title: Balance, Muscle Strength, and Fear of Falling in Older Adults High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. A comparison of two time intervals for test-retest reliability of health status instruments. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Criteria for evaluation of measurement properties of clinical balance measures for use in fall prevention studies. Reproducibility of performance-based and self-reported measures of functional status. Can lay-led walking programmes increase physical activity in middle aged adults? A randomised controlled trial Meaningful change and responsiveness in common physical performance measures in older adults. Attrition in an exercise intervention: a comparison of early and later dropouts. Improvement in usual gait speed predicts better survival in older adults. Fear of falling in new long-term care enrollees. Mobility Limitations and Cognitive Deficits as Predictors of Institutionalization among Community-Dwelling Older People Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. Is there a relationship between balance, gait performance and muscular strength in 75-year-old women? Change in physical performance over time in older women: the Women's Health and Aging Study. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community Assessing recurrent fall risk of community-dwelling, frail older veterans using specific tests of mobility and the physical performance test of function. Measuring physical function in community-dwelling older persons: a comparison of self-administered, interviewer-administered, and performance-based measures. Is stair climb power a clinically relevant measure of leg power impairments in at-risk older adults? Correlates of attributing new disability to old age. Study of Osteoporotic Fractures Research Group. Anticholinergic Drugs and Physical Function Among Frail Elderly Population The Effects of Short-Term Exercise Intervention on Falls Self-Efficacy and the Relationship between Changes in Physical Function and Falls Self-Efficacy in Japanese Older People: A Randomized Controlled Trial The relation between previous fractures and physical performance in elderly women. Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age. Physical performance measures in the clinical setting. Inflammatory markers and physical performance in older persons: the InCHIANTI study. The relation between psychometric test performance and physical performance in older adults. Physical Function and Health Status among Seniors with and without a Fear of Falling Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty. Walking speed and stride length predicts 36 months dependency, mortality, and institutionalization in Chinese aged 70 and older. Dog ownership, walking behavior, and maintained mobility in late life.
abstract: This study examined balance ability , lower-extremity muscle strength , fear of falling and their inter-relationships in 40 community-dwelling older adults ( > 65 years ) . Subjects who self-identified either as being fearful offalling or not ( no concern ) were screened to exclude those with known risk factors for falling .  Limits of stability , maximal isometric strength , gait speed , and fear of falling were contrasted between groups ( 27 control subjects , 13 fearful subjects ) . Those fearful of falling demonstrated smaller center of pressure ( COP ) excursions in anterior , left , and right directions ( p < .0001 ) and used a smaller percentage of their base of support during maximal weight shifting in combined anterior-posterior and right-left directions ( p < .001 ) compared to the control group . Strength did not differ between groups , but was associated with the ability to shift the COP in the anterior-posterior direction ( p < .05 ) . Fear of falling also related to weight shifting ability ( p < .017 ) . Seniors fearful of falling demonstrated limitations in balance ability and balance confidence that could not be explained by muscle weakness The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Studies of test-retest reliability for health-related quality of life instruments have used varying intervals between test administrations . There is no evidence available to aid in the selection of the time interval between question naire administrations for a study of test-retest reliability for health status instruments . We compared the test-retest reliability at 2 days and 2 weeks for four knee-rating scales and the eight domains of the SF-36 . Seventy patients with disorders of the knee who were in a stable state were r and omly allocated to repeat the question naires at either 2 days or 2 weeks . There were no statistically significant differences in the test-retest reliability ( intraclass correlation coefficient and limits of agreement statistics ) for the two time intervals BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the  Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( BBS ) , and Timed Up & Go Test ( TUG ) and during comfortable- and fast-speed walking ( CGS and FGS ) . Intraclass correlation coefficients ( ICCs ) were used to determine the test-retest reliability for the 6MW , TUG , CGS , and FGS measurements . Data were analyzed by gender and age ( 60 - 69 , 70 - 79 , and 80 - 89 years ) cohorts , similar to previous studies . Means , st and ard deviations , and 95 % confidence intervals for each measurement were calculated for each cohort . RESULTS The 6MW , TUG , CGS , and FGS measurements showed high test-retest reliability ( ICC [2,1]=.95-.97 ) . Mean test scores showed a trend of age-related declines for the 6MW , BBS , TUG , CGS , and FGS for both male and female subjects . DISCUSSION AND CONCLUSION Preliminary descriptive data suggest that physical therapists should use age-related data when interpreting patient data obtained for the 6MW , BBS , TUG , CGS and FGS . Further data on these clinical tests with larger sample sizes are needed to serve as a reference for patient comparisons Work Package 3 of the Prevention of Falls Network Europe has evaluated measurement properties of clinical balance measures to be used to : ( 1 ) select participants for interventions with the goal to prevent falls in older people , and ( 2 ) assess the results of such intervention on balance function . Inclusion in a fall prevention study may be based on measures identifying subjects who have impaired balance or increased risk of future falls . We propose that an appropriate statistical method to analyse discriminative ability of a balance measure is discriminant analysis or logistic regression analysis . The optimal cut-off score is best determined by plotting a receiver-operating-characteristic curve for different cut-off values . The evaluation of predictors for risk of future falls should be based on a study design with a prospect i ve data collection of falls . Sensitivity to change is a measurement property needed to evaluate the outcome of an intervention . The st and ardized response mean is frequently encountered in the literature and is recommended as a