Prognostic Value of Usual Gait Speed in Well-Functioning Older People—Results from the Health, Aging and Body Composition Study

Department of Psychiatry, VU University Amsterdam, Amsterdamo, North Holland, Netherlands
Journal of the American Geriatrics Society (Impact Factor: 4.57). 10/2005; 53(10):1675-80. DOI: 10.1111/j.1532-5415.2005.53501.x
Source: PubMed


To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons.
Prospective cohort study.
Health, Aging and Body Composition Study.
Three thousand forty-seven well-functioning older persons (mean age 74.2).
Usual gait speed on a 6-m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n=2,031) and then validate (Sample B; n=1,016) usual gait-speed cutpoints. Rates of persistent lower extremity limitation events (mean follow-up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high- (< 1 m/s) and low risk (> or = 1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health-related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses.
A graded response was seen between risk groups and health-related outcomes. Participants in the high-risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR)=2.20, 95% confidence interval (CI)=1.76-2.74), persistent severe lower extremity limitation (RR=2.29, 95% CI=1.63-3.20), death (RR=1.64, 95% CI=1.14-2.37), and hospitalization (RR=1.48, 95% CI=1.02-2.13) than those in the low-risk group.
Usual gait speed of less than 1 m/s identifies persons at high risk of health-related outcomes in well-functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.

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    • "Therefore, walking speed is an important indicator of health status and function and can be used as a 'vital sign' (Fritz and Lusardi 2009; Studenski et al. 2011; Taekema et al. 2012). It has been shown that walking speed associates with aspects of poor health status or outcomes in older adults, such as mortality (Abellan van Kan et al. 2009; Cesari et al. 2005; Newman et al. 2006; Toots et al. 2013), mobility impairment (Newman et al. 2006; Purser et al. 2005; Rolland et al. 2004), falls (Abellan van Kan et al. 2009; Montero-Odasso et al. 2005), presence of cognitive impairment (Auyeung et al. 2008; Camicioli et al. 1998), cardiopulmonary diseases (Dumurgier et al. 2010; Ilgin et al. 2011; Newman et al. 2006; Rosano et al. 2011), hospitalization , and nursing home placement (van Abellan et al. 2009; Cesari et al. 2005; Giuliani et al. 2008; Montero- Odasso et al. 2005). Cut-off values for walking speed are used for the prediction of aforementioned health outcomes and underpin clinical decision making. "
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    ABSTRACT: Walking speed is shown to be an important indicator of the health status and function in older adults and part of the comprehensive geriatric assessment in clinical practice. The present study aimed to assess the influence of different assessment methods on walking speed and its association with the key aspects of poor health status, i.e., the presence of low cognitive performance and cardiopulmonary disease. In 288 community-dwelling elderly (mean age 82.2 ± 7.1 years) referred to a geriatric outpatient clinic, walking speed was assessed with the 4-m, 10-m, and 6-min walking tests. The mean walking speed assessed with the 10-m walking test was higher compared to the 4-m and 6-min walking tests (mean difference (95 % CI) 0.11 m/s (0.10; 0.13) and 0.08 m/s (0.04; 0.13), respectively). No significant difference was found in the walking speed assessed with the 4-m compared to the 6-min walking test (mean difference (95 % CI) -0.03 m/s (-0.08; 0.03)). ICCs showed excellent agreement of the 4-m with the 10-m walking test and fair to good agreement of the 6-min with the 4-m as well as 10-m walking test. The presence of low cognitive performance was negatively associated with walking speed, with the highest effect size for the 4-m walking test. The presence of cardiopulmonary disease was negatively associated with walking speed as well, with the highest effect size for the 6-min walking test. In conclusion, in the clinically relevant population of elderly outpatients, walking speed and its interpretation depends on the assessment method, which therefore cannot be used interchangeably in clinical practice.
    Full-text · Article · Dec 2014 · Journal of the American Aging Association
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    • "The test was timed with a digital stopwatch , and subjects were instructed to perform as many repetitions as possible during a 30-s time period. Usual gait speed (UGS) assessment was verified according to Cesari et al. (2005). Briefly, the subjects were instructed to stand with their feet behind a starting line and then to walk at their normal pace during a 6-m distance until the finish line. "
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    ABSTRACT: Muscle quality is an important component of the functional profile of the elderly, and previous studies have shown that both muscle quantity and quality independently contribute to muscle strength of the elderly. This study aimed to verify the association between quadriceps femoris muscle quality, analyzed by specific tension and echo intensity (EI), and rate of torque development (RTD) of the knee extensor muscles with the functional performance in elderly active women. Forty-five healthy, active elderly women (70.28 ± 6.2) volunteered to participate in this study. Quadriceps femoris muscle thickness and EI were determined by ultrasonography. Knee extension isometric peak torque and RTD were obtained from maximal isometric voluntary contraction curves. The 30-s sit-to-stand-up (30SS) test and usual gait speed (UGS) test were applied to evaluate functional performance. Rectus femoris EI presented a significant negative correlation with 30SS (r = −0.505, P < 0.01), UGS (r s = −0.347, P < 0.05), and isometric peak torque (r = −0.314, P < 0.05). The quadriceps femoris EI correlated negatively with 30SS (r = −0.493, P < 0.01) and isometric peak torque (r = −0.409, P < 0.01). The EI of the quadriceps femoris and all quadriceps muscle portions significantly correlated with RTD. RTD significantly correlated with physical performance in both functional tests (30SS = r = 0.340, P < 0.05; UGS = r s = 0.371, P < 0.05). We concluded that muscle EI may be an important predictor of functional performance and knee extensor power capacity in elderly, active women.
    Full-text · Article · Oct 2014 · Journal of the American Aging Association
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    • "Temporal-spatial gait variables have repeatedly been shown to be important for identification of injury/disease [4–6], prediction of falls [7, 8], and quantification of the effect of interventions [9, 10]. In particular, gait speed has been associated with health status, activity levels and quality of life, and is predictive of future morbidity and mortality [11–14]. "
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    ABSTRACT: Measurement of temporal-spatial gait variables is common in aging research with several methods available. This study investigated the differences in temporal-spatial gait outcomes derived from two different programs for processing instrumented walkway data. Data were collected with GAITRite® hardware from 86 healthy older people and 44 older people four months following surgical repair of hip fracture. Temporal-spatial variables were derived using both GAITRite® and PKmas® processing programs from the same raw footfall data. The mean differences between the two programs for most variables were negligible, including for Speed (mean difference 0.3 ± 0.6 cm/sec, or 0.3% of the mean GAITRite® Speed). The mean absolute percentage difference for all 18 gait variables examined ranged from 0.04% for Stride Duration to 66% for Foot Angle. The ICCs were almost perfect (≥0.99) for all variables apart from Base Width, Foot Angle, Stride Length Variability, Step Length Variability, Step Duration Variability and Step Width Variability, which were all never-the-less above 0.84. There were systematic differences for Base Width (PKmas® values 1.6 cm lower than GAITRite®) and Foot Angle (PKMAS® values 0.7° higher than GAITRite®). The differences can be explained by the differences in definitions and calculations between the programs. The study demonstrated that for most variables the outcomes from both programs can be used interchangeably for evaluation of gait among older people collected with GAITRite® hardware. However, validity and reliability for Base Width and Foot Angle derived by PKMAS® would benefit from further investigation.
    Full-text · Article · Aug 2014 · BMC Research Notes
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