Walking Ability and All-Cause Mortality in Older Women

Abstract

In this study self-reported ability to walk 2 km and six-minute walking test (6MWT) performance were examined as predictors of all-cause mortality in 434 women, aged 63–76 years. The primary outcome measure was all-cause mortality (follow-up: 8 years). Predictors were self-reported difficulties in walking 2 km and 6-min walking distance tertiles of ≤495, 496–560 and ≥561 m, and no test result due to refusal by the physician to grant permission to perform the test or participant's inability or unwillingness to perform the test. During the follow-up, 39 participants died. Participants reporting minor (age- and body mass index-adjusted hazard ratio 2.53, 95% confidence interval 1.12–5.69) or major (7.93, 3.49–18.05) difficulties in walking 2 km had increased risk of death compared with those reporting no difficulties. Participants with no 6MWT result (6.99, 2.46–19.86) were at an increased risk of death when compared with participants who walked ≥561 m. A similar trend (2.47, 0.81–7.56) was found for participants with walking distance of ≤495 m during the 6MWT. The trends remained similar after adjustments for other confounders. In conclusion, self-reported difficulties in walking 2 km are associated with an increased risk of death in older community-dwelling women. Objectively measured walking ability gives similar results.

Key words

self-reported walking difficulties - six-minute walking test - mortality

References

• 1 American Thoracic Society . ATS Statement: guidelines for the six-minute walk test.  Am J Respir Crit Care Med. 2002;  166 111-117
• 2 Bittner V, Weiner DH, Yusuf S, Rogers WJ, McIntyre KM, Bangdiwala SI, Kronenberg MW, Kostis JB, Kohn RM, Guillotte M, Greenberg B, Woods PA, Bourassa MG. Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction.  JAMA. 1993;  270 1702-1707
• 3 Blair SN, Kohl 3rd HW, Paffenbarger Jr RS, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women.  JAMA. 1989;  262 2395-2401
• 4 Brock DB, Lemke JH, Branch LG, Evans DA, Berkman LF. Mortality and physical functioning in epidemiologic studies of three older populations.  J Aging Soc Policy. 1994;  6 21-37
• 5 Casanova C, Cote C, Marin JM, Pinto-Plata V, de Torres JP, Aguirre-Jaíme A, Vassaux C, Celli BR. Distance and oxygen desaturation during the 6-min walk test as predictors of long-term mortality in patients with COPD.  Chest. 2008;  134 746-752
• 6 Cote CG, Pinto-Plata V, Kasprzyk K, Dordelly LJ, Celli BR. The 6-min walk distance, peak oxygen uptake, and mortality in COPD.  Chest. 2007;  132 1778-1785
• 7 Dumurgier J, Elbaz A, Ducimetière P, Tavernier B, Alpérovitch A, Tzourio C. Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study.  BMJ. 2009;  339 b4460 . doi:10.1136/bmj.b4460
• 8 Grimby G. Physical activity and muscle training in the elderly.  Acta Med Scand Suppl. 1986;  711 233-237
• 9 Gulati M, Pandey DK, Arnsdorf MF, Lauderdale DS, Thisted RA, Wicklund RH, Al-Hani AJ, Black HR. Exercise capacity and the risk of death in women. The St James Women Take Heart Project.  Circulation. 2003;  108 1554-1559
• 10 Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.  J Ger Med Sci. 1994;  49 M85-M94
• 11 Harriss DJ, Atkinson G. International Journal of Sports Medicine – Ethical Standards in Sport and Exercise Science Research.  Int J Sports Med. 2009;  30 701-702
• 12 Kaprio J, Koskenvuo M. Genetic and environmental factors in complex diseases: the older Finnish twin cohort.  Twin Res. 2002;  5 358-365
• 13 Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women. A meta-analysis.  JAMA. 2009;  301 2024-2035
• 14 Lakka TA, Venäläinen JM, Rauramaa R, Salonen R, Tuomilehto J, Salonen JT. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men.  N Engl J Med. 1994;  330 1549-1554
• 15 McDermott MM, Tian L, Liu K, Guralnik JM, Ferrucci L, Tan J, Pearce WH, Schneider JR, Criqui MH. Prognostic value of functional performance for mortality in patients with peripheral artery disease.  J Am Coll Cardiol. 2008;  51 1482-1489
• 16 Miyamoto S, Nagaya N, Satoh T, Kyotani S, Sakamaki F, Fujita M, Nakanishi N, Miyatake K. Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing.  Am J Respir Crit Care Med. 2000;  161 487-492
• 17 Mutikainen S, Ortega-Alonso A, Alén M, Kaprio J, Karjalainen J, Rantanen T, Kujala UM. Genetic influences on resting electrocardiographic variables in older women: a twin study.  Ann Noninvasive Electrocardiol. 2009;  14 57-64
• 18 Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing.  N Engl J Med. 2002;  346 793-801
• 19 Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC, Pahor M, Satterfield S, Brach JS, Studenski SA, Harris TB. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability.  JAMA. 2006;  295 2018-2026
• 20 Pajala S, Era P, Koskenvuo M, Kaprio J, Tolvanen A, Heikkinen E, Tiainen K, Rantanen T. Contribution of genetic and environmental effects to postural balance in older female twins.  J Appl Physiol. 2004;  96 308-315
• 21 Peters RK, Cady Jr LD, Bischoff DP, Bernstein L, Pike MC. Physical fitness and subsequent myocardial infarction in healthy workers.  JAMA. 1983;  249 3052-3056
• 22 Sarna S, Kaprio J, Sistonen P, Koskenvuo M. Diagnosis of twin zygosity by mailed questionnaire.  Hum Hered. 1978;  28 241-254
• 23 Solway S, Brooks D, Lacasse Y, Thomas S. A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.  Chest. 2001;  119 256-270
• 24 Tilvis RS, Lallukka KM, Saarela M, Sairanen S, Valvanne J. Prognostic significance of difficulties in mobility in a five-year follow-up study of four birth cohorts.  Arch Gerontol Geriatr. 1997;  25 311-319
• 25 Vestergaard S, Patel KV, Bandinelli S, Ferrucci L, Guralnik JM. Characteristics of 400-meter walk test performance and subsequent mortality in older adults.  Rejuvenation Res. 2009;  12 177-184
• 26 Williams RL. A note on robust variance estimation for cluster-correlated data.  Biometrics. 2000;  56 645-646

Correspondence