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 Cross-Cultural Adaptation and Validation of the Spanish-Language Version of the SARC-F to Assess Sarcopenia in Mexican Community-Dwelling Older Adults. Meaningful change and responsiveness in common physical performance measures in older adults. Psychometric evaluation of the original and Canadian French version of the activities-specific balance confidence scale among people with stroke. Physical performance measures in the clinical setting. Pedometer accuracy in nursing home and community-dwelling older adults. A Pilot Randomized Controlled Trial of the Effects of Chair Yoga on Pain and Physical Function Among Community‐Dwelling Older Adults With Lower Extremity Osteoarthritis Is timed up and go better than gait speed in predicting health, function, and falls in older adults? The relationship among physical activity, obesity, and physical function in community-dwelling older women. Test-Retest Reliability and Minimal Detectable Change Scores for the Timed “Up & Go” Test, the Six-Minute Walk Test, and Gait Speed in People With Alzheimer Disease Sensori-motor function, gait patterns and falls in community-dwelling women. Is gait speed a valid measure to predict community ambulation in patients with Parkinson's disease? Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews A Randomized Trial to Measure the Impact of a Community-Based Cognitive Training Intervention on Balance and Gait in Cognitively Intact Black Older Adults Improvement in usual gait speed predicts better survival in older adults. Functional performance and quality of life related to training and detraining of community-dwelling elderly
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 : OBJECTIVES To cross-culturally adapt and vali date the Spanish- language version of the SARC-F  in Mexican community-dwelling older adults . DESIGN Cross-sectional analysis of a prospect i ve cohort . SETTING The FraDySMex study , a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City . PARTICIPANTS Participants were 487 men and women older than 60 years , living in the design ated area in Mexico City . MEASUREMENTS Information from question naires regarding demographic characteristics , comorbidities , mental status , nutritional status , dependence in activities of daily living , frailty , and quality of life . Objective measurements of muscle mass , strength and function were as follows : skeletal muscle mass index ( SMI ) was taken using dual-energy x-ray , grip strength using a h and dynamometer , 6-meter gait speed using a GAIT Rite instrumented walkway , peak torque and power for knee extension using a isokinetic dynamometer , lower extremity functioning measured by the Short Physical Performance Battery ( SPPB ) , and balance using evaluation on a foam surface , with closed eyes , in the Modified Clinical Test of Sensory Integration . The SARC-F scale translated to Spanish and the consensus panels ' criteria from European , international , and Asian sarcopenia working groups were applied to evaluate sarcopenia . RESULTS The Spanish language version of the SARC-F scale showed reliability ( Cronbach alfa = 0.641 . All items in the scale correlated to the scale 's total score , rho = 0.43 to 0.76 ) , temporal consistency evaluated by test-retest ( CCI = 0.80 ) , criterion validity when compared to the consensus panels ' criteria ( high specificity and negative predictive values ) . The scale was also correlated to other measures related to sarcopenia ( such as age , quality of life , self-rated health status , cognition , dependence in activities of daily living , nutritional status , depression , gait speed , grip strength , peak torque and power for knee extension , SPPB , balance , SMI , and frailty ) . CONCLUSION The SARC-F scale was successfully adapted to Spanish language and vali date d in community-dwelling Mexican older adults OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change OBJECTIVE To evaluate the internal and absolute reliability and construct validity of the Activities-Specific Balance Confidence ( ABC ) scale and a new Canadian French version ( ABC-CF ) of it among people with stroke . DESIGN Cross-sectional data from a r and omized controlled trial . SETTING Community . PARTICIPANTS Ninety-one people with a residual walking deficit between 57 and 386 days poststroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The ABC and ABC-CF scales , Berg Balance Scale ( BBS ) , comfortable and maximum gait speeds , Timed Up & Go ( TUG ) test , 6-minute walk