Associations Between Potentially Modifiable and Nonmodifiable Risk Factors and Gait Speed in Middle- and Older-Aged Adults: Results From the Canadian Longitudinal Study on Aging

Erica Figgins, Yun-Hee Choi, Mark Speechley, Manuel Montero-Odasso, Erica Figgins, Yun-Hee Choi, Mark Speechley, Manuel Montero-Odasso

Abstract

Background: Gait speed is a strong predictor of morbidity and mortality in older adults. Understanding the factors associated with gait speed and the associated adverse outcomes will inform mitigation strategies. We assessed the potentially modifiable and nonmodifiable factors associated with gait speed in a large national cohort of middle and older-aged Canadian adults.

Methods: We examined cross-sectional baseline data from the Canadian Longitudinal Study on Aging (CLSA) Comprehensive cohort. The study sample included 20 201 community-dwelling adults aged 45-85 years. The associations between sociodemographic and anthropometric factors, chronic conditions, and cognitive, clinical, and lifestyle factors and 4-m usual gait speed (m/s) were estimated using hierarchical multivariable linear regression.

Results: The coefficient of determination, R 2, of the final regression model was 19.7%, with 12.9% of gait speed variability explained by sociodemographic and anthropometric factors, and nonmodifiable chronic conditions and 6.8% explained by potentially modifiable chronic conditions, cognitive, clinical, and lifestyle factors. Potentially modifiable factors significantly associated with gait speed include cardiovascular conditions (unstandardized regression coefficient, B = -0.018; p < .001), stroke (B = -0.025; p = .003), hypertension (B = -0.007; p = .026), serum Vitamin D (B = 0.004; p < .001), C-reactive protein (B = -0.005; p = .005), depressive symptoms (B = -0.003; p < .001), physical activity (B = 0.0001; p < .001), grip strength (B = 0.003; p < .001), current smoking (B = -0.026; p < .001), severe obesity (B = -0.086; p < .001), and chronic pain (B = -0.008; p = .018).

Conclusions: The correlates of gait speed in adulthood are multifactorial, with many being potentially modifiable through interventions and education. Our results provide a life-course-perspective framework for future longitudinal assessments risk factors affecting gait speed.

Keywords: CLSA; Gait speed; Mobility; Risk factors; Walking.

© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

References

    1. Verghese J, LeValley A, Hall CB, Katz MJ, Ambrose AF, Lipton RB. Epidemiology of gait disorders in community-residing older adults. J Am Geriatr Soc. 2006;54:255–261. doi:10.1111/j.1532-5415.2005.00580.x
    1. Abellan van Kan G, Rolland Y, Andrieu S, et al. . Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging. 2009;13:881–889. doi:10.1007/s12603-009-0246-z
    1. Studenski S, Perera S, Patel K, et al. . Gait speed and survival in older adults. JAMA. 2011;305:50–58. doi:10.1001/jama.2010.1923
    1. Rasmussen LJH, Caspi A, Ambler A, et al. . Association of neurocognitive and physical function with gait speed in midlife. JAMA Netw Open. 2019;2:e1913123. doi:10.1001/jamanetworkopen.2019.13123
    1. Montero-Odasso M, Schapira M, Soriano ER, et al. . Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci. 2005;60:1304–1309. doi:10.1093/gerona/60.10.1304
    1. Cummings SR, Studenski S, Ferrucci L. A diagnosis of dismobility–giving mobility clinical visibility: a Mobility Working Group recommendation. JAMA. 2014;311:2061–2062. doi:10.1001/jama.2014.3033
    1. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54:743–749. doi:10.1111/j.1532-5415.2006.00701.x
    1. Schmid A, Duncan PW, Studenski S, et al. . Improvements in speed-based gait classifications are meaningful. Stroke. 2007;38:2096–2100. doi:10.1161/STROKEAHA.106.475921
    1. Montero-Odasso M, Verghese J, Beauchet O, et al. . Gait and cognition: a complementary approach to understanding brain function and the risk of falling. JAGS. 2012;60(11):2127–2136. doi:10.1111/j.1532-5415.2012.04209.x
    1. Montero-Odasso M, Sarquis-Adamson Y, Song HY, et al. . Polypharmacy, gait performance, and falls in community-dwelling older adults. JAGS. 2019;67(6):1182–1188. doi:10.1111/jgs.15774
    1. Quiben MU, Hazuda HP. Factors contributing to 50-ft walking speed and observed ethnic differences in older community-dwelling Mexican Americans and European Americans. Phys Ther. 2015;95:871–883. doi:10.2522/ptj.20140152
    1. Forrest KY, Zmuda JM, Cauley JA. Correlates of decline in lower extremity performance in older women: a 10-year follow-up study. J Gerontol A Biol Sci Med Sci. 2006;61:1194–1200. doi:10.1093/gerona/61.11.1194
    1. Granic A, Mossop H, Engstrom G, et al. . Factors associated with physical performance measures in a multiethnic cohort of older adults. Gerontol Geriatr Med. 2018;4:2333721418778623. doi:10.1177/2333721418778623
    1. Raina PS, Wolfson C, Kirkland SA, et al. . The Canadian longitudinal study on aging (CLSA). Can J Aging Rev Can Vieil. 2009;28(3):221–229. doi:10.1017/S0714980809990055
    1. Moss L. SOP: timed (4-metre) walk test. . Published online 2014. Accessed February 13, 2020.
    1. O’Donnell MJ, Xavier D, Liu L, et al. ; INTERSTROKE investigators . Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–123. doi:10.1016/S0140-6736(10)60834-3
    1. Yusuf S, Hawken S, Ounpuu S, et al. ; INTERHEART Study Investigators . Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–952. doi:10.1016/S0140-6736(04)17018-9
    1. Verghese J, Wang C, Allali G, Holtzer R, Ayers E. Modifiable risk factors for new-onset slow gait in older adults. J Am Med Dir Assoc. 2016;17(5):421–425. doi:10.1016/j.jamda.2016.01.017
    1. Porta M.A Dictionary of Epidemiology. 6th ed. Oxford University Press; 2014.
    1. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84. doi:10.1016/S0749-3797(18)30622-6
    1. Rey A. L’examen clinique en psychologie. . Published online 1958. Accessed June 2, 2020.
    1. Crossley M, D’Arcy C, Rawson NS. . Letter and category fluency in community-dwelling Canadian seniors: a comparison of normal participants to those with dementia of the Alzheimer or vascular type. J Clin Exp Neuropsychol. 1997;19:52–62. doi:10.1080/01688639708403836
    1. Teng E. The mental alternations test (MAT). Clin Neuropsychol. 1995;9:287. doi:10.1080/13854049508400492
    1. Troyer AK, Leach L, Strauss E. Aging and response inhibition: normative data for the Victoria Stroop Test. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2006;13:20–35. doi:10.1080/138255890968187
    1. Demnitz N, Hogan DB, Dawes H, et al. . Cognition and mobility show a global association in middle- and late-adulthood: analyses from the Canadian Longitudinal Study on Aging. Gait Posture. 2018;64:238–243. doi:10.1016/j.gaitpost.2018.06.116
