Effect of testing procedures on gait speed measurement: A systematic review

Gait speed assessment in confined spaces: Development of a novel automated 4-m static-start test to measure dynamic-start gait speed

OBJECTIVES

To promote standardization and feasible measurements of gait speed across the field, we developed a device that used light detection and ranging (LiDAR) technology to measure gait speed from a standing-start testing procedure conducted on a 4-m total walkway. We compared this automated (LiDAR-based) standing-start 4-m gait speed test (AS-4MG) with automated and manual (stopwatch-based) dynamic-start 4-m gait speed tests (AD-4MG and MD-4MG, respectively) on between-method agreement, measurement repeatability, and predictive validity with functional outcomes.

METHODS

A sample of 48 community-dwelling adults (mean [SD], 69 [9] years) participated in this method comparison study. Participants completed a survey and a physical function assessment, from which self-reported stair difficulty, handgrip strength, sit-to-stand performance, and gait speed (AS-, AD-, and MD-4MG) were measured.

RESULTS

Mean AS-4MG, AD-4MG, and MD-4MG were 1.12, 1.13, and 1.14 m/s, respectively, with a strong correlation (r = 0.94) and no systematic bias observed between AS-4MG and the referent AD-4MG. In the analyses of repeated gait measurements, coefficients of repeatability were <0.20 m/s for the automated tests (0.16 and 0.18 m/s for AS-4MG and AD-4MG, respectively) but not for MD-4MG (0.22 m/s). Correlations between gait speed and functional measures ranged between 0.44 and 0.68 (Ps < 0.01). Correlations for the automated tests were comparable, while AS-4MG correlations tended to exceed MD-4MG correlations.

CONCLUSIONS

In community-dwelling adults, the AS-4MG test was unbiased when compared with the AD-4MG, encompassing a 9-m walkway, with both tests showing equivalence of measurement repeatability and predictive validity. The AS-4MG potentially allows gait measurements in confined spaces (e.g., doctor's office) where the gait speed test was previously unfeasible. Geriatr Gerontol Int 2025; 25: 449-453.

Discriminative Ability and Associations of Sarcopenia Using Point-of-Care Ultrasound with Functional, Mobility and Frailty Status in Older Inpatients

Background/Objectives: We aimed to assess the discriminative ability of point-of-care ultrasound (POCUS) of the rectus femoris (RF) to detect sarcopenia and to examine associations of these sarcopenia measures with functional, mobility, and frailty status among older inpatients. Methods: Data were analysed from 161 patients aged 70 years and older consecutively admitted to a tertiary geriatric rehabilitation hospital between October and December 2023. The RF thickness and cross-sectional area (CSA) were measured using POCUS applying validated cut-offs. Ability of muscle ultrasound to detect sarcopenia based on bioelectrical impedance analysis (BIA) as the reference standard was calculated using receiver operating characteristics analyses (ROC). Second, associations of sarcopenia measures based on either the ultrasonographic RF thickness, or the RF cross-sectional area with functional, frailty, and mobility status were analysed using multivariable logistic regression analyses. Results: Mean age was 84.0 years (standard deviation (SD) 6.1 years) and 64.4% were women. Overall, 31 (19.3%) patients had sarcopenia based on low grip strength and low muscle mass using the BIA. The mean ultrasonographic RF thickness and CSA were 13 mm (SD 4.1) and 4.3 cm2 (SD 1.7), respectively. Correlation coefficients of the RF thickness with BIA-muscle mass were r = 0.52 in males, versus r = 0.40 in females. Both sarcopenia measures using the RF thickness and CSA were positively associated with functional (adjusted odds ratio (OR) 9.3 (95% CI 3.7-23.4) and 9.2 (3.6-23.7)) and frailty status (OR 4.0 (95% CI 2.1-12.1) and 4.3 (1.8-10.4)). None of the sarcopenia measures were significantly associated with mobility status. Conclusions: Rectus femoris thickness and CSA measured by POCUS showed a fair discriminative ability to detect sarcopenia based on BIA, suggesting that BIA and POCUS measure different aspects of muscle health. A strong association between sarcopenia based on POCUS and functional and frailty status suggest the potential utility of POCUS in the diagnostic evaluation of sarcopenia among older hospitalised patients; however, further study is required. Research should focus on establishing valid sex-specific cut-offs for grip strength and muscle mass, with the ultimate goal of developing a low-cost, bedside, and sensitive diagnostic toolkit for detecting sarcopenia in older patients.

Health & Gait: a dataset for gait-based analysis

Acquiring gait metrics and anthropometric data is crucial for evaluating an individual's physical status. Automating this assessment process alleviates the burden on healthcare professionals and accelerates patient monitoring. Current automation techniques depend on specific, expensive systems such as OptoGait or MuscleLAB, which necessitate training and physical space. A more accessible alternative could be artificial vision systems that are operable via mobile devices. This article introduces Health&Gait, the first dataset for video-based gait analysis, comprising 398 participants and 1, 564 videos. The dataset provides information such as the participant's silhouette, semantic segmentation, optical flow, and human pose. Furthermore, each participant's data includes their sex, anthropometric measurements like height and weight, and gait parameters such as step or stride length and gait speed. The technical evaluation demonstrates the utility of the information extracted from the videos and the gait parameters in tackling tasks like sex classification and regression of weight and age. Health&Gait facilitates the progression of artificial vision algorithms for automated gait analysis.

Measurement Practice of Slow Gait Speed for Motoric Cognitive Risk Syndrome: A Systematic Review

OBJECTIVES

Individuals with motoric cognitive risk (MCR) syndrome have a high dementia risk. However, a knowledge gap exists in the measurement procedure for slow gait speed, which is a crucial component of MCR diagnosis. The study aimed to systematically review slow gait speed measurement practices in MCR diagnosis to identify critical constructs in gait speed measurement procedure.

DESIGN

Systematic review.

SETTING AND PARTICIPANTS

Included studies were conducted in clinical and community settings, involving participants with MCR receiving gait speed measurement.

METHODS

A systematic search across PubMed, Medline, Embase, CINHAL (EBSCO), Web of Science, Cochrane Library, and ProQuest Dissertation from inception until January 2024 for articles with detailed MCR diagnosis. Study quality was evaluated with the Joanna Briggs Institute (JBI) Critical Appraisal Checklists and slow gait speed measurement methods were summarized through narrative synthesis.

RESULTS

From 27,600 unique entries, 50 relevant studies with 55 cohorts were identified and included in the review. Slow gait speed measurement methods in existing MCR studies showed heterogeneity in measurement tools, start/end protocols and buffer distance, walking test distance, number of tests, calculation methods, and cutoff values. Commonly, manual stopwatches and 4-meter walking test distance with a 2-meter buffer at each end at a usual pace were used, averaging 2 tests for gait speed analysis, with the need for cohort-specific slow gait cutoff values.

