**3. Physical function assessments in elderly people**

#### **3.1. Performance assessment**

The assessment measures are taken by well‐trained staff who had nursing, physiotherapy, occupational therapy, or similar qualifications.

#### *3.1.1. Grip strength assessment*

Muscle function is assessed by the grip strength (GS) (**Figure 4**). GS is measured in kilograms in the participant's dominant hand using a Smedley‐type handheld dynamometer (GRIP‐D; Takei Ltd, Niigata, Japan).

#### *3.1.2. Five‐meter walk test*

Five‐meter walk test is assessed with walking conducted at a normal pace (usual walking speed; UWS). Two marks are used to indicate the path (start and end) of a 5‐m walk path space. UWS is measured using a stopwatch system. Examiner tells the subjects to walk on a straight and flat surface at UWS. Moreover, examiner tells the subjects to maintain gait past the end of the walk path for a further 2.5 m.

#### *3.1.3. One‐legged standing time test*

Balance function is assessed with one‐legged standing time (**Figure 5**). One‐legged standing time is used to measure how long a subject remains standing on one leg (eyes open). Subjects are allowed to decide which leg to use as support leg. Next, examiner tells the subjects to lift the converse foot from flat floor. Moreover, examiner tells the subjects to confirm sure not to press the lifted leg against support leg. The test ended when lifted leg touched the support leg, the lifted leg touched the floor, or after 60 s of successful balance.

Comprehensive Physical Function Assessment in Elderly People http://dx.doi.org/10.5772/67528 31

**Figure 4.** Grip strength assessment.

elderly people, particularly those above 65 years, compared with younger people [18, 19]. Mechanisms related to the initiation and stepping patterns of gait, such as hip extension, step width, and cadence, have previously been reported to be related to the energy cost of walking in older adults with slow and variable gait [15]. Abe et al. reported that women of advanced age (75 years or older) have diminished pulmonary function, physical function, and mobility, and that diminished pulmonary function is associated with declining physical function [20]. Malatesta et al. reported that healthy octogenarians exhibited higher walking cost and greater stride time variability [21] and also reported that these declines in physi‐ cal performances were apparent at age 80 years and over in women and at age 90 years and

This suggests that going activity to extension of LSA may better impact walking efficiency

The assessment measures are taken by well‐trained staff who had nursing, physiotherapy,

Muscle function is assessed by the grip strength (GS) (**Figure 4**). GS is measured in kilograms in the participant's dominant hand using a Smedley‐type handheld dynamometer (GRIP‐D;

Five‐meter walk test is assessed with walking conducted at a normal pace (usual walking speed; UWS). Two marks are used to indicate the path (start and end) of a 5‐m walk path space. UWS is measured using a stopwatch system. Examiner tells the subjects to walk on a straight and flat surface at UWS. Moreover, examiner tells the subjects to maintain gait past

Balance function is assessed with one‐legged standing time (**Figure 5**). One‐legged standing time is used to measure how long a subject remains standing on one leg (eyes open). Subjects are allowed to decide which leg to use as support leg. Next, examiner tells the subjects to lift the converse foot from flat floor. Moreover, examiner tells the subjects to confirm sure not to press the lifted leg against support leg. The test ended when lifted leg touched the support

leg, the lifted leg touched the floor, or after 60 s of successful balance.

in older adults manifests as walking

over in men [13]. Shimada reported that increased VO2

than efforts to improve gait speed and muscle strength.

occupational therapy, or similar qualifications.

the end of the walk path for a further 2.5 m.

*3.1.3. One‐legged standing time test*

**3.1. Performance assessment**

30 Clinical Physical Therapy

*3.1.1. Grip strength assessment*

Takei Ltd, Niigata, Japan).

*3.1.2. Five‐meter walk test*

becomes inefficient and reduced endurance capacity occurs [22].

**3. Physical function assessments in elderly people**

#### *3.1.4. The 6‐min walking distance test*

6MD is performed in a 10‐m, straight corridor. In the 6MD, participants are instructed to walk as quickly as possible to cover the longest distance possible within 6 min. This test measures the distance that a participant could quickly walk on a flat, hard surface in a period of 6 min.

#### *3.1.5. Appendicular skeletal muscle mass assessment*

In the elderly, muscle weakness is associated with the muscle atrophy aging (sarcopenia) pro‐ gressive loss. Skeletal muscle mass loss may also have the potential to impact quality of life and ultimately the need for long‐term care in elderly people [23]. Several studies developed equations for estimating skeletal muscle mass [24–26].

#### *3.1.6. Prediction models*

#### **Sanada K, et al., 2010: Prediction models of sarcopenia [24]**

Men: appendicular skeletal muscle mass = 0.326 × body mass index (BMI) − 0.047 × waist cir‐ cumference ‐ 0.011 × Age + 5.135 (*R*<sup>2</sup>  = 0.68).

Women: appendicular skeletal muscle mass = 0.156 × BMI + 0.044 × hand grip strength − 0.010 ×  waist circumference + 2.747 (*R*<sup>2</sup>  = 0.57).

#### **Yoshida D, et al., 2014: Bioelectrical impedance analysis [25]**

Men: appendicular skeletal muscle mass = 0.197 × (impedance index) + 0.179 × (weight) 0.019 (*R*<sup>2</sup>  = 0.87).

Women: appendicular skeletal muscle mass = 0.221 × (impedance index) + 0.117 × (weight) +  0.881 (*R*<sup>2</sup>  = 0.89).

#### **Ito T, et al., 2016: Simple estimation of appendicular muscle mass [26]**

Appendicular skeletal muscle mass = 5.051 × (gender: men = 1, women = 0) + 0.364 × (BMI)  + 0.168 × (maximum calf circumference) − 0.815 (*R*<sup>2</sup>  = 0.80).

#### **3.2. Reduced physical activity**

Past studies have provided the first evidence that slightly constricted life space may serve as an important marker and/or risk factor for the development of frailty, whereas severely constricted life space may indicate a high risk of mortality [27]. Webber et al. reported how mobility impairments can lead to limitations in accessing different life spaces and stressed the associations among determinants that influence mobility [28]. Previous study reported falls and reduced life space closely related to physical performance [29, 30].
