Journal of Geriatric Physical Therapy Vol. 32;2:09
Clinical Assistant Professor, Physical erapy Program, De-
partment of Exercise Science, Arnold School of Public Health,
University of South Carolina, Columbia SC
Professor of Physical erapy & Geriatrics, Dept. of Physical
erapy & Human Movement Science, College of Education
& Health Professions, Sacred Heart University, Faireld, CT
Walking speed is “almost the perfect measure.”
measure, self-selected walking
speed (WS), also termed gait velocity, correlates with functional
and balance condence.
It has the potential to pre-
dict future health status,
and functional decline
ing speed reects both functional and physiological changes,
is a discriminating factor in determining potential for rehabili-
and aids in prediction of falls
and fear of falling.
Furthermore, progression of WS has been linked to clinical
meaningful changes in quality of life
and in home and com-
munity walking behavior.
Due to its ease of use
metric properties, WS has been used as a predictor and outcome
measure across multiple diagnoses.
In addition, WS was
chosen by a panel of experts as the standardized assessment to
measure locomotion for the Motor Function Domain of the
Walking speed, like blood pres-
sure, may be a general indicator
that can predict future events and
reect various underlying physi-
While WS can-
not stand alone as the only predic-
tor of functional abilities, just at
blood pressure is not the only sign
of heart disease; WS can be used
as a functional “vital sign” to help
determine outcomes such as func-
and the need for rehabilitation
Walking is a complex func-
tional activity; thus, many vari-
ables contribute to or inuence
WS. ese include, but are not
limited to, an individual’s health
performance and musculoskel-
and habitual activity level,
as well as the
characteristics of the environment
in which one walks.
formance measures used in conjunction with WS are often bet-
ter able to predict health status,
the use of WS alone can be
an excellent predictor.
For example, WS predicts the post
hospital discharge location 78% of the time, and the addition of
cognition or initial FIM scores does not signicantly strengthen
the ability of dening if a patient will be discharged to home or
to a skilled nursing facility.
Several standardized assessments and physical performance
tests reliably predict function and health related events. Yet the
consistent use of measures in physical therapy and other clinical
settings is not widely practiced.
Factors contributing to this
non-use of standardized assessments may include insucient
time, inadequate equipment or space, or lack of knowledge in
interpreting the assessment.
Walking speed is one standard-
ized measure that can be quickly and easily incorporated into
the PT examination/evaluation process.
Determining feasibility is the rst essential step in deciding
to use a test or measure in the clinic. e main questions clini-
cians should pose regarding a test’s or measure’s feasibility are:
(1) Is the test safe?
(2) Is it cost eﬀective?
(3) How easy is the test to administer? and
(4) How easily are the results of the test graded and interpreted?
White Paper: “Walking Speed: the Sixth Vital Sign”
Stacy Fritz, PT, PhD;
Michelle Lusardi, PT, PhD
0 mph 0.4 mph 0.9 mph 1.3 mph 1.8 mph 2.2 mph 2.7 mph 3.1 mph
10 meter walk time 50 sec 25 sec 16.7 sec 12.5 sec 10 sec 8.3 sec 7.1 sec
10 foot walk time 15.2 sec 7.6 sec 5 sec 3.8 sec 3 sec 2.5 sec 2.2 sec
ADL: activities of daily living; IADL: instrumental ADLs; D/C: discharged; WS: walking speed; mph: miles per hour;
Figure 1. A collection of walking speed times that are linked to dependence, hospitalization,
rehabilitation needs, discharge locations, and ambulation category.
Journal of Geriatric Physical Therapy Vol. 32;2:09
An armative answer to all these questions, as there is with
WS, lends to feasibility of use in a clinical setting. Walking
speed is safe, requires no special equipment, adds no signi-
cant cost to an assessment, requires little additional time (can
be administered in less than 2 minutes
), is easy to calculate
(distance/time), and is easy to interpret based on published
Figure 2. Self selected walking speed categorized by gender
and age (6-12 and teens,
Walking speed can be quickly and accurately assessed in the
majority of physical therapy practice settings, including home
care, subacute and acute rehabilitation facilities, long-term care
facilities, out-patient oces, and schools, as well as during com-
munity wellness/screening activities.
Measurements of walk-
ing speed are highly reliable, regardless of the method for mea-
surement, for diﬀerent patient populations and for individuals
with known impairments aﬀecting gait.
Examination of WS
requires a stopwatch and as little as a 20 foot space to walk
While most reported normative values are based on
measuring in the middle two-thirds of a longer walkway, al-
lowing walking speed to reach a steady state, others have used
If possible, timing WS three times dur-
ing the examination (with a few minutes of rest between trials)
and developing a mean WS value will provide a more accurate
estimate of actual self-selected walking speed than a single trial
Figure 3 displays a suggested reliable, inexpensive method
to collect WS by using the 10 meter (m) walk test.
quires a 20 m straight path, with 5 m for acceleration, 10 m
for steady-state walking, and 5 m for deceleration. Markers are
placed at the 5 and 15 m positions along the path. e patient
begins to walk “at a comfortable pace”
at one end of the path, and continues
walking until he or she reaches the
other end. e Physical erapist uses
a stopwatch to determine how much
time it takes for the patient to traverse
the 10 m center of the path, starting
the stopwatch as soon as the patient’s
limb crosses the rst marker and stop-
ping the stopwatch as soon as the pa-
tient’s limb crosses the second marker.
If a full 20 m walkway is not available, shorter distances can
be used, as long as there is adequate room for acceleration and
deceleration (eg, 5 ft acceleration, 10 ft. steady state, 5 ft. de-
While WS varies by age, gender, and anthropometrics, the
range for normal WS is 1.2-1.4m/sec.
is general guideline
can help in monitoring our patients, along with norms by age
(Figure 2), and other cited cutoﬀ points
1). Interpretation of WS also includes understating what con-
stitutes true change and what change may be due to measure-
In a recent study, with a diverse group of older
participants with varying diagnoses, 0.05 m/s was calculated as
the needed change for a small but meaningful improvement in
In addition, for patients who do not have normal walk-
ing speed, an improvement in WS of at least 0.1 m/s is a useful
predictor for well-being,
while a decrease in the same amount
is linked with poorer health status, more disability, longer hos-
pital stays, and increased medical costs.
e MDC scores are
specic to the population and will vary according to your cli-
Walking speed is an easily accessible screening tool
should be performed to oﬀer insight into our patients function-
al capacity and safety. Physical therapists, as specialists in move-
ment and function, can use WS as a practical and informative
functional sixth “vital sign” for all patients; examining walking
speed in the same way that we routinely monitor blood pres-
sure, pulse, respiration, temperature, and pain.
is sixth “vi-
tal sign” provides a relevant functional perspective to the health
status provided by the system-level vital signs assessed on most
visits to physicians’ oces.
is review summarizes the strong psychometric properties
of WS and robust evidence for using this clinical measurement.
Walking speed is easily measurable, clinically interpretable,
and a potentially modiable risk factor.
For these reasons, us-
ing WS as the sixth vital sign is both pragmatic and essential.
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