CONCLUSIONS AND IMPLICATIONS

The measurement practices of slow gait speed in MCR diagnosis were heterogeneous. A relatively comprehensive gait speed measurement procedure with 7 constructs was initially delineated in this study based on synthesis analysis, with the potential to improve diagnostic accuracy and consistency of MCR, although further validation is still needed.

Associations of 2 Established Methods of Measuring Gait Speed and Sit-To-Stand Performance with Frailty and Life-Space Mobility in Community-Dwelling Older Adults

OBJECTIVES

The 4-m gait speed (4mGS) and 10-m gait speed (10mGS) tests and the 30-second sit-to-stand (30sSTS) and 5-times sit-to-stand (5xSTS) tests are commonly used and advocated in consensus recommendations. We compared these tests on their predictive and clinical value concerning the risk of prefrailty/frailty and restricted life-space mobility (RLSM).

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A sample of 1235 community-dwelling adults (mean ± SD, 68 ± 7 years) participated in this prospective cohort study.

METHODS

At baseline assessment, participants completed a survey and functional assessment, from which gait speed, sit-to-stand performance, self-reported mobility limitation, 40-item Frailty Index, and Life Space Assessment were measured. Participants with a 40-item Frailty Index >0.15 and a Life Space Assessment <60 points were classified as having prefrailty/frailty and RLSM, respectively. At 1-year follow-up assessment, prefrailty/frailty and RLSM were evaluated.

RESULTS

Correlations between gait speed and sit-to-stand measures were high (ρ values >0.80). In multivariable ordinal models, these measures added incremental prognostic value beyond a base model comprising demographics and self-reported mobility limitation variables in predicting baseline and 1-year outcomes. Between 10mGS and 4mGS, models with 10mGS had higher concordance indices (differences, 0.005-0.009), and these differences translated to generally greater net benefit in decision curve analyses. Between 30sSTS and 5xSTS measures, no one measure consistently outperformed the other, with small net benefit differences between measures (<0.2%).

CONCLUSIONS AND IMPLICATIONS

In community-dwelling older adults, gait speed and sit-to-stand measures meaningfully predicted prefrailty/frailty and RLSM. 10mGS provided more robust prognostic information than the 4mGS, whereas 5xSTS and 30sSTS measures showed near equivalence of performance. These findings could guide the choice of functional measures in clinical and research settings.

Limited health literacy increases the likelihood of cognitive frailty among older adults

BACKGROUND

Cognitive frailty is a dual geriatric syndrome that is preventable with lifestyle changes. Lifestyle changes are influenced by literacy level. However, the association between limited health literacy (HL) and cognitive frailty (CF) is yet to be discovered.

OBJECTIVES

This study aims to determine the association between HL and CF among older adults.

METHODS

Data was collected between April 2021 to March 2022 in this cross-sectional study. Citizens aged 60 years and older who can understand Malay and English were selected through purposive sampling from the AGELESS Trial screening sample frame. HLS-M-Q18 was administered to determine HL and CDR, and Fried's Criteria were used to assess the CF status.

RESULTS

A total of 757 participants were included in the analysis. 68.2% of the total participants had a limited HL level. The prevalence of CF among older adults with limited HL was 48.2% as compared to those with adequate HL (28.2%) (p < 0.001). Based on the HLS-M-Q18 index scores, the robust group had a higher HL index score than those in the CF group: 36.1 (SD = 10.5) and 33.4 (SD = 8.6), respectively, p < 0.05. In binary logistic regression, limited HL, increasing age, lower income, lower education level and rural locality were associated with the increase of CF occurrence. Older adults with limited HL have 2.6 times higher odds of having CF.

CONCLUSION

Approximately two-thirds of multiethnic older adults in the study had limited HL, with those with limited HL has 2.6 times higher odds of having CF. These findings emphasize the importance of addressing HL to improve their health outcomes and well-being.

Acceptability, Reliability, and Validity of Virtually Administered Gait Speed Tests

OBJECTIVES

To evaluate the acceptability, reliability (inter- and intrarater), and validity (convergent, known groups, and predictive) of virtually administered gait speed tests for community-dwelling older adults.

DESIGN

A prospective cohort study was performed, tracking health outcomes for a year.

SETTING AND PARTICIPANTS

The 3-m gait speed test at usual and fast pace was administered to community-dwelling older adults over Zoom.

METHOD

To examine acceptability, participants completed questionnaires regarding telehealth usability and experience. Virtual gait speed tests were administered at baseline and 24 to 72 hours later to evaluate reliability. Self-report mobility measures were used to examine convergent and known-groups validity. Participants' health outcomes were tracked for a year to evaluate predictive validity.

RESULTS

Sixty participants completed the baseline assessment and 52 completed the second assessment. Participants reported an overall positive experience with the test. Intraclass correlation coefficients for reliability ranged from 0.79 to 0.90. For convergent validity, correlations >0.30 were found predominantly for usual gait speed with self-report mobility measures. Both the usual- and fast-gait speed were able to discriminate between difficulty walking and gait aid use. Usual gait speed was able to predict specialist and family doctor visits and fast gait speed was able to predict rehabilitation specialist visits over 1 year.

CONCLUSIONS AND IMPLICATIONS

Our findings demonstrate support for the acceptability, reliability, and validity of virtually administered gait speed tests for community-dwelling older adults. Although future studies are needed to examine the validity of virtual gait speed tests in larger and more diverse samples to improve generalizability of results, clinicians and researchers can virtually administer 3-m gait speed tests with confidence that scores are trustworthy and reflect older adults' mobility.

Gait speed in knee osteoarthritis: A simple 10-meter walk test predicts the distance covered in the 6-minute walk test

BACKGROUND

The 6-Minute Walk Test (6MWT) is a common performance-measure in Knee Osteoarthritis (KOA), but the pain and functional impairment characterizing the condition may interfere its adequate performance.

OBJECTIVES

The shorter 10-m Walk Test (10mWT) could predict the distance performed on the 6MWT, therefore decreasing the burden on patients, enhancing efficiency, and reducing space- and time-constraints in clinical settings.

DESIGN

A cross sectional study was conducted.

METHODS

The scores from the 6MWT and the shorter 10mWT of 58 ambulatory subjects with KOA were compared. Correlation, and a univariate regression analysis to explore the predictive ability of the 10mWT, were calculated.

RESULTS

Correlation was excellent (r = 0.913, p-value<0.001), and the predictive equation based on the 10mWT scores (R2 = 0.834, p-value<0.001) estimates the distance walked in the 6MWT with a relative error of 7.62%.

CONCLUSIONS

The 10mWT may be an excellent assessment-tool to predict the distance walked in the 6MWT, due to its low strain on patients and as a means of improving efficiency and reducing time-constraints.

