Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study



Given the potential consequences of falls among older adults, a major challenge is to identify people at risk before the first event. In this context, gait parameters have been suggested as markers of fall risk.


To examine, among older people, the prospective relationship between gait patterns assessed in comfortable and challenging walking conditions, and future fall(s).


A total of 105 adults older than 65 years, living independently at home and without a recent fall history were included in a 2-year, longitudinal, observational study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity and Minimum Toe Clearance (MTC) were recorded in comfortable (CW), fast (FW) and dual task walking (DTW) conditions. Gait parameter changes occurring between CW and FW and between CW and DTW were calculated and expressed in percent. DTW cost was calculated as the change of DTW relative to CW. Fall events were recorded using fall diaries. Comparisons according to fall occurrence were performed by means of univariate analysis and multivariate binary logistic regression analysis.


Two-year follow-up was available for 96 participants, of whom 35 (36.5%) fell at least once. Comparative analysis showed that future fallers had shorter FW stride length and higher symmetry DTW cost than non-fallers (p < 0.05). Binary logistic regression analysis showed that each additional percent of stride symmetry cost was associated with an increase in future fall risk (odds ratio 1.018, 95% Confidence Interval (CI) 1.002–1.033; p = 0.027).


Our results confirm the association between a symmetry decrease in DTW and future fall(s). Indeed in this study, the mean symmetry DTW cost in fallers is almost 20% higher than in non-fallers, meaning a fall risk that is around 36% higher than among non-fallers.


This exploratory study shows the usefulness of considering gait parameters, particularly symmetry in challenging walking conditions, for early identification of future fallers.

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  1. 1.

    Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35:ii37–ii41.

  2. 2.

    Thiem U, Klaaßen-Mielke R, Trampisch U, Moschny A, Pientka L, Hinrichs T (2014) Falls and EQ-5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study. Health Qual Life Outcomes 12:2.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE (2008) Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 37:19–24.

    Article  PubMed  Google Scholar 

  4. 4.

    Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D (2004) Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 33:368–373.

    Article  PubMed  Google Scholar 

  5. 5.

    Choi K, Ko Y (2015) Characteristics associated with fear of falling and activity restriction in south korean older adults. J Aging Health 27:1066–1083.

    Article  PubMed  Google Scholar 

  6. 6.

    Tinetti ME, Speechley M, Ginter SF (1988) Risk Factors for Falls among Elderly Persons Living in the Community. N Engl J Med 319:1701–1707.

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Craig J, Murray A, Mitchell S, Clark L, Saunders L, Burleigh L (2013) The high cost to health and social care of managing falls in older adults living in the community in Scotland. Scott Med J 58:198–203

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Morrison A, Fan T, Sen SS, Weisenfluh L (2013) Epidemiology of falls and osteoporotic fractures: a systematic review. Clinicoecon Outcomes Res 5:9–18.

    Article  PubMed  Google Scholar 

  9. 9.

    Delbaere K, Close JCT, Brodaty H, Sachdev P, Lord SR (2010) Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ 341:c4165.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Gillain S, Boutaayamou M, Beaudart C, Demonceau M, Bruyère O, Reginster JY, Garraux G, Petermans J (2018) Assessing gait parameters with accelerometer-based methods to identify older adults at risk of falls: a systematic review. Eur Geriatr Med 1–14.

  11. 11.

    Blake AJ, Bendall KMMJ, Dallosso H, Ebrahim SB, Arie TH, Fentem PH, Bassey EJ (1988) Falls by elderly people at home: prevalence and associated factors. Age Ageing 17:365–372

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Winter (1992) Foot trajectory in human gait: a precise and multifactorial motor control task. Phys Ther 72:45–53

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Mills PM, Barrett RS (2001) Swing phase mechanics of healthy young and elderly men. Hum Mov Sci 20:427–446.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Barrett RS, Mills PM, Begg RK (2010) A systematic review of the effect of ageing and falls history on minimum foot clearance characteristics during level walking. Gait Posture 32:429–435.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Alan RDA, John GB (2015) The effects of walking speed on minimum toe clearance and on the temporal relationship between minimum clearance and peak swing-foot velocity in unilateral trans-tibial amputees. Prosthet Orthot Int 39:120–125.

    Article  Google Scholar 

  16. 16.

