Journals of Gerontology: MEDICAL SCIENCES

Cite journal as: J Gerontol A Biol Sci Med Sci

doi:10.1093/gerona/glu146

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Walking Energetics, Fatigability, and Fatigue in Older

Adults: The Study of Energy and AgingPilot
Catherine A.Richardson,1 Nancy W.Glynn,2 Luigi G.Ferrucci,3 and Dawn C.Mackey1,4
1
Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.
Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh,
Pennsylvania.
3
San Francisco Coordinating Center, California Pacific Medical Center Research Institute.
4
California Pacific Medical Center, San Francisco.

Background. Slow gait speed increases morbidity and mortality in older adults. We examined how preferred gait
speed is associated with energetic requirements of walking, fatigability, and fatigue.
Methods. Older adults (n=36, 7089years) were categorized as slow or fast walkers based on median 400-m gait
speed. We measured VO2peak by graded treadmill exercise test and VO2 during 5-minute treadmill walking tests at standard (0.72 m/s) and preferred gait speeds. Fatigability was assessed with the Situational Fatigue Scale and the Borg rating
of perceived exertion at the end of walking tests. Fatigue was assessed by questionnaire.
Results. Preferred gait speed over 400 m (range: 0.751.58 m/s) averaged 1.34 m/s for fast walkers versus 1.05 m/s
for slow walkers (p < .001). VO2peak was 26% lower (18.5 vs 25.1ml/kg/min, p=.001) in slow walkers than fast walkers. To walk at 0.72 m/s, slow walkers used a larger percentage of VO2peak (59% vs 42%, p < .001). To walk at preferred
gait speed, slow walkers used more energy per unit distance (0.211 vs 0.186ml/kg/m, p=.047). Slow walkers reported
higher rating of perceived exertion during walking and greater overall fatigability on the Situational Fatigue Scale, but
no differences in fatigue.
Conclusions. Slow walking was associated with reduced aerobic capacity, greater energetic cost of walking, and
greater fatigability. Interventions to improve aerobic capacity or decrease energetic cost of walking may prevent slowing
of gait speed and promote mobility in older adults.
Key Words: Gait speedMobilityFatigueEpidemiologyEnergetics.
Received February 20, 2014; Accepted July 18, 2014
Decision Editor: Stephen Kritchevsky, PhD

obility is a key component of health across the

lifespan and is necessary for older adults to maintain
independent functioning and autonomy. Mobility limitation, defined as difficulty walking one-quarter mile or
climbing one flight of stairs, is reported by 30%40% of
adults aged 65years and older (1,2), and there is likely to
be a high degree of unrecognized mobility limitation (3)
because many older adults do not engage in regular volitional walking activity (4).
Gait speed is the most common marker of mobility (5).
Preferred gait speed slows with age (6,7), and slow preferred gait speed is a strong predictor of subsequent health
outcomes in older adults, including disability in activities
of daily living (8), mobility limitation and disability (8,9),
cardiovascular disease (9), hospitalizations and health care
service use (10), and mortality (9,11). However, the mechanisms underlying the development of age-related slow gait
speed are not well studied or understood, which hampers
disability prevention efforts for older adults.

One possibility is that slow gait speed develops as

an adaptive response to conserve energy and reduce the
fatigue associated with walking. As peak aerobic capacity
(VO2peak) declines with increasing age (12,13), the energetic requirements of walking at a given speed increase
relative to VO2peak, such that usual walking becomes more
intense. In turn, this may lead to higher levels of fatigue
associated with walking and compensatory slowing of preferred gait speed in order to reduce the energetic requirements of walking and levels of fatigue (14). Indeed, an
emerging body of evidence suggests that energy requirements during walking play a central role in the development
of mobility limitation in older adults (1518).
Fatigue refers to global self-reported tiredness, exhaustion, lack of energy, and weariness (19). Fatigue is associated with mortality (20), but it is challenging to assess how
fatigue influences physical function, including preferred
gait speed, because individuals likely modify their activities
to maintain feelings of fatigue within an acceptable range
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Address correspondence to Dawn C.Mackey, PhD, Department of Biomedical Physiology and Kinesiology, Simon
Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada. Email: dmackey@sfu.ca

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Richardson etal.

