Original Study| Volume 17, ISSUE 1, P65-70, January 01, 2016

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Is Trunk Posture in Walking a Better Marker than Gait Speed in Predicting Decline in Function and Subsequent Frailty?

Published:September 22, 2015DOI:



      Many recent guidelines and consensus on sarcopenia have incorporated gait speed and grip strength as diagnostic criteria without addressing early posture changes adopted to maintain gait speed before weakness is clinically evident.


      Older adults are known to compensate well for declining physiological reserve through environmental modification and posture adaptation. This study aimed to analyze and identify significant posture adaptation in older adults that is required to maintain gait speed in the face of increasing vulnerability. This would be a useful guide for early posture correction exercise interventions to prevent further decline, in addition to traditional gait, balance, and strength training.


      A community-based cross-sectional study.

      Setting and Participants

      The participants comprised 90 healthy community-dwelling Chinese men between the ages of 60 and 80 years and 20 Chinese adults between the ages of 21 and 50 years within the normal BMI range as a comparison group.


      All the participants underwent handgrip strength testing, 6-minute walk, timed up-and-go (TUG), and motion analysis for gait characteristics. Low function was characterized by slow walking speed (<1.0 m/s) and/or slow TUG (>10 seconds), whereas low strength was determined by hand grip dynamometer testing (<26 kg). The degree of frailty was classified using the Canadian Study for Health and Ageing Clinical Frailty Scale (CSHA-CFS) to differentiate between healthy and vulnerable older adults.


      As expected, the vulnerable older adults had lower functional performance and strength compared with the healthy older adults group. However, a significant number demonstrated posture adaptations in walking in all 3 groups, including those who maintained a good walking speed (>1.0 m/s). The extent of such adaptation was larger in the vulnerable group as compared with the healthy group.


      Although gait speed is a robust parameter for screening older adults for sarcopenia and frailty, our data suggest that identifying trunk posture adaptation before the onset of decline in gait speed will help in planning interventions in the at-risk community-dwelling older adults even before gait speed declines.


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        • Fried L.P.
        • Walston J.
        Frailty and failure to thrive.
        in: Hazzard W.R. Blass J.P. Ettinger Jr., W.H. Principles of Geriatric Medicine and Gerontology. 4th ed. McGraw Hill, New York1998: 1387-1402
        • Syddall H.E.
        • Westbury L.D.
        • Cooper C.
        • Sayer A.A.
        Self-reported walking speed: A useful marker of physical performance among community-dwelling older people?.
        J Am Med Dir Assoc. 2015; 16: 323-328
        • Guedes R.C.
        • Dias R.C.
        • Pereira L.S.M.
        • et al.
        Influence of dual task and frailty on gait parameters of older community dwelling individuals.
        Braz J Phys Ther. 2014; 18: 445-452
        • Parentoni A.N.
        • Mendonça V.A.
        • Dos Santos K.D.
        • et al.
        Gait speed as a predictor of respiratory muscle function, strength and frailty syndrome in community dwelling elderly people.
        J Frailty Aging. 2015; 4: 64-68
        • Afilalo J.
        • Eisenberg M.J.
        • Morin J.F.
        • et al.
        Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery.
        J Am Coll Cardiol. 2010; 56: 1668-1676
        • Quach L.
        • Galica A.M.
        • Jones R.N.
        • et al.
        The non-linear relationship between gait speed and falls: The maintenance of balance, independent living, intellect and zest in the elderly Boston study.
        J Am Geriatr Soc. 2011; 59: 1069-1073
        • Lord S.E.
        • McPherson K.
        • McNaughton H.K.
        • et al.
        Community ambulation after stroke: How important and obtainable is it and what measures appear predictive?.
        Arch Phys Med Rehabil. 2004; 85: 234-239
        • Kang H.G.
        • Dingwell J.B.
        Effects of walking speed, strength and range of motion on gait stability in healthy older adults.
        J Biomech. 2008; 41: 2899-2905
        • Chen L.K.
        • Liu L.K.
        • Woo J.
        • et al.
        Sarcopenia in Asia: Consensus report of the Asian Working Group for Sarcopenia.
        J Am Med Dir Assoc. 2014; 15: 95-101
        • Rockwood K.
        • Song X.
        • McKnight C.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        CMAJ. 2005; 173: 489-495
        • Chan D.C.
        • Tsou H.H.
        • Chen C.Y.
        • Chen C.Y.
        Validation of the Chinese-Canadian study of health and ageing clinical frailty scale (CSHA-CFS) telephone version.
        Arch Gerontol Geriatr. 2010; 50: e74-e80
        • Yang C.W.
        • Li T.C.
        • Li C.I.
        • et al.
        Insulin-like growth factor-1 and its binding protein-3 polymorphisms predict circulating igf-1 level and appendicular skeletal muscle mass in Chinese elderly.
        J Am Med Dir Assoc. 2015; 16: 365-370
        • Hyde Z.
        • Flicker L.
        • Almeida O.P.
        • et al.
        Low free testosterone predicts frailty in older men: The health in men study.
        J Clin Endocrinol Metab. 2010; 95: 3165-3172
        • Hennessey J.V.
        • Chromiak J.A.
        • DellaVentura S.
        • et al.
        Growth hormone administration and exercise effects on muscle fiber type and diameter in moderately frail older people.
        J Am Geriatr Soc. 2001; 49: 852-858
        • Kirby R.L.
        • Price N.A.
        • MacLeod D.A.
        The influence of foot position on standing balance.
        J Biomech. 1987; 20: 423-427
        • Berger L.
        • Chuzel M.
        • Buisson G.
        • Rougier P.
        Undisturbed upright stance control in the elderly: Part 1. Age-related changes in undisturbed upright stance control.
        J Mot Behav. 2005; 37: 348-358
        • Morley J.E.
        • Rolland Y.
        • Tolson D.
        • Vellas B.
        Increasing awareness of the factors producing falls: The Mini Falls Assessment.
        J Am Med Dir Assoc. 2012; 13: 87-90
        • Manckoundia P.
        • Mourey F.
        • Perennou D.
        • Pfitzenmeyer P.
        Backward disequilibrium in elderly subjects.
        Clin Interv Aging. 2008; 3: 667-672
        • Van Swearingen J.M.
        • Perera S.
        • Brach J.S.
        • et al.
        Impact of exercise to improve gait efficiency on activity and participation in older adults with mobility limitations: A randomized controlled trial.
        Phys Ther. 2011; 91: 1740-1751
        • Valenzuela T.
        Efficacy of progressive resistance training interventions in older adults in nursing homes: A systematic review.
        J Am Med Dir Assoc. 2012; 13: 418-428
        • Cadore E.L.
        • Rodriguez-Manas L.
        • Sinclair A.
        • Izquierdo M.
        Effects of different exercise interventions on risk of falls, gait ability and balance in physically frail older adults: A systematic review.
        Rejuvenation Res. 2013; 16: 105-114