    Schulz BW, Lloyd JD, Lee WE (2010) The effects of everyday concurrent tasks on overground minimum toe clearance and gait parameters. Gait Posture 32:18–22.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Linn BS, Linn MW, Gurel LEE (1968) Cumulative Illness Rating Scale. J Am Geriatr Soc 16:622–626.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, Mulsant B, Reynolds CF (1992) Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 41:237–248.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Jackson ASBS, Mahar MT, Wier LT, Ross RM, Stuteville JE (1990) Prediction of functional aerobic capacity without exercise testing. Med Sci Sports Exerc 22:863–870

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Jackson AS, Ross RM (1996) Methods and limitations of assessing functional work capacity objectively. J Back Musculoskelet Rehabil 6:265–276.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthr Care Res 63:S240–S252.

    Article  Google Scholar 

  22. 22.

    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged: the index of adl: a standardized measure of biological and psychosocial function. JAMA 185:914–919.

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Lawton MPBE (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Gillain S, Warzee E, Lekeu F, Wojtasik V, Maquet D, Croisier J-L, Salmon E, Petermans J (2009) The value of instrumental gait analysis in elderly healthy, MCI or Alzheimer’s disease subjects and a comparison with other clinical tests used in single and dual-task conditions. Ann Phys Rehabil Med 52:453–474.

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    D’Ath P, Katona P, Mullan E, Evans S, Katona C (1994) Screening, detection and management of depression in elderly primary care attenders. I: the acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the Development of Short Versions. Fam Pract 11:260–266

    Article  PubMed  Google Scholar 

  26. 26.

    Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699.

    Article  Google Scholar 

  27. 27.

    Vellas B, Balardy L, Gillette-Guyonnet S, Abellan Van Kan G, Ghisolfi-Marque A, Subra J, Bismuth S, Oustric S, Cesari M (2013) Looking for Frailty in Community-dwelling Older Persons: the Gérontopôle Frailty Screening Tool (GFST). The Journal of Nutrition, Health & Aging 17:629–631.

    Article  CAS  Google Scholar 

  28. 28.

    Rolfson DB, Tsuyuki RT, Tahir A, Rockwood K (2006) Validity and reliability of the Edmonton Frail Scale. Age and Aging 35:526–529

    Article  Google Scholar 

  29. 29.

    Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR (2010) The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing 39:210–216.

    Article  PubMed  Google Scholar 

  30. 30.

    Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N (2008) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170.

    Article  PubMed  Google Scholar 

  31. 31.

    Casellato L (1994) New developments in visual acuity charts. Ophthalmologica 208:95–97

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Janssen I, Heymsfield SB, Baumgartner RN, Ross R (2000) Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol 89:465–471

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (Sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50:889–896.

    Article  PubMed  Google Scholar 

  34. 34.

    Bautmans IM (2005) A fatigue resistance test for elderly persons based on grip strength: reliability and comparison with healthy young subjects. Aging Clin Exp Res 17:217–222

    Article  PubMed  Google Scholar 

  35. 35.

    Podsiadlo D, Richardson S (1991) The timed “up and go”; A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148.

    Article  CAS  Google Scholar 

  36. 36.

    Wrisley DM, Marchetti GF, Kuharsky DK, Whitney SL (2004) Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther 84:906–918

    PubMed  Google Scholar 

  37. 37.

    Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB (1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    Auvinet B, Berrut G, Touzard C, Moutel L, Collet N, Chaleil D, Barrey E (2002) Reference data for normal subjects obtained with an accelerometric device. Gait Posture 16:124–134.

    Article  PubMed  Google Scholar 

  39. 39.

    Gortoniii GE, Hebert DA, Gannotti ME (2008) Assessment of the kinematic variability among 12 motion analysis laboratories. Gait Posture 29:398–402.

    Article  Google Scholar 

  40. 40.

    Schwartz C, Denoël V, Forthomme B, Croisier J-L, Brüls O (2015) Merging multi-camera data to reduce motion analysis instrumental errors using Kalman filters. Comput Methods Biomech Biomed Eng 18:952–960.

    Article  Google Scholar 

  41. 41.

    Gillain S, Boutaayamou M, Dardenne N, Schwartz C, Demonceau M, Gerontitis C, Depierreux F, Salmon E, Garraux G, Bruyère O, Brüls O, Croisier J-L, Petermans J (2017) Data set of healthy old people assessed for three walking conditions using accelerometric and opto-electronic methods. Aging Clin Exp Res 29:1201–1209.

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Lamb SE, Jørstad-Stein EC, Hauer K, Becker C, on behalf of the Prevention of Falls Network E, Outcomes Consensus G (2005) Development of a common outcome data set for fall injury prevention trials: the prevention of falls network europe consensus. J Am Geriatr Soc 53:1618–1622.

