- •Treadmill-based gait perturbations are feasible in people with COPD.
- •People with COPD do not show large deficits in reactive gait stability.
- •People with COPD demonstrate some but reduced adaptability to perturbations.
- •Perturbation-based balance training may be considered for people with COPD.
- Maltais F.
- Decramer M.
- Casaburi R.
- Barreiro E.
- Burelle Y.
- Debigaré R.
- Dekhuijzen P.N.
- Franssen F.
- Gayan-Ramirez G.
- Gea J.
- Gosker H.R.
- Gosselink R.
- Hayot M.
- Hussain S.N.
- Janssens W.
- Polkey M.I.
- Roca J.
- Saey D.
- Schols A.M.
- Spruit M.A.
- Steiner M.
- Taivassalo T.
- Troosters T.
- Vogiatzis I.
- Wagner P.D.
- de Castro L.A.
- Ribeiro L.R.
- Mesquita R.
- de Carvalho D.R.
- Felcar J.M.
- Merli M.F.
- Fernandes K.B.
- da Silva R.A.
- Teixeira D.C.
- Spruit M.A.
- Pitta F.
- Probst V.S.
- McCrum C.
- Guralnik J.M.
- Simonsick E.M.
- Ferrucci L.
- Glynn R.J.
- Berkman L.F.
- Blazer D.G.
- Scherr P.A.
- Wallace R.B.
2.2 Aims assessment
2.3 Experimental procedure
2.4 Data processing
|COPD (n = 12)||Healthy (n = 12)|
|Mean ± SD||Minimum||Maximum||Mean ± SD||Minimum||Maximum|
|Age (yr.)||66.1 ± 8.5||54||79||66.9 ± 7.7||53||78|
|BMI (kg/m2)||26.8 ± 6.0||19.5||39.2||26.9 ± 2.9||22.6||33.2|
|FFMI (kg/m2)||17.3 ± 2.3||14.5||19.6|
|6MWD (m)||427 ± 70||327||569|
|67.9 ± 8.8||54.0||80.0|
|51.7 ± 23.3||24.8||93.7|
|FEV1/FVC (%)||36.3 ± 11.6||19.4||59.8|
|117.4 ± 16.2||80.9||139.0|
|144.7 ± 41.2||81.5||219.5|
|Quadriceps isometric peak torque (Nm)||129.8 ± 30.4||83.5||170.8|
|Quadriceps isokinetic peak torque (Nm)||101.8 ± 23.4||61.9||131.0|
|Quadriceps isokinetic peak torque (%pred)||76.3 ± 18.3||49.7||107.4|
|SPPB total score (points)||11 ± 1||9||12|
|Tinetti total score (points)|
: n = 10 due to missing data for two participants; FFMI: Fat Free Mass Index; 6MWD: 6 Minute Walk Distance;FEV1: Forced Expiratory Volume in 1st second; FVC: Forced Vital Capacity; TLC: Total Lung Capacity; RV: Residual Volume; SPPB: Short Physical Performance Battery; %pred: Percentage of predicted value.
|28 ± 1||26||28|
3.2 Feasibility of using walking perturbations and the stability-normalised walking speed in people with COPD
3.3 Responses to large walking perturbations in people with COPD
3.4 Adaptation potential following repeated perturbations in people with COPD
3.5 Additional post hoc analyses of the control group
- Mohan D.
- Benson V.S.
- Allinder M.
- Galwey N.
- Bolton C.E.
- Cockcroft J.R.
- MacNee W.
- Wilkinson I.B.
- Tal-Singer R.
- Polkey M.I.
- Stoffels A.A.F.
- De Brandt J.
- Meys R.
- van Hees H.W.H.
- Vaes A.W.
- Klijn P.
- Burtin C.
- Franssen F.M.E.
- van den Borst B.
- Sillen M.J.H.
- Wouters E.F.M.
- Janssen D.J.A.
- Spruit M.A.