test ( 6MWT ) , Barthel Index , physical function scale of the Medical Outcomes Study 36-Item Short-Form Health Survey , Geriatric Depression Scale ( GDS ) , and the EQ-5D visual analog scale ( EQ VAS ) . RESULTS Internal consistency ( Cronbach alpha ) was .94 and .93 and the st and ard error of measurement was 5.05 and 5.13 for the ABC ( n=51 ) and the ABC-CF ( n=35 ) scales , respectively . Spearman rho values ranged from .30 to .60 for the ABC scale and from .45 to .68 on the ABC-CF scale for associations with scores on the BBS , comfortable and maximum gait speeds , TUG , 6MWT , Barthel Index , physical function scale , GDS , and EQ VAS . CONCLUSIONS Evidence of internal and absolute reliability and of construct validity of the ABC and the ABC-CF scales supports their use for cross-sectional measurements of balance self-efficacy among community-dwelling people in the first year poststroke OBJECTIVES To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization , decline in health , and decline in function in primary care setting s serving older adults . DESIGN Prospect i ve cohort study . SETTING Primary care programs of a Medicare health maintenance organization ( HMO ) and Veterans Affairs ( VA ) system . PARTICIPANTS Four hundred eighty-seven persons aged 65 and older . MEASUREMENTS  Lower extremity performance Established Population for Epidemiologic Studies of the Elderly ( EPESE ) battery including  gait speed , chair st and s , and t and em balance tests ; demographics ; health care use ; health status ; functional status ; probability of repeated admission scale ( Pra ) ; and primary physician 's hospitalization risk estimate . RESULTS Veterans had poorer health and higher use than HMO members . Gait speed alone and the EPESE battery predicted hospitalization ; 41 % ( 21/51 ) of slow walkers ( gait speed < 0.6 m/s ) were hospitalized at least once , compared with 26 % ( 70/266 ) of intermediate walkers ( 0.6 - 1.0 m/s ) and 11 % ( 15/136 ) of fast walkers ( > 1.0 m/s ) ( P < .0001 ) . The relationship was stronger in the HMO than in the VA . Both performance measures remained independent predictors after accounting for Pra . The EPESE battery was superior to gait speed when both Pra and primary physician 's risk estimate were included . Both performance measures predicted decline in function and health status in both health systems . Performance measures , alone or in combination with self-report measures , were more able to predict outcomes than self-report alone . CONCLUSION Gait speed and a physical performance battery are brief , quantitative estimates of future risk for hospitalization and decline in health and function in clinical population s of older adults . Physical performance measures might serve as easily accessible " vital signs " to screen older adults in clinical setting PURPOSE The accuracy of pedometers has not been thoroughly tested with older adult population s. The purpose of the present study was to examine the effects of walking speed and gait disorders on the accuracy of Yamax pedometers with nursing home residents ( NH ) relative to older adults living in the community . METHODS Pedometer accuracy was evaluated against observed steps taken during a self-paced walking test ( slow , normal , and fast speeds ) in 26 NH residents and 28 seniors ' recreation center members ( SC ) . Devices were attached to clothing at the waist . Walking speed was ascertained from the timed walk and a gait assessment was conducted . Percent error was calculated as ( [ pedometer steps - observed steps]/observed steps ) x 100 . RESULTS The walking speeds of both sample s increased across self-selected paces ( P < 0.0001 ) . The community-dwelling older adults  walked significantly faster ( P < 0.0001 ) in all trials and had significantly higher ( P < 0.0001 ) gait assessment scores ( indicating fewer gait problems ) . Gait scores were positively associated with walking speed and pedometer percent error .  