Research Article| Volume 54, ISSUE 1, P10-19, January 2018

Download started.


Walking in Relation to Mortality in a Large Prospective Cohort of Older U.S. Adults

Published:October 19, 2017DOI:


      Engaging in >150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity weekly is recommended for optimal health. The relationship between walking, the most common activity especially for older adults, and total mortality is not well documented.


      Data from a large U.S. prospective cohort study including 62,178 men (mean age 70.7 years) and 77,077 women (mean age 68.9 years), among whom 24,688 men and 18,933 women died during 13 years of follow-up (1999–2012), were used to compute multivariable-adjusted hazard rate ratios and 95% CIs for walking as the sole form of activity or adjusted for other moderate- or vigorous-intensity physical activity in relation to total and cause-specific mortality (data analysis 2015–2016).


      Inactivity compared with walking only at less than recommended levels was associated with higher all-cause mortality (hazard rate ratio=1.26, 95% CI=1.21, 1.31). Meeting one to two times the recommendations through walking only was associated with lower all-cause mortality (hazard rate ratio=0.80, 95% CI=0.78, 0.83). Associations with walking adjusted for other moderate- or vigorous-intensity physical activity were similar to walking only. Walking was most strongly associated with respiratory disease mortality followed by cardiovascular disease mortality and then cancer mortality.


      In older adults, walking below minimum recommended levels is associated with lower all-cause mortality compared with inactivity. Walking at or above physical activity recommendations is associated with even greater decreased risk. Walking is simple, free, and does not require any training, and thus is an ideal activity for most Americans, especially as they age.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Leitzmann M.F.
        • Park Y.
        • Blair A.
        • et al.
        Physical activity recommendations and decreased risk of mortality.
        Arch Intern Med. 2007; 167: 2453-2460
        • Nocon M.
        • Hiemann T.
        • Muller-Riemenschneider F.
        • Thalau F.
        • Roll S.
        • Willich S.N.
        Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis.
        Eur J Cardiovasc Prev Rehabil. 2008; 15: 239-246
        • Paffenbarger Jr, R.S.
        • Hyde R.T.
        • Wing A.L.
        • Hsieh C.C.
        Physical activity, all-cause mortality, and longevity of college alumni.
        New Engl J Med. 1986; 314: 605-613
        • Blair S.
        • Morris J.
        Healthy hearts--and the universal benefits of being physically active: physical activity and health.
        Ann Epidemiol. 2009; 19: 253-256
        • Moore S.
        • Lee I.
        • Weiderpass E.
        • et al.
        Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults.
        JAMA Intern Med. 2016; 176: 816-825
        • Lee I.
        • Shiroma E.
        • Lobelo F.
        • et al.
        Impact of physical inactivity on the world’s major non-communicable diseases.
        Lancet. 2012; 380: 219-229
        • Carlson S.
        • Fulton J.
        • Pratt M.
        • Yang Z.
        • Adams E.
        Inadequate physical activity and health care expenditures in the United States.
        Prog Cardiovasc Dis. 2015; 57: 315-323
        • Ortman J.M.
        • Velkoff V.A.
        • Hogan H.
        An aging population: the older population in the United States. U.S..
        Census Bureau, 2014 (Accessed August 24, 2017)
        • Hoffman C.
        • Rice D.
        • Sung H.Y.
        Persons with chronic conditions. Their prevalence and costs.
        JAMA. 1996; 276: 1473-1479
        • Haskell W.L.
        • Lee I.M.
        • Pate R.R.
        • et al.
        Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1423-1434
        • Nelson M.E.
        • Rejeski W.J.
        • Blair S.N.
        • et al.
        Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.
        Circulation. 2007; 116: 1094-1105
      1. CDC/NCHS. National Health Interview Survey, Sample Adult Core Component. 2014.

