Comfortable and maximum walking speed of adults aged years: reference values and determinants

Transcription

1 Age and Ageing 1997; 26: Comfortable and maximum walking peed of adult aged year: reference value and determinant RICHAR W. BOHAO School of Allied Hearth, U-101, Univerity of Connecticut Storr, CT 06269, USA and epartment of Rehabilitation, Hartford Hopital, Hartford, CT USA Fax (+1) Abtract Objective: to etablih reference value for both comfortable and maximum gait peed and to decribe the reliability of the gait peed meaure and the correlation of elected variable with them. eign: decriptive and cro-ectional. Method: ubject were 230 healthy volunteer. Gait wa timed over a 7.62 m expane of floor. Actual and height normalized peed were determined. Lower extremity mucle trength wa meaured with a hand-held dynamometer. Reult: mean comfortable gait peed ranged from cm/ for women in their eventie to cm/ for men in their fortie. Mean maximum gait peed ranged from cm/ for women in their eventie to cm/ for men in their twentie. Both gait peed meaure were reliable (coefficient > 0.903) and correlated ignificantly with age (r^ 0.210), height (r^ 0.220) and the trength of four meaured lower extremity mucle action (r = ). The mucle action trength mot trongly correlated with gait peed were nondominant hip abduction (comfortable peed) and knee extenion (maximum peed). Concluion: thee normative value hould give clinician a reference againt which patient performance can be compared in a variety of etting. Gait peed can be expected to be reduced in individual of greater age and of leer height and lower extremity mucle trength. Keyword: gait meaurement, mucle trength Introduction For mot individual, independent functioning in the community preuppoe the ability to walk. It hould not be urpriing, therefore, that urvey of patient or the familie of patient participating in rehabilitation how them to conider walking a a high priority [ 1-3]. Although there are many apect of walking on which the clinician might focu, peed ha often been recommended for ue a a meaure of tatu and outcome [3-6]. Given the objectivity of peed and it importance to afe ambulation in the community [7-9], uch a recommendation i undertandable. If the clinician i to make judgement about the normality of a patient' peed, reference value are required for comparion. Some reference value have been publihed [10-15]. The applicability of available value, however, may be limited for reaon outlined recently [15]. The primary purpoe of thi tudy wa to provide reference value for comfortable and maximum gait peed for individual of year of age. I have alo aeed the intra-eion reliability of the gait peed meaure and determined the correlation of elected variable with the gait peed meaure. Material and method Following the proviion of written informed conent, 230 apparently healthy individual between 20 and 79 year of age participated in thi decriptive, croectional tudy. Prior to teting, all ubject claimed no known neuromucular, muculokeletal, or cardiovacular pathology affecting their ambulatory capacity and were able to walk at leat 30 m without aitance or the ue of a device. The age, ex, height and weight of each ubject wa documented (Table 1). Subject elfrated their work and leiure activity uing the fourlevel ordinal cale (1-4) of Saltin and Grimby [16]. The modal and median level of activity for the ubject wa 2. ownloaded from at Pennylvania State Univerity on February 27,

2 R. W. Bohannon Table I. Characteritic of ubject, orted by decade of age and ex ecade Sex(n) F(22) M(15) F(23) M(13) F(21) M(22) F(21) M(22) F(18) M(18) F(20) M(22) Age (year) Weight (kg) F, female; M, male;, mean;, tandard deviation. Height (cm) A digital topwatch wa ued to time ubject a they walked over a 7.62 m (25 foot) expane of floor. Lower extremity mucle trength wa meaured with an Ametek Accuforce Force Gauge (Ametek, Largo, FL, USA). The accuracy of the dynamometer wa verified periodically by vertical loading with certified weight. Comfortable and maximum gait peed were both meaured twice. Subject were provided with everal meter to accelerate and decelerate before and after the tet ditance. For the comfortable peed walking trial they were intructed to walk at their normal comfortable (natural) peed. For the maximum peed walking trial they were aked to walk a fat a they could afely without running. The iometric trength of four lower extremity mucle action (hip flexion, hip abduction, knee extenion and ankle doriflexion) wa meaured twice on each ide by a ingle teter uing a method decribed thoroughly elewhere [17]. The four action were meaured in the middle portion of their range with gravity leened or eliminated. The hip and ankle action were teted with Table 2. ecriptive tatitic ummarizing hand-held dynamometer meaurement of lower extremity mucle trength Mucle action Hip flexion Hip abduction Ankle doriflexion Knee extenion Side Force () Range ubject upine; knee extenion wa teted with ubject itting. A thereliabilityof the trength meaure ha been confirmed elewhere [17], only the peak force (in ewton) of the firt trial wa ued to characterize the trength of each mucle action. The Sytat tatitical program wa ued to perform decriptive and inferential analye [18]. Intracla correlation coefficient (equation 3,1) were ued to tet the intra-eion reliability of the gait peed meaure. eterminant of gait peed were examined uing Pearon product moment correlation, Spearman correlation and multiple regreion a appropriate. A multifactorial mixed model analyi of variance wa alo ued. Reult The gait peed meaure were found to be highly reliable. The coefficient were and for comfortable and maximum peed, repectively. Conequently, the reult of the firt trial are ued excluively in all ubequent analyi. A ummary of the lower extremity mucle trength meaurement i preented by action and ide in Table 2. Correlational analyi (Table 3) howed age, height and all mucle action trength to correlate ignificantly (P < 0.05) with both comfortable (r = ) and maximum (r = ) gait peed. For maximum gait peed, ex alo wa correlated ignificantly (r = 0.161). either leiure activity nor work activity correlated ignificantly with either gait peed meaure (r, = ). Regreion Table 3. Pearon correlation between gait peed and independent variable (n = 230) Independent variable Sex Age Weight Height Gait peed Comfortable r Ankle doriflexion trength Knee extenion trength Hipflexiontrengdi Hip abduction trength (0.236) (0.289) (0.002) (0.004) (0.002) Maximum r (P) (0.014) (0.181) ownloaded from at Pennylvania State Univerity on February 27, 2014, nondominant;, dominant;, mean;, tandard deviation., nondominant ide;, dominant ide. 16