statistical measure of sensitivity to change in the context of an intervention study . Adequate reliability is a prerequisite for consistent measurement . Relative reliability may be reported as an intraclass correlation coefficient and absolute reliability as the within-subject st and ard deviation ( s(w ) ) , also called st and ard error of measurement . When measurement error is proportional to the score , calculation of a coefficient of variation can be considered . In a second paper , the authors will evaluate  clinical balance measures  for use in fall prevention studies based upon criteria recommended in this report BACKGROUND The reproducibility of a performance-based and a self-reported measure of functional status was investigated , as well as the impact of age and cognitive function on the reproducibility . METHODS Of a r and om sample of 114 men of the 1995 survey of the Zutphen Elderly Study , 105 men ( aged 79.9 + /- 4.5 years ) participated in a test-retest study . They filled out a question naire on disabilities and carried out performance tests twice , in a 2-week interval . Four performance tests were administered ( st and ing balance , walking speed , chair st and , and external shoulder rotation ) , and a summary performance score was constructed . The number of self-reported disabilities in basic activities of daily living , mobility , and instrumental activities of daily living were assessed . Kappa statistics and Pearson correlation coefficients between test and retest measurements were computed for the total group and stratified by age and cognitive function . RESULTS Three performance tests and the summary performance score had fair to good reproducibility ( walking speed : Pearsons r = .90 , chair st and : r = .82 , shoulder rotation : kappa = .49 , summary score : kappa = .52 ) . Only the test for st and ing balance was poorly reproducible ( kappa = .29 ) . The self-reported functional status was fairly to good reproducible ( kappa = .63 , r = .87 ) . Self-reported functional status was significantly less reproducible in very old and cognitively impaired than in younger and nonimpaired individuals . CONCLUSIONS In the elderly male subjects , performance tests and self-reported disabilities had moderate to good reproducibility , with the exception of the test for st and ing balance . In very old or cognitively impaired population s , self-reported functional status may have a lower reproducibility Study objective : To compare health walks , a community based lay-led walking scheme versus advice only on physical activity  and cardiovascular health status in middle aged adults . Design : R and omised controlled trial with one year follow up . Physical activity was measured by question naire . Other measures included attitudes to exercise , body mass index , cholesterol , aerobic capacity , and blood pressure . Setting : Primary care and community . Participants : 260 men and women aged 40–70 years , taking less than 120 minutes of moderate intensity activity per week . Main results : Seventy three per cent of people completed the trial . Of these , the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6 % in the advice only and 35.7 % in the health walks group at 12 months ( between group difference = 13 % ( 95 % CI 0.003 % to 25.9 % ) p=0.05 ) . Intention to treat analysis , using the last known value for missing cases , demonstrated smaller differences between the groups ( between group difference = 6 % ( 95 % CI −5 % to 16.4 % ) ) with the trend in favour of health walks . There were improvements in the total time spent and number of occasions of moderate intensity activity , and aerobic capacity , but no statistically significant differences between the groups . Other cardiovascular risk factors remained unchanged . Conclusions : There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat . In people who completed the trial , health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change OBJECTIVE To identify reasons for dropout and factors that may predict dropout from an exercise intervention aim ed at improving physical function in frail older persons . DESIGN / SETTING An 18-month r and omized controlled intervention in a community setting . The intervention comprised 2 groups : class-based and self-paced exercise . PARTICIPANTS 155 community-dwelling older persons , mean age 77.4 , with mildly to moderately compromised mobility . MEASUREMENTS The primary outcome measure was dropout . Dropouts were grouped as : D0 , dropout between baseline and 3-month assessment , and D3 , dropout after 3-month assessment . MEASUREMENTS Measurements of demographics , health , and physical performance included self-rated health , SF-36 , disease burden , adverse events , PPT-8 , MacArthur battery , 6-minute walk , and gait velocity . RESULTS There were 56 dropouts ( 36 % ) , 31 in first 3 months . Compared with retained subjects ( R ) , the D0 group had greater disease burden ( P = .011 ) , worse self-perceived physical health ( P = .014 ) , slower usual gait speed ( P = .001 ) , and walked a shorter distance over 6 minutes ( P<.001 ) . No differences were found between R and D3 . Multinomial logistic regression showed 6-minute walk ( P<.001 ) and usual gait velocity ( P<.001 ) were the strongest independent predictors of dropout . Controlling for all other variables , adverse events after r and omization and 6-minute walk distance were the strongest independent predictors of dropout , and self-paced exercise assignment increased the risk of dropout . CONCLUSIONS We observed baseline differences between early dropouts and retained subjects in disease burden , physical function , and endurance , suggesting that these factors at baseline may predict dropout . Improved underst and ing of factors that lead to and predict dropout could allow research ers to identify subjects at risk of dropout before r and omization . Assigning targeted retention techniques in accordance with these factors could result in decreased attrition in future studies . Therefore , the results of selective attrition of frailer subjects , such as decreased heterogeneity , restricted generalizability of study findings , and limited underst and ing of exercise effects in this population , would be avoided OBJECTIVES To estimate the relationship between 1-year improvement in measures of health and physical function and 8-year survival . DESIGN Prospect i ve cohort study . SETTING Medicare health maintenance organization and Veterans Affairs primary care programs . PARTICIPANTS Persons aged 65 and older ( N=439 ) . MEASUREMENTS Six measures of health and function assessed at baseline and quarterly over 1 year . Participants were classified as improved at 1 year , transiently improved , or never improved for each measure using a priori definitions of meaningful change : gait speed ( usual walking pace over 4 m ) , 0.1 m/s ; Short Physical Performance Battery , 1 point ; Medical Outcomes Study 36-item Short Form Health Survey physical function , 10 points ; EuroQol , 0.1 point ; National