Locomotive Syndrome: A New Tool for Detecting Pre-Frailty

Locomotive Syndrome (Locomo) is a preventive framework developed by the Japanese Orthopaedic Association, consisting of three simple but comprehensive tools:

• • Two-Step Test: a walking function test calculated as the maximum stride length in two steps divided by the participant’s height

  • Stand-Up Test: an assessment of lower limb muscle strength by attempting to stand from progressively lower seats with one or both legs

  • 25-Item Geriatric Locomotive Function Scale (GLFS-25): a self-administered questionnaire evaluating physical pain, activities of daily living, social functions, and mental health over the past month

What makes Locomo particularly valuable is that it:

• • Detects risk earlier than frailty,

  • Targets reversible functional decline,

  • And is applicable to middle-aged adults, not just the elderly.

Our recent study using health screening data from over 35,000 adults in Japan revealed that Locomo and Metabolic Syndrome often overlap as early as midlife.

This underscores the need for preventive interventions beginning well before old age.

From Research to Real-World Practice

Unlike many functional assessment tools developed for research, the Locomotive Syndrome Risk Test is already implemented in real-world medical settings in Japan, including large-scale comprehensive health check-up programs known as ningen dock.

Its feasibility and scalability have been demonstrated in routine use, with screening operations involving tens of thousands of participants.

This makes Locomo not only a valid clinical assessment but also a practical and scalable public health tool for mobility preservation.

Toward Global Standardization of Mobility Assessment

Tools such as the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) Test, and grip strength measurements are widely used worldwide, yet they lack a unified framework for detecting early, reversible mobility loss.

The Locomotive Syndrome Risk Test offers:

• • A standardized, multi-dimensional approach,

  • Quantitative thresholds for stratifying risk, and

  • International adaptability, with English versions of GLFS-25 already available.

We propose that researchers around the world adopt the Locomotive Syndrome Risk Test in mobility-related studies, especially in midlife and aging populations.

Cross-national comparative research using the same criteria will help us build a more unified and proactive global response to mobility decline.

Join Us in Building a “Walkable” Future

Locomotive function is fundamental to autonomy, quality of life, and healthy aging.

As we face the global rise in frailty and long-term care needs, it is time to establish standardized, preventive strategiesto detect mobility decline at an early, treatable stage.

We invite researchers and clinicians worldwide to explore and implement the Locomotive Syndrome Risk Test in their own populations.

Let’s work together to create a future where mobility can be protected—and restored—before it’s too late.

🔗 English Resources on Locomotive Syndrome

• Locomotive Syndrome Risk Test – English Version

The Japanese Orthopaedic Association provides an English-language PDF brochure detailing Locomotive Syndrome and its assessment methods.

📄 Download the English brochure (PDF)