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Am Fam Physician. 2010;81(3):340

Background: Walking speed is commonly used as a marker of health in older adults. A number of studies have implicated decreased walking speed in adverse health events such as falls, hospital admissions, persistent lower extremity limitation, and even all-cause mortality. It is not known yet what specific events lead to an increase in all-cause mortality. Dumurgier and colleagues studied the prognostic value of walking speed and its relationship with overall mortality and cardiovascular-related death.

The Study: Well functioning adults 65 years and older were recruited for enrollment in the Three-City study, which was conducted in three cities in France. An extensive history concentrating on coronary artery disease, diabetes mellitus, hypertension, angina, peripheral artery disease, Parkinson disease, hypercholesterolemia, and recent hip fracture was collected from every participant. After baseline interview, patients 85 years or younger were invited to the study center for gait and walking speed assessment. Participants were asked to walk a total of 6 meters at their normal pace, and then again at their fastest pace without running. Patients were subsequently followed up at 1.8, 3.6, and 5.1 years. After considering all-cause mortality, the authors further divided causes of death into three groups: cancer, cardiovascular, and other.

Results: Outcomes were assessed using chi-square tests and the Kaplan-Meier method to associate thirds of walking speed (lower, middle, and upper thirds) with cause of death. A total of 3,208 men and women were assessed (209 of whom died) over 16,414 person-years, showing increased risk of all-cause mortality among patients in the lowest one third of baseline walking speed. Additionally, patients in the lowest one third of walking speed had a greater risk of cardiovascular death than persons in the upper two thirds, but showed no difference in relation to cancer mortality.

Conclusion: The authors conclude that slow walking speed in well functioning older adults is strongly associated with an increased risk of cardiovascular and all-cause mortality.

editor's note: Walking, and exercise in general, have been associated with decreased mortality and morbidity from cardiovascular causes. Lower walking speed appears to be predictive of all-cause mortality and cardiovascular death. In an accompanying editorial,1 walking speed is discussed as a marker of frailty, which has been associated with increased hospital admissions, falls, and disability. A comprehensive definition of frailty shown to predict adverse outcomes includes at least three of the following criteria: unintentional weight loss, self-reported exhaustion, weakness (reduced grip strength), slow walking speed, and low levels of physical activity. If we can intervene and provide therapy for the above listed symptoms, perhaps we could extend or better the life of the frail, older adult.—SUMI SEXTON, MD, Associate Medical Editor, American Family Physician

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