步態的生命歷程：年齡與性別的動態交互作用、策略性代償與典範轉變之敘述性綜述

The lifespan of gait: A narrative review of dynamic interactions, strategic compensations, and paradigm shifts in age and sex

年齡與性別是影響人類步態的核心變數。傳統研究通常將步態老化描述為被動的功能衰退，並單獨看待性別差異。本研究旨在整合近十年的原創性研究，探討年齡與性別交互作用對步態的真實影響，包含主動代償策略、性別差異探究、研究方法趨勢以及爭議與反思等。本研究參考PRISMA（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）流程，對Web of Science，PubMed，Scopus資料庫進行文獻檢索與篩選，最終納入166篇核心文獻進行主題式分析。方法學分析顯示，近十年同時使用兩種或以上技術的多模態整合分析成為步態研究的主流，約佔43%。研究結果顯示，步態老化並非簡單的功能衰退，而是以穩定優先的主動策略，由「踝策略」轉向「髖策略」，以及全身性的運動協調重組；男女的步態差異源於從骨骼形態到神經肌肉控制的多個層面，並導致截然不同的老化軌跡；這些老化模式與潛在缺陷，只有在功能性、認知性或生理性的壓力測試下才會顯現；在步態評估中需嚴格控制步速、身高與衰弱狀態等干擾變數，以釐清生理性老化與病理性衰退的界線。未來的研究應聚焦縱向研究，探究性別差異根源的協同作用以及區分能力衰退與策略選擇，並將實驗室中的關鍵生物力學指標轉化為可用於臨床早期風險識別的數位生物標記。

Age and gender are pivotal variables influencing human gait biomechanics. Traditional research has historically characterized gait aging merely as a passive process of functional decline, often examining gender differences in isolation. This study aims to synthesize original research from the past decade to provide a comprehensive understanding of the dynamic life course of gait. The analysis focuses on the genuine impacts of age and gender, the implementation of active compensatory strategies, transitions in methodological approaches, and emerging controversies and reflections within the field. Following the PRISMA guidelines, a systematic literature search and screening were conducted across the Web of Science, PubMed, and Scopus databases. Ultimately, 166 core articles were selected for thematic analysis. Methodological analysis reveals that multimodal integrated analysis—employing two or more concurrent technologies—has emerged as the mainstream approach in gait research over the last decade, accounting for approximately 43% of the studies. The results demonstrate that gait aging is not simply a passive functional deterioration but rather an active, ''stability-first'' adaptive strategy. This involves a significant redistribution of joint kinetics, specifically a shift from an ''ankle strategy'' to a ''hip strategy,'' accompanied by a systemic reorganization of motor coordination. Furthermore, gender-specific gait differences are shown to originate from multiple levels, ranging from skeletal morphology to neuromuscular control, resulting in distinct aging trajectories for men and women. Notably, these specific aging patterns and potential underlying deficits often become apparent only when the locomotor system is challenged under functional, cognitive, or physiological stress testing. Consequently, rigorous control of confounding variables—such as gait speed, body height, and frailty status—is essential in gait assessment to accurately distinguish between physiological aging and pathological decline. Future research should prioritize longitudinal study designs to investigate the synergistic mechanisms underlying gender differences and to differentiate between actual physiological capacity decline and adaptive strategic choices. Finally, a critical goal remains the translation of key biomechanical metrics from laboratory settings into clinically applicable digital biomarkers for early risk identification.