Peter C Coyle1,2, Jenifer M Pugliese2, J Megan Sions2, Mark S Eskander3, Jennifer A Schrack4,5, Gregory E Hicks2. 1. Department of Physical Therapy, University of Pittsburgh, Pennsylvania. 2. Department of Physical Therapy, University of Delaware, Newark. 3. Delaware Orthopaedic Specialists, Newark. 4. Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
BACKGROUND AND PURPOSE: Chronic low back pain with radiculopathy (CLBPR) is common among older adults and can lead to walking difficulty. Energy cost of walking strongly predicts changes in walking speed, which is predictive of mortality in older adults. The purposes of this study were to examine (1) the impact of pain provocation on the energy cost of walking and (2) the relationship between pain intensity and change in energy cost of walking. METHODS: Older adults (60-85 years) with (n = 20) and without (n = 20) CLBPR were matched on age, sex, and diabetes presence/absence. Energy cost of walking was measured with a portable metabolic gas analyzer, as participants walked for 20 minutes or less. Energy cost and pain measurements occurred during early and late stages of walking. Percent change in energy cost was calculated. Participants were grouped by their pain response during walking: increased pain (n = 13); consistent pain (n = 7); no pain, matched to individuals with increased pain (n = 13); and no pain, matched to individuals with consistent pain (n = 7). We examined the within-groups change in energy cost for all groups, as well as the relationship between late-stage pain intensity and percent change of energy cost for individuals whose pain increased. RESULTS AND DISCUSSION: Within the increased pain group, energy cost of walking significantly increased from early to late stages (median change = 0.003 mL/kg/m, P = .006), and late-stage pain intensity explained 41.2% (p = 0.040) of the variance in percent change. Since pain appears to be linked to energy cost, effective pain management with walking may be an important factor in preventing mobility decline. CONCLUSIONS: Among older adults with CLBPR, pain provocation drives increases in the energy cost of walking. Because high energy cost of walking is predictive of mobility decline, clinicians may focus on effective pain management strategies during walking, which may potentially decrease the risk of mobility decline.
BACKGROUND AND PURPOSE:Chronic low back pain with radiculopathy (CLBPR) is common among older adults and can lead to walking difficulty. Energy cost of walking strongly predicts changes in walking speed, which is predictive of mortality in older adults. The purposes of this study were to examine (1) the impact of pain provocation on the energy cost of walking and (2) the relationship between pain intensity and change in energy cost of walking. METHODS: Older adults (60-85 years) with (n = 20) and without (n = 20) CLBPR were matched on age, sex, and diabetes presence/absence. Energy cost of walking was measured with a portable metabolic gas analyzer, as participants walked for 20 minutes or less. Energy cost and pain measurements occurred during early and late stages of walking. Percent change in energy cost was calculated. Participants were grouped by their pain response during walking: increased pain (n = 13); consistent pain (n = 7); no pain, matched to individuals with increased pain (n = 13); and no pain, matched to individuals with consistent pain (n = 7). We examined the within-groups change in energy cost for all groups, as well as the relationship between late-stage pain intensity and percent change of energy cost for individuals whose pain increased. RESULTS AND DISCUSSION: Within the increased pain group, energy cost of walking significantly increased from early to late stages (median change = 0.003 mL/kg/m, P = .006), and late-stage pain intensity explained 41.2% (p = 0.040) of the variance in percent change. Since pain appears to be linked to energy cost, effective pain management with walking may be an important factor in preventing mobility decline. CONCLUSIONS: Among older adults with CLBPR, pain provocation drives increases in the energy cost of walking. Because high energy cost of walking is predictive of mobility decline, clinicians may focus on effective pain management strategies during walking, which may potentially decrease the risk of mobility decline.
Authors: J M Guralnik; L Ferrucci; C F Pieper; S G Leveille; K S Markides; G V Ostir; S Studenski; L F Berkman; R B Wallace Journal: J Gerontol A Biol Sci Med Sci Date: 2000-04 Impact factor: 6.053
Authors: Gregory E Hicks; Eleanor M Simonsick; Tamara B Harris; Anne B Newman; Debra K Weiner; Michael A Nevitt; Frances A Tylavsky Journal: J Gerontol A Biol Sci Med Sci Date: 2005-11 Impact factor: 6.053
Authors: Andrew W Gardner; Raphael M Ritti-Dias; Julie A Stoner; Polly S Montgomery; Kristy J Scott; Steve M Blevins Journal: J Vasc Surg Date: 2010-03 Impact factor: 4.268
Authors: S G Leveille; J M Guralnik; M Hochberg; R Hirsch; L Ferrucci; J Langlois; T Rantanen; S Ling Journal: J Gerontol A Biol Sci Med Sci Date: 1999-10 Impact factor: 6.053
Authors: Patrick J Knox; Corey B Simon; Ryan T Pohlig; Jenifer M Pugliese; Peter C Coyle; Jaclyn M Sions; Gregory E Hicks Journal: Clin J Pain Date: 2021-12-24 Impact factor: 3.442
Authors: Jo Armour Smith; Heidi Stabbert; Jennifer J Bagwell; Hsiang-Ling Teng; Vernie Wade; Szu-Ping Lee Journal: J Sport Health Sci Date: 2022-02-10 Impact factor: 13.077