{"publication_id":"d1ef7738-dd48-43f0-9c62-4e9211efdff2","content_hash":"sha256:9d6bac2815698b914df3e1cd8327b8b2340fcdb244eee67f77c9465310b052fe","nodes":[{"id":"d1ef7738-dd48-43f0-9c62-4e9211efdff2","type":"publication","title":"Research Synthesis: Gait Speed Longevity — full paper"},{"id":"claim_1","type":"claim","text":"Evidence-honesty note: 29/31 retained sources are indirect, review-level, adjacent, or mechanistic and are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims."},{"id":"claim_2","type":"claim","text":"This evidence synthesis employed an AI-assisted structured review with an audit trail to critically evaluate the relationship between gait speed and longevity, integrating findings from observational cohorts and randomized trials across multiple health domains."},{"id":"claim_3","type":"claim","text":"However, the evidence base is characterized by significant tension, as many interventions aimed at improving gait speed show mixed or null effects on underlying frailty, a key longevity intermediate."},{"id":"claim_4","type":"claim","text":"The evidence profile indicates that while slower gait speed is a robust independent predictor of mortality and morbidity across diverse populations, the current evidence is not consistent with that improving gait speed alone extends lifespan."},{"id":"claim_5","type":"claim","text":"Interpretation below therefore separates primary clinical-trial evidence from review-level, preclinical, and other indirect evidence."},{"id":"claim_6","type":"claim","text":"Gait speed has been proposed as a powerful, integrative biomarker of physiological reserve in aging, yet the central question of whether gait speed longevity represents a causal target or merely a downstream epiphenomenon of healthier aging remains unresolved. The aging global population faces a dual crisis: rising chronic disease burden and a search for scalable, low-cost interventions that extend healthspan, not just lifespan. A walking speed threshold of 0.8 m/s has been widely associated with impaired mobility and frailty risk (Studenski 2011), and more severe limitations fall below 0.6 m/s (Cesari 2009). These thresholds are not merely statistical artifacts; they correlate with disability, hospitalization, and mortality across dozens of cohorts. The clinical stakes of gait speed longevity research are therefore high, as even modest improvements of 0.1 m/s may mark a clinically meaningful functional change (Perera 2006). Annual age-related decline in gait speed among older adults approximates 0.05 m/s (Bohannon 1997), meaning that interventions capable of slowing or reversing this trajectory could, in principle, delay the onset of mobility dependence. It is in this context of population aging, rising healthcare costs, and the search for measurable geriatric outcomes that gait speed longevity has attracted intense research attention. However, the field must grapple with whether observed associations truly reflect a modifiable causal pathway or are confounded by residual health status."},{"id":"claim_7","type":"claim","text":"The geroscience hypothesis posits that targeting fundamental biological hallmarks of aging — such as cellular senescence, mitochondrial dysfunction, and chronic inflammation — should simultaneously delay or prevent multiple age-related diseases. Within this framework, gait speed longevity has been proposed as an accessible functional readout that may integrate the cumulative effects of these hallmarks on the musculoskeletal, nervous, and cardiovascular systems. If gait speed reflects systemic biological aging, then interventions that modulate aging biology should improve gait performance as a downstream marker. This logic has motivated the repurposing of existing drugs, such as metformin and NAD+ precursors, whose primary indications lie elsewhere but whose mechanisms appear to intersect with aging pathways. Alternatively, novel agents specifically designed to target aging biology may also yield gait speed improvements, though the pipeline remains largely preclinical. The appeal of repurposing lies in the existing safety and pharmacokinetic data for approved compounds, yet the evidence for gait speed longevity as a hard endpoint remains sparse compared to traditional cardiovascular or metabolic endpoints. It has been suggested that gait speed may function as a composite biomarker of geroscience target engagement, but this claim requires rigorous testing in dedicated aging-focused trials. The question of whether gait speed longevity truly indexes the rate of biological aging, or merely the presence of subclinical disease, is central to validating this hypothesis."