Chronic obstructive pulmonary disease patients increase medio-lateral stability and limit changes in antero-posterior stability to curb energy expenditure

Abstract

Background: A relationship exists between step width and energy expenditure, yet the contribution of dynamic stability to energy expenditure is not completely understood. Chronic obstructive pulmonary disease (COPD) patients' energy expenditure is increased due to airway obstruction. Further, they have a higher prevalence of falls and balance deficits compared to controls.

Research question: Is dynamic stability different between COPD patients and controls; and is the association between dynamic stability and energy expenditure different between groups?

Methods: Seventeen COPD patients (64.3 ± 7.6years) and 23 controls (59.9 ± 6.6years) walked on a treadmill at three speeds: self-selected walking speed (SSWS), -20%SSWS, and +20%SSWS. Mean and variability (standard deviation) of the anterior-posterior (AP) and medio-lateral (ML) margins of stability (MOS) were compared between groups and speed conditions, while controlling for covariates. Additionally, their association to metabolic power was examined.

Results: The association between stability and power did not significantly differ between groups. However, increased metabolic power was associated with decreased MOS AP mean (p < 0.0001), independent of speed. Increased MOS AP variability (p = 0.01) and increased SSWS (p's < 0.05) were associated with increased metabolic power. The MOS ML mean for COPD patients was greater than that of healthy patients (p = 0.02). MOS AP mean decreased as speed increased and differed by group (p = 0.048). For COPD patients, a plateau was observed at SSWS and did not decrease further at +20%SSWS compared to controls. MOS AP variability (p < 0.0001), MOS ML mean (p < 0.0001), and MOS ML variability (p = 0.003) decreased as speed increased and did not differ by group.

Significance: Patients with COPD operate at the upper limit of their metabolic reserve due to an increased cost of breathing. To compensate for their lack of stability, they walked with larger margins of stability in the ML direction, instead of changing the stability margins in the AP direction, due to its association with energy expenditure.

Keywords: Dynamic stability; Extrapolated center of mass; Metabolic power; Pulmonary disease.