Association between daily gait speed patterns and cognitive impairment in community-dwelling older adults.

Gait speed over a short distance is associated with cognitive impairment in older adults. Recently, daily gait speed has been assessed using accelerometers. However, because daily gait speed is only weakly correlation with gait speed over a short distance, its association with cognitive impairment needs to be investigated. The present study compared the daily gait speed patterns of normal cognition (NC), mild cognitive impairment (MCI), and general cognitive impairment (GCI) subjects measured every 3 h for two weeks using accelerometers. A total of 1959 participants were classified into the NC (N = 1519), MCI (N = 353), and GCI groups (N = 87). The results showed that the average daily gait speed of the GCI group was significantly lower than that of the NC group (p = 0.03). Furthermore, the average daily gait speeds of the MCI and NC groups were the same. However, the average daily gait speed of the MCI group during a specific time (12-15 o'clock) was significantly lower than that of the NC group (p < 0.01). These results suggest that changes in daily patterns may be detected by measuring daily gait speed, which depends on the degree of cognitive function.

Predictivity of daily gait speed using tri-axial accelerometers for two-year incident disability among Japanese older adults.

Gait speed is an important indicator of functional decline in older adults. Recently, daily gait speed has been assessed using accelerometers. However, it is unclear whether this parameter can predict the decline in functional abilities. This study investigates whether daily gait speed can be a predictor of incident disability risk as well as in-laboratory gait speed. A sample of 1860 older adults (Male: 728, Female: 1132; 70.1 ± 6.2 years) were instructed to wear accelerometers on the waist. The association between daily gait speed for two weeks and incident disability during a two-year period was analyzed by using the cut-off value for screening prefrailty in the previous study (106.3 cm/s). Furthermore, the associations with in-laboratory gait speed (cut-off value: 100 cm/s), number of steps (cut-off value: 6342.2 steps/day), and incident disability were also analyzed. Cox proportional hazards analysis showed a significant hazard ratio of low daily gait speed (HR, 2.97; p = 0.02) comparable to that of low in-laboratory gait speed (HR: 2.53; p = 0.01). Conversely, the number of steps had no significant association with incident disability (HR: 1.99; p = 0.12). These results suggest that daily gait speed can be a predictor of incident disability risk in older adults.

Screening prefrailty in Japanese community-dwelling older adults with daily gait speed and number of steps via tri-axial accelerometers.

Prefrailty is an intermediate stage between non-frailty and frailty. It is associated with an increased risk of progression to frailty, which makes it important to screen older adults for prefrailty at an early stage. This study verified whether daily gait speed and number of steps measured using a tri-axial accelerometer could be used to identify prefrailty. In total, 1692 Japanese community-dwelling older adults were divided into robust (n = 1032) and prefrail (n = 660) groups based on the Kihon Checklist, which is a self-administered questionnaire. Both daily gait speed and number of steps were measured for two weeks using tri-axial accelerometers. We also calculated the area under the ROC curve and the cut-off values for these parameters. Our results showed that the cut-off value for daily gait speed was 106.3 cm/s, while that for number of steps was 6342.2. In addition, we found that the combined assessment of both cut-off values was a more effective way to screen older adults with prefrailty status compared to either parameter alone. This is also considered an effective way to reduce national expenditures for daily care assistance.

Relationship between Daily and In-laboratory Gait Speed among Healthy Community-dwelling Older Adults.

Gait speed in laboratory settings (in-laboratory gait speed) is one of the important indicators associated with the decline in functional abilities in older adulthood. Recently, it has become possible to measure gait speed during daily living (daily gait speed) using accelerometers. However, the relationship between these two gait speed parameters is unclear. This study aimed to compare in-laboratory gait speed, measured by a sheet-type pressure sensor, and daily gait speed, measured by an accelerometer, in healthy community-dwelling older adults. Participants were aged ≥60 years, residing in Takahama city, Aichi, Japan. To calculate daily gait speed, participants were instructed to wear a tri-axial accelerometer on their waist. A total of 1965 participants were included in the final analysis. The results showed a weak association (r = 0.333, p < 0.001) between the two gait speed parameters. Furthermore, average daily gait speed was significantly lower than average in-laboratory gait speed. However, both gait speed parameters declined significantly with age. These results suggest that, in addition to in-laboratory gait speed, daily gait speed may be a helpful parameter for predicting decline in functional abilities.

