Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. Executive function, memory, and gait speed decline in well-functioning older adults. Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism The effects of hip and ankle stretching on gait function of older people. Impact of falls on the balance, gait, and activities of daily living functioning in community-dwelling Chinese older adults. Changes in executive functions and self-efficacy are independently associated with improved usual gait speed in older women
OBJECTIVES To define clinical ly relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons . DESIGN Prospect i ve cohort study . SETTING Health , Aging and Body Composition Study . PARTICIPANTS Three thous and forty-seven well-functioning older persons ( mean age 74.2 ) . MEASUREMENTS Usual gait speed on a 6-m course was assessed at baseline . Participants were r and omly divided into two groups to identify ( Sample A ; n=2,031 ) and then vali date ( 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 . RESULTS A grade d 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 . CONCLUSION 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 clinical ly meaningful cutpoint for usual gait speed may facilitate its use in clinical and research setting BACKGROUND In community-dwelling older adults , global cognitive function predicts longitudinal gait speed decline . Few prospect i ve studies have evaluated whether specific executive cognitive deficits in aging may account for gait slowing over time . METHODS Multiple cognitive tasks were administered at baseline in 909 participants in the Health , Aging , and Body Composition Study Cognitive Vitality Sub study ( mean age 75.2 ± 2.8 years , 50.6 % women , 48.4 % black ) . Usual gait speed ( m/s ) over 20 minutes was assessed at baseline and over a 5-year follow-up . RESULTS Poorer performance in each cognitive task was cross-sectionally associated with slower gait independent of demographic and health characteristics . In longitudinal analyses , each 1 SD poorer performance in global function , verbal memory , and executive function was associated with 0.003 - 0.004 m/s greater gait speed decline per year ( p = .03-.05 ) after adjustment for baseline gait speed , demographic , and health characteristics . CONCLUSIONS In this well-functioning cohort , several cognitive tasks were associated with gait speed cross-sectionally and predicted longitudinal gait speed decline . These data are consistent with a shared pathology underlying cognitive and motor declines but do not suggest that specific executive cognitive deficits account for slowing of usual gait in aging Background and Purpose : Distinguishing between a clinical ly significant change and change due to measurement error can be difficult . The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale ( BBS ) , forward and backward functional reach , the  Romberg Test and the Sharpened Romberg Test ( SRT ) with eyes open and closed , the Activities-specific Balance Confidence ( ABC ) Scale , the  Six-Minute Walk Test ( 6MWT ) , comfortable and fast gait speed , the  Timed “ Up & Go ” Test ( TUG ) , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , and the Unified Parkinson Disease Rating Scale ( UPDRS ) in people with parkinsonism . Subjects : Thirty-seven community-dwelling adults with parkinsonism ( mean age=71 years ) participated . The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale ; however , the scores ranged from 1 to 4 . Methods : Subjects were tested twice by the same raters , with 1 week between tests . Test-retest reliability was calculated using intraclass correlation coefficients ( ICCs ) . Minimal detectable change was calculated using a 95 % confidence interval ( MDC95 ) . Results : The ICCs for test-retest reliability were above .90 for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and comfortable and fast gait speeds . The MDC95 values for those functional tests were : BBS=5/56 , ABC Scale=13 % , SRT with eyes closed=19 seconds , 6MWT=82 m , comfortable gait speed=0.18 m/s , and fast gait speed=0.25 m/s . The ICCs for test-retest reliability of SF-36 scores were above .80 , with the exception of the social functioning subscale . The MDC95 values for the SF-36 ranged between 19 % and 45 % . The MDC95 values for the UPDRS Activities of Daily Living section , Motor Examination section , and total scores were 4/52 , 11/108 , and 13/176 , respectively . Discussion and Conclusion : Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinical ly significant . High test-retest reliability of scores for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and gait speed make them trustworthy functional assessment s in people with parkinsonism . The SF-36 and UPDRS provide quality -of-life and disease severity rating values in the ongoing assessment of people with parkinsonism OBJECTIVE To examine effects of hip and ankle stretching on gait function  of older people . DESIGN R and omized controlled trial . SETTING Flexibility training was performed in participants ' homes . Assessment s were performed in a biomechanics laboratory . PARTICIPANTS Forty healthy volunteers ( mean age + /- SD , 72.1+/-4.7 y ) r and omized to 2 groups :  intervention ( n=20 ) and control ( n=20 ) . INTERVENTION Intervention participants performed an 8-week stretching program , and control group participants maintained