Work

Clinical Walking Speed, Free-Living Walking Cadence, and All-Cause Mortality

Year: 2026

Type: article

Abstract: Importance: Walking speed has been shown to be associated with mortality and is conventionally obtained from short walking tests in clinical settings. Free-living walking parameters such as walking cadence can be derived from accelerometers. Objective: To examine whether walking parameters measured in clinical and free-living settings are associated with comparable discriminative ability for all-cause mortality risk. Design, Setting, and Participants: This population-based cohort study, the Whitehall II accelerometer substudy in the UK, included a baseline from January 2012 to December 2013 and follow-up through August 19, 2024. The study included participants with valid accelerometer data, clinical walking speed, covariates, and electronic health records information. Analyses were performed between September 2025 and February 2026. Exposures: Clinical walking speed in meters per second was obtained from a 2.44-m walking test, and 2 free-living metrics of walking cadence in steps per minute (the median walking cadence and the 95th percentile walking cadence) were derived from 9 days of wrist-worn accelerometer data. Main Outcomes and Measures: All-cause mortality was ascertained from a British national mortality register. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) for all-cause mortality. Discriminative ability was assessed using the Harrel concordance index (C index). Results: A total of 4067 participants (mean [SD] age, 69.3 [5.7] years; 3024 males [74.4%]) were included in the analysis. The median (IQR) follow-up was 11.8 (11.5-12.1) years. In models containing mortality risk factors (sociodemographic, behavioral, and health-related factors), higher clinical walking speed (HR, 0.77 [95% CI, 0.71-0.84]), median walking cadence (HR, 0.83 [95% CI, 0.77-0.90]), and 95th percentile walking cadence (HR, 0.82 [95% CI, 0.75-0.89]) were associated with lower all-cause mortality risk (per 1 higher SD) and with a similar discriminative ability (clinical walking speed: C index, 0.747 [95% CI, 0.730-0.764]; median walking cadence: C index, 0.744 [95% CI, 0.726-0.761]; and 95th percentile walking cadence: C index, 0.745 [95% CI, 0.727-0.762]). Only clinical walking speed was associated with an improved discriminative ability of a model including mortality risk factors. Conclusions and Relevance: In this cohort study, clinical walking speed and free-living walking cadence were both associated with all-cause mortality risk and had a similar discriminative ability for all-cause mortality. These results suggest that both measures can be used in population-based studies, and the choice between the 2 methods may depend on research objectives, implementation constraints, and the strengths of each method.

Source: JAMA Network Open

DOI: 10.1001/jamanetworkopen.2026.40122