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It’s hard to understate the importance of a gait speed test. This relatively simple-seeming measure provides a wealth of information for patients and older adults in particular. Gait speed can help determine a variety of diverse indicators, from fall risk to cognitive decline, and even death.

Understanding the importance of this test, what it indicates, and how to perform and measure it will help both you and your patients.

What is the Gait Speed Test?

The Gait Speed Test – sometimes also referred to as the Walking Speed test – is useful in assessing the mobility and functional status of a variety of patient populations. In fact, this measure is so important in assessing patients, it’s been referred to as the “6th vital sign” (Fritz et al, 2009).

The Gait Speed Test is precisely what its name implies – a test to measure the speed that a patient is able to walk over a specific distance on a level surface. The test is versatile – it can be performed in any number of environments – and can be offered to and completed by a wide range of individuals and diagnosis.

Why the Gait Speed Test Matters

As alluded to in the previous section, gait speed results are a powerful measure that is as crucial as vitals like blood pressure and can indicate far more than just functional mobility. Gait speed can also be used as a diagnostic tool in detecting “risky” individuals, who may be more vulnerable for adverse events.

There have been several studies published within the last year that propose cut-off values for independently predicting poor outcomes. The outcomes include falls (Stefan et al, 2020), fractures (Alajlouni et al, 2020), hospital length of stay and re-hospitalizations (Villani et al, 2020), quality of life (Lilamond et al, 2020), and post-operative delirium (Rao et al, 2020), to name a few.

Gait speed is considered a valid indicator of independence in various patient populations. Older adults who walk >1.1 m/s likely have the energy capacity to perform household activities (Studenski, 2009), whereas those who walk ≤0.67 m/s are more likely to experience onset of difficulty with self-care such as dressing or bathing (Huang et al, 2010).

Some people may experience these changes in function at different walking speeds. For example, individuals after a myocardial infarction, or heart attack, have 2.3-fold greater odds of developing new inability to perform activities of daily living (ADLs) when their comfortable speed is less than 0.8 m/s (Flint et al, 2018). This is because walking ability is influenced by several physiological subsystems which are affected differently based on varying diagnoses, and even age or gender. The subsystems that influence walking include the central nervous system, perceptual system, muscle, skeletal and joints, energy production, and peripheral nervous system (Ferrucci et al, 2000).

Gait speed results should be a key part of goal-setting and determining effectiveness of interventions. For every 0.2 m/s increase in speed achieved, there is a 38% decrease in the odds of demand for personal care (Studenski, 2003). For the results to be useful, however, administration of the test must be standardized and consistent each time it is completed.

How to Administer the Gait Speed Test

Despite being an indicator of potential issues in a variety of subsystems and a measure of potential independence, the gait speed test is easily conducted with very little equipment. All that is needed is the ability to measure out the appropriate distance for the test path and a means of tracking time.

While the 10-meter walk test is most common, shorter distances of 8- or even 4-meters can be used if necessary. The actual distance you choose, however, is less important than maintaining consistency on retests. A recent study by Krumpoch et el (2020) found small but statistically significant differences when comparing gait speed over 4- and 8-m distances.

Rope lengths, tape, or cones and a tape measure are all ways to quickly set up the walking course. For a 10-meter walk test, measure and mark the overall length of the track. Add 2 additional marks 2-meters before and after the start and end points. These segments allow for acceleration and deceleration so that the actual portion of the test that is being measured is the patient’s true walking speed.

The test should be performed a minimum of two times but ideally three times, and an average calculated. These instructions assume that a 10-meter distance is being measured.

When ready to perform the first trial, have the patient line up at the first mark (2-m before the starting line). Let them know that you’ll be timing them and that, when you say “Go” you want them to walk at their normal pace until you say “stop”.

Begin timing when the patient’s front foot first crosses the starting mark, and cease timing when they cross the 10-meter mark. Remember, don’t tell them to “Stop” until they are at least 2-meters past the end mark in order to minimize deceleration during the full 10-meters. If an assistive walking device is used, be sure to note that along with the times.

Scoring the Gait Speed Test

Assuming that three trials were completed, add up the results from those trials and divide by 3. This will give you the average seconds it takes the patient to walk the timed distance. Once the average is found, divide the distance – 10 meters – by the average number of seconds. This will give you the patient’s average speed in meters/second.

Gait speed calculators, such as the one included in Mobile Measures app, will significantly reduce the time and energy required to calculate scores, interpret results, and document findings. Try it out FREE for 2 weeks on both Android and Apple devices.

Walking speed or gait speed is a crucial measure that can indicate the need for further intervention and increased care. It can also be an early indicator of issues within a host of subsystems. With minimal equipment needed, there is little reason not to perform this vital test with patients who are able to safely participate.

References

1. Cesari M, Kritchevsky SB, Penninx BWHJ et al (2005) Prognostic value of usual gait speed in well-functioning older people–results from the Health, Aging and Body Composition Study. J Am Geri- atr Soc 53:1675–1680
2. Ferrucci L Bandinelli S Benvenuti E et al.  Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 2000;48(12):1618–1625
3. Flint K, Kennedy K, Arnold S, et al. Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction. J Am Heart Assoc. 2018;7e008296.
4. Fritz, S., Lusardi, M. White Paper: “Walking Speed: the Sixth Vital Sign”. Journal of Geriatric Physical Therapy. 2009; 32(2):2-5.
5. Huang W, Perera S, VanSwearingen J, Studenski S. Performance measures predict the onset of basic ADL difficulty in community-dwelling older adults. J Am Geriatr Soc. 2010;58(5):844-852.
6. Schoon Y, Bongers K, Van Kempen J et al (2014) Gait speed as a test for monitoring frailty in community-dwelling older people has the highest diagnostic value compared to step length and chair rise time. Eur J Phys Rehabil Med 50:693–701
7. Stefan L, Kosavic M, Zvonar M.Gait Speed as a Screening Tool for Foot Pain and the Risk of Falls in Community-Dwelling Older Women: A Cross-Sectional Study. Clinical Interventions in Aging. 2020; 15:1569–1574.
8. Studenski S Bradypedia: is gait speed ready for clinical use? J Nutr Health Aging 2009;13(10):878–880
9. Studenski S, Perera S, Patel K et al (2011) Gait speed and survival in older adults. JAMA 305:50–58
10. Studenski S, Perera S, Wallace D, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003;51(3):314-322.
11. Krumpoch S, Lindemann U, Rappi A, et al. The effect of different test protocols and walking distances on gait speed in older persons. Aging Clinical and Experimental Research. 2020. https://doi.org/10.1007/s40520-020-01703-z
12. Lilamand M, Saintout M, Vigan M, et al. Quality of life, physical performance and nutritional status in older patients hospitalized in a cardiology department. Journal of Geriatric Cardiology (2020) 17: 410-416.
13. Lindholm B, Brogårdh C, Odin P, Hagell P. Longitudinal prediction of falls and near falls frequencies in Parkinson’s disease: a prospective cohort study. Journal of Neurology. 2020.
14. Rao Q, Shi S, Afilalo J, et al. Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement. Clinical Interventions in Aging. 2020:15 1471–1479.
15. Villani ER, Vetrano DL, Franza L, Carfì A, Brandi V, Volpato S, Corsonello A, Lattanzio F, Ruggiero C, Onder G, Palmer K. Physical performance measures and hospital outcomes among Italian older adults: results from the CRIME project. Aging Clin Exp Res. 2020 Sep 14. doi: 10.1007/s40520-020-01691-0. Epub ahead of print. PMID: 32929695.