Pedometers significantly underestimated NH residents '  observed steps taken by 74 % ( slow ) , 55 % ( normal ) , and 46 % ( fast ) paces ( P < 0.0001 ) . In the SC sample , the instruments failed to detect 25 % , 13 % , and 7 % of actual steps taken , respectively ( P < 0.0001 ) . The magnitude of the error was greater for NH versus SC older adults ( P < 0.0001 ) across all trials . CONCLUSIONS Slow walking speed and gait disorders hamper the utility of pedometers for physical activity measurement in frail seniors , such as NH residents , when worn at the usual attachment site . Pedometers , however , can be confidently used with ostensibly healthy older adult population s for both assessment and motivation purpose OBJECTIVES To determine effects of Sit ' N ' Fit Chair Yoga , compared to a Health Education program ( HEP ) , on pain and physical function in older adults with lower extremity osteoarthritis ( OA ) who could not participate in st and ing exercise . DESIGN Two-arm r and omized controlled trial . SETTING One HUD senior housing facility and one day senior center in south Florida . PARTICIPANTS Community-dwelling older adults ( N = 131 ) were r and omly assigned to chair yoga  ( n = 66 ) or HEP ( n = 65 ) . Thirteen dropped after assignment but prior to the intervention ; six dropped during the intervention ; 106 of 112 completed at least 12 of 16 sessions ( 95 % retention rate ) . INTERVENTIONS Participants attended either chair yoga or HEP . Both interventions consisted of twice-weekly 45-minute sessions for 8 weeks . MEASUREMENTS Primary : pain , pain interference ; secondary : balance , gait speed , fatigue , functional ability measured at baseline , after 4 weeks of intervention , at the end of the 8-week intervention , and post-intervention ( 1 and 3 months ) . RESULTS The chair yoga group showed greater reduction in pain interference during the intervention ( P = .01 ) , sustained through 3 months ( P = .022 ) . WOMAC pain ( P = .048 ) , gait speed ( P = .024 ) , and fatigue ( P = .037 ) were improved in the yoga group during the intervention ( P = .048 ) but improvements were not sustained post intervention . Chair yoga had no effect on balance . CONCLUSION An 8-week chair yoga program was associated with reduction in pain , pain interference , and fatigue , and improvement in gait speed , but only the effects on pain interference were sustained 3 months post intervention . Chair yoga should be further explored as a nonpharmacologic intervention for older people with OA in the lower extremities . TRIAL REGISTRATION Clinical Trials.gov : NCT02113410 OBJECTIVES To assess whether the Timed Up and Go ( TUG ) is superior to gait speed in predicting multiple geriatric outcomes . DESIGN Prospect i ve cohort study . SETTING Medicare health maintenance organization and Veterans Affairs primary care clinics . PARTICIPANTS Adults aged 65 and older ( N=457 ) . MEASUREMENTS Baseline gait speed and TUG  were used to predict health decline according to EuroQol and Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) global health ; functional decline according to National Health Interview Survey ( NHIS ) activities of daily living ( ADLs ) score and SF-36 physical function index ; hospitalization ; and any falls and multiple falls over 1 year . RESULTS Mean age was 74 , and 44 % of participants were female . Odds ratios for all outcomes were equivalent for gait speed and TUG . Using area under the receiver operating characteristic curve of 0.7 or greater for acceptable predictive ability , gait speed and TUG each alone predicted decline in global health , new ADL difficulty , and falls , with no difference in predictive ability between performance measures . Neither performance measure predicted hospitalization , EuroQol decline , or physical function decline . As a continuous variable , TUG did not add predictive ability to gait speed for any outcome . CONCLUSION Gait speed predicts most geriatric outcomes , including falls , as does TUG . The time taken to complete TUG may not add to information provided by gait speed , although its qualitative elements may have other utility BACKGROUND The relationship between obesity and physical function is not well understood . Physical activity may be a key factor impacting on the relationship between obesity and physical function . METHODS Subjects included 171 community-dwelling women ( mean age = 74.3 , SD = 4.3 ) participating in a 14-year follow-up study to a walking intervention trial .  