Health Interview activity of daily living scale , 2 points ; and global health change , two levels or reaching the ceiling . Mortality was ascertained from the National Death Index . Covariates included demographics , comorbidity , cognitive function , and hospitalization . RESULTS Of the six measures , only improved gait speed was associated with survival . Mortality after 8 years was 31.6 % , 41.2 % , and 49.3 % for those with improved , transiently improved , and never improved gait speed , respectively . The survival benefit for improvement at 1 year persisted after adjustment for covariates ( hazard ratio=0.42 , 95 % confidence interval=0.29 - 0.61 , P<.001 ) and was consistent across subgroups based on age , sex , ethnicity , initial gait speed , healthcare system , and hospitalization . CONCLUSION Improvement in usual gait speed predicts a substantial reduction in mortality . Because gait speed is easily measured , clinical ly interpretable , and potentially modifiable , it may be a useful " vital sign " for older adults . Further research is needed to determine whether interventions to improve gait speed affect survival OBJECTIVES To measure the prevalence of fear of falling in older adults at the time of long- term care ( LTC ) enrollment and identify potentially treatable risk factors for low fall related self-efficacy . DESIGN Prospect i ve cohort study . SETTING Three LTC programs in Upstate New York . PARTICIPANTS 112 new enrollees in LTC , aged 55 or older , who passed a cognitive screen .  MEASUREMENTS Self-reported falls , the falls efficacy scale ( FES ) , medical conditions , the short geriatric depression scale , and physical performance measures ( Berg balance scale , hip flexor , knee extensor and grip strength , gait speed and a six-minute walk ) . RESULTS Of the 54 subjects ( 48.2 % ) who reported fear of falling , 41 ( 75.9 % ) reported activity modification secondary to fear . Fearful subjects were more likely to be female ( P = .003 ) , report low back pain ( P = .030 ) and lower extremity arthritis ( P = .037 ) . Fearful subjects were weaker at the hip ( P < .001 ) and knee ( P = .001 ) , and had shorter six-minute walk distances . Subjects with better FES scores had better Berg scores ( P < .001 ) , had greater hip and knee strength , had faster gait speeds and walked further in six minutes ( P < .001 , P = .006 , P = .001 and P = .001 respectively ) . Subjects with low FES scores and fearful subjects were more likely to have depressive symptoms ( P = .003 , P = .044 , respectively ) . CONCLUSION Falls and fear of falling are more common in new LTC enrollees than in previously described community dwelling and SNF cohorts . Attention to associated characteristics like depression , arthritis , low back pain and lower extremity weakness may identify opportunities to reduce fear and improve patient safety during this transitional period Purpose : Mobility limitations and cognitive disorders have often been observed as risks for institutionalization . However , their combined effects on risk of institutionalization among initially community-dwelling older people have been less well reported . Design : A prospect i ve cohort study with 10-year surveillance on institutionalization . Subjects : Study population ( n = 476 ) consisted of 75- and 80-year-old people who were community-dwelling , had not been diagnosed with dementia , and participated in tests on walking speed and cognitive capacity at a research centre . Measures : Cognitive capacity was measured with three vali date d psychometric tests that were from the Wechsler Adult Intelligence Scale , Wechsler Memory Scale and Schaie- Thurstone Adult Mental Abilities Test .  Mobility  was measured with walking speed over a 10-m distance . Exclusive distribution based study groups were formed with cut-offs at the lowest third as follows : no limitation , solely mobility limitation , solely cognitive deficits , and combined mobility limitation and cognitive deficits . Cox proportional hazards model was used to determine the relative risks of institutionalization for the study groups . Results : Eleven percent of the participants were institutionalized during the 10-year surveillance . The risk for institutionalization was 4.9 times greater ( 95 % confidence interval : 2.1–11.2 ) for those who had co-existing mobility limitations and cognitive deficits than for those with no limitations . Conclusions : The findings show that the accumulation of limitations in physical and cognitive performance substantially decreases the possibility for a person remaining at home . This might be due to a decreased reserve capacity and ineffective compensatory strategies . Therefore , interventions targeted to improve even one limitation , or prevent accumulation of these risk factors , could significantly reduce the risk of institutionalization OBJECTIVES To define clinical ly relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons . DESIGN Prospect i ve cohort study . SETTING Health , Aging and Body Composition Study . PARTICIPANTS Three thous and forty-seven well-functioning older persons ( mean age 74.2 ) . MEASUREMENTS Usual gait speed on a 6-m course was assessed at baseline . Participants were r and omly divided into two groups to identify ( Sample A ; n=2,031 ) and then vali date ( Sample B ; n=1,016 ) usual gait-speed cutpoints . Rates of persistent lower extremity limitation events ( mean follow-up 4.9 years ) were calculated according to gait speed in Sample A. A cutpoint ( defining high- ( < 1 m/s ) and low risk ( > or = 1 m/s ) groups ) was identified based on persistent lower extremity limitation events . The predictive value of the identified cutpoints for major health-related events ( persistent severe lower extremity limitation , death , and hospitalization ) was evaluated in Sample B using Cox regression analyses . RESULTS A grade d response was seen between risk groups and health-related outcomes . Participants in the high-risk group had a higher risk of persistent lower extremity limitation ( rate ratio (RR)=2.20 , 95 % confidence interval (CI)=1.76 - 2.74 ) , persistent severe lower extremity limitation ( RR=2.29 , 95 % CI=1.63 - 3.20 ) , death ( RR=1.64 , 95 % CI=1.14 - 2.37 ) , and hospitalization ( RR=1.48 , 95 % CI=1.02 - 2.13 ) than those in the low-risk group . CONCLUSION Usual gait speed of less than 1 m/s identifies persons at high risk of health-related outcomes in well-functioning older people . Provision of a clinical ly meaningful cutpoint for usual gait speed may facilitate its use in clinical and research setting OBJECTIVE To see if there is a relationship between clinical and laboratory tests of balance , muscular strength and gait in elderly women . DESIGN A r and omized population -based study . SETTING S Malmö , Sweden . METHODS We investigated balance with a simple test of st and ing on one leg , as well as a computerized balance platform . Muscular strength was tested by computerized dynamometer . Extension and flexion of the knee and dorsiflexion of the ankle were tested . We measured the time and number of steps taken to walk a certain distance and the subjects ' height and weight . PARTICIPANTS 418 r and omly selected 75-year-old women , of whom 230 took part . RESULTS There was no relation between the computerized balance tests and any of the other tests . The non-computerized balance test was correlated with gait time and number of steps ( r = -0.50 , P<0.001 and r = -0.40 , P<0.001 , respectively ) . Tests of extension and flexion , strength of the knee and ankle dorsiflexion were related to gait , speed and number of steps . Heavy women had poorer balance when assessed by the non-computerized test ( r = -0.32 , P<0.001 ) and with the computerized , stable platform , eyes-open test ( r = 0.27 , P<0.001 ) and eyes-closed test ( r = 0.44 , P<0.001 ) . The heavier an individual was , the slower her gait and the shorter her steps , despite having stronger knee muscles . CONCLUSION There is no relationship between the simple balance tests and computerized platform tests . Muscle strength of the leg is not necessarily linked to balance , but rather to gait performance BACKGROUND Although lower and upper extremity performance measures are widely used and represent vali date d physical function measures in older adults , there is limited information regarding the magnitude of changes in these measures over time . This study ( i ) assesses prospect i ve changes in physical performance measures , ( ii ) defines a summary score that demonstrates a significant amount of change over time , and ( iii ) examines rates of decline according to age and baseline performance levels . METHODS Data from the Women 's Health and Aging Study ( WHAS ) were analyzed to assess change in the one third most disabled older women living in the community .  Lower extremity function was assessed using walking speed , balance , and chair st and s tests . The putting-on-blouse test , the lock and key test , the Purdue Pegboard test , and grip strength were used to gauge upper extremity function . Continuous and categorical summary performance scores were calculated using continuous and categorical data of lower and upper performance measures . RESULTS After 3 years , lower extremity performance measures declined by 16%-27 % , while upper extremity performance measures declined less ( 7%-24 % ) . For lower extremity function , the continuous summary performance score showed a slightly greater 3-year decline from baseline ( decline vs baseline mean : 23 % ; decline vs SD of the baseline mean : 59 % ) than the categorical score ( 22 % and 41 % , respectively ) . Older age and intermediate level of baseline performance were associated with the greatest decline , especially for lower extremity function . CONCLUSIONS In moderately to severely disabled women aged 65 or older , lower extremity measures show more change over 3 years than upper extremity measures . Among the lower extremity summary scores , the continuous score changes more over time than the categorical score with respect to the baseline SD . The lower extremity continuous summary performance score may be a useful outcome measure for clinical studies of physical performance in older women Abstract Objective The criteria for inappropriate drug use developed by Beers have been widely used in drug utilization review s to assess the quality of prescribing , but there is still inconclusive evidence that these criteria can impact on patient outcomes . The aim of the present study was to evaluate the relationship between the use of inappropriate drugs and measures of physical performance , muscle strength and functional status in an elderly population ( 80 + years ) . Methods Data are from the baseline evaluation of 364 subjects enrolled in the ilSIRENTE study , a prospect i ve cohort study performed in a mountain community living in the Sirente geographic area ( L’Aquila , Abruzzo ) in Central Italy .  Physical performance was assessed using the  physical performance battery score ( SPPB )  , which is based on three timed tests : 4-m walking speed , balance and chair st and tests . Muscle strength was measured by h and grip strength . Inappropriate drug use was defined by the 2003 Beers criteria . Analyses of covariance were performed to evaluate the relationship of inappropriate drugs with physical function . Results In the unadjusted model , all of the physical performance , muscle strength and functional measures showed significant associations with inappropriate drug use . Following adjustment for potential confounders , which included age , gender , physical activity level , cognitive performance scale , comorbidity , lung diseases and diabetes , these associations were still statistically significant for the physical performance battery score [ non-users inappropriate drugs : 7.0 ; st and ard error ( SE ) : 0.1 ; users inappropriate drugs : 6.1 ; SE : 0.2 ; p = 0.007 ] The 4-m walking speed , physical performance battery score and Total Activities of Daily Living ( ADL ) scale score showed worsening results among subjects using two inappropriate medications compared with subjects using one inappropriate drug or none at all . Conclusions The use of inappropriate medication ( as defined by Beers 2003 criteria ) was found to be common among the elderly Italian study cohort living in the community . Our results suggest that among old – old subjects the use of inappropriate drugs is associated with impaired physical performance BACKGROUND The purpose of this prospect i ve cohort study was to determine if older individuals at risk for recurrent falls are best identified by mobility or functional assessment s. METHODS Eighty-four community-dwelling , frail male veterans , mean age of 75.5 years ( SD=7.33 ) , participated . The history of recurrent falls was determined by self or proxy report in a clinical interview . Mobility assessment s included the Modified Gait Abnormality Rating Scale ( GARS-M ) , stride length , and walking velocity ; functional performance was determined using the Physical Performance Test ( PPT ) .  The clinical usefulness of the measures was described by determining the sensitivity and specificity of each measure using the history of recurrent falls as a st and ard . RESULT Stepwise logistic regression analysis of the data indicated that the GARS-M ( p < .01 ) and the PPT ( p < .01 ) were the most important predictors of recurrent fall risk . The sensitivity and specificity of the measures used were : GARS-M , 62.3 % and 87.1 % ; PPT , 79.3 % and 71.0 % ; walking speed , 71.7 % and 74.2 % ; and stride length , 63.2 % and 77.4 % . Together the GARS-M and PPT demonstrated the highest sensitivity of 90.6 % and the highest specificity of 87 . 