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The Journal of Nutrition, Health & Aging Dec 2011
Topics: Activities of Daily Living; Age of Onset; Aging; Humans; Middle Aged; Mobility Limitation; Muscle Strength; Muscle Weakness; Sarcopenia
PubMed: 22159769
DOI: 10.1007/s12603-011-0364-2 -
Journal of Aging and Physical Activity Mar 2021The authors examined whether accelerometer-based free-living walking differs between those reporting walking modifications or perceiving walking difficulty versus those...
The authors examined whether accelerometer-based free-living walking differs between those reporting walking modifications or perceiving walking difficulty versus those with no difficulty. Community-dwelling 75-, 80-, or 85-year-old people (N = 479) wore accelerometers continuously for 3-7 days, and reported whether they perceived no difficulties, used walking modifications, or perceived difficulties walking 2 km. Daily walking minutes, walking bouts, walking bout intensity and duration, and activity fragmentation were calculated from accelerometer recordings, and cut points for increased risk for perceiving walking difficulties were calculated using receiver operating characteristic analysis. The authors' analyses showed that accumulating ≤83.1 daily walking minutes and walking bouts duration ≤47.8 s increased the likelihood of reporting walking modifications and difficulties. Accumulating walking bouts ≤99.4 per day, having walking bouts ≤0.119 g intensity, and ≥0.257 active to sedentary transition probability fragmented activity pattern were associated only with perceiving walking difficulties. The findings suggest that older people's accelerometer-based free-living walking reflects their self-reported walking capability.
Topics: Accelerometry; Aged; Aged, 80 and over; Humans; Independent Living; Mobility Limitation; Self Report; Walking
PubMed: 33780907
DOI: 10.1123/japa.2020-0389 -
The Journals of Gerontology. Series A,... May 2019
Topics: Accidental Falls; Aged; Creatine; Humans; Incidence; Male; Mobility Limitation; Physical Functional Performance; Prospective Studies
PubMed: 30215688
DOI: 10.1093/gerona/gly180 -
Experimental Gerontology Apr 2024Among older people, walking difficulty results from actual and perceived declines in physical capacities and environmental requirements for walking. We investigated...
Among older people, walking difficulty results from actual and perceived declines in physical capacities and environmental requirements for walking. We investigated whether the physiological complexity of the gait cycle covaries with experience of walking difficulty. Walking difficulty, gait speed, and gait cycle complexity were evaluated among 702 community-dwelling older people aged 75, 80, and 85 years who took part in the six-minute walking test in the research laboratory. Walking difficulty for 500 m was self-reported. Complexity was quantified as trunk acceleration multiscale entropy during the gait cycle. Complexity was then compared between those with no reported walking difficulty, walking with modifications but no difficulty, and those reporting walking difficulty. Higher entropy differentiated those reporting no difficulty walking from those reporting walking difficulties, while those reporting having modified their walking, but no difficulty formed an intermediate group that could not be clearly distinguished from the other categories. The higher complexity of the gait cycle is associated with slower gait speed and the presence of self-reported walking difficulty. Among older people, gait cycle complexity which primarily reflects the biomechanical dimensions of gait quality, could be a clinically meaningful measure reflecting specific features of the progression of walking decline. This encourages further investigation of the sensitivity of gait cycle complexity to detect early signs of gait deterioration and to support targeted interventions among older people.
