Posting on Know-Stroke.org as this topic of gait and mobility and getting people moving early as a primary prevention strategy for stroke and all co-morbidities is always part of my education as a health professional.  Perhaps after you read this study you’ll agree we should be prescribing a walking quota with our therapeutic exercise prescriptions, along with digital tools and trackers that can reinforce and monitor better guidelines for our patients as part of keeping a healthy body and brain in balance.

David Dansereau,MSPT 

Stroke Awareness | Recovery | Rehabilitation

I’ve been writing quite a bit about gait lately.  Not because I’m an expert in this area*, but because as a physical therapist I feel every patient I see should have this measurement recorded and monitored, regardless of age or condition. 

*[Personal sidebar] My kids will tell you otherwise by the way, as they are constantly accusing me of watching the way people walk when we are out in public …oh well- occupational hazard I guess.   I digress…

The latest study on gait provides more evidence to this observation that perhaps we should all take a closer look at how people walk and include this measurement more often and earlier as well.  

I’m referring to a recent study by Rasmussen et al. published October 11, 2019 in JAMA Network Open  which provides evidence suggesting that reduced gait speed in generally healthy adults in their 40s already reflects relatively worse physical and cognitive function and an accelerated rate of aging compared with adults with normal gait speed.  We are often trained as physical therapists to monitor gait only after we receive a referral for a lower extremity case or a new balance and fall patient. Quite often that patient is older and/or has been diagnosed with a neurodegenerative disorder. 

In my opinion, this study suggests that although gait speed has been a routine test under these cases, its use and meaning and application earlier in life which has been unclear, should perhaps be given more focus.

David Dansereau, MSPT

More insight on the brain and cognitive health

In addition to declining gait speed possibly having negative health consequences earlier in life than anticipated, the study also suggested slower gait speed at midlife was associated with lower early childhood indicators of brain health.  There is some discussion in the article about reaching too far in this assessment but it is still worth noting there is evidence worth following up on that gait speed might be a predictor of overall brain health.  

Study Design

The population studied was 904 individuals from New Zealand who were followed up regularly for more than 40 years, since age 3 years.  The authors assessed the rate of aging with 2 validated indicators: an independent perception of the rate of facial aging and a physiological index that measures the rate of change in 19 markers of body system health.  

These biomarkers were quite robust and included:

  1. body mass index
  2. waist-to-hip ratio
  3. total cholesterol level
  4. triglyceride level
  5. high-density lipoprotein cholesterol level
  6. ratio of apolipoprotein B100 to apolipoprotein A1
  7. lipoprotein(a) level
  8. creatinine clearance
  9. blood urea nitrogen level
  10. C-reactive protein level
  11. white blood cell count
  12. glycated hemoglobin level
  13. leptin level
  14. blood pressure (mean arterial pressure)
  15. cardiorespiratory fitness (maximum oxygen consumption)
  16. forced expiratory volume in 1 second 
  17. ratio of forced expiratory volume in 1 second to forced vital capacity
  18. gum health
  19. caries-affected tooth surfaces.

Results on the Brain and a Body Out of Balance

The study results reported slow gait speed was related to accelerated biological aging across multiple organ systems, smaller brain volume, more cortical thinning, smaller cortical surface area, and more white matter hyperintensities. Slow speed also was tied to poor balance and visual-motor coordination, weak strength, and older facial appearance.  It was noted people who had a lower IQ in midlife and participants who exhibited cognitive decline from childhood to adulthood had slower gait at age 45.

People who had poor neurocognitive functioning at age 3 also had slower gait in midlife.

Bottom Line : What can be done 

Start Moving and Stay Moving!

Limitations of this research aside, let’s study gait more and pay attention to educating and rewarding health practitioners on empowering patients to move and stay healthy.  

Reimbursement drives all we are able to do in primary prevention and health education, so let’s start making digital tools available to prove behavioral change education works.  

We can empower patients to take charge and walking and monitoring gait speed is a simple, inexpensive indicator of well-being across adulthood. Let’s pay attention and use this movement vital sign, but let’s also educate and fund an initiative to target our youth about how their bodies and bright minds actually work well before they reach midlife and start to slow down! Ask me about getting involved in my Bright Minds Project to tackle this problem!

David Dansereau at Know-Stroke.org
Let Me Know Your Thoughts!
Comment below or contact me with your solutions!

References:

Rasmussen  LJH, Caspi  A, Ambler  A,  et al.  Association of neurocognitive and physical function with gait speed in midlife.  JAMA Netw Open. 2019;2(10):e1913123. doi:10.1001/jamanetworkopen.2019.13123

Photo by Krzysztof Kowalik on Unsplash

Published by David Dansereau

Licensed Physical Therapist, Nutritionist and Author in private consulting practice at PTC Physical Therapy Consulting and SmartMovesPT. Know-Stroke.org is my blog and members resource to raise stroke awareness and educate the public about reducing stroke risk as well as provide tips, tools and review new technologies for stroke recovery. Learn about my book, Body in Balance sold on Amazon at www.physicaltherapycoach.com

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