Methods
Study Participants
Community-dwelling men (n=21) and women (n=17)
aged 7089 years were recruited from the Pittsburgh,
Pennsylvania area for the Study of Energy and Aging Pilot
between March and May 2010. Individuals met the following criteria at telephone screening: able to walk without
assistance of a device or another person; able to get in/out
of bed and chairs and walk across a small room without difficulty; body weight less than or equal to 285 lbs for men,
less than or equal to 250 lbs for women; and body mass
index 2032kg/m2. They reported no history of medical
conditions that might alter gait or ability to safely complete treadmill walking tests: hip fracture; stroke in past
12 months; cerebral hemorrhage in past 6 months; heart
attack, angioplasty, or heart surgery in past 3months; chest
pain during walking in past 30days; current treatment for
shortness of breath or a lung condition; usual aching, stiffness, or pain in their lower limbs and joints; and bilateral difficulty bending or straightening the knees fully. They had to
be willing and able to undergo a skeletal muscle biopsy and
a magnetic resonance scan. The study was approved by the
Institutional Review Boards at the University of Pittsburgh
and the California Pacific Medical Center. All participants
provided written informed consent. To be included in the
analysis dataset, participants had to complete a standard
speed (0.72 m/s) treadmill walking test (n=36).
Preferred GaitSpeed
Participants completed a 400-m overground walk by
walking 10 times around a 40-m course following the
instruction to walk at your usual pace without overexerting
yourself (22). Time to completion and rating of perceived
exertion (RPE) on the Borg scale (620) were recorded
upon completion; speed (m/s) was calculated. Participants
also completed two 6-m walk trials as part of a modified
Short Physical Performance Battery (SPPB) (23).
We divided participants into fast and slow walkers based
on median 400-m walk speed (1.19 m/s) to ensure adequate

sample sizes in both groups. A gait speed of 1.19 m/s is

similar to previously published reference values for preferred walking speed in older men and women between 70
and 89 years (24,25). Speed over 400 m may be a more
accurate reflection of preferred gait speed than speed over 6
m because it incorporates the time required to make appropriate stride length and frequency adjustments to settle into
a sustainable speed.
Peak O2 Consumption, VO2peak
VO2peak was determined by a modified Balke graded
treadmill exercise test (26). Major exclusion criteria were
ascertained during telephone screening. Participants
also had to have blood pressure less than or equal to
180/110mmHg, resting heart rate less than or equal to 110
bpm, and no evidence of cardiac arrhythmias during resting
12-lead electrocardiogram conducted prior to the VO2peak
test. To ensure participant safety during the VO2peak test,
the electrocardiogram was monitored continuously, and
blood pressure was measured every 2 minutes.
During the VO2peak test, walking speed was held constant at the participants fastest measured speed from the
two 6-m walk trials from the SPPB. Treadmill grade began
at 0% and was increased thereafter by 2% every 2 minutes
until attainment of VO2peak. Expired air was collected to
determine oxygen consumption (VO2) and carbon dioxide
production (VCO2) via indirect calorimetry (Moxus, AEI
Technologies, Pittsburgh, PA); data were saved as 20-second averages. VO2peak was defined as the highest 20-second average VO2 during the test and expressed as ml/kg/
min.
The VO2peak test was symptom limited and followed criteria outlined in the American College of Sports Medicine
guidelines (26), including strong encouragement to achieve
a respiratory exchange ratio greater than 1.05 and a Borg
RPE greater than 16. The test was terminated upon participant report of volitional fatigue.
O2 Consumption During Walking
Participants walked on a treadmill for 5 minutes at a
standard speed of 0.72 m/s, rested for 5 minutes, and then
walked on the treadmill for another 5 minutes at their preferred gait speed (measured from the fastest 6-m walk trial
from the SPPB). The standard speed (0.72 m/s) was chosen
because it was slow enough to minimize participant exclusion but not uncomfortably slow. VO2 (ml/kg/min) was
measured as described previously; values from the first 3
minutes of each test were discarded to allow time for participants to adjust to the workload and reach stable oxygen
consumption, and then values from the final 2 minutes were
averaged.
Oxygen consumption during treadmill walking at 0.72
m/s and at preferred gait speed were expressed in ml/kg/min
and divided by walking speed to determine the energetic

