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The elderly women demonstrated significantly smaller values of step length, stride length, ankle range of motion, pelvic obliquity, and velocity when compared with the younger women.. P

1986; 66:1382-1387.

PHYS THER

Patricia A Hageman and Daniel J Blanke

Women Comparison of Gait of Young Women and Elderly

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Comparison of Gait of Young Women

and Elderly Women

PATRICIA A HAGEMAN

and DANIEL J BLANKE

The purpose of our study was to describe and compare free-speed gait patterns

of healthy young women with healthy elderly women The evaluation was com-pleted with high-speed cinematography using synchronized front and side views

of 26 healthy volunteers One group was composed of 13 subjects 20 to 35 years

of age, and the other group was composed of 13 subjects 60 to 84 years of age

Each subject participated in one test session consisting of three filmed trials of free-speed ambulation down a 14-m walkway The processed film was analyzed for 10 gait characteristics Differences in gait characteristics between the two

groups were examined using a correlated t test (p < 01) The elderly women

demonstrated significantly smaller values of step length, stride length, ankle range of motion, pelvic obliquity, and velocity when compared with the younger women The results of our study suggest that the physical therapist should not establish similar expectations for young women and elderly women during gait rehabilitation

Key Words: Gait, Physical therapy

Understanding the effects of aging on movement and func­

tion is becoming increasingly important because of longer

average life spans and a growing elderly population Changes

in stereotypic movements such as walking patterns have been

reported as early as 60 years of age 1,2 Because elderly people

frequently utilize physical therapy services to achieve the

maximal functional ability of motor activities such as gait,

the collection of gait analysis data of healthy elderly subjects

is essential to establish realistic rehabilitation expectations of

the elderly population

Although advances in technology have made objective

methods of measuring gait more available, the physical ther­

apy literature contains only a few studies of gait comparisons

of healthy elderly women with healthy young women 3-5

These studies report that elderly women demonstrate shorter

step and stride lengths, lower average velocities, 3,5 and greater

variability in stride width 4 when compared with young

women None of these studies, however, provides conclusive

evidence of the effects of aging on the gait patterns of the

elderly population because of small sample sizes and limita­

tions in the number of specific gait characteristics examined

Additional comparisons of the gait characteristics of healthy

young women and healthy elderly women are necessary be­

cause gait training is a major portion of geriatric physical

therapy rehabilitation and because women constitute a ma­

jority of the over-60-years age group The purpose of this

study was to describe and compare the free-speed gait char­

acteristics of matched groups of healthy young women and healthy elderly women

METHOD

Subjects and Selection Procedure

Twenty-six female volunteers, thirteen 20 to 35 years of age and thirteen 60 years of age or older, were accepted as subjects Each subject provided informed consent in accordance with the procedures of the University of Nebraska Institutional Review Board

The health status of each subject was evaluated on the basis

of a medical review and an objective examination by a registered physical therapist, and all subjects were found to be free of disabling physical conditions or minor ailments that could affect or influence locomotion Specifically, the subjects were without musculoskeletal or neurological involvement or medication for these conditions Because leg length is an important determinant of stride length, 6 leg length was meas­ ured to ensure that each subject was without a leg-length discrepancy (± 1.9 cm), as defined by Subotnick 7 The per­ centage of body fat of each subject was determined using skin­ fold measurements to ensure that no subjects who were ex­ tremely lean or obese would be included in the study All subjects were within one standard deviation of the age-specific average percentage of body fat listed by Jackson et al 8 For those subjects 20 to 35 years of age, the mean percentage of body fat was 22.7 ± 6.8; for those subjects 60 years of age and older, the mean percentage of body fat was 31.1 ± 7.5 The elderly women meeting these criteria were tested first Young women meeting these criteria were recruited to match the elderly women on the basis of right leg length The matching of right leg lengths was within the same range suggested by Subotnick for leg-length discrepancies 7 to achieve

Mrs Hageman is Instructor, Division of Physical Therapy Education, Uni­

versity of Nebraska Medical Center, 42nd and Dewey Ave, Omaha, NE 68105

(USA)

