Fatigued Patients Walk Slower, Endure Shorter Distances, Study Finds

fatigue, walking problems

Fatigue may compromise and predict Parkinson’s patients’ mobility and their ability to walk over long distances, according to a recent study.

The results of the study, “Can fatigue predict walking capacity of patients with Parkinson’s disease?” were published in Arquivos de Neuro-Psiquiatria.

Lack of energy, or fatigue is one of the most common — and most disabling — symptoms in Parkinson’s disease (PD), and has a significant impact on patients’ quality of life.

“Although fatigue is an important symptom in PD, only few studies have assessed its association with mobility, walking capacity, and physical activity in patients,” the researchers noted.

Fatigue has been shown — following freezing of gait and general self-walking difficulties — as the third strongest factor that independently contributes to walking problems among people with Parkinson’s. Freezing of gait is a Parkinson’s motor symptom in which a person’s feet feel like they’ve become briefly “glued to the floor,” preventing forward movement despite an intention to walk.

A team of Brazilian researchers now investigated whether fatigue can predict mobility and walking capacity among people with Parkinson’s.

A total of 48 patients — 27 men and 21 women, mean age 67.2 years — were involved in the study, with 22 diagnosed with fatigue as measured by the Parkinson’s Fatigue Scale. All had their mobility and walking capacity tested using clinically validated tools, namely the Timed Up and Go or TUG test, the 10-Meter Walk Test (at usual and fastest speed), and the 6-Minute Walk Test, or 6WMT. The 6WMT assesses the distance a person walks over six minutes as a measure of aerobic capacity and endurance. The 10-Meter test, which measures walking speed over a short distance, is used to determine functional mobility, gait, and vestibular function, located in the inner ear.

Compared with the non-fatigued patients, individuals with fatigue were older, had worse cognitive functions, more severe and advanced disease, higher motor impairment (as assessed by higher scores on the UPDRS scale), and higher levels of functional dependence according to the Schwab and England Activities of Daily Living Scale.

Fatigued patients also walked slower. The results showed they had smaller comfortable and maximum gait speeds and distance covered during the 6MWT than participants without fatigue.

Among all participants, 31.2% spent more than 16 seconds performing the Timed Up and Go test, which indicates an increased risk of falling.

Fatigue, age, and motor symptoms were found to predict the participants’ endurance and their ability to walk over longer distances, as measured by the 6-Minute Walk Test, with fatigue being the most significant predictor.

According to the researchers, a study limitation was that any links between antidepressants intake — known to influence Parkinson’s patients — and non-motor symptoms were not assessed.

“From a clinical perspective, our results suggest that fatigue may reduce functionality in everyday activities of PD patients and prolong periods of sedentary behaviors. This is particularly important seen that PD-related fatigue is one of the most common and disabling symptoms in these patients,” the researchers said.

“Our results highlight the importance of recognition and management of this symptom,” the team concluded.

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Impaired Backward Walking Linked to Motor Symptoms, Fear of Falling in Early Parkinson’s, Korean Study Suggests

backward walking

Backward walking is significantly impaired and associated with motor symptoms and fear of falling in newly diagnosed Parkinson’s patients, a small Korean study suggests.

These results point to backward walking parameters as potential biomarkers of Parkinson’s disease progression. The researchers called for future studies investigating the dynamics of backward walking in people with Parkinson’s, and its link to falls.

The study, “Backward Gait is Associated with Motor Symptoms and Fear of Falling in Patients with De Novo Parkinson’s Disease,” was published in the Journal of Clinical Neurology.

People with Parkinson’s are at a significant risk of falls due to gait (walking) and balance problems. Specifically, these patients show increased stride-to-stride variability and take shorter and slower steps.

While most gait studies in people with Parkinson’s have focused on walking forward, backward gait has been suggested to be even more impaired in these patients. It’s also been associated with freezing of gait, defined as not being able to start stepping forward, with no apparent cause.

Several studies have also shown that people with Parkinson’s have considerably more difficulties in walking while performing a secondary cognitive task, known as dual-task gait. Dual-tasking measures an individual’s ability to carry out a cognitive task — such as counting, or naming words that start with a particular letter — while engaging in a motor skill like walking.

However, since changes in walking parameters are closely associated with the progression of motor symptoms, most of what is known about walking difficulties in Parkinson’s patients comes from studies preformed in people at advanced stages of the disease.

Thus, understanding gait dynamics and difficulties in early-stage Parkinson’s disease remains largely unknown.

Now, a team of Korean researchers set out to determine which type of gait — forward, backward, or dual-task — was more strongly associated with motor symptoms or the risk of falling in people with de novo Parkinson’s disease, meaning they are newly diagnosed and still untreated.

The study involved 24 individuals with de novo Parkinson’s — 13 men and nine women, who had the disease for less than five years, were between 50 and 75 years old, and were able to perform various types of gaits. An additional 27 unaffected people, including 16 men and 11 women, were used as controls.

Clinical data for all participants was measured through several tests and scales, including the Korean version of the Montreal Cognitive Assessment, the Fear of Falling Measure (FFM) — a rating scale in which lower scores indicate greater fear of falling — and the Unified Parkinson’s Disease Rating Scale part II and III, which assesses motor symptoms.

The participants’ gait parameters were analyzed using the computerized GAITRite system with a 4.6-meters (16 foot) long, pressure-sensitive walkway mat. Each type of gait was tested 10 times while walking at a comfortable speed. Dual-task gait consisted of walking while subtracting serial sevens.

Results showed that de novo Parkinson’s patients had a slower walking speed and shorter stride in all three gaits, compared with unaffected people. However, backward gait showed the highest stride-to-stride variability in both stride time and length.

Dual-task gait also showed significant variability in stride length between the two groups of participants, while forward gait showed no significant differences.

When looking at the potential associations between gait speed, motor symptoms, and fear of falling in these patients, the team found that reduced backward gait speed was significantly associated with a wider range of motor symptoms. These included walking difficulties, bradykinesia (difficulty in body movement), postural instability, and total motor score. These individuals also had an increased fear of falling.

Reduced dual-task gait speed was specifically linked to worse bradykinesia and total motor score, while reduced forward gait speed was associated with reduced tremor score. That was consistent with previous studies suggesting that reduced gait speed is “more pronounced in non-tremor-dominant [Parkinson’s] patients,” the researchers said. None of these gaits’ speeds were associated with fear of falling.

“These results indicate that slow walking with a short stride is a clear feature of de novo PD regardless of the gait task being performed, and the earliest alterations of gait variability may first become apparent in [backward gait], followed by [dual-task gait] and then [forward gait],” the researchers said.

The team added that these findings suggest that backward walking speed is more strongly associated with the risk of falling and is “a potential surrogate marker for the progression of motor symptoms or gait impairment in PD.”

Future studies are required to confirm and better understand the association of backward gait and motor symptoms and to investigate the clinical relevance of stride-to-stride variability in the different types of gaits, the researchers said. They also called for additional studies into the link between backward walking and falls in people with Parkinson’s disease.

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