Conflicts of interest
- ATS statement: guidelines for the six-minute walk test.Am. J. Respir. Crit. Care Med. 2002; 166: 111-117
- Differences in walking pattern during 6-min walk test between patients with COPD and healthy subjects.PLoS One. 2012; 7e37329
- Impairments in balance discriminate fallers from non-fallers in COPD.Respir. Med. 2009; 103: 1885-1891
- Impairments in systems underlying control of balance in COPD.Chest. 2012; 141: 1496-1503
- Circumstances and consequences of falls in independent community-dwelling older adults.Age Ageing. 1997; 26: 261-268
- Age and disease have a distinct influence on postural balance of patients with COPD.Copd. 2019; 16: 246-253
- Predictive and reactive locomotor adaptability in healthy elderly: a systematic review and meta-analysis.Sports Med. 2015; 45: 1759-1777
- Isometric and isokinetic knee extension and flexion torque in men and women aged 20–70.Scand. J. Rehabil. Med. 1989; 21: 45-53
- Assessing the stability of human locomotion: a review of current measures.J. R. Soc. Interface. 2013; 10: 20120999
- Lower limb muscle weakness predicts use of a multiple- versus single-step strategy to recover from forward loss of balance in older adults.J. Gerontol. A Biol. Sci. Med. Sci. 2012; 67: 1246-1252
- Lower limb muscle moments and power during recovery from forward loss of balance in male and female single and multiple steppers.Clin. Biomech. 2012; 27: 1031-1037
- Ankle muscle strength discriminates fallers from non-fallers.Front. Aging Neurosci. 2014; 6: 336
- The circumstances, orientations, and impact locations of falls in community-dwelling older women.Arch. Gerontol. Geriatr. 2017; 73: 240-247
- Balance impairment in patients with COPD.PLoS One. 2015; 10e0120573
- Static and functional balance in individuals with COPD: comparison with healthy controls and differences according to sex and disease severity.Respir. Care. 2016; 61: 1488-1496
- Chronic obstructive pulmonary disease and mortality following hip fracture: a population-based cohort study.Eur. J. Epidemiol. 2008; 23: 115-122
- Muscle weakness is related to slip-initiated falls among community-dwelling older adults.J. Biomech. 2016; 49: 238-243
- Effects of triceps surae muscle strength and tendon stiffness on the reactive dynamic stability and adaptability of older female adults during perturbed walking.J. Appl. Physiol. 2018; 124: 1541-1549
- The relationship between muscle quality and incidence of falls in older community-dwelling women: An 18-month follow-up study.Exp. Gerontol. 2018; 110: 241-246
- Muscle quality is associated with dynamic balance, fear of falling, and falls in older women.Exp. Gerontol. 2018; 104: 1-6
- Perturbation-based balance training for falls reduction among older adults: current evidence and implications for clinical practice.Geriatr Gerontol Int. 2017; 17: 2294-2303
- Global Strategy for Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease: 2020 Report.2020
- Current status of research on osteoporosis in COPD: a systematic review.Eur. Respir. J. 2009; 34: 209-218
- Developing and establishing biomechanical variables as risk biomarkers for preventable gait-related falls and assessment of intervention effectiveness.Front. Sports Act. Living. 2021; 3: 722363
- Lower extremity strength plays only a small role in determining the maximum recoverable lean angle in older adults.J. Gerontol. A Biol. Sci. Med. Sci. 2005; 60: 1447-1450
- A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.J. Gerontol. 1994; 49: M85-M94
- Fear of falling, fall-related self-efficacy, anxiety and depression in individuals with chronic obstructive pulmonary disease.Clin. Rehabil. 2009; 23: 1136-1144
- The condition for dynamic stability.J. Biomech. 2005; 38: 1-8
- Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease.PLoS One. 2013; 8e57949
- Age-related degeneration in leg-extensor muscle-tendon units decreases recovery performance after a forward fall: compensation with running experience.Eur. J. Appl. Physiol. 2007; 99: 73-85
- Age-related deficit in dynamic stability control after forward falls is affected by muscle strength and tendon stiffness.J. Electromyogr. Kinesiol. 2008; 18: 980-989
- Improving trip- and slip-resisting skills in older people: perturbation dose matters.Exerc. Sport Sci. Rev. 2020; 48: 40-47
