Usual Walking Speed Research Articles

Hip Fractures Among Elderly Women: Longitudinal Comparison of Physiological Function Changes and Health Care Utilization

To compare physiological and functional impairments and their impact on health care use patterns among disabled older women with and without hip fracture. Data from the 3-year longitudinal Women's Health and Aging Study I (WHAS-I) and Medicare Current Beneficiaries Survey (MCBS) were used for this comparison study. Outcome variables include physiological measures (eg, hip and knee strength, functional reach), functional impairments (ADLs, IADLs), and health care use (physician visits). Generalized Estimation Equation (GEE) models were used to examine the differences between groups on physiological and functional change and health service use over time. Three-year crude mortality rates were significantly higher in the hip fracture group (25%) than in the comparison group (18%); however, statistical significance did not persist after adjusting for age, race, education, living arrangement, depression, and comorbidity (RR = 1.5; P = .17). All physiological and functional measures deteriorated over time, regardless of presence or absence of hip fractures. After adjusting for covariates, the fracture group was significantly worse in knee strength (beta = -0.91; P = .01), usual walking speed (beta = -0.04; P = .01) and rapid walking speed (beta = -0.05; P = .02), and worse IADL function (beta = 0.26; P = .002) than the non-hip fracture group. The rate of additional impairment for both hip fracture group and non-hip fracture group was 0.013 IADL units per month (P = .001). However, there were no significant differences in health care use between the groups. In spite of worse physiological and IADL impairments, once the women recovered from hip fracture surgery, they did not necessarily use more health care resources than non-hip fracture patients. To prevent functional deterioration, interventions need to focus on knee strength and mobility training.

Use of pedometer and Internet-mediated walking program in patients with chronic obstructive pulmonary disease

We evaluated an Internet-mediated, pedometer-based program to promote walking in chronic obstructive pulmonary disease (COPD). First, we assessed the accuracy of the Omron HJ-720ITC pedometer (OMRON Healthcare, Inc; Bannockburn, Illinois) in 51 persons with COPD. The Bland-Altman plot showed a median difference of 3 steps (5th and 95th quintiles, -8.0 and 145.0, respectively). We calculated percent difference = ([manual - Omron step counts]/manual step counts) x 100. Variability in percent difference occurred at the lowest usual walking speeds. At speeds <or= 0.94 m/s, the mean +/- standard deviation percent difference was 14 +/- 26%. Nevertheless, the Omron captured >80% of the manual step counts in 20 of the 23 persons with walking speed <or= 0.94 m/s. Second, we examined step counts in 24 persons with COPD who used the Omron and an Internet-mediated, 16-week walking program. At baseline, participants with COPD walked an average of 3429 +/- 1502 steps per day. Sixteen participants completed the program with an average increase in daily step count of 988 +/- 1048 steps (p = 0.002). The Omron is accurate in persons with COPD with usual walking speeds > 0.94 m/s. Accuracy is more variable at lower speeds, but the Omron captures more than 80% of manual step counts in most persons.In this preliminary study, an Internet-mediated walking program using the Omron significantly increased step counts in COPD.

Factors Associated with the Timed Up and Go Test Score in Elderly Women

[Purpose] The purpose of this study was to determine the relationship between the Timed Up and Go (TUG) test score and the physical performance of women aged 75 years and over according to orthopedic status. [Subjects] The participants were 832 elderly women (mean age, 78.6 ± 2.7 years) who carried out their daily activities independently in their own homes and did not have histories of stroke or osteoarthritis of the hip. [Methods] Maximal voluntary contractions of the knee extensor and ankle plantar flexor muscle groups were measured using a hand-held dynamometer. One-leg standing time and usual walking speed were assessed as balance and walking performances. [Results] The TUG score was more strongly correlated with walking speed (r = -0.776) than the other measures of physical performance (r = -0.228 to -0.399). Correlations between the TUG score and walking speed were strongest for participants with knee osteoarthritis (r = -0.824) and fractures after 60 years of age (r = -0.809). A linear regression model of data from all participants showed that all performance scores and age were determinants of the TUG score (R2 = 0.634). The determinants of the TUG score for participants with osteoarthritis or fractures were walking speed and one-leg standing score, and age (R2 = 0.701) and walking speed, age, and knee strength (R2 = 0.688). Beta estimates of walking speed for all participants and for the subgroups were higher (-0.69 to -0.76) than those for the other determinants (-0.06 to 0.14). [Conclusion] Walking speed is a stronger determinant of the TUG score than muscle strength or balance for elderly women.