    Article  PubMed  Google Scholar 

  43. 43.

    Armstrong RA (2014) When to use the Bonferroni correction. Ophthalmic Physiol Opt 34:502–508.

    Article  Google Scholar 

  44. 44.

    Verghese J, Holtzer R, Lipton RB, Wang C (2009) Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci 64A:896–901.

    Article  PubMed Central  Google Scholar 

  45. 45.

    Srygley JM, Herman T, Giladi N, Hausdorff JM (2009) Self-report of missteps in older adults: a valid proxy of fall risk? Arch Phys Med Rehabil 90:786–792.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Laessoe U, Hoeck HC, Simonsen O, Sinkjaer T, Voigt M (2007) Fall risk in an active elderly population—can it be assessed? J Negative Results BioMed 6:2.

    Article  Google Scholar 

  47. 47.

    Callisaya ML, Blizzard L, McGinley JL, Srikanth VK (2012) Risk of falls in older people during fast-walking—the TASCOG study. Gait Posture 36:510–515.

    Article  CAS  PubMed  Google Scholar 

  48. 48.

    Mignardot JB, Deschamps T, Barrey E, Auvinet B, Berrut G, Cornu C, Constans T, de Decker L (2014) Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study. Front Aging Neurosci 6:22.

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Bautmans I, Jansen B, Van Keymolen B, Mets T (2011) Reliability and clinical correlates of 3D-accelerometry based gait analysis outcomes according to age and fall-risk. Gait Posture 33:366–372.

    Article  PubMed  Google Scholar 

  50. 50.

    van Schooten KS, Pijnappels M, Rispens SM, Elders PJM, Lips P, Daffertshofer A, Beek PJ, van Dieën JH (2016) Daily-life gait quality as predictor of falls in older people: a 1-year prospective cohort study. PLoS One 11:e0158623.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. 51.

    Mansfield A, Mochizuki G, Inness EL, McIlroy WE (2012) Clinical correlates of between-limb synchronization of standing balance control and falls during inpatient stroke rehabilitation. Neurorehabil Neural Repair 26:627–635.

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Yogev G, Plotnik M, Peretz C, Giladi N, Hausdorff JM (2007) Gait asymmetry in patients with Parkinson’s disease and elderly fallers: when does the bilateral coordination of gait require attention? Exp Brain Res 177:336–346.

    Article  PubMed  Google Scholar 

  53. 53.

    Morris R, Lord S, Bunce J, Burn D, Rochester L (2016) Gait and cognition: mapping the global and discrete relationships in ageing and neurodegenerative disease. Neurosci Biobehav Rev 64:326–345.

    Article  PubMed  Google Scholar 

  54. 54.

    Ebersbach G, Dimitrijevic MR, Poewe W (1995) Influence of concurrent tasks on gait: a dual-task approach. Percept Mot Skills 81:107–113.

    Article  CAS  PubMed  Google Scholar 

  55. 55.

    Beauchet O, Allali G, Poujol L, Barthelemy JC, Roche F, Annweiler C (2010) Decrease in gait variability while counting backward: a marker of “magnet effect”? J Neural Transm 117:1171–1176.

    Article  CAS  PubMed  Google Scholar 

  56. 56.

    Marschollek M, Rehwald A, Wolf K-H, Gietzelt M, Nemitz G, Schwabedissen ZU, Schulze HM (2011) Sensors vs. experts—a performance comparison of sensor-based fall risk assessment vs. conventional assessment in a sample of geriatric patients. BMC Med Inform Decis Mak 11:48–49.

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Doi T, Hirata S, Ono R, Tsutsumimoto K, Misu S, Ando H (2013) The harmonic ratio of trunk acceleration predicts falling among older people: results of a 1-year prospective study. J Neuroeng Rehabil 10:7–76.

    Article  PubMed  PubMed Central  Google Scholar 

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The authors would like to thank Mrs. Sophie Christelbach (MD) and Mrs. Celine Ricour (PhD) for their help for the recruitment, Mrs. Vinciane Wojtasik for the follow-up and Mrs. Fiona Ecarnot (EA3920, University Hospital Besancon, France) for her editorial support.


This study was supported by a grant from the Belgian fund for scientific research (F.N.R.S.).

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Correspondence to Sophie Gillain.

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Gillain, S., Boutaayamou, M., Schwartz, C. et al. Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study. Aging Clin Exp Res 31, 1057–1067 (2019).

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  • Gait symmetry
  • Dual task
  • Fall risk
  • Older people
  • Prospective study