How quickly older adults can take a step may predict longevity

by Ben-Gurion University of the Negev

edited by Gaby Clark, reviewed by Andrew Zinin

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Researchers from Ben-Gurion University of the Negev (BGU) have found that how quickly an older adult can execute a voluntary step—especially when distracted (concurrently performed cognitive task)—may serve as a valuable clinical predictor of survival. The exploratory study suggests that dynamic balance assessments capture an integration of neuromuscular vitality and central cognitive processing, offering a window into an individual's long-term functional health.

The research was led by Prof. Itshak Melzer from BGU's Department of Physical Therapy, alongside colleagues Ofri Gans-Or, Anat Reiner-Benaim and luly Treger from BGU and Soroka University Medical Center, in collaboration with Lars I.E. Oddsson from the University of Minnesota and RxFunction Inc.

Their findings were published in the journal Gerontology.

The predictive power of the split-second step

While medical care traditionally measures life expectancy through chronological age or the number of chronic illnesses, functional physical indicators like walking speed have increasingly proved to be strong indicators of health and independence. The research team sought to expand this clinical toolkit by evaluating whether postural sway (static balance) and voluntary step execution (dynamic balance) could predict survival rates over a long-term follow-up period.

By analyzing balance data from 120 community-dwelling older adults tracked for 10–17 years after initial testing, the researchers discovered a striking link between step initiation latency and mortality risk. Specifically, the study revealed that for every 0.100-second (100 milliseconds) increase in step initiation time under dual-task (distracted) conditions, the risk of mortality increased by 28% (Survival Hazard Ratio ≈ 1.28).

In other words, older adults who required an additional 100 milliseconds to initiate a step while simultaneously performing a cognitive task were at significantly greater risk of death during the follow-up period. This finding suggests that slower step initiation may serve as an indicator of reduced overall neurological and physiological resilience in aging.

Brain-body pacing: The dual-task filter

To evaluate the intersection of physical mobility and cognitive load, participants were tested under two conditions: a single-task (simply stepping as quickly as possible following a somatosensory cue) and a dual-task condition. The dual-task setup required participants to execute the rapid step while simultaneously performing a modified Stroop task—naming the ink color of words printed in mismatched colors.

The researchers noted that because sensory detection and basic nerve conduction speeds remain constant between simple and distracted stepping, any delay in initiating a step during the mental challenge is largely driven by central neural processing limitations. For older adults with a shorter survival prospect, executing a physical movement simultaneously requires a higher share of limited attentional capacity, which visibly slows motor output.

Traditional static balance measures, such as an increase in anterior-posterior postural sway velocity while standing barefoot with eyes closed, also demonstrated an ability to predict mortality but proved less effective and accurate than the dynamic stepping tests.

A low-cost window into functional vitality

Impaired step execution often marks a cascading decline in daily mobility, which can trigger a cycle of reduced physical activity, overall deconditioning and systemic health risks. Because a voluntary step test is straightforward to conduct and requires minimal professional specialization, it could serve as an accessible indicator of functional vitality in clinical environments.

"Incorporating dual-task based assessments into standard clinical evaluations could significantly improve survival prediction and help guide early interventions targeting cognitive-motor health," the authors conclude.

Crucially, because voluntary stepping speed is a modifiable trait that prior clinical trials have shown can be improved through targeted perturbation and balance rehabilitation training, these diagnostic measures offer a practical pathway to identify individuals who could benefit from specialized mobility programs to potentially extend longevity.

More information

Itshak Melzer et al, Speed of Voluntary Step Execution May Predict Survival among Older Adults: An Explorative Study, Gerontology (2026). DOI: 10.1159/000551264

Clinical categories

Healthy agingPhysiatryGeriatric palliative careNeurologyFitness & Physical activity Provided by Ben-Gurion University of the Negev Who's behind this story?

Gaby Clark

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