Perceived effort of walking: relationship with gait, physical function and activity, fear of falling, and confidence in walking in older adults with mobility limitations.
BACKGROUND
Although clinicians have a number of measures to use to describe walking performance, few, if any, of the measures capture a person's perceived effort in walking. Perceived effort of walking may be a factor in what a person does versus what he or she is able to do.


OBJECTIVE
The objective of this study was to examine the relationship of perceived effort of walking with gait, function, activity, fear of falling, and confidence in walking in older adults with mobility limitations. Design This investigation was a cross-sectional, descriptive, relational study.


METHODS
The study took place at a clinical research training center. The participants were 50 older adults (mean age=76.8 years, SD=5.5) with mobility limitations. The measurements used were the Rating of Perceived Exertion (RPE) for walking; gait speed; the Modified Gait Abnormality Rating Scale; energy cost of walking; Late Life Function and Disability Instrument (LLFDI) for total, basic, and advanced lower-extremity function and for disability limitations; activity and restriction subscales of the Survey of Activities and Fear of Falling in the Elderly (SAFFE); activity counts; SAFFE fear subscale; and Gait Efficacy Scale (GES). The relationship of the RPE of walking with gait, function, activity, fear, and confidence was determined by using Spearman rank order coefficients and an analysis of variance (adjusted for age and sex) for mean differences between groups defined by no exertion during walking and some exertion during walking.


RESULTS
The RPE was related to confidence in walking (GES, R=-.326, P=.021) and activity (activity counts, R=.295, P=.044). The RPE groups (no exertion versus some exertion) differed in LLFDI scores for total (57.9 versus 53.2), basic (68.6 versus 61.4), and advanced (49.1 versus 42.6) lower-extremity function; LLFDI scores for disability limitations (74.9 versus 67.5); SAFFE fear subscale scores (0.346 versus 0.643); and GES scores (80.1 versus 67.8) (all P<.05). Limitations The range of RPE scores for the participants studied was narrow. Thus, the real correlations between RPE and gait, physical function, and psychological aspects of walking may be greater than the relationships reported.


CONCLUSIONS
The perceived effort of walking was associated with physical activity and confidence in walking. Reducing the perceived effort of walking may be an important target of interventions to slow the decline in function of older adults with mobility limitations.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA.
Leslie M
LM
Julius
Jennifer S
JS
Brach
David M
DM
Wert
Jessie M
JM
VanSwearingen
D000058:Accidental Falls; D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005239:Fear; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009043:Motor Activity; D010465:Perception; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology / Q000523:psychology*