Just Get Out the Door! Importance of Walking Outside the Home for Maintaining Mobility: Findings from the Women's Health and Aging Study

Authors

  • Eleanor M. Simonsick PhD,

    1. From the *Clinical Research Branch, National Institute on Aging, Baltimore, MarylandDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandLaboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland§Department of Clinical and Experimental Medicine, Università di Ferrara, Ferrara, ItalyDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan.
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  • Jack M. Guralnik MD, PhD,

    1. From the *Clinical Research Branch, National Institute on Aging, Baltimore, MarylandDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandLaboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland§Department of Clinical and Experimental Medicine, Università di Ferrara, Ferrara, ItalyDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan.
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  • Stefano Volpato MD, MPH,

    1. From the *Clinical Research Branch, National Institute on Aging, Baltimore, MarylandDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandLaboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland§Department of Clinical and Experimental Medicine, Università di Ferrara, Ferrara, ItalyDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan.
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  • Jennifer Balfour PhD,

    1. From the *Clinical Research Branch, National Institute on Aging, Baltimore, MarylandDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandLaboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland§Department of Clinical and Experimental Medicine, Università di Ferrara, Ferrara, ItalyDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan.
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  • Linda P. Fried MD, MPH

    1. From the *Clinical Research Branch, National Institute on Aging, Baltimore, MarylandDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MarylandLaboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland§Department of Clinical and Experimental Medicine, Università di Ferrara, Ferrara, ItalyDepartment of Epidemiology, University of Michigan, Ann Arbor, Michigan.
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  • The Women's Health and Aging Study was supported by Contract NO1-AG-1–2112 from the National Institute on Aging.

Dr. Simonsick, National Institute on Aging/ASTRA, Harbor Hospital, 5th Floor, 3001 South Hanover Street, Baltimore, MD 21225. E-mail: simonsickel@grc.nia.nih.gov

Abstract

Objectives: To determine the association between volitional walking behavior and change in walking ability and lower extremity function over 1 year in functionally limited older women.

Design: Longitudinal cohort study.

Setting: Data were collected in participant's homes in Baltimore, Maryland.

Participants: One thousand two cognitively intact community-resident female Medicare beneficiaries aged 65 and older enrolled in the Women's Health and Aging Study.

Measurements: Reported walking behavior and change in reported walking difficulty, usual and rapid gait speed, and lower extremity physical performance score over 1 year.

Results: Of 800 functionally limited women who could walk unassisted at baseline and were alive and contacted 1 year later, 226 (28%) walked regularly, at least eight blocks per week. These women exhibited better health and functioning than nonwalkers (e.g., lower prevalence of depressive and fatigue symptoms and cardiovascular disease and higher mean ankle-arm index, forced expiratory volume in the first second, and gait speed). One year later, independent of initial functional status, social-psychological and behavioral factors, and health conditions, walkers were 1.8 times (95% confidence interval=1.2–2.7; P=.002) more likely to maintain reported walking ability and showed less decline in customary walking speed (0.009 m/s vs −0.070 m/s; P=.001) and functional performance score (−0.17 vs −0.73; P=.01) than women who walked less than eight blocks.

Conclusion: The strength, consistency, and specificity of the association between walking behavior and maintenance of mobility provide strong evidence that even a small amount of regular walking can confer short-term protection from further mobility loss in functionally limited women. The observation that most women capable of walking at least eight blocks per week were not doing so indicates the need to get more women “out the door” and to encourage those who walk a little to walk a little more.

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