Slow walking speed and health-related exit from employment among older workers over 5 years of follow-up: evidence from the Health and Employment After Fifty (HEAF) cohort study

INTRODUCTION

With demographic changes, there is increasing demand for individuals and governments to lengthen working lives. Jobs that are very physically demanding are likely to be more difficult to sustain at older ages. If workers at risk of mismatch of demand and capability could be identified early, there would be opportunities for intervention for health or lifestyle and/or re-training or redeployment.

OBJECTIVE

To investigate whether self-reported walking speed (a good measure of function in elderly people) predicted health-related job loss (HRJL) longitudinally over 5 years of follow-up among middle-aged workers.

DESIGN

Data came from the Health and Employment After Fifty (HEAF) prospective cohort study of middle-aged people (aged 50-64 years) in UK.

SETTING

General population survey (sampling frame was 24 General Practice registers).

PARTICIPANTS

The cohort included 8134 people recruited in 2013-2014. For the current analyses, 5217 people who ever worked and completed at least one follow-up questionnaire were eligible.

PRIMARY OUTCOME

Exit from employment mainly or partly for health reasons (HRJL).

RESULTS

At baseline, very slow walking speed was associated with: obesity, physical inactivity, smoking (men), financial hardship, lower educational attainment and not being in professional occupations. In total, 527 people (10%) reported at least one HRJL during follow-up. After adjustment, the HR for HRJL among men with very slow walking-speed was 4.32, 95% CI 2.72 to 6.87 and among women was 4.47, 95% CI 3.04 to 6.57. After further adjustment for 'difficulty coping with physical demands at work', hazards remained doubled in men and women.

CONCLUSIONS

Self-reported walking speed could help identify older workers who are at increased risk of HRJL. This could provide opportunities for intervention through optimising health and lifestyle, restricting physical workload, retraining or redeployment. Early appropriate intervention could enable longer working lives and promote healthier, more equal ageing.

Reference Values for Habitual and Fast Gait Speed in Singapore Adults Aged 21 to 80

Objectives: Gait speed indicates the individual's functional status and predicts overall health. This study aims to determine (1) the intra- and inter-rater and test-retest reliability of the dynamic 4 m gait speed test protocol; (2) establish the normative reference values of habitual and fast gait speeds in community-dwelling healthy Singaporean adults aged 21 to 80; and (3) explore the association of age, gender, height, weight, and body mass index (BMI) on gait speed. Methods: This prospective cross-sectional study recruited healthy ambulatory community-dwelling Singaporeans aged 21 to 80 who could ambulate independently without aid. Participants were excluded if they required walking aids; were pregnant; or had physical, medical, or cognitive conditions that may affect gait. Each participant completed at least two habitual and fast gait speed test trials via a 4 m walkway with a dynamic start. The data were analysed by descriptive statistics, the Mann-Whitney test, the Spearman coefficient, and the interclass correlation coefficient (ICC). Results: In total, 178 males and 201 females were included in the data analysis. The median age was 45.0 years [interquartile range (IQR) 26.2-59.0], and the median height was 1.64 metres (m) (IQR 1.58-1.70). The median habitual gait speed was 1.08 metre/second (m/s) (IQR 0.97-1.22), and the fast gait speed was 1.55 m/s (IQR 1.40-1.70). The ICC for reliability ranged from 0.84 to 0.99, indicating that the 4 m gait speed test had good-to-excellent reliability. Conclusions: Gait speeds were not influenced by gender but declined with age advancement. Age and height and age and BMI were weakly correlated to habitual and fast gait speed, respectively. We established the norm values for the 4 m gait speeds in Singapore and proved it to be a reliable gait speed assessment ready for immediate community applications.

Gait differences between COPD and healthy controls: systematic review and meta-analysis

BACKGROUND

Despite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls.

METHODS

We searched 11 electronic databases, supplemented by Google Scholar searches and manual collation of references, in November 2019 and updated the search in July 2021. Record screening and information extraction were performed independently by one reviewer and checked for accuracy by a second. Meta-analyses were performed in studies not considered at a high risk of bias.

RESULTS

Searches yielded 21 085 unique records, of which 25 were included in the systematic review (including 1015 people with COPD and 2229 healthy controls). Gait speed was assessed in 17 studies (usual speed: 12; fast speed: three; both speeds: two), step length in nine, step duration in seven, cadence in six, and step width in five. Five studies were considered at a high risk of bias. Low-quality evidence indicated that people with COPD walk more slowly than healthy controls at their usual speed (mean difference (MD) -19 cm·s-1, 95% CI -28 to -11 cm·s-1) and at a fast speed (MD -30 cm·s-1, 95% CI -47 to -13 cm·s-1). Alterations in other gait characteristics were not statistically significant.

CONCLUSION

Low-quality evidence shows that people with COPD walk more slowly than healthy controls, which could contribute to an increased falls risk. The evidence for alterations in spatial and temporal components of gait was inconclusive. Gait impairment appears to be an important but understudied area in COPD.

The Association Between Physical Function and Hyperkyphosis in Older Females: A Systematic Review and Meta-analysis

BACKGROUND AND PURPOSE

Thoracic hyperkyphosis may adversely influence physical function in older adults, but the literature is mixed and confounded by possible sex differences. This systematic review and meta-analysis aimed to examine the association between hyperkyphosis and physical function in older females.

METHODS

Scopus, ISI Web of Science, Cochrane Library, PubMed, CINAHL, and PEDro databases were searched through 2021 for studies that included measures of thoracic hyperkyphosis and physical function with extractable data for women older than 60 years. Studies were excluded if they were qualitative, case reports, case series, ecological studies, reviews, or were not published in English. The study quality and risk of bias were assessed using checklists from the National Heart, Lung, and Blood Institute. Data were synthesized using Cohen's d effect size and 95% confidence interval (CI), and random-effects models were used for the meta-analyses.

RESULTS AND DISCUSSION

Three cohort and 22 cross-sectional studies of fair to good quality met the inclusion criteria. Eight studies reporting single-group data showed a moderate association between greater kyphosis angles and lower physical function ( d = -0.57; 95% CI -0.73, -0.40). Fourteen studies reporting 2-group data showed a large negative effect on physical function for groups with greater kyphosis angles ( d = -1.16; 95% CI -1.53, -0.78). Three studies that reported multivariate data also tended to show negative associations between physical function and hyperkyphosis. Limitations include a relative lack of causal evidence; confirming causation requires additional longitudinal studies. Studies have assessed various physical function categories, including strength, gait, and balance. Future studies could determine the categories of function most affected so that preventive interventions could target hyperkyphosis appropriately.

