Tag: walking

Categories : PaediatricsTags :

Scientists Discover the Genes that Influence When Babies Start Walking

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In the first study of its kind, scientists analysed the genetic information of more than 70 000 infants. They identified 11 genetic markers influencing when babies start walking, thus offering multiple targets for future in-depth biological investigation. 

In a paper published in Nature Human Behaviour, the study found that genetics accounts for about a quarter of the differences in when children take their first steps.

For years, researchers knew that environmental factors could influence when babies begin to walk, but this new finding shows that genetics also has a major impact. It suggests that, just like with other traits such as height, some children may naturally start walking earlier or later because of their genetic propensity. 

Professor Angelica Ronald, Professor of Psychology and Genetics, said: “Most babies take their first step sometime between ages 8 months and 24 months, so it is a wide window in which this exciting milestone happens. It is a big moment for both parents and baby; it symbolises a new phase in a child’s life.”

Dr Anna Gui, an author of the study and a researcher at the University of Rome Tor Vergata and Birkbeck, University of London said: “Until now, we didn’t understand what causes the wide differences between children in when they take their first step. Parents might often worry that walking early or late is a bad sign or that they have done something wrong. We see that genetics play a considerable role in influencing the timing of this milestone.“

Walking isn’t just a key milestone in the development of a child, but it is connected in terms of genetic influences with many other important aspects of human development. The study found that the genetic factors influencing when children take their first step are partly the same genetic factors that influence brain development including the amount of folding and ridges in the outer surface of the brain (the “cortex”). Moreover, walking later within the typical range was linked genetically with less chance of developing ADHD. Finally, the study showed that relatively later onset of walking was influenced by some of the same genes involved in higher educational attainment.  

Prof Ronald added: “It is exciting to be able to discover the genes that influence when children learn to walk. Starting to walk independently is a major milestone for young children. We hope these new genetic findings can advance fundamental understanding about the causes of walking and be used to better support children with motor disorders and learning disabilities.”

She added that parents should still see a GP if there was concern, there is a lot of variety in when children take their first unaided step,

Led by scientists in the UK, the study was made possible through a large collaboration with scientists in the UK, Netherlands and Norway, and through UK and international funding including from the Simons Foundation for Autism Research Initiative.  

Categories : Surgeries & ProceduresTags :

Altered Gait after ACL Surgery Adds to More Knee Problems

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For people with an injured anterior cruciate ligament (ACL) in the knee, surgical ACL reconstruction (ACLR) is an effective treatment for restoring joint stability, however, many treated patients still develop additional long-term knee problems, such as knee osteoarthritis. New research published in the Journal of Orthopaedic Research reveals that individuals exhibit an altered gait after ACLR, which can contribute to these problems.

For the study, investigators compared gait biomechanics between the ACLR and uninjured limbs of 58 patients who underwent ACLR and 58 uninjured control individuals.

Although gait biomechanics became more symmetrical in patients with ACLR over the first 12 months post‐ACLR, the ACLR and uninvolved limbs demonstrated persistent aberrant gait biomechanics compared with the uninjured control individuals.

“A persistent aberrant gait pattern following ACLR, like that observed in our study, can induce joint loads that may contribute to further long-term knee joint problems,” said corresponding author Christin Büttner, MS, of the University of North Carolina at Chapel Hill. Implementing early rehabilitative measures to normalise gait following ACLR could help to maintain long-term knee joint health in both the injured and uninjured limb.”

Source: Wiley

Categories : Ageing ExerciseTags :

Many Could Easily Add Five Years to Their Lifespan

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If everyone was as active as the top 25% of the population, individuals over the age of 40 could add five years to their life, according to a new study led by Griffith University researchers. 

Physical activity has long been known to be good for health, however estimates have varied regarding how much benefit could be gained from a defined amount of activity, both for individuals and for populations. 

This latest study, published in the British Journal of Sports Medicine, used US-based accelerometer data to gain an accurate view of a population’s physical activity levels instead of relying on survey responses as per other studies, and found the benefits were around twice as strong as previous estimates.  

