Research Report
Assessing the Reliability and Validity of
a Shorter Walk Test Compared With the
10-Meter Walk Test for Measurements of Gait
Speed in Healthy, Older Adults
Denise M. Peters, DPT1; Stacy L. Fritz, PT, PhD2; Debra E. Krotish, PhD1
ABSTRACT
Background and Purpose: Walking speed is associated with
several health-related outcomes. Research examining how
differences in test walking distance affect walking speed
reliability and validity is limited. The primary purpose of this
study was to examine the reliability and concurrent validity of
gait speed measurements obtained from a 4-Meter Walk Test
compared with the commonly used 10-Meter Walk Test. A
second objective was to similarly examine 2 different timing
methods: stopwatch and automatic timers.
Methods: Forty-three healthy, older adults (mean age 84.3
6.9 years) performed 3 consecutive walking trials on the 4-
and 10-Meter Walk Tests at their self-selected walking speed.
Results: Gait speed measurements for both tests were shown
to have excellent test-retest reliability (ICC values of 0.96-
0.98), with similar results for stopwatch and automatic timer
assessments (ICC values of 0.99-1.00). Standard error of the
measurement (SEM) values were small (0.004-0.008 m/s)
across measurement methods. While the ICC value for gait
speed measurements between the 2 walk tests was 0.93, the
Bland-Altman analysis revealed a discrepancy of 0.15 to
0.17 m/s between measurement methods.
Discussion: Both 4- and 10-m gait speed assessments had
excellent test-retest reliability with similar SEM and minimal
detectable change values. There was little difference in SEM
values between the 2 timing methods. While the mean differ-
ence in gait speed between the 4- and 10-Meter Walk Tests
was small, the range of the measurement differences was
large enough to potentially mask meaningful changes in gait
speed over time if both methods were used interchangeably.
Conclusions: While the reliability of both walking tests is excel-
lent, the 4-Meter Walk Test does not exhibit a high enough
degree of concurrent validity with the 10-Meter Walk Test
to be used interchangeably for gait speed assessments in
healthy, older adults. We therefore recommend using the
10-Meter Walk Test to obtain the most valid clinical assess-
1Department
of Exercise Science, University of South
Carolina, Columbia.
2Palmetto Health, Division of Geriatrics, Columbia, South
Carolina.
There are no conflicts of interest, and no external funding
was used for this study.
Address correspondence to: Denise M. Peters, DPT,
Department of Exercise Science, University of South
Carolina, 921 Assembly St, 3rd Floor PHRC, Columbia, SC
29208 (petersd20@gmail.com).
DOI: 10.1519/JPT.0b013e318248e20d
24
Copyright 2013 The Section on Geriatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JPT200142.indd 24
ment of walking speed when using it as a 1-time indicator of
health status.
Key Words: older adult, gait speed, measurement, reliability,
validity
(J Geriatr Phys Ther 2013;36:24-30.)
INTRODUCTION
Walking speed is an important aspect of gait and is com-
monly used as an objective measure of functional mobility
in both clinical and research settings. Its importance lies
not only in its implications for community ambulation but
also because of its relationship to various health outcomes.
Walking speed has been shown to be a key factor in deter-
mining rehabilitation needs1,2 and discharge location3 and
has the potential to predict future functional decline4,5
and fall risk.6,7 Furthermore, a decline in walking speed
is associated with several health-related factors such as
disability, hospitalization, loss of independence, and mor-
tality.8-11 Improvement in walking speed has been linked
to constructive changes in quality of life12 and walking
behavior.13 This importance, combined with its ease of use
and objectivity, substantiates the use of walking speed as a
practical clinical measure that offers more insight into an
individuals overall functional capacity.
Walking speed can be quickly and easily assessed in most
clinical and research settings, and measurements of walking
speed have demonstrated good reliability across multiple
patient populations and in individuals with known gait
impairments.14-16 Great variation exists, however, in mea-
surement methods used to assess walking speed. There is
little consensus concerning optimal testing parameters such
as starting protocol, pace, and timed walking distance. Often
tests are chosen based more on tester preference and conve-
nience, especially in clinical settings where space is limited.
The 10-Meter Walk Test is a commonly used measure
for assessing walking speed.17-22 It requires a 20-m path that
includes 5 m for acceleration and deceleration. Practically,
however, a full 20-m walkway is not always available, so
there are several shorter distances commonly used to assess
walking speed including 3-, 4-, and 6-m assessments.23
Two studies with neurologic populations found significant
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12/7/12 7:21 PM