Measures of obesity [ body mass index ( BMI ) ] and physical activity ( Modified Paffenbarger Question naire ) were collected in 1982 , 1985 , 1995 , and 1999 . Physical function was assessed in 1999 using the Functional Status Question naire ( FSQ ) and gait speed . RESULTS Measures of obesity from 1982 to 1995 and measures of physical activity from 1982 to 1995 were related to physical function in 1999 . However , hierarchical regression analysis to predict physical function in 1999 controlling for the presence of chronic conditions indicated that physical activity from 1982 to 1995 , and not obesity from 1982 to 1995 , was an independent predictor of physical function ( FSQ : adjusted R2 = 0.09 , F = 4.68 , P < 0.001 ; gait speed : adjusted R2 = 18.0 , F = 9.41 , P < 0.0001 . CONCLUSION  Physical activity  appears to be as important if not more important than body weight in predicting future physical function Background : With the increasing incidence of Alzheimer disease ( AD ) , determining the validity and reliability of outcome measures for people with this disease is necessary . Objective : The goals of this study were to assess test-retest reliability of data for the Timed “ Up & Go ” Test ( TUG ) , the  Six-Minute Walk Test  ( 6MWT ) , and gait speed and to calculate minimal detectable change ( MDC ) scores for each outcome measure . Performance differences between groups with mild to moderate AD and moderately severe to severe AD ( as determined by the Functional Assessment Staging [ FAST ] scale ) were studied . Design : This was a prospect i ve , nonexperimental , descriptive method ological study . Methods : Background data collected for 51 people with AD included : use of an assistive device , Mini-Mental Status Examination scores , and FAST scale scores . Each participant engaged in 2 test sessions , separated by a 30- to 60-minute rest period , which included 2 TUG trials , 1 6MWT trial , and 2 gait speed trials using a computerized gait assessment system . A specific cuing protocol was followed to achieve optimal performance during test sessions . Results : Test-retest reliability values for the TUG , the 6MWT , and gait speed were high for all participants together and for the mild to moderate AD and moderately severe to severe AD groups separately ( intraclass correlation coefficients ≥.973 ) ; however , individual variability of performance also was high . Calculated MDC scores at the 90 % confidence interval were : TUG=4.09 seconds , 6MWT=33.5 m ( 110 ft ) , and gait speed=9.4 cm/s . The 2 groups were significantly different in performance of clinical tests , with the participants who were more cognitively impaired being more physically and functionally impaired . Limitations : A single research er for data collection limited sample numbers and prohibited blinding to dementia level . Conclusions : The TUG , the 6MWT , and gait speed are reliable outcome measures for use with people with AD , recognizing that individual variability of performance is high . Minimal detectable change scores at the 90 % confidence interval can be used to assess change in performance over time and the impact of treatment Tests of vision , vestibular function , peripheral sensation , strength , reaction time , balance and gait were administered to 183 community-dwelling women aged 22 - 99 years .  Walking speed , stride length and cadence declined with age with corresponding increases in stance duration and percentage of the stride in the stance phase . Visual acuity and contrast sensitivity , tactile and vibration sense in the lower limb , vestibular function ( as assessed by the vestibular X Writing Test ) , quadriceps and ankle dorsiflexion strength and reaction time were significantly associated with all five gait parameters . Postural sway measures were associated with walking speed , stride length and percentage of the stride in the stance phase . Multiple regression analyses revealed seven sensori-motor measures as significant predictors for one or more of the gait parameters : low contrast visual acuity , tactile sensitivity , vibration sense , vestibular X-test writing performance , quadriceps strength , reaction time and sway . Quadriceps strength was included as a predictor variable for every gait parameter and in each case had the strongest beta weight . Women who fell on two or more occasions in a one-year prospect i ve period had significantly reduced and more variable cadence and significantly increased stance duration ( measured in absolute terms and as a percentage of stride ) than those who did not fall or fell on one occasion only . The study findings eluci date the relative importance of specific physiological systems in the maintenance of normal gait and identify temporal gait measures that are associated with falling in older people OBJECTIVE To investigate the predictive value of gait speed for community walking in Parkinson 's disease and to develop a multivariate prediction model for community walking . DESIGN Data from baseline assessment s in a r and omized clinical trial were used . SUBJECTS A total of 153 patients with Parkinson 's disease were included . METHODS  Community walking  was evaluated using the mobility domain of the Nottingham extended activities of daily living index ( NEAI ) . Patients who scored 3 points on item 1 ( " Did you walk around outside ? " ) and item 5 ( " Did you cross roads ? " ) were considered community walkers .  