CONCLUSIONS

Hyperkyphosis was associated with lower physical function in older women. Three cohort studies suggest that greater kyphosis angles may predict greater loss of physical function over time. These results imply that therapies that help to minimize hyperkyphosis may help preserve function in older women.

Association between Dietary Practice and Gait Speed in Community-Dwelling Older Adults with Overweight and Obesity: A Cross-Sectional Study

Slow gait speed is associated with poorer clinical outcomes and higher rates of functional limitation and mortality in older adults, especially when combined with overweight or obesity. Aging is also associated with nutritional deficits. The aim of our study was to assess the potential association between dietary practice and gait speed performance in community-dwelling older adults with overweight and obesity. Participants underwent body composition measurement with the Tanita MC-780MA Bioimpedance Analyzer (BIA). Dietary patterns were assessed with the Mini Nutritional Assessment (MNA) questionnaire, and a dietary adequacy (DA) score system was constructed. The four-meter gait speed test was performed in order to assess gait speed. Of 222 participants, aged 67.6 ± 6.6 years, with a body mass index (BMI) of 31.9 ± 4.5 kg/m2, 34.7% had reduced gait speed and lower DA compared to those with normal gait speed (2.99 ± 1.12 vs. 3.37 ± 1.07; p < 0.05). The DA score of participants with slower gait speed was more likely to fall below the median than that of participants with normal gait speed (70.1% vs. 51.7%; p < 0.05). Participants with slower gait speed were more likely to be nutritionally at risk of low DA (22.1% vs. 10.3%; p < 0.05). Logistic regression analysis, after adjustment for confounders, showed that the risk of having a slow gait speed was 75% lower among those with a higher DA score (OR = 0.25; 95% CI = 0.11-0.53). Older adults with overweight or obesity in community dwellings might need to be supported with nutritional interventions that can improve their gait speed.

Association of intrinsic capacity with functional ability, sarcopenia and systemic inflammation in pre-frail older adults

Background

Decline in intrinsic capacity (IC) has been shown to accelerate progression to disability. The study aims to explore association of IC composite score with functional ability, sarcopenia and systemic inflammation in pre-frail older adults.

Methods

Cross-sectional study of pre-frail older adults ≥60 years old recruited from the community and primary care centers. Composite scores of four domains of IC were measured: locomotion, vitality, cognition and psychological. FRAIL scale was used to define pre-frailty. Muscle mass was measured using the bioelectrical impedance analysis. Systemic inflammation biomarkers [Interleukin-6 (IL-6), Interleukin-10 (IL-10), Tumor Necrosis Factor Alpha (TNF-α), and Growth differentiated factor 15 (GDF-15)] were measured. Participants in the lowest tertile (T1) exhibited greater decline in IC.

Results

A total of 398 pre-frail older adults were recruited, mean age was 72.7 ± 5.8 years, 60.1% female, education level 7.8 years, and 85.2% were of Chinese ethnicity. A total of 75.1% had decline in locomotion, 40.5% in vitality, 53.2% in cognition and 41.7% in psychological domain. A total of 95% had decline in at least one domain. T1 was significantly associated with ADL impairment (aOR 3.36, 95% CI 1.78-6.32), IADL impairment (aOR 2.37, 95% CI 1.36-4.13), poor perceived health (aOR 0.96, 95% CI 0.95-0.98), fall (aOR 1.63, 95% CI 1.05-2.84), cognitive impairment (aOR 8.21, 95% CI 4.69-14.39), depression (aOR 101.82, 95% CI 33.62-308.37), and sarcopenia (aOR 2.40, 95% CI 1.60-5.45). T1 had significant associations with GDF-15, IL-10, and IL-10 to TNF-α ratio.

Conclusion

Decline in IC composite score among pre-frail older adults was associated with functional limitation, sarcopenia, and systemic inflammation.

Turning speed as a more responsive metric of age-related decline in mobility: A comparative study with gait speed

BACKGROUND

Navigating your environment requires both straight-line gait as well as turning. Gait speed normative values are well established and utilized in determining a person's functional status, however, it has limitations. This study sought to examine whether turning speed declines with age and how it compared to gait speed age-related decline.

METHODS

A secondary analysis was performed on 275 community dwelling adults between the ages of 18-88 that performed a timed walking test with an inertial measurement unit on their lumbar spine. Turning speed and walking speed were extracted for each participant. A series of mixed models were compared, and Akaike's Information Criterion was used to determine the best fit model between age and turning speed and age and gait speed.

FINDINGS

Turning speed and gait speed normative values were reported for each age decade. A linear model with a random intercept of "Condition" was used to assess the relationship between age and turning speed. The results indicated a significant negative relationship between age and turning speed (B = -0.66, p < 0.001). A spline-fit model determined a significant negative relationship between age and gait speed after the age of 65 (B = -0.0097, p = 0.002). The effect of age on gait speed before age 65 was not significant.

INTERPRETATION

Turning speed significantly declines with age in a linear fashion while gait speed begins to decline after age 65. Turning speed may be more responsive to age than gait speed. More research is needed to determine if the decline in turning speed with age is associated with a decline in function.

Correlates of Gait Speed Among Older Adults From 6 Countries: Findings From the COSMIC Collaboration

BACKGROUND

Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates across Australian, Asian, and African countries.

METHODS

We used data from 6 population-based cohorts of adults aged 65+ from 6 countries and 3 continents (N = 6 472), with samples ranging from 231 to 1 913. All cohorts are members of the Cohort Studies of Memory in an International Consortium collaboration. We investigated whether clinical (body mass index [BMI], hypertension, stroke, apolipoprotein status), psychological (cognition, mood, general health), and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models were controlled for age, sex, and education, and were sex-stratified.

RESULTS

Age- and sex-standardized usual gait speed means ranged from 0.61 to 1.06 m/s and rapid gait speed means ranged from 1.16 to 1.64 m/s. Lower BMI and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely nonsignificant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex, except physical activity, where the greater intensity was associated with usual gait among men but not women.

CONCLUSIONS

This study is among the first to describe the usual and rapid gait speeds across older adults in Africa, Asia, and Australia.

Laboratory and free-living gait performance in adults with COPD and healthy controls

Background

Gait characteristics are important risk factors for falls, hospitalisations and mortality in older adults, but the impact of COPD on gait performance remains unclear. We aimed to identify differences in gait characteristics between adults with COPD and healthy age-matched controls during 1) laboratory tests that included complex movements and obstacles, 2) simulated daily-life activities (supervised) and 3) free-living daily-life activities (unsupervised).

Methods

This case-control study used a multi-sensor wearable system (INDIP) to obtain seven gait characteristics for each walking bout performed by adults with mild-to-severe COPD (n=17; forced expiratory volume in 1 s 57±19% predicted) and controls (n=20) during laboratory tests, and during simulated and free-living daily-life activities. Gait characteristics were compared between adults with COPD and healthy controls for all walking bouts combined, and for shorter (≤30 s) and longer (>30 s) walking bouts separately.