differences in fast walking speed between 5- and 10-m test
distances,24 and in self-selected walking speed between
10 m and real-life environments (eg, parking lot of a
shopping center).25 Overall, however, research examining
how subtle differences in test walking distance affect gait
speed reliability and validity is limited both within and
across patient populations. It is unclear whether shorter
test walking distances provide as accurate, representative
assessments of walking speed as longer distances.
The primary purpose of this study was to examine
the validity of a 4-Meter Walk Test compared with the
commonly used 10-Meter Walk Test when used to assess
walking speed in healthy, older adults. An additional objec-
tive was to examine the reliability and validity of walking
speed measurements obtained through 2 different methods:
the use of a stopwatch and automatic timers. If reliable,
representative assessments of gait speed can be achieved
using shorter distances with a handheld timer, this might
increase the use of walking speed measurements in clinical
settings, thereby offering more insight into an individuals
functional health status and imparting clinically meaning
information to help guide and monitor patient treatment.
Although reliability assessments across longer time inter-
vals is more applicable for clinical outcomes, intrasession
reliability is an important first step to determine reliability
of a measurement without external influences (eg, time)
and is appropriate for 1-time assessments such as when
using walking speed as a vital sign.26
METHODS
Design and Participants
A cross-sectional study design was used with comparisons
of gait speed between 2 different walking tests. Forty-three
participants were recruited from a local retirement com-
munity. Inclusion criteria included age 65 years or older,
the ability to reliably follow 2-step instructions, and the
ability to walk 20 m with or without an assistive device.
Exclusion criteria included severe weight-bearing pain
(rated 5/10 on the visual analog pain scale), severe visual
impairment, and/or severe arthritis or orthopedic prob-
lems that limited ambulation ability. All participants gave
written informed consent. The study was approved by the
institutional review board at Palmetto Health.
Walking Procedure and Measurement
Walking speed was assessed at participants self-selected
walking pace using a 4-Meter Walk Test (with 2 m pro-
vided for acceleration/deceleration) and the 10-Meter
Walk Test (with 5 m provided for acceleration/decelera-
tion) (Figure 1). Distances were provided at the beginning
and end of the timed walkway to allow participants
space to accelerate/decelerate outside the data collection
area to help reduce gait variability introduced during
these phases.23,27 Each participant completed 3 consecu-
tive trials for each walking test, for a total of 6 walking
trials. Order of administration of the 2 different walking
Journal of GERIATRIC Physical Therapy
Copyright 2013 The Section on Geriatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JPT200142.indd 25
Research Report
Figure 1. Outline of the 4- and 10-Meter Walk Tests.
conditions was randomly varied among participants so
that not all participants were performing the longer walk-
ing test at the end of the testing session. Participants were
instructed to walk at your comfortable, usual pace until
they reached the end of the marked path. Wireless timers
(Brower Timing Systems) that send radio transmissions
were used to record walking time. These timers were
placed at the beginning and end of the timed walkway
area and automatically started/stopped as the participant
walked past them. In addition, a member of the research
team simultaneously measured walking time with a stop-
watch, starting the stopwatch as soon as the participants
lead leg (or assistive device) crossed the first marker and
stopping it when the participants lead leg (or assistive
device) crossed the second marker. The same person per-
formed all stopwatch measurements to prevent introduc-
ing interrater variability. Participants were provided rest
breaks as needed throughout the testing session.
Data Analysis
The Shapiro-Wilks test was used to test for normality of
data. Intraclass correlation coefficients (ICC3,1) were calcu-
lated to examine the reliability of gait speed measurements
across walking trials 2 and 3 for the 4- and 10-Meter Walk
Tests for both stopwatch and automatic timer assessments.
The ICC values were interpreted using the benchmarks
suggested by Menz et al28: more than 0.75 excellent reli-
ability; 0.40 to 0.75 fair to good reliability; and less than
0.40 poor reliability. To quantify the amount of change
in gait speed that must be observed to be considered to
exceed measurement error and variability, the minimal
detectable change (MDC) was calculated at both the 90%
and 95% confidence levels using the following formulas:
MDC90 1.64 SEM 2 and MDC95 1.96 SEM
2, where SEM is standard error of measurement. The
SEM value was determined using the formula [SD (1
r)], where r is the test-retest reliability coefficient (in this
case, ICC3,1) and SD is the standard deviation of the trial
difference scores.29,30 The SEM is the estimated standard
deviation of measurement error, or the difference between
the observed values and the true values. The SEM was
multiplied by 1.64 or 1.96 to reflect the 90% or 95%
confidence intervals (CIs), respectively. This value was
multiplied by the square root of 2 to account for the error
associated with repeat measurements.29,31
The agreement between stopwatch and automatic timer
assessments (for both the 4- and 10-Meter Walk Tests)
25
12/7/12 7:21 PM
 Research Report