3 Walking peed reference value Table 4. Mean () and tandard deviation () of comfortable and maximum gait peed preented by ex and decade of age Sex/decade Men Women Comfortable gait peed (cm/) Actual * actual peed (cm/)/height (cm) Height-normalized* analyi demontrated that weight, height, ex and nondominant hip abduction trength offered the bet overall explanation of comfortable gait peed (r = 0.360, r 2 = 0.129). Regreion analyi revealed that age, height, weight and nondominant knee extenion trength provided the bet overall explanation of maximum gait peed (r = 0.643, r 2 = 0.414). Baed on the reult of the correlational and regreion analyi, reference value for actual gait peed were determined for each ex and decade eparately. Actual gait peed and height-normalized 300 ECAE OF AGE Figure I. Mean maximum (broken line) and comfortable (olid line) gait peed of 230 ubject preented by decade of age Maximum gait peed (cm/) Actual Height-normalized* gait peed [actual peed (cm/)/height (cm)] are ummarized in Table 4. The mixed model analyi of variance howed a ignificant effect of condition (comfortable veru maximum) on peed (F YT5&9V, P ), a ignificant effect of decade of age on peed (F = , P ) and a ignificant interactive effect of condition and decade of age on peed (F , P = 0.000). The interaction reflect the greater rate of decline in maximum peed gait compared with comfortable peed gait with increaed decade of age. The interactive effect of gait meaurement condition (comfortable v maximum) and decade of age are illutrated in Figure 1. icuion The reference value for gait peed preented in thi tudy are not the firt publihed [10-15]. The value are, however, more comprehenive than mot a they include both actual and height-normalized decription of both comfortable and maximum gait peed. Moreover, the value preented in thi paper were obtained uing procedure that are applicable in a variety of etting. Conequently, the performance of individual teted in uch etting, uing the method decribed herein, can be compared with the value preented in Table 4. The reliability of the gait peed meaure of thi tudy and the general comparability of the comfortable peed meaure with previouly reported meaure [10-15] provide further upport for the value of the reported meaure. For mot clinical application the actual meaure of gait peed reported ownloaded from at Pennylvania State Univerity on February 27,

