Biomechanics, Physical Activity, and Pain in Individuals With Knee Osteoarthritis Following Gait Retraining 7 views

Knee osteoarthritis (KOA) is an extremely common joint disorder that results in increases in pain, decreases in quality of life, and higher risk of all cause mortality in over 365 million people worldwide. Repetitive loading of the knee joint is a large component of the development and progression of the disorder and emerging research has identified manipulating step rate as a potential method to manage the disorder. While exercise and walking are a key component of the treatment and management of KOA, many biomechanical changes occur during walking gait in individuals with KOA. Increasing walking step rate has been shown to decrease loading in the knee joint linked to further joint degradation in individuals with KOA making it a viable option for intervention. Given the history of walking interventions in this population, it would be useful to understand how walking interventions combining increases in walking speed and step rate impact factors crucial to KOA such as pain, knee joint loading, physical activity, and energetic cost of walking. Manuscript I focused on examining differences in how increases to step rate and walking speed differentially impacted individuals with KOA compared to healthy controls. The primary finding was that when matched to age, sex, height, and preferred walking speed there are no differences in energy expenditure or efficiency between groups, though the KOA group adopted a gait strategy that minimized their knee adduction moment. Manuscript II focused on the feasibility and effect of a two-week multisession intervention on knee joint biomechanics and pain in a group of individuals with KOA. The intervention was found to be effective at increasing preferred walking speed and step rate as well as decreasing pain, without causing changes to knee flexion or adduction moments. Manuscript III examined the impacts of the same intervention on measures of physical activity and tested the feasibility of a shank worn wearable device for physical activity and gait speed detection. In this case, the two-week intervention was not effective at increasing total step counts, minutes of moderate-to-vigorous physical activity, or increase habitual walking speed measured outside the lab. Maintaining walking speed is an important target for individuals with KOA as KOA alone does not render an individual less economical including when adopting a protective strategy for the knee. Step-rate based gait retraining in walking is a novel method of physical activity that may increase the energy expenditure of a session of exercise, though does not impact physical activity or knee joint loading after multiple sessions. This method could be a useful tool for clinicians seeking to manage pain and encourage exercise in individuals with KOA.

PHD (Doctor of Philosophy)

step rate; walking; arthritis; metabolic cost of walking; inertial measurement unit

English

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2026-04-27