and between 4- and 10-m gait speed assessments was

MDC95
examined using ICC2,1 and the Bland-Altman method32

0.02

0.02
(95% limits of agreement), with similar interpretation of
ICC point estimates as previously described. Validity was
examined for both single trial (second walking trial) and

MDC90

0.02

0.01
average (across all 3 walking trials) gait speed assessments.
The Bland-Altman technique allows one to visually assess
the agreement between 4- and 10-m gait speed assessments

0.008

0.006
SEM
(or between stopwatch and automatic timer assessments)
by plotting the difference in the measurement methods

4-m Walk, m/s

against the mean of the 2 measurements.32,33 The result-

0.96 (0.94-0.98)

0.97 (0.95-0.99)
ICC (95% CI)
ing plot shows the size and range of the measurement

Abbreviations: CI, confidence interval; ICC, intraclass correlation coefficient; MDC90, minimal detectable change at 90% CI; MDC95, minimal detectable change at 95% CI; SEM, standard error of measurement.
differences and their distribution around the mean. The
95% limits of agreement (mean difference 1.96 SD of
the differences between measurement methods) provide
an indication of how far apart measurements by the

0.97 (0.23)

0.97 (0.23)
2 walking tests (or 2 timing methods) are likely to be for

Trial 3b
most individuals. 34 A smaller range between these 2 limits
indicates a better level of agreement, and how close the
measurements have to be is a clinical question/decision (is

0.97 (0.22)

0.97 (0.22)
the discrepancy between methods large enough to mean-

Trial 2b
ingfully affect the interpretation of results?), not based on
statistical testing. When comparing the 2 timing methods,
single-trial assessments of walking speed were used in the
Bland-Altman analyses. When comparing 4- and 10-m
MDC95

0.01

0.01
gait speed assessments, stopwatch assessments of walking
speed were used for the Bland-Altman analyses, as this
Table. Test-Retest Reliability of Gait Speed Measurements Across Consecutive Walking Trialsa

from of measurement has more clinical utility than auto-

matic timers. In addition, paired t tests were performed to
MDC90

0.01

0.01
test for systematic differences in gait speed between the
2 walk tests, with .05. All statistical analyses were
conducted using PASW version 18.0 (SPSS, Chicago, IL).
0.005

0.004
SEM

RESULTS
10-m Walk, m/s

Forty-three community-dwelling older adults (32 women,

11 men) with a mean age 84.3 years (SD 6.9) participated
0.98 (0.96-0.99)

0.98 (0.96-0.99)
ICC (95% CI)

in the study. Average walking speed (across all 3 trials) on

the 10-Meter Walk Test varied between 0.50 and 1.43 m/s,
with a mean walking speed of 0.96 m/s (SD 0.23) per
stopwatch assessment. Seven participants used an assis-
tive device for ambulation. One participant was unable to
0.98 (0.24)

0.98 (0.23)

complete a third ambulation trial due to personal time con-

Trial 3b

straints, so reliability analyses were performed and walking

aAll values except ICC values are expressed in m/s.

speed/time was averaged across the first 2 trials for this

participant. The Shapiro-Wilks test showed that gait speed
bGait speed values expressed as mean (SD).
0.97 (0.22)

0.97 (0.22)

measurements were normally distributed.