Results

Slower walking speed (-11 cm·s-1, 95% CI: -20 to -3) and lower cadence (-6.6 steps·min-1, 95% CI: -12.3 to -0.9) were recorded in adults with COPD compared to healthy controls during longer (>30 s) free-living walking bouts, but not during shorter (≤30 s) walking bouts in either laboratory or free-living settings. Double support duration and gait variability measures were generally comparable between the two groups.

Conclusion

Gait impairment of adults with mild-to-severe COPD mainly manifests during relatively long walking bouts (>30 s) in free-living conditions. Future research should determine the underlying mechanism(s) of this impairment to facilitate the development of interventions that can improve free-living gait performance in adults with COPD.

Gait speed in idiopathic pulmonary fibrosis: Quickly stepping in the right direction

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Winning the race with aging: age-related changes in gait speed and its association with cognitive performance in dogs

Introduction

In humans, gait speed is a crucial component in geriatric evaluation since decreasing speed can be a harbinger of cognitive decline and dementia. Aging companion dogs can suffer from age-related mobility impairment, cognitive decline and dementia known as canine cognitive dysfunction syndrome. We hypothesized that there would be an association between gait speed and cognition in aging dogs.

Methods

We measured gait speed on and off leash in 46 adult and 49 senior dogs. Cognitive performance in senior dogs was assessed by means of the Canine Dementia Scale and a battery of cognitive tests.

Results

We demonstrated that dogs' food-motivated gait speed off leash is correlated with fractional lifespan and cognitive performance in dogs, particularly in the domains of attention and working memory.

Discussion

Food-motivated gait speed off leash represents a relatively easy variable to measure in clinical settings. Moreover, it proves to be a more effective indicator of age-related deterioration and cognitive decline than gait speed on leash.

Intravenous errc carboxymaltos vesus oral ferrous sulfate replament in elderly patients after acute non-variceal gastrointestinal bleeding (): protocol of a multicentre, open-label, randomised controlled trial

INTRODUCTION

Acute gastrointestinal bleeding (GIB) is a life-threatening emergency with a critical economic burden. As a result of bleeding, anaemia often requires intravenous or oral iron supplementation. Elderly patients are even more prone to untoward outcomes after hospital discharge if iron supplementation is inefficient. There is a gap in current guidelines on which supplementation route clinicians should choose. We aim to investigate the effect of one dose of intravenous iron therapy versus 3-month oral iron administration on anaemia in an elderly population.

METHODS AND ANALYSIS

The FIERCE study is an open-label, randomised controlled, two-armed trial. At least 48 hours after the acute non-variceal GIB treatment, patients will be recruited in participating centres. A random sequence generator will allocate the participants to group A (intravenous ferric carboxymaltose, 1000 mg) or group B (oral ferrous sulfate (FS), ca. 200 mg every day) with an allocation ratio of 1:1 on the day of the planned discharge from the hospital. Randomisation will be stratified for participating centres and the need for transfusion within the same hospitalisation before recruitment to the trial. Quality of life assessment, functional measurement and laboratory tests will be performed at baseline, 1 and 3 months±7 days after enrolment to the trial. The primary endpoint is a composite endpoint, including all-cause mortality, anaemia-associated unplanned emergency visit and anaemia-associated unplanned hospital admission within 3 months of enrolment in the trial.

ETHICS AND DISSEMINATION

The study has been approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (46395-5/2021/EÜIG). We will disseminate our results to the medical community and will publish our results in peer-reviewed journals.

TRIAL REGISTRATION

The trial has been registered at ClinicalTrials.gov (NCT05060731).

Assessment of the 4-meter walk test test-retest reliability and concurrent validity and its correlation with the five sit-to-stand test in chronic ambulatory stroke survivors

BACKGROUND

The 4-meter walk test (4-MWT) is a widely used measure to assess gait speed in the elderly but has not been validated for stroke survivors to date.

OBJECTIVES

To assess the test-retest reliability and concurrent validity of the 4-MWT compared to the 10-meter walk test (10-MWT) as a measure of gait speed in chronic post-stroke.

SECONDARY OUTCOME MEASURE

to assess the correlation of both gait measures with the 5 times sit-to-stand test (5TSTS).

METHODS

A cross-sectional observational study was conducted. Reliability was assessed by intraclass correlation coefficient (ICC_2,1), standard error of measurement (SEM) and minimal detectable change (MDC-95%). Bland & Altman analysis was used to quantify agreement between the 4-MWT and the 10-MWT. Two consecutive walking trials of the 4-MWT and 10-MWT followed by 5TSTS were performed all on the same day. A single researcher made all measurements.

RESULTS

Thirty-six chronic ambulatory post-stroke (average age 58.56 ± 11.28 years) were analyzed at their self-selected walking speed with a dynamic start. The 4-MWT showed excellent concurrent validity and test-retest reliability: ICC_2.1 = 0.991 (95% CI: 0.983, 0.996); SEM= 0.032 and MDC- 95% = 0.090 m/second) with a strong positive correlation with the 10-MWT (r = 0.957, p < 0.001). The Bland & Altman analysis showed a concordance of -0.05 m/second bias (p = 0.039) (95% limits of agreement: 0.20 to -0.29 m/second). The paired t-test showed no statistically significant difference in the mean of both walking tests (p < 0.091). However, there was only moderate correlation between the two gait assessments and the 5TSTS.

CONCLUSIONS

This study indicates excellent test-retest reliability concurrent validity and strong correlation between 4-MWT and 10-MWT with a dynamic start at comfortable speed. The 4-MWT could be used as a measure of gait speed in both outpatients and home settings in chronic ambulatory stroke survivors.

Treadmill training with virtual reality to enhance gait and cognitive function among people with multiple sclerosis: a randomized controlled trial

BACKGROUND

Motor and cognitive impairments impact the everyday functioning of people with MS (pwMS). The present randomized controlled trial (RCT) evaluated the benefits of a combined motor-cognitive virtual reality training program on key motor and cognitive symptoms and related outcomes in pwMS.

METHODS

In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. Both groups received three training sessions per week for 6 weeks. Dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score) were the primary outcomes. Secondary outcomes included additional tests of cognitive function, mobility, and patient-reported questionnaires. These were measured before, after, and 3 months after training.

RESULTS

Gait speed improved (p < 0.005) in both groups, similarly, by about 10 cm/s. The TT + VR group (n = 53 analyzed per-protocol) showed a clinically meaningful improvement of 4.4 points (95% CI 1.9-6.8, p = 0.001) in SDMT, compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9-2.5 points, p = 0.358) (group X time interaction effect p = 0.027). Furthermore, TT + VR group-specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002).

