Effects Of Increasing Walking Cadence On Knee Joint Loading And Pain In Adults With Knee Osteoarthritis

Gait retraining is a strategy to manage altered loading patterns and pain characteristic of knee osteoarthritis (OA). Increasing cadence (steps/minute) may be a promising gait modification approach because lower preferred cadence is associated with higher knee joint loading and risk of cartilage worsening. PURPOSE: Determine the acute effects of increasing cadence on knee adduction and flexion moment peaks and impulses, and knee pain in adults with knee OA. METHODS: 25 participants with knee OA (age = 61.8 ± 7.3; 81.8% female) completed a 5-minute walk at fixed speed on an instrumented, split-belt treadmill. Baseline cadence (steps/minute) was first measured. Five, randomized experimental cadence conditions (2%, 4%, 6%, 8%, or 10% over baseline cadence) were then completed. A custom-written LabVIEW code was used to monitor and provide real-time visual feedback on cadence. Auditory cues from a metronome set to the target cadence were simultaneously provided. Participants were instructed to keep their cadence within ±1 step/minute of the target, and to walk to the beat of the metronome. Kinematics and ground reaction forces were sampled for the duration of each condition (2 minutes). Knee pain was reported on a 0-10 scale during a 1-minute rest period between each condition. Linear mixed effects models evaluated the effect of cadence on each outcome: knee adduction moment peaks and impulse, knee flexion moment peak and impulse, and knee pain. RESULTS: Increasing cadence by 2-10% did not significantly change knee adduction moment peaks or impulse. Peak knee flexion moment increased by 3-32% and knee flexion moment impulse reduced by 2-9% with increases in cadence, but these results were not significant (peak knee flexion moment, p = 0.06; knee flexion moment impulse, p = 0.05). Increasing cadence did not affect knee pain. CONCLUSIONS: In adults with knee OA, increasing preferred walking cadence by 2-10% at a fixed speed has no immediate effect on surrogate measures of knee joint loading or pain. Future research investigating cadence modification should consider feedback type and delivery and practice time, as these factors are known to influence motor performance. ACSM Foundation Doctoral Student Grant; Foundation for Physical Therapy