Habitual Walking Speed Research Articles

Development of physical performance after acute hip fracture. A pragmatic study in a regular clinical geriatric setting

Background and aim: Hip fracture is a leading cause of mortality, morbidity, and disability in older people. The aim of the present study was to prospectively assess the development of physical performance in patients with hip fracture after surgery. Setting: Prospective, observational study in a Swedish university hospital. Methods: Assessment of 102 consecutive patients (65 females), with a mean age of 82 years (range 35-98) without specific inclusion or exclusion criteria. Seven physical functions were assessed using the following 4 measuring methods and 3 rating scales at baseline 7 to 10 days after surgery and follow-up after 4 months (F4): 10-m habitual walking speed (HWS), timed up and go (TUG), 30-second chair stand test (CST), handgrip strength (HGS), Berg balance scale (BBS), functional ambulation category (FAC), and general mobility. Results: The 47% dropout patients were significantly older and more often lived alone or in nursing homes and used indoor walking aids. At baseline, the mean HWS was 0.4/0.5 (females/males) m/s; TUG 53/30 s; CST 4/5 kg, and HGS 17.4/31.2 kg. The medians of BBS and FAC were 20/20 and 4/4, respectively. There were significant mean improvements at F4 for all 4 measured functions, except for HGS in males but for neither of the rating scales. There was a large heterogeneity in all assessed variables, both at baseline and regarding change at 4 months. Therefore, the mean/median results are depicted in figures, showing all individual results at baseline and F4, compared to reference values and discussed in relation to degree of improvement. Conclusion: The observed large heterogeneity at baseline as well as F4 makes it essentially meaningless to report means and median data of functional assessment of patients with hip fracture. There is a strong need for individualization in both health analysis and how the treatment program is targeted, carried through, and evaluated over time in patients with hip fracture.

Musculoskeletal pain and physical functioning in the oldest old

Little is known about the impact of pain on physical functioning among the oldest-old subjects. In this study, we first examined the associations between the number of painful sites and measures of physical functioning reflecting different stages of the disablement process (physical impairment, functional limitation and disability) among nonagenarians (more than ninety years old persons). Second, we described the effect of painful sites on disability during a 2-year follow-up period. This study is based on baseline (n = 1177) and 2-year follow-up (n = 709) data of the nationwide Danish 1905 cohort study. Musculoskeletal pain was assessed as reported pain in back, hips or knees when moving or resting. Physical performance measures included maximum grip strength and habitual walking speed. Disability in performing activities of daily living was defined as the need for assistive device or personal help in transferring, dressing, washing, using toilet and/or walking indoors. At baseline, the number of painful sites was significantly associated with measured grip strength and walking speed as well as self-reported disability in a stepwise manner; the more sites with pain, the poorer the physical functioning. The follow-up analyses showed corresponding but slightly weaker stepwise associations between baseline pain and disability level at follow-up, and indicated that although on the whole, single or multi-site pain did not predict the onset of disability, multi-site pain increased the risk of developing severe disability. The findings of this study suggest that musculoskeletal pain in nonagenarians is highly prevalent and is associated with poor physical performance and disability.

Executive function moderates the role of muscular fitness in determining functional mobility in older adults

Both physical and cognitive factors are known to independently predict functional mobility in older people. However, the combined predictive value of both physical fitness and cognitive factors on functional mobility has been less investigated. The aim of the present study was to assess if cognitive executive functions moderate the role of physical fitness in determining functional mobility of older individuals. Fifty-seven 65- to 75-year-old healthy participants performed tests of functional mobility (habitual and maximal walking speed, maximal walking speed while picking up objects/stepping over obstacles), physical fitness (peak power, knee extensors torque, back/lower limb flexibility, aerobic fitness), and executive function (inhibition and cognitive flexibility). Maximal walking speeds were predicted by physical fitness parameters and their interaction with cognitive factors. Knee extensor torque emerged as the main predictor of all tested locomotor performances at maximal speed. The effect of peak power and back/lower limb flexibility was moderated by executive functions. In particular, inhibition and cognitive flexibility differed in the way in which they moderate the role of fitness. High levels of cognitive flexibility seem necessary to take advantage of leg power for walking at maximal speed. In contrast, high levels of inhibitory capacity seem to compensate for low levels of back/lower limb flexibility when picking up movements are added to a locomotor task. These findings may have important practical implications for the design and implementation of multi-component training programs aimed at optimizing functional abilities in older adults.