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(14,19). Therefore, two individuals may report similar levels of fatigue when the work performed to induce the fatigue
is vastly different. To overcome this measurement issue of
self pacing, the construct of fatigability was introduced as
the degree of fatigue experienced during performance of a
defined activity, which normalizes fatigue to activity level
(19). Studies are beginning to show that higher levels of fatigability are associated with worse physical function (21).
Accordingly, the objectives of this study were to test the
hypotheses that (i) slower preferred gait speed is associated with higher energetic requirements during walking and
higher levels of fatigability and (ii) preferred gait speed is
not associated with fatigue.

Walking Energetics and Fatigability

cost of walking per unit distance (Cw, ml/kg/m). They were

also expressed relative to VO2peak (%).

Other Measures
Weight (kg) was measured with a standard balance beam
scale and height (cm) with a Harpenden Stadiometer; body
mass index was calculated (kg/ m2). Race, smoking status,
mobility impairment, and self-rated health were reported
through clinic interview. Depressive symptoms were
measured with the short form Center for Epidemiological
Studies Depression Scale (29), and cognitive function
was measured with the Teng Modified Mini-Mental State
(3MS) Examination. Physical activity was assessed using
the Physical Activity Scale for the Elderly (30). Physical
function was evaluated using the SPPB. One repetition
maximum leg extensor strength (lbs air pressure) and overall leg extensor power (Watts) were measured on a Keiser
leg extension machine. Participants were asked to report
physician-diagnosed medical conditions.
Statistical Analyses
Data were summarized as mean (SD) or N (%) for normally distributed variables and median (interquartile range)

for skewed variables. Participants were divided into slow

and fast walkers based on median preferred gait speed from
the 400-m walk (1.19 m/s). Differences between fast and
slow walkers were compared using independent samples
t-tests, nonparametric MannWhitney U-tests, and chisquare tests. Pearson correlation coefficients were used to
examine linear associations between preferred gait speed
and measures of oxygen consumption and fatigability.
Stepwise linear regression was used to examine energetic
determinants of preferred gait speed. All analyses were performed using an alpha of 0.05 for statistical significance;
we did not perform Bonferroni or other corrections for multiple comparisons due to the pilot and exploratory nature of
the study. All statistical analyses were performed in SPSS
(version 19.0; Chicago, IL).
Results
Preferred gait speed on the 400-m walk ranged from 0.75
to 1.58 m/s; mean [SD] preferred gait speed was 1.34 [0.12]
m/s for fast walkers and 1.05 [0.13] m/s for slow walkers.
Compared with fast walkers, slow walkers were older and
had lower SPPB and Physical Activity Scale for the Elderly
scores (Table1). There were no differences between slow
and fast walkers for other descriptive characteristics.
VO2peak was 26.3% lower among slow walkers than
fast walkers (18.5 [4.9] vs 25.1 [5.1] ml/kg/min, p=.001)
(Table2). At the standard gait speed of 0.72 m/s, VO2 was
not significantly different between slow and fast walkers, but slow walkers used a larger percentage of VO2peak
(58.9% [12.8] vs 41.8% [11.2], p < .001). At preferred gait
speed, VO2 was not significantly different between slow
and fast walkers, but there was a trend toward slow walkers using a larger percentage of VO2peak (68.8% [18.1]
vs 58.5% [16.2], p=.095), despite their slower gait speed
(1.08 [0.17] vs 1.32 [0.16] m/s, p < .001). The energetic cost
of walking (Cw), which normalizes VO2 for gait speed, was
higher among slow walkers than fast walkers at preferred
gait speed (0.211 [0.1690.229] vs 0.186 [0.1670.200] ml/
kg/m, p=.047).
Fatigability was greater among slow walkers (Table 2).
Slow walkers had higher summary scores on the SFS (14.7
[7.6] vs 9.4 [7.2], p=.042) and reported higher levels of
perceived fatigue for walking for 1 hour (1.5 [03] vs 0
[01], p = .019). Slow walkers also reported higher RPE
while walking at 0.72 m/s (10.0 [9.011.0] vs 8.5 [7.09.3],
p = .049) and at preferred gait speed (12.6 [1.9] vs 10.8
[1.9], p=.014).
There were no differences between slow and fast
walkers on any measures of global fatigue (p > .2 for all
comparisons).
Preferred gait speed (from the 400-m walk) was moderately to strongly correlated with VO2peak (r=.666, p <
.001), VO2 at preferred gait speed (r=.454, p < .001), the SFS
summary score (r=.397, p=.017), and perceived fatigue

