Nav: Home

Walking speed points to future clinical outcomes for older patients with blood cancers

June 05, 2019

Researchers at Dana-Farber Cancer Institute and the VA Boston Healthcare System have uncovered a new vital sign for gauging survival and likelihood of having an unplanned hospitalization in older patients with blood cancers: the speed at which they can walk.

In a study published today in the journal Blood, the researchers report that for every 0.1 meter per second decrease in how fast patients walk four meters (about 13 feet), the risk of dying, unexpectedly going to the hospital, or using the emergency room increased by 22 percent, 33 percent, and 34 percent, respectively. The association was strongest in patients with non-Hodgkin lymphoma.

"The slower someone walks, the higher their risk of problems," said the study's senior author, Jane A. Driver, MD, MPH, co-director of the Older Adult Hematologic Malignancy (OHM) Program at Dana-Farber and associate director of the Geriatric Research Education and Clinical Center at VA Boston Healthcare System.

Measuring gait speed not only helps identify individuals who are frail and may have worse long-term outcomes, but it also can indicate those who are in better-than-expected shape based on their age. Researchers say the study results support efforts to integrate gait speed as a routine part of medical assessments for older patients with blood cancer, and that it should be measured over time to guide treatment plans.

"There is an unmet need for brief screening tests for frailty that can easily fit into clinic workflow and predict important clinical outcomes. This test can be done in less than a minute and takes no longer than measuring blood pressure or other vital signs," said Driver. "Based on our findings, it is as good as other commonly used methods which take considerably more time and resources and may not be practical for many oncology clinics."

The new study enrolled 448 adults ages 75 years and older who had hematologic cancers. Participants were 79.7 years old on average and completed several screenings for cognition, frailty, gait, and grip strength. Gait speed was measured using the National Institutes of Health 4-meter gait speed test. Patients were asked to walk at a normal pace for 4 meters and their speed was recorded in meters per second using a stopwatch.

The association between slower walking speed and poorer outcomes persisted even after adjusting for cancer type and aggressiveness, patient age and other demographic factors, as well as traditional measures of frailty and functional status. Gait speed remained an independent predictor of death even after accounting for standard measures of physical health.

Patients whose performance status - their general well-being and quality of life - was rated as very good or excellent by their physician were stratified into three groups by gait speed - those at risk or frail, pre-frail, or robust. Of the 314 patients in this group, nearly 20 percent had an unplanned hospital stay unrelated to elective or scheduled treatments, and 16.8 percent visited the emergency department.

"Our study reveals that the current standard of care for functional assessment in oncology--performance status--is not sufficient for elders with blood cancers. Gait speed appears to be much better at differentiating those patients at highest risk for poor outcomes," explained Gregory A. Abel, MD, MPH, director of the OHM clinic.

So much a part of everyday life that it's easily taken for granted, walking is a complex activity that involves multiple bodily systems, including the musculoskeletal, cardiovascular, and nervous systems, all of which must function properly together. Gait speed has been widely used as an assessment in rehabilitative and geriatric medicine. Measuring it doesn't require special equipment, is reasonably efficient, and has value even for patients who use a cane or a walker, Driver noted.
-end-
The first author of the study is Michael A. Liu, of Dana-Farber, Brigham and Women's Hospital (BWH), and the VA Boston Healthcare System. Co-authors are: Anays Murillo, MPH, Robert Soiffer, MD, Richard M. Stone, MD, and Gregory A. Abel, MD, MPH, of Dana-Farber; Clark DuMontier, MD, of Dana-Farber and Beth Israel Deaconess Medical Center; Tammy Hshieh, MD, MPH, of Dana-Farber and BWH; and Jonathan F. Bean, MD, of Spaulding Rehabilitation Hospital.

The study was supported in part by training grants from the National Heart, Lung, and Blood Institute (grant # HL007479) and the National Institute on Aging (AG000158); the Murphy Family Fund from Dana-Farber Cancer Institute; and a Clinical Research Scholar Award from the American Cancer Society. Driver is funded by a Veterans' Administration Merit Review Award.

Dana-Farber Cancer Institute

Related Walking Articles:

These feet were made for walking
Many of us take our feet for granted, but they have a challenging job in the biomechanics department.
Walking sharks discovered in the tropics
Four new species of tropical sharks that use their fins to walk are causing a stir in waters off northern Australia and New Guinea.
Micro implants could restore standing and walking
Researchers at the University of Alberta are focused on restoring lower-body function after severe spinal injuries using a tiny spinal implant.
Walking changes vision
When people walk around, they process visual information differently than at rest: the peripheral visual field shows enhanced processing.
Virtual walking system for re-experiencing the journey of another person
Virtual-reality researchers have developed a virtual-walking system that records a person's walking and re-plays it with vision and foot vibrations.
A large study indicates how cities can promote walking for travel
Coinciding with the European Mobility Week, a study performed in seven European cities focuses on walking for travel, a strategy to increase physical activity in cities.
Robotic cane shown to improve stability in walking
By adding electronics and computation technology to a simple cane that has been around since ancient times, Columbia Engineering researchers have transformed it into a 21st century robotic device that can provide light-touch assistance in walking to the aged and others with impaired mobility.
Water walking -- The new mode of rock skipping
Utah State University's Splash Lab not only reveals the physics of how elastic spheres interact with water, but it also lays the foundation for the future design of water-walking drones.
Just an hour of weekly walking staves off disability
Just one hour a week of brisk walking -- as if you are late to an appointment or trying to make a train -- staves off disability in older adults with arthritis pain, or aching or stiffness in a knee, hip, ankle or foot, reports a new Northwestern Medicine study.
Untangling the where and when of walking in the brain
How do our brains know when and where to place our feet in order to prevent us from tripping each time we find ourselves on a new terrain such as a icy path, or a sandy beach?
More Walking News and Walking Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Teaching For Better Humans 2.0
More than test scores or good grades–what do kids need for the future? This hour, TED speakers explore how to help children grow into better humans, both during and after this time of crisis. Guests include educators Richard Culatta and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Space
One of the most consistent questions we get at the show is from parents who want to know which episodes are kid-friendly and which aren't. So today, we're releasing a separate feed, Radiolab for Kids. To kick it off, we're rerunning an all-time favorite episode: Space. In the 60's, space exploration was an American obsession. This hour, we chart the path from romance to increasing cynicism. We begin with Ann Druyan, widow of Carl Sagan, with a story about the Voyager expedition, true love, and a golden record that travels through space. And astrophysicist Neil de Grasse Tyson explains the Coepernican Principle, and just how insignificant we are. Support Radiolab today at Radiolab.org/donate.