Usual Walking Speed Predicts Decline of Functional Capacity among Community-Dwelling Older Japanese Women: a 4-year Longitudinal Study

[Purpose] In this study, we examined the physical predictors of the decline of functional capacity among community-dwelling older Japanese individuals. [Methods] A total of 265 Japanese individuals aged 68-96 years participated in a baseline survey and a follow-up 4 years later. In this survey, participants performed tests for grip strength, one-legged standing, and 5-m walking. At baseline and the follow-up survey, we measured functional capacity using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), which consists of the instrumental self-maintenance scale, the intellectual activity scale, and the social role scale. [Results] There was only a weak association between physical performance and the decline of functional status in men. The 5-m walking time was most sensitive at predicting the future decline of the instrumental self-maintenance scale in women. Even after controlling for age, body mass index, grip strength, and one-legged standing, a slower 5-m walking time (greater than 4.6 sec) indicated an increased risk of future decline in instrumental self-maintenance in women (odds ratio = 5.31, p<0.01). [Conclusions] The usual walking speed is the best performance measure for predicting the decline of instrumental self-maintenance among Japanese older women.

Physical Performance and Subsequent Disability and Survival in Older Adults with Malignancy: Results from the Health, Aging and Body Composition Study

To evaluate objective physical performance measures as predictors of survival and subsequent disability in older patients with cancer. Longitudinal cohort study. Health, Aging and Body Composition (Health ABC) Study. Four hundred twenty-nine individuals diagnosed with cancer during the first 6 years of follow-up of the Health ABC Study. The associations between precancer measures of physical performance (20-m usual gait speed, 400-m long-distance corridor walk (LDCW), and grip strength) and overall survival and a short-term outcome of 2-year progression to disability or death were evaluated. Cox proportional hazards and logistic regression models, stratified for metastatic disease, respectively, were used for outcomes. Mean age was 77.2, 36.1% were women, and 45.7% were black. Faster 20-m usual walking speed was associated with a lower risk of death in the metastatic group (hazard ratio=0.89, 95% confidence interval (CI)=0.79-0.99) and lower 2-year progression to disability or death in the nonmetastatic group (odds ratio (OR)=0.77, 95% CI=0.64-0.94). Ability to complete the 400-m LDCW was associated with lower 2-year progression to disability or death in the nonmetastatic group (OR=0.24, 95% CI=0.10-0.62). There were no associations between grip strength and disability or death. Lower extremity physical performance tests (usual gait speed and 400-m LDCW) were associated with survival and 2-year progression to disability or death. Objective physical performance measures may help inform pretreatment evaluations in older adults with cancer.

Association between the Trail Making Test and physical performance in elderly Japanese

The Trail Making Test (TMT) is used in Western countries as an indicator of executive function, but there is little information regarding its use in Japan. Our previous initial study showed that the TMT was significantly associated with mobility-related functions among elderly Japanese living in the community and in this study, we increased the number of participants to clarify that result. The TMT, comprised of two parts (part A and part B), was administered to 493 subjects aged 65 years or older (164 men, 329 women). Our assessment used the time difference (DeltaTMT) between parts B and A, and eight physical performance indicators: four of preventive care (usual walking speed, timed Up & Go [TUG], one-leg standing balance and handgrip strength) and four movement parameters (maximum walking speed, dual-task TUG, stair climbing and obstacle-negotiating gait). The median DeltaTMT score was 64.01 s for men and 65.56 s for women. The DeltaTMT score increased with age, and there was no difference between sexes. Multinomial logistic regression analysis showed that a poor DeltaTMT was related to low tertiles for all physical performances. It related to the intermediate tertile of TUG and maximum walking speed, dual-task TUG, stair climbing and obstacle-negotiating gait. The TMT reflects complex walking performance, so it can be a useful synthetic indicator for health programs promoting independence in elderly Japanese.

