Elsevier

Gait & Posture

Volume 45, March 2016, Pages 12-18
Gait & Posture

Effect of calendar age on physical performance: A comparison of standard clinical measures with instrumented measures in middle-aged to older adults

https://doi.org/10.1016/j.gaitpost.2015.12.018Get rights and content

Abstract

Background

Decline in physical performance is highly prevalent during aging. Identification of sensitive markers of age-related changes in physical performance is important for early detection, development of therapeutic strategies and insight into underlying mechanisms. We studied the association of calendar age and familial longevity with standard clinical and instrumented measures of physical performance in a cohort of healthy middle-aged to older adults.

Methods

Cross-sectional analysis within the Leiden Longevity Study consisting of offspring of nonagenarian siblings and their partners (n = 300, mean age (SD) 65.3 (6.7) years). Standard clinical measures were 25-meter walking speed and total duration of the chair stand test (CST). Instrumented measures were determined using a body fixed sensor. Dependence of physical performance on calendar age and familial longevity (offspring versus partner status) was analyzed using linear and logistic regression, respectively, adjusted for gender and height.

Results

Higher calendar age was associated with slower walking speed and longer duration of the CST (standardized β (95% CI) −.024 (−.042; −.006) and .035 (.014;.056), respectively). Instrumented measures showed similar effect sizes with strongest associations for gait stability and symmetry in mediolateral direction and for the extension and flexion phase of sit-to-stand and stand-to-sit transfers, respectively. No differences were observed between offspring of nonagenarian siblings and their partners.

Conclusions

Standard clinical and instrumented measures of physical performance are associated with similar effect size to age-related changes in physical performance observable from middle age. The potential added value of instrumented measures for understanding underlying mechanisms requires further attention.

Introduction

Decline in physical performance is highly prevalent during aging leading to loss of independence and a poorer quality of life [1]. Furthermore, older adults with impaired physical performance have a high risk of falls, further reducing the quality of life and placing a heavy economic burden on society [2]. Identification of sensitive markers of age-related changes in physical performance is of utmost importance for the early detection, development of therapeutic strategies and insight into underlying mechanisms.

Assessment of physical performance is part of the comprehensive geriatric assessment (CGA) in clinical practice. Important clinical measures of physical performance commonly include walking speed and the duration of repeated sit-to-stand movements, assessed by the chair stand test (CST) [3], [4]. Walking speed is an important indicator of health status and function by reflecting the interaction of several underlying systems, such as the central and peripheral nervous, sensory, muscular, skeletal, and cardiopulmonary system [5], [6]. Sit-to-stand movements are one of the most mechanically demanding functional tasks during daily activities [7]. Furthermore, the CST is an important indicator for the performance of other daily activities, like climbing stairs, by measuring lower body strength [8].

Standard clinical measures of physical performance, using simply total time as the outcome, provide a common output representing a combination of possible underlying mechanisms. Based on previous studies showing the association of calendar age with various instrumented measures of physical performance and their use in the early identification and prediction of pathology [9], [10], [11], instrumented measures might be sensitive markers of age-related changes in physical performance providing possible insights into underlying determinants. Therefore, we assessed the association of calendar age with standard clinical and instrumented measures of the 25-meter walk and CST in a study population of offspring of nonagenarian siblings together with their partners. We used this study population of middle-aged to older adults to be able to assess changes in physical performance that are already observable from middle age in the absence of overt diseases. Additionally, we compared both measures between the offspring of nonagenarian siblings, who are enriched for familial factors of longevity, and their partners to assess the sensitivity for familial longevity representing the biological age of the participants, i.e. the person's rate of aging compared to their calendar age.

Section snippets

Leiden Longevity Study

The Leiden Longevity Study is a longitudinal cohort consisting of 421 families of long-lived Caucasian siblings of Dutch descent [12]. Families were recruited if at least two long-lived siblings were alive and met the age criteria of ≥89 years for males and ≥91 years for females. Additionally, the offspring of these long-lived families were included together with their partners as controls being of comparable age and sharing the same socioeconomic and geographical background. Enrolment took

Results

The characteristics of the participants are shown in Table 1 together with the characteristics stratified for offspring and partners. Mean age (SD) of all participants was 65.3 (6.7) years. Offspring and partners had similar calendar age, years of education and measures of anthropometrics. The prevalence of age-related diseases, like diabetes mellitus and hypertension, was lower among offspring compared to their partners. In Fig. 2, the 25-meter walking speed and duration of the CST for all

Discussion

In this study population of middle-aged to older adults, physical performance assessed with the 25-meter walk and CST was lower at higher calendar age. The effect size for the standard clinical measures dependent on calendar age was similar to those of instrumented measures assessed with a body fixed sensor at the lower back. No statistically significant association was found between familial longevity and both standard clinical and instrumented measures of physical performance, comparing

Conflict of interest

None to declare for all authors.

Acknowledgements

This work was supported by a grant from the Netherlands Organization for Scientific Research (ZonMw), the Ministry of Health, Welfare and Sports, the Netherlands Genomics Initiative/Netherlands Organization for Scientific Research (NGI/NWO; 05040202 and 050-060-810 Netherlands Consortium for Healthy Aging (NCHA)) and the seventh framework program MYOAGE (HEALTH-2007-2.4.5-10).

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