Standing, Transition, and Walking Ability in Older Adults: The Case for Independently Evaluating Different Domains of Mobility Function

Background: Independent mobility is a complex behavior that relies on the ability to walk, maintain stability, and transition between postures. However, guidelines for assessment that details what elements of mobility to evaluate and how they should be measured remain unclear. Methods: Performance on tests of standing, sit-to-stand, and walking were evaluated in a cohort of 135 complex, comorbid, and older adults (mean age 87 ± 5.5 years). Correlational analysis was conducted to examine the degree of association for measures within and between mobility domains on a subset of participants (n = 83) able to complete all tasks unaided. Participants were also grouped by the presence of risk markers for frailty (gait speed and grip strength) to determine if the level of overall impairment impacted performance scores and if among those with risk markers, the degree of association was greater. Results: Within-domain relationships for sit-to-stand and walking were modest (rho = 0.01–0.60). Associations either did not exist or relationships were weak for measures reflecting different domains (rho = −0.35 to 0.25, p > 0.05). As expected, gait speed differed between those with and without frailty risk markers (p < 0.001); however, balance and sit-to-stand measures did not (p ≥ 0.05). Conclusions: This study highlights the need to independently evaluate different mobility domains within an individual as a standard assessment approach. Modest within-domain relationships emphasize the need to account for multiple, unique control challenges within more complex domains. These findings have important implications for standardized mobility assessment and targeted rehabilitation strategies for older adults.

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IMPLEMENTATION OF A COMMUNITY WALKING PROGRAM (WALK ON!) FOR FUNCTIONALLY-LIMITED OLDER ADULTS

Journal of Frailty & Aging ◽

10.14283/jfa.2020.12 ◽

2020 ◽

pp. 1-7

Author(s):

B.J. Nicklas ◽

E.A. Chmelo ◽

J. Sheedy ◽

J.B. Moore

Keyword(s):

Older Adults ◽

Focus Group ◽

Physical Function ◽

Gait Speed ◽

Assistive Device ◽

Walking Ability ◽

Mobility Limitations ◽

Long Distance ◽

Walking Program ◽

Usual Gait Speed

Background: Walking interventions improve physical function, reduce fall risk, and prevent mobility disability—even in those with compromised walking ability. However, most prior studies have been conducted in controlled research settings, with no dissemination of an evidence-based walking program for older adults who have mobility limitations and/or are socially isolated. Objectives: This study reports data on the feasibility and acceptability of a community-based walking program (Walk On!) for older adults who are functionally limited, and assesses changes in physical function among attendees. The program sessions focused on long-distance walking, and took place for one-hour, for two days/week, and for 12 weeks at a time. Design: Pilot implementation study. Setting: Local church in Winston-Salem, NC. Participants: 49 program participants; Measurements: Physical function battery and satisfaction survey data, as well as formative evaluation data from six attendees of a focus group, are reported. Results: The majority of the participants were >75 years (71%), female (65%), and presented with low levels of physical function (usual gait speed=0.79±0.16; 30.6% used an assistive device). Satisfaction with the program was high (100% would recommend it to others) and focus group results were overwhelmingly positive. Mean attendance to scheduled sessions was 77%±21%, and 63% of participants attended at least 75% of scheduled sessions (n=8 attended 100%). On average, participants improved their 6-min walk distance by 8.9%, their SPPB score by 15.4%, their timed-up-go time by 9.0%, and their usual gait speed by 11.4%. Conclusion: The results of the initial evaluation of Walk On! show high feasibility and acceptability of the program, as well as efficacy for improving physical function. Further research is needed to evaluate a delivery method for wider implementation of the program and to definitively test its effectiveness for improving function and other health benefits.

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Cross-sectional associations of housework with cognitive, physical and sensorimotor functions in younger and older community-dwelling adults: the Yishun Study

BMJ Open ◽

10.1136/bmjopen-2021-052557 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052557

Author(s):

Shuen Yee Lee ◽

Benedict Wei Jun Pang ◽

Lay Khoon Lau ◽

Khalid Abdul Jabbar ◽

Wei Ting Seah ◽

...