Evaluation of toe function based on the plantar pressure distribution while walking and its relationships with general gait parameters.

The foot is an important part of the human body that helps to maintain and shift a person's center of gravity. The roles of the toes in balancing and walking have been the focus of recent research. However, there are few methods or systems that can be used to quantitatively evaluate toe function while walking with respect to aging. Therefore, the purpose of this study is to develop an evaluation method for toe function based on the plantar pressure distribution while walking and evaluate how it relates to general gait parameters. Herein, we propose a method to identify the boundary position between the toe and foot based on the foot pressure distribution matrix. This technique was applied to gait analysis for 1774 female and 1553 male participants aged 20-90 years. The results of the statistical analysis suggest that the toe area ratio may reflect gait function and aging.

Age-related changes in gingival blood flow parameters measured using laser speckle flowmetry.

Previous studies have suggested a possible relationship between age-related changes to human gingival hemodynamics and periodontal disease. However, firmly establishing this has been difficult because of a lack of suitable tools. Our study investigated whether a non-invasive laser speckle flowgraphy (LSFG)-based 2-dimensional technique could be used to assess maxillary anterior gingival blood flow under resting conditions. In total, 124 healthy male volunteers aged between 22 and 69 years were included in the study and delineated into young (Y; 22-37 years, n = 45), middle-aged (M; 38-53 years, n = 43), and elderly groups (E; 54-69 years, n = 36). The differences in gingival hemodynamics were compared among age groups and pulse waveform analysis performed to calculate blood flow indices, mean blur rate (MBR), gingival vascular conductance (MBR/mean blood pressure [MBP]), and three pulse waveform parameters (acceleration time index [ATI], falling rate, and blowout time [BOT]). Although no statistically significant differences were observed in the MBR of the three age groups, vascular conductance (MBR/MBP) was lower in groups M and E compared to group Y and correlated negatively with age. ATI and falling rates were also significantly higher in group E relative to group Y, whereas average BOT was significantly lower. All of the assessed parameters correlated with age. These data suggest that there are age-related decreases in the ability to maintain blood flow in the human maxillary anterior gingiva under resting conditions which may impact the likelihood of periodontal disease.

Foot pressure analysis of gait pattern in older Japanese females requiring different personal care support levels.

[Purpose] This study evaluated gait parameters and foot pressure in two regions of the feet among older females with different personal care support needs to analyze factors that contribute to higher support requirements. [Subjects and Methods] Thirty-two older females were divided into support-need and care-need level groups. Gait parameters (speed, cadence, step length, step width, gait angle, toe angle, double support phase, swing phase, and stance phase) and foot pressure during a 5-m walk were measured and analyzed in the two groups. [Results] The percentage of the double support phase on both feet and the right stance phase were significantly higher in the care-need level group, while that of the right swing phase was significantly lower than that of the support-need level group. Additionally, the phase showing peak pressure on the left rear foot was significantly delayed and the left forefoot pressure in the terminal stance was significantly lower in the care-need level group than in the support-need level group. [Conclusion] These findings show that the temporal duration parameters and foot pressure on a particular side were significantly different between the two groups and suggest that these differences were associated with a higher care level.

Exercise and Nutritional Supplementation on Community-Dwelling Elderly Japanese Women With Sarcopenic Obesity: A Randomized Controlled Trial.