Trial 2b

Reliability Across Walking Trials

Both 4- and 10-m gait speed measurements were shown to
Automatic timer

have excellent test-retest reliability, with ICC values ranging

from 0.96 to 0.98 (Table). Reliability was similar for both
Stopwatch

stopwatch and automatic timer assessments, with SEM

values between 0.004 and 0.008 m/s and MDC90/MDC95
values between 0.01 and 0.02 m/s.
26 Volume 36 Number 1 January-March 2013
Copyright 2013 The Section on Geriatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.

JPT200142.indd 26 12/7/12 7:21 PM


Validity of Stopwatch Measurements Compared With
Automatic Timer
Agreement between the 2 timing methods was excellent
for both walking tests, with ICC values ranging from 0.99
(95% CI: 0.988-0.996) to 1.00 (95% CI: 0.999-1.00).
The values for ICC were similar for both single-trial and
average gait speed assessments. Figure 2 shows a Bland-
Altman plot for the differences in gait speed between the
2 timing methods. While no obvious relationship between
the difference and mean was observed for stopwatch and
automatic timer assessments, there was a slightly better
level of agreement between the 2 timing methods on the
10-Meter Walk Test (95% limits of agreement ranged
from 0.02 to 0.02 m/s) than on the 4-Meter Walk Test
(95% limits of agreement ranged from 0.05 to 0.05
m/s).
Validity of 4- and 10-m Stopwatch Assessments of
Gait Speed
Gait speed measurements were not significantly different
between 4- and 10-m walk assessments for either single-
Figure 2. Bland-Altman plots representing comparisons
between stopwatch (SW) and automatic timer single-trial
gait speed assessments for the 4-Meter Walk Test (A) and
10-Meter Walk Test (B). The solid line represents the mean
difference in gait speed between the 2 timing methods,
with the dashed lines representing the upper and lower
95% limits of agreement, mean 2 (SD).
Journal of GERIATRIC Physical Therapy
Copyright 2013 The Section on Geriatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JPT200142.indd 27
Research Report
trial (P .957) or average (P .349) gait speed compari-
sons. When comparing the second ambulation trial, both
the 4- and 10-Meter Walk Test resulted in a mean gait
speed value of 0.97 m/s (SD 0.22). When examining
average gait speed across the 2 tests, the 10-Meter Walk
Test resulted in a mean gait speed value of 0.96 m/s (SD
0.23) compared with 0.95 m/s (SD 0.22) for the 4-Meter
Walk Test.
The ICC value for single-trial gait speed measurements
between the 4- and 10-Meter Walk Tests was 0.93 (95%
CI: 0.87-0.96) and for average gait speed measurements
was 0.93 (95% CI: 0.88-0.96). Figure 3 shows a Bland-
Altman plot for the differences in gait speed between the
2 walking tests. No obvious relationship between the
difference and the mean was observed for 4- and 10-m
gait speed assessments, with similar mean differences and
95% limits of agreement noted for both single-trial (mean
difference: 0.0007 m/s; 95% limits of agreement: 0.17
to 0.17 m/s) and average (mean difference: 0.0118 m/s;
95% limits of agreement: 0.17 to 0.15 m/s) gait speed
comparisons.
Figure 3. Bland-Altman plots representing comparisons
between 4- and 10-m gait speed assessments obtained
using a stopwatch for single-trial (A) and average (B) gait
speeds. The solid line represents the mean difference in
gait speed between the 2 walking tests, with the dashed
lines representing the upper and lower 95% limits of
agreement, mean 2 (SD).
27
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 Research Report
DISCUSSION
The use of automatic timers to record walking time is sim-
ple, but few clinical settings have such devices. Stopwatches,
on the contrary, are a more accessible instrument and often
used in both clinical and research settings to record walking
time for calculations of gait speed across various distances.
Our results indicate excellent agreement both within and
between stopwatch and automatic timer assessments across
2 different walking distances (4 and 10 m) in healthy, older
adults, with little difference in SEM values between the 2
timing methods. Our ICC values were on the upper end of
similar studies (ICC values from 0.88 to 0.97) that have
examined the reliability of gait speed measurements in this
patient population.15,35,36 Furthermore, the Bland-Altman
analysis displayed a small range between the 95% limits
of agreement (0.05 m/s or less), indicating a clinically
acceptable degree of agreement such that the use of one
timing method over the other would not meaningfully
affect interpretation of gait speed results.
If walking speed is to be used as a vital sign in health
care assessments, measurement methods associated with a
small SEM value are important to ensure a small degree of
measurement error when assessing baseline values. Both
4- and 10-m gait speed assessments had excellent test-retest
reliability, with similar SEM values when examined across
