The United Nations (UN) has proclaimed 2021–2030 the Decade of Healthy Ageing, with the World Health Organization (WHO) leading international action to improve the lives of older people, their families, and communities. The Decade brings together a variety of stakeholders for ten years of concerted action to (a) change how we think, feel and act towards age and ageing; (b) develop communities in ways that foster the abilities of older people; (c) deliver person-centred, integrated care and primary health services that are responsive to older people; and (d) provide older people access to long-term care when they need it [1, 2].
Healthy ageing [3] is defined by the World Health Organization (WHO) as “the process of developing and maintaining the functional ability that enables wellbeing in older age” [4, 5]. Functional ability comprises the health-related attributes that enable people to be and to do what they have reason to value. It is made up of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. Intrinsic capacity is the composite of all the physical and mental capacities of an individual. To assess the impact of its actions at the national, regional, and global levels, the WHO proposed intrinsic capacity and functional ability as outcome indicators of healthy ageing. WHO’s integrated care for older people (ICOPE) framework suggests locomotor capacity as one of the domains of intrinsic physical capacity [6].
Locomotor capacity is broadly described as a person’s bodily capacity or physical capacity to move from one place to another [2, 7]. Four main characteristics proposed in a recent publication include a function of joints, bones, reflexes and muscle strength [2]. Other attributes (such as balance, endurance, muscle power) of the musculoskeletal system are also crucial in assessing locomotor capacity in older persons. While there is some clarity on the structure of intrinsic capacity and its subdomains, clear and consensual conceptual and operational definitions of locomotor capacity are still lacking.
To close these gaps, the WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging (Liège, Belgium), in collaboration with the WHO Ageing and Health Unit, held a virtual Working Group meeting (see Supplementary Material for the participants), convening experts from around the world, to discuss the conceptual and operational definitions of locomotor capacity. The purpose of this Working Group was to provide WHO with clear conceptual and operational definitions of locomotor capacity, to enable the monitoring and evaluation of the impact of public health actions taken at the national, regional, and global levels to improve the lives of older people, their families, and communities, within the framework of the UN’s Decade of Healthy Ageing initiative.
Briefly, the most important points discussed by the experts during this initial Working Group were:
Potential issues: locomotor capacity is often described as a person’s bodily capacity or physical capacity to move from one place to another. Although this implies the evaluation of mechanisms involved in the movement, there are three main issues with the current description discussed in the meeting: (a) movement of a person from one location to another would imply moving inside the home and from home to different locations in the community (e.g. park); this overlaps with the ability to be mobile, which is the domain of functional ability, (b) the description does not specify all the necessary attributes that should be considered for measurement, and (c) it did not clearly state whether it is a function of the body or a function of a person in the environment as the term bodily capacity was not clearly described.
Mobility vs locomotor capacity: differently, mobility is a domain of functional ability that captures how a potential (locomotor capacity) is actualized in real life when interacting with the environment. Locomotor capacity is a domain of intrinsic capacity and mainly relates to the individual’s body function, whereas mobility reflects the interaction between an individual and his environment.
Defining mobility: it is essential to define mobility better before defining the concept of locomotor capacity. Both concepts have some aspects in common. For instance, in some WHO documents, gait speed is a measure of locomotor capacity, but, for example, asking older persons whether they can walk 100 m is considered a measure of mobility. The WHO representatives emphasize that another Working group on mobility is currently working on the conceptual and operational definitions of the ability to be mobile.
Attributes of locomotor capacity: experts agreed that locomotor capacity could be defined using at least the following attributes: endurance, balance, muscle strength, muscle function, muscle power and joint function of the body.
Assessment of locomotor capacity: experts suggested that the term ‘capacity’ refers to the highest possible level of functioning in a given domain at a given moment in time. Consequently, an assessment tool would require a test that puts the particular locomotor aspect under stress. In this regard, some discussion emerged regarding whether locomotor capacity could be captured by performance-based tests or reported directly by older people.