Do older pedestrians have enough time to cross roads in Dublin? A critique of the Traffic Management Guidelines based on clinical research findings

the safety of older pedestrians at urban intersections is a matter of gerontological concern. Many older pedestrians report inability to complete crossings in the time given by pedestrian lights. Standard times for pedestrian lights in Dublin pelican crossings are specified in the Traffic Management Guidelines (TMG). The Technology Research for Independent Living Centre is building a database of gait assessments of Irish community-dwelling older people using GAITRite. to compare the usual walking speed of our participants against that required by the TMG. cross-sectional observational study. comprehensive geriatric assessment outpatient clinic. 355 community-dwelling older subjects aged > or =60 assessed between August 2007 and September 2008 (mean age 72.7, SD 7.2). linear regression analysis between age and observed walking speed, followed by comparison of predicted walking speeds at four different ages (i.e. 60, 70, 80 and 89) against minimum walking speeds required to cross standard Irish roads when regulated by the pelican system. age and walking speed had a strong inverse correlation F (1, 353) = 108.48, P < 0.001, R(2) = 0.235. The regression predicted a walking speed of 1.30 m/s (95% confidence interval 1.24-1.35) at the age of 60, 1.10 (1.07-1.13) at 70, 0.91 (0.87-0.94) at 80 and 0.73 (0.66-0.80) at 89. Against these predicted walking speeds, standard crossing times appeared insufficient for very old people. as currently defined in the TMG, maximum pedestrian crossing times at pelican crossings may represent a hazard for very old people. This should be addressed within the Irish authorities' plan to improve safety and equality for older people.

Depression status as a reliable predictor of functional decline among Japanese community‐dwelling older adults: a 12‐year population‐based prospective cohort study

This study aimed to examine a longitudinal relationship between depression status and functional decline among Japanese community-dwelling older adults, using a 12-year population-based, prospective cohort study design. A total of 710 men and women, aged 65 years and over, participated in the study. Katz's Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence were used to measure the functional capacities of basic activities of daily living (BADL) and higher-level competence, respectively. For the purpose of analysis, a decline in each subscale of functional capacity during the follow-up period were used as outcome variables; depression status assessed by the Japanese version of the 30-item Geriatric Depression Scale (GDS), with a cut-off of 11, was used as an independent variable; and age, gender, education level, history of chronic disease, hospitalization, smoking, physical activity, living alone, hearing problems, physical pain, dietary habits, and usual walking speed at baseline were used as covariates. Use of the multivariate Cox proportional hazards model adjusted for potential confounders showed that depression status was significantly and independently associated with BADL decline (risk ratio (RR) = 1.46, 95% confidence interval (CI): 1.13-1.89) and with higher-level competence decline (RR = 1.56, 95% CI: 1.18-2.04). Our study found an independent relationship between depression status and longitudinal change in functional capacity among community-dwelling older individuals, suggesting that depression status is a reliable predictor of functional decline (both of BADL decline and higher-level competence decline) in older adults.

Intensity of Nordic Walking in young females with different peak O2 consumption

The purpose of this cross-sectional study was to determine the physiological reaction to the different intensity Nordic Walking exercise in young females with different aerobic capacity values. Twenty-eight 19-24-year-old female university students participated in the study. Their peak O2 consumption (VO2 peak kg(-1)) and individual ventilatory threshold (IVT) were measured using a continuous incremental protocol until volitional exhaustion on treadmill. The subjects were analysed as a whole group (n = 28) and were also divided into three groups based on the measured VO2 peak kg(-1) (Difference between groups is 1 SD) as follows: 1. >46 ml min(-1) kg(-1) (n = 8), 2. 41-46 ml min(-1) kg(-1) (n = 12) and 3. <41 ml min(-1) kg(-1) (n = 8). The second test consisted of four times 1 km Nordic Walking with increasing speed on the 200 m indoor track, performed as a continuous study (Step 1 - slow walking, Step 2 - usual speed walking, Step 3 - faster speed walking and Step 4 - maximal speed walking). During the walking test expired gas was sampled breath-by-breath and heart rate (HR) was recorded continuously. Ratings of perceived exertion (RPE) were asked using the Borg RPE scale separately for every 1 km of the walking test. No significant differences emerged between groups in HR of IVT (172.4 +/- 10.3-176.4 +/- 4.9 beats min(-1)) or maximal HR (190.1 +/- 7.3-191.6 +/- 7.8 beats min(-1)) during the treadmill test. During maximal speed walking the speed (7.4 +/- 0.4-7.5 +/- 0.6 km h(-1)) and O2 consumption (30.4 +/- 3.9-34.0 +/- 4.5 ml min(-1) kg(-1)) were relatively similar between groups (P > 0.05). However, during maximal speed walking, the O2 consumption in the second and third groups was similar with the IVT (94.9 +/- 17.5% and 99.4 +/- 15.5%, respectively) but in the first group it was only 75.5 +/- 8.0% from IVT. Mean HR during the maximal speed walking was in the first group 151.6 +/- 12.5 beats min(-1), in the second (169.7 +/- 10.3 beats min(-1)) and the third (173.1 +/- 15.8 beats min(-1)) groups it was comparable with the calculated IVT level. The Borg RPE was very low in every group (11.9 +/- 2.0-14.4 +/- 2.3) and the relationship with VO2and HR was not significant during maximal speed Nordic Walking. In summary, the present study indicated that walking is an acceptable exercise for young females independent of their initial VO2 peak level. However, females with low initial VO2 peak can be recommended to exercise with the subjective 'faster speed walking'. In contrast, females with high initial VO2 peak should exercise with maximal speed.