DISCUSSION

These findings suggest that both TT and TT + VR improve usual and dual-task gait in pwMS. Nonetheless, a multi-modal approach based on VR positively impacts multiple aspects of cognitive function and mental health, more than seen after treadmill-treading alone. Trial registered at ClinicalTrials.Gov NCT02427997.

Comparison of manual and automated measures of walking speed: Distance and pace matter

BACKGROUND

Walking speed (WS) represents a global marker of individual health and provides a simple and objective measure of motor performances for use in clinical and research settings. WS is most often measured over relatively short distances at usual (UWS) or fast (FWS) pace, using manual (e.g., stopwatch) or automated methods (e.g., photoelectric cells). As the time needed to walk over these distances is very short, we hypothesized that measurement error related to manual compared to automated WS measures is more pronounced for shorter distances and FWS and investigated the reliability and agreement of WS in a subsample of the Constances cohort at two paces and over two distances.

METHODS

We recruited 100 community-dwelling participants (50 % women) aged 45-70y (mean = 56.1y). WS was measured manually (stopwatches) and using photoelectric cells, at two paces (UWS/FWS) and over two distances (3 m/5 m). Agreement was examined using Bland and Altman plots and intraclass correlation coefficients (ICC).

RESULTS

Participants were on average 169.8 cm tall, and their mean body mass index was 25.4 kg/m². Agreement between manual stopwatches and photoelectric cells was excellent (ICCs between 0.92 and 0.97), but it was lower for smaller distances, with significantly lower ICCs over 3 m compared to 5 m both for UWS (difference_ICC = -0.04) and FWS (difference_ICC = -0.05). Bias of manual measures was constant for UWS and increased with increasing FWS. There were inter-rater effects, with better agreement for UWS and 5 m compared to FWS and 3 m.

CONCLUSIONS

Both distance and pace have an influence on the reliability of WS measures using manual timing methods. Our findings also suggest the presence of rater effects and better agreement for 5 m and UWS. These findings are helpful for the design of studies that include manual measures of WS, especially FWS, in order to reduce measurement error and suggest that longer distances are preferable.

Association of clinical outcome assessments of mobility capacity and incident disability in community-dwelling older adults - a systematic review and meta-analysis

The objective of the present review is to synthesize all available research on the association between mobility capacity and incident disability in non-disabled older adults. MEDLINE, EMBASE and CINAHL databases were searched without any limits or restrictions until February 2021. Published reports of longitudinal cohort studies that estimated a direct association between baseline mobility capacity, assessed with a standardized outcome assessment, and subsequent development of disability, including initially non-disabled older adults were included. The risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Random-effect models were used to explore the objective. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The main outcome measures were the pooled relative risks (RR) per one conventional unit per mobility assessment for incident disability. A total of 40 reports (85,515 participants at baseline) were included. For usual and fast gait speed, the RR per -0.1 m/s was 1.23 (95% CI: 1.18-1.28; 26,638 participants) and 1.28 (95% CI: 1.19-1.38; 8161 participants), respectively. Each point decrease in Short Physical Performance Battery score increased the risk of incident disability by 30% (RR = 1.30, 95% CI: 1.23-1.38; 9183 participants). The RR of incident disability by each second increase in Timed Up and Go test and Chair Rise Test performance was 1.15 (95% CI: 1.09-1.21; 30,426 participants) and 1.07 (95% CI: 1.04-1.10; 9450 participants), respectively. The review concludes that among community-dwelling non-disabled older adults, poor mobility capacity is a potent modifiable risk factor for incident disability. Mobility impairment should be mandated as a quality indicator of health for older people.

Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician

Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.

Measurement Properties of Remotely or Self-Administered Lower Extremity Mobility Performance Measures in Adults: A Systematic Review

OBJECTIVE

For individuals who face barriers to care assessment, there is a need for remote administration or self-administration of physical performance measures that assess mobility to determine current functional status and to monitor and predict future changes in functional status. The primary purpose of this review is to evaluate the available measurement properties of scores for remotely or self-administered lower extremity mobility performance measures in adults. This review also outlines the test procedures and population suitability of these measures.

METHODS

Data sources were Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL, Ovid AMED, and Cochrane CENTRAL-which were searched from inception to January 26, 2021-and the reference lists of relevant studies. Two individuals independently screened studies that assessed at least 1 prespecified measurement property of scores for a remote and/or self-administered lower extremity physical performance measure assessing mobility in an adult population. Two individuals independently extracted data on study characteristics, measurement properties, feasibility, and interpretability using piloted extraction forms. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk of Bias tool was used to assess methodological quality. Data were qualitatively summarized, and results were compared against COSMIN's criteria for good measurement properties. Level of evidence was determined using COSMIN's modified GRADE approach.

RESULTS

Fourteen studies detailing 19 outcome measures were included. Many studies displayed "sufficient" measurement properties based on COSMIN's criteria; however, risk of bias for most of the included studies was rated adequate or doubtful.

CONCLUSION

Clinicians and researchers can consider the measurement properties of scores and feasibility of different approaches presented in this review when determining how to assess or monitor mobility in adult populations.

IMPACT

Assessing mobility via remote or self-administered physical performance measures in adult populations appears to be feasible using a variety of methods including simple tools (chair, stopwatch), videoconferencing, and smartphone applications. This strategy may be particularly valuable for self-management of chronic conditions and decreasing barriers to accessing care.

Ultrasound assessment of sarcopenia in patients with rheumatoid arthritis

OBJECTIVES

To evaluate the efficacy of ultrasound (US) as a diagnostic tool for sarcopenia in patients with rheumatoid arthritis (RA).

METHODS

Female RA patients aged >50 years and matched controls were cross-sectionally assessed. Sarcopenia was diagnosed based on the 2019-updated Asian Working Group for Sarcopenia definition. The cross-sectional area (CSA) and echo intensity (EI) of the biceps brachii, rectus femoris, and EI of the vastus lateralis were examined bilaterally. Correction for subcutaneous fat and calculation of the recorrected EI (rcEI) were performed. We performed logistic regression using both muscle rcEI and CSA with receiver operating curve analysis to evaluate the discriminative performance per muscle group.

RESULTS

Seventy-eight consecutive RA patients and 15 age-and sex-matched controls were assessed. Sarcopenia was diagnosed in 34 RA patients (43.6%). The rcEI of examined muscles were significantly higher, whereas CSA were significantly lower in sarcopenic RA patients than in non-sarcopenic patients and matched controls. The combined discriminative performance of rcEI and CSA was superior to those of rcEI or CSA alone.

CONCLUSIONS

This study suggests the use of US for the diagnosis of sarcopenia in RA patients. The diagnostic performance increases when both echogenicity and CSA are considered together rather than individually.

