Associations between locomotive and non-locomotive physical activity and physical performance in older community-dwelling females with and without locomotive syndrome: a cross-sectional study

Background Locomotive syndrome (LS) is a condition of reduced mobility due to a disorder of the locomotive system. Increasing moderate to vigorous physical activity (MVPA) has been recommended to prevent LS. However, to increase daily MVPA is difficult for older people with LS. The MVPA consists of not only locomotive activities such as walking but also non-locomotive activities such as household activities. The aim of this study was to examine the associations between locomotive/non-locomotive MVPA and physical performance in older females with and without LS. Methods Participants of this cross-sectional study were 143 older community-dwelling Japanese females. The participants were divided into two groups based on the results of the stand-up test: the normal group (NL) (n = 86) and the LS group (n = 57). Both the locomotive and non-locomotive PA seperately measured with its intensity. The intensity of physical activity (PA) was calculated as METs and classified as sedentary behavior (SB 1–1.5 metabolic equivalent tasks (METs)), low-intensity physical activity (LPA 1.6–2.9 METs), and MVPA (≥ 3 METs). For example, locomotive LPA is slow walking speed of 54 m/min, and locomotive MVPA is walking speed of 67 m/min. While non-locomotive LPA is office work and cooking, non-locomotive MVPA is housecleaning. Physical function was evaluated by handgrip strength, walking speed, and 2-step test. Results Walking speed, hand-grip strength, 2-step test, daily step counts, and all PA measurements were not significantly different between two groups. In the LS, locomotive MVPA (r = 0.293, p < 0.05) and total MVPA (r = 0.299, p < 0.05) was significantly correlated with walking speed, but not in the NL. Conclusions Walking speed was positively correlated with locomotive MVPA and total MVPA in the LS group, but not in NL group. This result suggests that slow walking speed in older people with LS occur in connection with lower locomotive MVPA and total MVPA.

A study of the accuracy of the Fitbit Zip in measuring steps both indoors and outdoors in a mixed rehabilitation population

Objective: To assess (1) step count accuracy of the Fitbit Zip, compared to manual step count, in people receiving outpatient rehabilitation, in indoor and outdoor conditions, and (2) impact of slow walking speed on Fitbit accuracy. Design: Observational study. Setting: A metropolitan rehabilitation hospital. Subjects: Adults ( n = 88) attending a subacute rehabilitation outpatient clinic with walking speeds of between 0.4 and 1.0 m/s. Interventions: Two 2-minute walk tests, one indoors and one outdoors, completed in random order. Main measures: Step count recorded manually by observation and by a Fitbit Zip, attached to the shoe on the dominant or non-affected side. Subgroup analysis included assessment accuracy for those considered limited community walkers (slower than 0.8 m/s) and those considered community walkers (faster than 0.8 m/s). Results: The Fitbit significantly ( P < 0.05) undercounted steps compared to manual step count, indoors and outdoors, with percentage agreement slightly higher outdoors (mean 92.4%) than indoors (90.1%). Overall, there was excellent consistent agreement between the Fitbit and manual step count for both indoor (ICC 0.83) and outdoor (ICC 0.88) walks. The accuracy of the Fitbit was significantly ( P < 0.05) reduced in those who walked slower than 0.8 m/s outdoors (ICC 0.80) compared to those who walk faster than 0.8 m/s (ICC 0.90). Conclusions: The Fitbit Zip shows high step count accuracy with manual step count in a mixed subacute rehabilitation population. However, accuracy is affected by walking speed, with decreased accuracy in limited community walkers.

Using hand grip strength to detect slow walking speed in older adults: the Yilan study

Background Walking speed is an important health indicator in older adults, although its measurement can be challenging because of the functional decline due to aging and limited environment. The aim of this study was to examine whether hand grip strength can be a useful proxy for detecting slow walking speed in this population. Methods A cross-sectional study was conducted using the cohort from the Yilan Study in Taiwan. Community-dwelling older adults aged 65 years and older were included. Slow walking speed was defined as a 6-meter walking speed < 1.0 m/s, according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Stepwise multiple linear regression was used to determine the most significant variables associated with walking speed. Receiver operating characteristic analysis was used to determine the optimal cutoff values for hand grip strength in detecting slow walking speed. Results A total of 301 participants with an average age of 73.9 ± 6.8 years were included; 55.1 % participants were women. In stepwise multiple linear regression analysis that included various variables, hand grip strength was found to be the most explainable factor associated with walking speed among all participants and among participants of each sex. The optimal cutoff values for hand grip strength in the detection of slow walking speed were 19.73 kg for all participants (sensitivity: 55 %, specificity: 83 %, area under the curve: 0.74, accuracy: 66.9 %), 35.10 kg for men (sensitivity: 92 %, specificity: 42 %, area under the curve: 0.70, accuracy: 66.4 %), and 17.93 kg for women (sensitivity: 62 %, specificity: 80 %, area under the curve: 0.76, accuracy: 67.9 %). Conclusions Hand grip strength was found to be a useful proxy for the identification of slow walking speed in older adults.

