Structured walking programs that boost step rate may offer a simple, measurable way to enhance functional independence for older adults facing frailty.
Study: Walking cadence as a measure of activity intensity and impact on functional capacity for prefrail and frail older adults. Image Credit: fongbeerredhot / Shutterstock
In a recent article published in the journal PLOS One, researchers utilized data from a previous clinical trial to investigate whether prefrail or frail older adults could increase the number of steps they walk per minute as a result of an exercise intervention and whether this increase could improve their physical function.
Participants in the intervention group significantly increased their walking cadence compared to the casual walking group. Additionally, those who improved their cadence from their baseline comfortable pace had higher odds of meaningfully improving their walking performance, particularly when the increases occurred during the main intervention phase (Phase 3).
Background
Frailty is a clinical condition in older adults characterized by increased vulnerability to health stressors and a higher risk of adverse outcomes, such as disability and hospitalization.
Since four of the five frailty domains – slowness, weakness, exhaustion, low physical activity, and weight loss – relate to mobility, exercise is a key strategy to counteract functional decline.
Walking is an effective and accessible intervention for frail older adults. It improves cardiovascular and immune function, reduces disease risk, and may enhance aerobic capacity, which is often diminished in this group.
Exercise effectiveness is determined by its intensity, frequency, and duration, with intensity being the most challenging to measure reliably in older adults due to the effects of medication and subjective inaccuracies in common tools, such as heart rate monitoring or perceived exertion scales.
Walking cadence, defined as the number of steps per minute, offers a simple and objective measure of intensity. It can be tracked using accelerometers, including those found in smartphones, and has been shown to be associated with better mobility outcomes.
However, it is unclear whether frail or prefrail older adults can intentionally increase cadence during sustained walking interventions and whether doing so improves their functional capacity.
About the Study
This study was a secondary analysis of a randomized controlled trial conducted between 2017 and 2022 in 14 retirement communities located in the Chicago area.
Participants aged 60 and older who were prefrail or frail and able to walk at least 10 feet with no more than moderate assistance were randomly assigned to one of two walking programs: high-intensity walking (HIW) or casual speed walking (CSW).
The intervention lasted four months, with participants attending 48 sessions (three per week), each lasting 45 minutes.
Sessions progressed through three phases: acclimation, ramp-up, and the primary intervention. During Phase 2 (ramp-up), HIW participants were encouraged to reach 70% of their maximum heart rate, monitored by wearable devices. Throughout Phases 2 and 3, standardized motivational prompts were used for both groups. Cadence was tracked using thigh-worn accelerometers, which recorded the number of steps taken per minute during uninterrupted walking bouts of at least 1 minute in duration.
The primary outcome was a clinically meaningful improvement in the 6-minute walk test, defined as a gain of 30 meters or more, based on established thresholds for frail older adults.
Statistical analyses included participant-level linear and logistic mixed-effects models to evaluate differences in walking cadence and its association with functional improvement across intervention phases.
Key Findings
Out of 215 individuals screened, 102 prefrail or frail older adults completed the study and were included in the analysis, comprising 56 participants in the CSW group and 46 in the HIW group.
Baseline characteristics were similar between groups, except for a higher proportion of women in the HIW group. No initial differences were observed in frailty levels or physical performance, including the 6-minute walk test.
Throughout the intervention, participants in the HIW group significantly increased their walking cadence compared to the CSW group, with the largest difference in Phase 3 (median 100 vs. 77 steps/minute).
While CSW participants took more breaks, the total duration of breaks was similar between groups. At follow-up, 65% of HIW participants, compared to 39% of CSW participants, showed clinically meaningful improvements in the walking test.
Participant-level regression models revealed that a 1-step/minute increase in cadence during Phase 3 was associated with approximately 11% higher odds (odds ratio [OR] 1.11) of achieving a meaningful improvement in walking distance.
The effect of group assignment on functional improvement became non-significant when cadence increases were accounted for, indicating that cadence fully mediated the observed improvements.
An increase of approximately 14 steps/minute from participants’ baseline comfortable walking pace (Phase 1) was associated with a 10% increase in the odds (OR 1.10) of achieving clinically meaningful improvement.
Conclusions
This study re-analyzed clinical trial data to explore if walking cadence can be increased and whether such changes predict improvements in walking performance.
Researchers found that prefrail and frail older adults can increase their walking cadence during supervised walking sessions and that doing so enhances functional capacity, measured by improvements in the walking test.
A rise in cadence from their comfortable baseline pace was linked to functional gains, supporting cadence as a practical and objective measure of walking intensity in older adults and demonstrating that increases in cadence mediate intervention effectiveness.
Key strengths include the use of thigh-worn accelerometers, which provide accurate step counts even at slow speeds, and the focus on individual changes rather than fixed cadence thresholds.
Limitations include possible selection bias, as motivated participants were recruited from retirement communities with baseline walking capacity below community norms (mean ~256 meters). The intervention’s success also depended on supervision and motivational prompting, which could limit generalizability to unsupervised settings.
The authors suggest that future research should investigate optimal cadence targets and the effectiveness of real-time feedback in maximizing functional gains.
Journal reference:
- Walking cadence as a measure of activity intensity and impact on functional capacity for prefrail and frail older adults. Rubin, D.S., Hung, A., Yamamoto, E., Hedeker, D., Conroy, D.E., Huisingh-Scheetz, M., Brach, J.S., Glynn, N.W., Danilovich, M.K. PLOS One (2025). DOI: 10.1371/journal.pone.0323759 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0323759