A Matched Cohort Analysis for Examining the Association Between Slow Gait Speed and Shortened Longevity in Older Americans

This investigation examined the association between slow gait speed, as defined with newly established cut-points, and all-cause mortality in older Americans with a matched cohort analysis. The analytic sample included 10,259 Americans aged ≥65 years from the 2006-2014 waves of the Health and Retirement Study. Walking speed was measured in participant residences. Slow gait speed cut-points of <0.60 and <0.75 m/s were used separately for classifying participants as having slow walking speed. Nearest-neighbor propensity score matching was used to match the slow to the not-slow cohorts separately using both cut-points using relevant covariates. Persons with gait speed <0.60 m/s had a 1.42 higher hazard for mortality (95% CI: 1.28-1.57). Older Americans with gait speed <0.75 m/s had a 1.36 higher hazard for mortality (95% CI: 1.23-1.50). Slow gait speed may represent failing health and addressing how slow gait speed could be improved may help with referrals to appropriate interventions.

Association of possible sarcopenic obesity with osteoporosis and fragility fractures in postmenopausal women

Possible sarcopenic obese women had a decreased likelihood of osteoporosis but an increased likelihood of fragility fractures compared with non-sarcopenic non-obese and sarcopenia-only women. Furthermore, possible sarcopenic obese women had lower values of trabecular bone score than non-sarcopenic non-obese and sarcopenia-only women.

PURPOSE

The coexistence of possible sarcopenia and obesity may have opposing effects on osteoporosis. This study aimed to investigate whether possible sarcopenic obesity is associated with osteoporosis or fragility fracture.

METHODS

In this cross-sectional study of 1007 postmenopausal women from Taiwan, bone mineral density of the spine and hips was evaluated using dual-energy X-ray absorptiometry (DXA), and bone microarchitecture was evaluated using the trabecular bone score (TBS) derived from a lumbar spine image acquired by DXA. According to the definition of sarcopenia by the 2019 Asian Working Group for Sarcopenia, possible sarcopenia was defined by either low muscle strength or reduced physical performance. Obesity was defined as a body mass index of ≥ 27 kg/m². Based on the presence of possible sarcopenia and obesity, study participants were classified as follows: control (non-sarcopenic non-obese), sarcopenic (non-obese), obese (non-sarcopenic), and sarcopenic obese. Prevalent fragility fractures were determined by retrospectively reviewing medical records.

RESULTS

In this study, 10.1% of participants were classified as sarcopenic obese, 9.1% as obese, 35.2% as sarcopenic, and 45.6% as control. Relative to the control group, the sarcopenic obese group (OR, 0.28; 95% CI 0.18, 0.46) and obese group (OR, 0.38; 95% CI 0.23, 0.61) had a decreased likelihood of osteoporosis. However, the sarcopenic obese group (OR, 2.29; 95% CI 1.31, 4.00) and obese group (OR, 1.94; 95% CI 1.04, 3.62) had an increased likelihood of fragility fractures than with the control group. In addition, the sarcopenic obese group had a higher likelihood of fragility fractures than the sarcopenic group. Possible sarcopenic obese women also had significantly lower TBS values than those in the control and sarcopenic groups.

CONCLUSIONS

Possible sarcopenic obese women had a lower likelihood of osteoporosis but a higher likelihood of fragility fractures than non-sarcopenic non-obese and sarcopenia-only women. Furthermore, possible sarcopenic obese individuals had lower values of TBS than non-sarcopenic non-obese and sarcopenia-only women.

Wearable gait analysis systems: ready to be used by medical practitioners in geriatric wards?

Aim

To investigate the feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system.

Findings

Wearable gait analysis can be implemented into geriatric wards, showing its readiness for a transformation from a pure research tool to a practically usable gait analysis system.

Message

Despite good transferability into clinical practice, future research should aim to increase functionality and applicability of wearable gait analysis systems in clinical contexts.

Purpose

We assess feasibility of wearable gait analysis in geriatric wards by testing the effectiveness and acceptance of the system.

Methods

Gait parameters of 83 patients (83.34 ± 5.88 years, 58/25 female/male) were recorded at admission and/or discharge to/from two geriatric inpatient wards. Gait parameters were tested for statistically significant differences between admission and discharge. Walking distance measured by a wearable gait analysis system was correlated with distance assessed by physiotherapists. Examiners rated usability using the system usability scale. Patients reported acceptability on a five-point Likert-scale.

Results

The total distance measures highly correlate (r = 0.89). System Usability Scale is above the median threshold of 68, indicating good usability. Majority of patients does not have objections regarding the use of the system. Among other gait parameters, mean heel strike angle changes significantly between admission and discharge.

Conclusion

Wearable gait analysis system is objectively and subjectively usable in a clinical setting and accepted by patients. It offers a reasonably valid assessment of gait parameters and is a feasible way for instrumented gait analysis.

Test–retest reliability for performance-based outcome measures among individuals with arthrogryposis multiplex congenita

Background

Most individuals with arthrogryposis multiplex congenita, a rare condition characterized by joint contractures in ≥ 2 body regions, have foot and ankle involvement leading to compromised gait and balance. The purpose of this study was to establish between-days, test–retest reliability for performance-based outcome measures evaluating gait and balance, i.e., the 10-m Walk Test, Figure-of-8 Walk Test, 360-degree Turn Test, and modified Four Square Step Test, among adolescents and adults with arthrogryposis multiplex congenita.

Methods

This reliability study included ambulatory participants, aged 10 to 50 years, with a medical diagnosis of arthrogryposis multiplex congenita. Participants completed performance-based measures, in a randomized order, on two separate occasions. Intraclass correlation coefficients with 95% confidence intervals and minimal detectable changes at the 90% and 95% confidence level were calculated.

Results

Participants included 38 community-ambulators with a median of 13 out of 14 upper and lower joint regions affected. Intraclass correlation coefficient point estimates and 95% confidence intervals ranged from .85-.97 and .70-.98, respectively. Minimal detectable changes were 10 to 39% of sample means and were largest for the modified Four Square Step Test.

Conclusions

Among individuals with arthrogryposis, gait speed per the 10-m Walk Test, as well as non-linear walking and dynamic balance assessment per the Figure-of-8 Walk and 360 Degree Turn Tests, have adequate test–retest reliability enabling evaluation of individual patient changes. Changes in groups of ambulatory individuals with arthrogryposis multiplex congenita may be reliably evaluated with all of the studied outcome measures.