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Fatigue and Fatigability

To measure global perceived fatigue, participants were
asked four questions from the Physical Energy Scale from
the Motivation and Energy Inventory (27) during the clinic
interview. They were asked to consider the past 4 weeks
and rate how much time they felt physically tired during
the day, exhausted, and energetic (0=all of the time
to 6=none of the time). They were asked how often they
ran out of energy before the end of the day (0=every
or nearly every day to 5 = never). Part way through
the Study of Energy and Aging Pilot, an additional set of
fatigue questions were added in which participants (n=24)
were asked if they had been feeling unusually tired during the past month, as well as to rate how often they felt
weak, sleepy, lively, and tired (0=not at all to
10 = very). Participants also rated their overall energy
level during the past month (0=no energy to 10=most
energy you have ever had).
Fatigability, a phenotype that normalizes fatigue to activity level (19), was assessed during the clinic interview with
the Situational Fatigue Scale (SFS), which measured mental
and physical fatigue in relation to situational demands of 13
items; individual items were scored from 0=no fatigue at
all to 5=extreme fatigue, and item scores were summed
to yield a total SFS score ranging from 0 to 65 (28). We also
separately examined the item score for the activity of taking a walk for 1 hour. RPE at the end of the 400 m, standard speed treadmill, and preferred speed treadmill walks
were also considered fatigability measures (21).

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Richardson etal.

Table1. Baseline Characteristics of SEA Pilot Participants

Total Sample(N = 36)

Fast Walkers(N = 18)

78.4 (5.0)
20 (55.6)
34 (94.4)
71.5 (12.2)
1.66 (0.10)
25.7 (2.7)
353 (86)
328 (133)

80.3 (4.6)
11 (61.1)
17 (94.4)
74.8 (13.8)
1.67 (0.10)
26.6 (2.9)
346 (65)
321 (115)

76.4 (4.8)
9 (50.0)
17 (94.4)
68.1 (9.8)
1.65 (0.11)
24.9 (2.1)
361 (104)
336 (153)

8 (22.2)
16 (44.4)
12 (33.3)

3 (16.7)
6 (33.3)
9 (50.0)

5 (27.8)
10 (55.6)
3 (16.7)

3 (8.3)
2 (5.6)
2 (5.6)
10 (27.8)
5 (13.9)
19 (52.8)
7 (19.4)
95.5 (92.097.0)
135 (55)
11.5 (1012)
1.20 (0.20)
1.20 (0.19)
2 (5.6)
34 (94.4)
25 (69.4)
11 (30.6)

2 (11.1)
1 (5.6)
1 (5.6)
6 (33.3)
3 (16.7)
11 (61.1)
5 (27.8)
95 (93.597.0)
111 (45)
10 (912)
1.08 (0.17)
1.05 (0.13)
1 (5.6)
16 (88.9)
13 (72.2)
5 (27.8)

1 (5.6)
1 (5.6)
1 (5.6)
4 (22.2)
2 (11.1)
8 (44.4)
2 (11.1)
96 (90.898.3)
159 (55)
12 (1112)
1.32 (0.16)
1.34 (0.12)
1 (5.6)
18 (100.0)

p Value
.017
.502
.000
.104
.559
.060
.621
.734
.105

.546
1.000
1.000
.457
.630
.317
.206
.455
.006
.002
<.001
<.001
1.000
.146
.717

12 (66.7)
6 (33.3)

