Elderly pedestrians often report difficulty completing crossings in the time estimated by traffic lights, and reduced walking speed while commuting may be associated with negative health outcomes. It ...is also worth highlighting the scarcity of Brazilian studies, which reinforces the need for investigations aimed at this topic of interest.
To analyze the gait speed of community-dwelling elderly; to verify the association of socioeconomic, clinical and health factors, considering the regulated crossing time on roads with pedestrian traffic lights and alternative cutoff points for walking speed.
A cross-sectional study was conducted with 411 elderly people (70.15±7.25 years old) from Macapá, Amapá. Socioeconomic, clinical and health variables were collected using a structured form. Walking speed was assessed using the usual walking speed test, which is among the Short Physical Performance Battery (SPPB) tests (time to walk 4 meters). For the analysis of the established time (<1.2 m/s) for crossing roads with traffic lights for pedestrians, data consulted from the city's traffic departments and alternative cutoff points (<1.1 m/s; <1 .0 m/s and 0.9 m/s). Data were analyzed using descriptive and inferential statistics from the binary logistic regression model (p<0.05 and 95%CI).
The mean walking speed time was 0.99±0.29 m/s. A total of 123 traffic lights were recorded in the city of Macapá, of which (56.1%) are pedestrian traffic lights; most roads (87.8%) do not have indications for crossing; 52% do not have a crosswalk demarcated on the road; and 80.5% do not have lowering or adaptation of the track at the crossing point. Most of the elderly (76.4%) presented a walking speed lower than the crossing time established by the regulation of roads with traffic lights for pedestrians (<1.2 m/s); and when considering alternative cutoff points, it remained unfavorable for most elderly people, except for the <0.9m/s classification. The logistic regression model indicated that elderly women, those of advanced age, with dependence for instrumental activities of daily living and with reduced muscle strength probably walk for less time than established by the traffic department (<1.2 m/s) and at alternative cutoff points.
The current weather pattern does not promote safety and exposes the elderly population to risks when crossing roads with traffic lights. The implementation of a time standard that considers the specificities of the elderly population in this city becomes fundamental.
Through the data obtained from this study, it will be possible to suggest a revision of the standards established for carrying out crossings in order to consider the specificities of the elderly population, as well as to favor their insertion safely in the place where they live, providing conditions that allow their autonomy and integration into society.
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Physical fitness training for stroke patients Saunders, David H; Sanderson, Mark; Hayes, Sara ...
Cochrane database of systematic reviews,
03/2020, Volume:
2020, Issue:
3
Journal Article
Peer reviewed
Open access
Background
Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function.
...Objectives
The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function.
Search methods
In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field.
Selection criteria
Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non‐exercise intervention in stroke survivors.
Data collection and analysis
Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random‐effects meta‐analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses.
Main results
We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants).
Death was not influenced by any intervention; risk differences were all 0.00 (low‐certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow‐up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate‐certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low‐certainty evidence). There were too few data to assess the effects of resistance training on disability.
Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention‐specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate‐certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow‐up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons.
Authors' conclusions
Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post‐stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under‐investigated despite being a key outcome of interest for patients. Further well‐designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long‐term benefits.
Locomotion is the most common form of movement in nature. Its study allows analysis of interactions between muscle functions (motor) and lever system arrangements (transmission), thereby facilitating ...performance analysis of various body organs and systems. Thus, it is a powerful model to study various aspects of integrative physiology. The results of this model can be applied in understanding body functions and design principles as performance outputs of interest for medical and biological sciences. The overall efficiency (
) during locomotion is an example of an integrative parameter, which results from the ratio between mechanical output and metabolic input. Although the concepts of cost (i.e., metabolic expenditure relative to distance) and power (i.e., metabolic expenditure relative to time) are included in its calculation, the
establishes peculiar relations with these variables. For a better approach to these aspects, in this study, we presented the physical-mathematical formulation of efficiency, as well as its conceptual definitions and applications. Furthermore, the concepts of efficiency, cost, and power are discussed from the biological and medical perspectives. Terrestrial locomotion is a powerful model to study integrative physiology in humans, because by analyzing the mechanical and metabolic determinants, we may verify the efficiency and economy relationship through locomotion type, and its characteristics and restrictions. Thus, it is possible to elaborate further on various improved intervention strategies, such as physical training, competition strategies, and ergogenic supplementation.
