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Background: The aging of the world's population and the increase in sedentary lifestyles are leading to an increase in walking impairments at older ages. Here, we aimed to comprehensively discuss walking in the context of an aging population; and identify and agree on a list of future research priorities and policy actions. Methods: We followed a participatory approach and held a multidisciplinary two-day workshop on October, 2023 in Barcelona, Spain, with experts in the fields of aging and walking, and participants from the general public. Results: A total of 56 national and international participants, from a multidisciplinary background, joined the workshop. They had a median age of 40 years (range 24–83), and 62% were female. Participants discussed the meaning of walking from different perspectives and its change with age and in the presence of diverse mobility-impairing conditions; the emotional and social components of walking; and the role of the environment in walking. Participants identified unmet needs, research priorities and policy actions related to walking in older ages. Conclusions: This two-day workshop provided a space for professionals and public to comprehensively discuss walking at older ages. Participants highlighted the relevance of a better and more comprehensive assessment of walking; the need to shift focus towards comprehensive health that considers physical, emotional and social aspects as well as individuals' preferences and expectations; and the importance of translating research into action. Future work can draw on the discussions held during this event in a thought-provoking and hypothesis-generating way. [ABSTRACT FROM AUTHOR]

The authors examined whether accelerometer-based free-living walking differs between those reporting walking modifications or perceiving walking difficulty versus those with no difficulty. Community-dwelling 75-, 80-, or 85-year-old people (N = 479) wore accelerometers continuously for 3–7 days, and reported whether they perceived no difficulties, used walking modifications, or perceived difficulties walking 2 km. Daily walking minutes, walking bouts, walking bout intensity and duration, and activity fragmentation were calculated from accelerometer recordings, and cut points for increased risk for perceiving walking difficulties were calculated using receiver operating characteristic analysis. The authors' analyses showed that accumulating ≤83.1 daily walking minutes and walking bouts duration ≤47.8 s increased the likelihood of reporting walking modifications and difficulties. Accumulating walking bouts ≤99.4 per day, having walking bouts ≤0.119 g intensity, and ≥0.257 active to sedentary transition probability fragmented activity pattern were associated only with perceiving walking difficulties. The findings suggest that older people's accelerometer-based free-living walking reflects their self-reported walking capability. [ABSTRACT FROM AUTHOR]

Background: The ability to walk is a key issue for independent old age. Optimizing older peoples' opportunities for an autonomous and active life and reducing health disparities requires a better understanding of how to support independent mobility in older people. With increasing age, changes in gait parameters such as step length and cadence are common and have been shown to increase the risk of mobility decline. However, gait assessments are typically based on laboratory measures, even though walking in a laboratory environment may be significantly different from walking in outdoor environments. Objective: This project will study alterations in biomechanical features of gait by comparing walking on a treadmill in a laboratory, level outdoor, and hilly outdoor environments. In addition, we will study the possible contribution of changes in gait between these environments to outdoor mobility among older people. Methods: Participants of the study were recruited through senior organizations of Central Finland and the University of the Third Age, Jyväskylä. Inclusion criteria were community-dwelling, aged 70 years and older, able to walk at least 1 km without assistive devices, able to communicate, and living in central Finland. Exclusion criteria were the use of mobility devices, severe sensory deficit (vision and hearing), memory impairment (Mini-Mental State Examination ≤23), and neurological conditions (eg, stroke, Parkinson disease, and multiple sclerosis). The study protocol included 2 research visits. First, indoor measurements were conducted, including interviews (participation, health, and demographics), physical performance tests (short physical performance battery and Timed Up and Go), and motion analysis on a treadmill in the laboratory (3D Vicon and next-generation inertial measurement units [NGIMUs]). Second, outdoor walking tests were conducted, including walking on level (sports track) and hilly (uphill and downhill) terrain, while movement was monitored via NGIMUs, pressure insoles, heart rate, and video data. Results: A total of 40 people (n=26, 65% women; mean age 76.3, SD 5.45 years) met the inclusion criteria and took part in the study. Data collection took place between May and September 2022. The first result is expected to be published in the spring of 2024. Conclusions: This multidisciplinary study will provide new scientific knowledge about how gait biomechanics are altered in varied environments, and how this influences opportunities to participate in outdoor activities for older people. International Registered Report Identifier (IRRID): RR1-10.2196/52898 [ABSTRACT FROM AUTHOR]

The authors studied associations of nature- and infrastructure-based features with physical activity (PA) in different urban neighborhood types; 848 community-dwelling people aged 75–90 years reported PA and three perceived nature-based destinations and seven infrastructure-based features as outdoor mobility facilitators. Neighborhood type was defined using a geographic information system based on proximity to central service areas and residential density (city center, subcenter, and dense and dispersed areas outside centers). PA was higher in dense areas and the city center. Binary logistic regression showed that perceiving nature-based destinations increased the odds for higher PA in the city center and areas outside centers. In dispersed areas, perceived infrastructure-based facilitators were especially associated with higher PA. Environmental features were not associated with PA in subcenters. Higher residential density, as a proxy for a higher amount of infrastructure, rather than center proximity, may underlie older adults' PA. The spatial context should be acknowledged in studies on environment–PA associations. [ABSTRACT FROM AUTHOR]