Dr Blanke is Associate Professor, Department of Health, Physical Education,

and Recreation, University of Nebraska at Omaha, Omaha, NE 68182

This article was submitted June 4,1985; was with the authors for revision 12

weeks; and was accepted January 29, 1986

RESEARCH

a close pairing of subjects between the young and elderly

groups

Instrumentation

High-speed cinematography was used to record the subjects'

gait The motion-recording system included two high-speed

cameras positioned to orient their optical axes at 90 degrees

with one camera parallel to and the other camera

perpendic-ular to a 14-m walkway (Figure) The front camera, a Photec

IV* fitted with a 50-mm Nikon† lens, was positioned 15.6 m

from the center of the walkway The side camera, a LoCam*

fitted with a 25-mm Cosimcar* lens, was positioned 8 m from

the center of the walkway The cameras were positioned

according to the procedure of Sutherland and Hagy.9 Each

camera was set to run at 100 frames a second A 1-m reference

scale was included in the field of view of both cameras A

lighting device also was placed in the view of both cameras to

provide a common reference point so that frames could be

matched later to analyze any phase of the walking cycle

The processed film was displayed on a Lafayette

Data-viewer§ rear projection system This system projects the film

image of the subject onto a viewing screen and allows the film

to be viewed frame by frame or advanced up to 24 frames a

second, depending on the viewer's needs for each variable

that is measured The desired measurements were made

di-rectly from the projected image A Numonics" digitizer was

used in conjunction with the projection system to assign

separate X,Y-coordinate values for any landmark from both

front- and side-view films The coordinate values for the

landmarks were stored in a computer# and were used for

calculating the variables

Procedure

Each subject was scheduled for one 45-minute testing

ses-sion All testing was performed at the Gait Analysis

Labora-tory at the University of Nebraska at Omaha Appropriate

shorts and sleeveless shirt were the required dress A 1.9-cm

white dot with a 0.6-cm blue center was placed on the

following anatomical points in accordance with the

proce-dures of Sutherland and Hagy9 and Sutherland et al10: right

and left anterior-superior iliac spines (ASISs), center of both

right and left patellae with the knee flexed to 25 degrees, right

and left malleoli, and the space between the second and third

metatarsals of both the right and left feet Other markers

included a pelvic stick that consisted of a 15.5-cm dowel

directed perpendicularly from an Orthoplast® base The base

was attached to a web belt with buckle closure The belt was

placed on the subject so that the stick projected anteriorly

from a point midway between the ASISs A tibial stick of

similar construction was placed around the maximal

circum-ference of the calf so that the stick projected anteriorly from

the tibial crest

The subjects then walked barefoot along the 14-m walkway

Each subject was advised to walk at the pace she normally

would choose when walking on a clear sidewalk The first

Camera

Lighting Figure Walkway plan of Gait Analysis Laboratory

4.75 m of the walkway allowed each subject to accelerate to her chosen walking speed before reaching the filmed area The area from which measurements were taken was 3.25 m long, allowing one to two gait cycles, depending on the size

of the subject and her walking speed The last 6 m of the walkway ensured that each subject did not decelerate until she had left the filmed walkway area Each subject performed three trials

Measurements

We used the procedure that was described by Sutherland and Hagy9 and validated in 1980 by Sutherland et al10 to obtain the measurements with the processed film Reliability

of the measurements taken from our processed film was high when test-retest results were compared during a pilot study The same observer (P.A.H.) made all of the test-retest meas-urements from the film, recording a maximum deviation of 2.5 degrees for rotational measurements and a maximum deviation of 2 cm for distance measurements

