Energy Cost of Walking in Relation to Impairment and Functional Independence After Stroke: The Role of Walking Speed.
Amine Guediri, Maxence Compagnat, Alix Poyet and 2 others
In 30 stroke survivors with mostly mild deficits, the energy cost of walking correlated with impairment and daily independence, but every correlation vanished once walking speed was accounted for.
The number adds nothing beyond what you already know from how fast the patient walks.
Key findings
1Before accounting for walking speed, the energy cost of walking showed significant correlations with both neurological impairment (NIHSS) and daily independence (Barthel Index) across multiple walking tasks, with the strongest correlations during irregular-terrain walking (ρ = 0.59 for both measures).
2After adjusting for walking speed, no correlation between energy cost and either impairment or independence remained statistically significant for any of the six walking tasks.
3The authors conclude that the apparent link between energy cost and clinical outcomes is largely explained by walking speed rather than by independent differences in walking energetics, and that energy cost should not be interpreted without simultaneously considering gait velocity.
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What it does not show
Only 30 participants, all from one hospital, which limits generalisability and statistical power. The cohort had very mild deficits (NIHSS median 2) and near-complete independence (Barthel median 100), so the study says little about patients with moderate-to-severe impairment; the authors note a likely ceiling effect on the Barthel Index. Cross-sectional design: no causal inferences can be drawn. No correction for multiple comparisons across the six tasks and two clinical scales; the authors themselves flag the results as exploratory. Nine of the 30 participants used walking aids, which may have influenced speed, oxygen consumption, and energy cost. The NIHSS is a global neurological scale that includes non-motor domains; it may be less sensitive than a motor-specific measure (e.g., Fugl-Meyer) for capturing the deficits most relevant to walking energetics. Energy cost is mathematically defined as oxygen consumption divided by speed, so adjusting for speed in the same analysis is somewhat circular and complicates interpretation of any 'independent' effect. Two participants could not complete the required duration for certain tasks and had those data points excluded.
Declared interests
Funded by the Limoges University Hospital and the University of Limoges. The authors declare no conflicts of interest. No industry sponsor is named.
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