Notes: Continuous variables reported as mean (SD), p values from independent samples t-tests, unless otherwise indicated. Categorical variables reported as N
(%), p values from chi-square tests. Data missing for N = 1 fast walker for leg extensor power. CES-D = Center for Epidemiologic Studies Depression Scale; COPD
= chronic obstructive pulmonary disease; MMSE = Mini-Mental State Examination; PASE = Physical Activity Scale for the Elderly; SEA=Study of Energy and
Aging; SPPB = Short Physical Performance Battery.
*Reported as median (interquartile range), p values from MannWhitney U-tests. Mobility impairment: unable to walk 1/4 mile (34 blocks) outside on level
ground or walk up 10 stairs.

associated with walking for one hour (r=.357, p=.033)

(Figure1). The stepwise linear regression analyses considered the following candidate determinants of preferred gait
speed: age, leg extensor one repetition maximum, Physical
Activity Scale for the Elderly score, VO2peak, VO2 at preferred gait speed, VO2 at 0.72 m/s relative to VO2peak, RPE
during preferred speed and standard speed treadmill tests,
the SFS summary score, and perceived fatigue for walking
for 1 hour. The final model included terms for VO2peak (p
< .001) and VO2 at preferred gait speed (p=.033), which
together explained 53% of the variability in preferred gait
speed (Table3).
Discussion
Among 70- to 89-year-old adults, we found that slow
walkers had reduced aerobic capacity compared with fast
walkers, reflected by lower VO2peak values. As a consequence, the physiologic effort of walking was higher
in slow walkers than fast walkers. Specifically, slow
walkers used 59% of their VO2peak to walk at the slow

speed of 0.72 m/s, whereas fast walkers used only 42%

of their VO2peak. To walk at their preferred gait speed,
slow walkers used 69% of their VO2peak and fast walkers
used 59% of their VO2peak, demonstrating that preferred
speed walking required a significant physiologic effort,
especially for slow walkers. For comparison, young
adults, regardless of fitness, consistently use 55% of their
VO2peak to walk at a rapid pace (31). Thus, preferred
speed walking for older adults requires greater effort than
rapid speed walking for young adults. Our results corroborate those reported by Fiser and colleagues, who studied
walking intensity in 60- to 88-year-old adults (15), and
Schrack and colleagues, who studied walking energetics
in 33- to 94-year-old adults in the Baltimore Longitudinal
Study of Aging (32).
A novel finding is that higher rates of energy expenditure
during walking were accompanied by greater fatigability.
Slow walkers reported higher RPE levels when walking at
0.72 m/s and at preferred gait speed, and greater overall
fatigability on the SFS, indicating that they tire more easily

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Age (y)
Men, N (%)
White, N (%)
Weight (kg)
Height (m)
Body mass index (kg/m2)
Leg extensor 1 repetition maximum (lbs)
Leg extensor power (Watts)
Medical conditions, N (%)
None
1
2+
Medical history, N (%)
Myocardial infarction
Congestive heart failure
COPD, asthma, emphysema or bronchitis
Osteoarthritis
Depression
Cancer
Depressed, CES-D score > 10, N (%)
Teng MMSE score (/100)*
PASE score
SPPB (/12)*
SPPB 6-m preferred gait speed (m/s)
400-m gait speed (m/s)
Mobility impairment, N (%)
Excellent/good self-rated health, N (%)
Smoking status, N (%)
Never
Past

Slow Walkers(N = 18)

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Walking Energetics and Fatigability

Table2. Walking Energetics and Fatigability for Slow and Fast Walkers
Fast Walkers
(N = 18)

p Value

18.5 (4.9)
17.3 (1.4)
2.6 (0.1)
10.9 (1.3)
58.9 (12.8)
13.4 (11.115.2)
68.8 (18.1)
0.211 (0.1690.229)

25.1 (5.1)
17.8 (1.8)
2.7 (0.1)
10.1 (2.1)
41.8 (11.2)
14.3 (12.117.0)
58.5 (16.2)
0.186 (0.1670.200)