consecutive walking trials. For example, if an individual
exhibited a gait speed of 0.98 m/s on the 10-Meter Walk
Test, our results indicate that we could be 95% confident
that this individuals true gait speed is between 0.97 and
0.99 m/s, or 2 times the SEM (0.005 m/s for stopwatch
assessments); similarly, if the 4-Meter Walk Test was used
as a screening tool, our results indicate that we could be
95% confident that this individuals true gait speed is
between 0.96 and 1.00 m/s.
Another extrapolation is to look at gait speed changes
over time (eg, from pre- to posttreatment). Our results
indicate that a change in gait speed of 0.01 m/s or more or
0.02 m/s or more is necessary for 10- and 4-m walk assess-
ments, respectively, to be 95% confident that a true change
has occurred beyond measurement error in healthy, older
adults. As several participants required an assistive device
to walk, future research work could examine measure-
ment reliability and determine MDC values specific to this
subpopulation of individuals. Furthermore, MDC values
calculated from measurements taken across longer time
intervals, such as days or weeks, could be in a manner dif-
ferent from those that are calculated from repeat measure-
ments taken within the same testing session.
Examining the validity of a shorter walk test compared
with the commonly used 10-Meter Walk Test when deter-
mining gait speed is important, as space is often a limiting
factor in clinical settings. While the ICC value quantifies the
reliability of 2 methods, it alone is insufficient to evaluate
patterns of discrepancy that may be present among differ-
ences in the data. The Bland-Altman method aids in the
28
Copyright 2013 The Section on Geriatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
JPT200142.indd 28
determination of whether 2 methods of clinical measure-
ment agree sufficiently for them to be used interchange-
ably, or one in place of the other.32,33 The 2 methods may
be used interchangeably if the calculated 95% limits of
agreement are close enough, per clinical decision, such that
a difference between measurement methods as extreme as
described by the limits of agreement would not meaning-
fully affect interpretation of results.32,34 The ICC values
for our data (0.93) indicated excellent agreement between
4- and 10-m walking speed assessments, as mean gait
speed values differed by just 0.0007 m/s (SD 0.09) and
0.0118 m/s (SD 0.08) for single-trial and average gait
speed assessments, respectively, with slightly higher gait
speed values obtained with the 10-Meter Walk Test. While
the mean difference in gait speed between the 2 measures
was small, the range of the upper and lower 95% limits
of agreement was 0.15 to 0.17 m/s. Several studies
have demonstrated 0.08 to 0.14 m/s as the needed change
for a meaningful improvement in walking speed in older
adults.9,17,37 In addition, improvements in walking speed
of 0.1 m/s or more have been shown to be a useful pre-
dictor for well-being whereas decreases in walking speed
of the same amount have been linked with poorer health
outcomes.26 Given these values of meaningful change in
gait speed, the calculated limits of agreement in our study
indicate that the degree of agreement between 4- and 10-m
gait speed assessments is not sufficient to permit using
the 2 walking tests interchangeably in assessments of gait
speed in healthy, older adults. The discrepancy between
measurement methods is large enough to potentially mask
meaningful changes in gait speed over time if both meth-
ods are used. Therefore, although the reliability of both
walking tests is excellent, the 4-Meter Walk Test does not
exhibit a high enough degree of concurrent validity with
the 10-Meter Walk Test to be used interchangeably for gait
speed assessments in healthy, older adults.
This study is one of the few to investigate how subtle
differences in test walking distance affect the validity of
walking speed assessments. We did not attempt, how-
ever, to investigate the reliability and validity of different
walking speed assessments in specific patient populations,
which has been the focus of previous research.24,25 Our
results indicate that although reliable assessments of walk-
ing speed in healthy, older adults can be obtained using
a 4-Meter Walk Test, 4-m walking speed assessments
cannot be used interchangeably with 10-Meter Walk Test
assessments. Consideration must be taken when viewing
our results, however, as they may have been influenced
by a number of limitations present in this study. First, our
study sample was relatively small, and it is possible that a
lesser discrepancy between measurement methods might
have been observed with a larger sample size. Furthermore,
our sample included both individuals who ambulated with
and without an assistive device, which improves external
validity but increases variability in sample characteristics.
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12/7/12 7:21 PM

