Population Health Unit - "Salus In Apulia Study", National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
J Cachexia Sarcopenia Muscle. 2021 Apr;12(2):274-297. doi: 10.1002/jcsm.12667. Epub 2021 Feb 16.
Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross-sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health-related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty-five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one-third referred to multi-domain indexes or models and only 5% referred to other single-domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical-and population-based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health-related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology-based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes.
衰老通常与身体功能下降有关，最终导致日常生活活动（ADL）丧失自主性。行走是一种非常常见的 ADL，对老年生活质量的主要决定因素很重要，它需要整合许多生理系统。步态速度被描述为“第六生命体征”，因为它是衰老和疾病中健康和功能的核心指标。我们回顾了截至 2020 年 6 月的原始研究，这些研究评估了纵向和横断面观察性研究中的虚弱状况，特别关注在老年人中如何测量步态以及采用的步态参数如何影响估计的虚弱模型以及各种研究的健康相关结果（即临床、认知、身体和营养结果）。有 85 项研究符合搜索策略，并被纳入本系统评价。根据虚弱工具，超过 60%的研究使用了 Fried 及其同事提出的身体表型模型，而三分之一的研究参考了多领域指数或模型，只有 5%的研究参考了其他单一领域的虚弱模型（社会或认知）。步态测量和方案的高度异质性限制了直接比较研究结果的可能性，这可能是造成临床和人群基础环境中不同结局测量值差异的一个重要问题。步态似乎是健康和功能的指标，在虚弱的老年人中也是如此，不同的步态参数似乎可以预测临床、认知和身体领域的不良健康相关结局，在营养领域的预测程度较低。步态有可能阐明认知和运动能力下降的共同基本机制。技术的进步可能会扩展步态在不同临床环境中的有效性，也适用于虚弱的老年人，因此应该鼓励基于技术的评估。结合各种步态参数可以增强虚弱预测和不同虚弱表型的分类。
