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To determine age- and sex-specific reference values for six physical performance measures, i.

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We conducted a pooled analysis of data from six cohort studies collected between and as part of the Tokyo Metropolitan Institute of Gerontology-Longitudinal Interdisciplinary Study on Aging. The pooled analysis included cross-sectional data from nondisabled, community-dwelling adults aged 65 years or older men, women; mean age: Unweighted simple mean standard deviation hand-grip strength, one-legged stance, usual gait speed, usual gait step length, maximum gait speed, and maximum gait step length were We also constructed age- and sex-specific appraisal standards according to quintiles.

Our pooled analysis yielded inclusive age- and sex-specific reference values and appraisal standards for major physical performance measures in nondisabled, community-dwelling, older Japanese adults. The characteristics of age-related decline in physical performance measures differed between sexes.

This is an open-access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The funders had no role in study de, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Physical performance measures PPMs such as usual gait speed and hand-grip strength are indicators not only of physical function, but also current and future overall well-being, in older adults [1][2]. Recent systematic reviews and meta- and pooled analyses [3] — [6] showed that PPMs are effective at predicting adverse health outcomes, e.

A recent case-finding algorithm for sarcopenia [11] also included usual gait speed and hand-grip strength as appropriate screening tools. Thus, there is growing evidence of the importance of maintaining adequate physical performance in later life.

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Some studies reported normative or reference values for PPMs [12] — [19] ; however, no published study included age- and sex-specific reference values for multiple major PPMs among Asian adults or Japanese adults. Aoyagi et al. Because absolute levels of physical performance may vary between countries, it is difficult to extrapolate reference values from studies of Western populations [12] — [17][19] to older Japanese people.

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Furthermore, the measuring protocols used for several PPMs, especially gait speed and hand-grip strength, varied considerably between studies and countries, which makes comparison of values difficult [21] — [24]. Therefore, age- and sex-specific PPM reference values specifically for older Japanese adults should be established using unified measuring protocols. Collaborative research and the combining of cohort data have recently increased in the area of ageing studies [25].

Although the use of a cross-study approach allows analyses to encompass many geographic areas and much larger samples, there may be problems due to differences between studies in the measurement of variables and the protocols used. In the present study, we pooled cross-sectional data from cohort studies of the TMIG-LISA to establish reference values for six PPMs hand-grip strength, one-legged stance with eyes open, and gait speed and step length at both usual and maximum pacesclassified by age and sex.

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In addition, we investigated age and sex differences in these measures. The data sources for this study were derived from the TMIG-LISA [7][26] — [30]which was established to determine risk factors for participants with geriatric diseases or chronic medical conditions and to identify factors that accelerate or decelerate aging in representative samples of older Japanese adults.

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We used baseline data or data from the year with the highest participation rate, all of which were collected between and The details of the study participants are discussed below Figure 1. Nangai village is a mainly agricultural area in the northern Japanese prefecture of Akita [31]. The baseline survey was held from July through Augustand the participant selection process is described in more detail elsewhere [7][26][28][29].

In the present pooled analysis, we used surveillance data from The target population included residents men, women aged 65 years or older.

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A total of ambulatory residents participated in the survey men, participation rate of Two thousand residents men, women aged 71 years or older living in 36 residential areas in Itabashi ward were randomly recruited. After excluding 55 people who were institutionalized, invitations for the comprehensive health checkups were sent out.

Ultimately, residents participated in the baseline survey men, participation rate of The Act on Assurance of Medical Care for Elderly People, which went into effect in Japan inrequires all municipal governments in Japan to offer annual preventive health checkups to citizens aged 40 years or older.

In conjunction with this service, we launched a longitudinal study on the aging and health of older adults living in Yoita town, a rural community in central Niigata Prefecture, Japan, in which older participants underwent an additional comprehensive geriatric assessment [32]. A total of residents men, women aged 70 years or older were invited to participate in a baseline survey in Of those, residents participated in the survey men, participation rate of We also conducted a longitudinal study in Kusatsu town, a rural community in north-west Gunma Prefecture, Japan, in [32].

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We used data from health checkups conducted in The study targeted National Health Insurance subscribers aged 65—74 years and individuals 75 years or older in the Medical Insurance System for the Elderly Aged 75 or Over men, women. Of that population, residents participated in the survey men, participation rate of The full details of the participant selection process were ly published [33].

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Briefly, residents men, women aged 65—84 years were selected using stratified sampling classified by age and residential area and random sampling strategies. Of those, people participated in a baseline survey in participation rate of Ultimately, 9 persons declined to participate in the study, and a total of people were included in the study men, participation rate of After excluding people who were institutionalized or overlapped from studies, invitations men, women for the health checkups were sent out.