.001
.666
.015
.188
<.001
.159
.095
.047

14.7 (7.6)
1.5 (03)
10.0 (9.011.0)
12.6 (1.9)
10.8 (2.2)

9.4 (7.2)
0 (01)
8.5 (79.3)
10.8 (1.9)
9.6 (1.8)

.042
.019
.049
.014
.066

Notes: Continuous variables reported as mean (SD), p values from independent t-tests, unless otherwise indicated. Categorical variables reported as N (%), p
values from chi-square tests. Among slow walkers, data missing from N=1 for VO2peak and associated variables; N=1 was found to be an outlier for VO2 at 0.72 m/s
and was excluded from this and associated variables. Data missing from N=3 for VO2 at preferred gait speed and associated variables. Data missing from N=1 for
RPE at 0.72 m/s, from N=4 for RPE at end of preferred gait speed test. Among fast walkers, data missing from N=2 for VO2 at preferred gait speed and associated
variables. Cw=energetic cost of walking; RPE=rating of perceived exertion; RMR=resting metabolic rate.
*Reported as median (interquartile range), p values from MannWhitney U-tests.

Figure1. Associations between preferred 400-m gait speed, walking energetics, and fatigability. Regression lines are shown as dashed lines.

during daily tasks than fast walkers, including walking

for 1 hour. This suggests that fatigability increases as the
energy requirements of walking approach ones energetic

capacity. Interestingly, there were no differences in measures of global fatigue between slow and fast walkers. The
phenotype of fatigability was introduced recently (19) to

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Measures of walking energetics

VO2peak (ml/kg/min)
RPE at VO2peak
RMR (ml/kg/min)
VO2 at 0.72 m/s (ml/kg/min)
VO2 at 0.72 m/s relative to VO2peak (%)
VO2 at preferred gait speed (ml/kg/min)*
VO2 at preferred gait speed relative to VO2peak (%)
Cw at preferred gait speed (ml/kg/m)*
Measures of fatigability
Situational Fatigue Scale (SFS) total (13 items)
Fatigue while walking 1 h (05)*
RPE at 0.72 m/s*
RPE at preferred gait speed
RPE at end of 400-m walk

Slow Walkers
(N = 18)

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Richardson etal.

Table3. Parameter Estimates From Stepwise Linear Regression

Model to Predict Preferred Gait Speed
Variable
Intercept
VO2peak (ml/kg/min)
VO2 at preferred gait speed (ml/kg/min)

Coefficient ()

SE

p Value

0.596
0.018
0.017

0.115
0.004
0.008

<.001
<.001
.033

normalize fatigue to activity level, and our results show, for

the first time, that measures of fatigability are more strongly
associated with gait speed in older adults than global measures of fatigue. RPE during walking, which combines a
self-reported measure of exertion with an objective measure
of physical work, appears to be a simple and useful measure of fatigability (21). Others have measured fatigability
as the degree of reported fatigue following performance of
standardized lab-based tasks that simulate common activities of daily living such as sweeping and grocery shopping
(33), the degree of performance deterioration during standard tasks (21,34), and the degree of tiredness reported after
completion of standardized walks (34). These studies have
shown fatigability is correlated with physical activity, physical function deficits including gait speed, and self-reported
fatigue. Although the health outcomes associated with high
levels of fatigue in older adults are well established (35),
future research is needed to evaluate whether high levels of
fatigability are also predictive of health outcomes, including incident mobility limitation, mobility disability, and
mortality.
The energetic cost of walking (Cw, ml/kg/m), which normalizes VO2 to gait speed, has a well-established U-shaped
relationship with gait speed, with maximum economy or
minimum energetic cost falling anywhere between 1.1 and
1.3 m/s (36,37). Mean preferred gait speeds of slow and
fast walkers in our study were consistent with this range;
nevertheless, we found Cw was elevated among slow walkers compared with fast walkers, indicating that the energy
expenditure required to cover a given distance is greater
for slow walkers. This has important implications for daily
mobility, as higher energy costs may limit the amount and
extent of daily movement. Future research should examine
the relationship between Cw and mobility limitation in older
adults.
Slowing of gait speed is a hallmark of the aging process, but the mechanisms underlying age-related slowing of gait speed are still poorly understood. Our results
provide support for the hypothesis that age-related slow
gait speed develops as an adaptive response to conserve
energy and thereby manage the effort of walking and
reduce fatigue associated with walking. This hypothesis