},{"id":"claim_8","type":"claim","text":"Among the candidate interventions for gait speed longevity, the evidence base is heterogeneous and, at times, contradictory. A key concern is that gait speed is highly sensitive to contextual factors — including pain, cognition, medication burden, and environmental conditions — that may confound any drug-outcome relationship. This finding stands in tension with the cardioprotective rationale for statin use, and it underscores the complexity of attributing gait speed changes to any single pharmacological mechanism. Conversely, Mone 2025 observed that patients with heart failure with preserved ejection fraction (HFpEF) and elevated stress hyperglycemia ratios demonstrated significantly reduced physical performance, including a mean gait speed of 0.65 ± 0.20 m/s, linking metabolic dysregulation to mobility impairment. These observational findings suggest that gait speed longevity may be modulated by systemic metabolic health, yet the causal direction remains uncertain. The regulatory landscape for aging interventions has not yet established gait speed as a primary endpoint for drug approval, further complicating translation from bench to bedside. It appears that the field is at an inflection point: mechanistic plausibility is high, but the human trial evidence needed to support gait speed longevity as a clinical target is still emerging."},{"id":"claim_9","type":"claim","text":"The human RCT landscape for interventions targeting gait speed longevity encompasses a diverse array of study designs, endpoints, and population characteristics, but no single trial has definitively established causality. Pan 2025 evaluated a multicomponent Otago Exercise Program combined with resistance training in pre-frail nursing home residents, demonstrating improvements in physical function over 12 weeks, though the primary focus was sarcopenia rather than gait speed alone. Rice 2025 examined home-based exercise in older adults with a previous fall, finding that baseline gait speed modified intervention efficacy — with slower walkers (<0.80 m/s) exhibiting differential fall-rate outcomes at 6 and 12 months. This stratification highlights a critical issue: gait speed longevity interventions may have heterogeneous effects depending on baseline functional status. OlasoGonzalez 2026, a mechanistic RCT, reported that a multidomain lifestyle intervention was associated with improved functional trajectories and favorable changes in epigenetic aging markers in frail older adults (mean age ~80 years), with statistically significant improvements across multiple endpoints (P < 0.0001). The inclusion of epigenetic clocks as endpoints represents an important advance, linking gait speed longevity directly to biological aging measures. However, the small sample size (n = 19 per group in the control arm) and short follow-up limit generalizability. Karim 2026 tested multi-strain probiotics on frailty in osteoarthritis patients, demonstrating reduced frailty scores and improved walking-related pain (P < 0.05), suggesting that non-pharmacological and microbiome-targeted approaches may also influence gait speed longevity. Across the corpus, these trials reflect a field in which intervention heterogeneity, population diversity, and endpoint variability make cross-study comparison challenging."},{"id":"claim_10","type":"claim","text":"This synthesis contributes a structured, evidence-weighted evaluation of the Gait speed longevity literature that separates clinical outcomes from mechanistic insights. Across the curated evidence base, positive signals for gait speed longevity appear in frailty and contextual outcome domains, while negative and null findings also cluster in these same categories — reflecting the cross-study disagreements identified in the accompanying cross-study disagreement map. Similarly, Li 2026 found that physical frailty predicted postoperative complications and cognitive impairment in liver cancer patients, with frailty criteria count associated with increased risk (OR = 2.07 [95% CI 1.14–3.75]; P = 0.01), but this does not demonstrate that gait speed-targeted interventions can mitigate surgical risk. The synthesis reveals that the Gait speed longevity anti-aging case, as currently constituted, is incomplete: mechanistic plausibility coexists with mixed or sparse human-RCT evidence, and the boundary conditions remain to be established. Future research must address cross-outcome tensions through head-to-head trials, standardized gait speed measurement protocols, and inclusion of both surrogate and hard endpoints. The question of whether gait speed longevity represents a true causal target for aging interventions, or a convenient but ultimately non-specific marker, will only be resolved through this rigorous, structured approach."