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Posted on 11-10-2011

Morning everyone! Came across a great article from the Journal of the American Medical Association that I thought you may be interested in: 

Gait (walking) Speed and Survival in Older Adults

Journal of the American Medical Association January 5, 2011; Vol. 305; No. 1; pp. 50-58

Dr. Stephanie Studenski, MD, MPH, Dr. Subashan Perera, PhD, Dr. Kushang Patel, PhD, Dr. Caterina Rosano, MD, PhD, Dr. Kimberly Faulkner, PhD, Dr. Marco Inzitari, MD, PhD, Dr. Jennifer Brach, PhD, Dr. Julie Chandler, PhD, Dr. Peggy Cawthon, PhD, Dr. Elizabeth Barrett Connor, MD, Dr. Michael Nevitt, PhD, Dr. Marjolein Visser, PhD, Dr. Stephen Kritchevsky, PhD, Dr. Stefania Badinelli, MD, Dr. Tamara Harris, MD, Dr. Anne B. Newman, MD, Dr. Jane Cauley, PhD, Dr. Luigi Ferrucci, MD, PhD, and Dr. Jack Guralnik, MD, PhD

FROM ABSTRACT:

Context
Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates.

Design, Setting, and Participants
Pooled analysis of 9 cohort studies, using individual data from 34,485 community- dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean age of 73.5 years and had a mean gait speed of 0.92 m/s [2.1 m/h].

Results
Gait speed was associated with survival in all studies.

Survival increased across the full range of gait speeds, with significant increments per 0.1 [.22 m/h] m/s.

At age 75, predicted 10-year survival across the range of gait speeds ranged from 19% to 87% in men and from 35% to 91% in women.

Predicted survival based on age, sex, and gait speed was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization.

Conclusion
In this pooled analysis of individual data from 9 selected cohorts, [increased] gait speed was associated with survival in older adults.

KEY POINTS :

1) There are no well-established approaches to predicting life expectancy that incorporate health and function.

2) Gait speed, also often termed walking speed, is associated with increased survival, has been shown to reflect health and functional status, and is a useful clinical indicator of well-being among the older adults. The purpose of this study is to evaluate the association of gait speed with survival in older adults and to determine the degree to which gait speed explains variability in survival after accounting for age and sex.

3) In this study, gait speeds ranged from less than 0.4 m/s [.9 m/h] (n=1247) to more than 1.4 m/s [3.13 m/h] (n=1491). The risk of death was estimated per 0.1 m/s [.22 m/h] higher gait speed. The authors examined the survival HRs for gait speed in subgroups, including age, sex, race/ethnicity, BMI, smoking history, use of mobility aids, prior hospitalization, self-reported health, functional status, and selected chronic diseases.

4)  For each 0.1 m/s [.22 m/h] faster gait speed survival was increased 12%.

5)  "Gait speed was associated with differences in the probability of survival at all ages in both sexes, but was especially informative after age 75 years."

6) "Predicted years of remaining life for each sex and age increased as gait speed increased, with a gait speed of about 0.8 m/s [1.8 m/h] at the median life expectancy at most ages for both sexes."

7) "Gait speeds of 1.0 m/s [2.25 m/h] or higher consistently demonstrated survival that was longer than expected by age and sex alone. In this older adult population, the relationship of gait speed with remaining years of life was consistent across age groups."

8) "Gait speed might help refine survival estimates in clinical practice or research because it is simple and informative."

9) "Why would gait speed predict survival? Walking requires energy, movement control, and support and places demands on multiple organ systems, including the heart, lungs, circulatory, nervous, and musculoskeletal systems. Slowing gait may reflect both damaged systems and a high-energy cost of walking."

10) "Gait speed could be considered a simple and accessible summary indicator of vitality because it integrates known and unrecognized disturbances in multiple organ systems, many of which affect survival. In addition, decreasing mobility may induce a vicious cycle of reduced physical activity and de-conditioning that has a direct effect on health and survival."

11) "Because gait speed can be assessed by nonprofessional staff using a 4-m walkway and a stopwatch, it is relatively simple to measure compared with many medical assessments."

12) "Gait speeds faster than 1.0 m/s [2.25 m/h] suggest healthier aging while gait speeds slower than 0.6 m/s [1.34 m/h] increase the likelihood of poor health and function."

13) "In our data, predicted life expectancy at the median for age and sex occurs at about 0.8 m/s [1.8 m/h]; faster gait speeds predict life expectancy beyond the median. Perhaps a gait speed faster than 1.0 m/s [2.25 m/h] suggests better than average life expectancy and above 1.2 m/s [2.7 m/h] suggests exceptional life expectancy."

14) Baseline gait speed might help to characterize the overall health of older research participants.

15) "The data provided herein are intended to aid clinicians, investigators, and health system planners who seek simple indicators of health and survival in older adults. Gait speed has potential to be implemented in practice, using a stop watch and a 4-m course. From a standing start, individuals are instructed to walk at their usual pace, as if they were walking down the street, and given no further encouragement or instructions. The data in this article can be used to help interpret the results. Gait speed may be a simple and accessible indicator of the health of the older person." 

So for those of you who know someone elderly or are elderly yourself.  This study shows the importance of maintaining your fitness levels and to continue moving!  If you feel stuck or concerned at your lack of endurance, strength, and/or stamina....give our office a call (243-9464) and let me put together a realistic program to get you back on your feet...walking that is!

 Have a blessed day!

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