Identification of Disability Risk in Addition to Slow Walking Speed in Older Adults

<b><i>Introduction:</i></b> A cutoff speed of 1.0 m/s for walking at a comfortable pace is critical for predicting future functional decline. However, some older adults with walking speeds below the cutoff point maintain an independent living. We aimed to identify specific predictors of disability development in older adults with slow walking speeds in contrast to those with a normal walking speed. <b><i>Methods:</i></b> This prospective cohort study on 12,046 community-dwelling independent Japanese older adults (mean age, 73.6 ± 5.4 years) was conducted between 2011 and 2015. Participants were classified into slow walking speed (comfortable walking speed slower than 1.0 m/s) and normal walking speed (speed of 1.0 m/s or faster) groups and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional hazards regression models were used to identify predictors of disability development in the slow and normal walking groups. <b><i>Results:</i></b> Overall, 26.8% of participants had a slow walking speed. At follow-up, 17.3% and 5.1% of participants in the slow and normal walking groups, respectively, developed disability (<i>p</i> &#x3c; 0.01). Cox regression models revealed that age (hazard ratio 1.07, 95% confidence interval 1.05–1.09), walking speed (0.12, 0.07–0.22), grip strength (0.97, 0.95–0.99), Parkinson’s disease (4.65, 2.59–8.33), word list memory-immediate recognition score (0.90, 0.85–0.97), word list memory-delayed recall score (0.94, 0.89–1.00), Symbol Digit Substitution Test (SDST) score (0.98, 0.96–0.99), and 15-item Geriatric Depression Scale (GDS) score (1.04, 1.01–1.07) were significantly associated with disability incidence in the slow walking group. In the normal walking group, age, grip strength, depression, diabetes, cognition, GDS score, and reduced participation in outdoor activity were significantly associated with disability incidence; however, there was no significant association with walking speed. <b><i>Conclusions:</i></b> Decreased walking speeds have considerably greater impact on disability development in older adults with a slow walking speed than in those with a normal walking speed. Health-care providers should explore modifiable factors for reducing walking speed; they should also encourage improvement of risk factors such as muscle weakness and depression to reduce disability risk in older adults with slow walking speeds.

What cut-point in gait speed best discriminates community dwelling older adults with mobility complaints from those without? A pooled analysis from the Sarcopenia Definitions and Outcomes Consortium

Background Cut-points to define slow walking speed have largely been derived from expert opinion. Methods Study participants (13,589 men and 5,043 women aged ≥65years) had walking speed (m/s) measured over 4-6 meters (mean ± SD: 1.20 ± 0.27 m/s in men and 0.94 ± 0.24 m/s in women.) Mobility limitation was defined as self-reported any difficulty with walking ~1/4 mile (prevalence: 12.6% men, 26.4% women). Sex-stratified classification and regression tree (CART) models with 10-fold cross-validation identified walking speed cut-points that optimally discriminated those who reported mobility limitation from those who did not. Results Among 5,043 women, CART analysis identified two cut-points, classifying 4,144 (82.2%) with walking speed ≥0.75 m/s, which we labeled as “fast”; 478 (9.5%) as “intermediate” (walking speed ≥0.62 m/s but &lt;0.75 m/s); and 421 (8.3%) as “slow” (walking speed &lt;0.62 m/s). Among 13,589 men, CART analysis identified three cut-points, classifying 10,001 (73.6%) with walking speed ≥1.00 m/s (“very fast”); 2,901 (21.3%) as “fast” (walking speed ≥0.74 m/s but &lt;1.00 m/s); 497 (3.7%) as “intermediate” (walking speed ≥0.57 m/s but &lt;0.74 m/s); and 190 (1.4%) as “slow” (walking speed &lt;0.57 m/s). Prevalence of self-reported mobility limitation was lowest in the “fast” or “very fast” (11% for men and 19% for women) and highest in the “slow” (60.5% in men and 71.0% in women). Rounding the two slower cut-points to 0.60 m/s and 0.75 m/s reclassified very few participants. Conclusions Cut-points in walking speed of ~0.60 m/s and 0.75 m/s discriminate those with self-reported mobility limitation from those without.

84 COVID-19 and Associations with Frailty and Multimorbidity: A Prospective Analysis of UK Biobank Participants

Introduction Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. We therefore investigated whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19 in the UK Biobank. Method 502,640 participants aged 40–69 years at baseline (54–79 years at COVID-19 testing) were recruited across UK 2006–10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available 16/03/2020–01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. Results 4,510 participants were tested for COVID-19 (positive = 1,326, negative = 3,184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥4 comorbidity groupings vs 0–1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. Furthermore, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. Conclusions Frailty and multimorbidity do not appear to aid risk stratification, in terms of a positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.