},{"id":"claim_11","type":"claim","text":"Preclinical and mechanistic investigations provide a plausible biological foundation for the Gait speed longevity association, though the evidence remains largely observational and indirect in humans. Walking performance integrates multiple physiological domains — skeletal muscle contractile function, mitochondrial oxidative phosphorylation, central motor planning, peripheral nerve conduction, and cardiopulmonary reserve — suggesting that gait speed may serve as a proxy for systemic biological integrity. In the Fried frailty phenotype, gait speed is one of five cardinal criteria, and its impairment signals accelerated biological aging across interconnected pathways including inflammation, sarcopenia, and metabolic dysregulation. Furthermore, depression has been shown to mediate the association between frailty and motoric cognitive risk syndrome, illustrating the bidirectional interplay between psychological and motor domains in the Gait speed longevity construct (Li 2026b, P < 0.001). However, the causal directionality of these associations remains uncertain, as most preclinical models cannot fully recapitulate the complexity of human walking, and the translation from mechanistic biomarkers to hard longevity endpoints requires further validation (Ioannidis 2005)."},{"id":"claim_12","type":"claim","text":"The clinical-trial landscape for interventions targeting gait speed in the context of longevity is characterized by small mechanistic studies, heterogeneous populations, and varying intervention durations, with no large-scale hard-outcome trial yet completed. Multicomponent exercise programs, including the Otago Exercise Program combined with resistance training, have demonstrated efficacy in pre-frail nursing home residents over 12-week interventions, with significant improvements in body composition and physical function (Pan 2025, P < 0.001). Resistance training modality matters for frailty outcomes, with high-speed resistance training preserving one-leg stand performance over 16 weeks while low-speed training showed performance reductions (Coelho-Junior 2021, P = 0.01), suggesting that movement velocity during training may differentially engage gait-speed-relevant neuromuscular pathways. Exergaming incorporating a resistance component has been explored as an alternative to traditional resistance training in pre-frail and frail nursing home residents, though the evidence remains preliminary (Liu 2026). Protein supplementation combined with resistance training has been evaluated in a systematic review and meta-analysis for gait speed outcomes in older adults (Li 2024), yet the overall clinical-trial landscape suffers from small sample sizes, short durations, and the absence of mortality or longevity-specific endpoints."},{"id":"claim_13","type":"claim","text":"Methodological challenges pervade the Gait speed longevity literature and constrain the strength of causal inference that can be drawn from the existing evidence. Endpoint selection remains contentious: usual gait speed, fast gait speed, gait speed reserve, dual-task gait speed, and community walking speed each capture distinct aspects of locomotor capacity, and their measurement properties vary across populations (Mehdipour 2024). A clinically meaningful change threshold of 0.1 m/s (Perera 2006) has been widely adopted, yet the sensitivity and specificity of this threshold for detecting meaningful longevity-relevant change has not been systematically validated across all clinical contexts. Heterogeneity in study populations — spanning community-dwelling older adults, nursing home residents, cancer patients, hemodialysis patients, and hemiplegia patients — complicates meta-analytic synthesis and limits the generalizability of pooled effect estimates. The mechanism-to-clinic gap is pronounced: while gait speed plausibly reflects mitochondrial function, sarcopenia, neuroinflammation, and cardiovascular reserve, few trials have simultaneously measured mechanistic biomarkers and hard clinical endpoints, leaving surrogate-endpoint validity uncertain (Ioannidis 2005). Treatment duration in existing trials ranges from 3 to 16 weeks, far shorter than the multi-year follow-up periods needed to ascertain longevity effects, and attrition rates in long-duration RCTs of older adults typically approach 20% (Schulz 2010), threatening both statistical power and external validity. Concurrent interventions — including polypharmacy, nutritional supplementation, and psychosocial support — create confounding pathways that are difficult to disentangle from the direct effects of gait-speed-targeted therapies. Ultimately, resolving these methodological challenges will require large-scale, long-duration RCTs with pre-specified gait speed endpoints, mechanistic biomarker substudies, and adjudicated hard outcomes including all-cause mortality."},{"id":"claim_14","type":"claim","text":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias appraisal, and claim registry) rather than from re-parsed full text."},{"id":"claim_15","type":"claim","text":"Per-source risk-of-bias was rated using design-appropriate Cochrane RoB-2 (RCTs), ROBINS-I (non-randomised studies), and AMSTAR-2 (systematic reviews / meta-analyses). Ratings recorded in `risk_of_bias.json`."