Open Access Highly Accessed Research article

Education-related differences in physical performance after age 60: a cross-sectional study assessing variation by age, gender and occupation

Anna-Karin Welmer12*, Ingemar Kåreholt13, Elisabeth Rydwik14, Sara Angleman1 and Hui-Xin Wang1

Author Affiliations

1 Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, 16, S-113 30 Stockholm, Sweden

2 Karolinska University Hospital, Stockholm, Sweden

3 Institute for Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden

4 Research and Development Unit, Jakobsbergs Hospital, Järfälla, Sweden

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BMC Public Health 2013, 13:641  doi:10.1186/1471-2458-13-641

Published: 10 July 2013



Having a low level of education has been associated with worse physical performance. However, it is unclear whether this association varies by age, gender or the occupational categories of manual and non-manual work. This study examined whether there are education-related differences across four dimensions of physical performance by age, gender or occupational class and to what extent chronic diseases and lifestyle-related factors may explain such differences.


Participants were a random sample of 3212 people, 60 years and older, both living in their own homes and in institutions, from the Swedish National Study on Aging and Care, in Kungsholmen, Stockholm. Trained nurses assessed physical performance in grip strength, walking speed, balance and chair stands, and gathered data on education, occupation and lifestyle-related factors, such as physical exercise, body mass index, smoking and alcohol consumption. Diagnoses of chronic diseases were made by the examining physician.


Censored normal regression analyses showed that persons with university education had better grip strength, balance, chair stand time and walking speed than people with elementary school education. The differences in balance and walking speed remained statistically significant (p < 0.05) after adjustment for chronic diseases and lifestyle. However, age-stratified analyses revealed that the differences were no longer statistically significant in advanced age (80+ years). Gender-stratified analyses revealed that women with university education had significantly better grip strength, balance and walking speed compared to women with elementary school education and men with university education had significantly better chair stands and walking speed compared to men with elementary school education in multivariate adjusted models. Further analyses stratified by gender and occupational class suggested that the education-related difference in grip strength was only evident among female manual workers, while the difference in balance and walking speed was only evident among female and male non-manual workers, respectively.


Higher education was associated with better lower extremity performance in people aged 60 to 80, but not in advanced age (80+ years). Our results indicate that higher education is associated with better grip strength among female manual workers and with better balance and walking speed among female and male non-manual workers, respectively.

Educational status; Aging; Chronic diseases; Muscle strength; Walking; Postural balance