    1. Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46:153–162. doi:10.1016/0895-4356(93)90053-4
    1. Canadian Longitudinal Study on Aging. CLSA technical document: sampling and computation of response rates and sample weights for the tracking (telephone interview) participants and comprehensive participants.. Published online July 11, 2017. Accessed January 30, 2020.
    1. Boros K, Freemont T. Physiology of ageing of the musculoskeletal system. Best Pract Res Clin Rheumatol. 2017;31:203–217. doi:10.1016/j.berh.2017.09.003
    1. Elbaz A, Artaud F, Dugravot A, Tzourio C, Singh-Manoux A. The gait speed advantage of taller stature is lost with age. Sci Rep. 2018;8:1485. doi:10.1038/s41598-018-19882-1
    1. Montero-Odasso M, Pieruccini-Faria F, Bartha R, et al. ; ONDRI Investigators . Motor phenotype in neurodegenerative disorders: gait and balance platform study design protocol for the Ontario Neurodegenerative Research Initiative (ONDRI). J Alzheimers Dis. 2017;59:707–721. doi:10.3233/JAD-170149
    1. Muir SW, Speechley M, Wells J, Borrie M, Gopaul K, Montero-Odasso M. Gait assessment in mild cognitive impairment and Alzheimer’s disease: the effect of dual-task challenges across the cognitive spectrum. Gait Posture. 2012;35:96–100. doi:10.1016/j.gaitpost.2011.08.014
    1. Morris R, Lord S, Bunce J, Burn D, Rochester L. Gait and cognition: mapping the global and discrete relationships in ageing and neurodegenerative disease. Neurosci Biobehav Rev. 2016;64:326–345. doi:10.1016/j.neubiorev.2016.02.012
    1. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780–791. doi:10.1111/j.1532-5415.2007.01156.x
    1. Cruz-Jentoft AJ, Michel J-P. Sarcopenia: a useful paradigm for physical frailty. Eur Geriatr Med. 2013;4:102–105. doi:10.1016/j.eurger.2013.02.009
    1. Vennu V, Misra H. Evaluation of gait speed over time in adults with arthritis: data from the osteoarthritis initiative. Indian J Rheumatol. 2018;13:154. doi:10.4103/injr.injr_34_18
    1. White DK, Niu J, Zhang Y. Is symptomatic knee osteoarthritis a risk factor for a trajectory of fast decline in gait speed? Results from a longitudinal cohort study. Arthritis Care Res (Hoboken). 2013;65:187–194. doi:10.1002/acr.21816
    1. Auyeung TW, Kwok T, Lee J, Leung PC, Leung J, Woo J. Functional decline in cognitive impairment–the relationship between physical and cognitive function. Neuroepidemiology. 2008;31:167–173. doi:10.1159/000154929
    1. Kawai H, Ihara K, Kera T, et al. . Association between statin use and physical function among community-dwelling older Japanese adults. Geriatr Gerontol Int. 2018;18:623–630. doi:10.1111/ggi.13228
    1. Schrack JA, Simonsick EM, Chaves PH, Ferrucci L. The role of energetic cost in the age-related slowing of gait speed. J Am Geriatr Soc. 2012;60:1811–1816. doi:10.1111/j.1532-5415.2012.04153.x
    1. Veronese N, Stubbs B, Volpato S, et al. . Association between gait speed with mortality, cardiovascular disease and cancer: a systematic review and meta-analysis of prospective cohort studies. J Am Med Dir Assoc. 2018;19:981–988.e7. doi:10.1016/j.jamda.2018.06.007
    1. Straus SE, Majumdar SR, McAlister FA. New evidence for stroke prevention: scientific review. JAMA. 2002;288:1388–1395. doi:10.1001/jama.288.11.1388
    1. Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992;82:816. doi:10.2105/AJPH.82.6.816
    1. Sulander T, Martelin T, Sainio P, Rahkonen O, Nissinen A, Uutela A. Trends and educational disparities in functional capacity among people aged 65-84 years. Int J Epidemiol. 2006;35:1255–1261. doi:10.1093/ije/dyl183
    1. Pampel FC, Krueger PM, Denney JT. Socioeconomic disparities in health behaviors. Annu Rev Sociol. 2010;36:349–370. doi:10.1146/annurev.soc.012809.102529
    1. Verlinden VJ, Maksimovic A, Mirza SS, et al. . The associations of alcohol, coffee and tobacco consumption with gait in a community-dwelling population. Eur J Clin Nutr. 2016;70:116–122. doi:10.1038/ejcn.2015.120
    1. Ortolá R, García-Esquinas E, León-Muñoz LM, et al. . Patterns of alcohol consumption and risk of frailty in community-dwelling older adults. J Gerontol Ser Biomed Sci Med Sci. 2016;71:251–258. doi:10.1093/gerona/glv125