* Photomic Systems, Inc, 265 H Sobrante Way, Sunnyvale, CA 94086

† Nikon, Inc, 623 Stewart Ave, Garden City, NY 11530

‡ Redlake Corp, 1711 Dell Ave, Campbell, CA 95008

§ Lafayette Instrument Co, PO Box 5729, Lafayette, IN 47903

║Numonics Corp, 418 Pierce St, Lansdale, PA 19446

# Model 4052, Tektronix, Inc, PO Box 500, Beaverton, OR 97077

plantar-flexion and dorsiflexion range of motion, average

velocity of the center of gravity, step length, stride length, and

vertical excursion of the center of gravity Step length was

measured as the distance in the line of travel between the

right heel-strike and the following left heel-strike, beginning

with the first full-body side view of the right heel-strike A

scale factor was calculated using the 1-m reference scale in

the cameras' field of view The measured film step length was

multiplied by the scale factor to determine the actual step

length

Stride length was measured as the distance in the line of

travel between successive points of foot-floor contact of the

right foot, beginning with the first total-body view involving

a right foot step Actual stride length was calculated by mul­

tiplying the scale factor by the measured film stride length

Average walking velocity was recorded as the total distance

traveled by the subject's center of gravity during one gait cycle

divided by the time elapsed during the movement, recorded

in centimeters per second Center of gravity was calculated at

the initial point of the right foot-floor contact during the first

total-body view and the successive points of right foot-floor

contact Center of gravity was determined according to the

segmentation method 11 We calculated cycle time by counting

the number of frames for one gait cycle and dividing the

number by the film speed

Vertical center-of-gravity excursion was calculated by com­

paring the center of gravity of digitized frames at mid-stance

and double-support phases of the gait cycle Vertical

center-of-gravity excursion was determined by subtracting the lowest

vertical point from the highest vertical point

A side view provided the method for determining the ankle

plantar-flexion-dorsiflexion range of motion The total degree

of movement at the ankle formed by the line between the

knee and ankle center and the line along the bottom of the

foot was recorded in degrees These measurements were ob­

tained directly from the viewing screen with a protractor

The front-view camera provided the data for determining

stride width, lateral center-of-gravity excursion, pelvic ob­

liquity, pelvic rotation, and tibial rotation Stride width was

measured as the horizontal distance between two consecutive

steps measured from a point between the second and third

metatarsals of each foot Because the subject image became

larger as the subject approached the camera, the appropriate

scale factor was used for each point measured and confirmed

by measurements from the side view The actual distance

between the metatarsal points of both feet was the stride

width

Lateral center-of-gravity excursion was considered to be the

total lateral movement the body's center of gravity traveled

during one gait cycle The center-of-gravity (X,Y) coordinates

for the mid-stance position of full weight bearing on the right

foot and on the left foot were calculated Using the appropriate

scale factor for each center of gravity, the actual distance

between the two center-of-gravity points was calculated

Pelvic obliquity was the arc of upward and downward

movement from the horizontal plane of the right ASIS during

one gait cycle This measurement was obtained directly from

the viewing screen with a protractor When the right ASIS

was at the highest vertical point, the angle of upward move­

ment was measured as the angle formed by the intersection

of two lines The first line was the segment between the right

located at the base of the pelvic-stick attachment The second line was the segment between the base of the pelvic-stick attachment to the horizontal plane The angle of downward movement was determined in a similar fashion and added to the angle of upward movement for the total arc of movement Pelvic rotation was the degree of rotation that the pelvis moved about a vertical axis At 0 degrees of rotation, the

15.5-cm pelvic stick pointed directly ahead At the point of greatest observed rotation to the right, the distance that the tip of the pelvic stick had rotated to the right from the neutral position was measured This distance was converted into an actual distance using the appropriate scale factor Considering this distance and the stick length to be two sides of a triangle, we used a trigonometric function to calculate the angle of rotation

to the right The same method was used for recording the greatest observed rotation to the left The total rotation was the sum of the degrees of rotation to the right arid left Tibial rotation was the degree the tibia rotated during foot-floor contact of the right foot The rotation of the tibial stick about a vertical axis was calculated in the same manner as the pelvic-stick rotation

Data Analysis Descriptive statistics were calculated for each variable meas­

ured in both groups An independent t test was used to

compare the basic descriptive characteristics between the groups Because the groups were nonrandom and matched for leg length, which may have affected the experimental

variables, a correlated t test was used to compare gait char­

acteristics between the groups All comparisons were evalu­ ated at the 01 level of significance

RESULTS The basic descriptive characteristics of both groups of women are presented in Table 1 The groups appeared to be well matched for leg length because no statistical differences were found between the two groups for either right or left leg-length comparisons Although no differences were found in height or weight between the groups, the elderly women had

a higher percentage of body fat than the younger women Both groups, however, were within the normal range for percentage of body fat based on their age ranges

Gait characteristics measured from the film of the side-view camera are reported in Table 2 A comparison of the means

of these variables reveals significant differences of all variables except the vertical excursion of the center of gravity The younger female group demonstrated a longer step length and stride length than the elderly women Greater ankle move­ ment was observed in the walking patterns of the young women than in those of the elderly women The young women also ambulated at a significantly faster rate than the elderly women

Table 3 lists the comparison of variables measured from the front-view camera The only variable that revealed a significant difference between the two groups of women was pelvic obliquity because the young women demonstrated substantially greater pelvic obliquity compared with the el­ derly women We found no significant differences between the groups for pelvic or tibial rotation or for lateral center-of-gravity excursion

RESEARCH

TABLE 1

Basic Descriptive Characteristics of the Groups

Variable

Age (yr)

Height (cm)

Mass (kg)

Body fat (%)

Leg length (cm)

Left

Right

66.85 161.00 61.43 25.27 86.98 86.69

Elderly Women (n = 13)

s 7.60 9.16 17.04 5.79 4.71 4.66

Range (60.0-84.0) (138.4-172.7) (37.7-107.9) (17.2-35.1) (78.5-95.6) (78.3-96.9)