Topics: Humans; Aged; Independent Living; Entropy; Gait; Walking; Walking Speed; Mobility Limitation
PubMed: 38382681
DOI: 10.1016/j.exger.2024.112381 -
Neurology May 2021
Topics: Adolescent; Botulism; Clinical Reasoning; Diagnosis, Differential; Dyspnea; Humans; Male; Mobility Limitation; Walking
PubMed: 33504640
DOI: 10.1212/WNL.0000000000011544 -
PM & R : the Journal of Injury,... Jan 2017Individuals with central nervous system injuries are a large and apparently rapidly expanding population-as suggested by 2013 statistics from the American Heart... (Review)
Review
Individuals with central nervous system injuries are a large and apparently rapidly expanding population-as suggested by 2013 statistics from the American Heart Association. Increasing survival rates and lifespans emphasize the need to improve the quality of life for this population. In persons with central nervous system injuries, mobility limitations are among the most important factors contributing to reduced life satisfaction. Decreased mobility and subsequently reduced overall activity levels also contribute to lower levels of physical health. Braces to assist walking are options for greater-functioning individuals but still limit overall mobility as the result of increased energy expenditure and difficulty of use. For individuals with greater levels of mobility impairment, wheelchairs remain the preferred mobility aid yet still fall considerably short compared with upright bipedal walking. Furthermore, the promise of functional electrical stimulation as a means to achieve walking has yet to materialize. None of these options allow individuals to achieve walking at speeds or levels comparable with those seen in individuals with unimpaired gait. Medical exoskeletons hold much promise to fulfill this unmet need and have advanced as a viable option in both therapeutic and personal mobility state, particularly during the past decade. The present review highlights the major developments in this technology, with a focus on exoskeletons for lower limb that may encompass the spine and that aim to allow independent upright walking for those who otherwise do not have this option. Specifically reviewed are powered exoskeletons that are either commercially available or have the potential to restore upright walking function. This paper includes a basic description of how each exoskeleton device works, a summation of key features, their known limitations, and a discussion of current and future clinical applicability.
Topics: Energy Metabolism; Exoskeleton Device; Humans; Lower Extremity; Mobility Limitation; Quality of Life; Trauma, Nervous System; Walking
PubMed: 27565639
DOI: 10.1016/j.pmrj.2016.07.534 -
Journal of the American Geriatrics... Apr 2009To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of...
OBJECTIVES
To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation.
DESIGN
Observational prospective cohort study and cross-sectional analyses.
SETTING
Community and research center.
PARTICIPANTS
Seven hundred twenty-seven community-living people aged 75 to 81 were interviewed at baseline, of whom 314 took part in a 3.5-year follow-up.
MEASUREMENTS
Fear of moving outdoors and its potential individual and environmental correlates were assessed at baseline. Perceived difficulties in walking 0.5 km and 2 km were assessed twice a year over a 3.5-year period.
RESULTS
At baseline, 65% of the women and 29% of the men reported fear of moving outdoors. Poor socioeconomic status; musculoskeletal diseases; slow walking speed; and the presence of poor street conditions, hills in the nearby environment, and noisy traffic correlated with fear of moving outdoors. At the first 6-month follow-up, participants with fear of moving outdoors had more than four times the adjusted risk (odds ratio (OR)=4.6, 95% confidence interval (CI)=1.92-11.00) of developing difficulties in walking 0.5 km and a three times greater adjusted risk (OR=3.10, 95% CI=1.49-6.46) for developing difficulty in walking 2 km compared with those without fear. The difference in the prevalence of walking difficulties remained statistically significant over the 3.5-year follow-up (P=.02 and P=.009, respectively).
CONCLUSION
Fear of moving outdoors is common in older adults and increases the risk of developing self-reported difficulties in walking 0.5 km and 2 km. Knowledge about individual and environmental factors underlying fear of moving outdoors and finding ways to alleviate fear of moving outdoors are important for community planning and prevention of disability.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Chi-Square Distribution; Cross-Sectional Studies; Environment; Fear; Female; Finland; Geriatric Assessment; Humans; Interviews as Topic; Logistic Models; Male; Mobility Limitation; Musculoskeletal Diseases; Prospective Studies; Residence Characteristics; Risk Factors; Socioeconomic Factors
PubMed: 19392955
DOI: 10.1111/j.1532-5415.2009.02180.x -
Pediatrics in Review Jan 2018
Topics: Child, Preschool; Guillain-Barre Syndrome; Humans; Leg; Male; Mobility Limitation; Musculoskeletal Pain
PubMed: 29292285
DOI: 10.1542/pir.2017-0061 -
Journal of the American Geriatrics... Aug 2014To determine whether performance speeds mediate the association between visual impairment and self-reported mobility disability over an 8-year period.
OBJECTIVES
To determine whether performance speeds mediate the association between visual impairment and self-reported mobility disability over an 8-year period.
