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Accelerometers are widespread in research applications, yet whether they are superior to structured clinic-based assessments is unknown. Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wrist accelerometers (Actigraph GT9X) in predicting fall rates in 432 older adults (age 77.29±5.46 yrs, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Accelerometry-based gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Across all participants, every 10 steps/min higher cadence was associated with a 13.2% lower fall rate (p=0.036). Mobility measures were not related to falls (p&amp;gt;0.05). Among higher-functioning participants (cadence ≥100 steps/min), every 10 steps/min higher free-living cadence (p=0.01) was associated with a 27.7% lower fall rate. Data collected from accelerometers may provide a more sensitive indicator of fall risk than in-clinic tests.

Free-Living Gait Cadence Measured by Wearable Accelerometers for Assessing Fall Risk