Enriched Rehabilitation Improves Gait Disorder and Cognitive Function in Parkinson's Disease: A Randomized Clinical Trial

Background: Studies on non-pharmacological strategies for improving gait performance and cognition in Parkinson's disease (PD) are of great significance. We aimed to investigate the effect of and mechanism underlying enriched rehabilitation as a potentially effective strategy for improving gait performance and cognition in early-stage PD. Methods: Forty participants with early-stage PD were randomly assigned to receive 12 weeks (2 h/day, 6 days/week) of enriched rehabilitation (ER; n = 20; mean age, 66.14 ± 4.15 years; 45% men) or conventional rehabilitation (CR; n = 20; mean age 65.32 ± 4.23 years; 50% men). In addition, 20 age-matched healthy volunteers were enrolled as a control (HC) group. We assessed the general motor function using the Unified PD Rating Scale-Part III (UPDRS-III) and gait performance during single-task (ST) and dual-task (DT) conditions pre- and post-intervention. Cognitive function assessments included the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Trail Making Test (TMT), which were conducted pre- and post-intervention. We also investigated alteration in positive resting-state functional connectivity (RSFC) of the left dorsolateral prefrontal cortex (DLPFC) in participants with PD, mediated by ER, using functional magnetic resonance imaging (fMRI). Results: Compared with the HC group, PD participants in both ER and CR groups performed consistently poorer on cognitive and motor assessments. Significant improvements were observed in general motor function as assessed by the UPDRS-III in both ER and CR groups post-intervention. However, only the ER group showed improvements in gait parameters under ST and DT conditions post-intervention. Moreover, ER had a significant effect on cognition, which was reflected in increased MoCA, SDMT, and TMT scores post-intervention. MoCA, SDMT, and TMT scores were significantly different between ER and CR groups post-intervention. The RSFC analysis showed strengthened positive functional connectivity between the left DLPFC and other brain areas including the left insula and left inferior frontal gyrus (LIFG) post-ER. Conclusion: Our findings indicated that ER could serve as a potentially effective therapy for early-stage PD for improving gait performance and cognitive function. The underlying mechanism based on fMRI involved strengthened RSFC between the left DLPFC and other brain areas (e.g., the left insula and LIFG).

Overground Walking in a Fully Immersive Virtual Reality: A Comprehensive Study on the Effects on Full-Body Walking Biomechanics

Virtual reality (VR) is an emerging technology offering tremendous opportunities to aid gait rehabilitation. To this date, real walking with users immersed in virtual environments with head-mounted displays (HMDs) is either possible with treadmills or room-scale (overground) VR setups. Especially for the latter, there is a growing interest in applications for interactive gait training as they could allow for more self-paced and natural walking. This study investigated if walking in an overground VR environment has relevant effects on 3D gait biomechanics. A convenience sample of 21 healthy individuals underwent standard 3D gait analysis during four randomly assigned walking conditions: the real laboratory (RLab), a virtual laboratory resembling the real world (VRLab), a small version of the VRlab (VRLab-), and a version which is twice as long as the VRlab (VRLab+). To immerse the participants in the virtual environment we used a VR-HMD, which was operated wireless and calibrated in a way that the virtual labs would match the real-world. Walking speed and a single measure of gait kinematic variability (GaitSD) served as primary outcomes next to standard spatio-temporal parameters, their coefficients of variant (CV%), kinematics, and kinetics. Briefly described, participants demonstrated a slower walking pattern (-0.09 ± 0.06 m/s) and small accompanying kinematic and kinetic changes. Participants also showed a markedly increased gait variability in lower extremity gait kinematics and spatio-temporal parameters. No differences were found between walking in VRLab+ vs. VRLab-. Most of the kinematic and kinetic differences were too small to be regarded as relevant, but increased kinematic variability (+57%) along with increased percent double support time (+4%), and increased step width variability (+38%) indicate gait adaptions toward a more conservative or cautious gait due to instability induced by the VR environment. We suggest considering these effects in the design of VR-based overground training devices. Our study lays the foundation for upcoming developments in the field of VR-assisted gait rehabilitation as it describes how VR in overground walking scenarios impacts our gait pattern. This information is of high relevance when one wants to develop purposeful rehabilitation tools.

Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes

Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice.

Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

OBJECTIVE

The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults.

METHODS

A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48 ± 2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to "Are you afraid of falling?") at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF.

RESULTS

Multivariable logistic regression showed that prefrailty or frailty increase the risk of not only future falls (odds ratio [OR]: 1.57; 95% CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95% CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95% CI = 1.04-1.68).

CONCLUSIONS

Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting.

IMPACT

Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high risk not only for falls but also for FOF.

Performance of the EWGSOP2 Cut-Points of Low Grip Strength for Identifying Sarcopenia and Frailty Phenotype: A Cross-Sectional Study in Older Inpatients

Background: The European Working Group on Sarcopenia has recently proposed revised cut-off values for the definition of low grip strength (EWGSOP2). We therefore compared performance of the EWGSOP2 cut-off definition of low grip strength with other internationally used cut-off points in a sample of older patients. Methods: We analyzed geriatric assessment data in a cross-sectional sample of 98 older patients admitted to a post-acute care hospital. First, we compared prevalence of sarcopenia and frailty phenotype in our sample using low grip strength cut-points from the EWGSOP2 and seven other internationally used consensus statements. Second, we calculated correlations between low grip strength and two independent surrogate outcomes (i.e., gait speed, and the clinical frailty scale) for the EWGSOP2 and the other seven cut-point definitions. Results: Prevalence of sarcopenia based on the EWGSOP2 grip strength cut-off values was significantly lower (10.2%) than five of the seven other cut-point definitions (e.g., 19.4% based on Sarcopenia Definitions and Outcomes Consortium (SDOC) criteria). Similarly, frailty phenotype prevalence was significantly lower based on EWGSOP2 cut-points (57.1%) as compared to SDOC (70.4%). The correlation coefficient of gait speed with low grip strength based on EWGSOP2 cut-points was lower (0.145) as compared to other criteria (e.g., SDOC 0.240). Conclusions: Sarcopenia and frailty phenotype were identified considerably less using the EWGSOP2 cut-points for low grip strength, potentially underestimating prevalence of sarcopenia and frailty phenotype in post-acute hospital patients.

BLE-GSpeed: A New BLE-Based Dataset to Estimate User Gait Speed

To estimate the user gait speed can be crucial in many topics, such as health care systems, since the presence of difficulties in walking is a core indicator of health and function in aging and disease. Methods for non-invasive and continuous assessment of the gait speed may be key to enable early detection of cognitive diseases such as dementia or Alzheimer’s disease. Wearable technologies can provide innovative solutions for healthcare problems. Bluetooth Low Energy (BLE) technology is excellent for wearables because it is very energy efficient, secure, and inexpensive. In this paper, the BLE-GSpeed database is presented. The dataset is composed of several BLE RSSI measurements obtained while users were walking at a constant speed along a corridor. Moreover, a set of experiments using a baseline algorithm to estimate the gait speed are also presented to provide baseline results to the research community.