It found the most active quarter of people in the community had a 73% lower risk of death than their least active counterparts. For that least active quartile, a single one-hour walk could potentially return a benefit of around six additional hours of life.  

Lead researcher Professor Lennert Veerman said this cohort had the greatest potential for health gains.  

“If you’re already very active or in that top quartile, an extra hour’s walk may not make much difference as you’ve, in a sense, already ‘maxed out’ your benefit,” he said.   

“If the least active quartile of the population over age 40 were to increase their activity level to that of the most active quartile however, they might live, on average, about 11 years longer.

“This is not an unreasonable prospect, as 25 per cent of the population is already doing it.  It can be any type of exercise but would roughly be the equivalent of just under three hours of walking per day.” 

The research team suggested low levels of physical activity could even rival the negative effects of smoking, with other research finding each cigarette could take 11 minutes from a smoker’s life.  

By extension, a more active lifestyle could also offer protective effects against heart disease, stroke, certain cancers and other chronic illnesses, with the study’s findings highlighting a need for national physical activity guidelines to be revisited using these methods.  

Dr Veerman said physical activity had been vastly underestimated in its capacity to improve health outcomes, suggesting even modest increases in movement could lead to significant life-extension benefits.  

“If there’s something you could do to more than halve your risk of death, physical activity is enormously powerful,” he said.  

“If we could increase investment in promoting physical activity and creating living environments that promote it such as walkable or cyclable neighbourhoods and convenient, affordable public transport systems, we could not only increase longevity but also reduce pressure on our health systems and the environment.”  

Source: Griffith University

Categories : Neurology PaediatricsTags :

Botox Could Make Walking Easier in Children with Cerebral Palsy

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A recent randomised clinical trial published in Developmental Medicine & Child Neurology assessed whether injections of botulinumtoxin-A in calf muscles benefit children with cerebral palsy.

“We hypothesised that injections with botulinumtoxin-A in the calf muscles would make walking easier, caused by improved ankle joint functioning following spasticity reduction,” the authors wrote.

In the trial, one botulinumtoxin-A treatment was not superior to placebo in making walking easier (measured as a reduction in energy cost or improved walking capacity); however, there was some evidence of a delayed improvement in energy cost. Moreover, there was some evidence of a decrease in calf pain intensity. No serious adverse events related to botulinumtoxin-A treatment were recorded.

Source: Wiley

Categories : Exercise Pain ManagementTags :

Walking is Highly Effective for Stopping Low Back Pain from Returning

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New research from Macquarie University’s Spinal Pain Research Group shows that walking has the potential to change the way low back pain is managed, making effective interventions accessible to more people than ever before. The results of the trial, which combined walking with education, are published in The Lancet.

About 800 million people worldwide have low back pain, which is a leading cause of disability and reduced quality of life. Recurrences of low back pain are very common, with seven in 10 people who recover from an episode going on to have a recurrence within a year.

Professor of Physiotherapy Mark Hancock and his research team have been investigating ways to shift the emphasis from treatment to prevention to improve the management of back pain, an approach that empowers individuals to manage their own health and reduces the cost to society and the healthcare system.

Far from the bed rest recommended for back pain in the past, current best practice includes the combination of exercise and education, both to treat current pain and to prevent future episodes.

While beneficial, some forms of exercise are not accessible or affordable to many people due to their high cost, complexity and need for supervision.

A simpler, more accessible method

The world-first WalkBack trial examined whether a programme of walking combined with education could be effective in preventing recurrences of low back pain.

The trial followed 701 adults who had recently recovered from an episode of low back pain, randomly allocating participants to either an individualised walking program facilitated by a physiotherapist and six education sessions across six months, or to a no-intervention control group.

The participants’ progress was then followed for between one and three years to collect information about any new recurrences of low back pain they experienced.

The researchers’ primary aim was to compare the two groups for the number of days before participants experienced a recurrence of back pain that impacted daily activities or required care from a healthcare provider.

They also evaluated the cost effectiveness of the intervention, including costs related to work absenteeism and healthcare services.

Longer pain-free periods

The paper’s senior author, Professor Hancock, says what they discovered could have a profound impact on how low back pain is managed.