Background: Many older people report a willingness to increase outdoor physical activity (PA), but no opportunities for it, a situation termed as unmet PA need. The authors studied whether lower neighborhood mobility and PA precede the development of unmet PA need. Methods: Community-dwelling 75- to 90-year-old people (n = 700) were interviewed annually for 2 years. Unmet PA need, neighborhood mobility, and PA were self-reported. In addition, accelerometer-based step counts were assessed among a subgroup (n = 156). Results: Logistic regression analyses revealed that lower baseline neighborhood mobility (odds ratio 3.02, 95% confidence interval [1.86, 4.90] vs. daily) and PA (odds ratio 4.37, 95% confidence interval [2.62, 7.29] vs. high) were associated with the development of unmet PA need over 2 years. The participants with higher step counts had a lower risk for unmet PA need (odds ratio 0.68, 95% confidence interval, [0.54, 0.87]). Conclusion: Maintaining higher PA levels and finding solutions for daily outdoor mobility, especially for those with declines in health, may protect from the development of unmet PA need. [ABSTRACT FROM AUTHOR]

Life-space mobility describes the extent of community mobility of older persons. The aim of this cross-sectional study was to examine the relationship between socioeconomic status (SES) and life-space mobility and to investigate whether associations might be explained by SES-related disparities in health and functioning. The participants (n = 848) were community-dwelling adults aged 75–90. Education and occupation were used to indicate SES. Life-space assessment (range 0–120) was used to indicate distance and frequency of moving and assistance needed in moving. People with low education had lower life-space mobility scores than those with intermediate or high education: marginal means 63.5, 64.8, and 70.0 (p = .003), respectively. SES-related health disparities, i.e., higher body mass index, poorer cognitive capacity, and poorer physical performance explained the association, rendering it nonsignificant (marginal means 65.2, 65.3, and 67.5, p = .390). Low SES and restricted life-space mobility often coexist with overweight, reduced cognition, and poorer physical performance. [ABSTRACT FROM AUTHOR]

This cross-sectional study investigated associations between reasons to go outdoors and objectively-measured walking activity in various life-space areas among older people. During the study, 174 community-dwelling older people aged 75–90 from central Finland wore an accelerometer over seven days and recorded their reasons to go outdoors in an activity diary. The most common reasons for going outdoors were shopping, walking for exercise, social visits, and running errands. Activities done in multiple life-space areas contributed more to daily step counts than those done in the neighborhood or town and beyond. Those who went shopping or walked for exercise accumulated higher daily step counts than those who did not go outdoors for these reasons. These results show that shopping and walking for exercise are common reasons to go outdoors for community-dwelling older people and may facilitate walking activity in older age. Future studies on how individual trips contribute to the accumulation of steps are warranted. [ABSTRACT FROM AUTHOR]

Background: Outdoor mobility enables participation in essential out-of-home activities in old age. Aim: To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking. Methods: Community-dwelling participants of AGNES study (2017–2018, initial age 75–85) responded to AGNES-COVID-19 postal survey in spring 2020 (N = 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed. Results: Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p = 0.001), a smaller increase in physical activity (p < 0.001), and a smaller decline in autonomy in participation outdoors (p = 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p < 0.001 for both). Discussion: Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline. Conclusion: Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed. [ABSTRACT FROM AUTHOR]

Abstract Background A crucial issue for the sustainability of societies is how to maintain health and functioning in older people. With increasing age, losses in vision, hearing, balance, mobility and cognitive capacity render older people particularly exposed to environmental barriers. A central building block of human functioning is walking. Walking difficulties may start to develop in midlife and become increasingly prevalent with age. Life-space mobility reflects actual mobility performance by taking into account the balance between older adults internal physiologic capacity and the external challenges they encounter in daily life. The aim of the Life-Space Mobility in Old Age (LISPE) project is to examine how home and neighborhood characteristics influence people’s health, functioning, disability, quality of life and life-space mobility in the context of aging. In addition, examine whether a person’s health and function influence life-space mobility. Design This paper describes the study protocol of the LISPE project, which is a 2-year prospective cohort study of community-dwelling older people aged 75 to 90 (n = 848). The data consists of a baseline survey including face-to-face interviews, objective observation of the home environment and a physical performance test in the participant’s home. All the baseline participants will be interviewed over the phone one and two years after baseline to collect data on life-space mobility, disability and participation restriction. Additional home interviews and environmental evaluations will be conducted for those who relocate during the study period. Data on mortality and health service use will be collected from national registers. In a substudy on walking activity and life space, 358 participants kept a 7-day diary and, in addition, 176 participants also wore an accelerometer. Discussion Our study, which includes extensive data collection with a large sample, provides a unique opportunity to study topics of importance for aging societies. A novel approach is employed which enables us to study the interactions of environmental features and individual characteristics underlying the life-space of older people. Potentially, the results of this study will contribute to improvements in strategies to postpone or prevent progression to disability and loss of independence.