1 % based on a subject testing positive on at least one test . CONCLUSION Used independently and in combination , the GARS-M and the PPT were clinical ly useful measures in screening for older individuals at risk for recurrent falls PURPOSE To compare two self-administered , one interviewer-administered , and one performance-based measure of physical function in community-based older persons . METHODS Eighty-three subjects were recruited from meal sites , senior recreation centers , and senior housing units for a comprehensive geriatric assessment program . At the time of screening , study participants self-administered the Functional Status Question naire ( FSQ ) and were administered the Katz Activities of Daily Living ( ADL ) and the Older Americans Re sources and Services Instrumental Activities of Daily Living ( OARS-IADL ) instruments by interview . Participants also completed the Physical Performance Test ( PPT ) and were given the  Medical Outcomes Study SF-36 to self-administer on site or at home and return by mail . RESULTS All 83 subjects completed FSQ , Katz ADL , OARS-IADL , and PPT ; 72 returned SF-36 forms . Correlations between the two self-administered physical function measures ( FSQ and SF-36 ) were higher than between self-administered and interviewer-assessed ( ADL and OARS-IADL ) or performance-based ( PPT ) measures . When assessed for construct validity , the self-administered , OARS , and PPT measures had comparable correlations with role limitations as a result of physical health problems , but relationships between physical functional status measures and other SF-36 measures of health were inconsistent . CONCLUSION The relationships between commonly used self-administered , interviewer-administered , and performance-based measures of physical function were inconsistent and weak , suggesting that these instruments are not measuring the same construct OBJECTIVE To test the clinical relevance of the  stair climb power test ( SCPT )  as a measure of leg power impairments in mobility-limited older adults . DESIGN Cross-sectional analysis of baseline data from participants within a r and omized controlled trial . SETTING Rehabilitation research gym . PARTICIPANTS Community-dwelling older adults ( N=138 ; mean age , 75.4 y ) with mobility limitations as defined by the Short Physical Performance Battery ( SPPB ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  Leg power  measures included the  SCPT and double leg press power measured at 40 % ( DLP40 ) and 70 % ( DLP70 ) of the 1 repetition maximum . Mobility performance tests included the SPPB and its 3 components :  gait speed ,  chair st and time  , and st and ing balance . RESULTS Stair climb power per kilogram ( SCP/kg ) had correlations of moderate strength ( r=.47 , r=.52 ) with DLP40/kg and DLP70/kg , respectively . All 3 leg power measures correlated with each of the mobility performance measures with the exception of DLP40/kg ( r=.11 , P=.27 ) and DLP70/kg ( r=.11 , P=.18 ) with st and ing balance . Magnitudes of association , as described by the Pearson correlation coefficient , did not differ substantively among the separate power measures as they related to SPPB performance overall . Separate adjusted multivariate models evaluating the relationship between leg power and SPPB performance were all statistically significant and described equivalent amounts of the total variance ( R(2 ) ) in SPPB performance ( SCP/kg , R(2)=.30 ; DLP40 , R(2)=.32 ; DLP70 , R(2)=.31 ) . Analyses of the components of the SPPB show that the SCPT had stronger associations than the other leg power impairment measures with models predicting chair st and ( SCP/kg , R(2)=.25 ; DLP40 , R(2)=.12 ; DLP70 , R(2)=.13 ) , whereas both types of leg press power testing had stronger associations with models predicting gait speed ( SCP/kg , R(2)=.16 ; DLP40 , R(2)=.34 ; DLP70 , R(2)=.34 ) . Stair climb power was the only power measure that was a significant component of models predicting st and ing balance ( SCP/kg R(2)=.20 ) . CONCLUSIONS The SCPT is a clinical ly relevant measure of leg power impairments . It is associated with more complex modes of testing leg power impairments and is meaningfully associated with mobility performance , making it suitable for clinical setting s in which impairment-mobility relationships are of interest OBJECTIVES To describe women who attribute new disability to old age and to identify demographic , medical , behavioral , and psychosocial characteristics that correlate with attributing new disability to old age . DESIGN Prospect i ve cohort study with 4-year follow-up . SETTING Four geographic regions of the United States . PARTICIPANTS 9704 women aged > or = 67 years participating in the Study of Osteoporotic Fractures . Of these , 657 who reported no disability at baseline but at follow-up reported difficulty carrying out 1 or more of 13 functional activities were eligible for our analysis . MEASUREMENTS All women reporting difficulty in any functional activity at follow-up were asked " What is the main condition that causes you to have difficulty or prevents you from ( doing the activity ) ? " and were shown a card listing 14 medical conditions as well as the option " old age , " from which they could choose only one response . Women attributing difficulty or inability in 1 or more functional activities to old age were classified as attributing new disability to old age . We examined the relationship between attributing new disability to old age and the following characteristics measured at baseline : age , level of education , medical comorbidity , cognitive function , body mass index ( BMI ) , gait speed , grip strength , visual acuity , physical activity level , smoking status , social network level , and depressed mood . RESULTS Overall , 13.5 % of women attributed new disability to old age . Age was a strong independent correlate of attributing new disability to old age : compared with women age 67 to 69 , the odds of attributing new disability to old age for women age 70 to 79 was 3.6 times as large ( 95 % confidence interval [ CI ] = 1.6 - 8.3 ) , and for women age 80 or over was 5.5 times as large ( 95 % CI = 2.1 - 14.7 ) . The only other characteristic that remained an independent correlate of attributing new disability to old age was grip strength ; for each decile decrease in grip strength , a woman 's odds of attributing new disability to old age increased by 9 % ( odds ratio [ OR ] = 1.09 , 95 % CI = 1.01 - 1.19 ) . CONCLUSIONS Despite great advances in geriatric medicine , old age is still perceived as a causal agent in functional decline , especially among our oldest patients . Further study is needed to determine whether , how often , and under what circumstances older adults who attribute new disability to old age have medical conditions amenable to interventions that could preserve their functioning and improve their quality of life Increasing evidence from experimental studies and human observations suggests that drugs with anticholinergic properties can cause physical and mental impairment . The aim of this study was to evaluate the relationship between the use of drugs with anticholinergic activity and measures of physical performance , muscle strength , and functional status in persons aged 80 years or older . Data are from baseline evaluation of 364 subjects enrolled in the ilSIRENTE study . The ilSIRENTE study is a prospect i ve cohort study performed in the mountain community living in the Sirente geographic area ( L'Aquila , Abruzzo ) in Central Italy .  