OPEN ACCESS

http://dx.doi.org/10.20463/jenb.2016.09.20.3.7

J Exerc Nutrition Biochem. 2016;20(3):046-050

The reliability and validity of gait

Received: 2016/06/08, Revised: 2016/07/22,
speed with different walking pace
Accepted: 2016/08/01, Published: 2016/09/30
and distances against general
©2016 Hee-jae Kim et al.; Licensee Journal of Exer-
cise Nutrition and Biochemistry. This is an open acc- health, physical function, and
essarticle distributed under the terms of the creative
commons attribution license (http://creativecommons.
org/licenses/by/2.0), which permits unrestricted use,
chronic disease in aged adults
distribution, and reproduction in any medium, provid-
ed the orginal work is properly cited.
Hee-jae Kim1,2/ Ilhyoek Park1/Hyo joo Lee1/On Lee1*
*Corresponding author : On Lee
Institute of Sports Science, Seoul National University, 1. Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
1 Gwanak-ro, Gwanak-gu, Seoul 151-742, Korea. 2. Physical Activity and Performance Institute, Konkuk University, Seoul, Republic of Korea
Tel : +82-2-880-7804 Fax : +82-2-872-2867
Email : fair98@snu.ac.kr
©2016 The Korean Society for Exercise Nutrition
INTRODUCTION
[Purpose] Gait speed is an important objec- Gait speed is an important objective measure of functional mobili-
tive values associated with several health-re- ty, particularly for older adults. The significance of gait speed lies on
lated outcomes including functional mobility in its relationship to various health outcomes, such as functional decline,
aging people. However, walking test method-
discharge location and mortality1, 2, 3. Gait speed is also a potentially
ologies and descriptions are not standardized
considering specific aims of research. This useful factor to predict future functional decline, rehabilitations and
study examine the reliability and validity of fear of falling4, 5. Gait speed is frequently used for evaluation of dis-
gait speed measured at various distances and ability in clinical intervention trials and daily settings6. Moreover, gait
paces in elderly Koreans. speed can be quickly and easily measured, it is frequently included in
[Methods] Fifty-four female participants ≥70 research study7. Gait speed has been described as a reliable and valid
years of age were recruited from a local retire- measurement for seniors’ walking performance and is regarded as a
ment community. Gait speed was assessed pivotal factor associated with the quality of life8.
at 4, 6 and 10 meters, and at usual- and fast- Gait speed has not been assessed in a standardized fashion. Graham
pace walking mode. The short physical perfor-
et al.9 reported that clinical assessments of walking velocity are not
mance battery (SPPB) that estimates senior
fitness includes three tests of lower-body
conducted uniformly and that common methodologic factors might
function. Data concerning for the chronic con- influence the clinical interpretation of gait performances. Marked vari-
ditions and self-perceived health of the par- ations have been described in gait speed test methodology within both
ticipants was collected using questionnaires. clinical practice and published research. Although most gait speed test
Concurrent validity of gait speed using the methods have excellent interrater and test-retest reliabilities, there is
aforementioned test protocols was determined
no consensus regarding the optimal measurement protocol including
by calculating the Pearson correlation coeffi-
cients.
walking distance, instructed pace and start mode9.
Gait test distance is marginally related to the mean velocity in the
[Results] Significant positive correlations were elderly. In general, 4, 6 and 10 meters are used for short-distance walk
evident between skeletal muscle mass and
maximal pace walking regardless of distance
test for elderly adults. This discordance in walking length has led to
(r=.301~.308; p<.05), but not with body fat. All confusion concerning the optimal measuring method for gait speed.
gait tests significantly positively correlated with Differences in gait speed between usual- and fast-paced tests within the
self-rated health (normal pace r=.328~.346, same participant group have been described. Graham et al.9 reported
p<.05; maximal pace r=.427~.472, p<.001) that the intended pace significantly affects mean gait velocity in elderly
and depression (normal pace r=.279~.430, individuals. Additionally, the dynamic start mode effectively eliminates
p<.05; maximal pace r=.413~.456, p<.001).
the acceleration phase from the timed performance. In prior research,
[Conclusion] Walking test at the normal pace the dynamic protocol showed greater mean velocity compared with
appears suitable for estimating physical func- static-start conditions, although the difference was not significant.
tion and deterioration due to chronic disease.
In the elderly, few studies have examined how subtle differences in
Walking test at a maximum pace might be
useful for estimating subjective general health
test walking distance and walking pace affect gait speed reliability and
and skeletal muscle mass. validity. It is uncertain whether a longer walking distance produces
a more accurate determination of gait speed than a shorter distance.
[Key words] gait speed, Reliability, Validity,
Walking test.
Presently, we examine the reliability and validity of the gait speed in

J Exerc Nutrition Biochem. 2016;20(3):046-050, http://dx.doi.org/10.20463/jenb.2016.09.20.3.7 46

 Reliability and Validity of Gait Speed Test
Journal of Exercise Nutrition & Biochemistry

elderly Koreans. Intraclass correlation coefficient (ICCs) toe of the other foot) and tandem (heel of one foot direct-
was evaluated to examine test-retest reliability of variant ly in front of and touching the other foot) positions for
walking distances (4, 6 and 10 meters) and walking pace 10 seconds each. For gait speed, a 4-meter walk at the
(usual- or fast-pace). We also evaluated the validity of participant’s usual pace was timed. For those who did not
gait speed using protocols featuring varied physical func- have 4 meters of space available in their homes, a 3-meter
tion, body composition and presence of depression. course was used and scoring was modified as indicated
in the instructions. The test was repeated twice with the
faster of the two walks used. For the ability to rise from
METHODS a chair, participants were asked to stand up and sit down
five times as quickly as possible with arms folded across
Design and participants their chests. This was done only after participants first
A cross-sectional study design was used to compare demonstrated the ability to rise once without using their
different gait speed measurements including walking arms. Further details on the administration of these tests
distance and walking pace. Sixty-five female participants have been published10. A summary performance score was
were recruited from a local retirement community. Inclu- obtained by adding the scores of each individual SPPB
sion criteria included age ≥70 years, ability to reliably component test (range 0-12), with higher scores indicat-
follow two-step instructions and the ability to walk 100 ing better lower-body function11.
meters with or without an assistive device. Exclusion
criteria included severe visual impairment and/or severe Questionnaires
arthritis or orthopedic problems that limited ambulation. The data for the chronic conditions and health self-per-
All participants gave written informed consent. The Seoul ception of participants was collected using questionnaires.
National University Institutional Review Board approved Perception of general health was self-reported with a
this study (SNUIRB 1210/001-003). score ranging from 1 to 10 points. Chronic conditions
were assessed by self-reporting as having been diagnosed
Body composition and blood pressure by a medical doctor for hypertension, heart diseases, dia-
Anthropometric parameters were screened by the same betes, cancer, chronic respiratory disease, arthritis or de-
examiner. Height was evaluated using an extensometer. pression. Chronic diseases including cancer and chronic
Body weight, body mass index (BMI), fat mass, percent respiratory disease were excluded because of the extreme-
body fat, fat free mass and skeletal muscle mass were ly low number of cases.
measured by bioimpendence analysis using an Inbody
370 (Biospace, Korea). Blood pressure was measured at Statistical analysis
resting condition using a Biospace- BPBIO320. Statistical analysis were processed using SPSS 18.0 (Sta-
tistics Package for Social Science, Ver. 18.0 for Windows;
Walking procedure and measurement SPSS Inc., Chicago IL, USA). ICCs were used to estimate
We assessed gait speed over 4, 6 and 10 meters, and test–retest reliability. We determined the concurrent validity
usual- and fast-pace walking mode. The test was repeated of the gait speed with variant test protocols by calculating
twice with the mean of the two trials used for scoring pur- the Pearson correlation coefficients between body compo-
poses. Participants were instructed to walk from a stand- sition, self-rated health, depression and physical function
ing start at a pace that was normal and comfortable for assessed by combinations of the SBBP components.
them or to walk as fast as they could until they reached
the end of the marked path. A trained tester walked behind
the participant and stopped timing when the participant’s RESULTS
foot contacted the floor at the end of the walking course.
Participants were provided rest breaks as needed through- Subject characteristics are shown in Table 1. All sub-
out the testing session. jects were females ≥70 years of age and able to walk
independently. Table 2 shows the estimates of test–retest
Short physical performance battery (SPPB) mea- reliability for gait tests with different distance and pace.
surement
The SPPB includes three components of lower-body
Table 1. Characteristics of participants
function: a hierarchical test of standing balance, a 4-meter
walk and five repetitive chair stands10. Each SPPB com- N=65 Mean ± S.E.M
ponent test is scored from 0 to 4 with a score of 0 repre- Age (years) 77.70 ± 4.8
senting inability to perform the test and a score of 4 repre- Height (cm) 151.09 ± 4.5
senting the highest category of performance, with scoring Body weight (kg) 55.90 ± 7.0
cut-points derived from a large representative population Skeletal muscle mass (kg) 20.04 ± 5.0
of older persons11. For the balance tasks, the participants Body fat percentage (%) 35.90 ± 5.6
were asked to stand with their feet side-by-side, followed Systolic blood pressure (mmHg) 138.66 ± 73.0
by the semi-tandem (heel of one foot alongside the big Diastolic blood pressure (mmHg) 70.98 ± 8.6

J Exerc Nutrition Biochem. 2016;20(3):046-050, http://dx.doi.org/10.20463/jenb.2016.09.20.3.7 47

 Reliability and Validity of Gait Speed Test
Journal of Exercise Nutrition & Biochemistry

Table 2. Reliability of walking test (ICC)

Normal pace Maximal pace

4M 6M 10 M 4M 6M 10 M

ICC (95% CI) .715** .861** .902** .837** .905** .933*

Table 3. Validity of walking speed with different measuring protocols against health-related variables

Normal pace Maximal pace

4M 6M 10 M 4M 6M 10 M

SPPB R (Pearson) .735 .677 .740 .563 .592 .601

(Gait + Balance + Chair) p <.001 <.001 <.001 <.001 <.001 <.001
R (Pearson) .554 .506 .568 .531 .495 .536
Balance + Chair
p <.001 <.001 <.001 <.001 <.001 <.001
R (Pearson) .328 .346 .346 .427 .452 .472
Self-rated health
p .008 .002 .005 <.001 <.001 <.001
R (Pearson) .031 .063 .034 .071 .053 .022
Body Fat (%)
p .804 .616 .789 .573 .674 .864
R (Pearson) .074 .055 .097 .303* .308* .301*
Skeletal muscle mass (%)
p .556 .662 .442 .014 .013 .015
.281 0.279 0.322 0.430 0.413 0.446 0.456
Depression score
<0.05 <0.05 <0.01 <0.001 <0.001 <0.001 <0.001

ICC for the 4-, 6- and 8-meter gait test was r= .715, .837; DISCUSSION
r=.861, .905; and r=.902, .933, respectively. Reliability
increased with gait distance and speed. There was no sig- In the present study, we examined the reliability and
nificant difference in the gait tests each participant walked validity of the gait speed with various walking pace and
between the first and second tests. distance in aged group. The validity of gait speed with
Table 3 presents the Pearson’s correlation coefficients normal pace was higher than that with maximal pace
used to assess the validity of gait tests with the three against physical function. Relatively higher values of
distances and two walking paces according to body com- validity were found at maximal walking pace against
position, self-rated health and depression. Significant pos- perception of general health and skeletal muscle mass.
itive correlations were evident between skeletal muscle In addition, although there was no statistical difference
mass and maximal pace walking regardless of distance between gait speed and chronic diseases, there was a
(r=.301~.308; p<.05), but not for body fat. All gait tests tendency that gait speed at normal pace showed a higher
were significantly positively correlated with self-rat- validity than that at maximal pace. Taken together, the re-
ed health (normal pace r=.328~.346, p<.05; maximal sults suggest that an appropriate protocol of walking test
pace r=.427~.472, p<.001) and depression (normal pace could be differently applied by specific research purpose.
r=.279~.430, p<.05; maximal pace r=.413~.456, p<.001). Both floor and ceiling effects for measures of gate
The correlation score increased with gait distance and speed have been reported in patient groups suggesting
maximum speed walking produced a higher score than that a short-distance walking test has a narrow range of
normal speed in both variables. applications11, 12, 13. Although there are considerable vari-
Table 3 summarizes the correlations between various ations in testing methods, measurement of the gate speed
gait tests and combination of SBBP components. All gait is valid and sensitive outcome measurement in a broad
tests were significantly positively correlated with a com- range of people.13, 14, 15, 16. Therefore, the study to assess
bination of SPPB components. There were moderate to gate-test methodology including walking distance and
high correlations between the various gait tests and SPPB pace was needed in aged population.
total score: 4-meter walk (r=.735, .563), 6-meter walk The ICC values were similar to those reported in stud-
(r=.677, .592) and 10-meter walk (r=.740, .601). There ies evaluating reliability of gait test (0.88 to 0.97) in ag-
were moderate correlations between various gait tests ing populations16, 17, 18, 19. As shown in Table 2, higher ICC
and combination of SPPB components (sum of balance values were observed at the longest walking distance of
and chair score): 4-meter walk (r=.554, .531), 6-meter 10 meters compared to 4 and 6 meters. In addition, ICC
walk (r=.506, .496) and 10-meter walk (r=.568, .536). In values of gait test at maximal speed were higher than that
contrast with results from Table 3, normal speed walking at the normal pace (Table 2). Although the walking test at
produced a higher score than maximal speed walking. a maximal pace over a longer distance has better reliabili-
Four-meter walk at a normal pace produced the second ty in elderly individuals, test distance and pace have to be
highest score among all values. considered according to the purpose of the measurements

J Exerc Nutrition Biochem. 2016;20(3):046-050, http://dx.doi.org/10.20463/jenb.2016.09.20.3.7 48

 Reliability and Validity of Gait Speed Test
Journal of Exercise Nutrition & Biochemistry

and the clinical health conditions of participants, rather are the relatively small sample size, disproportion sex
than by the criterion of a high level of reliability. representation and lack of medical examination. Future
Concurrent validity of walking test with various walk- studies evaluating the validity of elderly walking test
ing distances and paces was examined against physical against health including chronic disorders will be needed
function, measures of general health, body composition and will require a large number of participants.
and chronic diseases in the elderly participants. Physical In conclusion, our data reveals a high level of validity
function evaluated as SPPB scores positively correlated was found following the walk speed test with different
with walking speed without regard to walking distance distance or pace against various health related factors in
or pace (Table 3). Since SPPB scores including 4-meter aged adults. Based on our results and previous review
walking speed, the high correlation between SPPB score articles, walking test at the normal pace might be adopt-
and walking speed was inevitable. Therefore, we addi- ed for estimating physical function and chronic disease,
tionally estimated the relationship between walking speed whereas walking test at the maximal pace might be adopt-
and SPPB scores excluding the 4-meter walking score ed for estimating subjective general health and skeletal
(scores of balance test and chair stand). High correlation muscle mass. Additional studies are needed to determine
between SPPB scores excluding 4-meter walking test if differences in walk testing methods will yield predict-
score and walking speed was found, whereas there was no able and meaningful differences in the distribution of per-
difference among all of the test groups. These results sug- formance scores.
gest that walking test regardless of test distance or walk-
ing pace is positively associated with physical function in
aged adults. Furthermore, it might be possible to use gait REFERENCES
speed to estimate physical function in elderly individuals
when test conditions including space or time are limited 1. Montero-Odasso M, Schapira M, Soriano ER, Varela M, Ka-
in clinical setting. plan R, Camera LA, Mayorga LM. Gait velocity as a single
Walking speed at a maximal pace was associated predictor of adverse events in healthy seniors aged 75 years
with better subjective evaluation for the general heath and older. J Gerontol A Biol Sci Med Sci. 2005; 60: 1304-9.
(self-rated health). A similar tendency was found in the 2. Rabadi MH, Blau A. Admission ambulation velocity predicts
relationship between skeletal muscle mass and walking length of stay and discharge disposition following stroke in
speed with maximal pace, but no association was apparent an acute rehabilitation hospital. Neurorehabil Neural Repair.
between body fat and maximal walking speed. In healthy 2005; 19: 20-6.
aged individuals, decreased muscle mass and muscle 3. Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW,
strength in the lower extremities affects walking speed Rooney E, Fox M, Guralnik JM. Physical performance mea-
and can affect daily physical activities19, 20. Therefore, sures in the clinical setting. J Am Geriatr Soc. 2003; 51: 314-
measurement of walking speed at maximal pace could be 22.
the one of the most efficient variable for predicting the 4. Penninx BW, Ferrucci L, Leveille SG, Rantanen T, Pahor M,
health conditions following decrease of muscle functions Guralnik JM. Lower extremity performance in nondisabled
in aging population. older persons as a predictor of subsequent hospitalization. J
Differences in walking speed between normal pace and Gerontol A Biol Sci Med Sci. 2000; 55: 691-7.
maximal pace with in the same participants have been 5. Hardy SE, Perera S, Roumani YF, Chandler JM, Studenski
described20, 21, 22, 23. It is important to note that in prior SA. Improvement in usual gait speed predicts better survival
studies normal (usual and/or comfortable) pace was used in older adults. J Am Geriatr Soc. 2007; 55: 1727-34.
approximately twice as often as maximal pace8, 9, and that 6. Cesari M, Kritchevsky SB, Penninx BW, Nicklas BJ, Simonsick
normal pace was considered the more common normative EM, Newman AB, Tylavsky FA, Brach JS, Satterfield S, Bauer
value than maximal pace standards17, 18. Both normal and DC, Visser M, Rubin SM, Harris TB, Pahor M. Prognostic val-
maximal pace walking measurement are important and ue of usual gait speed in well-functioning older people--results
that the difference between normal and maximal walking from the Health, Aging and Body Composition Study. J Am
velocities (i.e., the ability to voluntarily increase walking Geriatr Soc. 2005; 53: 1675-80.
velocity) may be the best indicator of community-based 7. Graham JE, Ostir GV, Fisher SR, Ottenbacher KJ. Assessing
ambulation ability in aged adults9, 20. Presently, several walking speed in clinical research: a systematic review. J Eval
values including subjective estimate of general health, de- Clin Pract. 2008; 14: 552-62.
pression statues and skeletal muscle mass showed higher 8. English CK, Hillier SL, Stiller K, Warden-Flood A. The sensi-
correlation with maximal pace than normal pace. Consid- tivity of three commonly used outcome measures to detect
ering the results of relatively lower association with less change amongst patients receiving inpatient rehabilitation fol-
than 10-meter walking distance, the appropriate protocol lowing stroke. Clin Rehabil. 2006; 20: 52-5.
of walking pace needs more deliberation than walking 9. Graham JE, Ostir GV, Kuo YF, Fisher SR, Ottenbacher KJ.
distance in the specific research purpose. Relationship between test methodology and mean velocity in
This study is one of the few to investigate the suitable timed walk tests: a review. Arch Phys Med Rehabil. 2008; 89:
methods of gait test for the valid indicator of physical 865-72.
function and general health in aging population. However, 10. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace
several limitations of the present study are noted. These RB. Lower-extremity function in persons over the age of 70

J Exerc Nutrition Biochem. 2016;20(3):046-050, http://dx.doi.org/10.20463/jenb.2016.09.20.3.7 49

 Reliability and Validity of Gait Speed Test
Journal of Exercise Nutrition & Biochemistry

years as a predictor of subsequent disability. N Engl J Med. Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go
1995; 332: 556-61. Test, and gait speeds. Phys Ther. 2002; 82: 128-37.
11. Guralnik JM, Winograd CH. Physical performance measures 18. Bohannon RW, Andrews AW, Thomas MW. Walking speed:
in the assessment of older persons. Aging (Milano). 1994; 6: reference values and correlates for older adults. J Orthop
303-5. Sports Phys Ther. 1996; 24: 86-90.
12. Tyson SF, DeSouza LH. Reliability and validity of functional 19. Hollman JH, Childs KB, McNeil ML, Mueller AC, Quilter CM,
balance tests post stroke. Clin Rehabil. 2004; 18: 916-23. Youdas JW. Number of strides required for reliable mea-
13. Erdmann PG, van Meeteren NL, Kalmijn S, Wokke JH, Hel- surements of pace, rhythm and variability parameters of gait
ders PJ, van den Berg LH. Functional health status of patients during normal and dual task walking in older individuals. Gait
with chronic inflammatory neuropathies. J Peripher Nerv Syst. Posture. 2010; 32: 23-8.
2005; 10: 181-9. 20. Willen C, Sunnerhagen KS, Ekman C, Grimby G. How is
14. van Hedel HJ, Wirz M, Curt A. Improving walking assessment walking speed related to muscle strength? A study of healthy
in subjects with an incomplete spinal cord injury: responsive- persons and persons with late effects of polio. Arch Phys Med
ness. Spinal Cord. 2006; 44: 352-6. Rehabil. 2004; 85: 1923-8.
15. Vos-Vromans DC, de Bie RA, Erdmann PG, van Meeteren NL. 21. Dobkin BH. Short-distance walking speed and timed walking
The responsiveness of the ten-meter walking test and other distance: redundant measures for clinical trials? Neurology.
measures in patients with hemiparesis in the acute phase. 2006; 66: 584-6.
Physiother Theory Pract. 2005; 21: 173-80. 22. Moseley AM, Lanzarone S, Bosman JM, van Loo MA, de Bie
16. Herman S, Kiely DK, Leveille S, O’Neill E, Cyberey S, Bean RA, Hassett L, Caplan B. Ecological validity of walking speed
JF. Upper and lower limb muscle power relationships in mobil- assessment after traumatic brain injury: a pilot study. J Head
ity-limited older adults. J Gerontol A Biol Sci Med Sci. 2005; Trauma Rehabil. 2004; 19: 341-8.
60: 476-80. 23. Riley PO, DellaCroce U, Kerrigan DC. Effect of age on lower
17. Steffen TM, Hacker TA, Mollinger L. Age- and gender-relat- extremity joint moment contributions to gait speed. Gait Pos-
ed test performance in community-dwelling elderly people: ture. 2001; 14: 264-70.

J Exerc Nutrition Biochem. 2016;20(3):046-050, http://dx.doi.org/10.20463/jenb.2016.09.20.3.7 50