{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:38:55Z","timestamp":1785760735199,"version":"3.56.0"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,8,4]],"date-time":"2024-08-04T00:00:00Z","timestamp":1722729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"JSPS KAKENHI","award":["20K19381"],"award-info":[{"award-number":["20K19381"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Clinical walk tests may not predict the development of frailty in healthy older adults. With advancements in wearable technology, it may be possible to predict the development of frailty using loading asymmetry parameters during clinical walk tests. This prospective cohort study aimed to test the hypothesis that increased limb loading asymmetry predicts frailty risk in community-living older adults. Sixty-three independently ambulant community-living adults aged \u2265 65 years were recruited, and forty-seven subjects completed the ten-month follow-up after baseline. Loading asymmetry index of net and regional (forefoot, midfoot, and rearfoot) plantar forces were collected using force sensing insoles during a 10 m walk test with their maximum speed. Development of frailty was defined if the participant progressed from baseline at least one grading group of frailty at the follow-up period using the Kihon Checklist. Fourteen subjects developed frailty during the follow-up period. Increased risk of frailty was associated with each 1% increase in loading asymmetry of net impulse (Odds ratio 1.153, 95%CI 1.001 to 1.329). Net impulse asymmetry significantly correlated with asymmetry of peak force in midfoot force. These results indicate the feasibility of measuring plantar forces of gait during clinical walking tests and underscore the potential of using load asymmetry as a tool to augment frailty risk assessment in community-dwelling older adults.<\/jats:p>","DOI":"10.3390\/s24155054","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T13:57:28Z","timestamp":1722866248000},"page":"5054","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["In-Shoe Sensor Measures of Loading Asymmetry during Gait as a Predictor of Frailty Development in Community-Dwelling Older Adults"],"prefix":"10.3390","volume":"24","author":[{"given":"Tatsuya","family":"Nakanowatari","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6 Sakae-machi, Fukushima 960-8516, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Hoshi","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6 Sakae-machi, Fukushima 960-8516, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Asao","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, Fukushima Medical University School of Health Sciences, 10-6 Sakae-machi, Fukushima 960-8516, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimasa","family":"Sone","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, Fukushima Medical University School of Health Sciences, 10-6 Sakae-machi, Fukushima 960-8516, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1566-1015","authenticated-orcid":false,"given":"Naoto","family":"Kamide","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5428-9784","authenticated-orcid":false,"given":"Yoshitaka","family":"Shiba","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Fukushima Medical University School of Health Sciences, 10-6 Sakae-machi, Fukushima 960-8516, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e198398","DOI":"10.1001\/jamanetworkopen.2019.8398","article-title":"Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis","volume":"2","author":"Chin","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in older adults: Evidence for a phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1111\/j.1532-5415.2010.03146.x","article-title":"Frailty, mortality, and health-related quality of life in older Mexican Americans","volume":"58","author":"Masel","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1089\/pop.2010.0063","article-title":"Potential Medicare savings through prevention and risk reduction","volume":"14","author":"Rula","year":"2011","journal-title":"Popul. Health Manag."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12984-021-00909-0","article-title":"How wearable sensors have been utilised to evaluate frailty in older adults: A systematic review","volume":"18","author":"Vavasour","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_6","first-page":"176","article-title":"Is Technology Present in Frailty? Technology a Back-up Tool for Dealing with Frailty in the Elderly: A Systematic Review","volume":"8","year":"2017","journal-title":"Aging Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/s00391-016-1129-7","article-title":"Technology-based measurements for screening, monitoring and preventing frailty","volume":"49","author":"Dasenbrock","year":"2016","journal-title":"Z. Gerontol. Geriatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000354211","article-title":"Frailty and technology: A systematic review of gait analysis in those with frailty","volume":"60","author":"Schwenk","year":"2014","journal-title":"Gerontology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.gaitpost.2010.11.006","article-title":"Gait patterns during different walking conditions in older adults with and without knee osteoarthritis\u2014Results from the Baltimore Longitudinal Study of Aging","volume":"33","author":"Ko","year":"2011","journal-title":"Gait Posture"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.clinbiomech.2009.09.002","article-title":"A three-dimensional kinematic and kinetic comparison of overground and treadmill walking in healthy elderly subjects","volume":"25","author":"Watt","year":"2010","journal-title":"Clin. Biomech."