Keyword(s):

Older Adults ◽

Physical Function ◽

Gait Speed ◽

High Volume ◽

Community Dwelling ◽

Functional Health ◽

Attention And Memory ◽

Recreational Physical Activity ◽

Cross Sectional ◽

Sit To Stand

ObjectivesRegular moderate-to-vigorous intensity recreational physical activity (PA) improves physical and cognitive functions. However, the age-associated relationships between non-recreational PA and functional ability remain less explored. We examined the associations between housework and functional health among younger and older Singaporean community-dwelling adults.DesignCross-sectional study.Setting and participantsYounger (<65 years, n=249) and older (≥65 years, n=240) community-dwelling adults were randomly recruited from a large residential town in Singapore.Outcome measuresPhysical function was assessed using Short Physical Performance Battery (SPPB), repeated-chair-sit-to-stand and gait speed. Cognitive and sensorimotor functions were assessed using Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Physiological Profile Assessment (PPA), respectively.MethodsLight housework (LH) and heavy housework (HH), recreational, and occupational and transport-related PAs were assessed using PA questionnaires. Participants were dichotomised into low-volume and high-volume LH and HH groups. Results were adjusted for level of recreational and other non-recreational PAs.ResultsAmong older but not younger adults, RBANS scores were 8% and 5% higher in high HH and LH groups compared with low HH and LH groups, respectively (p=0.012 and p=0.016). Specifically, HH was associated with 14% higher attention score (p=0.014), and LH was associated with 12% and 8% higher immediate and delayed memory scores, respectively (p<0.001 and p=0.004). In older adults, sit-to-stand time and PPA scores were 8% and 23% lower in the high HH group than the low HH group, respectively (p=0.011 and p=0.040). SPPB and gait speed did not differ with age or HH. LH was not associated with physical or sensorimotor function.ConclusionsAmong older adults, housework is associated with higher cognitive function, specifically in attention and memory. Associations of housework with physical function and sensorimotor performance were intensity dependent. Housework PA is positively associated with functional health among community-dwelling older adults, independent of recreation and other non-recreational PAs. Further longitudinal and intervention studies are needed to establish causality.

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Fall prevention among older adults: Case reports exemplifying the value of incorporating lumbar stabilization training during balance exercises

South African Journal of Physiotherapy ◽

10.4102/sajp.v69i3.30 ◽

2013 ◽

Vol 69 (3) ◽

Author(s):

P. Van Der Merwe ◽

M.A. Wilmarth

Keyword(s):

Older Adults ◽

Gait Speed ◽

Fear Of Falling ◽

Case Reports ◽

Balance Training ◽

Cost Effective ◽

Sit To Stand ◽

Balance Exercise ◽

Balance Exercises ◽

Lumbar Stabilization

Background: Older adults are at risk of fallingeach year. Fall injuries results in many health care expenses anddisabilities, yet non-western countries lack the infra-structure andresources for prevention programs. Balance exercises have beenfound to be a cost effective evidence-based intervention in treatingand preventing falls among older adults in western countries.Purpose: The aim of this report was to show that lumbar stabilizationexercises are not only a beneficial addition to a balanceprogram for the prevention and treatment of falls in older adults,but to demonstrate that these exercise can more rapidly improve thefunctional status of older adults, limiting healthcare costs.Case description: Two high functional older adults with a historyof falls presented with poor balance and fear of falling. Both patientsreceived the same balance exercise regime however lumbar stabilization exercises were added to one of the patient’s exerciseprograms. Gait speed, lower extremity strength and balance were assessed with the Balance Evaluation systems test (BESTest),figure-of-eight, four-step-square (FSST), five-time-sit-to-stand tests (5TSTS) after two weeks and four weeks of treatment.Outcomes. All the outcome measures showed statistically significant improvements. Greater improvements in vertical stabilitylimits (14%), gait speed (9%), stability during gait (20%) and five-time-sit-to-stand test were seen with the addition of lumbarstabilization exercises.Discussion. The addition of lumbar stabilization exercises during balance training is of value to improve gait speed, balancetesting scores in stability in gait and vertical stability limits.

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Performance on sit-to-stand tests in relation to measures of functional fitness and sarcopenia diagnosis in community-dwelling older adults

European Review of Aging and Physical Activity ◽

10.1186/s11556-020-00255-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Xianyang Sherman Yee ◽

Yee Sien Ng ◽

John Carson Allen ◽

Aisyah Latib ◽

Ee Ling Tay ◽

...