Maintenance of Aquatic Training-Induced Benefits on Mobility and Lower-Extremity Muscles Among Persons With Unilateral Knee Replacement

Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Maintenance of aquatic training-induced benefits on mobility and lower-extremity muscles among persons with unilateral knee replacement. Objective To evaluate the maintenance of observed aquatic training-induced benefits at 12-month follow-up. Design Twelve-month follow-up of a randomized controlled study. Setting Research laboratory and hospital rehabilitation pool. Participants Population-based sample of 55 to 75-year-old women and men 4 to 18 months (on average 10mo) after unilateral knee replacement. Fifty people were willing to participate in the exercise trial and 42 people in the follow-up study. Intervention Twelve-month follow-up of 12-week progressive aquatic resistance training, or no intervention. Main Outcome Measures Isokinetic knee extensor and flexor power, thigh muscle cross-sectional area (CSA), habitual walking speed, stair ascending time, and sit-to-stand test. Results After a 12-month follow-up, a 32% (95% confidence interval [CI], 10–53) training effect in knee extensor power ( P=.008) and 50% (95% CI, 9–90) in knee flexor power ( P=.005) of the operated knee remained. In muscle CSA, the training-induced benefit had disappeared at the follow-up. All the significant 12-week improvements in habitual walking speed, stair ascending time, and sit-to-stand in the training group compared with controls were lost at follow-up. Conclusions After the 12-month follow-up, the 12-week aquatic training-induced benefits in knee extensor and flexor power were maintained, whereas the mobility benefits had disappeared. Aquatic resistance training should be continued at least on some level to maintain the training-induced benefits in mobility.

Investigation into the reliability and validity of the measurement of elderly people's clinical walking speed: A systematic review

The number of available walking tests has increased dramatically over the past decades. Therefore, it is highly important to help clinicians choose the most appropriate walking test for a specific setting. This systematic review aimed to critically evaluate the reliability, validity, and responsiveness of clinical walking speed in a broad population of elderly persons living in the community, sheltered housing, or institutions. Literature searches were performed in several different databases. Key words were based on the topic of the measurement properties of performance-based clinical tools for quantifying walking. The instrument selected for review was walking speed. The methods and results of all the evaluated measurement properties were rated by using a standard checklist for appraising the qualitative attributes and measurement properties of the instrument. A total number of 3,781 abstracts were reviewed, and 86 articles were chosen for inclusion. Habitual walking speed seems to be highly reliable in community-dwelling people and residents in mixed settings. There have not been any studies that accord with our inclusion and exclusion criteria that have evaluated the reliability of maximum walking speed in an aged population. Walking speed is a highly valid test, both at habitual and maximum speed. Few studies gave information about responsiveness for walking speed, which means that these results cannot be evaluated properly. Habitual walking speed is a reliable measure, but maximum walking speed needs further evaluation. Both habitual and maximum walking speeds are valid instruments, and they predict death, hospitalization/institutionalization, and decline in mobility.

A study on the relationship between muscle function, functional mobility and level of physical activity in community-dwelling elderly

to evaluate the relationship between lower extremity muscle function, calf circumference (CC), handgrip strength (HG), functional mobility and level of physical activity among age groups (65-69, 70-79, 80+) of older adults (men and women) and to identify the best parameter for screening muscle function loss in the elderly. 81 community-dwelling elderly (42 women and 39 men) participated. Walking speed (Multisprint Kit), HG (Jamar dynamometer), hip, knee and ankle muscle function (Biodex isokinetic dynamometer), level of physical activity (Human Activity Profile) and CC (tape measure) were evaluated. ANOVA, Pearson correlation and ROC curves were used for statistical analysis. Dominant CC (34.9±3 vs 37.7±3.6), habitual (1.1±0.2 vs 1.2±0.2) and fast (1.4±0.3 vs 1.7±0.3) walking speed, HG (23.8±7.5 vs 31.8±10.3), average peak torque and average hip, knee and ankle power (p<0.05) were lower for the 80+ group than for the 65-69 year-olds. There were no differences in physical activity level among age groups. Moderate significant correlations were found between muscle function parameters, walking speed and HG; a fair degree of relationship was found between muscle function parameters, CC and level of physical activity (p<0.05). The ROC curve analysis suggested a cutoff point of 14.51 Kgf for screening muscle function loss in elderly women (p=0.03). This study demonstrated an association between muscle function, HG and fast walking speed, a decrease in these parameters with age and the possibility of using HG to screen for muscle function of the lower extremities.

