Real-world gait speed estimation, frailty and handgrip strength: a cohort-based study

Gait speed is a reliable outcome measure across multiple diagnoses, recognized as the 6th vital sign. The focus of the present study was on assessment of gait speed in long-term real-life settings with the aim to: (1) demonstrate feasibility in large cohort studies, using data recorded with a wrist-worn accelerometer device; (2) investigate whether the walking speed assessed in the real-world is consistent with expected trends, and associated with clinical scores such as frailty/handgrip strength. This cross-sectional study included n = 2809 participants (1508 women, 1301 men, [45-75] years old), monitored with a wrist-worn device for 13 consecutive days. Validated algorithms were used to detect the gait bouts and estimate speed. A set of metrics were derived from the statistical distribution of speed of gait bouts categorized by duration (short, medium, long). The estimated usual gait speed (1-1.6 m/s) appears consistent with normative values and expected trends with age, gender, BMI and physical activity levels. Speed metrics significantly improved detection of frailty: AUC increase from 0.763 (no speed metrics) to 0.798, 0.800 and 0.793 for the 95th percentile of individual's gait speed for bout durations < 30, 30-120 and > 120 s, respectively (all p < 0.001). Similarly, speed metrics also improved the prediction of handgrip strength: AUC increase from 0.669 (no speed metrics) to 0.696, 0.696 and 0.691 for the 95th percentile of individual's gait speed for bout durations < 30, 30-120 and > 120 s, respectively (all p < 0.001). Forward stepwise regression showed that the 95th percentile speed of gait bouts with medium duration (30-120 s) to be the best predictor for both conditions. The study provides evidence that real-world gait speed can be estimated using a wrist-worn wearable system, and can be used as reliable indicator of age-related functional decline.