Keyword(s):

Older Adults ◽

Grip Strength ◽

Muscle Mass ◽

Physical Performance ◽

Gait Speed ◽

Dynamic Balance ◽

Community Dwelling ◽

Sit To Stand ◽

Fitness Measures ◽

Community Dwelling Older Adults

Abstract Background The sit-to-stand (STS) test has been deployed as surrogate measures of strength or physical performance in sarcopenia diagnosis. This study examines the relationship of two common STS variants – Five Times Sit-to-Stand Test (5TSTS) and 30 s Chair Stand Test (30CST) – with grip strength, muscle mass and functional measures, and their impact on sarcopenia prevalence in community-dwelling older adults. Methods This is a cross-sectional analysis of 887 community-dwelling adults aged ≥50 years. Participants completed a battery of physical fitness tests - 5TSTS, 30CST, grip strength, gait speed, Timed-Up-and-Go (TUG) for dynamic balance and six-minute walk test (6MWT) for cardiorespiratory endurance. Muscle mass was measured using multi-frequency segmental bioelectrical impedance analysis (BIA). We performed correlation analysis between STS performance and other fitness measures and muscle mass, followed by multiple linear regression for the independent determinants of STS performance. Results Mean participant age was 67.3±7 years, with female predominance (72.9%). STS tests exhibited weak correlations with grip strength (30CST, r = 0.290; 5TSTS, r = − 0.242; both p< 0.01), and stronger correlations with gait speed (30CST, r = 0.517; 5TSTS, r = − 0.533; both p< 0.01), endurance (30CST, r = 0.558; 5TSTS, r = − 0.531; both p < 0.01) and dynamic balance (30CST, r = − 0.501; 5TSTS, r = 0.646; both p< 0.01). Muscle mass correlated with grip strength but not STS. In multiple regression analysis, all fitness measures were independently associated with 30CST performance. Performance in both STS tests remained independent of muscle mass. There was no significant difference in prevalence of possible sarcopenia diagnosis using grip strength or STS (30CST, 25.0%; 5TSTS, 22.1%; grip strength, 22.3%; p = 0.276). When both measures are used, prevalence is significantly higher (42.0%; p = 0.276). Prevalence of confirmed sarcopenia with inclusion of muscle mass was significantly lower using STS compared with grip strength (30CST, 4.6%; 5TSTS, 4.1% vs. grip strength, 7.1%; p< 0.05). Conclusion In the sarcopenia construct, STS tests better represents muscle physical performance rather than muscle strength. Different subsets of population with possible sarcopenia are identified depending on the test used. The lack of association of STS performance with muscle mass results in a lower prevalence of confirmed sarcopenia compared with grip strength, but may better reflect changes in muscle quality.

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Older Veterans With Chronic Pain Who Persist in Group Exercise Show Improved Mobility

Innovation in Aging ◽

10.1093/geroni/igaa057.2790 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 772-772

Author(s):

Odessa Addison ◽

Jamie Giffuni ◽

Megan Kelly ◽

Beth Hogans ◽

Leslie Katzel ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Chronic Pain ◽

Gait Speed ◽

Exercise Adherence ◽

Group Exercise ◽

Assessment Scores ◽

Mobility Assessment ◽

Program Attrition ◽

Lower Mobility

Abstract Approximately 50% of older adults receiving care at VA are Veterans with chronic pain (V-CP). While physical activity can reduce chronic pain and increase mobility, little is known about group exercise (GE) effects for V-CP. We hypothesized that attrition may limit GE effectiveness. In this study, we retrospectively compared program attrition and participant mobility at three-months of Gerofit GE. At baseline, Older V-CP (N=21) had lower mobility assessment scores (gait speed, 6MW, chair stands, TUG: 1.04 m/s, 443 yd, 11, 9.35s vs. 1.09 m/s, 463 yd, 12, 8.19s respectively) compared to unaffected Veterans. Three-month attrition was higher for older V-CP (54% vs 39%). For those completing three months GE, gains in mobility were similar. We conclude that Veterans with chronic pain are less likely to persist in group exercise but those who persist benefit much like those without pain. Further study is needed to understand successful exercise adherence.

