Journal of General Internal Medicine

, Volume 29, Issue 9, pp 1263–1269 | Cite as

Walking Cadence and Mortality Among Community-Dwelling Older Adults

  • Justin C. Brown
  • Michael O. Harhay
  • Meera N. Harhay
Original Research



Older adults are encouraged to walk ≥100 steps∙minute−1 for moderate-intensity physical activity (i.e., brisk walking). It is unknown if the ability to walk ≥100 steps∙minute−1 predicts mortality.


To determine if the ability to walk ≥100 steps∙minute−1 predicts mortality among older adults.


A population-based cohort study among 5,000 older adults from the Third National Health and Nutrition Survey (NHANES III; 1988–1994). Vital status and cause of death were collected through December 31, 2006. Median follow-up was 13.4 years. Average participant age was 70.6 years.


Walking cadence (steps∙minute−1) was calculated using a timed 2.4-m walk. Walking cadence was dichotomized at 100 steps∙minute−1 (≥100 steps∙minute−1 versus <100 steps∙minute−1) to demarcate the lower threshold of absolutely defined moderate-intensity physical activity. Walking cadence was also analyzed as a continuous variable. Predicted survival was compared between walking cadence and gait speed. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular-specific and cancer-specific mortality and mortality from other causes.


Among 5,000 participants, 3,039 (61 %) walked ≥100 steps∙minute−1. During follow-up, 3,171 subjects died. In multivariable-adjusted analysis, ability to walk ≥100 steps∙minute−1 predicted a 21 % reduction in all-cause mortality (hazard ratio [HR], 0.79; 95 % confidence interval [95 % CI], 0.71–0.89, p < 0.001). Each ten-step increase in walking cadence predicted a 4 % reduction in all-cause mortality (HR, 0.96, [0.94–0.98], p < 0.001). In secondary analyses, ability to walk ≥100 steps∙minute−1 predicted reductions in cardiovascular-specific mortality (HR, 0.79 [0.67–0.92], p = 0.002), cancer-specific mortality (HR, 0.76 [0.58–0.99], p = 0.050), and mortality from other causes (HR, 0.82 [0.68–0.97], p = 0.025). Predicted survival, adjusted for age and sex, was not different using walking cadence versus gait speed.


Walking cadence was a cross-sectional measurement.


The ability to walk ≥100 steps∙minute−1 predicts a reduction in mortality among a sample of community-dwelling older adults.