Obstacle-negotiating gait and related physical measurement indicators for the community-dwelling elderly in Japan

The aim of this study is to assess obstacle-negotiating gait (ONG) and explore its related physical factors. Subjects comprised 571 community-dwelling persons (195 men and 376 women) age ≥65 years and without cognitive impairment. ONG, timed up and go (TUG), and stair-climbing were measured and their relations were assessed. Walking ability (usual walking speed = UWS and daily walking steps = DWS), balance deficiency, and musculoskeletal function (handgrip strength and bone health) were examined objectively to explore ONG related physical factors. Logistic regression and general linear model analysis were performed with adjustment for age and body mass index (BMI). Time of ONG was 7.72 s in men and 8.93 s in women. Logistic regression analysis showed that the fast tertiles of ONG corresponding to the fast levels of TUG and stair-climbing had the highest odds ratio values. General linear model analysis showed that ONG was significantly associated with UWS and balance deficiency (no) in men, and with UWS, handgrip strength, DWS and balance deficiency (no) in women. Overall, ONG was considerably associated with falls screening tools and its determinants were also the main causes of falls. Training in ONG could be an attractive strategy for the prevention of falls among the elderly.

地域高齢者の咬合力と介護予防因子との関連について

Mastication ability is well documented as a risk factor for disability in the elderly. The aim of the present study was to assess occlusal force, one index of mastication ability, among elderly Japanese and clarify related factors through both physical measurements and questionnaires. Subjects were 372 community-dwelling persons (101 men, 271 women) aged 60-87 years and registered at five welfare centers for the aged in a metropolitan suburb. Occlusal force was measured with dental prescale/occluzer system. Physical measurements and questionnaires were performed to explore related factors. Occlusal force was 502.4 N in men and 372.2 N in women. In the 60-69 and 70-79 age stratifications, men had significantly higher occlusal force than women. Occlusal force correlated significantly with age (r=-0.2, p<0.01), and number of residual teeth (r=0.6, p<0.01). After adjustment for age and the number of residual teeth, occlusal force had positive partial correlation with handgrip strength in men, and positive partial correlations with usual walking speed and body muscle mass, and negative partial correlation with timed up and go in women. From the questionnaire, high occlusal force was significantly associated with "can bite hard food" in both men and women; and with lifestyle factors ("walking regularly", "no smoking", and "alcohol consumption") in men; and with psychological factors ("intraoral satisfaction" and "no depression tendency") and physical factors ("can walk 1-km" and "can go out alone to distant places") in women. Occlusal force was related to physical fitness, ability of movement, and lifestyle.