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Serum levels of C-terminal telopeptide (CTX) are associated with muscle function in community-dwelling older adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glac008 ◽

2022 ◽

Author(s):

Ben Kirk ◽

Nicky Lieu ◽

Sara Vogrin ◽

Myrla Sales ◽

Julie A Pasco ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Muscle Function ◽

Type I Collagen ◽

Community Dwelling ◽

Type I ◽

Timed Up And Go ◽

Sit To Stand ◽

Diagnostic Power ◽

Community Dwelling Older Adults

Abstract Background Markers of bone metabolism have been associated with muscle mass and function. Whether serum cross-linked C-terminal telopeptides of type I collagen (CTX) is also associated with these measures in older adults remains unknown. Methods In community-dwelling older adults at high risk of falls and fractures, serum CTX (biochemical immunoassays) was used as the exposure, while appendicular lean mass (dual-energy x-ray absorptiometry) and muscle function (grip strength [hydraulic dynamometer], short physical performance battery [SPPB], gait speed, sit to stand, balance, Timed Up and Go [TUG]) were used as outcomes. Potential covariates including demographic, lifestyle and clinical factors were considered in statistical models. Areas under the ROC curves were calculated for significant outcomes. Results 299 older adults (median age: 79 years, IQR: 73, 84; 75.6% women) were included. In multivariable models, CTX was negatively associated with SPPB (β = 0.95, 95% CI: 0.92, 0.98) and balance (β = 0.92, 0.86, 0.99) scores, and positively associated with sit to stand (β = 1.02, 95% CI: 1.00, 1.05) and TUG (β = 1.03, 95% CI: 1.00, 1.05). Trend line for gait speed (β = 0.99, 95% CI: 0.98, 1.01) was in the hypothesized direction but did not reach significance. AUC curves showed low diagnostic power (<0.7) of CTX in identifying poor muscle function (SPPB: 0.63; sit to stand: 0.64; TUG: 0.61). Conclusion In older adults, higher CTX levels were associated with poorer lower-limb muscle function (but showed poor diagnostic power for these measures). These clinical data build on the biomedical link between bone and muscle.

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Prediction of Reduced Gait Speed Using 5-Time Sit-to-Stand Test in Healthy Older Adults

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2021.11.002 ◽

2021 ◽

Author(s):

Daniela Cristina Carvalho de Abreu ◽

Jaqueline Mello Porto ◽

Patricia Silva Tofani ◽

Roberta de Matos Brunelli Braghin ◽

Renato Campos Freire Junior

Keyword(s):

Older Adults ◽

Gait Speed ◽

Healthy Older Adults ◽

Stand Test ◽

Sit To Stand

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Weight management intervention identifies association of decreased DNA methylation age with improved functional age measures in older adults with obesity

Clinical Epigenetics ◽

10.1186/s13148-021-01031-7 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Curtis L. Petersen ◽

Brock C. Christensen ◽

John A. Batsis

Keyword(s):

Older Adults ◽

Dna Methylation ◽

Weight Loss ◽

Grip Strength ◽

Functional Ability ◽

Gait Speed ◽

Healthy Aging ◽

Biological Age ◽

Sit To Stand ◽

Dna Methylation Age

Abstract Background Assessing functional ability is an important component of understanding healthy aging. Objective measures of functional ability include grip strength, gait speed, sit-to-stand time, and 6-min walk distance. Using samples from a weight loss clinical trial in older adults with obesity, we examined the association between changes in physical function and DNA-methylation-based biological age at baseline and 12 weeks in 16 individuals. Peripheral blood DNA methylation was measured (pre/post) with the Illumina HumanMethylationEPIC array and the Hannum, Horvath, and PhenoAge DNA methylation age clocks were used. Linear regression models adjusted for chronological age and sex tested the relationship between DNA methylation age and grip strength, gait speed, sit-to-stand, and 6-min walk. Results Participant mean weight loss was 4.6 kg, and DNA methylation age decreased 0.8, 1.1, and 0.5 years using the Hannum, Horvath, and PhenoAge DNA methylation clocks respectively. Mean grip strength increased 3.2 kg. Decreased Hannum methylation age was significantly associated with increased grip strength (β = −0.30, p = 0.04), and increased gait speed (β = 0.02, p = 0.05), in adjusted models. Similarly, decreased methylation age using the PhenoAge clock was associated with significantly increased gait speed (β = 0.02, p = 0.04). A decrease in Horvath DNA methylation age and increase in physical functional ability did not demonstrate a significant association. Conclusions The observed relationship between increased physical functional ability and decreased biological age using DNA methylation clocks demonstrate the potential utility of DNA methylation clocks to assess interventional approaches to improve health in older obese adults. Trial registration: National Institute on Aging (NIA), NCT03104192. Posted April 7, 2017, https://clinicaltrials.gov/ct2/show/NCT03104192

