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Gait Speed As the Sixth Vital Sign

Sarah Stillings, MA, PT, MPT, CHT

April 30, 2020

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Question

Can you review gait speed including how to perform and its significance to the elderly population? 

Answer

The reason that walking speed or gait speed is sometimes called the sixth vital sign is because it tells us so much about the functional abilities of older adults. A reduction in gait speed is associated with a senior's prognosis for decreased balance confidence, the future decline in health status and an increased risk of future falls, disability, cognitive impairment, need for hospitalization or institutional care, and even mortality. One study by Kirkwood et al showed that declines and walking velocity typically started at about age 65 decreasing by about 0.03 meters per second on average per year after that age and after age 71 walking speed decreased by about 0.18 meters per second per year on average. By the time most adults reach age 75 to 80, there has been a significant decline in gait speed and thus they have this increased risk of adverse health effects. Tests of walking speed are appropriate for most ambulatory older patients and in all rehab settings. Seniors who use an assistive device should be tested with that device and this should be documented with the test results. There are several different protocols for measuring gait speed that has been studied and they use various distances. The consensus appears to be that distances of four meters or less have reduced accuracy and are not recommended. Most authors recommend using either five meters or 10 meters and it should be along a straight path that does not involve turns. The start and endpoints and the path should be marked on the floor with tape if that's possible. If that's not feasible in the setting where you work, you can stretch out a rope of the appropriate distance and lay that on the floor. Several studies also recommend that the patient be allowed a 2.5 to three-meter acceleration before the testing area and a deceleration area of equal length beyond it because the research shows that the accuracy of the gait speed test is improved when the patient has a walking start as opposed to a static start. 

To do this test the therapist begins the timer with the first foot fall at the start point and ends it when the patient passes the endpoint. The number of meters that were covered is divided by the overall time to give a figure of velocity in meters per second. Most walking speed tests involve asking the patient to walk at a self-selected, which is a normal or comfortable pace. However, there are occasions when a maximum gait speed test may be useful. This is sometimes also called the fast walking test. The maximum gait speed test is considered a more accurate measure of the individual's community mobility than normal gait speed. For example, it can provide information about the patient's ability to increase speed in response to environmental demands such as quickly crossing the street at a busy intersection. There are several good online calculators and apps that can be used for walking speed tests. Research suggests that a gait speed of less than or equal to 0.8 meters per second is a predictor of poor clinical outcomes

 

Kirkwood, R. N., de Souza Moreira, B., Mingoti, S. A., Faria, B. F., Sampaio, R. F., & Resende, R. A. (2018). The slowing down phenomenon: What is the age of major gait velocity decline?. Maturitas115, 31-36.


sarah stillings

Sarah Stillings, MA, PT, MPT, CHT

Sarah R. (Sally) Stillings received her physical therapy degree from the University of North Carolina at Chapel Hill and practices in Texas. In her extensive career as a PT, she has held a variety of clinical, teaching, and administrative roles, including general PT practitioner, Certified Hand Therapist, clinic coordinator and manager, and continuing education instructor. She enjoys creating evidence-based continuing education materials for physical therapy and occupational therapy professionals. Many of her courses focus on best practices in geriatric care.


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