Review Article

Walking Speed and Mortality: An Updated Systematic Review

Authors: Irene Rosmaninho, MD, Pedro Ribeirinho-Soares, MD, José Pedro L. Nunes, MD


Objective: The aim of our systematic review was to update the current evidence on the association between slow walking speed (WS) and mortality, expanding the current knowledge available in the literature.

Methods: A systematic review of the published data on the association of WS and mortality was carried out by searching on PubMed and ISI Web of Knowledge databases.

Results: From a title and abstract analysis, 61 articles were included that met the prespecified criteria. After a full-text analysis, 6 articles were excluded and the remaining articles accounted for 120,838 patients and > 25,148 deaths were registered. The duration of follow-ups ranged between 2 and 21 years. In general, studies have shown a consistent association between WS and mortality from all causes.

Conclusions: WS showed continuous and consistent evidence to be a good predictor of mortality. As such, our study supports the use of this tool in clinical practice as a way to improve health care.
Posted in: Allergy and Immunology4

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1. Ferrucci L, Cooper R, Shardell M, et al. Age-related change in mobility: perspectives from life course epidemiology and geroscience. J Gerontol A Biol Sci Med Sci 2016;71:1184–1194.
2. Rowe JW, Kahn RL. Successful aging. Gerontologist 1997;37:433–440.
3. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 2009;301:2024–2035.
4. Fritz S, M. Lusardi M. White paper: “walking speed: the sixth vital sign”. J Geriatr Phys Ther 2009;32:2–5.
5. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA 2011;305:50–58.
6. Van Kan GA, Rolland Y, Andrieu S, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 2009;13:881–889.
7. Kamiya K, Hamazaki N, Matsue Y, et al. Gait speed has comparable prognostic capability to six-minute walk distance in older patients with cardiovascular disease. Eur J Prev Cardiol 2018;25:212–219.
8. Hall WJ. Update in geriatrics. Ann Intern Med 2006;145:538–543.
9. Woo J. Walking speed: a summary indicator of frailty? J Am Med Dir Assoc 2015;16:635–637.
10. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146–M157.
11. Barak Y, Wagenaar RC, Holt KG. Gait characteristics of elderly people with a history of falls: a dynamic approach. Phys Ther 2006;86:1501–1510.
12. Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000;55:M221–M231.
13. Perera S, Patel KV, Rosano C, et al. Gait speed predicts incident disability: a pooled analysis. J Gerontol A Biol Sci Med Sci 2016;71:63–71.
14. Montero-Odasso M, Schapira M, Soriano ER, et al. Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci 2005:60:1304–1309.
15. Penninx BW, Ferrucci L, Leveille SG, et al. Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. J Gerontol A Biol Sci Med Sci 2000;55:M691–M697.
16. Kuate-Tegueu C, Avila-Funes J-A, Simo N, et al. Association of gait speed, psychomotor speed, and dementia. J Alzheimers Dis 2017;60:585–592.
17. Rosso AL, Verghese J, Metti AL, et al. Slowing gait and risk for cognitive impairment: the hippocampus as a shared neural substrate. Neurology 2017; 89:336–342.
18. Cooper R, Kuh D, Hardy R. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 2010;341:c4467.
19. Liu B, Hu X, Zhang Q, et al. Usual walking speed and all-cause mortality risk in older people: a systematic review and meta-analysis. Gait Posture 2016;44:172–177.
20. Veronese N, Stubbs B, Volpato S, et al. Association between gait speed with mortality, cardiovascular disease and cancer: a systematic review and meta-analysis of prospective cohort studies. J Am Med Dir Assoc 2018; 19:981–988.e7.
21. Haffar S, Shalimar, Kaur RJ, et al. Acute liver failure caused by hepatitis E virus genotype 3 and 4: a systematic review and pooled analysis. Liver Int 2018;38:1965–1973.