        • U.S. DHHS
        Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities.
        U.S. DHHS, Office of the Surgeon General, Washington, DC2015
        • CDC
        Walking among adults in the United States, 2005 and 2010.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 595-601
        • Lee I.
        • Rexrode K.
        • Cook N.
        • Manson J.
        • Buring J.
        Physical activity and coronary heart disease in women: Is “No pain, no gain” passé?.
        JAMA. 2001; 285: 1447-1454
        • Jeon C.
        • Lokken R.
        • Hu F.
        • van Dam R.
        Physical activity of moderate intensity and risk of type 2 diabetes: a systematic review.
        Diabetes Care. 2007; 30: 744-752
        • Hildebrand J.
        • Gapstur S.
        • Campbell P.
        • Gaudet M.
        • Patel A.
        Recreational physical activity and leisure-time sitting in relation to postmenopausal breast cancer risk.
        Cancer Epidemiol Biomarkers Prev. 2013; 22: 1906-1912
        • Chao A.
        • Connell C.
        • Jacobs E.
        • et al.
        Amount, type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: the Cancer Prevention Study II Nutrition Cohort.
        Cancer Epidemiol Biomarkers Prev. 2004; 13: 2187-2195
        • Arem H.
        • Moore S.
        • Patel A.
        • et al.
        Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship.
        JAMA Intern Med. 2015; 175: 959-967
        • Kelly P.
        • Kahlmeier S.
        • Gotschi T.
        • et al.
        Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship.
        Int J Behav Nutr Phys Act. 2014; 11: 1-15
        • Samitz G.
        • Matthias E.
        • Zwahlen M.
        Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies.
        Int J Epidemiol. 2011; 40: 1382-1400
        • Woodcock J.
        • Franco O.
        • Orsini N.
        • Roberts I.
        Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies.
        Int J Epidemiol. 2011; 40: 121-138
        • Hamer M.
        • Chida Y.
        Walking and primary prevention: a meta-analysis of prospective cohort studies.
        Br J Sports Med. 2008; 42: 238-243
        • Smith T.C.
        • Wingard D.L.
        • Smith B.
        • Kritz-Silverstein D.
        • Barrett-Connor E.
        Walking provides strong protection from cardiovascular disease mortality in older adults with diabetes.
        J Clin Epidemiol. 2007; 60: 309-317
        • Bath P.A.
        • Morgan K.
        Customary physical activity and physical health outcomes in later life.
        Age Ageing. 1998; 27: 29-34
        • Hakim A.A.
        • Petrovitch H.
        • Burchfiel C.M.
        • et al.
        Effects of walking on mortality among nonsmoking retired men.
        N Engl J Med. 1998; 338: 94-99
        • LaCroix A.Z.
        • Leveille S.G.
        • Hecht J.A.
        • Grothaus L.C.
        • Wagner E.H.
        Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults?.
        J Am Geriatr Soc. 1996; 44: 113-120
        • Klenk J.
        • Dallmeier D.
        • Denkinger M.D.
        • et al.
        Objectively measured walking duration and sedentary behavior and four-year mortality in older people.
        PLoS One. 2016; 11: e0153779
        • Gregg E.W.
        • Cauley J.A.
        • Stone K.
        • et al.
        Relationship of changes in physical activity and mortality among older women.
        JAMA. 2003; 289: 2379-2386
        • Stessman J.
        • Maaravi Y.
        • Hammerman-Rozenberg R.
        • Cohen A.
        The effects of physical activity on mortality in the Jerusalem 70-year-olds Longitudinal Study.
        J Am Geriatr Soc. 2000; 48: 499-504
        • Bijnen F.C.
        • Caspersen C.J.
        • Feskens E.J.
        • Saris W.H.
        • Mosterd W.L.
        • Kromhout D.
        Physical activity and 10-year mortality from cardiovascular diseases and all causes: The Zutphen Elderly Study.
        Arch Intern Med. 1998; 158: 1499-1505
        • Calle E.E.
        • Rodriguez C.
        • Jacobs E.J.
        • et al.
        The American Cancer Society Cancer Prevention Study II Nutrition Cohort: rationale, study design, and baseline characteristics.
