Gait Speed and Survival in Older Adults

Study Questions:

Is there a relationship between gait speed and survival?

Methods:

A pooled analysis was conducted in nine cohort studies (collected between 1986 and 2000), using individual data from 34,485 community-dwelling older adults ages 65 years or older with baseline gait speed data, and follow-up for 6-21 years. Gait speed was calculated for each participant using distance in meters and time in seconds. All studies used instructions to walk at usual pace and from a standing start. The walk distance varied from 8 feet to 6 meters.

Results:

Participants were a mean (standard deviation) age of 73.5 (5.9) years; 59.6% were women; 79.8% were white; and mean (SD) gait speed was 0.92 (0.27) m/s. There were 17,528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%), and 10-year survival rate was 59.7% (95% CI, 46.5% -70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; p < 0.001). Survival increased across the full range of gait speeds, with significant increments per 0.1 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.

Conclusions:

In this pooled analysis of individual data from nine selected cohorts, gait speed was associated with survival in older adults.

Perspective:

That gait speed is associated with an improved survival is consistent with our understanding of the correlation between increased physical activity, fitness, and general health. Walking requires energy, movement, and support, and places demands on multiple organ systems, including the heart-vascular, lungs, nervous, and musculoskeletal systems. 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 deconditioning that has a direct effect on health and survival.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Follow-Up Studies, Blood Pressure, Posture, Musculoskeletal System, Registries, Incidence, Walking, Body Mass Index, Survival Rate, Heart Failure, Gait, Medicare, Hospitalization, United States


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