In conclusion, based on the discussion above, the Working Group proposed a conceptual working definition that defines locomotor capacity as “a state (static or dynamic over time) of the musculoskeletal system that encompasses endurance, balance, muscle strength, muscle function, muscle power and a joint function of the body”. A systematic review of measures of locomotor capacity will be undertaken in the coming months to develop operational definitions for monitoring and evaluation of public health actions focusing on older persons. Further meetings and works are planned to elaborate the operational definition of locomotor capacity.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The members of the WHO Collaborating Center Working Group on Locomotor Capacity Al-Daghri Nasser, College of Science and Chair for Biomarkers of Chronic Diseases, King Saud University, Riyadh, Saudi Arabia. Andrieu Sandrine, Clinical epidemiology and public health department, Gerontopôle, Toulouse University Hospital, France. Annweiler Cédric, Department of Geriatric Medicine, University of Angers, France. Aubertin-Leheudre Mylène, Exercise sciences department, Université du Québec à Montréal (UQAM), Canada. Bautmans Ivan, Gerontology and Frailty in Ageing research departments, Vrije Universiteit Brussel (VUB), Belgium. Beaudart Charlotte, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Belgium. Becker Clemens, Digital Geriatric Medicine, University of Heidelberg, Germany. Bruyère Olivier, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Belgium. Buckinx Fanny, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Belgium. Campusano Claudia, Universidad de los Andes, Chile. Cesari Matteo, Geriatric Fellowship Program, University of Milan, Italy. Chandran Manju, Osteoporosis and Bone Metabolism Unit, Singapore General Hospital, Singapore. Cherubini Antonio, Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy. Clark Patricia, Clinical Epidemiology Research Unit, National University of México UNAM, Mexico. Cooper Cyrus, MRC Lifecourse Epidemiology Unit, University of Southampton, UK. Cruz-Jentoft Alfonso, Geriatric Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. Dennison Elaine, MRC Lifecourse Epidemiology Unit, University of Southampton, UK. Fouasson Chailloux Alban, “Regenerative Medicine and Skeleton” research centre, University Hospital of Nantes, France. Fuggle Nick, MRC Lifecourse Epidemiology Center, University of Southampton, UK. Gichu Muthoni, Ministry of Health Kenya, Division of Geriatric Medicine, Kenya. Gielen Evelien, Unit of Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Belgium. Guicheux Jérôme, “Regenerative Medicine and Skeleton” research centre, University of Nantes, France. Harvey Nick, MRC Lifecourse Epidemiology Centre, University of Southampton, UK. Haugen Ida, Division of Rheumatology and Research, Diakonhjemmet Hospital, Norway. Honvo Germain, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liège, Belgium. Lamy Olivier, Bone Unit, Lausanne University Hospital, Switzerland. Landi Francesco, Geriatric Internal Medicine Unit, A. Gemelli University Hospital, Rome, Italy. Lane Nancy, Davis School of Medicine in Saccramento, University of California, USA. Lazaretti Castro Marise, Bone and Mineral Research Unit, Federal University of Sao Paulo (UNIFESP), Brazil. Lewiecki Mike, Bone Health TeleECHO, University of New Mexico Health Sciences Center in Albuquerque, New Mexico, USA. Matijevic Radmila, Rehabilitation Unit, Orthopaedic and Trauma, University of Novi Sad, Serbia. Messina Osvaldo Daniel, Rheumatology, C Argerich Hospital, University of Buenos Aires, Argentina. Mkinsi Ouafa, Department of Rheumatology, Ibn Rochd University Hospital, Casablanca, Morocco. Mobasheri Ali, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland. Njeze Ngozi, University of Nigeria Medical school, Nsukka, Nigeria. Pinto Daniel, Department of Physical Therapy, Marquette University, USA. Reginster Jean-Yves, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Belgium. Rizzoli René, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland. Rolland Yves, Gérontopôle of Toulouse, University Toulouse III Paul Sabatier, France. Saleh Yousef, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Singer Andrea, Division of Women’s Primary Care, MedStar Georgetown University Hospital, USA. Thomas Thierry, Rheumatology Department, University Hospital of Saint-Étienne (UHSE), France. Van der Velde Nathalie, Amsterdam UMC, The Netherlands. Vellas Bruno, Gérontopôle & Department of Geriatric Internal Medicine, Toulouse University Hospital, France. Veronese Nicola, Geriatric Unit, Department of Medicine, University of Palermo, Italy. Visser Marjolein, Vrije Universiteit Amsterdam, The Netherlands. Zee A Han, College of Medicine, The Catholic University of Korea, Seoul, South-Korea.
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Footnotes
The name of the members of the WHO Collaborating Center Working Group on locomotor capacity is mentioned in the Acknowledgements section.
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Nicola Veronese and Germain Honvo are Joint first authorship.
Jean-Yves Reginster and Anshu Banerjee are Joint last authorship.
Contributor Information
Nicola Veronese, Email: nicola.veronese@unipa.it.
the members of the WHO Collaborating Center Working Group on Locomotor Capacity:
Al- Daghri Nasser, Andrieu Sandrine, Annweiler Cédric, Aubertin- Leheudre Mylène, Bautmans Ivan, Beaudart Charlotte, Becker Clemens, Bruyère Olivier, Buckinx Fanny, Campusano Claudia, Cesari Matteo, Chandran Manju, Cherubini Antonio, Clark Patricia, Cooper Cyrus, Cruz- Jentoft Alfonso, Dennison Elaine, Fouasson Chailloux Alban, Fuggle Nick, Gichu Muthoni, Gielen Evelien, Guicheux Jérôme, Harvey Nick, Haugen Ida, Honvo Germain, Lamy Olivier, Landi Francesco, Lane Nancy, Lazaretti Castro Marise, Lewiecki Mike, Matijevic Radmila, Mkinsi Ouafa, Mobasheri Ali, Njeze Ngozi, Pinto Daniel, Reginster Jean-Yves, Rizzoli René, Rolland Yves, Saleh Yousef, Singer Andrea, Thomas Thierry, Van der Velde Nathalie, Vellas Bruno, Veronese Nicola, Visser Marjolein, and Zee A Han
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