Human body measurement data related to walking can characterize functional movement and thereby become an important tool for health assessment. Single-camera-captured two-dimensional (2D) image ...sequences of marker-less walking individuals might be a simple approach for estimating human body measurement data which could be used in walking speed-related health assessment. Conventional body measurement data of 2D images are dependent on body-worn garments (used as segmental markers) and are susceptible to changes in the distance between the participant and camera in indoor and outdoor settings. In this study, we propose five ratio-based body measurement data that can be extracted from 2D images and can be used to classify three walking speeds (i.e., slow, normal, and fast) using a deep learning-based bidirectional long short-term memory classification model. The results showed that average classification accuracies of 88.08% and 79.18% could be achieved in indoor and outdoor environments, respectively. Additionally, the proposed ratio-based body measurement data are independent of body-worn garments and not susceptible to changes in the distance between the walking individual and camera. As a simple but efficient technique, the proposed walking speed classification has great potential to be employed in clinics and aged care homes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Walking speed strongly correlates with health outcomes, making accurate assessment essential for clinical evaluations. However, assessments tend to be conducted over short distances, often in a ...laboratory or clinical setting, and may not capture natural walking behavior. To address this gap, the following questions are investigated in this work: Is walking speed significantly influenced by the continuity and duration of a walking bout? Can preferred walking speed be inferred by grouping walking bouts using duration and continuity?
We collected two weeks of continuous data from fifteen healthy young adults using a thigh-worn accelerometer and a heart rate monitor. Walking strides were identified and grouped into walking periods. We quantified the duration and the continuity of each walking period. Continuity is used to parameterize changes in stepping rate related to pauses during a bout of walking. Finally, we analyzed the influence of duration and continuity on estimates of stride speed, and examined how the distribution of walking speed varies depending on different walking modes (defined by duration and continuity).
We found that continuity and duration can be used to explain some of the variability in real-world walking speed (p<0.001). Speeds estimated from long continuous walks with many strides (42% of all recorded strides) had the lowest standard deviation. Walking speed during these bouts was 1.41ms−1 (SD = 0.26ms−1).
Walking behavior in the real world is largely variable. Features of real-world walks, like duration and continuity, can be used to explain some of the variability observed in walking speed. As such, we recommend using long continuous walks to confidently isolate the preferred walking behavior of an individual.
•Walking speed varied significantly with duration and continuity.•Long continuous walks may best capture preferred walking speed.•Real-world walking data can be parsed using the framework herein.•This framework can be extended for persistent monitoring of clinical populations.
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An effective evacuation model can steer passengers from unsafe zones to safety in a time-sensitive manner on passenger ships. The International Maritime Organization highly recommends constructing ...robust evacuation models rooted in understanding human behavior and ship design. This study addresses the challenge by focusing on walking speed, a key determinant of human behavior, the capacity of transitional points (e.g., exit stairs), and the distance of passengers to the exit stairs for a safe and rapid evacuation. This study presents a multi-period human evacuation model aimed at optimizing the evacuation time of the slowest passenger, identifying the optimal number of stairs, and planning route evacuation under passenger walking speed uncertainty affected by the heeling angle for a deck of a passenger ship.
A robust optimization approach is also employed to manage uncertainty by defining uncertainty sets for passengers’ walking speeds. The computation of the price of robustness spans various test problems at various levels of conservatism. This research offers multiple managerial implications for maritime industry leaders, paving the way for more efficient evacuation planning.
•Multi-period human evacuation model for passenger ships under walking speed uncertainty.•Optimized evacuation time, determined the number of exit stairs, and personalized evacuation plans.•Robust optimization technique for managing uncertainty in walking speeds.•Dynamic evacuation strategies to adjust walking speeds to adapt to evolving conditions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
An animal’s self-motion generates optic flow across its retina, and it can use this visual signal to regulate its orientation and speed through the world. While orientation control has been studied ...extensively in Drosophila and other insects, much less is known about the visual cues and circuits that regulate translational speed. Here, we show that flies regulate walking speed with an algorithm that is tuned to the speed of visual motion, causing them to slow when visual objects are nearby. This regulation does not depend strongly on the spatial structure or the direction of visual stimuli, making it algorithmically distinct from the classic computation that controls orientation. Despite the different algorithms, the visual circuits that regulate walking speed overlap with those that regulate orientation. Taken together, our findings suggest that walking speed is controlled by a hierarchical computation that combines multiple motion detectors with distinct tunings.
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•Drosophila slows in response to visual motion to stabilize its walking speed•Slowing is tuned to the speed of visual stimuli•Walking speed modulation relies on T4 and T5 neurons•A model combining multiple motion detectors can explain the behavioral results
During navigation, animals regulate both rotation and translation. Creamer et al. investigate how visual motion cues regulate walking speed in Drosophila. They find that orientation and walking speed are stabilized by algorithms with distinct tunings but employ overlapping circuitry.