22. Zhao W, Ukawa S, Tsushita K, et al. Association of gait speed with mortality among the Japanese elderly in the New Integrated Suburban Seniority Investigation Project: a prospective cohort study. Age Ageing 2014;44: 153–157.
23. Imran TF, Orkaby A, Chen J, et al. Walking pace is inversely associated with risk of death and cardiovascular disease: the Physicians’ Health Study. Atherosclerosis 2019;289:51–56.
24. Petermann-Rocha F, Ho FK, Welsh P, et al. Physical capability markers used to define sarcopenia and their association with cardiovascular and respiratory outcomes and all-cause mortality: a prospective study from UK Biobank. Maturitas 2020;138:69–75.
25. Jotheeswaran A, Bryce R, Prina M, et al. Frailty and the prediction of dependence and mortality in low-and middle-income countries: a 10/66 population-based cohort study. BMC Med 2015;13:138.
26. Goldman N, Glei DA, Weinstein M. What matters most for predicting survival? A multinational population-based cohort study. PloS One 2016; 11:e0159273.
27. Berges I-M, Graham JE, Ostir GV, et al. Sex differences in mortality among older frail Mexican Americans. J Womens Health 2009;18:1647–1651.
28. Goldman N, Glei DA, Rosero-Bixby L, et al. Performance-based measures of physical function as mortality predictors: incremental value beyond selfreports. Demogr Res 2014;30:227.
29. Lee W-J, Peng L-N, Chiou S-T, et al. Physical health indicators improve prediction of cardiovascular and all-cause mortality among middle-aged and older people: a national population-based study. Sci Rep 2017;7:1–8.
30. Lee W-J, Peng L-N, Lin M-H, et al. Determinants and indicators of successful ageing associated with mortality: a 4-year population-based study. Aging (Albany NY) 2020;12:2670.
31. Keevil VL, Luben R, Hayat S, et al. Physical capability predicts mortality in late mid-life as well as in old age: findings from a large British cohort study. Arch Gerontol Geriatr 2018;74:77–82.
32. Sobestiansky S, Michaelsson K, Cederholm T. Sarcopenia prevalence and associations with mortality and hospitalisation by various sarcopenia definitions in 85–89 year old community-dwelling men: a report from the ULSAM study. BMC Geriatr 2019;19:318.
33. Hsu B, Merom D, Blyth FM, et al. Total physical activity, exercise intensity, and walking speed as predictors of all-cause and cause-specific mortality over 7 years in older men: the Concord Health and Aging in Men Project. J Am Med Dir Assoc 2018;19:216–222.
34. Stanaway FF, Gnjidic D, Blyth FM, et al. How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. BMJ 2011;343:d7679.
35. Idland G, Engedal K, Bergland A. Physical performance and 13.5-year mortality in elderly women. Scand J Public Health 2013;41:102–108.
36. Blain H, Carriere I, Sourial N, et al. Balance and walking speed predict subsequent 8-year mortality independently of current and intermediate events in well-functioning women aged 75 years and older. J Nutr Health Aging 2010;14:595–600.
37. Rolland Y, Lauwers-Cances V, Cesari M, et al. Physical performance measures as predictors of mortality in a cohort of community-dwelling older French women. Eur J Epidemiol 2006;21:113–122.
38. Cesari M, Kritchevsky SB, Penninx BWHJ, et al. Prognostic value of usual gait speed in well-functioning older people—results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2005;53:1675–1680.
39. Cesari M, Kritchevsky SB, Newman AB, et al. Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2009;57:251–259.
40. Graham JE, Al Snih S, Berges IM, et al. Frailty and 10-year mortality in community-living Mexican American older adults. Gerontology 2009;55: 644–651.
41. Abe T, Kitamura A, Taniguchi Y, T., et al. Pathway from gait speed to incidence of disability and mortality in older adults: a mediating role of physical activity. Maturitas 2019;123:32–36.
42. Woo J, Ho SC, Yu AL. Walking speed and stride length predicts 36 months dependency, mortality, and institutionalization in Chinese aged 70 and older. J Am Geriatr Soc 1999;47:1257–1260.
43. Lyyra T-M, Leskinen E, Heikkinen E. A cohort study found good respiratory, sensory and motor functions decreased mortality risk in older people. J Clin Epidemiol 2005;58:509–516.