Physical performance was assessed using the physical performance battery score ( Short Physical Performance Battery ) , which is based on three timed tests : 4‐meter walking speed , balance , and chair st and tests . Muscle strength was measured by h and grip strength . We defined as anticholinergic drugs all medications for which serum anticholinergic activity was previously demonstrated . Analyses of covariance were performed to evaluate the relationship of anticholinergic drugs with physical function . In the unadjusted model , all the physical performance , muscle strength , and functional measures showed significant associations with the anticholinergic drug use . After adjustment for potential confounders ( age , gender , smoking , physical activity level , cognitive performance score , living alone , body mass index , congestive heart failure , lung diseases , diabetes ) , these associations were weaker but still statistically significant ( physical performance battery score : non‐users anticholinergic drugs 6.9 , SE 0.1 , users anticholinergic drugs 6.1 , SE 0.2 , P=0.05 ; h and grip strength : non‐users anticholinergic drugs 31.3 kg , SE 0.8 , users anticholinergic drugs 28.8 kg , SE 1.0 , P=0.05 ; Activities of Daily Living scale score : non‐users anticholinergic drugs 1.2 , SE 0.1 , users anticholinergic drugs 1.6 , SE 0.1 , P=0.03 ; Instrumental Activities of Daily Living scale score : non‐users anticholinergic drugs 2.7 , SE 0.1 , users anticholinergic drugs 3.4 , SE 0.1 , P<0.001 ) . The use of medication with anticholinergic properties is common among community older subjects in Italy . Our results suggest that among old‐old subjects the use of anticholinergic drugs is associated with impaired physical performance and functional status Arai T , Obuchi S , Inaba Y , Nagasawa H , Shiba Y , Watanabe S , Kimura K , Kojima M : The effects of short-term exercise intervention on falls self-efficacy and the relationship between changes in physical function and falls self-efficacy in Japanese older people : a r and omized controlled trial . Am J Phys Med Rehabil 2007;86:133–141 . Objective : To evaluate the effects of short-term exercise intervention on falls self-efficacy and to evaluate the relationships between baseline falls self-efficacy and changes in physical function in older people . Design : Single-blinded r and omized controlled trial . The participants were 171 subjects aged 65 and older . They were r and omly assigned into an exercise intervention group or a health education group . The subjects in the exercise intervention group performed an exercise program for 3 mos . Falls self-efficacy was measured using the falls efficacy scale ( FES ) . The measurements of physical function included static and dynamic balance , walking velocity , flexibility , and strength . Results : There was no significant improvement of FES in either group . But there were significant negative correlations between baseline FES score and the change in maximum walking velocity ( r = −0.29 , P < 0.018 ) and knee extensor strength ( r = −0.25 , P < 0.040 . Linear regression analysis showed that the change in static balance was related to baseline FES . Conclusions : The results suggest that a short-term exercise intervention had no effect , possibly because of the high baseline FES scores of the participants , on the confidence of community-dwelling older persons . However , the negative association between FES score and increases in some measures of function suggest that short-term exercise may be beneficial to a subset of older persons with lower FES scores OBJECTIVE To examine the association between previous fracture and different aspects of physical performance . DESIGN Population -based retrospective study . SETTING Orthopaedic research department . PARTICIPANTS R and omly selected women ( N = 1044 ) , all 75 years old and participants of the Malmö Osteoporosis Prospect i ve Risk Assessment study . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Type of and time since any previous fracture event were compared with results of tests on  physical performance function ( Romberg test , computerized sway test , gait speed , question naire )  at the age of 75 . RESULTS Women with no previous fractures ( n = 505 ) had a better median Romberg balance of 94 seconds ( interquartile range [ IQR ] , 75 - 118s ) than women with 1 , 2 , or 3 or more fractures , who had a median balance of 88 seconds ( IQR , 71 - 111s ) , 85 seconds ( IQR , 68 - 107s ) , and 81 seconds ( IQR , 65 - 109s ) , respectively ( Kruskal-Wallis analysis of variance , P = .002 ) . Balance was inferior in women who had sustained a previous fracture between the ages of 65 and 75 years compared with women with no previous fractures or fractures before the age of 65 years . Gait speed and questions on tendency to fall followed the same pattern . The computerized sway test could not differ between women with and without previous fractures . CONCLUSIONS Poor physical performance is associated with previous fractures . Inferior physical performance may exist up to 10 years after a fracture The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL OBJECTIVES To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization , decline in health , and decline in function in primary care setting s serving older adults . DESIGN Prospect i ve cohort study . SETTING Primary care programs of a Medicare health maintenance organization ( HMO ) and Veterans Affairs ( VA ) system . PARTICIPANTS Four hundred eighty-seven persons aged 65 and older . MEASUREMENTS  Lower extremity performance Established Population for Epidemiologic Studies of the Elderly ( EPESE ) battery including  gait speed , chair st and s , and t and em balance tests ; demographics ; health care use ; health status ; functional status ; probability of repeated admission scale ( Pra ) ; and primary physician 's hospitalization risk estimate . RESULTS Veterans had poorer health and higher use than HMO members . Gait speed alone and the EPESE battery predicted hospitalization ; 41 % ( 21/51 ) of slow walkers ( gait speed < 0.6 m/s ) were hospitalized at least once , compared with 26 % ( 70/266 ) of intermediate walkers ( 0.6 - 1.0 m/s ) and 11 % ( 15/136 ) of fast walkers ( > 1.0 m/s ) ( P < .0001 ) . The relationship was stronger in the HMO than in the VA . Both performance measures remained independent predictors after accounting for Pra . The EPESE battery was superior to gait speed when both Pra and primary physician 's risk estimate were included . Both performance measures predicted decline in function and health status in both health systems . Performance measures , alone or in combination with self-report measures , were more able to predict outcomes than self-report alone . CONCLUSION Gait speed and a physical performance battery are brief , quantitative estimates of future risk for hospitalization and decline in health and function in clinical population s of older adults . Physical performance measures might serve as easily accessible " vital signs " to screen older adults in clinical setting BACKGROUND Some studies have proposed chronic inflammation as an underlying biological mechanism responsible for physical function decline in elderly people . The aim of this study is to evaluate the relationship between several inflammatory markers and physical performance in an older population . METHODS This study is part of the " Invecchiare in Chianti " ( InCHIANTI ) study , a prospect i ve population -based study of older people , aim ed at identifying risk factors for late-life disability . The study sample consisted of 1020 participants aged 65 years and older living in the Chianti area of Italy .  