Gait speed was measured with the 6-m or 10-m timed walking test . Age , gender , marital status , disease duration , disease severity , motor impairment , balance , freezing of gait , fear of falling , previous falls , cognitive function , executive function , fatigue , anxiety and depression were investigated for their contribution to the multivariate model . RESULTS Seventy patients ( 46 % ) were classified as community walkers . A gait speed of 0.88 m/s correctly predicted 70 % of patients as community walkers . The multivariate model , including gait speed and fear of falling , correctly predicted 78 % of patients as community walkers . CONCLUSION Timed walking tests are valid measurements to predict community walking in Parkinson 's disease . However , evaluation of community walking should include an assessment of fear of falling BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the  Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( BBS ) , and Timed Up & Go Test ( TUG ) and during comfortable- and fast-speed walking ( CGS and FGS ) . Intraclass correlation coefficients ( ICCs ) were used to determine the test-retest reliability for the 6MW , TUG , CGS , and FGS measurements . Data were analyzed by gender and age ( 60 - 69 , 70 - 79 , and 80 - 89 years ) cohorts , similar to previous studies . Means , st and ard deviations , and 95 % confidence intervals for each measurement were calculated for each cohort . RESULTS The 6MW , TUG , CGS , and FGS measurements showed high test-retest reliability ( ICC [2,1]=.95-.97 ) . Mean test scores showed a trend of age-related declines for the 6MW , BBS , TUG , CGS , and FGS for both male and female subjects . DISCUSSION AND CONCLUSION Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW , BBS , TUG , CGS and FGS . Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons OBJECTIVES To assess the predictive value of five performance-based measures for the onset of difficulty in activities of daily living ( ADLs ) . DESIGN A prospect i ve cohort study ; home visits every 6 months for 18 months . SETTING Community-based . PARTICIPANTS Community-dwelling older adults , n=110 , ( mean age 80.3+/-7.0 ; range 67 - 98 ) who reported no difficulty in basic ADLs .  MEASUREMENTS The  Short Physical Performance Battery ( SPPB ) , gait speed , Berg Balance Scale ( BBS ) , grip strength , and Timed Up and Go Test ( TUG ) were evaluated at baseline . Seven ADL items  were assessed at baseline and 6 , 12 , and 18 months . The onset of ADL disability was self-report of difficulty in any of the seven ADL items . Logistic regression models were fitted for each of the physical performance measures to predict onset of ADL difficulty at 6 , 12 , and 18 months . RESULTS After controlling for age , comorbid conditions , and sex , the BBS was the most consistent and best predictor for the onset of ADL difficulty over an 18-month period ( 6 months , c-statistic=0.725 , ( 95 % confidence interval (CI)=0.60 - 0.85 ; 12 months , c-statistic=0.840 95 % CI=0.75 , 0.93 ; 18 months , c-statistic=0.821 , 95 % CI=0.71 , 0.93 ) . The SPPB showed excellent predictive value for the onset of difficulty at 12 months . Ninety-five , 89 , and 75 older adults completed the 6 , 12 , and 18-month follow-up visits , respectively . CONCLUSION BBS , followed by SPPB , TUG , gait speed , and grip strength , were predictive of the onset of ADL difficulty over an 18-month period in community-dwelling older adults . Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty and may help to detect early functional decline Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Introduction . Fall prevention is important for maintaining mobility and independence into old age . Approaches for reducing falls include exercise , tai chi , and home modifications ; however , causes of falling are multifactorial and include not just physical but cognitive factors . Cognitive decline occurs with age , but older adults with the greatest declines in executive function experience more falls . The purpose of this study was twofold : to demonstrate the feasibility of a community-based cognitive training program for cognitively intact Black older adults and to analyze its impact on gait and balance in this population . Method . This pilot study used a pretest/posttest