Cited by 147Balance, Gait, and Falls PreventionFrailty in Older AdultsNutrition and Health in Aging

Mobility Limitation in Self-Described Well-Functioning Older Adults: Importance of Endurance Walk Testing

Open access
Simonsick, E. M., Newman, A. B., Visser, M., Goodpaster, B., Kritchevsky, S. B., Rubin, S., Nevitt, M. C., Harris, T. B. +1 more·2008·The Journals of Gerontology Series A: Biological Sciences and Medical Sciences

Abstract

BACKGROUND: Mobility limitations are prevalent, potentially reversible precursors to mobility loss that may go undetected in older adults. This study evaluates standardized administration of an endurance walk test for identifying unrecognized and impending mobility limitation in community elders. METHODS: Men and women (1480 and 1576, respectively) aged 70-79 years with no reported mobility limitation participating in the Health, Aging and Body Composition study were administered the Long Distance Corridor Walk. Walk performance was examined to determine unrecognized mobility deficits at baseline and predict new self-recognition of mobility limitation within 2 years. RESULTS: On testing, 23% and 36% of men and women evidenced mobility deficits defined as a contraindication to exertion, meeting stopping criteria or exceeding 7 minutes to walk 400 m. Unrecognized deficits increased with age and were more prevalent in blacks, smokers, obese individuals, and infrequent walkers. Within 2 years, 21% and 34% of men and women developed newly recognized mobility limitation; those with baseline unrecognized deficits had higher rates, 40% and 54% (p <.001), respectively. For each additional 30 seconds over 5 minutes needed to walk 400 m, likelihood of newly recognized mobility limitation increased by 65% and 37% in men and women independent of age, race, obesity, smoking status, habitual walking, reported walking ease, and usual gait speed. CONCLUSIONS: A sizable proportion of elders who report no walking difficulty have observable deficits in walking performance that precede and predict their recognition of mobility limitation. Endurance walk testing can help identify these deficits and provide the basis for treatment to delay progression of mobility loss.

Integrity signals

Registry

Crossref · 10.1093/gerona/63.8.841

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 16 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Using a more restrictive definition of poor LDCW performance, needing more than 6.5 minutes to complete 400 m, improved sensitivity to .53 in men and .64 in women with little reduction in specificity (.81 and .69).

    “Using a more restrictive definition of poor performance on the LDCW, needing .6.5 minutes to complete 400 m, for instance, improves sensitivity to .53 and .64 with little diminution of specificity (.81 and .69).”
    Quote in the paperSubstantial claim
  • Findingown data

    Among those completing the LDCW, each additional 30 seconds over 5 minutes needed to walk 400 m was associated with a 65% higher likelihood of newly recognized mobility limitation in men and a 37% higher likelihood in women, independent of age, race, obesity, smoking status, habitual walking, reported walking ease, and usual gait speed.

    “For each additional 30 seconds over 5 minutes needed to walk 400 m, likelihood of newly recognized mobility limitation increased by 65% and 37% in men and women independent of age, race, obesity, smoking status, habitual walking, reported walking ease, and usual gait speed.”
    Quote in the paperSubstantial claim
  • Findingown data

    Participants with baseline unrecognized mobility deficits had higher rates of newly recognized mobility limitation than those without such deficits: 40.0% vs 15.8% in men and 54.0% vs 23.6% in women (p<.001).

    “Persons identified as having unrecognized deficits at baseline had higher rates of newly recognized limitation (40.0%vs 15.8% in men and 54.0% vs 23.6% in women; p , .001) and mobility disability (18.2% vs 3.7% in men and 23.1% vs 6.0% in women; p , .001) relative to those with no objective evidence of mobility deficits at baseline.”
    Quote in the paperSubstantial claim
  • Findingown data

    Participants with baseline unrecognized mobility deficits had higher rates of mobility disability than those without such deficits: 18.2% vs 3.7% in men and 23.1% vs 6.0% in women (p<.001).

    “Persons identified as having unrecognized deficits at baseline had higher rates of newly recognized limitation (40.0%vs 15.8% in men and 54.0% vs 23.6% in women; p , .001) and mobility disability (18.2% vs 3.7% in men and 23.1% vs 6.0% in women; p , .001) relative to those with no objective evidence of mobility deficits at baseline.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the Health ABC cohort of 70-79 year olds who reported no mobility limitation, 23% of men and 36% of women had unrecognized mobility deficits at baseline, defined as a contraindication to exertion, meeting stopping criteria, or needing more than 7 minutes to walk 400 m.