- Effects of walking speed on gait stability and interlimb coordination in younger and older adults.Gait Posture. 2014; 39: 378-385
- Association between falls in elderly women and chronic diseases and drug use: cross sectional study.BMJ. 2003; 327: 712-717
- Generalization of treadmill perturbation to overground slip during gait: effect of different perturbation distances on slip recovery.J. Biomech. 2016; 49: 149-154
- Intensity and generalization of treadmill slip training: high or low, progressive increase or decrease?.J. Biomech. 2016; 49: 135-140
- Spatiotemporal gait characteristics in patients with COPD during the gait real-time analysis interactive lab-based 6-minute walk test.PLoS One. 2017; 12e0190099
- Subjects with COPD walk with less consistent organization of movement patterns of the lower extremity.Respir. Care. 2020; 65: 158-168
- Balance impairment in individuals with COPD: a systematic review with meta-analysis.Thorax. 2020; 75: 539-546
- Dynamic stability control in forward falls: postural corrections after muscle fatigue in young and older adults.Eur. J. Appl. Physiol. 2008; 103: 295-306
- An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease.Am. J. Respir. Crit. Care Med. 2014; 189: e15-e62
- Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials.Phys. Ther. 2015; 95: 700-709
- Adaptation of stability during perturbed walking in Parkinson's disease.Sci. Rep. 2017; 7: 17875
- A Trip to Remember: Assessing and Improving Walking Stability in Older Adults.Maastricht University, Gildeprint Drukkerijen2019https://doi.org/10.26481/dis.20191219cm
- Deficient recovery response and adaptive feedback potential in dynamic gait stability in unilateral peripheral vestibular disorder patients.Phys. Rep. 2014; 2e12222
- A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults.Eur. Rev. Aging Phys. Act. 2017; 14: 3
- Retention, savings and interlimb transfer of reactive gait adaptations in humans following unexpected perturbations.Commun. Biol. 2018; 1: 230
- The walking speed-dependency of gait variability in bilateral vestibulopathy and its association with clinical tests of vestibular function.Sci. Rep. 2019; 9: 18392
- Stability-normalised walking speed: a new approach for human gait perturbation research.J. Biomech. 2019; 87: 48-53
- Older adults demonstrate interlimb transfer of reactive gait adaptations to repeated unpredictable gait perturbations.Geroscience. 2020; 42: 39-49
- Short Physical Performance Battery: What Does Each Sub-Test Measure in Patients with Chronic Obstructive Pulmonary Disease? Chronic Obstructive Pulmonary Diseases (Miami, Fla.).7. 2020: 13-25
- Reactive but not predictive locomotor adaptability is impaired in young Parkinson's disease patients.Gait Posture. 2016; 48: 177-182
- Gait abnormalities of COPD are not directly related to respiratory function.Gait Posture. 2017; 58: 352-357
- Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis.Br. J. Sports Med. 2017; 51: 586-593
- Balance and falls in acute exacerbation of chronic obstructive pulmonary disease: a prospective study.Copd. 2017; 14: 518-525
- Falls prevalence and risk factors in people with chronic obstructive pulmonary disease: a systematic review.Respir. Med. 2020; 176: 106284
- Association between disease-related factors and balance and falls among the elderly with COPD: a cross-sectional study.Aging Clin. Exp. Res. 2011; 23: 372-377
- Learning from laboratory-induced falling: long-term motor retention among older adults.Age (Dordr.). 2014; 36: 9640
- Effects of age and acute muscle fatigue on reactive postural control in healthy adults.Clin. Biomech. 2015; 30: 1108-1113
- Effects of quadriceps fatigue on the biomechanics of gait and slip propensity.Gait Posture. 2008; 28: 568-573
- Gait characteristics as risk factors for falling from trips induced in older adults.J. Gerontol. A Biol. Sci. Med. Sci. 1999; 54: M583-M590
- Influence of lower extremity strength of healthy older adults on the outcome of an induced trip.J. Am. Geriatr. Soc. 2002; 50: 256-262
- Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers.Gait Posture. 2005; 21: 388-394
- Identification of elderly fallers by muscle strength measures.Eur. J. Appl. Physiol. 2008; 102: 585-592
- Postural control in chronic obstructive pulmonary disease: a systematic review.Int. J. Chron. Obstruct. Pulmon. Dis. 2015; 10: 1233-1239