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Notes: Model R2 = .53. Other candidate determinant variables (age, leg

extensor one repetition maximum, Physical Activity Scale for the Elderly score,
VO2 at 0.72 m/s relative to VO2peak, rating of perceived exertion during preferred speed and standard speed treadmill tests, the Situational Fatigue Scale
summary score, and perceived fatigue for walking for one hour) were excluded
by the stepwise procedure at p .10.

was first introduced by Schrack and colleagues (17), and

they later provided empirical evidence to support it by
demonstrating that energy expenditure per minute was
constant among adults aged 3296 years, whereas gait
speed declined substantially with increasing age (32). In
addition, Willis and coworkers showed that young adults
select a preferred walking speed in which perceived exertion is close to minimal (38). Our results suggest that the
adaptation may be incomplete in older adults, as slow
walkers still experienced higher intensities of walking
and fatigability than fast walkers. Although slow and
fast walkers had similar absolute levels of VO2 during
standard and preferred speed walking tests, slow walkers experienced higher levels of physiologic effort due to
reduced VO2peak and increased energeticcost.
The results of our correlation and linear regression analyses showed that preferred gait speed was independently
associated with VO2peak and VO2 at preferred gait speed.
If slow walking speed and increased fatigability develop as
a consequence of deteriorating aerobic capacity, then interventions could focus on increasing VO2peak and making a
larger reserve of energy available. Alternatively, interventions could reduce the energetic cost of walking (18), which
would also reduce the physiologic effort associated with
walking.
This study has limitations. It was cross-sectional and
involved a small sample size. Alarger prospective study
is needed to determine whether measures of walking
energetics are associated with the onset of declines in
preferred walking speed, mobility limitation, and disability and to extend the current findings to older adults
with a wider range of physical function; our participants
were quite high functioning based on SPPB scores and
gait speed. For instance, mean preferred gait speed among
slow walkers (1.05 m/s) was faster than commonly used
clinical cutpoints for slow walking such as 1.0 m/s. We
hypothesize results will be exacerbated in a more representative population with lower functioning older adults.
With the small sample size, we observed some nonsignificant trends in baseline characteristics between slow and
fast walkers (eg, body mass index, number of medical conditions) that would likely be significant in a larger study.
Also, the standard speed used in this study, 0.72 m/s, was
quite slow; we expect that a faster standard speed would
have elicited differences in VO2, given that the energetic
cost of walking at preferred gait speed was elevated
among slow walkers. To minimize participant burden, we
measured preferred overground gait speed during a 6-m
walk and used this as preferred speed on the treadmill;
however, preferred overground and preferred treadmill
speeds sometimes differ (39), which some (39) but not all
(40) have attributed to differences in gait kinematics and
kinetics. When speed is held constant, oxygen consumption during treadmill walking may be higher than during
overground walking (40). Although we did not directly

Walking Energetics and Fatigability

Funding
This work was supported by the National Institute on Aging at the
National Institutes of Health (1RC2AG036594).
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measure energy requirements of overground walking,

our approach of using preferred overground speed during
treadmill walking tests likely provided a better simulation
of the energetic requirements of overground walking than
using preferred treadmill speed (39). Furthermore, we
expect similar, and perhaps stronger, relationships would
be observed with overground walking as with treadmill
walking.
In summary, we observed that slow walkers had reduced
VO2peak and a greater energetic cost of walking. As a result,
the effort associated with walking was higher among slow
walkers than fast walkers, and slow walkers experienced
greater fatigability than fast walkers. Interventions that
improve aerobic capacity or decrease the energetic cost of
walking in older adults may prevent slowing of gait speed
and promote mobility.

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