Future studies with a larger number of individuals who use
an assistive device could examine measurement reliability
and validity in this subpopulation. In addition, the stabil-
ity of gait speed measurements over time was not assessed
in this study; reliability and validity analyses among gait
speed measurements based on walking trials performed on
separate days may result in different ICC and MDC values
than the current study. Intrasession reliability needs to
be assessed first, however, to decrease possible variations
from external influences, followed by reliability evalua-
tions across longer time intervals. Also, the participants in
our study were all relatively healthy, older adults with a
mean self-selected walking speed of 0.96 m/s (SD 0.23),
which is similar to 8,20 or somewhat lower15,36,38 than gait
speed values obtained from other studies examining walk-
ing speed in older adults. These results might be different
for older adults who ambulate at slower or faster walking
speeds and/or who have specific pathologies (eg, stroke).
Finally, although the differences in gait speed measure-
ments between the 4- and 10-Meter Walk Tests greatly
exceeded the MDC values of the current study (0.01-0.02
m/s), we considered MDC values from other studies to
strengthen our conclusions; however, the amount of change
that is considered meaningful by other studies may not
really be meaningful if these values did not exceed measure-
ment error and variability.
CONCLUSIONS
Although 4- and 10-m walking speed assessments in
healthy, older adults demonstrated excellent test-retest
reliability and were highly correlated, our results indicate
that there is insufficient agreement between the 2 walk-
ing tests to permit them to be used interchangeably in this
patient population. We therefore recommend the use of
the 10-Meter Walk Test to obtain the most valid clinical
assessment of walking speed in healthy, older adults; how-
ever, a 4-Meter Walk Test can be used if space is a limiting
factor, but the same walking test needs to be used for all
subsequent measurements of gait speed for evaluations of
meaningful change in gait speed over time. Our results also
demonstrated that handheld stopwatches were as reliable
as automatic timers in measurements of gait speed. Further
research should continue to examine how subtle differences
in walking test parameters affect walking speed assessments
across different patient populations. If a shorter walking
test can provide a high, clinically acceptable degree of agree-
ment of gait speed measures compared with the 10-Meter
Walk Test, this might increase the use of walking speed
measurements in clinical settings to offer more insight into
a patients functional mobility and health status.
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Call for Reviewers

The Journal of Geriatric Physical Therapy is seeking to expand our cadre of manuscript reviewers.
Job Description:
Receive 4 - 5 manuscript per year for blinded peer review
Emphasis on quality of science: importance of research question, clarity of study design, appropriateness of analysis,
accuracy of interpretation of results
2-week turn around for review
Materials available at www.editorialmanager.com/jgpt
possible recommendations: reject, revise with additional revie w, minor revision, accept
provide confidential comments to editor
provide constructive criticism and suggestions to authors
follow reviewed manuscripts through revision process
develop review skills
Prerequisites:
Graduate Degree beyond entry level (e.g., PhD, EdD, DSc, or t-DPT)
Submission, revision, and acceptance of at least two manuscripts in a peer-reviewed journal
To Apply: please send letter of application highlighting research interests/experience and current CV to Michelle Lusardi,
PT, DPT, PhD, JGPT Editor at lusardim@sacredheart.edu

30 Volume 36 Number 1 January-March 2013

Copyright 2013 The Section on Geriatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.

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