physical function disability mobility aging physical activity 



Justin C. Brown had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Meera N. Harhay has received training grants (5T32DK007006-38 and F32DK096758-01) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Michael O. Harhay is supported as a pre-doctoral fellow by National Cancer Institute (NCI) grant R01 CA159932. Justin C. Brown is supported as a pre-doctoral fellow by NCI grant U54 CA155850. This study was completed without funding.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Vincent GK, Velkoff VA. The Next Four Decades: The Older Population in the United States: 2010 to 2050. Current Population Reports. Washington, DC: US Department of Commerce, Economics and Statistics Administration, US Census Bureau; 2010:P25-1138.Google Scholar
  2. 2.
    Manton KG, Vaupel JW. Survival after the age of 80 in the united states, Sweden, France, England, and Japan. N Engl J Med. 1995;333(18):1232–1235.PubMedCrossRefGoogle Scholar
  3. 3.
    Katz S, Branch LG, Branson MH, Papsidero JA, Beck JC, Greer DS. Active life expectancy. N Engl J Med. 1983;309(20):1218–1224.PubMedCrossRefGoogle Scholar
  4. 4.
    Walston J, Hadley EC, Ferrucci L, et al. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the american geriatrics Society/National institute on aging research conference on frailty in older adults. J Am Geriatr Soc. 2006;54(6):991–1001.PubMedCrossRefGoogle Scholar
  5. 5.
    Lonergan ET, Krevans JR. A national agenda for research on aging. N Engl J Med. 1991;324(25):1825–1828.PubMedCrossRefGoogle Scholar
  6. 6.
    Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–M94.PubMedCrossRefGoogle Scholar
  7. 7.
    Newman AB, Simonsick EM, Naydeck BL, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;295(17):2018–2026.PubMedCrossRefGoogle Scholar
  8. 8.
    Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the american college of sports medicine and the american heart association. Med Sci Sports Exerc. 2007;39(8):1435.PubMedCrossRefGoogle Scholar
  9. 9.
    King AC, Rejeski WJ, Buchner DM. Physical activity interventions targeting older adults: a critical review and recommendations. Am J Prev Med. 1998;15(4):316–333.PubMedCrossRefGoogle Scholar
  10. 10.
    United States. Public Health Service. Office of the Surgeon General, National Center for Chronic Disease Prevention, Health Promotion (US), President’s Council on Physical Fitness, Sports (US). Physical Activity and Health: A Report of the Surgeon. Jones & Bartlett Learning; 1996.Google Scholar
  11. 11.
    LIFE Study Investigators, Pahor M, Blair SN, et al. Effects of a physical activity intervention on measures of physical performance: results of the lifestyle interventions and independence for elders pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006;61(11):1157–1165.PubMedGoogle Scholar
  12. 12.
    Tudor-Locke C, Craig CL, Aoyagi Y, et al. How many steps/day are enough for older adults and special populations? Int J Behav Nutr Phys Act. 2011;8(1):80.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Marshall SJ, Levy SS, Tudor-Locke CE, et al. Translating physical activity recommendations into a pedometer-based step goal: 3000 steps in 30 minutes. Am J Prev Med. 2009;36(5):410–415.PubMedCrossRefGoogle Scholar
  14. 14.
    Bouchard DR, Langlois M, Boisvert-Vigneault K, Farand P, Paulin M, Baillargeon J. Pilot study: can older inactive adults learn how to reach the required intensity of physical activity guideline? Clin Interv Aging. 2013;8:501–508.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health. JAMA. 2007;298(19):2296–2304.PubMedCrossRefGoogle Scholar
  16. 16.
    McKay J, Wright A, Lowry R, Steele K, Ryde G, Mutrie N. Walking on prescription: the utility of a pedometer pack for increasing physical activity in primary care. Patient Educ Couns. 2009;76(1):71–76.PubMedCrossRefGoogle Scholar
  17. 17.
    Eakin EG, Brown WJ, Marshall AL, Mummery K, Larsen E. Physical activity promotion in primary care: bridging the gap between research and practice. Am J Prev Med. 2004;27(4):297–303.PubMedGoogle Scholar
  18. 18.
    Eakin EG, Glasgow RE, Riley KM. Review of primary care-based physical activity intervention studies. J Fam Pract. 2000;49(2):158–168.PubMedGoogle Scholar
  19. 19.
    Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–58.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Plan and operation of the third national health and nutrition examination survey, 1988–94. series 1: Programs and collection procedures. Vital Health Stat 1. 1994;(32)(32):1–407.Google Scholar
  21. 21.
    Ostchega Y, Harris TB, Hirsch R, Parson VL, Kington R, Katzoff M. Reliability and prevalence of physical performance examination assessing mobility and balance in older persons in the US: data from the third national health and nutrition examination survey. J Am Geriatr Soc. 2000;48(9):1136–1141.PubMedGoogle Scholar
  22. 22.
    Rogot E, Sorlie P, Johnson NJ. Probabilistic methods in matching census samples to the national death index. J Chron Dis. 1986;39(9):719–734.PubMedCrossRefGoogle Scholar
  23. 23.
    World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems. World Health Organization; 2004.Google Scholar
  24. 24.
    Harrell FE. Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. Springer; 2001.Google Scholar
  25. 25.
    Apfel CC, Kranke P, Greim CA, Roewer N. What can be expected from risk scores for predicting postoperative nausea and vomiting? Br J Anaesth. 2001;86(6):822–827.PubMedCrossRefGoogle Scholar
  26. 26.
    Korn EL, Graubard BI. Epidemiologic studies utilizing surveys: accounting for the sampling design. Am J Public Health. 1991;81(9):1166–1173.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Salzman B. Gait and balance disorders in older adults. Am Fam Physician. 2010;82(1):61–68.PubMedGoogle Scholar
  28. 28.
    Tudor-Locke C, Camhi SM, Leonardi C, et al. Patterns of adult stepping cadence in the 2005–2006 NHANES. Prev Med. 2011;53(3):178–181.PubMedCrossRefGoogle Scholar
  29. 29.
    Silver KH, Macko RF, Forrester LW, Goldberg AP, Smith GV. Effects of aerobic treadmill training on gait velocity, cadence, and gait symmetry in chronic hemiparetic stroke: a preliminary report. Neurorehabil Neural Repair. 2000;14(1):65–71.PubMedCrossRefGoogle Scholar
  30. 30.
    Hardy SE, Perera S, Roumani YF, Chandler JM, Studenski SA. Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc. 2007;55(11):1727–1734.PubMedCrossRefGoogle Scholar
  31. 31.
    Yates T, Haffner SM, Schulte PJ, et al. Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysis. Lancet. 2014;383(9922):1059–1066.PubMedCrossRefGoogle Scholar
  32. 32.
    Drillis R. Objective recording and biomechanics of pathological gait. Ann N Y Acad Sci. 1958;74(1):86–109.PubMedCrossRefGoogle Scholar
  33. 33.
    Wass E, Taylor NF, Matsas A. Familiarisation to treadmill walking in unimpaired older people. Gait Posture. 2005;21(1):72–79.PubMedCrossRefGoogle Scholar
  34. 34.
    Dean CM, Richards CL, Malouin F. Walking speed over 10 metres overestimates locomotor capacity after stroke. Clin Rehabil. 2001;15(4):415–421.PubMedCrossRefGoogle Scholar
  35. 35.
    Ezzati TM, Massey J, Waksberg J, Chu A, Maurer K. Sample design: Third national health and nutrition examination survey. Vital and health statistics.Series 2, Data evaluation and methods research. 1992(113):1–35.Google Scholar

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Justin C. Brown
    • 1
    • 3
  • Michael O. Harhay
    • 1
    • 3
  • Meera N. Harhay
    • 1
    • 2
    • 3
  1. 1.Center for Clinical Epidemiology & BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Renal-Electrolyte and Hypertension DivisionUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.University of Pennsylvania School of MedicinePhiladelphiaUSA

Personalised recommendations