The impact of increased perceived fatigue on spatiotemporal and postural gait features in Parkinson’s Disease: a preliminary analysis

Introduction Fatigue is a disabling symptom affecting ~50% [1] of people with Parkinson’s disease (PwPD). Although several studies associate fatigue with other non-motor symptoms, few have investigated how increased perceived fatigue impacts spatiotemporal and kinematic gait features in PwPD. This cross-sectional study aimed to explore the effect of increased perceived fatigue on gait performance in this population. Methods Fifteen PwPD (age 70.9 ± 5.1 years; H&Y 2–3; 10 females) were recruited. Participants wore optical markers (LAMB protocol) and performed continuous overground walking in a gait lab with a motion tracking system (SMART-TD and P6000, BTS S.p.A., Milan, Italy) until reaching a perceived exertion of 17 (lower limbs or breath) on the Borg scale [2]. Spatiotemporal and kinematic gait parameters were recorded at baseline (T0), at regular intervals, and immediately post-task (T1). Median and interquartile ranges [Q1– Q3] were reported; T0–T1 changes were analysed using the Wilcoxon signed-rank test. Results Normalized gait speed (%BH/s) decreased from 83.9 [75.9–90.2] at T0 to 75.5 [73.3–91.1] at T1. Double support time (%Stride) increased from 27.6 [25.0–29.2] to 28.0 [26.4–30.4], and step width (%BH) from 6.7 [5.4–8.2] to 7.7 [6.1–8.9] (both p ≤ 0.05) as reported in Figure 1 for each participants across time. The hip flexion (deg) at ipsilateral heel strike decreased from 33.8 [26.4– 35.1] to 31.5 [25.7–38.2], while knee flexion (deg) during monopodalic stance increased from 22.8 [19.4–24.7] to 24.5 [20.9–26.2]. Finally, step length asymmetry (%Stride) increased from 1.5 [0.6– 2.5] to 2.1 [0.8–2.6]. Figure 1. Rolling median plots for each participant showing (Panel A) Double Support Time (% of Stride) and (Panel B) Step Width (% of Body Height) over time during the walking trial. Discussion These findings suggest that increased perceived fatigue influences multiple gait aspects in PwPD. Specifically, it was associated with altered dynamic balance (e.g. increased double support time), changes in postural strategies (e.g. reduced hip flexion), and a potential decline in gait quality (e.g. increased step length asymmetry). Overall, the results highlight the multidimensional motor impact of fatigue and its relevance as a rehabilitation target. References [1] Siciliano M, et al. Mov Disord. 2018 Nov;33(11):1712-1723 [2] Penko AL, et al. Int J Exerc Sci. 2017 Jan 1;10(1):76-86