23.92 165.10 60.43 20.37 86.81 86.65

Young Women (n-13)

s 3.57 8.15 8.20 2.79 4.24 4.40

Range (20.0-33.0) (154.9-182.9) (49.8-74.9) (16.0-25.4) (80.0-94.1) (80.9-95.6)

t

-1.20 a

0.19 a

2.75 a,b

0.39 c

0.10 c

DISCUSSION

Our study resulted from a need to gain a better

understand-ing of the gait characteristics of young women and elderly

women Whether physical therapists should expect elderly

women to have the same rehabilitation potential as young

women is not conclusive Previous gait studies of healthy

women either did not consider the specific matching of

groups3 or used a smaller sample size5 than that used in our

study Previous studies comparing the gait characteristics of

young and elderly women have emphasized gait intercycle

variability4 and the influences of heel height on gait.5 This

study of the linear, temporal, and rotational aspects of the

gait patterns of healthy young women and healthy elderly

women may be helpful to the physical therapist who uses gait

characteristics to evaluate a patient's progress

We adhered strictly to the criteria established for subject

selection in this study Matching the young group with the

elderly group using leg-length measurements was considered

crucial because of the influence of leg length on stride length.6

The results of our study are in close agreement with the

findings of other gait studies involving adult women and those

involving adult men The step- and stride-length

measure-ments of the elderly women in our study are similar to values

TABLE 2

Comparison of Gait Characteristics Measured from the

Side-View Camera

Variable

Step length

(cm)

Stride length

(cm)

Ankle range of

motion (°)

Velocity (cm/

sec)

Vertical

center-of-gravity

ex-cursion (cm)

Elderly Women (n = 13)

66.34 134.92 24.62 131.94

2.87

s 6.77 14.71 4.61 23.85

1.34

Young Women (n = 13)

80.68 162.70 31.31 159.53

3.51

s 5.43 10.84 5.22 16.39

1.77

ta

7.10 b

6.47 b

-3.93 b

-4.90 b

-1.33

published in a study by Murray et al5 involving 30 women aged 20 to 70 years and in a study by Chao et al12 involving

37 women aged 32 to 85 years Finley et al3 reported shorter step and stride lengths for the young women and elderly women in their study than those of our study The shorter step and stride lengths of the subjects in the Finley et al study may have represented the effects of cumbersome equipment worn by their subjects during walking The healthy elderly women in our study demonstrated similar step- and stride-length values to those reported by Sutherland and associates10

for 15 healthy men aged 19 to 40 years

The young women demonstrated significantly larger values for step length than the elderly women The values of the young women in our study were similar to the values of 30 healthy men aged 20 to 65 years recorded during free-speed gait by Murray et al.13 The mean step and stride lengths of the men were 78 cm and 156 cm, respectively The young women in our study demonstrated a greater walking velocity than the women aged 20 to 36 years in a 1984 study by Murray etal.14

Our finding of larger means for step and stride lengths for the young women is not surprising because the mean walking velocity of the young group was significantly greater than the

TABLE 3 Comparison of Gait Characteristics Measured from the Front-View Camera

Variable

Lateral center-of-gravity excur-sion (cm) Stride width (cm) Pelvic obliquity (°) Pelvic rotation (°) Tibial rotation (°)

Elderly Women (n = 13)

3.03 10.02 6.77 11.77 15.31

s

2.13 3.58 2.05 4.30 7.10

Young Women (n = 13)