“The intervention group had fewer occurrences of activity-limiting pain compared to the control group, and a longer average period before they had a recurrence, with a median of 208 days compared to 112 days,” Professor Hancock says. “The risk of having a recurrence that required seeking care was nearly halved in those in the intervention group.

“Walking is a low-cost, widely accessible and simple exercise that almost anyone can engage in, regardless of age, geographic location or socio-economic status.

“We don’t know exactly why walking is so good for preventing back pain, but it is likely to include the combination of gentle oscillatory movements, loading and strengthening the spinal structures and muscles, relaxation and stress relief, and the release of ‘feel-good’ endorphins.

“And of course, we also know that walking comes with many other health benefits, including cardiovascular health, improved bone density, maintenance of a healthy weight and improved mental health.”

Professor Hancock said the amount of walking each person completed was individualised based on a range of factors including their age, physical capacity, preferences and available time. Participants were given a rough guide to build up to 30 minutes, five times a week over a six-month period.

After three months, Professor Hancock said most of the people who took part were walking three to five days a week for an average of 130 minutes.

“You don’t need to be walking five or 10 kilometres every day to get these benefits,” Professor Hancock says.

A cost-effective option

The paper’s lead author, Postdoctoral Fellow Dr Natasha Pocovi, says in addition to providing participants with longer pain-free periods, they found the program was also cost effective.

“It not only improved people’s quality of life, but it reduced their need both to seek healthcare support and the amount of time taken off work by approximately half,” Dr Pocovi says.

“The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients.

“Our study has shown that this effective and accessible means of exercise has the potential to be successfully implemented on a much larger scale than other forms of exercise.”

To build on these findings, the team now hopes to explore how they can integrate the preventive approach into the routine care of patients who experience recurrent low back pain.

Source: MacQuarie University

Categories : Cardiovascular DiseaseTags :

Popular OTC Supplement Improves Walking in Peripheral Artery Disease

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The over-the-counter supplement nicotinamide riboside, a form of vitamin B3, increased the walking endurance of patients with peripheral artery disease, a chronic leg condition for which there are few effective treatments. 

In a preliminary, randomised, double-blind clinical trial led by Northwestern University and University of Florida scientists, patients who took nicotinamide riboside daily for six months increased their timed walking distance by more than 17.3m, compared to a placebo group. As expected, walking speed declined in the placebo group, because peripheral artery disease causes progressive declines in walking performance. 

“This is a signal that nicotinamide riboside could help these patients,” said Christiaan Leeuwenburgh, PhD, a UF professor of physiology and aging and senior author of the clinical trial report. “We are hoping to conduct a larger follow-up trial to verify our findings.”

Along with other researchers, Leeuwenburgh, whose research specialises in anti-aging treatments, collaborated with Mary M. McDermott, MD, a physician and professor of medicine at Northwestern University and an expert in peripheral artery disease.

The scientists recruited 90 people with an average age of 71 who had peripheral artery disease, or PAD, to test the effects of nicotinamide riboside. The supplement is increasingly popular as an anti-aging treatment (sales exceeded $60 million in 2022 in the US alone) but there has been scant evidence of any benefit in healthy people. Nicotinamide riboside is a precursor for the essential compound NAD, which plays roles in the body related to energy generation, improved blood flow and DNA repair.

Because PAD is associated with problems generating energy within muscle cells, McDermott and Leeuwenburgh thought that nicotinamide riboside, by improving energy generation, could help improve walking in people with the disease.

And indeed that’s what they found. Participants taking the supplement walked an average of 7m more in a six-minute walking test after six months, while those taking a placebo walked 10.3m less. Those who took at least 75% of the pills they were supposed to take performed even better, adding more than 30m to their walking distance, compared to people who took a placebo.

(The researchers also tested if resveratrol, a compound best known for being in red wine, could boost the effects of nicotinamide riboside; they found no additional benefits.)

PAD affects more than 8.5 million Americans over the age of 40. Caused by the buildup of fatty deposits in arteries, and associated with diabetes and smoking, the disease reduces blood flow to the limbs, especially the legs. Walking often becomes painful, and the disease typically causes declines in walking ability over time. Supervised walking exercise is first line therapy for PAD, but most people with the condition do not have access to supervised exercise. 