44. Elbaz A, Sabia S, Brunner E, et al. Association of walking speed in late midlife with mortality: results from the Whitehall II cohort study. Age (Dordr) 2013;35:943–952.
45. Yazdanyar A, Aziz MM, Enright PL, et al. Association between 6-minute walk test and all-cause mortality, coronary heart disease–specific mortality, and incident coronary heart disease. J Aging Health 2014;26:583–599.
46. Veronese N, Stubbs B, Fontana L, et al. A comparison of objective physical performance tests and future mortality in the elderly people. J Gerontol A Biol Sci Med Sci 2017;72:362–368.
47. Woo J, Yu R, Leung J. Predictive ability of individual items of the Cardiovascular Health Study (CHS) scale compared with the summative score. J Am Med Dir Assoc 2018;19:444–449.
48. Woo J, Yau F, Leung J, et al. Peak oxygen uptake, six-minute walk distance, six-meter walk speed, and pulse pressure as predictors of seven year all-cause and cardiovascular mortality in community-living older adults. Exp Gerontol 2019;124:110645.
49. Koivunen K, Sillanpää E, von Bonsdorff M, et al. Mortality risk among older people who did versus did not sustain a fracture: baseline pre-fracture strength and gait speed as predictors in a 15-year follow-up. J Gerontol A Biol Sci Med Sci 2020;75:1996–2002.
50. Verlinden VJ, van der Geest JN, Hoogendam YY, et al. Gait patterns in a community-dwelling population aged 50 years and older. Gait Posture 2013;37:500–505.
51. Dommershuijsen LJ, Isik BM, Darweesh SKL, et al. Unraveling the association between gait and mortality—one step at a time. J Gerontol A Biol Sci Med Sci 2020;75:1184–1190.
52. Rosero-Bixby L, Dow WH. Predicting mortality with biomarkers: a population-based prospective cohort study for elderly Costa Ricans. Popul Health Metrics 2012;10:11.
53. Sanders JB, Bremmer MA, Comijs HC, et al. Gait speed and processing speed as clinical markers for geriatric health outcomes. Am J Geriatr Psychiatry 2017;25:374–385.
54. Dumurgier J, Elbaz A, Ducimetière P, et al. Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study. BMJ 2009;339:b4460.
55. Boulifard DA, Ayers E, Verghese J. Home-based gait speed assessment: normative data and racial/ethnic correlates among older adults. J Am Med Dir Assoc 2019;20:1224–1229.
56. Vetrano DL, Landi F, De Buyser SL, et al. Predictors of length of hospital stay among older adults admitted to acute care wards: a multicentre observational study. Eur J Intern Med 2014;25:56–62.
57. Havighurst RJ. Successful aging. Gerontologist 1961;1:8–13.
58. Kim S, Myers L, Wyckoff J, et al. The frailty index outperforms DNA methylation age and its derivatives as an indicator of biological age. Geroscience 2017;39:83–92.
59. Applegate WB, Blass JP, Williams TF. Instruments for the functional assessment of older patients. N Engl J Med 1990;322:1207–1214.
60. Cesari M, Penninx BWJH, Pahor M, et al. Inflammatory markers and physical performance in older persons: the InCHIANTI study. J Gerontol A Biol Sci Med Sci 2004;59:M242–M248.
61. Elbaz A, Ripert M, Tavernier B, et al. Common carotid artery intima-media thickness, carotid plaques, and walking speed. Stroke 2005;36:2198–2202.
62. Lelli D, Tolone S, Pulignano G, et al. Nutritional status is associated with physical function and disability in older adults with chronic heart failure. Eur J Intern Med 2020;74:73–78.
63. Afilalo J, Eisenberg MJ, Morin J-F, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol 2010;56:1668–1676.
64. Wolfe A. Institute of Medicine report: crossing the quality chasm: a new health care system for the 21st century. Policy Politics Nurs Pract 2001;2: 233–235.
65. Pasma JH, Stijntjes M, Ou SS, et al. Walking speed in elderly outpatients depends on the assessment method. Age (Dordr) 2014;36:9736.
66. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85–M94.
67. Pavasini R, Guralnik J, Brown JC, et al. Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med 2016;14:215.