. No significant difference was found in Ec at self-selected (0.12 ± 0.04 versus 0.11 ± 0.02 mLO2 kg−1 m−1 in PD and control subjects, respectively) and maximal (0.14 ± 0.03 versus 0.15 ± 0.02  mLO2 kg−1 m−1 in PD and control subjects, respectively) speed. However, the Ec increment from self-selected to fastest velocity was significantly lower (P = 0.02) in PD patients. PD patients failed to walk at a self-selected speed, which minimizes the Ec. This could be mainly due to the inability to develop a wider stride. Cardiorespiratory adaptation was not affected, except for the possible reduced cardiac adaptation observed in some (28%) cases. Presumably, rehabilitation procedures that improve flexibility and step length may help maintain walking ability.

Keywords

Parkinson’s disease Gait Spontaneous walking Oxygen consumption Efficiency Clinical scores 

References

  1. 1.
    Canning CG, Ada L, Johnson JJ, McWhirter S (2006) Walking capacity in mild to moderate Parkinson’s disease. Arch Phys Med Rehabil 87:371–375PubMedCrossRefGoogle Scholar
  2. 2.
    Gomez-Esteban JC, Zarranz JJ, Lezcano E, Tijero B, Luna A, Velasco F, Rouco I, Garamendi I (2007) Influence of motor symptoms upon the quality of life of patients with Parkinson’s disease. Eur Neurol 57:161–165PubMedCrossRefGoogle Scholar
  3. 3.
    Morris ME, Huxham F, McGinley J, Dodd K, Iansek R (2001) The biomechanics and motor control of gait in Parkinson disease. Clin Biomech 16:459–470CrossRefGoogle Scholar
  4. 4.
    Sofuwa O, Nieuwboer A, Desloovere K, Willems AM, Chavret F, Jonkers I (2005) Quantitative gait analysis in Parkinson’s disease: comparison with a healthy control group. Arch Phys Med Rehabil 86:1007–1013PubMedCrossRefGoogle Scholar
  5. 5.
    Winogrodzka A, Wagenaar RC, Booij J, Wolters EC (2005) Rigidity and bradykinesia reduce interlimb coordination in Parkinsonian gait. Arch Phys Med Rehabil 86:183–189PubMedCrossRefGoogle Scholar
  6. 6.
    Protas EJ, Stanley RK, Jankovic J, MacNeill B (1996) Cardiovascular and metabolic responses to upper- and lower-extremity exercise in men with idiopathic Parkinson’s disease. Phys Ther 76:34–40PubMedGoogle Scholar
  7. 7.
    Stanley RK, Protas EJ, Jankovic J (1999) Exercise performance in those having Parkinson’s disease and healthy normals. Med Sci Sports Exerc 31:761–766PubMedCrossRefGoogle Scholar
  8. 8.
    Christiansen CL, Schenkman ML, McFann K, Wolfe P, Kohrt WM (2009) Walking economy in people with Parkinson’s disease. Mov Disord 24:1481–1487PubMedCrossRefGoogle Scholar
  9. 9.
    Pelosin E, Faelli E, Lofrano F, Avanzino L, Marinelli L, Bove M, Ruggeri P, Abbruzzese G (2009) Effects of treadmill training on walking economy in Parkinson’s disease: a pilot study. Neurol Sci 30:499–504PubMedCrossRefGoogle Scholar
  10. 10.
    Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56:33–39PubMedCrossRefGoogle Scholar
  11. 11.
    Goetz CG, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stebbins GT, Stern MB, Tilley BC, Dodel R, Dubois B, Holloway R, Jankovic J, Kuliseversusky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, Van Hilten JJ, LaPelle N (2007) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan. Mov Disord 22:41–47PubMedCrossRefGoogle Scholar
  12. 12.
    Goetz CG, Poewe W, Rascol O, Sampaio C, Stebbins GT, Counsell C, Giladi N, Holloway RG, Moore CG, Wenning GK, Yahr MD, Seidl L (2004) Movement Disorder Society Task Force Report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord 19:1020–1028PubMedCrossRefGoogle Scholar
  13. 13.
    Tanaka H, Monahan KD, Seals DR (2001) Age-predicted maximal heart rate revisited. J Am Coll Cardiol 37:153–156PubMedCrossRefGoogle Scholar
  14. 14.
    Margaria R (1976) Biomechanics and energetics of muscular exercise. Clarendon Press, OxfordGoogle Scholar
  15. 15.
    Musshoff K, Reindell H, STEIM H, Konig K (1959) Oxygen absorption per heart beat (oxygen pulse) as a function of stroke volume, arteriovenous difference, minute volume and heart volume. Z Kreislaufforsch 48:255–277PubMedGoogle Scholar
  16. 16.
    Canning CG, Alison JA, Allen NE, Groeller H (1997) Parkinson’s disease: an investigation of exercise capacity, respiratory function, and gait. Arch Phys Med Rehabil 78:199–207PubMedCrossRefGoogle Scholar
  17. 17.
    Alexander NB, Dengel DR, Olson RJ, Krajewski KM (2003) Oxygen-uptake (VO2) kinetics and functional mobility performance in impaired older adults. J Gerontol A Biol Sci Med Sci 58:734–739PubMedCrossRefGoogle Scholar
  18. 18.
    Haas BM, Trew M, Castle PC (2004) Effects of respiratory muscle weakness on daily living function, quality of life, activity levels, and exercise capacity in mild to moderate Parkinson’s disease. Am J Phys Med Rehabil 83:601–607PubMedCrossRefGoogle Scholar
  19. 19.
    Mian OS, Thom JM, Ardigo LP, Narici MV, Minetti AE (2006) Metabolic cost, mechanical work, and efficiency during walking in young and older men. Acta Physiol 186:127–139CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Martina A. Maggioni
    • 1
  • Arsenio Veicsteinas
    • 1
    • 2
  • Susanna Rampichini
    • 1
  • Emiliano Cè
    • 1
    • 2
  • Raffaello Nemni
    • 3
  • Giulio Riboldazzi
    • 4
  • Giampiero Merati
    • 1
    • 2
  1. 1.Department of Sport, Nutrition and Health SciencesUniversity of MilanMilanItaly
  2. 2.Centre of Sports Medicine Don C. Gnocchi FoundationMilanItaly
  3. 3.Centre of Neurology Don C. Gnocchi FoundationMilanItaly
  4. 4.Parkinson’s Disease and Movement Disorders’ CentreOspedale di CircoloVareseItaly

Personalised recommendations