- Comparative postural control in COPD patients and healthy individuals during dynamic and static activities.J. Cardiopulm. Rehabil. Prev. 2017; 37: 139-145
- Effects of fatigue on balance recovery from unexpected trips.Hum. Factors. 2020; 62: 919-927
- Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations.Eur. Respir. J. 2012; 40: 1324-1343
- Adaptive changes in responses to repeated locomotor perturbations in cerebellar patients.Exp. Brain Res. 1998; 122: 31-43
- Improving hip fractures outcomes for COPD patients.Copd. 2013; 10: 11-19
- Development of a balance recovery performance measure for gait perturbation training based on the center of pressure.Front. Sports Act. Living. 2021; 3: 617430
- Falls in patients with chronic obstructive pulmonary disease: a call for further research.Respir. Med. 2009; 103: 1257-1269
- Falls in people with chronic obstructive pulmonary disease: an observational cohort study.Respir. Med. 2011; 105: 461-469
- Postural control is impaired in people with COPD: an observational study.Physiother. Can. 2011; 63: 423-431
- Limiting factors in walking performance of subjects with COPD.Respir. Care. 2018; 63: 301-310
- Osteoporosis in chronic obstructive pulmonary disease.Clin. Med. Insights Circ. Respir. Pulm. Med. 2015; 9: 5-21
- The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999–2008.BMC Pulm. Med. 2012; 12: 26
- Exercise for preventing falls in older people living in the community.Cochrane Database Syst. Rev. 2019; 1CD012424
- Exercise for preventing falls in older people living in the community.Cochrane Database Syst. Rev. 2019; 587
- Efficacy of lower-limb muscle training modalities in severely dyspnoeic individuals with COPD and quadriceps muscle weakness: results from the DICES trial.Thorax. 2014; 69: 525-531
- Metabolic load during strength training or NMES in individuals with COPD: results from the DICEStrial.BMC Pulm. Med. 2014; 14: 146
- Comparison of reaction time and functional balance in chronic obstructive pulmonary disease and healthy participants.Heart Lung. 2019; 48: 570-573
- Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65.Age Ageing. 2002; 31: 119-125
- Reference values for residual volume, functional residual capacity and total lung capacity. ATS workshop on lung volume measurements. Official statement of the European respiratory society.Eur. Respir. J. 1995; 8: 492-506
- Phenotypic characteristics of patients with chronic obstructive pulmonary disease after stratification for the short physical performance battery summary score.Arch. Phys. Med. Rehabil. 2020; 101: 1887-1897
- Dynamic stability control during perturbed walking can be assessed by a reduced kinematic model across the adult female lifespan.Hum. Mov. Sci. 2013; 32: 1404-1414
- Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury.BMC Public Health. 2005; 5: 86
- Performance-oriented assessment of mobility problems in elderly patients.J. Am. Geriatr. Soc. 1986; 34: 119-126
- Effects of unilateral leg muscle fatigue on balance control in perturbed and unperturbed gait in healthy elderly.Gait Posture. 2014; 40: 215-219
- Six minute walking distance in healthy elderly subjects.Eur. Respir. J. 1999; 14: 270-274
- Balance impairment and systemic inflammation in chronic obstructive pulmonary disease.Int. J. Chron. Obstruct. Pulmon. Dis. 2015; 10: 1847-1852
- Treadmill-gait slip training in community-dwelling older adults: mechanisms of immediate adaptation for a progressive ascending-mixed-intensity protocol.Exp. Brain Res. 2019; 237: 2305-2317
- Reduced intensity in gait-slip training can still improve stability.J. Biomech. 2014; 47: 2330-2338
- Walking abnormalities are associated with COPD: an investigation of the NHANES III dataset.Respir. Med. 2011; 105: 80-87
- Gait mechanics in patients with chronic obstructive pulmonary disease.Respir. Res. 2015; 16: 31
- Two simple methods for determining gait events during treadmill and overground walking using kinematic data.Gait Posture. 2008; 27: 710-714
User LicenseCreative Commons Attribution (CC BY 4.0) |
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article
- Reuse portions or extracts from the article in other works
- Sell or re-use for commercial purposes
Elsevier's open access license policy