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Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study

BMJ 2009; 339 doi: (Published 11 November 2009) Cite this as: BMJ 2009;339:b4460
  1. Julien Dumurgier, neurologist123,
  2. Alexis Elbaz, epidemiologist12,
  3. Pierre Ducimetière, senior epidemiologist45,
  4. Béatrice Tavernier, geriatrician6,
  5. Annick Alpérovitch, senior epidemiologist12,
  6. Christophe Tzourio, head of the Inserm neuroepidemiology unit12
  1. 1INSERM, U708, F-75013, Paris, France
  2. 2UPMC Univ Paris 06, F-75005, Paris, France
  3. 3CMRR Paris Nord-IDF, GH Lariboisière – Fernand Widal, F-75010, Paris, France
  4. 4INSERM, U780, Villejuif, France
  5. 5Université Paris-Sud, France
  6. 6CHU de Dijon, Department of Geriatrics, F-21000, Dijon, France
  1. Correspondence to: Alexis Elbaz alexis.elbaz{at}
  • Accepted 28 August 2009


Objective To study the relation between low walking speed and the risk of death in older people, both overall and with regard to the main causes of death.

Design Prospective cohort study.

Setting Dijon centre (France) of the Three-City study.

Participants 3208 men and women aged ≥65 living in the community, recruited from 1999 to 2001, and followed for an average of 5.1 years.

Main outcome measures Mortality, overall and according to the main causes of death, by thirds of baseline walking speed (measured at maximum speed over six metres), adjusted for several potential confounders; Kaplan-Meier survival curves by thirds of baseline walking speed. Vital status during follow-up. Causes of death.

Results During 16 414 person years of follow-up, 209 participants died (99 from cancer, 59 from cardiovascular disease, 51 from other causes). Participants in the lowest third of baseline walking speed had an increased risk of death (hazard ratio 1.44, 95% confidence interval 1.03 to 1.99) compared with the upper thirds. Analyses for specific causes of death showed that participants with low walking speed had about a threefold increased risk of cardiovascular death (2.92, 1.46 to 5.84) compared with participants who walked faster. There was no relation with cancer mortality (1.03, 0.65 to 1.70). In stratified analyses, cardiovascular mortality was increased across various strata defined by sex, median age, median body mass index (BMI), and level of physical activity.

Conclusion Slow walking speed in older people is strongly associated with an increased risk of cardiovascular mortality.


  • Contributors: JD conducted the statistical analyses under the supervision of AE. All authors participated in designing the analyses, interpreting the results, and writing the manuscript. All authors had full access to the data and are guarantors for the study.

  • Funding: The 3C study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Victor Segalen-Bordeaux II University, and the Sanofi-Synthélabo Company. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, Haute Autorité de la Santé, Institut National de Prévention et d’Education pour la Santé (INPES), Conseils Régionaux of Bourgogne, Fondation de France, Ministry of Research-INSERM Program, “Cohortes et collections de données biologiques,” Mutuelle Générale de l’Education Nationale, Institut de la Longévité, Conseil Général de la Côte d’or. JD was supported by a PhD scholarship from the Fondation pour la Recherche Médicale. The funding organisations played no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

  • Competing interests: None declared.

  • Ethical approval: The study was approved by the ethical committee of the University Kremlin-Bicêtre Hospital; each participant signed an informed consent form.

  • Data sharing: No additional data available.

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