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We compare the effects of Nordic walking training (NW) and Free walk (FW) on functional parameters (motor symptoms, balance) and functional mobility (Timed Up and Go at Self‐selected Speed – TUGSS, ...and at forced speed, TUGFS; Self‐selected Walking Speed, SSW; locomotor rehabilitation index, LRI) of Parkinson's disease (PD) patients. The study included 33 patients with clinical diagnosis of idiopathic PD, and staging between 1 and 4 in the Hoehn and Yahr scale (H&Y) randomized into two groups: NW (N = 16) and FW (N = 17) for 6 weeks. Baseline characteristics were compared trough a one‐way ANOVA. Outcomes were analyzed using the Generalized Estimation Equations (GEE) with a Bonferroni post‐hoc. Data were analyzed using SPSS v.20.0. Improvements in UPDRS III (P < 0.001), balance scores (P < 0.035), TUGSS distance (P < 0.001), TUGFS distance (P < 0.001), SSW (P < 0.001), and LRI (P < 0.001) were found for both groups. However, the NW group showed significant differences (P < 0.001) when compared to the FW group for the functional mobility. We conclude the NW improves functional parameters and walking mobility demonstrating that NW is as effective as the FW, including benefits for FW on the functional mobility of people with PD.
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BFBNIB, FSPLJ, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
•Greater fatigue is associated with lower usual walk speed in individuals with multiple sclerosis.•Greater fatigue is associated with lower fast walk speed in individuals with multiple ...sclerosis.•Higher fatigue is related to reduced mobility in individuals with multiple sclerosis.
Fatigue is a common symptom in patients with multiple sclerosis and it can lead to activity limitations. Thus, it is important to analyze the relationship between fatigue and activity outcomes, such as walking speed and mobility.
To investigate the relationship between fatigue and walking speed and mobility in individuals with multiple sclerosis.
A cross-sectional study was performed. Adults with multiple sclerosis, without cognitive impairments and who were able to walk were recruited. Fatigue was assessed with the Modified Fatigue Impact Scale (MFIS). Walking speed, usual and fast, was assessed with the 10-meter Walk Test (10MWT), and mobility with the Timed Up and Go Test (TUG). Pearson correlation analysis was performed. A significance level of 5 % was used.
Thirty participants were included, most of the relapsing-remitting multiple sclerosis (n = 24, 80 %). A mean age of 41 (11) years and the median Expanded Disability Status Scale (EDSS) score was 2.65 (2.18) points. Mean MFIS score was 41.87 ± 19.42 points, mean usual walking speed was 1.02 ± 0.28 m/s, mean fast walking speed was 1.55 ± 0.48 m/s, and the mean total time in the TUG was 10.07 ± 3.05 s. A significant negative correlation of moderate magnitude was found between fatigue and usual walking speed (r=₋0.51, p < 0.05). A significant negative correlation of moderate magnitude was found between fatigue and fast walking speed (r=₋0.54, p < 0.05). A significant, positive correlation of moderate magnitude was found between fatigue and mobility (r = 0.54, p < 0.05).
There was a correlation between fatigue and walking speed and mobility in individuals with multiple sclerosis. These results highlight the need to assess fatigue in individuals with multiple sclerosis, since the presence of fatigue is associated with reduced walking speed and mobility.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Independent ambulation requires adaptability. Self-selected and maximum walking speeds are often both assessed to demonstrate the ability to adapt speed to different tasks and environments. However, ...purposefully walking at a slow speed (slowWS) could also be an appropriate adaptation in certain situations but has rarely been investigated.
The purpose of this study was to assess the reliability, responsiveness, and concurrent validity of slowWS in community-dwelling older adults.
This was an observational, cross-sectional study of 110 community-dwelling older adults. Test-retest and inter-rater reliabilities of slowWS were assessed with intra-class correlation coefficients. Standard error of measurement (SEM) and minimal detectable change (MDC95) were calculated to determine responsiveness. Concurrent validity was assessed with Spearman rank-order correlations between slowWS and a battery of tests previously shown to be related to walking speed.
Walking speed measurement for slowWS was shown to have excellent test-retest and interrater reliability (ICCs values of 0.971–0.997). Standard error of measurement value was small (0.015 m/sec) and MDC95 was 0.04 m/sec. SlowWS was not found to significantly correlate to any other study variable.
Walking speed, whether self-selected, maximum, or slow, can be measured reliably with a stopwatch and specific verbal commands. While slowWS could be beneficial for certain tasks or environments, walking slowly was not associated with age, sex, comorbidity, or measures of cognition, depression, strength, balance, disability, or life-space in this sample.
•Slow walking speed measurement has excellent test-retest and interrater reliability.•Slow walking speed SEM and MDC95 values are similar to those for other walking speeds.•Walking at multiple speeds may allow assessment of challenging walking conditions.
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