r and omized trial design with assignment to an intervention or control group . Participants assigned to the intervention completed a computer-based cognitive training class that met 2 days a week for 60 min over 10 weeks . Classes were held at senior/community centers . Primary outcomes included balance as measured by the Berg Balance Scale ( BBS ) , 10-meter gait speed , and 10-meter gait speed under visuospatial dual-task condition . All measures were assessed at baseline and immediately post-intervention . Results . Participants were community-dwelling Black adults with a mean age of 72.5 and history of falls ( N = 45 ) . Compared to controls , intervention participants experienced statistically significant improvements in BBS and gait speed . Mean performance on distracted gait speed also improved more for intervention participants compared to controls . Conclusion . Findings from this pilot r and omized trial demonstrate the feasibility of a community-based cognitive training intervention . They provide initial evidence that cognitive training may be an efficacious approach toward improving balance and gait in older adults known to have a history of falls OBJECTIVES To estimate the relationship between 1-year improvement in measures of health and physical function and 8-year survival . DESIGN Prospect i ve cohort study . SETTING Medicare health maintenance organization and Veterans Affairs primary care programs . PARTICIPANTS Persons aged 65 and older ( N=439 ) . MEASUREMENTS Six measures of health and function assessed at baseline and quarterly over 1 year . Participants were classified as improved at 1 year , transiently improved , or never improved for each measure using a priori definitions of meaningful change : gait speed ( usual walking pace over 4 m ) , 0.1 m/s ; Short Physical Performance Battery , 1 point ; Medical Outcomes Study 36-item Short Form Health Survey physical function , 10 points ; EuroQol , 0.1 point ; National Health Interview activity of daily living scale , 2 points ; and global health change , two levels or reaching the ceiling . Mortality was ascertained from the National Death Index . Covariates included demographics , comorbidity , cognitive function , and hospitalization . RESULTS Of the six measures , only improved gait speed was associated with survival . Mortality after 8 years was 31.6 % , 41.2 % , and 49.3 % for those with improved , transiently improved , and never improved gait speed , respectively . The survival benefit for improvement at 1 year persisted after adjustment for covariates ( hazard ratio=0.42 , 95 % confidence interval=0.29 - 0.61 , P<.001 ) and was consistent across subgroups based on age , sex , ethnicity , initial gait speed , healthcare system , and hospitalization . CONCLUSION Improvement in usual gait speed predicts a substantial reduction in mortality . Because gait speed is easily measured , clinical ly interpretable , and potentially modifiable , it may be a useful " vital sign " for older adults . Further research is needed to determine whether interventions to improve gait speed affect survival Purpose . Despite clear evidence of physiological declines during detraining , the effects of detraining on functional performance and quality of life have not often been investigated . The purpose of this study was to investigate functional performance and quality of life measures after a training and detraining programme with community-dwelling elderly . Method . Twenty-three subjects took part in a combined programme of muscle strengthening and aerobic conditioning twice a week and were assessed at baseline , after training , and after one , two , and three months of detraining .  Functional performance was assessed by gait speed and by the rate of ascending and descending stairs , while quality of life was evaluated by the Nottingham Health Profile . Results . Repeated measures ANOVA showed that gains observed in measures of gait speed , ascending , and descending stairs returned to baseline after one , two , and three months of detraining , respectively . However , the gains in quality of life remained unchanged . Conclusions . One-month detraining was enough to show functional decline , with gait speed the most sensitive parameter to detect these changes and QL measure most resilient , beneficial factor during the detraining process . Based on these findings , it is recommended that programmes devised for elderly should not be interrupted , to maintain the acquired benefits
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 .