    “On testing, 23% and 36% of men and women evidenced mobility deficits defined as a contraindication to exertion, meeting stopping criteria or exceeding 7 minutes to walk 400 m.”
    Quote in the paperSubstantial claim
  • May combine two claims. 21
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 5
  • May combine two claims. The quote only partly states this claim.

    Findingown data

    For identifying impending mobility limitation, reporting that walking 1 mile is other than very easy had the highest sensitivity (.68 men, .84 women) but lowest specificity (.62 men, .50 women) and positive predictive value (.33 men, .47 women); gait speed below 1.0 m/s had the lowest sensitivity (.30 men, .43 women) but highest specificity (.89 men, .78 women); poor LDCW performance had the same.

    “Evaluating the sensitivity, specificity, and positive predictive value of these assessments for identifying impending mobility limitation we found for both men and women, reporting that walking 1 mile is other than very easy had the highest sensitivity (.68 and .84)but lowest specificity (.62 and .50)and positive predictive value (.33 and .47)whereas gait speed ,1.0 m/s had the lowest sensitivity”
    Quote in the paperSubstantial claim
  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the cohort, 42% of men and 51% of women walked less than 30 minutes in the previous week, and more than 90% of these reported no walking at all.

    “As shown in Table 1, within this cohort of 70-year-olds reporting no walking difficulty, 42% of men and 51% of women walked ,30 minutes in the previous week, of which .90% reported no walking at all.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    After adjustment for demographic and behavioral factors, gait speed, and reported ease walking 1 mile, men and women unable to complete or performing poorly on the LDCW were 2.66 (1.79-3.94) and 2.28 (1.70-3.05) times more likely to have newly recognized limitations.

    “After accounting for demographic and behavioral factors, gait speed, and reported ease walking 1 mile, men and women unable to complete or performing poorly on the LDCW were 2.66 (1.79-3.94)and 2.28 (1.70-3.05)times more likely to have newly recognized limitations.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Within two years, 21% of men and 34% of women met criteria for newly self-recognized mobility limitation, and 7% of men and 12% of women met criteria for mobility disability.

    “Within 2 years, 21% and 34% of men and women met criteria for newly self-recognized mobility limitation by reporting difficulty walking one-quarter mile or climbing one flight of stairs at two consecutive semiannual contacts; 7% and 12% met criteria for mobility disability.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Among black women, 48% met criteria for unrecognized deficits and 42% had self-recognized limitation within 2 years.

    “For instance, 48% of black women Note: Nonwalkers reported walking a total of ,30 minutes in a typical week.Persons with unrecognized mobility deficits constitute those who were either excluded from the Long Distance Corridor Walk-that is, had a medical contraindication to exertion, were unable to complete the 400-meter walk, or needed .7 minutes to walk 400 meters as quickly as possible.met crit”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Women who walked less than 30 minutes per week had a higher prevalence of unrecognized mobility deficits than women who walked at least 30 minutes per week (43.7% vs 27.5%, p<.001); the corresponding difference in men was smaller (25.7% vs 21.0%, p=.041).

    “Unrecognized deficits were substantially greater in women who walked infrequently relative to women who walked at least 30 minutes per week-43.7%versus 27.5% (p , .001).Respective differences were less remarkable in men-25.7%versus 21.0% (p ¼ .041).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    55% of men and 38% of women reported that walking 1 mile was very easy, and 85% of men and 71% of women had a usual gait speed above 1.0 m/s.

    “Overall, 55% of men and 38% of women reported that walking for 1 mile is very easy, and 85% and 71% had a usual gait speed exceeding 1.0 m/s, typically considered indicative of good mobility (12,14).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In both sexes, those excluded from attempting and those unable to complete the LDCW had much higher rates of newly recognized limitation than those completing the LDCW; among completers, men needing at least 6 minutes 30 seconds and women needing at least 7 minutes had greater or comparably high rates.

    “Figure 1 shows that, in both men and women, those excluded from attempting and those unable to complete the LDCW had much higher rates of newly recognized limitation than those completing the LDCW, but that among persons completing the LDCW, men needing at least 6 minutes and 30 seconds and women needing at least 7 minutes had greater or comparably high rates of newly recognized limitation.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    All three measures-LDCW performance, gait speed, and reported ease walking 1 mile-showed an independent association with newly self-recognized mobility limitation.

    “All three measures showed an independent association with newly self-recognized mobility limitation (Table 4), suggesting that each contributes a unique dimension of mobility status.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    The odds ratios for newly recognized mobility limitation and mobility disability associated with baseline unrecognized deficits were 2.36 (1.75-3.18) and 4.02 (2.56-6.31) in men, and 2.37 (1.85-3.04) and 2.93 (2.05-4.18) in women.

