The Way You Walk: Why Gait Matters
Like most everything else, the way we walk changes as we age. Maybe you’ve noticed it in yourself or a friend: a slower step, a slight stagger, or a limp, a shuffle, a tilt. But how do you know what’s normal and what’s not?
“While many people experience some slight changes in their gait as they age, for others this doesn’t happen until they are extremely old,” says Peter V. Rabins, M.D., M.P.H., a professor at the Erickson School of Aging, University of Maryland, Baltimore County, and professor of psychiatry at Johns Hopkins University School of Medicine in Baltimore.
“Most important, though, walking difficulty should not be accepted as an inevitable consequence of aging. It can signal an underlying condition that needs medical attention," he adds.
A 2013 study in the journal PLOS ONE estimated that about 10 percent of people between ages 60 and 69, and nearly 62 percent among people ages 80 to 97, have a gait, or walking pattern, disorder.
Abnormal gait changes can signal a nervous system condition, such as Parkinson’s disease; a bone, muscle, or joint disorder, such as arthritis; psychological factors, such as anxiety or depression; or drug side effects.
Some gait disturbances are associated with an increased risk of developing dementia and cardiovascular disease. Any type of gait change predisposes adults to falls and serious injuries.
“If you notice a change in gait in yourself or a loved one, have the change checked out by a doctor to detect the underlying causes and prevent falls and future immobility,” Rabins says.
Normal age-related gait changes
Several distinct elements determine whether gait is normal in healthy older adults:
• Speed. Most adults walk more slowly as they age. In people who don’t have significant health problems, gait speed declines by about 0.2 percent a year up to age 63, and up to 1.6 percent each year after that. A reason for a slower gait may be decreased strength in the calf muscles, which you use to propel yourself forward.
• Cadence. For most people, cadence, or rhythm, doesn’t change as they age. Cadence is related to leg length: Tall people take longer steps at a slower cadence, and short people take shorter steps at a faster cadence. The appearance of deceleration is due not to cadence but to shorter steps as a person ages.
• Double stance time. The length of time a person has both feet on the ground while walking can double with age. A person with a longer double stance time may look as if he or she is walking on ice.
• Walking posture. An upright walking position is normal in healthy older adults, although some people may tilt their pelvis forward with an inward curve in the lower back (known as lumbar lordosis) because of tight hip-flexor muscles, weak abdominal muscles, and increased abdominal fat.
• Joint motion. Because ankle flexibility may be reduced, gait may change slightly as the back foot lifts off the ground when walking. Older adults also have a limited range of motion in the hips.
Age-related gait changes can result from a general reduction in fitness, including stiffness, loss of limb strength, a declining sense of balance, and less lung and heart capacity.
On average, people with stronger legs or more range of motion in their ankles and hips walk faster. Walking speed has been linked to overall health and life expectancy: Fast walkers (defined as 1 meter per second, or 2.5 mph, or more) are more likely to outlive slower walkers. And having to stop walking while talking is a predictor of future falls.
The fear of falling can cause a gait change. Called cautious gait, this change in gait occurs in older adults who have already taken a stumble or who have poor vision. A person with cautious gait may have exaggerated age-related gait changes and walk with careful, wide-legged movements and minimal arm movement.
If a cautious gait isn’t corrected, and fear of falling becomes obsessive, it can lead to a phobic gait disorder in which a person becomes completely unable to walk.
Many causes of the gait disorders listed above can be improved, and treatment can help prevent injuries from falls and improve mobility. Drug therapy can improve symptoms of many conditions that affect gait and surgery may help in conditions such as arthritis and hydrocephalus.
Many conditions, such as arthritis and Parkinson’s disease, improve with exercise. Formal physical therapy can lead to dramatic improvements; group activities, such as a tai chi class, can have good results.
Resistance exercises, balance training, and walking can help. Physical therapy routines aimed at strengthening and lengthening specific muscles are often effective.
Using a cane or a walker can help prevent falls. A physical or occupational therapist can design a program specific to your needs. Consider installing grip bars and brighter lights, and remove tripping hazards like electrical cords and throw rugs.
“A change in gait or walking difficulties is not an inevitable consequence of aging,” Rabins says. “Weakness, unsteadiness, slowness, pain, or stumbling while walking should be assessed by your doctor.”
Putting gait to the test
Your doctor can sometimes get a good idea of what’s causing your gait problem by watching the way you move. He or she may ask you to perform various movements and perhaps time you while you do them.
In the "Timed Get Up and Go" test, you get up from a chair without using your hands, walk 3 meters (about 10 feet), turn, and return to sit back down. You should be able to complete the action in about 10 seconds. If you take 14 seconds or more, it’s considered abnormal, and you have an increased risk of falling.