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Title: Plantar pressure variability and asymmetry in elderly performing 60-minute treadmill brisk-walking : paving the way towards fatigue-induced instability assessment using wearable in-shoe pressure sensors
Authors: Zhang, G 
Wong, DWC 
Wong, IKK 
Chen, TLW 
Hong, TTH 
Peng, Y 
Wang, Y 
Tan, Q 
Zhang, M 
Issue Date: May-2021
Source: Sensors, 1 May 2021, v. 21, no. 9, 3217
Abstract: Evaluation of potential fatigue for the elderly could minimize their risk of injury and thus encourage them to do more physical exercises. Fatigue-related gait instability was often assessed by the changes of joint kinematics, whilst planar pressure variability and asymmetry parameters may complement and provide better estimation. We hypothesized that fatigue condition (induced by the treadmill brisk-walking task) would lead to instability and could be reflected by the variability and asymmetry of plantar pressure. Fifteen elderly adults participated in the 60-min brisk walking trial on a treadmill without a pause, which could ensure that the fatigue-inducing effect is continuous and participants will not recover halfway. The plantar pressure data were extracted at baseline, the 30th min, and the 60th min. The median of contact time, peak pressure, and pressure-time integrals in each plantar region was calculated, in addition to their asymmetry and variability. After 60 min of brisk walking, there were significant increases in peak pressure at the medial and lateral arch regions, and central metatarsal regions, in addition to their impulses (p < 0.05). In addition, the variability of plantar pressure at the medial arch was significantly increased (p < 0.05), but their asymmetry was decreased. On the other hand, the contact time was significantly increased at all plantar regions (p < 0.05). The weakened muscle control and shock absorption upon fatigue could be the reason for the increased peak pressure, impulse, and variability, while the improved symmetry and prolonged plantar contact time could be a compensatory mechanism to restore stability. The outcome of this study can facilitate the development of gait instability or fatigue assessment using wearable in-shoe pressure sensors.
Keywords: Balance
Gait instability
Gait parameters
Prolonged walking
Publisher: Molecular Diversity Preservation International (MDPI)
Journal: Sensors 
EISSN: 1424-8220
DOI: 10.3390/s21093217
Rights: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (
The following publication Zhang, G., Wong, D. W. C., Wong, I. K. K., Chen, T. L. W., Hong, T. T. H., Peng, Y., ... & Zhang, M. (2021). Plantar Pressure Variability and Asymmetry in Elderly Performing 60-Minute Treadmill Brisk-Walking: Paving the Way towards Fatigue-Induced Instability Assessment Using Wearable In-Shoe Pressure Sensors. Sensors, 21(9), 3217 is available at
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