Gait Speed As A Medical Measure Of Vitality

As a person ages, we notice that some seem frail early in life yet others continue as vital for decades. Is there a way to detect frailty onset or even potential lifespan? There may be with a simple gait test.

New research suggests that “gait speed” can predict survival. The test is simple. Have the person walk a four meter distance starting from a standing still position. Measure the time with a stop watch. Speeds of greater than 1.0m/sec closely associates with healthier aging. Below 0.6m/sec correlates with poor health and less functional capability. A breakpoint of about 0.8m/sec separates individuals who will survive for less than or more than the median. Over 1m/sec suggests better than average survival and over 1.2m/sec suggests an even greater survival advantage. These are from a Jan 5, 2011 publication by Dr. Stephanie Studenski and colleagues in the Journal of the American Medical Association.
Fragility may seem to be just a subjective observation but, as I posted previously, there is a real science to frailty measurement.

Those predicted to live another five to ten years or more might be given greater consideration for preventive measures that normally take years to achieve a benefit. On the other hand, those with high risk for a short life span might be considered further for what modifiable circumstances could be adjusted to the patient’s benefit.

The data for these analyses were from nine studies conducted from 1986 to 2000. Each study had over 400 older participants, each community dwelling, whose gait speed was recorded and then followed for survival for five plus years. The graphic will illustrate the findings.

Here is a short video; click here and then click on "Walking Speed"
JAMA Report Video
And for a graphic of the results go here  http://bit.ly/zHU13Y

These data help to differentiate the old (based on age) from the geriatric (based on biology). In an accompanying editorial, Dr. M. Cesari points out that not only is it useful to make this differentiation in older individuals but in other groups as well. For example in oncology practices, it is well known that performance status predicts outcome. Restated, those with low performance scores should normally not be treated with aggressive chemotherapy (the exception is in certain well defined situations) because the side effects are likely to outweigh the possible benefits. Surgeons, likewise, need to know who might be likely to encounter an adverse outcome. Gait speed might prove a useful way to select out who should likely not have chemotherapy or who should likely not have elective major surgery. Cesari points out that gait speed is not just a measure of leg function. It probably is a marker of a generalized physiologic function that correlates with health status.
Gait speed may become a marker to differentiate the chronologically old from the functionally geriatric. Check out your own rate.

Frailty – Common In Older Ages But Is It Preventable?

Americans are aging – fast. And that means more chronic illnesses like arthritis, heart failure and cancer. It also means more falls, more osteoporotic fractures, poorer hearing and vision and myriad other problems we equate with aging. It also means some older folks become “frail,” irrespective of chronologic age.

You know a person is frail when you see him or her – instinctively you will think a person is “frail” if they are “skinny,” weak, tired, inactive and slow. But frailty can actually be measured. Among the systems is one developed by the Cardiovascular Health Study, a longitudinal program that evaluated cardiovascular risk factors with annual examinations from 1989 to 1999 for individuals over age 65. This was followed through to the present with annual telephone follow-ups. Their “frailty indicator variables” include unintentional weight loss of more than ten pounds (as some measure of loss of muscle mass), grip strength,(as a measure of weakness) , fatigue score on a standardized test (as a measure of tired), physical activity (measure of inactivity), and walking speed (“slowness.”)

Using this approach, and if we define “frail” as having three or more of these five characteristics, about 7% of adults over age 65 living in the community will be regarded as frail. Importantly, frailty is not the result of co-morbidities but co-morbidity is a risk factor for frailty and disability is a frequent outcome of frailty.

With this definition of 3 or more characteristics, frail individuals will be found to have more falls, more hospitalizations, more fractures, increased sleep disordered breathing and more difficulty with the activities of daily living. They also, on average, demonstrate certain biological differences such as elevated C-reactive protein.

One person – otherwise healthy – might become frail in his 70’s whereas someone else might not until his 90’s or even after 100. That would suggest a possible genetic component and some preliminary studies as consistent with this theory.

We know that our bodies begin to “decline” with aging beginning in middle age. Bone mineral density for example declines about 1% per year. So too does cardiac function, muscle mass, lung capacity, etc. These processes are “normal” but can be slowed. Regular aerobic and weight bearing exercise will help maintain all of these functions. The decline will continue but at a slower rate.

What can we each do now? After checking in with your health care provider, a reasonable regimen might include:

Daily aerobic exercise for about 30 minutes
Resistance exercises (weights, Nautilus, etc)
Balance training

A personal trainer or physical therapist might be useful to give guidance and check out if the exercises are being done correctly and with enough intensity.

Then it might be good to add in a

Nutrition consultation to be sure your diet is appropriate for your age and lifestyle. For example, do you get enough protein in your diet?

And you might want to include some mental exercises to complement your physical ones. Studying a foreign language, playing chess or bridge, or Sudoku challenges your brain – but not TV watching or mindless books (even if they are interesting.)

This approach will slow the normal aging process and it may even help prevent the onset of frailty and is sequela. And for certain you will feel better, have fewer falls and other problems common with older age.