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Talk or Walk? Gait Speed over Self-Report in Association with Cognitive Speed in Healthy Older Adults

GeroPsych ◽

10.1024/1662-9647/a000202 ◽

2019 ◽

Vol 32 (1) ◽

pp. 41-52

Author(s):

Matthew C. Costello ◽

Shane J. Sizemore ◽

Kimberly E. O’Brien ◽

Lydia K. Manning

Keyword(s):

Older Adults ◽

Older Adult ◽

Gait Speed ◽

Well Being ◽

Self Report ◽

Subjective Report ◽

Healthy Older Adults ◽

Relative Value ◽

Cognitive Speed ◽

Age Range

Abstract. This study explores the relative value of both subjectively reported cognitive speed and gait speed in association with objectively derived cognitive speed. It also explores how these factors are affected by psychological and physical well-being. A group of 90 cognitively healthy older adults ( M = 73.38, SD = 8.06 years, range = 60–89 years) were tested in a three-task cognitive battery to determine objective cognitive speed as well as measures of gait speed, well-being, and subjective cognitive speed. Analyses indicated that gait speed was associated with objective cognitive speed to a greater degree than was subjective report, the latter being more closely related to well-being than to objective cognitive speed. These results were largely invariant across the 30-year age range of our older adult sample.

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Combining tDCS With a Motor-Cognitive Task to Reduce the Negative Impact of Dual-Tasking on the Gait of Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.921 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 287-288

Author(s):

Jeffrey Hausdorff ◽

Nofar Schneider ◽

Marina Brozgol ◽

Pablo Cornejo Thumm ◽

Nir Giladi ◽

...

Keyword(s):

Older Adults ◽

Virtual Reality ◽

Executive Function ◽

Dual Task ◽

Gait Speed ◽

Negative Impact ◽

Virtual Reality Environment ◽

Dual Tasking ◽

Concurrent Performance ◽

Dual Task Cost

Abstract The simultaneous performance of a secondary task while walking (i.e., dual tasking) increases motor-cognitive interference and fall risk in older adults. Combining transcranial direct current stimulation (tDCS) with the concurrent performance of a task that putatively involves the same brain networks targeted by the tDCS may reduce the negative impact of dual-tasking on walking. We examined whether tDCS applied while walking reduces the dual-task costs to gait and whether this combination is better than tDCS alone or walking alone (with sham stimulation). In 25 healthy older adults (aged 75.7±10.5yrs), a double-blind, within-subject, cross-over pilot study evaluated the acute after-effects of 20 minutes of tDCS targeting the primary motor cortex and the dorsal lateral pre frontal cortex during three separate sessions:1) tDCS while walking on a treadmill in a virtual-reality environment (tDCS+walking), 2) tDCS while seated (tDCS+seated), and 3) walking in the virtual-reality environment with sham tDCS (sham+walking). The complex walking condition taxed motor and cognitive abilities. During each session, single- and dual-task walking and cognitive function were assessed before and immediately after stimulation. Compared to pre-tDCS performance, tDCS+walking reduced the dual-task cost to gait speed (p=0.004) and other gait features (e.g., variability p=0.02), and improved (p<0.001) executive function (Stroop interference score). tDCS+seated and sham+walking did not affect the dual-task cost to gait speed (p>0.17). These initial findings demonstrate that tDCS delivered during challenging walking ameliorates dual-task gait and executive function in older adults, suggesting that the concurrent performance of related tasks enhances the efficacy of the neural stimulation and mobility.

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