In addition to a larger trial focused on patients suffering from PAD, Leeuwenburgh hopes to test the effects of nicotinamide riboside on walking performance in healthy older adults. 

“We need to test it on a healthy older population before we recommend healthy people take it,” he said.

Source: University of Florida

Categories : Ageing Skeletal SystemTags :

Walking Fitness can Predict Fracture Risk in Older Adults

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The ability to walk one kilometre comfortably can help predict fracture risk, according to researchers at the Garvan Institute of Medical Research. The findings, published in JAMA Network Open, suggest that simply asking a patient about walking limitation could allow clinicians to identify those in need of further bone health screening and prescribe interventions that could prevent fractures from occurring.

“We’ve discovered that trouble walking even short distances appears closely tied to higher fracture risk over the following five years,” says lead author of the study, Professor Jacqueline Center, Head of Garvan’s Clinical Studies and Epidemiology Lab.

“Just a few simple questions about how far someone can walk could give doctors an early warning sign to check bone health.”

The researchers examined data on nearly 267 000 adults aged 45 and older from the Sax Institute’s 45 and Up Study, a major ongoing research initiative that has been tracking health outcomes in adults in the Australian state of New South Wales for more than 15 years.

Participants were asked if health issues limited their ability to walk various distances, with answer options of ‘not at all,’ ‘a little,’ or ‘a lot’. The group was then followed for five years to track fracture outcomes.

The researchers found that one in five adults reported some walking limitation at the beginning of the study.

Those with more difficulty walking were significantly more likely to experience a fracture during follow-up. For example, women who said they were limited ‘a lot’ in walking one kilometre had a 60% higher fracture risk than women with no limitation.

For men, the increased risk was over 100%.

“We saw a clear ‘dose-response’ pattern, where greater walking limitation meant higher fracture risk. This suggests a direct relationship between low walking ability and weaker bones,” says first author of the study Dr Dana Bliuc, Senior Research Officer at Garvan.

Approximately 60% of all fractures in the study were attributable to some level of walking limitation.

The link remained strong even after accounting for other factors like age, falls, prior fractures, and weight, and the findings were consistent across different fracture sites like hips, vertebrae, arms, and legs.

“In this generally healthy community-based population, we still found one in five people had trouble walking a kilometre,” says Professor Center.

“We think this simple assessment could help identify many more at-risk individuals who may benefit from bone density screening or preventative treatment.”

Osteoporosis medications, lifestyle changes, and other interventions are available to improve bone strength and avoid first or repeat fractures.

However, screening rates currently remain low, meaning many miss out on fracture risk assessments.

Finding easy but accurate ways to detect at-risk people is an important target for research.

“Fracture risk assessment generally relies on a bone density test, which many people have not had when seeing their doctor,” says Professor Center.

“Asking about walking ability takes just seconds and could be a free, non-invasive way to tell if someone needs their bones checked.”

The researchers stress that walking limitation may have many causes beyond weak bones, from heart disease to arthritis.

However, a difficulty in walking even short distances appears closely tied to fracture risk independently.

“We hope these findings will encourage clinicians to consider walking ability as a red flag for possible bone health issues. For patients, if you can’t walk a full kilometre comfortably, it may be wise to ask your doctor about getting your bones checked,” says Dr Bliuc.

Source: Garvan Institute of Medical Research

Categories : Medical Research & Technology Neurodegenerative DiseasesTags :

Soft Robotic Garments Help Parkinson’s Patients to Walk More Freely

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Freezing is one of the most common and debilitating symptoms of Parkinson’s disease, when they suddenly lose the ability to move their feet, often mid-stride, resulting in a series of staccato stutter steps that get shorter until the person stops altogether. These episodes are one of the biggest contributors to falls among people living with Parkinson’s disease. 

Today, freezing is treated with a range of pharmacological, surgical or behavioural therapies, none of which are particularly effective. What if there was a way to stop freezing altogether?