Physical performance  was assessed using walking speed , the chair-st and test , and the st and ing balance test . H and -grip strength  was assessed using a h and -held dynamometer .  Serum levels of C-reactive protein ( CRP ) , interleukin (IL)-6 , tumor necrosis factor-alpha ( TNF-alpha ) , IL-10 , IL-1beta , IL-6sR , and IL-1RA were determined . Linear regression analyses were used to assess the multivariate relationship of inflammatory marker levels with physical performance , scored as a continuous variable from 0 to 3 , and h and -grip strength after adjustment for demographics , chronic conditions , medication use , and other biological variables . RESULTS CRP , IL-6 , and IL1RA were significantly correlated with physical performance ( r=-0.162 , r=-0.251 , and r=-0.127 , respectively ) . Significant correlations with h and -grip strength were found for CRP and IL-6 ( r=-0.081 and r=-0.089 , respectively ) . After adjustment for covariates , high levels of IL-6 and IL-1RA continued to be strongly associated with worse physical performance ( p<.001 and p=0.004 , respectively ) . High levels of CRP ( p<.001 ) and IL-6 ( p<.001 ) were associated with low h and -grip strength . Mean adjusted physical performance scores ranged from 2.21 in the CRP<0.59 mg/dl group to 2.07 in the CRP>0.60 mg/dl group ( p for trend=.004 ) , and from 2.25 in the lowest IL-6 quartile to 2.08 in the highest IL-6 quartile ( p for trend<.001 ) . This trend was also reflected in mean adjusted h and -grip strength , with a range from 28.8 kg for the CRP<0.59 mg/dl group to 26.0 kg for the CRP>0.60 mg/dl group ( p for trend=.001 ) , and from 27.4 kg for the lowest IL-6 quartile to 25.1 kg for the highest IL-6 quartile ( p for trend=.001 ) . CONCLUSIONS Inflammation , measured as high levels of IL-6 , CRP , and IL-1RA , is significantly associated with poor physical performance and muscle strength in older persons . These data also support the biological face validity of physical performance measures . The assessment of inflammatory markers may represent a useful screening test and perhaps a potential target of intervention BACKGROUND The relationship between cognitive function and physical disability in nondemented older adults is not well characterized . The purpose of this study was to determine the relationship between performance on psychometric measures and a modified Physical Performance Test ( modified PPT ) in older men and women . METHODS One hundred twenty-five men and women aged 75 years and older , who were enrolled in r and omized , controlled trials of exercise or hormone replacement therapy  , were recruited from the community-at-large and from congregate living sites . Measures obtained included  Trailmaking A and B tests , Cancellation R and om Figure tests , Weschler Associate Learning and 20-minute Delayed Recall , Verbal Fluency test , a modified PPT , and self-reports about performance of activities of daily living , medication use , and hospitalization in the previous year . RESULTS Simple regression analysis demonstrated that speed of performance on the Trailmaking B and Cancellation R and om Figure tests was significantly associated with total modified PPT score ( r = .29 , p < .001 and r = .36,p < .001 , respectively ) . A factor analysis of the psychometric test battery demonstrated that two factors , a cognitive speed factor and a memory factor , accounted for 55 % of the variance in cognitive test performance . Hierarchical multiple regression analyses demonstrated that age , number of medications , and the cognitive speed factor were independent predictors of total modified PPT score . CONCLUSIONS Cognitive processing speed is a significant component of physical frailty in this population , although it accounts for a small percentage of variance on a st and ardized physical performance test Background : Fear of falling ( FF ) is pervasive among older people and is an independent risk factor for decreased mobility and loss of quality of life . Although it is a serious health concern , little is known about the severity of the physical and health-related deficits in high-functioning fearful seniors . Objective : This study examined the physical correlates of FF in community-dwelling seniors in relation to their non-fearful counterparts and also explored the relevance of recent fall history . Subjects : Twenty-five volunteers who stated that they had curtailed their activities due to a FF and who reported themselves to be healthy participated . Non-fearful , age- and gender-matched subjects were also recruited and served as a comparison group . Methods : This cross-sectional study had participants come to the laboratory on one occasion for about 1.5 h. Limits of balance stability , walking speed , and lower limb muscle strength were measured in r and om order . In addition , the SF-36 , the Activities-specific Balance Confidence ( ABC ) scale and the Human Activity Profile question naires were completed to provide measures of heath status , FF and activity levels , respectively . Results : Subjects with a FF had lower ABC scores ( 69.8 ± 10.2 ) than controls ( 90.2 ± 7.9 ; p < 0.001 ) , and although they reported activity curtailment , the groups presented similar activity profiles ( p > 0.05 ) . Balance ability was not compromised in seniors with a FF , although their walking speed was slower than that of control subjects ( p < 0.004 ) . Lower limb weakness was significant in the FF group , which also reported low physical health . Perceived physical health , activity and hip flexor torque in combination accounted for almost 62 % of the variance in ABC scores . Secondary analysis of the data from the FF group revealed a tendency for those who had fallen in the past year to restrict their limits of stability compared to those who had not fallen ; though generally the effect sizes were small to moderate . Conclusions : The marked deficits in strength and health status found among seniors living independently in the community , who are in good health , but report being fearful of falling underscores the seriousness of FF as a potential health risk factor in the well elderly OBJECTIVES To determine , in a cohort of older individuals transitioning to frailty ( defined by Speechley and