Prognostic Value of Usual Gait Speed in Well-Functioning Older People—Results from the Health, Aging and Body Composition Study

Authors

  • Matteo Cesari MD, PhD,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Stephen B. Kritchevsky PhD,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Brenda W. H. J. Penninx PhD,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Barbara J. Nicklas PhD,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Eleanor M. Simonsick PhD,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Anne B. Newman MD, MPH,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Frances A. Tylavsky DrPH,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Jennifer S. Brach PT, PhD, GCS,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Suzanne Satterfield MD, DrPH,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Douglas C. Bauer MD,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Marjolein Visser PhD,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Susan M. Rubin MPH,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Tamara B. Harris MD, MS,

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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  • Marco Pahor MD

    1. From the *Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FloridaSticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North CarolinaDepartment of Psychiatry§Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the NetherlandsIntramural Research Program, National Institute on Aging, Baltimore, Maryland; Departments of Medicine#Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania**Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee††Department of Medicine, University of California at San Francisco, San Francisco, California‡‡Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, Maryland.
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Address correspondence to Matteo Cesari, MD, PhD, Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, 1329 SW 16th Street, Room 5273, Gainesville, FL 32608. E-mail: mcesari@aging.ufl.edu

Abstract

Objectives: To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons.

Design: Prospective cohort study.

Setting: Health, Aging and Body Composition Study.

Participants: Three thousand 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 randomly divided into two groups to identify (Sample A; n=2,031) and then validate (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 (≥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 graded 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 clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.

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