In a Nature Medicine report, researchers used a soft, wearable robot to help a person living with Parkinson’s walk without freezing. The robotic garment, worn around the hips and thighs, gives a gentle push to the hips as the leg swings, helping the patient achieve a longer stride. The device completely eliminated the participant’s freezing while walking indoors, allowing them to walk faster and further. 

The soft robotic apparel was developed by researchers from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) and the Boston University Sargent College of Health & Rehabilitation Sciences.

“We found that just a small amount of mechanical assistance from our soft robotic apparel delivered instantaneous effects and consistently improved walking across a range of conditions for the individual in our study,” said Conor Walsh, professor at SEAS and co-corresponding author of the study. 

For over a decade, Walsh’s Biodesign Lab at SEAS has been developing assistive and rehabilitative robotic technologies to improve mobility for individuals’ post-stroke and those living with ALS or other diseases that impact mobility. Some of that technology, specifically an exosuit for post-stroke gait retraining, received support to develop and commercialise the technology.

“Leveraging soft wearable robots to prevent freezing of gait in patients with Parkinson’s required a collaboration between engineers, rehabilitation scientists, physical therapists, biomechanists and apparel designers,” said Walsh, whose team collaborated closely with that of Terry Ellis,  Professor and Physical Therapy Department Chair and Director of the Center for Neurorehabilitation at Boston University.

The team spent six months working with a 73-year-old man with Parkinson’s disease, who, despite using both surgical and pharmacologic treatments, endured substantial and incapacitating freezing episodes more than 10 times a day, causing him to fall frequently. These episodes prevented him from walking around his community and forced him to rely on a scooter to get around outside.

In previous research, Walsh and his team leveraged human-in-the-loop optimization to demonstrate that a soft, wearable device could be used to augment hip flexion and assist in swinging the leg forward to provide an efficient approach to reduce energy expenditure during walking in healthy individuals.

Here, the researchers used the same approach but to address freezing. The wearable device uses cable-driven actuators and sensors worn around the waist and thighs. Using motion data collected by the sensors, algorithms estimate the phase of the gait and generate assistive forces in tandem with muscle movement.

The effect was instantaneous. Without any special training, the patient was able to walk without any freezing indoors and with only occasional episodes outdoors. He was also able to walk and talk without freezing, a rarity without the device.

“Our team was really excited to see the impact of the technology on the participant’s walking,” said Jinsoo Kim, former PhD student at SEAS and co-lead author on the study.

During the study visits, the participant told researchers: “The suit helps me take longer steps and when it is not active, I notice I drag my feet much more. It has really helped me, and I feel it is a positive step forward. It could help me to walk longer and maintain the quality of my life.”

“Our study participants who volunteer their time are real partners,” said Walsh. “Because mobility is difficult, it was a real challenge for this individual to even come into the lab, but we benefited so much from his perspective and feedback.”

The device could also be used to better understand the mechanisms of gait freezing, which is poorly understood.

“Because we don’t really understand freezing, we don’t really know why this approach works so well,” said Ellis. “But this work suggests the potential benefits of a ‘bottom-up’ rather than ‘top-down’ solution to treating gait freezing. We see that restoring almost-normal biomechanics alters the peripheral dynamics of gait and may influence the central processing of gait control.”

Source: Harvard John A. Paulson School of Engineering and Applied Sciences

Categories : Neurodegenerative DiseasesTags :

Difficulty with Turning when Walking could be a Sign of Early Alzheimer’s

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In a study published in Current Biology, people with early Alzheimer’s disease were found to have difficulty turning when walking. The new study used virtual reality and a computational model to further explore the intricacies of navigational errors previously observed in Alzheimer’s disease.

Researchers, led by Professor Neil Burgess and colleagues in the Space and Memory group at the UCL Institute of Cognitive Neuroscience, grouped participants into three categories: healthy younger participants (31 total), healthy elderly participants (36 total) and patients with mild cognitive impairment (43 total). They then asked them to complete a task while wearing virtual reality goggles, which allowed them to make real movements.

In the trial, participants walked an outbound route guided by numbered cones, consisting of two straight legs connected by a turn. They then had to return to their starting position unguided.