},{"id":"claim_16","type":"claim","text":"Evidence-tension synthesis: claims grouped by outcome class (cardiometabolic, cognitive, contextual adjacent evidence, frailty, longevity, muscle function); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates."},{"id":"claim_17","type":"claim","text":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified."},{"id":"claim_18","type":"claim","text":"Outcome-class note:** Contextual Adjacent Evidence denotes background, boundary-condition, or adjacent-outcome sources. It is not pooled with direct outcome evidence; these sources bound scope, safety, methods, and translation rather than serving as equal-weight support for the main efficacy claim."},{"id":"claim_19","type":"claim","text":"| Evidence domain | Corpus slice | Strongest signal | Directness | Main limitation |"},{"id":"claim_20","type":"claim","text":"| Contextual Adjacent Evidence | n=8; claims=537 | no extracted directional signal in 3/8 sources | 1 direct; 5 indirect; 2 review | limited corpus depth in this outcome class |"},{"id":"claim_21","type":"claim","text":"Contextual Adjacent Evidence: n=8; claims=537; no extracted directional signal in 3/8 sources | directness: 1 direct; 5 indirect; 2 review; main limitation: directionally heterogeneous."},{"id":"claim_22","type":"claim","text":"Quantitatively, the evidence presents a mixed profile within this class. The specific p-values from each study's analysis are detailed in the evidence synthesis."},{"id":"claim_23","type":"claim","text":"Mechanistically, these findings connect systemic cardiometabolic stress to the neuromuscular and energy systems governing gait. The statin-associated reduction in GSR (Spiegeleer 2025) may involve statin-related myalgia or mitochondrial dysfunction, though the observational design precludes causal inference. Preclinical and mechanistic human studies suggest that hyperglycemia and insulin resistance (implied by a high SHR) can lead to endothelial dysfunction, peripheral neuropathy, and sarcopenia, all of which degrade walking performance. Thus, the negative signal from Mone 2025 in a frail HFpEF cohort aligns with a plausible pathway where metabolic derangement directly impairs the functional capacity critical for longevity."},{"id":"claim_24","type":"claim","text":"The primary evidence base for gait speed's association with cognitive outcomes in older adults comes from a secondary analysis of the SPRINT MIND trial. This study, a systematic review, examined whether baseline gait speed predicted future cognitive impairment in older adults with hypertension (Mirzai 2025). The population comprised older adults enrolled in the Systolic Blood Pressure Intervention Trial, a major clinical RCT. The analysis focused on gait speed as a predictive biomarker, with cognitive impairment as the primary endpoint. The study design allowed for longitudinal assessment of this relationship in a hypertensive cohort."},{"id":"claim_25","type":"claim","text":"The quantitative findings from this analysis showed a null association. Specifically, the study concluded that slow baseline gait speed did not predict future cognitive impairment in this hypertensive older adult population (Mirzai 2025). This null effect direction is a key finding, as it contrasts with hypotheses derived from mechanistic plausibility. No significant p-values or effect sizes for this primary association were reported in the available excerpts. The result suggests that in the specific context of controlled hypertension, the predictive value of gait speed for cognition may be attenuated."},{"id":"claim_26","type":"claim","text":"Mechanistically, gait speed is considered an integrative measure of neurological, musculoskeletal, and cardiovascular health, making a plausible link to cognitive decline. Preclinical data and observational human studies have often supported this connection, suggesting shared pathways like cerebral small vessel disease. By contrast, the clinical RCT data from SPRINT MIND present a challenge to this narrative. The discrepancy highlights that the relationship between gait speed and cognitive outcomes may be highly context-dependent, particularly regarding the presence of treated comorbidities like hypertension."},{"id":"claim_27","type":"claim","text":"A within-corpus tension exists between the mechanistic expectation and the clinical RCT evidence. The mechanistic substrate for a gait-cognition link remains biologically plausible, supported by broader literature on frailty and aging. However, the curated evidence from Mirzai 2025, a high-quality secondary analysis of a major RCT, found a null association. This tension underscores that the boundary conditions for gait speed as a cognitive predictor require further establishment, particularly regarding the influence of specific patient populations and comorbidity management."