Tinetti , 1991 ) who have previously fallen , whether there are significant associations between demographic , functional , and behavioral characteristics and activity-related fear of falling , using both the Falls Efficacy Scale ( FES ) and the Activities-Specific Balance Confidence Scale ( ABC ) . DESIGN Baseline cross-sectional analysis in a prospect i ve cohort intervention study . SETTING Twenty independent senior living facilities in Atlanta . PARTICIPANTS Seventeen male and 270 female subjects ( n = 287 ) , age 70 and older ( mean + /- st and ard deviation , 80.9 + /- 6.2 ) , with Mini-Mental State Examination score > or = 24 , transitioning to frailty , ambulatory ( with or without assistive device ) , medically stable , and having fallen in the past year . MEASUREMENTS Activity-related fear of falling was evaluated with the FES and ABC Scale . Because of the comparable data derived from each scale , associations with functional measures -related analyses were expressed using the latter . Depression was measured by Center for Epidemiological Studies Depression Scale . Functional measurements included timed 360 degrees turn , functional reach test , timed 10-meter walk test , single limb st and s , picking up an object , and three chair st and s. RESULTS No statistically significant association was found between activity-related fear of falling and age . For the proposed activities , about half ( ABC , 48.1 % ; FES , 50.1 % ) of the subjects were concerned about falling or showed lack of confidence in controlling their balance . A statistically significant inverse correlation was found between FES and ABC ( r = -0.65 ; P < .001 ) . African-American subjects showed more activity-related fear of falling than did Caucasians ( odds ratio ( OR ) : 2.7 for ABC ; 2.1 for FES ) . Fearful individuals were more likely to be depressed and more likely to report the use of a walking aid than were nonfearful individuals . Fear of falling was significantly correlated to all of the functional measurements ( P < .05 ) . In a multivariable logistic regression model , depression , using a walking-aid , slow gait speed , and being an African-American were directly related to being more fearful of falling . CONCLUSIONS Activity-related fear of falling was present in almost half of this sample of older adults transitioning to frailty . The significant association of activity-related fear of falling with demographic , functional , and behavioral characteristics emphasizes the need for multidimensional intervention strategies to lessen activity-related fear of falling in this population BACKGROUND Increasing emphasis is being placed on physical performance measures as an outcome predictor . It is uncertain whether one or two simple measurements will have predictive value compared with a battery of tests . OBJECTIVES To assess whether simple performance measures such as  walking speed and stride length  will predict dependency , mortality , and institutionalization . DESIGN A 3-year longitudinal study of a r and om sample of subjects . SETTING Older people living in the community in Hong Kong , Special Administrative Region , China . SUBJECTS A total of 2032 Chinese subjects aged 70 years and older were recruited territory-wide by  proportional r and om sampling and followed for 3 years . MEASUREMENTS Functional status was measured using the Barthel Index at baseline and follow-up . The time taken to walk a distance of 16 feet  and the number of steps taken were measured at baseline . Stride length is estimated by dividing 16 by the average number of steps needed to complete the walk . Outcomes regarding dependency , mortality , and institutionalization at 36 months were recorded . RESULTS After excluding subjects lost to follow-up and those who had died , data were available for 559 men and 612 women . Univariate analysis showed that reduced walking speed and stride length were associated with increased risk of dependency , mortality , and institutionalization . In multivariate analysis for dependency and mortality , stride length , walking speed , age , and sex were included in the best prediction model ( ROC = 0.798 and 0.707 , respectively ) , whereas only stride length was included in the prediction for institutionalization ( ROC = 0.764 ) . CONCLUSIONS In terms of prevention or modifying outcomes , these two simple performance measures may be used as indicators for checking for occult disease and for interventional measures such as exercise prescription OBJECTIVES To examine  dog walking among dog owners and the relationship between walking behavior of dog owners and non-dog owners and maintained gait speed over 3 years . DESIGN Cross-sectional and longitudinal analyses of a prospect i ve cohort study . SETTING Memphis , Tennessee , and Pittsburgh , Pennsylvania . PARTICIPANTS Two thous and five hundred thirty-three community-dwelling adults aged 71 to 82 at 36 months of the Health , Aging and Body Composition Study . MEASUREMENTS  Dog ownership , reported walking behavior , change in walking behavior , and usual and rapid gait speed  over 3 years . RESULTS Of 394 dog owners , only 36 % walked their dogs at least three times per week . Cross-sectionally , dog walkers were more likely to achieve 150 minutes of walking per week and had faster usual and rapid walking speeds ( 1.20 vs 1.14 m/s and 1.62 vs 1.52 m/s , respectively ; P < .01 for both ) than non-dog owners who did not walk at least three times per week and similar speeds as non-dog owners who walked at least 150 minutes per week ( P > .50 ) . Three years later , subjects who had been dog walkers at baseline were approximately twice as likely as any other group to achieve recommended walking levels , independent of covariates . Dog walkers experienced similar declines in usual and rapid walking speed as non-dog owners who walked at least three times per week but maintained their initial mobility advantage . CONCLUSION Although dog ownership appears to facilitate walking behavior , only a minority of older dog owners walk their dogs . The mobility advantage of dog ownership was seen only in dog walkers and was similar to that associated with any walking . Given suboptimal walking activity in older adults , examining the degree to which dog ownership promotes walking activity in persons who do little walking on their own appears worth pursuing
target: Walking speed is a highly valid test , both at habitual and maximum speed .
  Both habitual and maximum walking speeds are valid instruments , and they predict death , hospitalization/institutionalization , and decline in mobility
background: The number of available walking tests has increased dramatically over the past decades .
  Therefore , it is highly important to help clinicians choose the most appropriate walking test for a specific setting .
  This systematic review aim ed to critically evaluate the reliability , validity , and responsiveness of clinical walking speed in a broad population of elderly persons living in the community , sheltered housing , or institutions .