4 R. W. Bohannon in thi paper are probably ufficient for reference. Given the relationhip of height and gait peed and the etablihed uefulne of height for reducing interindividual variability in gait peed [19, 20], ome clinician may wih to determine an individual' height and ue it to normalize gait peed before conulting reference value and making judgement about the normality of that individual' performance. The identification of determinant of gait peed erve everal purpoe. One i to provide an appropriate framework for preenting reference value. The eparate proviion of reference value normalized againt height i one example of uch a ue. Alo relevant to thi tudy i the preentation of value by ex and decade of age. The preentation of reference value for both the comfortable and maximum peed condition i another. Another reaon for identifying determinant i to find variable which, if altered, may reult in the alteration of another variable of interet. Although correlation do not prove caue and effect, they do provide an explanation of patient performance and indicate target for potentially fruitful intervention. In thi tudy, a in everal tudie of apparently healthy individual previouly publihed [10,11,15], mucle trength meaure repreent uch variable. ot only did all meaured mucle action trength correlate ignificantly with both gait peed, but the trength of a pecific action added ignificantly to the explanation of gait peed offered by other non-trength variable. Conequently, trength doe not appear to be a mere puriou covariate. Thi fact notwithtanding, no ingle mucle action trength explained more than 25% of the variance in gait peed. Conequently, mucle trength hould not receive an exceive emphai if the intention of a therapeutic intervention i to increae gait peed. The higher correlation between mucle trength and gait peed among patient with weakne [21-23] and evidence that trengthening regimen are ometime accompanied by increae in gait peed [24, 25], on the other hand, ugget that the importance of mucle trength hould not be diregarded. Concluion Reference value for both comfortable and maximum gait peed are preented which clinician can ue a a bai for judgement about patient performance. Age, height and lower extremity mucle trength were correlated ignificantly with both comfortable and maximum peed but the influence of the variable on maximum peed wa greater. Thee correlation have relevance to the interpretation of gait peed meaurement and the election of potentially fruitful target for therapeutic intervention. Key point Gait peed meaure obtained during a ingle tet eion are reliable. Gait peed decreae with increaed age. Maximum gait peed decline more teeply than comfortable gait peed with increaing age. Abolute and height normalized gait peed value provided herein can erve a a bai for judgement about patient walking performance. Reference 1. Bohannon RW, Andrew AW, Smith MB. Rehabilitation goal of patient with hemiplegia. Int J Rehabil Re 1988; 11: Mumma CM. Perceived loe following troke. Rehabilitation uring 1986; 11: elon P, Hughe S, Virjee S, Bereford H, Murray C, Waton E, Sandercock P. Walking peed a a meaure of diability. Care Elderly 1991; 3: Pincu T, Callahan LF, Vaughn WK. Quetionnaire, walking time and button tet meaure of functional capacity a predictive marker for mortality in rheumatoid arthriti. J Rheumatoid 1987; 14: Boontra AM, Fidler V, Eima WH. Walking peed of normal ubject and amputee: apect of validity of gait analyi. Prothet Orthot Intern 1993; 17: Friedman PJ, Richmond E, Bakett JJ. A propective trial of erial gait peed a a meaure of rehabilitation in the elderty. Age Ageing 1988; 17: Cohen JJ, Sveen J, Walker JM, Brummel-Smith K. Etablihed criteria for community ambulation. Topic Geriatric Rehabil 1987; 3: Robinett CS, Vondran MA. Functional ambulation velocity and ditance requirement in rural and urban communitie. Phy Ther 1988; 68: Finlay O. Exercie training and walking peed in elderly women following hip urgery 'beating the little green man.' Phyiotherapy 1993; 79: Baey EJ, Bendall MJ, Pearon M. Mucle trength in the tricep urae and objectively meaured cutomary walking activity in men and women over 65 year of age. Clin Sci 1988; 74: Cunningham A, Rechnitzer PA, Pearce ME, onner AP. eterminant of elf-elected walking pace acro age 19 to 66. J Gerontol 1982; 37: obb RJ, Charlett A, Bowe SG, O'eUl CJA Weller C, Hughe Jet a/. I thi walk normal? Age Ageing 1993; 22: Hinmann JE, Cunningham A, Rechnitzcr PA, Pateron H. Age related change in peed of walking. Med Sci Sport Exerc 1988; 20: Oberg T, Karznia A, Oberg K. Baic gait parameter: reference data for normal ubject, year of age. J Rehabil Re 1993; 30: ownloaded from at Pennylvania State Univerity on February 27,

5 Walking peed reference value 15. Bohannon RW, Andrew AW, Thoma MW. Walking peed: reference value and correlate for older adult. J Orthop Sport Phy Thcr 1996; 24: Saltin B, Grimby G. Phyiological analyi of middleaged and former athlete. Circulation 1968; 38: Andrew AW, Thoma MW, Bohannon RW. ormative value for iometric mucle force meaurement obtained with hand-held dynamometer. Phy Ther 1996; 76: Wilkinon L. Sytat. The Sytem for Statitic. Evanton, H, USA. Sytat Inc, Grieve W, Gear RJ. The relationhip between length of tride, tep frequency, time of wing and peed of walking for children and adult. Ergonomic 1966; 5: Roenrot P, Wall JC, Charteri J. The relationhip between velocity, tride time, upport time and wing time during normal walking. J Hum Movement Studie 1980; 6: Water RL, Yakura JS, Adkin R, Barne G. eterminant of gait performance following pinal cord injury. Arch Phy Med Rehabil 1989; 70: Perry J, Mulroy SJ, Renwick SE. The relationhip of lower extremity trength and gait parameter in patient with pot-polio yndrome. Arch Phy Med Rehabil 1993; 74: Bohannon RW. Selected determinant of ambulatory capacity in patient with hemiplegia. Clin Rehabil 1989; 3: Fiatraone MA, Mark EC, Ryan, Meredith C, Iipitz LA, Evan WJ. High intenity trength training in nonagenarian. JAMA 1990; 263: Judge JO, Underwood M, Gennoa T. Exercie to improve gait velocity in older peron. Arch Phy Med Rehabil 1993; 74: Received in revied form 18 September 1996 ownloaded from at Pennylvania State Univerity on February 27,

6 aiy Hanen, age 92 with her wedding photograph. Photograph: Ian Beeley. ownloaded from at Pennylvania State Univerity on February 27, 2014