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.gaitpost.2019.04.011","article-title":"Ankle power biofeedback attenuates the distal-to-proximal redistribution in older adults","volume":"71","author":"Browne","year":"2019","journal-title":"Gait Posture"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1080\/02640414.2018.1545515","article-title":"Validation of a wireless shoe insole for ground reaction force measurement","volume":"37","author":"Burns","year":"2019","journal-title":"J. Sports Sci."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Peebles, A.T., Maguire, L.A., Renner, K.E., and Queen, R.M. (2018). Validity and Repeatability of Single-Sensor Loadsol Insoles during Landing. Sensors, 18.","DOI":"10.3390\/s18124082"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Renner, K.E., Williams, D.S.B., and Queen, R.M. (2019). The Reliability and Validity of the Loadsol\u00ae under Various Walking and Running Conditions. Sensors, 19.","DOI":"10.3390\/s19020265"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1080\/17461391.2018.1477993","article-title":"Accuracy and precision of loadsol((R)) insole force-sensors for the quantification of ground reaction force-based biomechanical running parameters","volume":"18","author":"Seiberl","year":"2018","journal-title":"Eur. J. Sport Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.gaitpost.2021.04.017","article-title":"Detection of age and gender differences in walking using mobile wearable sensors","volume":"87","author":"Renner","year":"2021","journal-title":"Gait Posture"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.gaitpost.2023.10.022","article-title":"Detecting differences in limb load asymmetry during walking between older adult fallers and non-fallers using in-shoe sensors","volume":"107","author":"Nakanowatari","year":"2023","journal-title":"Gait Posture"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bolam, S.M., Batinica, B., Yeung, T.C., Weaver, S., Cantamessa, A., Vanderboor, T.C., Yeung, S., Munro, J.T., Fernandez, J.W., and Besier, T.F. (2021). Remote Patient Monitoring with Wearable Sensors Following Knee Arthroplasty. Sensors, 21.","DOI":"10.3390\/s21155143"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1093\/gerona\/glx225","article-title":"Oral Frailty as a Risk Factor for Physical Frailty and Mortality in Community-Dwelling Elderly","volume":"73","author":"Tanaka","year":"2018","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/joor.12578","article-title":"A 5-year longitudinal study of association of maximum bite force with development of frailty in community-dwelling older adults","volume":"45","author":"Iwasaki","year":"2018","journal-title":"J. Oral Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/ggi.12543","article-title":"Validity of the Kihon Checklist for assessing frailty status","volume":"16","author":"Satake","year":"2016","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/ageing\/26.1.15","article-title":"Comfortable and maximum walking speed of adults aged 20-79 years: Reference values and determinants","volume":"26","author":"Bohannon","year":"1997","journal-title":"Age Ageing"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \"Up & Go\": A test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1532-5415.1997.tb00946.x","article-title":"Gait changes in older adults: Predictors of falls or indicators of fear","volume":"45","author":"Maki","year":"1997","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1063320","DOI":"10.3389\/fragi.2022.1063320","article-title":"Physical ability, cervical function, and walking plantar pressure in frail and pre-frail older adults: An attentional focus approach","volume":"3","author":"Pinloche","year":"2022","journal-title":"Front Aging"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Anzai, E., Ren, D., Cazenille, L., Aubert-Kato, N., Tripette, J., and Ohta, Y. (2022). Random forest algorithms to classify frailty and falling history in seniors using plantar pressure measurement insoles: A large-scale feasibility study. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03425-5"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Drzal-Grabiec, J., Snela, S., Rykala, J., Podgorska, J., and Banas, A. (2013). Changes in the body posture of women occurring with age. BMC Geriatr., 13.","DOI":"10.1186\/1471-2318-13-108"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Iosa, M., Fusco, A., Morone, G., and Paolucci, S. (2014). Development and decline of upright gait stability. Front. Aging Neurosci., 6.","DOI":"10.3389\/fnagi.2014.00014"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1136\/bmj.329.7478.1328","article-title":"Tibialis posterior dysfunction: A common and treatable cause of adult acquired flatfoot","volume":"329","author":"Angel","year":"2004","journal-title":"BMJ"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1111\/ggi.12833","article-title":"Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty?","volume":"16","author":"Sampaio","year":"2016","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/ggi.13810","article-title":"Diagnostic test accuracy of self-reported screening instruments in identifying frailty in community-dwelling older people: A systematic review","volume":"20","author":"Ambagtsheer","year":"2020","journal-title":"Geriatr. Gerontol. Int."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/15\/5054\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:29:57Z","timestamp":1760110197000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/15\/5054"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,4]]},"references-count":31,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["s24155054"],"URL":"https:\/\/doi.org\/10.3390\/s24155054","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,4]]}}}