DESIGN
Longitudinal analysis.
SETTING
Salisbury, Maryland.
PARTICIPANTS
Salisbury Eye Evaluation Study participants aged 65 and older (N=2,520).
MEASUREMENTS
Visual impairment was defined as best-corrected visual acuity worse than 20/40 in the better-seeing eye or visual field less than 20°. Self-reported mobility disability on three tasks was assessed: walking up stairs, walking down stairs, and walking 150 feet. Performance speed on three similar tasks was measured: walking up steps (steps/s), walking down steps (steps/s), and walking 4 m (m/s).
RESULTS
For each year of observation, the odds of reporting mobility disability was significantly greater for participants who were visually impaired (VI) than for those who were not (NVI) (odds ratio (OR) difficulty walking up steps=1.58, 95% confidence interval (CI)=1.32-1.89; OR difficulty walking down steps=1.90, 95% CI=1.59-2.28; OR difficulty walking 150 feet=2.11, 95% CI=1.77-2.51). Once performance speed on a similar mobility task was included in the models, VI participants were no longer more likely to report mobility disability than those who were NVI (OR difficulty walking up steps=0.84, 95% CI=0.65-1.11; OR difficulty walking down steps=0.96, 95% CI=0.74-1.24; OR difficulty walking 150 feet=1.22, 95% CI=0.98-1.50).
CONCLUSION
Slower performance speed in VI individuals largely accounted for the difference in the odds of reporting mobility disability, suggesting that VI older adults walk slower and are therefore more likely to report mobility disability than those who are NVI. Improving mobility performance in older adults with visual impairment may minimize the perception of mobility disability.
Topics: Acceleration; Aged; Aged, 80 and over; Disability Evaluation; Female; Geriatric Assessment; Humans; Longitudinal Studies; Male; Maryland; Mobility Limitation; Risk Factors; Visual Acuity; Visually Impaired Persons
PubMed: 25040870
DOI: 10.1111/jgs.12937 -
Archives of Physical Medicine and... Mar 2015To test the proposed mechanism of action of a task-specific motor learning intervention by examining its effect on measures of the motor control of gait. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To test the proposed mechanism of action of a task-specific motor learning intervention by examining its effect on measures of the motor control of gait.
DESIGN
Single-blinded randomized clinical trial.
SETTING
University research laboratory.
PARTICIPANTS
Adults (N=40) aged ≥65 years with gait speed >1.0m/s and impaired motor skill (figure-of-8 walk time >8s).
INTERVENTIONS
The 2 interventions included a task-oriented motor learning and a standard exercise program; both interventions included strength training. Both lasted 12 weeks, with twice-weekly, 1-hour, physical therapist-supervised sessions.
MAIN OUTCOME MEASURES
Two measures of the motor control of gait, gait variability and smoothness of walking, were assessed pre- and postintervention by assessors masked to the treatment arm.
RESULTS
Of 40 randomized subjects, 38 completed the trial (mean age ± SD, 77.1±6.0y). The motor learning group improved more than the standard group in double-support time variability (.13m/s vs .05m/s; adjusted difference [AD]=.006, P=.03). Smoothness of walking in the anteroposterior direction improved more in the motor learning than standard group for all conditions (usual: AD=.53, P=.05; narrow: AD=.56, P=.01; dual task: AD=.57, P=.04). Smoothness of walking in the vertical direction also improved more in the motor learning than standard group for the narrow-path (AD=.71, P=.01) and dual-task (AD=.89, P=.01) conditions.
CONCLUSIONS
Among older adults with subclinical walking difficulty, there is initial evidence that task-oriented motor learning exercise results in gains in the motor control of walking, while standard exercise does not. Task-oriented motor learning exercise is a promising intervention for improving timing and coordination deficits related to mobility difficulties in older adults, and needs to be evaluated in a definitive larger trial.
Topics: Aged; Exercise Therapy; Female; Humans; Male; Mobility Limitation; Motor Skills; Resistance Training; Single-Blind Method; Treatment Outcome; Walking
PubMed: 25448244
DOI: 10.1016/j.apmr.2014.10.018