activity level for 8 weeks . One investigator made weekly visits to instruct and monitor participants . MAIN OUTCOME MEASURES Primary outcome measures were passive joint motion for hip extension and ankle dorsiflexion and freely chosen gait speed . Secondary outcome measures were gait parameters during freely chosen gait speed and set gait speed walking ( stride length , joint displacement ) . RESULTS Compared with the control group , the intervention group had increased combined hip and knee motion ( P=.023 ) , ankle motion ( P=.020 ) , and freely chosen gait speed ( P=.016 ) . The intervention group showed statistically nonsignificant trends of increased stride length at freely chosen gait speed and set gait speed . CONCLUSIONS Findings suggest joint motion is a modifiable impairment that is effectively targeted with flexibility training for older people . Participants in the intervention group had improvements in joint motion as well as increased freely chosen gait speed . Mechanisms responsible for changes in freely chosen gait speed warrant further investigation OBJECTIVE The objective of the present study was to investigate the impact of incident falls on the balance , gait , and Activities of Daily Living functioning in community-dwelling older adults . METHODS This was a population -based , 1-year prospect i ve cohort study in older adults . We performed baseline assessment of potential predictors , the 1-year occurrence of falls , and then 1-year re assessment of the following outcome measures : the Barthel Index ( BI ) , Lawton 's Instrumental Activities of Daily Living ( IADL ) scale , gait speed , and Tinetti Balance and Gait Evaluation 's total mobility score ( TMS ) . At 1 year of follow-up , participants who had declined by > or = 1 st and ard deviation ( SD ) below the baseline mean value of each outcome measure were classified as " decliners . " RESULTS Of the 1517 participants , 93.5 % ( n = 1419 ) completed the 1-year follow-up re assessment of BI and IADL . For gait speed and TMS , respectively , 88.2 % ( n = 1338 ) and 88.3 % ( n = 1339 ) completed the 1-year outcome assessment . Fallers , particularly recurrent fallers , experienced significantly greater 1-year declines in the four functional measures . Multivariate logistic regression analyses showed that an incident fall was a significant independent predictor for decliners in the BI , Lawton 's IADL score , gait speed , and TMS after adjustment of all significant confounding factors . The relative risks of an incident fall as an independent predictor for decliners in the BI , IADL score , gait speed , and TMS were 2.4 ( 95 % confidence interval [ CI ] , 1.4 - 4.0 ; p = .01 ) , 2.9 ( 95 % CI , 1.7 - 5.2 ; p < .001 ) , 2.4 ( 95 % CI , 1.5 - 3.8 ; p < .001 ) , and 4.6 ( 95 % CI , 2.7 - 7.8 ; p < .001 ) , respectively . CONCLUSIONS Incident falls have a significant negative impact on the balance , gait , and Activities of Daily Living functioning in community-dwelling older adults Background Improved usual gait speed predicts substantial reduction in mortality . A better underst and ing of the modifiable factors that are independently associated with improved gait speed would ensure that intervention strategies are developed based on a valid theoretical framework . Thus , we examined the independent association of change in executive functions and change in falls-related self-efficacy with improved gait speed among community-dwelling senior women . Methods A secondary analysis of the 135 senior women aged 65 to 75 years old who completed a 12-month r and omized controlled trial of resistance training . Usual gait speed  was assessed using a 4-meter walk . Three executive processes were assessed by st and ard neuropsychological tests : 1 ) set shifting ; 2 ) working memory ; and 3 ) selective attention and response inhibition . A linear regression model was constructed to determine the independent association of change in executive functions and falls-related self-efficacy with change in gait speed . Results Improved selective attention and conflict resolution , and falls-related self-efficacy , were independently associated with improved gait speed after accounting for age , global cognition , baseline gait speed , and change in quadriceps strength . The total variance explained was 24 % . Conclusions Interventions that target executive functions and falls-related self-efficacy , in addition to physical functions , to improve gait speed may be more efficacious than those that do not . Trial Registration Clinical Trials.gov Identifier :
Gait speed at usual pace in acute care setting s was 0.46 m/s ( 95 % CI : 0.34 - 0.57 ) , which was significantly slower than the gait speed of 0.74 m/s ( 95 % CI : 0.65 - 0.83 ) recorded in outpatient setting s. CONCLUSIONS Gait speed is an important measure in comprehensive geriatric assessment .
The consolidation of data from multiple studies reported in this meta- analysis highlights the mobility limitations experienced by older people in clinical setting s and the need for ongoing rehabilitation to attain levels sufficient for reintegration in the community
BACKGROUND  Gait speed  is a quick , inexpensive , reliable measure of functional capacity with well-documented predictive value for major health-related outcomes .
Numerous epidemiological studies have documented gait speed in healthy , community-dwelling older people .