Measuring habitual walking speed of people with type 2 diabetes: are they meeting recommendations?

R evised physical activity guidelines for individuals with type 2 diabetes recommend at least 150 min/week of moderate-intensity aerobic physical activity (40–60% of VO2max or 50–70% of maximum heart rate) and/or 90 min/week of aerobic exercise ( 60% of VO2max or 70% of maximum heart rate) (1). In a structured exercise program or in the laboratory setting, levels of physical activity can be closely monitored; however, selfdirected walking is the most common and most acceptable form of physical activity (2,3) to people with type 2 diabetes, and little is known about self-paced walking speed (and therefore intensity). A walking speed of 4.0 km/h is widely accepted as moderately intense physical activity (4). Numerous studies examining the beneficial effects of physical activity for people with type 2 diabetes exist (rev. in 1,5). Few, however, have directly measured walking speed. Previous research (6,7) demonstrated efficacy in increasing physical activity of participants using the First Step Program (FSP), a pedometer-based, self-paced walking program designed to help people with type 2 diabetes increase their steps per day. Despite the increase in physical activity, improvements in health outcomes were modest. In contrast, the implementation of the FSP in a worksite setting involving healthy adults resulted in significant reductions in weight, BMI, waist girth, and resting heart rate (8). We hypothesize that a slower walking speed in the people with type 2 diabetes may contribute to the smaller improvements in health-related outcomes in this population. Therefore, the objective of this study was to determine self-paced walking speed and other characteristics of ambulation in a group of people with type 2 diabetes who had recently completed the FSP.