虚弱高齢者を対象とした運動ｖｓ．運動＋栄養介入（大豆ペプチド）の効果に関する無作為化比較試験

We conducted a randomized controlled trial to examine whether supplementation with soy peptide enhanced the effects of resistance training for community-dwelling frail elderly. The subjects comprised 33 elderly persons who had reported one or more fall experiences in the previous year (designated as “fallers”), and 50 elderly persons who had two or more geriatric syndromes among fall experience, urinary incontinence, disability in one or more items of five instrumental activities of daily living, and a low frequency of going outdoors. The subjects within each subgroup were randomly allocated into an exercise group and exercise plus nutritional supplementation group. Both groups participated in 1-hour supervised resistance training classes twice a week for 12 weeks. The nutritional supplementation group was given a soy-peptide beverage equivalent to an intake of 32 g of soy protein per week during this period. After the 12-week intervention period, the exercise plus nutritional supplementation group within the fallers showed a greater improvement in knee-extension power and usual walking speed, and greater reduction of white blood cell count than the exercise group. However, no significant additive effect of supplementation was apparent in the multiple-geriatric syndrome subgroup. Supplementation of soy peptide may enhance the effect of resistance training in a certain subset of the frail elderly.

Accuracy of uniaxial accelerometer in chronic obstructive pulmonary disease

Wearable sensors have been developed and used in nondisabled adults. Little is known about their accuracy in patients with chronic disease. We tested the ActiHealth accelerometer, which measures step counts, in subjects with chronic obstructive pulmonary disease (COPD). We determined the intra- and interdevice coefficients of variation (CVs). We assessed the accuracy of the device in 15 nondisabled males and 46 subjects with COPD. Accuracy was defined as percent step capture, (device step count divided by manual step count) times 100. Predictors of percent step capture were identified using linear regression methods. The accelerometer has an intradevice CV ranging from 0.008 to 0.025 and an interdevice CV of 0.64. In nondisabled males, median percent step capture was 96% (interquartile range 81%-98%). In subjects with COPD, median percent step capture was 86% (interquartile range 72%-96%). Usual walking speed was the most important predictor of percent step capture (p = 0.004). The ActiHealth accelerometer has acceptable intra- and interdevice CVs. It is highly accurate in nondisabled subjects. The accuracy declines in subjects with COPD based on walking speed. Prior to using the ActiHealth accelerometer, researchers and clinicians should assess walking speed and percent step capture in each subject.

Assessment of the best gait parameter in relation to bone status in community-dwelling young–old and old–old women in Japan

Even if physical exercise contributes to bone health of the elderly, intense activities have the potential to worsen the risk of osteoporosis. This fact and the inevitable decrease of mobility with age increase the likelihood that the mobility parameter that best benefits bone health differs with age. The aim of this study was to objectively assess the gait parameter that most strongly influences bone health of young–old and old–old women. Subjects comprised 200 community-dwelling elderly women (132 young–old, 68 old–old) registered at welfare centers for the aged. Bone status was examined in the right heel by quantitative ultrasound (QUS) and indicated as stiffness index (SI). Gait parameters including usual and maximum walking speed (UWS and MWS, respectively), daily walking steps (DWS), obstacle-negotiating gait, and stair-climbing were examined objectively. Other bone-related physical factors (body components, handgrip strength, and masticatory function) were measured and adjusted while performing assessment. After adjustment for covariates, multiple linear regression analysis showed that MWS had the strongest association with SI in young–old women and DWS had the strongest association with SI in old–old women. To prevent osteoporosis, brisk walking exercise and engaging in movement in everyday life, respectively, should be advocated for young–old women and old–old women in Japan.

Recurrent Falls and Dual Task–Related Decrease in Walking Speed: Is There a Relationship?

To determine whether dual task-related changes in walking speed were associated with recurrent falls in frail older adults. Twelve-month prospective cohort study. Thirteen senior housing facilities. Two hundred thirteen subjects (mean age 84.4+/-5.5). Usual and dual-tasking walking speeds (m/s) were calculated on a 10-m straight walkway at baseline. Information on incident falls during the follow-up year was collected monthly, and participants were divided into three groups based on the occurrence of falls (0, 1, and >or=2). Recurrent falls were defined as two or more falls during the 12-month follow-up period. Twenty subjects (9.4%) were classified as recurrent fallers. The occurrence of recurrent falls was associated with age (crude odds ratio (OR)=1.11, P=.02), number of drugs (crude OR=1.28, P=.002), and walking speed under both walking conditions (crude OR=0.96, P=.002 for usual walking and crude OR=0.60, P=.005 for walking while counting backward). Multiple Poisson regression showed that only walking speed while dual tasking and number of drugs were associated with incident falls (incident rate ratio (IRR)=0.84, P=.045 and IRR=1.10, P=.004). Slower walking speed while counting backward was associated with recurrent falls, suggesting that changes in gait performance while dual tasking might be an inexpensive way of identifying frail older adults prone to falling.

