Age-Related Imbalance Is Associated with Slower Walking Speed: An Analysis from the National Health and Nutrition Examination Survey

Background and Purpose: Walking speed is an important dimension of gait function and is known to decline with age. Gait function is a process of dynamic balance and motor control that relies on multiple sensory inputs (eg, visual, proprioceptive, and vestibular) and motor outputs. These sensory and motor physiologic systems also play a role in static postural control, which has been shown to decline with age. In this study, we evaluated whether imbalance that occurs as part of healthy aging is associated with slower walking speed in a nationally representative sample of older adults. Methods: We performed a cross-sectional analysis of the previously collected 1999 to 2002 National Health and Nutrition Examination Survey (NHANES) data to evaluate whether age-related imbalance is associated with slower walking speed in older adults aged 50 to 85 years (n = 2116). Balance was assessed on a pass/fail basis during a challenging postural task - condition 4 of the modified Romberg Test - and walking speed was determined using a 20-ft (6.10 m) timed walk. Multivariable linear regression was used to evaluate the association between imbalance and walking speed, adjusting for demographic and health-related covariates. A structural equation model was developed to estimate the extent to which imbalance mediates the association between age and slower walking speed. Results: In the unadjusted regression model, inability to perform the NHANES balance task was significantly associated with 0.10 m/s slower walking speed (95% confidence interval: -0.13 to -0.07; P <.01). In the multivariable regression analysis, inability to perform the balance task was significantly associated with 0.06 m/s slower walking speed (95% confidence interval: -0.09 to -0.03; P <.01), an effect size equivalent to 12 years of age. The structural equation model estimated that age-related imbalance mediates 12.2% of the association between age and slower walking speed in older adults. Conclusions: In a nationally representative sample, age-related balance limitation was associated with slower walking speed. Balance impairment may lead to walking speed declines. In addition, reduced static postural control and dynamic walking speed that occur with aging may share common etiologic origins, including the decline in visual, proprioceptive, and vestibular sensory and motor functions.