The Association of Vision, Hearing, and Dual-Sensory Loss with Walking Speed and Incident Slow Walking: Longitudinal and Time to Event Analyses in the Health and Retirement Study

With the aging of the population, vision (VL), hearing (HL), and dual-sensory (DSL, concurrent VL and HL) loss will likely constitute important public health challenges. Walking speed is an indicator of functional status and is associated with mortality. Using the Health and Retirement Study, a nationally representative U.S. cohort, we analyzed the longitudinal relationship between sensory loss and walking speed. In multivariable mixed effects linear models, baseline walking speed was slower by 0.05 m/s (95% confidence interval [CI] = 0.04–0.07) for VL, 0.02 (95% CI = 0.003–0.03) for HL, and 0.07 (95% CI = 0.05–0.08) for DSL compared with those without sensory loss. Similar annual declines in walking speeds occurred in all groups. In time-to-event analyses, the risk of incident slow walking speed (walking speed < 0.6 m/s) was 43% (95% CI = 25–65%), 29% (95% CI = 13–48%), and 35% (95% CI = 13–61%) higher among those with VL, HL, and DSL respectively, relative to those without sensory loss. The risk of incident very slow walking speed (walking speed < 0.4 m/s) was significantly higher among those with HL and DSL relative to those without sensory loss, and significantly higher among those with DSL relative to those with VL or HL alone. Addressing sensory loss and teaching compensatory strategies may help mitigate the effect of sensory loss on walking speed.

COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants

Frailty and multimorbidity, which are more prevalent in older people, have been suggested as risk factors for severe COVID-19 disease. We investigated whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19 in the UK Biobank. 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK 2006-10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. 4,510 participants were tested for COVID-19 (positive=1,326, negative=3,184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR=1.4 [95%CI=1.1, 1.8]), report slow walking speed (OR=1.3 [1.1, 1.6]), report two or more falls in the past year (OR=1.3 [1.0, 1.5]) and be multimorbid (≥4 comorbidity groupings vs 0-1: OR=1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. Furthermore, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. In conclusion, frailty and multimorbidity do not appear to aid risk stratification, in terms of a positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.

Motoric cognitive risk syndrome and incident dementia in older adults from the Québec NuAge cohort

Background The co-occurrence of slow walking speed and subjective cognitive complaint (SCC) in non-demented individuals defines motoric cognitive risk syndrome (MCR), which is a pre-dementia stage. There is no information on the association between MCR and incident dementia in Québec’s older population. Objective The study aims to examine the association of MCR and its individual components (i.e. SCC and slow walking speed) with incident dementia in community-dwelling older adults living in the province of Québec (Canada). Design Québec older people population-based observational cohort study with 3 years of follow-up. Setting Community dwellings. Subjects A subset of participants (n = 1,098) in ‘Nutrition as a determinant of successful aging: The Québec longitudinal study’ (NuAge). Methods At baseline, participants with MCR were identified. Incident dementia was measured at annual follow-up visits using the Modified Mini-Mental State (≤79/100) test and Instrumental Activity Daily Living scale (≤6/8) score values. Results The prevalence of MCR was 4.2% at baseline and the overall incidence of dementia was 3.6%. MCR (Hazard Ratio (HR) = 5.18, with 95% confidence interval (CI) = [2.43–11.03] and P ≤ 0.001) and SCC alone (HR = 2.54, with 95% CI = [1.33–4.85] and P = 0.005) were associated with incident dementia, but slow walking speed was not (HR = 0.81, with 95%CI = [0.25–2.63] and P = 0.736). Conclusions MCR and SCC are associated with incident dementia in NuAge study participants.

Does the 1-year Decline in Walking Speed Predict Mortality Risk Beyond Current Walking Speed in Adults With Knee Osteoarthritis?

Objective To investigate whether walking speed at 1 timepoint, decline over the past 12 months, or both predict mortality risk over 11 years in adults with, or at risk of, knee osteoarthritis (OA). Methods Using the data from the Osteoarthritis Initiative, we defined slow versus adequate walking speed as walking < 1.22 versus ≥ 1.22 m/s on a 20m walk test during the 12-month follow-up visit. We defined meaningful decline (yes/no) as slowing ≥ 0.08 m/s over the past year. At the 12-month visit, we classified adequate sustainers as those with adequate walking speed and no meaningful decline, slow sustainers as slow walking speed and no meaningful decline, adequate decliners as adequate walking speed and meaningful decline, and slow decliners as slow walking speed and meaningful decline. Mortality was recorded over 11 years. To examine the association of walking speed with mortality, HR and 95% CI were calculated using Cox regression, adjusted for potential confounders. Results Of 4229 participants in the analytic sample (58% female, age 62 ± 9 yrs, BMI 29 ± 5 kg/m2), 6% (n = 270) died over 11 years. Slow sustainers and slow decliners had 2-times increased mortality risk compared to adequate sustainers (HR 1.96, 95% CI 1.44–2.66 for slow sustainers, and HR 2.08, 95% CI 1.46–2.96 for slow decliners). Adequate decliners had 0.43 times the mortality risk compared with adequate sustainers (HR 0.57, 95% CI 0.32–1.01). Conclusion In adults with, or at risk of, knee OA, walking slower than 1.22 m/s in the present increased mortality risk, regardless of decline over the previous year.