    “The respective odds ratios and 95% confidence intervals for limitation and disability were 2.36 (1.75-3.18)and 4.02 (2.56-6.31) in men and 2.37 (1.85-3.04)and 2.93 (2.05-4.18) in women.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Among participants who had neither a gait speed below 1.0 m/s nor reported walking 1 mile as other than very easy, rates of newly self-recognized limitation in those unable to complete the LDCW or needing more than 5.5 minutes to walk 400 m versus those completing in less than 5.5 minutes were 20.1% vs 6.3% in men (p<.001) and 14.9% vs 9.2% in women (p=.048).

    “In these 739 men and 502 women, rates of newly selfrecognized limitation in those unable to complete the LDCW or needing more than 5.5 minutes to walk 400 m versus those completing 400 m in ,5.5 minutes were 20.1% versus 6.3% in men (p , .001) and 14.9% versus 9.2% in women (p ¼ .048).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Among those who stopped, 14% of men and 38% of women who stopped because heart rate exceeded 135 developed newly recognized mobility limitation, compared with 64% of men and 67% of women who stopped for other reasons (p<.001).

    “Examining this group separately, we found that 14% and 38% of men and women developed newly recognized mobility limitation in contrast to 64% and 67% who stopped for other reasons (p , .001).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingreasoning

    Overall, 30% of the cohort had unrecognized deficits and 27% developed self-recognized mobility limitation within 2 years; one third of those with limitation had mobility disability.

    “As nearly half did not routinely walk, it is not surprising that overall, 30% had unrecognized deficits and 27% developed selfrecognized mobility limitation within 2 years; of these persons, one third had mobility disability.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    The likelihood of unrecognized mobility deficits rose with age and was higher among black participants, current or recent smokers, and obese individuals, independent of other attributes, in both men and women.

    “As shown in Table 3, in both men and women, the likelihood of unrecognized mobility deficits increased with age and was greater in blacks, current or recent smokers, and obese individuals independent of other attributes.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Both a gait speed below 1.0 m/s and reporting that walking 1 mile is other than very easy predicted development of newly self-recognized mobility limitation.

    “As evident from Table 4, both having a gait speed ,1.0 m/s and reporting that walking 1 mile is other than very easy predicted development of newly self-recognized mobility limitation.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    11% of men and 22% of women showed objective evidence of mobility deficits, either because they could not complete the LDCW (7% and 14%) or needed more than 7 minutes to walk 400 m.

    “Despite reports of no walking difficulty, 23% of men and 36% of women exhibited evidence of unrecognized mobility deficits; 12% and 14%, respectively, met established criteria indicating that brisk walking may be unsafe (21), and 11% and 22% showed objective evidence of mobility deficits, either because they could not complete the LDCW (7% and 14%) or needed .7 minutes to walk 400 m ''as quickly”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The study cohort had a mean age of 74 years, 51% were women, 42% were black, and equal numbers came from Memphis and Pittsburgh.

    “The study cohort mean age was 74 years, 51% were women and 42% were black, and equal numbers were from Memphis and Pittsburgh.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Within sex strata, black participants and Memphis participants were more likely to walk infrequently, as were current or recent male smokers, obese women, and women who did not complete high school.

    “Within sex-strata, blacks and Memphis participants were more likely to walk infrequently as were current or recent male smokers, obese women, and women who did not complete high school.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Premisecitation

    Older men typically demonstrate better physical performance than women at a given level of reported functioning.

    “Because older men typically demonstrate better physical performance than women at a given level of reported functioning (25), analyses were conducted separately for men and women.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The LDCW encourages a near maximal effort in older ambulatory adults.

    “Self-paced corridor walks however, may be more practical for older adults in both clinical and community settings (30)(31)(32), and the LDCW in particular encourages a near maximal effort in older ambulatory adults (19).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Test performance may have directly influenced participant discovery of existing walking difficulty.

    “Last, we must acknowledge that test performance may have directly influenced participant discovery of existing walking difficulty.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationown data

    When sufficient time and/or space are unavailable, asking individuals whether walking 1 mile would be easy and/or administering a short walk test can aid identification of persons with covert mobility limitation.

    “When sufficient time and/or space are unavailable, the multivariate analyses indicate that simply asking individuals whether walking 1 mile would be easy for them and/or administering a short walk test can aid identification of persons with covert mobility limitation (30).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    The LDCW has previously been shown to have prognostic value for prevalent subclinical cardiovascular disease and for all-cause and cardiovascular mortality, cardiovascular events, and functional limitation over 4-6 years.

