Association of Long-Distance Corridor Walk Performance With Mortality, Cardiovascular Disease, Mobility Limitation, and Disability

Department of Epidemiology, Physical Therapy, University of Pittsburgh, Pittsburgh, Pa 15213, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2006; 295(17):2018-26. DOI: 10.1001/jama.295.17.2018
Source: PubMed


Aerobic fitness, an important predictor of cardiovascular disease and mortality, is difficult to assess by maximal exercise testing in older adults. Extended walking tests have been examined as outcome predictors in medically ill populations but not in community-dwelling older adults.
To determine whether an extended walking test predicts poor outcomes in older adults.
Observational cohort study enrolling 3075 community-dwelling adults aged 70 to 79 years living in Pittsburgh, Pa, or Memphis, Tenn. Of those participating in the Health, Aging, and Body Composition Study, 1584 (52%) were women and 1281 (42%) were black. Participants enrolled from March 1997 to April 1998. Ability to complete the long-distance corridor walk and total performance time was assessed at the baseline examination.
Total mortality, incident cardiovascular disease, incident mobility limitation, and mobility disability were ascertained after a mean (SD) of 4.9 (0.9) years.
Among patients eligible to exercise, 351 died, 308 had episodes of incident cardiovascular disease, 1116 had occurrences of mobility limitation, and 509 had occurrences of mobility disability. Inability to complete walking 400 m tended to be associated with a higher risk of mortality and incident cardiovascular disease and, after accounting for potential confounders, was associated with incident mobility limitation (212.6 vs 79.1 events/1000 person-years; adjusted hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.58-2.18; P<.001) and mobility disability (85.2 vs 28.8 events/1000 person-years; adjusted HR, 1.95; 95% CI, 1.56-2.44; P<.001). Of those who completed 400 m, each additional minute of performance time was associated with an adjusted HR of 1.29 (95% CI, 1.12-1.48) for mortality, 1.20 (95% CI, 1.01-1.42) for incident cardiovascular disease, 1.52 (95% CI, 1.41-1.63) for mobility limitation, and 1.52 (95% CI, 1.37-1.70) for disability after adjustment for demographics, health behaviors, clinical and subclinical disease, and cardiovascular disease risk factors. Findings were consistent in both men and women and blacks and whites. Among participants who completed the test and after adjusting for potential confounders, those in the poorest quartile of functional capacity (walk time >362 seconds) had a higher risk of death than those in the best quartile (walk time <290 seconds; adjusted HR, 3.23; 95% CI, 2.11-4.94; P<.001).
Older adults in the community who reported no difficulty walking had a wide range of performance on this extended walking test. Ability to do the test and performance were important prognostic factors for total mortality, cardiovascular disease, mobility limitation, and mobility disability in persons in their eighth decade.

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Available from: Eleanor M Simonsick, Oct 05, 2015
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    • "But the underlying limitations lie in the morbidity and mortality predictions [2]. Cardiovascular diseases caused by the heart beat problems can be reflected by the parameters derived from the electrocardiography (ECG) to some extend [3]. The ECG tracings consist of clear heart beat waveforms. "
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    IEEE International Symposium on Circuits and Systems (ISCAS), Lisbon, Portugal; 05/2015
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    • "Decline in gait performance is common among older adults, even in the absence of neurological pathology or acute clinical events. Such age-related gait decline has been widely studied and reliably shown to increase the risk for morbidity, hospitalization, and mortality [Newman et al., 2006; Studenski et al., 2011; Verghese et al., 2006]. "
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    Human Brain Mapping 12/2014; 36(4). DOI:10.1002/hbm.22717 · 5.97 Impact Factor
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    • "Using the long-distance corridor walk allowed us to test the association between CRF and brain health in a sample of very old adults. This sample had a mean age of 83 and only 14.9% walked at a pace of at least 1.34 m/s which was the typical starting pace for treadmill protocols (Newman et al., 2006). Thus, the majority of these participants would not have been able to perform a treadmill test to quantify their CRF levels. "
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    ABSTRACT: A positive association between cardiorespiratory fitness (CRF) and white matter integrity has been consistently reported in older adults. However, it is unknown whether this association exists in adults over 80 with a range of chronic disease conditions and low physical activity participation, which can influence both CRF and brain health. This study examined whether higher CRF was associated with greater microstructural integrity of gray and white matter in areas related to memory and information processing in adults over 80 and examined moderating effects of chronic diseases and physical activity. CRF was measured as time to walk 400 m as quickly as possible with concurrent 3Telsa diffusion tensor imaging in 164 participants (57.1%female, 40.3%black). Fractional anisotropy (FA) was computed for cingulum, uncinate and superior longitudinal fasciculi. Mean diffusivity (MD) was computed for dorsolateral prefrontal cortex, hippocampus, parahippocampus, and entorhinal cortex. Moderating effects were tested using hierarchical regression models. Higher CRF was associated with higher FA in cingulum and lower MD in hippocampus and entorhinal cortex (β, sex-adjusted p: -0.182, 0.019; 0.165, 0.035; and 0.220, 0.006, respectively). Hypertension attenuated the association with MD in entorhinal cortex. Moderating effects of chronic diseases and physical activity in walking and climbing stairs on these associations were not significant. The association of higher CRF with greater microstructural integrity in selected subcortical areas appears robust, even among very old adults with a range of chronic diseases. Intervention studies should investigate whether increasing CRF can preserve memory and information processing by improving microstructure and potential effects of hypertension management.
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