In Octoberambulatory residents received health checkups participation rate of Of those, residents agreed to participate in the study men, participation rate of The final, pooled sample size was men and women; All participants provided written informed consent, and all studies included in the pooled analysis were conducted with the approval of the institutional review board and ethics committee of the TMIG.

Age, body height and weight, history of chronic disease hypertension, stroke, heart disease, and diabetes mellitusself-rated health, alcohol drinking and smoking status, and Tokyo Metropolitan Institute of Gerontology Index of Competence TMIG-IC [34] were assessed in all cohorts. History of chronic disease was determined through face-to-face interviews by physicians. Participants were asked whether a physician had diagnosed the specific condition yes or no.

Self-rated health excellent, good, fair, or pooralcohol drinking and smoking status current, past, or neverand TMIG-IC were determined on the basis of questionnaire responses.

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The total score ranges from 0 to 13; lower scores indicate lower functional capacity [34]. Well-trained staff measured hand-grip strength, one-legged stance with eyes open, and gait speed and step length at both usual and maximum paces. Participants wore the same type of shoe that had been prepared for them during the initial assessment. Hand-grip strength was assessed in all cohorts using common Smedley-type hand dynamometers [7][29]. Participants stood with their arms hanging naturally at their sides holding the dynamometer with the grip size adjusted to a comfortable level.

They were instructed and verbally encouraged to squeeze the hand-grip as hard as possible. In all other cohorts, participants performed one trial with the dominant hand. Participants were asked to place their hands at their waists while staring at a mark on the wall, raise one leg, and stand as long as possible.

They were timed until they lost their balance or reached the maximum of 60 s [7].

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Participants performed two trials, and the better time to the nearest 0. Usual and maximum gait speeds were measured over 5 m, with acceleration and deceleration phases of 3 m each, in all cohorts excepting ITABASHI11, in which participants were measured over a distance of 10 m, with acceleration and deceleration phases of 3 m each. Wang et al [35] reported that usual and maximum gait speeds measured over different distances are comparable only if acceleration and deceleration phases are used.

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We combined the 5 m and 10 m gait speeds because the acceleration and deceleration phases were identical for both measurement distances and because 3 m is considered sufficient to maintain steady usual and maximum gait speeds [35][36]. Participants stood with their feet behind but just touching a starting line marked with tape at 0 m.

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The actual walking time was measured over 5 m, starting with the body trunk past the 3-m mark and ending with the body trunk after the 8-m m in the ITABASHI11 mark [7][29]. Usual gait speed was measured once. Maximum gait speed was measured twice, and the better of the two to the nearest 0. Step length is a component of gait speed and an independent predictor of cognitive decline [32]. Two other staff members measured mean step length by marking the heel points near the tape at 3 and 8 m and dividing the distance between the two heel points by the of steps required [32].

Usual gait step length was measured once. Maximum gait step length was measured twice, and the better of the two to the nearest 0. We used descriptive statistics to characterize the study population.

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Differences in characteristics between men and women were analyzed using the unpaired t test, chi-square test, and Mann-Whitney U test. The means and standard deviations SDs of all PPMs were tabulated per 5-year age group 65—69, 70—74, 75—79, 80—84, and 85 years or older for each sex. We also calculated gait speed and step length at both usual and maximum paces normalized for height computed as speed or length divided by height in meters because height is a predictor of gait speed [12].

Similarly, we normalized hand-grip strength for weight computed as strength in kg divided by weight in kg. Furthermore, we performed a random effects meta-analysis using a Microsoft Excel spreheet developed by Neyeloff et al. To evaluate linear trends in the means of PPMs between the age groups, we used weighted one-way analyses of variance by sex. Furthermore, we visualized univariate regression lines between age and PPMs in both sexes. In these analyses, we used the mean deviations of the independent variables to avoid issues related to multicolinearity [39].

In addition, one-legged stance with eyes open was log transformed. Quintiles of each physical performance measure were used to construct appraisal standards according to sex and age group.

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We used an alpha level of 0. Table 1 shows the s of participants who provided complete data for each variable. Among the six PPMs, hand-grip strength and usual and maximum gait speed were assessed in all cohorts. The rates of missing data were 2. The lowest and highest rates of missing data were for usual and maximum gait speeds, respectively.

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The s of participants with complete data for each variable, by cohort, are available as Table S1 in File S1. Table 2 summarizes the characteristics of the study participants. There was no ificant difference in age distribution between sexes.

All PPM values were ificantly higher in men than in women.

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Tables 3 and 4 present unweighted simple means and SDs for PPMs according to age group in men and women, respectively. Unweighted simple means for PPMs according to age group were very similar to and only slightly lower than weighted means Table S6 in File S1. The Q statistics for all age strata had probability levels exceeding 0. These associations and interactions remained ificant after adjusting for chronic diseases, alcohol intake and smoking status.

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A Japanese version of the questionnaire is also available.