Is Trunk Posture in Walking a Better Marker than Gait Speed in Predicting Decline in Function and Subsequent Frailty?

Abstract

Background: Many recent guidelines and consensus on sarcopenia have incorporated gait speed and grip strength as diagnostic criteria without addressing early posture changes adopted to maintain gait speed before weakness is clinically evident.

Objectives: Older adults are known to compensate well for declining physiological reserve through environmental modification and posture adaptation. This study aimed to analyze and identify significant posture adaptation in older adults that is required to maintain gait speed in the face of increasing vulnerability. This would be a useful guide for early posture correction exercise interventions to prevent further decline, in addition to traditional gait, balance, and strength training.

Design: A community-based cross-sectional study.

Setting and participants: The participants comprised 90 healthy community-dwelling Chinese men between the ages of 60 and 80 years and 20 Chinese adults between the ages of 21 and 50 years within the normal BMI range as a comparison group.

Measurements: All the participants underwent handgrip strength testing, 6-minute walk, timed up-and-go (TUG), and motion analysis for gait characteristics. Low function was characterized by slow walking speed (<1.0 m/s) and/or slow TUG (>10 seconds), whereas low strength was determined by hand grip dynamometer testing (<26 kg). The degree of frailty was classified using the Canadian Study for Health and Ageing Clinical Frailty Scale (CSHA-CFS) to differentiate between healthy and vulnerable older adults.

Results: As expected, the vulnerable older adults had lower functional performance and strength compared with the healthy older adults group. However, a significant number demonstrated posture adaptations in walking in all 3 groups, including those who maintained a good walking speed (>1.0 m/s). The extent of such adaptation was larger in the vulnerable group as compared with the healthy group.

Conclusion: Although gait speed is a robust parameter for screening older adults for sarcopenia and frailty, our data suggest that identifying trunk posture adaptation before the onset of decline in gait speed will help in planning interventions in the at-risk community-dwelling older adults even before gait speed declines.

Keywords: Sarcopenia; falls; frailty; gait analysis; gait speed; posture adaptation; walking speed.