Walking and Mobility

Walking is the sixth vital sign. Here’s how to do it right.
Mobility is key to staying healthy and independent as you age. We asked experts to weigh in on how to do it right—and when to start thinking about it.

Walking might seem simple. But it’s not, explains epidemiologist Peggy Cawthon, science director of the California Pacific Medical Center Research Institute. It’s an amazingly complex behavior that continues to baffle researchers, especially ones trying to understand how to improve our lives as we age.

“For reasons we don’t understand, the speed you walk is related to your risk of dying,” she says. Folks who can keep up the pace are likely to stick around longer.

And they’re likely to live better. Lack of mobility is one of the top reasons that seniors lose independence, according to the National Institute on Aging, and it’s also closely linked to cognitive decline.

Over the past decade, gait speed has emerged as the sixth vital sign, since it can predict a huge range of health problems. “Walking involves every system of the body,” adds Jessie VanSwearingen, professor of physical therapy at the University of Pittsburgh. Even if doctors haven’t noticed anything amiss, changes in someone’s walking could be a tipoff that a diagnosis isn’t far behind.


According to the National Institutes of Health, there are four types of exercises we should all be getting to help us stay active: endurance, strength, balance, and flexibility. That’s just the start of the equation. “I’m in the camp that exercise is important, but it’s not the elixir that solves all problems. No one thing will save you,” Cawthon says.

There’s also a lot left to learn about how the brain influences it all, notes On-Yee (Amy) Lo, of the Hebrew SeniorLife Marcus Institute for Aging Research and an Assistant Professor at Harvard Medical School and Beth Israel Deaconess Medical Center. She has seen plenty of patients with perfectly functioning muscles. “But when you tell them to move, they can’t,” she says.

So what, um, steps should we take to protect our mobility—especially as we get farther away from those toddler years? Here are a few ideas:

Don’t stop moving

Experts agree that pretty much the worst thing a person can do is to stop moving. You’ll feel the effects almost immediately, says Pete McCall, director of education for EōS Fitness and author of Smarter Recovery: A Practical Guide to Maximizing Training Results. Sitting for hours leaves him sore, and it’s the days when he uses his hands that his arthritis doesn’t bother him as much. These are helpful reminders that our bodies demand action.

“But I don’t need to crush myself at every workout,” says McCall, who shared his quick go-to routine for limbering up his spine, hips, and ankles on the American Council on Exercise website. “It’s almost like brushing my teeth. If I don’t do it for a day or two, I notice,” he says. He uses the moves—which include hip circles and getting down on one knee, and then reaching with the opposite arm to twist the upper body—before or after a workout, or as an active recovery day.

If that sounds too complicated, McCall’s suggestion is to follow the advice he gives his 80-year-old dad. “I yell at him to walk and do yoga,” he says, noting that poses such as cat-cow and the warrior series force you to pay attention to your spine.

Even if you’re injured, try to find something active that works for you, like swimming or biking. “The magic is whatever exercise people can do,” Lo says. In her case, as a working mom of a four-year-old, that’s usually chasing her kid around.

Curious about pickleball? Or taking up ballroom dancing? Don’t be afraid of learning new skills, says Jennifer Brach, professor of physical therapy at the University of Pittsburgh. “Find the program you enjoy, so you stick with it.”

Train yourself to walk with good technique

To truly improve your walking once it starts to decline, however, you need to think like an athlete. Imagine you want to play tennis, but you have a bad backhand. Playing lots of tennis won’t fix the problem, VanSwearingen says. You need to improve your technique. It’s the same thing with walking.

A treadmill can coach you on how it’s done. “It drags your foot behind you and makes you take a step,” she says. It also makes it easy to experiment with different speeds to find what is most comfortable. For most of the population, that is about 1.3 meters per second, or about three miles per hour, VanSwearingen says. To practice adaptability, she suggests occasionally bumping up your speed by 10 percent for a minute.

No matter what surface you’re strolling on, VanSwearingen offers this suggestion: “Walk from your feet.” Rather than thinking about picking up a foot and placing it in front of you, use your feet to provide propulsion and push the ground away. And don’t look down, unless you want to fall. “The brain assumes you want to go where you’re looking,” she adds.

This approach to walking is the basis of On the Move, a 12-week-long course developed at the University of Pittsburgh. Rather than focusing on strength and endurance—the typical targets for a fitness class—it emphasizes timing and coordination. “We use the analogy of cars. Instead of giving someone a bigger engine, our program is tuning up the system so it runs more efficiently,” Brach says. “When you’re more efficient, you can do more.”

For example, she explains, to initiate walking, you must subtly shift your weight back and to the side. “Many of our exercises start with a step back, so when you get that weight on the back foot, you can push off to step forward,” Brach says. Using these strategies to be become a better walker can lead to additional benefits like weight loss and lower blood pressure.

Give your brain a boost

Ultimately, the body part in charge of everything is your brain. So don’t forget that when crafting your mobility preservation plan. Cawthon points to the power of tai chi, which has been shown to improve balance and reduce the risk of falls. Scientists are investigating whether that’s because of the physical aspect of the practice or its cognitive demands, which include learning a specific sequence of movements.

A recent study published in the Annals of Internal Medicine touted the beneficial effects of “cognitively-enhanced” tai chi. Participants who did extra mental gymnastics—like spelling a word backward and forward as they moved through each pose—performed better on a mental cognition test than folks who did standard tai chi or stretching exercises.


Finding ways to protect against dementia is a big deal, says Lo, who notes that half of people with dementia experience falls, compared to 30 percent of the general older population. But a variety of promising interventions could help boost mobility, including non-invasive brain stimulation.

Many seniors know—but don’t follow—recommended physical activity guidelines, Lo explains. So she has been studying what happens when behavioral counseling is paired with a few zaps of electric current targeting an area of the brain related to motivation and executive function. Participants with the stimulation walked more steps on average than the control group, and they have been maintaining that even several months later, she says. Another study in the works will use brain stimulation to improve unsteady gait in older adults.

She’s also collaborating with music therapists to experiment with music stimulation. “Older adults with dementia or Parkinson's disease may not be able to initiate movement, but if you play music, they are able to follow it,” Lo says.

Start planning now

So when should we face the music about our mobility? There is no definitive answer for when walking problems begin to crop up. “You should be as active as you can be at any age,” Cawthon says, noting that people who are healthy in their 20s and 30s are best equipped to handle future age-related challenges. “The best time to start is now. Next best is tomorrow,” she says.

One key moment to consider mobility is when you’re deciding where to live. Are you moving into a single-story place or multi-story building? Is there an elevator? “It’s hard to imagine when you’re buying a house that you might want to put in a ramp,” Cawthon says. But a home that is conducive to mobility can make a huge difference in how comfortably you’re able to maneuver through your environment.


What’s outside is just as critical. “If you live in a neighborhood with nice sidewalks that are well maintained and has a low crime rate, you’re more inclined to get out and walk,” Brach says. Areas where it’s easy to run errands on foot also encourage seniors to stay mobile.

Van Swearingen recommends paying attention to how you feel and what you’re thinking about. Say, you need to get up from your chair and cross the room. Hopefully, that’s an idea that barely registers. But if you find yourself concentrating on how you’re going to accomplish that task, it’s a warning sign. “If those thoughts are on your mind, it’s time,” she says.