Walking and Health Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Longitudinal Studies

Abstract

Objective: We systematically reviewed evidence on the association between habitual walking (regular, non-prescribed walking as part of daily living quantified by duration, distance, step count, frequency and/or volume) and health outcomes among community-dwelling older adults. Data Source: MEDLINE, Embase, Global Health, and Psych Info databases; searched from inception to 5th September 2025. Study Inclusion and Exclusion Criteria: Prospective cohort studies on habitual walking and health outcomes among older adults (65+ years) published in English were included. Data extraction and synthesis: Quality of studies was assessed using the risk of bias in non-randomised studies of exposure (ROBINS-E) tool. A meta-analysis (random effects model) examined the association between daily step count and all-cause mortality. Results: Of 25 175 records identified, 46 studies (367 843 older adults and 28 unique outcomes) were included. The pooled estimates of walking are based on 19 206 older adults. Older adults who performed an average of 5694 steps/day, had a 13% lower risk of all-cause mortality (HR: 0.87, 0.80-0.95) per additional 1000 steps/day. Benefits remained similar regardless of walking pace. Walking benefits were observed across mortality, disease onset, hospitalisation, cognitive, psychological and functional outcomes. Conclusion: Walking is a simple, accessible method of physical activity with minimal risk of injury, associated with a lower risk of multiple health outcomes. Public health campaigns and policies should advocate walking to promote healthier ageing.