The relationship of reduced peripheral nerve function and diabetes with physical performance in older white and black adults: the Health, Aging, and Body Composition (Health ABC) study.

OBJECTIVE—Poor peripheral nerve function is prevalent in diabetes and older populations, and it has great potential to contribute to poor physical performance.RESEARCH DESIGN AND METHODS—Cross-sectional analyses were done for the Health, Aging, and Body Composition (Health ABC) Study participants (n = 2,364; 48% men; 38% black; aged 73–82 years). Sensory and motor peripheral nerve function in legs/feet was assessed by 10- and 1.4-g monofilament perception, vibration detection, and peroneal motor nerve conduction amplitude and velocity. The Health ABC lower-extremity performance battery was a supplemented version of the Established Populations for the Epidemiologic Studies of the Elderly battery (chair stands, standing balance, and 6-m walk), adding increased stand duration, single foot stand, and narrow walk.RESULTS—Diabetic participants had fewer chair stands (0.34 vs. 0.36 stands/s), shorter standing balance time (0.69 vs. 0.75 ratio), slower usual walking speed (1.11 vs. 1.14 m/s), slower narrow walking speed (0.80 vs. 0.90 m/s), and lower performance battery score (6.43 vs. 6.93) (all P < 0.05). Peripheral nerve function was associated with each physical performance measure independently. After addition of peripheral nerve function in fully adjusted models, diabetes remained significantly related to a lower performance battery score and slower narrow walking speed but not to chair stands, standing balance, or usual walking speed.CONCLUSIONS—Poor peripheral nerve function accounts for a portion of worse physical performance in diabetes and may be directly associated with physical performance in older diabetic and nondiabetic adults. The impact of peripheral nerve function on incident disability should be evaluated in older adults.

地域高齢者を対象としたTrail Making Testの意義―身体機能とTrail Making Testの成績についての横断分析から―

The Trail Making Test (TMT) has been studied in western countries as an indicator of executive function, but there are few data on the TMT in Japan. This study was conducted to assess the characteristics of TMT and to explore the effect of TMT on physical function among community-dwelling elderly Japanese to promote health in the aged. Subjects were 175 individuals aged>or=65 years (57 men and 118 women). The TMT test which consists of two parts (part A and part B)was performed. 8 physical function items such as indicators of functional decline (usual walking speed, timed up-and-go (TUG), one-leg standing balance, and handgrip strength), and indicators of mobility (maximum walking speed, TUG with cup, stair-climbing, obstacle-negotiating gait) were measured. For this analysis, we used a difference score defined as TMT calculated as the difference between times (part B-part A=TMT). Data were analyzed by sex respectively. The median TMT value was 58.61 seconds in men and 65.67 seconds in women. TMT value increased with age and there was no difference between men and women in absolute values. multinomial logistic regression analysis showed that poor TMT was related to low tertiles of TUG, handgrip strength, MWS, TUG with cup, stair-climbing and obstacle-negotiating gait, and to intermediate tertile of MWS with adjustment for age and sex. TMT was significantly associated with mobility-related functions, suggesting that TMT, as the indicator of executive function, should be considered to be included in the test batteries for evaluating older people.