This study investigated the associations of personal goals with exercise activity, as well as the relationships between exercise-related and other personal goals, among older women. Both cross-sectional and longitudinal designs were used with a sample of 308 women ages 66-79 at baseline. Women who reported exercise-related personal goals were 4 times as likely to report high exercise activity at baseline than those who did not report exercise-related goals. Longitudinal results were parallel. Goals related to cultural activities, as well as to busying oneself around the home, coincided with exercise-related goals, whereas goals related to own and other people’s health and independent living lowered the odds of having exercise-related goals. Helping older adults to set realistic exercise-related goals that are compatible with their other life goals may yield an increase in their exercise activity, but this should be evaluated in a controlled trial. [ABSTRACT FROM AUTHOR]

Objective: To describe the natural history of social participation in people aged 85 years and over. Methods: Prospective cohort study;Newcastle 85+ study. Data were collected at baseline (n = 850) and at 18-, 36- and 60-month follow-ups (n = 344). Participation in 19 social activities (e.g. playing bingo, doing volunteer work and watching television) was measured at each time point. Results: The mean number of activities reported at baseline was 8.7 (SD 2.6). The number of activities was higher in those with higher educational attainment and intact walking ability (both p < .001). Social participation decreased significantly over time (p < .001) and at a similar rate in both sexes and for those with/without limited walking ability but at a higher rate in those with higher than lower educational attainment (p = .019).Discussion: Social participation seems to decrease significantly between ages 85 and 90 years; ways of encouraging social participation in this age group are needed. [ABSTRACT FROM AUTHOR]

Objectives: To examine associations of perceived outdoor environment with the prevalence and development of adaptive (e.g., slower pace) and maladaptive (e.g., avoiding walking) modifications in walking 2 km among older people. Methods: Community-dwelling 75-90 -year-old persons (N = 848) reported environmental outdoor mobility facilitators and barriers at baseline. Modifications in walking 2 km (adaptive, maladaptive, or no) were assessed at baseline and one and two years later. Results: Outdoor mobility facilitators were more often reported by those not using modifications or using adaptive versus maladaptive walking modifications. Differences in health and physical capacity explained most of the associations between outdoor mobility barriers and walking modifications. Perceived outdoor environment did not systematically predict future adaptive or maladaptive walking modifications. Discussion: Facilitators may compensate the declined physical capacity and alleviate the strain of walking longer distances by enabling the use of adaptive walking modifications, while lack of such facilitators fuels avoidance of walking longer distances. [ABSTRACT FROM AUTHOR]

Background: Fatigue related to task standardized by duration and intensity, termed fatigability, could manifest as shortening of activity bouts throughout the day causing daily activity to accumulate in a more fragmented pattern. Our purpose was to study the association of activity fragmentation with physical and mental dimensions of fatigability.Methods: A cross-sectional study of 485 community-dwelling 75-, 80-, and 85-year-old people using a thigh-worn accelerometer for 3-7 days. Activity fragmentation was studied as Active-to-Sedentary Transition Probability for 2 operational definitions of physical activity: accelerations equivalent to at least light physical activity and for upright posture. Physical fatigability was assessed as perceived exertion fatigability, performance fatigability severity, and with the Physical Fatigue Subscale of the Situational Fatigue Scale. Mental fatigability was assessed with the Mental Fatigue Subscale of the Situational Fatigue Scale and as a decrease in perceived mental alertness after a 6-minute walk test.Results: Higher activity fragmentation was associated with higher self-reported physical fatigability, perceived exertion fatigability, and performance fatigability severity, independent of total activity minutes (β = 0.13-0.33, p < .05 for all). Higher activity fragmentation was not associated with mental fatigability in the fully adjusted models. The associations with fatigability indices were similar for both activity fragmentation indicators. Associations of activity fragmentation and performance fatigability severity were similar also among those with the highest intensity-based physical activity volume.Conclusions: The findings provide support that studying fragmented activity patterns can be useful in identifying those at risk for high fatigability, even among those with relatively high physical activity level. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to study the associations of objectively defined hilliness with the prevalence and incidence of walking difficulties among community-dwelling older adults, and to explore whether behavioral, health, or socioeconomic factors would fully or partially explain these associations. Method: Baseline interviews (n = 848, 75-90 years) on difficulties in walking 500 m, frequency of moving through the neighborhood, and perceived hilliness as a barrier to outdoor mobility were conducted. Two-year follow-up interviews (n = 551) on difficulties in walking 500 m were conducted among participants without baseline walking difficulties. Hilliness objectively defined as the mean slope in 500-m road network. Results: Logistic regression showed that hilliness was associated with incident walking difficulties at the 2-year follow-up (odds ratio [OR] = 1.66, 95% confidence interval [CI] = [1.09, 2.51]) but not with the prevalence of walking difficulties at baseline. Adding behavioral, health, or socioeconomic factors to the models did not markedly change the results. Discussion: Greater hilliness should be considered a risk factor for developing walking difficulties among older adults. [ABSTRACT FROM AUTHOR]