    1. Chang M, Saczynski JS, Snaedal J, et al. . Midlife physical activity preserves lower extremity function in older adults: age gene/environment susceptibility-Reykjavik study. J Am Geriatr Soc. 2013;61:237–242. doi:10.1111/jgs.12077
    1. Toffanello ED, Perissinotto E, Sergi G, et al. . Vitamin D and physical performance in elderly subjects: the Pro.V.A study. PLoS One. 2012;7:e34950. doi:10.1371/journal.pone.0034950
    1. Kositsawat J, Barry LC, Kuchel GA. C-reactive protein, vitamin D deficiency, and slow gait speed. J Am Geriatr Soc. 2013;61:1574–1579. doi:10.1111/jgs.12403
    1. Mendes J, Santos A, Borges N, et al. . Vitamin D status and functional parameters: a cross-sectional study in an older population. PLoS One. 2018;13:e0201840. doi:10.1371/journal.pone.0201840
    1. Annweiler C, Henni S, Walrand S, Montero-Odasso M, Duque G, Duval GT. Vitamin D and walking speed in older adults: systematic review and meta-analysis. Maturitas. 2017;106:8–25. doi:10.1016/j.maturitas.2017.07.012
    1. Rantanen T, Guralnik JM, Foley D, et al. . Midlife hand grip strength as a predictor of old age disability. JAMA. 1999;281:558–560. doi:10.1001/jama.281.6.558
    1. Dodds R, Kuh D, Aihie Sayer A, Cooper R. Physical activity levels across adult life and grip strength in early old age: updating findings from a British birth cohort. Age Ageing. 2013;42:794–798. doi:10.1093/ageing/aft124
    1. Demakakos P, Cooper R, Hamer M, de Oliveira C, Hardy R, Breeze E. The bidirectional association between depressive symptoms and gait speed: evidence from the English Longitudinal Study of Ageing (ELSA). PLoS One. 2013;8:e68632. doi:10.1371/journal.pone.0068632
    1. Brown PJ, Rutherford BR, Yaffe K, et al. . The depressed frail phenotype: the clinical manifestation of increased biological aging. Am J Geriatr Psychiatry. 2016;24:1084–1094. doi:10.1016/j.jagp.2016.06.005
    1. Eggermont LH, Bean JF, Guralnik JM, Leveille SG. Comparing pain severity versus pain location in the MOBILIZE Boston study: chronic pain and lower extremity function. J Gerontol A Biol Sci Med Sci. 2009;64:763–770. doi:10.1093/gerona/glp016
    1. Sawa R, Doi T, Misu S, et al. . The severity and number of musculoskeletal pain associated with gait in community-dwelling elderly individuals. Gait Posture. 2017;54:242–247. doi:10.1016/j.gaitpost.2017.03.013
    1. Cruz-Almeida Y, Rosso A, Marcum Z, et al. ; Health ABC Study . Associations of musculoskeletal pain with mobility in older adults: potential cerebral mechanisms. J Gerontol A Biol Sci Med Sci. 2017;72:1270–1276. doi:10.1093/gerona/glx084
    1. Vincent HK, Vincent KR, Lamb KM. Obesity and mobility disability in the older adult. Obes Rev. 2010;11:568–579. doi:10.1111/j.1467-789X.2009.00703.x
    1. Beavers KM, Beavers DP, Houston DK, et al. . Associations between body composition and gait-speed decline: results from the Health, Aging, and Body Composition study. Am J Clin Nutr. 2013;97:552–560. doi:10.3945/ajcn.112.047860
    1. Ruggero CR, Bilton TL, Teixeira LF, et al. . Gait speed correlates in a multiracial population of community-dwelling older adults living in Brazil: a cross-sectional population-based study. BMC Public Health. 2013;13:182. doi:10.1186/1471-2458-13-182
    1. Fritel X, Lachal L, Cassou B, Fauconnier A, Dargent-Molina P. Mobility impairment is associated with urge but not stress urinary incontinence in community-dwelling older women: results from the Ossébo study. BJOG Int J Obstet Gynaecol. 2013;120:1566–1574. doi:10.1111/1471-0528.12316
    1. Hausdorff JM, Yogev G, Springer S, Simon ES, Giladi N. Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res. 2005;164:541–548. doi:10.1007/s00221-005-2280-3
    1. Montero-Odasso MM, Barnes B, Speechley M, et al. . Disentangling cognitive-frailty: results from the gait and brain study. J Gerontol A Biol Sci Med Sci. 2016;71:1476–1482. doi:10.1093/gerona/glw044
    1. Annweiler C, Beauchet O, Bartha R, Montero-Odasso M. Slow gait in MCI is associated with ventricular enlargement: results from the Gait and Brain Study. Journal of Neural Transmission. 2013;120:1083–1092. doi:10.1007/s00702-012-0926-4
    1. Montero-Odasso M, Hachinski V. Preludes to brain failure: executive dysfunction and gait disturbances. Neurological Sciences. 2014;35:601–604. doi:10.1007/s10072-013-1613-4

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe