Sex-specific differences in gait patterns of healthy older adults: Results from the Baltimore Longitudinal Study of Aging
Introduction
Walking is one of the most important activities that healthy adults perform every day. The effects of normal aging and orthopedic conditions on customary walking patterns have been investigated extensively (Beauchet et al., 2009, Cho et al., 2004, DeVita and Hortobagyi, 2000, Kerrigan et al., 2001, Ko et al., 2009, McGibbon and Krebs, 2004, Srygley et al., 2009, Winter et al., 1990). In many of these studies, the effect of sex on gait patterns was accounted for in the statistical analysis, therefore hiding any possible difference in gait between men and women. However, understanding differences in gait between older men and women is important to start discriminating normal sex related patterns from early pathologic changes.
Previous studies revealed sex differences in gait patterns among young adults. When walking at a self-selected speed, young healthy women tend to have shorter stride length and slower gait speed compared to healthy young men, mostly due to a shorter height (Cho et al., 2004). Moreover, healthy young women tend to generate greater mechanical joint power from the hip and knee joints during late stance compared to healthy young men (Kerrigan et al., 1998). However, it is unclear whether such differences in gait parameters between young men and women are retained in the older populations. Clarifying this issue is important because older adults have higher prevalence of pathologies that affect gait performance and increase the likelihood of mobility disability (Helbostad et al., 2007; Simonsick et al., 2008). Although there is evidence that older women tend to walk at slower speed than men of similar age (Oberg et al., 1993, Samson et al., 2001), it is still unknown whether sex differences also exist in the other kinetic and kinematic gait patterns.
Full three dimensional (3D) gait analysis has recently emerged as an excellent method of assessing gait performance (McGibbon and Krebs, 2004; Teixeira-Salmela et al., 2008) as it provides both kinetic and kinematic measures as well as basic spatiotemporal gait parameters. By collecting simultaneous information of kinematics and kinetics, mechanical work expenditures (MWE) in the generative and absorptive phases (Ko et al., 2010), can estimate the size and direction for the muscle loading during walking, thus providing information essential to evaluate performance and energetics in gait analysis.
This study investigated sex differences in the basic spatiotemporal gait parameters, angular kinematics, and joint mechanical work in an adult population. The goal of the present study was to investigate sex-differences in the general gait patterns and also in the age-association of gait patterns among older adults using a relatively large sample of participants in the Baltimore Longitudinal Study of Aging (BLSA). The 336 study participants were tested in the BLSA gait lab while walking at self-selected speed. Two hypotheses were raised in this study. Firstly, that sex affects the basic spatiotemporal gait parameters, angular kinematics, and joint mechanical work in an adult. And, secondly, that within the sex groups, there are different age effects upon these measures.
Section snippets
Participants
Data were collected from 336 BLSA participants (162 women) who were between 50 and 96 years old. The inclusion of participants 50 years of age or older was based on prior reports of a significant drop in self-selected speed around this age (Bohannon, 1997, Tolea et al., 2010). The study was conducted by the investigators of Intramural Research Program of the National Institute on Aging, National Institutes of Health in the Clinical Research Branch Gait Laboratory between January 2008 and April
Results
Descriptive statistics for age, height, mass, and body-mass index (BMI) are summarized in Table 1 separately for women and men. On average, the men were older (p=0.001), taller (p<0.001), and weighed more (p<0.001), compared to the women.
Differences between women and men in regards to the mean values of basic spatiotemporal gait parameters and the association with age are summarized in Table 2. After adjusting for age, height, and mass, there was no sex difference in gait speed (p=0.185) or its
Discussion
The effects of sex and age on basic spatiotemporal gait parameters, and joint angular kinematics and kinetics of the lower extremity joints were investigated using 3D gait analysis in a relatively large sample of older women and men who walked at self-selected speed. Partially supporting the hypotheses, a subset of joint angular kinematics and kinetic parameters differed between the men and women, while age-associations in those variables and gait speed were generally similar.
Our findings
Conflict of interest statement
All the authors declare that no financial or personal relationships were conducted with other people or organizations that could inappropriately influence or bias this work.
Acknowledgements
This research was supported entirely by the Intramural Research Program of the NIH, National Institute on Aging. Data for these analyses were obtained from the Baltimore Longitudinal Study of Aging, a study performed by the National Institute on Aging.
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