OBJECTIVES: To investigate the effects of exercise and/or nutritional supplementation on body composition, blood components, and physical function in community-dwelling elderly Japanese women with sarcopenic obesity. DESIGN: Randomized controlled trial. SETTING: Urban community in Tokyo, Japan. PARTICIPANTS: Among 1213 community-dwelling elderly women over 70 years of age, 307 were defined with sarcopenic obesity, and 139 women participated in the study. INTERVENTION: Participants were randomly assigned to one of four intervention groups. The exercise and nutrition (Ex + N) and exercise only (Ex) groups attended 60-minute exercise classes twice a week for 3 months. The Ex + N and nutrition only (N) groups were provided with essential amino acid supplementation and tea fortified with catechins to be taken daily for 3 months. Health education classes were provided to the control (HE) group every 2 weeks. MEASUREMENTS: Bioelectric impedance analysis was used to measure body composition. Skeletal muscle mass index was calculated using measures of muscle mass and height. Physical function measures included grip strength, knee extension strength, usual walking speed, and walking parameters (stride, step length, width, walking angles). Blood samples were obtained to analyze levels of albumin, triglycerides, cholesterol, hemoglobin A1c, leptin, cystatin C, vitamin D, interleukin-6, and high-sensitivity C-reactive protein. RESULTS: Significant between-group × time interactions were observed in usual walking speed (P = .012), stride (P = .004), right step length (P = .003), average number of steps (P = .029), and vitamin D (P < .001). Compared to the HE group, the Ex + N intervention significantly decreased total body fat mass (P = .036) and increased stride (P = .038) and vitamin D (P < .001). Significant reductions in trunk fat were observed in the Ex group compared with HE (P = .014). The Ex + N and Ex interventions were over four times as likely (odds ratio [95% confidence interval]) to reduce body fat mass than the HE group (4.42 [1.21-16.19]; 4.50 [1.13-17.9], respectively). Significant odds ratios of the Ex + N intervention improving walking speed (3.05 [1.01-9.19]), vitamin D (14.22 [1.64-123.02]), and leptin (3.86 [1.19-12.47]) were also observed. CONCLUSION: Although exercise and nutrition have beneficial effects on individual variables of body composition, blood components, and physical function, improvements in muscle mass and variable combinations such as percent fat + skeletal muscle mass index or percent fat + physical functions were not observed in this population. Further large-scale and long-term investigation is necessary.

[Are gait parameters related to knee pain, urinary incontinence and a history of falls in community-dwelling elderly women?].

AIM: To examine the association between gait parameters and knee pain, urinary incontinence, and a history of falls. METHODS: Comprehensive health examinations were conducted in 2009 among 971 elderly women over 70 years of age, in which the questionnaire and gait parameter results of 870 participants were analyzed. Knee pain, urinary incontinence and a history of falls were assessed through face-to-face interview surveys. Gait parameters were measured using a walk-way to assess walking speed, cadence, stride, stride length, step width, walking angle, toe angle and the differences in each parameter between the right and left foot. Multiple logistic regression analyses were performed to examine the associations between the gait parameters and knee pain, urinary incontinence and a history of falls. RESULTS: The elderly women with knee pain, urinary incontinence and a history of falls had slower walking speeds, smaller strides and strides length, and wider step width and walking angles. The multiple logistic regression analysis showed the walking speed to be significantly associated with mild knee pain and urinary incontinence and single a history of fall; moderate/severe knee pain was significantly associated with step width (OR=0.58, 95%CI=0.40-0.84) and walking angle (OR=1.62, 95%CI=1.30-2.01); moderate/severe urinary incontinence was significantly associated with walking speed (OR=0.97, 95%CI=0.96-0.99), walking angle (OR=1.14, 95%CI=1.02-1.26), and difference in walking angle between the right and left foot (OR=1.43, 95%CI=1.09-1.86); multiple a history of falls was significantly associated with stride length (OR=0.85, 95%CI=0.79-0.93) and the difference in walking angle between the right and left foot (OR=1.36, 95%CI=1.01-1.85). CONCLUSIONS: The data suggest that combining assessments of walking speed and other gait parameters may be an effective screening method for the early detection of geriatric syndromes.