},{"id":"claim_28","type":"claim","text":"The evidence base for gait speed's relationship with contextual health outcomes in older adults is characterized by observational cohort studies. Park 2026 conducted a cross-sectional study in Korea involving middle-aged and older adults, examining the association between usual gait speed (UGS) and depression. The FRAILMERIT multicenter clinical trial (Saro 2025) enrolled prefrail or frail older adults, using gait speed as an inclusion criterion for its multicomponent intervention."},{"id":"claim_29","type":"claim","text":"Mechanistically, the link between gait speed and longevity-relevant outcomes involves pathways beyond simple mobility. The favorable epigenetic aging changes reported in OlasoGonzalez 2026's RCT suggest that multidomain interventions impacting gait may influence biological aging markers. This positions gait speed as both a functional readout and a potential mediator of systemic aging processes."},{"id":"claim_30","type":"claim","text":"The corpus includes 16 studies examining the relationship between gait speed and frailty outcomes, spanning observational cohorts, systematic reviews, and one clinical RCT. Populations ranged from community-dwelling older adults to patients with hematologic malignancies, cancer, hemodialysis, and Parkinson's disease. Study designs were predominantly observational cohorts, with several systematic reviews and meta-analyses providing synthesis-level evidence. The sole clinical RCT (Karim 2026) examined multi-strain probiotic supplementation in osteoarthritis patients, while other intervention-focused studies assessed digital health approaches (Dai 2026) and protein supplementation combined with resistance training (Li 2024). Gait speed was measured using various protocols including usual gait speed, fast gait speed, and dual-task walking conditions."},{"id":"source_1","type":"source","study":"The association between statins and gait speed reserve in older adults: effects of concomitant medication","year":2025,"doi":"10.1007/s11357-025-01682-x","url":"https://doi.org/10.1007/s11357-025-01682-x","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_2","type":"source","study":"Effects of Multicomponent Otago Exercise Program with Added Resistance Training on Sarcopenia in Pre-Frailty Older Adults in Nursing Homes: A Randomized Controlled Trial","year":2025,"doi":"10.2147/CIA.S552924","url":"https://doi.org/10.2147/CIA.S552924","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_3","type":"source","study":"Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial","year":2025,"doi":"10.1093/ptj/pzaf008","url":"https://doi.org/10.1093/ptj/pzaf008","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_4","type":"source","study":"A Pilot Study on the Short‐Term Effects of an Electric Knee–Ankle–Foot Orthosis on Gait Performance and Physiological Cost Index in Patients With Hemiplegia: Influence of Initial Balance Ability Assessed by the Berg Balance Scale","year":2026,"doi":"10.1155/bmri/5528235","url":"https://doi.org/10.1155/bmri/5528235","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_5","type":"source","study":"Efficacy of a Multicomponent Intervention for Frailty or Physical Function in Prefrail or Frail Older Adults: FRAILMERIT Multicenter Clinical Trial","year":2025,"doi":"10.1111/jgs.70266","url":"https://doi.org/10.1111/jgs.70266","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_6","type":"source","study":"Usual gait speed is inversely associated with depression in middle-aged and older adults: A cross-sectional study in Korea","year":2026,"doi":"10.1371/journal.pone.0338458","url":"https://doi.org/10.1371/journal.pone.0338458","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_7","type":"source","study":"Effects of Low-Speed and High-Speed Resistance Training Programs on Frailty Status, Physical Performance, Cognitive Function, and Blood Pressure in Prefrail and Frail Older Adults","year":2021,"doi":"10.3389/fmed.2021.702436","url":"https://doi.org/10.3389/fmed.2021.702436","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_8","type":"source","study":"Impact of Preoperative Frailty on Postoperative Complications and Cognitive Impairment in Liver Cancer Patients: An Observational Cohort Study","year":2026,"doi":"10.2147/CIA.S589717","url":"https://doi.org/10.2147/CIA.S589717","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_9","type":"source","study":"The Effect of Cognitive Task, Gait Speed, and Age on Cognitive–Motor Interference during Walking","year":2023,"doi":"10.3390/s23177368","url":"https://doi.org/10.3390/s23177368","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_10","type":"source","study":"Associations between declines in uneven terrain walking speed and visuospatial working memory in older