Energetics of Walking in Elderly People: Factors Related to Gait Speed

Slow walking speed in elderly people predicts increased morbidity and mortality. We examined factors that may be associated with decreased habitual walking speed in older men and women. Older (range: 60-88 years, mean = 72.5 years) men (n = 25) and women (n = 24) were recruited. The Short Physical Performance Battery, body composition, VO(₂peak) on a treadmill, VO₂ and rated perceived exertion during 10 minutes of walking at habitual gait speed and at a walking speed of 0.9 m/s, muscle strength, and level of physical activity were measured. VO(₂peak) was strongly related to habitual gait speed (r = .744, p < .001) and remained significant even after controlling for age, muscle strength, and gender. Compared with the tertile of fastest walkers (mean gait speed, 1.37 ± 0.04 m/s), the tertile of slowest walkers (0.87 ± 0.02 m/s) were older (p < .001), shorter (p = .026), had lower lean body mass (p = .011), lower strength ( p < .001), less self-reported daily physical activity (p = .102), and higher relative (to VO(₂peak)) intensity during walking at their habitual speed (65.3% ± 3.9% vs 54.3% ± 2.1% of VO(₂peak), p = .013). VO(p₂eak) was strongly associated with habitual walking speed, suggesting that as aerobic capacity declines with age, the exertion associated with habitual gait speed increases. A slowing of walking speed may be a response to increased perception of exertion. The extent to which exercise training affects habitual gait speed and fatigue is not clear.

Effects of Aquatic Resistance Training on Mobility Limitation and Lower-Limb Impairments After Knee Replacement

Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement. Objective To study the effects of aquatic resistance training on mobility, muscle power, and cross-sectional area. Design Randomized controlled trial. Setting Research laboratory and hospital rehabilitation pool. Participants Population-based sample (N=50) of eligible women and men 55 to 75 years old 4 to 18 months after unilateral knee replacement with no contraindications who were willing to participate in the trial. Interventions Twelve-week progressive aquatic resistance training (n=26) or no intervention (n=24). Main Outcome Measures Mobility limitation assessed by walking speed and stair ascending time, and self-reported physical functional difficulty, pain, and stiffness assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. Knee extensor power and knee flexor power assessed isokinetically, and thigh muscle cross-sectional area (CSA) by computed tomography. Results Compared with the change in the control group, habitual walking speed increased by 9% ( P=.005) and stair ascending time decreased by 15% ( P=.006) in the aquatic training group. There was no significant difference between the groups in the WOMAC scores. The training increased knee extensor power by 32% ( P<.001) in the operated and 10% ( P=.001) in the nonoperated leg, and knee flexor power by 48% ( P=.003) in the operated and 8% ( P=.002) in the nonoperated leg compared with controls. The mean increase in thigh muscle CSA of the operated leg was 3% ( P=.018) and that of the nonoperated leg 2% ( P=.019) after training compared with controls. Conclusions Progressive aquatic resistance training had favorable effects on mobility limitation by increasing walking speed and decreasing stair ascending time. In addition, training increased lower limb muscle power and muscle CSA. Resistance training in water is a feasible mode of rehabilitation that has wide-ranging positive effects on patients after knee replacement surgery.

An exercise intervention to improve diabetic patients’ gait in a real-life environment

Aims Gait characteristics and balance are altered in diabetic individuals. Little is known about possible treatment strategies. This study evaluated the effect of a specific training program on diabetic patients’ gait. Methods A randomized controlled trial ( N = 71) with an intervention (IG) ( N = 35), and control group (CG) ( N = 36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-oriented strengthening. Controls received no treatment. Results After intervention the IG increased their habitual walking speed by 0.149 ms −1 (0.54 km h −1) on tarred terrain and by 0.169 ms −1 (0.61 km h −1) on the cobblestones. This significant treatment effect ( p < 0.001) decreased slightly at the six-month follow-up, but remained significant ( p < 0.001). In a similar manner, significant improvement was observed for cadence, gait cycle time and stance time on both terrains. All outcomes except stance time on the tarred terrain remained significant at the six-month follow-up. No significant effect was observed for stride length and the coefficient of variation of gait cycle time (on either surface) at the corrected significance level of p < 0.004. CG patients’ parameters all remained unchanged or progressively deteriorated compared to baseline values. Discussion Cadence contributed 80%, whereas stride length only contributed 20% to the change of gait velocity. This may be due to the treatment or to diabetic patients’ potential to regulate their cadence and stride length. Conclusion A specific training program can improve diabetic patients’ gait in a real life environment. A challenging environment highlights treatment effects on patients’ gait better than an evenly tarred surface.

The gait and balance of patients with diabetes can be improved: a randomised controlled trial

Aims/hypothesisGait characteristics and balance are altered in diabetic patients. Little is known about possible treatment strategies. This study evaluates the effect of a specific training programme on gait and balance of diabetic patients.MethodsThis was a randomised controlled trial (n = 71) with an intervention (n = 35) and control group (n = 36). The intervention consisted of physiotherapeutic group training including gait and balance exercises with function-orientated strengthening (twice weekly over 12 weeks). Controls received no treatment. Individuals were allocated to the groups in a central office. Gait, balance, fear of falls, muscle strength and joint mobility were measured at baseline, after intervention and at 6-month follow-up.ResultsThe trial is closed to recruitment and follow-up. After training, the intervention group increased habitual walking speed by 0.149 m/s (p < 0.001) compared with the control group. Patients in the intervention group also significantly improved their balance (time to walk over a beam, balance index recorded on Biodex balance system), their performance-oriented mobility, their degree of concern about falling, their hip and ankle plantar flexor strength, and their hip flexion mobility compared with the control group. After 6 months, all these variables remained significant except for the Biodex sway index and ankle plantar flexor strength. Two patients developed pain in their Achilles tendon: the progression for two related exercises was slowed down.Conclusions/interpretationSpecific training can improve gait speed, balance, muscle strength and joint mobility in diabetic patients. Further studies are needed to explore the influence of these improvements on the number of reported falls, patients’ physical activity levels and quality of life.Trial registration:ClinicalTrials.gov NCT00637546Funding:This work was supported by the Swiss National Foundation (SNF): PBSKP-123446/1/Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-009-1592-4) contains supplementary material, which is available to authorised users.

Linking C-Reactive Protein to Late-Life Disability in the National Health and Nutrition Examination Survey (NHANES) 1999-2002

Chronic inflammation, measured by interleukin-6, predicts incident disability among elderly people. However, little is known about the relation of C-reactive protein (CRP) to disability. Participants (>60 years old, N = 1680) were from the National Health and Nutrition Examination Survey 1999-2002. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) was obtained by self-report. Peak muscle power was the product of isokinetic peak leg torque and peak force velocity. Functional limitations were evaluated via habitual walking speed, which was obtained from a 20-foot timed walk. CRP levels were quantified by using latex-enhanced nephelometry. Elevated CRP levels were associated with disability in IADL, LSA, LEM, and GPA, independent of basic demographics, chronic medical diseases, health behaviors, as well as nutritional markers. The corresponding odds ratios of disability for each standard-deviation increase in natural-log-transformed CRP were 1.18 (95% confidence interval [CI], 1.02-1.35), 1.18 (95% CI, 1.00-1.39), 1.17 (95% CI, 1.03-1.33), and 1.17 (95% CI, 1.05-1.31), respectively. The relationship diminished after additional adjustment of leg power and/or walking speed, meaning that impairment in leg power and limitations in gait speed likely mediate the association between CRP and disability. CRP had an inverse relationship to leg power and walking speed. Likewise, additional adjustment for leg power substantially diminished the association between CRP and walking speed, suggesting a mediating effect of power between CRP and gait speed. Independent of chronic diseases, elevated CRP is associated with multiple domains of disability through mediation of muscle power, habitual gait speed, or both. Future research is needed to understand CRP as a risk factor for disability in older populations.

Measuring Habitual Walking Speed of People With Type 2 Diabetes

Revised physical activity guidelines for individuals with type 2 diabetes recommend at least 150 min/week of moderate-intensity aerobic physical activity (40–60% of V o2max or 50–70% of maximum heart rate) and/or 90 min/week of aerobic exercise (>60% of V o2max or >70% of maximum heart rate) (1). In a structured exercise program or in the laboratory setting, levels of physical activity can be closely monitored; however, self-directed walking is the most common and most acceptable form of physical activity (2,3) to people with type 2 diabetes, and little is known about self-paced walking speed (and therefore intensity). A walking speed of 4.0 km/h is widely accepted as moderately intense physical activity (4). Numerous studies examining the beneficial effects of physical activity for people with type 2 diabetes exist (rev. in 1,5). Few, however, have directly measured walking speed. Previous research (6,7) demonstrated efficacy in increasing physical activity of participants using the First Step Program (FSP), a pedometer-based, self-paced walking program designed to help people with type 2 diabetes increase their steps per day. Despite the increase in physical activity, improvements in health outcomes were modest. In contrast, the implementation of the FSP in a worksite setting involving healthy adults resulted in significant reductions in weight, BMI, waist girth, and resting heart rate (8). We hypothesize that a slower walking speed …

Dependences of ground reaction force parameters on habitual walking speed in hemiparetic subjects

Dependences of vertical and horizontal ground reaction force parameters on habitual walking speed were studied in samples of 144 and 23 hemiparetic stroke patients admitted to our rehabilitation unit. Statistical correlations across subjects were not significant for the normalized vertical force peaks and for the maximum of the mediolateral shear force. Correlations between the vertical loading and deloading rates, as well as the anteriorposterior braking and propulsive force peaks, and translational impulse were substantial and significant across subjects, with degrees of predictability between 46 and 83% for the dependent variables on the basis of speed × body mass. After a 4-week period of comprehensive rehabilitation according to the Bobath concept (neurodevelopmental technique), changes in symmetry parameters were, for all practical concerns, uncorrelated to changes in spontaneous walking speed. It is concluded that measurement of gait symmetry may provide additional, unredundant information about therapeutic effects that cannot be gained by measurement of walking speed alone. It remains a conceptual problem whether parameters of symmetry or the functional change in walking speed should be regarded as more important for the assessment of improvement or deterioration.