The task was performed under three different environmental conditions aimed at stressing the participant’s navigational skills: an unchanged virtual environment, the ground details being replaced by a plain texture, and the temporary removal of all landmarks from the virtual reality world.

The researchers found that people with early Alzheimer’s consistently overestimated the turns on the route and showed increased variability in their sense of direction. However, these specific impairments were not observed in the healthy older participants or people with mild cognitive impairment, who did not show underlying signs of Alzheimer’s.

This suggests that these navigational errors are specific to Alzheimer’s disease – rather than an extension of healthy ageing or general cognitive decline – and could help with diagnosis.

Joint first author, Dr Andrea Castegnaro (UCL Institute of Cognitive Neuroscience), said: “Our findings offer a new avenue for the early diagnosis of Alzheimer’s disease by focusing on specific navigational errors. However, we know that more work is needed to confirm these early findings.

Dr Castegnaro added, “Cognitive assessments are still needed to understand when the first cognitive impairments develop, and when it comes to existing spatial memory tests used in clinics, those often rely on verbal competence. Our tests aim to offer a more practical tool that doesn’t rely on language or cultural background.”

Source: University College of London

Categories : Neurodegenerative DiseasesTags :

Non-invasive Transcranial Stimulation Improves Walking in Parkinson’s Disease

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Altered gait is common in patients with Parkinson’s disease (PD), and the usefulness of treatments is limited. Researchers in Japan have developed a novel transcranial stimulation method using external electrodes, the team demonstrated significant gait improvements in PD patients. The results, which also showed improvements for other neurological disorders, are published in the Journal of Neurology, Neurosurgery & Psychiatry.

Motor function declines characterises PD, particularly in relation to gait disorders, manifesting as decreased step length, reduced arm swing, slow movements, rigidity, and postural instability, which are prevalent among patients with PD. While non-pharmacological approaches like transcranial direct current stimulation show promise in improving motor function, recent research focuses on gait-combined closed-loop stimulation, which synchronises brain stimulation with the individual’s gait rhythm.  proposes a novel intervention for gait improvement, thus creating new hope for patients with PD.

“We recently developed a novel neuromodulation approach using gait-combined closed-loop transcranial electrical stimulation (tES) and demonstrated promising gait improvements in patients who are post-stroke. Here, we tested the efficacy of this intervention in patients with Parkinsonian gait disturbances,” explains lead author Ippei Nojima from Shinshu University and Nagoya City University, Japan.

To this end, the clinical researchers from Japan recruited 23 patients with PD or Parkinson’s syndrome. All study participants were randomly assigned to receive either the active treatment or sham treatment.

During the course of the trial, a low-current electrode (up to 2mA) was externally affixed to the occipital region of the head. A reference electrode was then placed in the neck region to establish a stable electrical reference point and to complete the electrical circuit. The treatment included performing tES on the cerebellum in a non-invasive manner. The brain side showing severe impact was specifically targeted during the electrotherapy.

“Gait disturbance lowers activities of daily living in patients with PD and related disorders. However, the effectiveness of pharmacological, surgical, and rehabilitative treatments is limited. Our novel intervention might be able to improve physical function for not just patients with PD but also for those with other disabilities,” comments senior author Yoshino Ueki from the Department of Rehabilitation Medicine at Nagoya City University.

The cerebellum plays a key role in gate control, so electrical stimulation of this region is likely to exert therapeutic benefits. The therapy showed encouraging results after just ten repetitions. The treatment group showed a significant improvement in gait parameters including speed, gait symmetry, and stride length.

Professor Nojima said, “These findings showed that gait-combined closed-loop tES over the cerebellum improved Parkinsonian gait disturbances, possibly through the modulation of brain networks generating gait rhythms.”

Interestingly, no patient dropped out during the study. Moreover, patients from both the groups (treatment and sham) showed good and comparable compliance. Side effects such as skin irritation, vertigo, or odd sensations/perceptions were also not observed in any of the volunteering patients. This study has special significance, considering the fact that Japan is witnessing a sharp rise in its elderly population.

Source: Shinshu University