都市部在住の高齢女性肥満者における老年症候群の有症状況および関連要因―介護予防のための包括的健診―

To evaluate the prevalence of geriatric syndrome and risk factors associated with obesity in community-dwelling elderly women. The baseline survey was conducted in November 2006. Subjects were 925 women aged 70 years and older who participated in a comprehensive health examination which included a face-to-face interview, body composition, and physical fitness tests. The participants were classified, the based on percentage of body fat, as normal (<30.0), mild obesity (30.0 to 34.9), and obesity (>or=35.0) groups. To evaluate the differences among the groups with regard to the physical fitness and the interview data, one-way analysis of variance performed for continuous variables and the chi-square test for categorical variables. Multivariate logistic regression models were used to assess the factors associated with obesity in elderly women. Although obese women had a higher prevalence of urinary incontinence than the normal and mild obese women, there were no significant differences in history of falls during the last year, or fear of falling. A high percentage of body fat was significantly associated with a higher level of instrumental activities of daily living (IADL) and intellectual activity disability, use of 3 or more medications, pain, and circumference (abdominal, hip, calf), and was associated with a lower level of balance and walking ability. According to the logistic model, history of hypertension (odds ratio (OR)=1.70, 95%confidence intervals (CI)=1.25-2.32), pain (OR=1.46, 95%CI=1.07-2.01), urinary incontinence (OR=1.44, 95%CI=1.08-1.92), SBP (OR=1.02, 95%CI=1.01-1.03), and usual walking speed (OR=0.43, 95%CI=0.24-0.75) were independent variables significantly associated with obesity. These cross-sectional data show that a higher percentage of body fat is associated with high prevalence of urinary incontinence, IADL and intellectual activity disability, and is related to lower level of walking ability and balance. The present study suggests that regular physical activity and weight control may contribute to the prevention of IADL disability and improvement of physical fitness in obese elderly women.

Relationship of race and poverty to lower extremity function and decline: Findings from the women's health and aging study

Race- and poverty-related disparities in physical function are well documented, though little is known about effects of race and poverty on functional decline and the progression of disability. We examined cross-sectional and longitudinal relationships between race, poverty and lower extremity function using data from moderately to severely disabled women in the U.S. Women's Health and Aging Study. Severity of lower extremity functional limitation was determined from scaled responses of reported difficulty walking ¼ mile, walking across a room, climbing stairs, and stooping, crouching or kneeling. Usual walking speed assessed over 4 m was our objective measure of function. Of the 996 women who described themselves as black or white, 284 (29%) were black and 367 (37%) were living at or below 100% of the federal poverty level. Independent of demographic and health-related factors, among white women, the poor exhibited consistently worse lower extremity function than the non-poor; this association, however, was not observed in black women. Among the non-poor, black women had slower walking speeds, and reported more limitation in lower extremity function than their non-poor white counterparts, even after adjusting for demographic variables and health-related characteristics. After 3 years, accounting for baseline function, demographic and health-related factors, race and poverty status were unrelated to functional decline. Thus, while race and poverty status were associated with functional deficits in old age, they do not appear to impact the rate of functional decline or progression of disability over 3 years.

Six Weeks of Intensive Treadmill Training Improves Gait and Quality of Life in Patients With Parkinson’s Disease: A Pilot Study

Herman T, Giladi N, Gruendlinger L, Hausdorff JM. Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson’s disease: a pilot study. Objective To evaluate the effects of 6 weeks of intensive treadmill training on gait rhythmicity, functional mobility, and quality of life (QOL) in patients with Parkinson’s disease (PD). Design An open-label, before-after pilot study. Setting Outpatient movement disorders clinic. Participants Nine patients with PD who were able to ambulate independently and were not demented. Mean age was 70±6.8 years. Patients had mild to moderate PD (Hoehn and Yahr stage range, 1.5−3). Interventions Patients walked on a treadmill for 30 minutes during each training session, 4 training sessions a week, for 6 weeks. Once a week, usual overground walking speed was re-evaluated and the treadmill speed was adjusted accordingly. Main Outcome Measures The 39-item Parkinson’s Disease Questionnaire (PDQ-39), motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS), gait speed, stride time variability, swing time variability, and the Short Physical Performance Battery (SPPB). Results A comparison of the measures taken before and after the treadmill intervention indicates general improvement. QOL, as measured by the PDQ-39, was reduced (improved) from 32 to 22 ( P<.014). Parkinsonian symptoms, as measured by the UPDRS, decreased (improved) from 29 to 22 ( P<.043). Usual gait speed increased from 1.11 to 1.26m/s ( P<.014). Swing time variability was lower (better) in all but one patient, changing from 3.0% to 2.3% ( P<.06). Scores on the SPPB also improved ( P<.008). Interestingly, many of the improvements persisted even 4 weeks later. Conclusions These results show the potential to enhance gait rhythmicity in patients with PD and suggest that a progressive and intensive treadmill training program can be used to minimize impairments in gait, reduce fall risk, and increase QOL in these patients.