Short-stepping gait in severe heart failure

Background—Patients with severe chronic heart failure seem to take shorter steps than healthy controls when walking on a treadmill and when walking freely along a corridor. In healthy individuals the pattern of walking affects the oxygen cost of exercise, and so this observation might be relevant to the limitation of exercise in heart failure. Method—Length of stride was analysed as stride/stature index in 15 controls, 10 patients with moderate heart failure, 10 patients with severe heart failure, and 10 patients with angina, walking at a constant speed/stature index. Results—The stride/stature index was 0·64 in the controls in patients with New York Heart Association (NYHA) class II heart failure, and in patients with angina. It was 0·49 in patients with NYHA class III heart failure. In the patients with heart failure the stride/stature index correlated with exercise capacity determined as peak oxygen consumption Vo2max (R = +0·62, p < 0·005). When healthy controls walked in time to a metronome adjusted to decrease their stride/stature index to approximately that seen in severe heart failure steady-state oxygen consumption increased by a mean of 15%. Conclusions—The length of stride is reduced in severe heart failure, and when healthy controls adopt this gait the oxygen cost of walking is increased. A short-stepping gait may contribute to the limitation of exercise capacity in heart failure.