2.39 8.31 9.86 11.77 16.69

s

1.50 3.12 2.38 4.44 5.50

ta

0.10 1.58 -3.65 b

0.00 -0.51

a ctf=24

*p<.01

c df=12

a (df=12

b p<.01

adf=12

b p < 0 1

ambulation rate of the elderly women, however, was not

abnormally slow Their mean walking speed of 131.9 ± 23.9

cm/sec was similar to values obtained by Murray et al5

involving women aged 20 to 70 years whose mean free-speed

velocity was 130.0 ±15.0 cm/sec The mean walking velocity

of the elderly women also was similar to values obtained in a

study by Sutherland et al involving men aged 19 to 40 years

whose mean walking velocity was 121.6 cm/sec.10

A progressive increase in pelvic obliquity corresponding to

increased walking speeds has been reported.614 Pelvic

ob-liquity was greater in the young women, as compared with

the elderly women The pelvic obliquity values of adult men

reported in the literature ranged from five to eight degrees,10

which is similar to the findings of our study

Both groups of women maintained lateral and vertical

center-of-gravity excursions within a 5-cm range reported in

the literature.6 Stride widths, however, were extremely

varia-ble among both groups Gabell and Nayak reported similar

findings.4 Young subjects (21-47 years of age) and elderly

subjects (66-84 years of age) in their study demonstrated

variability within the gait cycle, primarily in stride width

The elderly women demonstrated substantially less

move-ment at the ankle during free-speed gait than the young

women In a study by Murray et al that compared the gait

patterns of young men and elderly men, the elderly men

(60-65 years of age) also showed a marked reduction of ankle

movement during ankle plantar flexion at the end of

ipsilat-eral stance.13 The reason for the decrease in ankle movement

is not clear, but it may have resulted from slower gait speeds,

as suggested previously.5

Rotation about the thigh and tibia have been reported in

phase with pelvic rotation The rotary displacement increases

progressively from the pelvis to the thigh to the tibia with

values of 8 degrees of rotation documented at the pelvis to 19

degrees of rotation measured at the tibia.15 This progressive

increase in rotation from the pelvis to the tibia was

demon-strated by both young and elderly subjects in our study, and

no significant differences were found between groups The

values obtained in our study were similar to reported ranges

for adult women during free-speed gait,5 but were larger than

the values reported for the free-speed gait patterns of men.610

Because pelvic rotation facilitates forward movement of the

hip joint of the swinging leg, increased pelvic rotation would

be expected during an increased stride length A significant

increase in pelvic rotation was not demonstrated by the young

women, however, even though they demonstrated a

signifi-cantly larger stride length when compared with the elderly

women This finding may be attributed to individual variation

in the interaction between stride length, walking velocity, and

pelvic rotation.4

Despite significant differences among several gait

charac-teristics of both the young and elderly women, the elderly

women demonstrated values of step length, stride length,

walking velocity, pelvic rotation, and tibial rotation that were

similar to or exceeded those values of healthy young men and

women in other studies These findings suggest that both the

young women and the elderly women from our study walk

faster today than their counterparts of 15 to 20 years ago

previous studies may have been caused by differences in subject selection and measuring techniques Subject cooper-ation and ability to follow directions may have influenced the results Because we used a small subject sample, a true random sampling of the age groups may not have been represented Some subjects may have had an undiagnosed or unrecognized pathological condition that affected their gait, despite our adherence to the guidelines established for subject selection

Clinical Implications

The results of our study suggest that the clinician should not expect the same gait training rehabilitation potential for both young women and elderly women because differences exist between the gait characteristics of healthy young women and healthy elderly women The degree to which a patholog-ical condition may further affect the rehabilitation expecta-tions of both groups during gait training is beyond the scope

of this study

Based on the results of our study, the clinician may expect

an elderly woman to ambulate with a smaller step and stride length, a slower walking speed, less pelvic obliquity, and less ankle movement than a younger woman with a similar leg length No differences between the young and elderly women would be expected in center-of-gravity excursion, pelvic and tibial rotation, or stride width

Physical therapists are involved in the gait training of geriatric patients Because of the frequency with which they treat elderly women, clinicians must know the effects of age

on gait to understand the potential of gait training rehabili-tation for this patient group

Further study in this area is needed before definitive state-ments can be made about the effects of aging Care must be taken when applying the results of this study to other popu-lations Further research could focus on the comparison of additional gait characteristics such as hip motion, hip rotation, angling of the feet, and upper extremity movement of young women and elderly women

CONCLUSIONS

For the sample of subjects we examined, the following conclusions can be made:

1 The young women and the elderly women did not dem-onstrate significant differences in vertical center-of-gravity excursion, lateral center-of-gravity excursion, stride width, pelvic rotation, or tibial rotation

2 The young women demonstrated significantly larger values than those of the elderly women in step length, stride length, ankle range of motion, pelvic obliquity, and walk-ing velocity

3 The values of the gait characteristics of both the young women and the elderly women in this study were larger than those of their counterparts of 15 years ago Despite these apparent changes, the effects of aging were observed

in these gait characteristics: step length, stride length, ankle range of motion, pelvic obliquity, and walking velocity

RESEARCH

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11 Nutter J, Blanke D, Wang T: Microcomputers aid movement analysis Collegiate Microcomputer 3:1-11, 1985

12 Chao E, Laughman R, Schneider E, et al: Normative data of knee joint motion and ground reaction forces in adult level walking J Biomech 16:219-232 1983

13 Murray M, Drought A, Kory R: Walking patterns of normal men J Bone Joint Surg [Am] 46:335-360, 1964

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1986; 66:1382-1387.

PHYS THER

Patricia A Hageman and Daniel J Blanke

Women

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