        Cancer. 2002; 94: 500-511
        • Garfinkel L.
        Selection, follow-up, and analysis in the American Cancer Society prospective studies.
        Natl Cancer Inst Monogr. 1985; 67: 49-52
        • Calle E.E.
        • Terrell D.
        Utility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II participants.
        Am J Epidemiol. 1993; 137: 235-241
        • WHO
        International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. 10th ed. WHO, Geneva1992
        • Ainsworth B.E.
        • Haskell W.L.
        • Whitt M.C.
        • et al.
        Compendium of physical activities: an update of activity codes and MET intensities.
        Med Sci Sports Exerc. 2000; 32: S498-S504
        • Willett W.
        • Sampson L.
        • Stampfer M.
        • et al.
        Reproducibility and validity of a semiquantitative food frequency questionnaire.
        Am J Epidemiol. 1985; 122: 51-65
        • Manson J.E.
        • Greenland P.
        • Lacroix A.Z.
        • et al.
        Walking compared with vigorous exercise for the prevention of cardiovascular events in women.
        New Engl J Med. 2002; 347: 716-725
        • Sattelmair J.
        • Petrtman J.
        • Ding E.
        • Kohl H.
        • Haskell W.
        • Lee I.
        Dose response between physical activity and risk of coronary heart disease: a meta-analysis.
        Circulation. 2011; 124: 789-795
        • Mayer-Davis E.
        • D’Agostino Jr, R.
        • Karter A.
        • et al.
        Intensity and amount of physical activity in relation to insulin sensitivity: The Insulin Resistance Atherosclerosis Study.
        JAMA. 1998; 279: 669-674
        • Williams P.
        Vigorous exercise, fitness, and incident hypertension, high cholesterol, and diabetes.
        Med Sci Sports Exerc. 2008; 40: 998-1006
        • Murtagh E.
        • Nichols L.
        • Mohammed M.
        • Holder R.
        • Nevill A.
        • Murphy M.
        The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials.
        Prev Med. 2015; 72: 34-43
        • Liu L.
        • Yun S.
        • Tingting L.
        • et al.
        Leisure time physical activity and cancer risk: evaluation of the WHO’s recommendation based on 126 high-quality epidemiological studies.
        Br J Sports Med. 2016; 50: 372-378
        • Ballard-Barbash R.
        • Friedenreich C.
        • Courneya K.
        • Siddiqi S.
        • McTiernan A.
        • Alfano C.
        Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review.
        J Natl Cancer Inst. 2012; 104: 815-840
        • Wolf A.M.
        • Hunter D.J.
        • Colditz G.A.
        • et al.
        Reproducibility and validity of a self-administered physical activity questionnaire.
        Int J Epidemiol. 1994; 23: 991-999
        • Liu B.
        • Hu X.
        • Zhang Q.
        • et al.
        Usual walking speed and all-cause mortality risk in older people: a systematic review and meta-analysis.
        Gait Posture. 2016; 44: 172-177
        • Conn V.
        Depressive symptom outcomes of physical activity interventions: meta-analysis findings.
        Ann Behav Med. 2010; 39: 128-138
        • Mummery K.
        • Schofield G.
        • Caperchione C.
        Physical activity dose-response effects on mental health status in older adults.
        Aust N Z J Public Health. 2004; 28: 188-192
        • Carvalho A.
        • Rea I.
        • Parimon T.
        • Cusack B.
        Physical activity and cognitive function in individuals over 60 years of age: a systematic review.
        Clin Interv Aging. 2014; 9: 661-682
        • Lacey B.
        • Golledge J.
        • Yeap B.
        • et al.
        Physical activity and vascular disease in a prospective cohort study of older men: The Health In MenStudy (HIMS).
        BMC Geriatr. 2015; 15: 164
        • Soares-Miranda L.
        • Siscovick D.
        • Psaty B.
        • Longstreth W.J.
        • Mozaffarian D.
        Physical activity and risk of coronary heart disease and stroke in older adults: The Cardiovascular Health Study.
        Circulation. 2016; 133: 147-155
        • Morris J.
        • Hardman A.
        Walking to health.
        Sports Med. 1997; 23: 306-332