adults","year":2026,"doi":"10.3389/fnagi.2025.1644741","url":"https://doi.org/10.3389/fnagi.2025.1644741","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_11","type":"source","study":"Impact of Physical Frailty on Early Intolerance to CAPOX Chemotherapy in Patients With Colon, Rectal, and Gastric Cancer","year":2026,"doi":"10.1002/cam4.71800","url":"https://doi.org/10.1002/cam4.71800","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_12","type":"source","study":"A Multidomain Lifestyle Intervention Is Associated With Improved Functional Trajectories and Favorable Changes in Epigenetic Aging Markers in Frail Older Adults: A Randomized Controlled Trial","year":2026,"doi":"10.1111/acel.70376","url":"https://doi.org/10.1111/acel.70376","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_13","type":"source","study":"Effects of exergaming with a resistance component versus traditional resistance training on sarcopenia in pre-frail and frail nursing home residents: a pilot randomized controlled trial","year":2026,"doi":"10.1007/s41999-025-01294-w","url":"https://doi.org/10.1007/s41999-025-01294-w","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_14","type":"source","study":"Effects of frailty and walking speed on gait variability in older adults","year":2026,"doi":"10.3389/fmed.2026.1785926","url":"https://doi.org/10.3389/fmed.2026.1785926","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_15","type":"source","study":"Stress hyperglycemia ratio and physical frailty in HFpEF","year":2025,"doi":"10.1186/s12933-025-03020-z","url":"https://doi.org/10.1186/s12933-025-03020-z","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_16","type":"source","study":"Depressive symptoms mediate the association between frailty and motoric cognitive risk syndrome in Chinese adults: Evidence from CHARLS 2011–2013","year":2026,"doi":"10.1097/MD.0000000000047166","url":"https://doi.org/10.1097/MD.0000000000047166","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_17","type":"source","study":"The prognostic value of gait speed in hemodialysis patients: A prospective observational study","year":2026,"doi":"10.1371/journal.pone.0343612","url":"https://doi.org/10.1371/journal.pone.0343612","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_18","type":"source","study":"An integrative approach to detecting potential blood-based biomarkers of cognitive frailty","year":2025,"doi":"10.1016/j.jnha.2025.100726","url":"https://doi.org/10.1016/j.jnha.2025.100726","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_19","type":"source","study":"Assessment of Frailty in Community-Dwelling Older Adults Using Smartphone-Based Digital Lifelogging: A Multi-Center, Prospective Observational Study","year":2025,"doi":"10.3390/s26010215","url":"https://doi.org/10.3390/s26010215","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_20","type":"source","study":"Clinical Utility of Gait Speed Indices for Identifying Sarcopenia in Older Adults with Type 2 Diabetes","year":2026,"doi":"10.3390/geriatrics11020046","url":"https://doi.org/10.3390/geriatrics11020046","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_21","type":"source","study":"Single-task, dual-task, and community gait speeds of older adults in Singapore: their associations with frailty, cognition, and age-friendly cities","year":2026,"doi":"10.1093/geroni/igag019","url":"https://doi.org/10.1093/geroni/igag019","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_22","type":"source","study":"Measurement properties of the usual and fast gait speed tests in community-dwelling older adults: a COSMIN-based systematic review","year":2024,"doi":"10.1093/ageing/afae055","url":"https://doi.org/10.1093/ageing/afae055","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_23","type":"source","study":"Frailty in Patients With Hematologic Malignancies and Patients Undergoing Hematopoietic Stem Cell Transplantation: A Systematic Review","year":2026,"doi":"10.1002/cnr2.70456","url":"https://doi.org/10.1002/cnr2.70456","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_24","type":"source","study":"Effectiveness of Digital Health Interventions in Older Adults With Frailty and Sarcopenia: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","year":2026,"doi":"10.2196/88374","url":"https://doi.org/10.2196/88374","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review-level"},{"id":"source_25","type":"source","study":"Effect of a 3-week program of cane training and use on gait of individuals with Parkinson’s disease: Protocol for a randomized controlled trial","year":2026,"doi":"10.1371/journal.pone.0341248","url":"https://doi.org/10.1371/journal.pone.0341248","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"primary"},{"id":"source_26","type":"source","study":"Effect of Protein Supplementation Combined With Resistance Training in Gait Speed in Older 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