    “Previously, we demonstrated the prognostic value of the LDCW for identifying prevalent subclinical cardiovascular disease (26) and all-cause and cardiovascular mortality, cardiovascular events and functional limitation over 4-6 years (27).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [26] source

      Not checked in the free run.

    • cites [27] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mobility limitation is an initial, potentially reversible stage of mobility loss and a precursor to mobility disability.

    “Mobility limitation, typically defined as reported difficulty walking for one-quarter mile or climbing one flight of stairs, represents an initial, potentially reversible stage of mobility loss; a precursor to mobility disability, the inability to ambulate without great difficulty or assistance (1,2).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] source

      Not checked in the free run.

    • cites [2] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The link between fitness and functional capacity is well established.

    “The link between fitness and functional capacity is well established (24,28), but rarely has objectively measured fitness been applied to identification of covert or impending mobility limitations (29).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [24] source

      Not checked in the free run.

    • cites [28] source

      Not checked in the free run.

25 of 25
  • The paper relies on this without support.

    Meeting the LDCW exclusion criteria, stopping criteria, or needing more than 7 minutes to walk 400 m indicates an unrecognized mobility deficit.

    “Unrecognized mobility deficits.-Atbaseline, unrecognized mobility deficits were considered present when a participant: (a) met established exclusion criteria (see above) indicating a contraindication to exertion or outright refused to attempt the LDCW; (b) met stopping criteria and did not complete the LDCW; or (c) needed .7 minutes to walk 400 m, which equates to a cardiorespiratory fitness level”
  • The paper relies on this without support.

    Self-reported absence of difficulty walking one-quarter mile accurately identifies older adults without mobility limitation.

    “As a condition of study eligibility, all participants were free of reported difficulty walking for one-quarter mile.”
  • The paper relies on this without support.

    Two consecutive semiannual reports of difficulty within 2 years represent persistent newly recognized mobility limitation.

    “The requirement for two consecutive reports of difficulty distinguishes transient from persistent limitations.”
  • The paper relies on this without support.

    The covariates included in the models adequately control for confounding of the association between LDCW performance and newly recognized mobility limitation.

    “After accounting for demographic and behavioral factors, gait speed, and reported ease walking 1 mile, men and women unable to complete or performing poorly on the LDCW were 2.66 (1.79-3.94)and 2.28 (1.70-3.05)times more likely to have newly recognized limitations.”
4 of 4

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Each contradiction between two passages listed here was confirmed by an independent check.

  • Obesity definitions disagree at a BMI of 30

    Minor

    The methods include participants whose BMI equals 30 in the obesity category, while the Table 1 note includes only those whose BMI exceeds 30.

1 of 1

Cites

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Research works printed but not linked: 6

  1. 2000, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 55A, M221
  2. 2001, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56A, M644
  3. Gohdes, 2005, Preventing chronic disease [electronic resource], 2, A17
  4. 2001, Journal of the American College of Cardiology, 137, 153
  5. 1999, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54A, M353
  6. 1994, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 49A, M85

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Authors
Simonsick, E. M., Newman, A. B., Visser, M., Goodpaster, B., Kritchevsky, S. B., Rubin, S., Nevitt, M. C., Harris, T. B., & for the Health, A. A. B. C. S.
Affiliations
  • Johns Hopkins University (US)
  • University of Pittsburgh (US)
  • Vrije Universiteit Amsterdam (NL)
  • Wake Forest University Health Sciences (US)
  • University of California, San Francisco (US)
  • National Institute on Aging (US)
Venue
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
Published
2008-08-01
Volume
63
Issue
8
Pages
841-847
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
OpenAlex
W2168523787
Cited by
147
References
35
Citations by year
2026: 6 · 2025: 4 · 2024: 7 · 2023: 13 · 2022: 14 · 2021: 8 · 2020: 10 · 2019: 6 · 2018: 12 · 2017: 11 · 2016: 9 · 2015: 5 · 2014: 7 · 2013: 6 · 2012: 6
FWCI
19.66
Type
journal article
Language
en
Open access
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • VU Research Portal (publishedVersion, other-oa)
  • Pure Amsterdam UMC (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • National Institutes of Health (N01-AG-6-2103, n01ag062101-007, n01ag062103-006, N01‐AG‐6‐2106, n01ag062106-007, N01-AG-6-2101)
  • National Institute on Aging (N01‐AG‐6–2101, N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106, N01AG62106, N01-AG-62103)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
mobility limitations, older adults, walking performance, Health, Aging, and Body Composition Study
MeSH terms
Aged, Disability Evaluation, Exercise Test, Female, Humans, Male, Physical Endurance, Cohort Studies, Multivariate Analysis, Walking, Mobility Limitation

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