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A 10-Week Community-Based Barefoot Walking Program: Mobility-Related Functional Outcomes and Selected Health Indicators in Older Adults — A Non-Randomized Controlled Study

This non-randomized controlled study found that a 10-week community-based barefoot walking program significantly improved mobility-related functional outcomes and selected anthropometric measures in older adults, though it did not yield significant changes in cardiometabolic indicators.

Original authors: Alchan Kim, Da Ae Kim, Minju Kim, Hyerang Yun, Muncheong Choi, Hong-Sun Song

Published 2026-10-09

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CC BY 4.0

Original authors: Alchan Kim, Da Ae Kim, Minju Kim, Hyerang Yun, Muncheong Choi, Hong-Sun Song

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

As people grow older, the goal of health shifts from simply avoiding illness to keeping the body capable of moving through the world. This concept, often called healthy aging, relies heavily on mobility—the ability to walk, balance, and perform daily tasks without assistance. While walking is a natural and accessible way to stay active, researchers have long wondered if the specific conditions of that walk matter. Does the surface beneath one's feet change how the body responds? For decades, scientists have known that removing shoes alters how a person walks, changing the way muscles fire and how the foot interacts with the ground. Yet, most studies on this topic have been short experiments in a lab, leaving a gap in our understanding of what happens when older adults engage in a sustained, real-world walking program without shoes.

In a rural area of South Korea, a team of researchers set out to fill this gap with a ten-week community program. They invited thirty adults, aged sixty to seventy-nine, to participate in a supervised walking routine. The participants were split into two groups based on their availability and willingness to join, rather than by random chance. One group walked barefoot on natural outdoor surfaces, while the other group continued their usual daily lives without any structured exercise. The barefoot walkers met three times a week under the guidance of exercise specialists. Their journey began on soft sand, which is gentle on the feet, and gradually progressed to a mix of sand and gravel as their bodies adapted over the ten weeks. Each session included a warm-up, thirty to forty minutes of walking, and a cool-down, with the intensity increasing slowly to ensure safety.

The results of this program showed a clear pattern of improvement in specific physical abilities, though not in every area of health. The most striking changes appeared in how well the participants could move and how their bodies were composed. The group that walked barefoot showed a significant boost in their functional aerobic endurance, which is a measure of how long they could keep stepping at a steady pace. In a test where they stepped up and down for two minutes, the barefoot walkers increased their repetitions from an average of about 113 to 126. In contrast, the control group, who did not change their habits, saw their performance drop slightly. Similarly, the barefoot group improved their lower-body strength, managing to stand up from a chair more times in thirty seconds than before, while the other group saw only a tiny, negligible change. They also became faster and more coordinated when walking in a figure-eight pattern around obstacles.

Beyond movement, the barefoot walking program influenced the participants' body composition in ways that the control group did not experience. The walking group saw a slight reduction in their body fat mass and the percentage of fat in their bodies, while the control group actually gained a small amount of fat over the same period. Perhaps most notably, the waist circumference of the barefoot walkers decreased, whereas the waistline of the control group expanded. These changes suggest that the specific demands of walking barefoot on uneven surfaces may help maintain a leaner body shape and better muscle function as people age.

However, the study did not find evidence that this type of walking improved the body's internal chemical markers or heart health indicators. Despite the physical improvements, there were no significant changes in blood pressure, blood sugar levels, or cholesterol readings for either group. The researchers noted that the program was relatively short, lasting only ten weeks, and that factors like diet and sleep were not strictly controlled, which might explain why these internal health markers remained unchanged. Furthermore, because the groups were not randomly assigned, the researchers could not definitively prove that the barefoot walking caused all the improvements, as the groups started with different ages and body sizes.

Ultimately, this study offers a glimpse into how a simple, accessible activity can support active aging. It suggests that walking barefoot on natural surfaces like sand and gravel can sharpen mobility, boost endurance, and help manage body fat in older adults. While it did not act as a cure-all for heart health or blood chemistry, the findings highlight that the way we move matters. For older adults looking to maintain their independence and physical capability, a structured program of walking on varied, natural ground appears to be a promising and practical tool, provided it is done safely and with proper supervision.

Technical Summary: A 10-Week Community-Based Barefoot Walking Program

Problem Statement
As global populations age, the focus of geriatric health has shifted from disease prevention to the preservation of functional ability, with mobility serving as a central component of healthy aging. While structured physical activity is known to support mobility, the specific impact of walking conditions—particularly barefoot walking on varied natural surfaces—remains unclear. Existing literature offers conflicting short-term data on how barefoot conditions affect gait mechanics and balance in older adults, and few studies have evaluated sustained, community-based barefoot walking programs. This study aimed to examine whether a 10-week supervised barefoot walking program could improve mobility-related functional outcomes, body composition, and cardiometabolic markers in older adults living in a rural community setting.

Methodology
The study employed a non-randomized, community-based controlled intervention design conducted in Andong, Republic of Korea.

Participants: 30 community-dwelling adults aged 60–79 were recruited via convenience sampling. They were allocated to a barefoot walking group ( $n=15$ ) or a usual-lifestyle control group ( $n=15$ ). Due to attrition, 25 participants completed the study (barefoot: $n=12$ ; control: $n=13$ ).
Intervention: The barefoot walking group participated in supervised sessions three times weekly for 10 weeks. The program utilized a progressive surface protocol:
- Weeks 1–3: Soft sand (RPE 9–11).
- Weeks 4–6: Gradual introduction of combined sand-and-gravel surfaces.
- Weeks 7–10: Predominantly combined sand-and-gravel surfaces (RPE 12–14).
  Each session included a 5-minute warm-up, 30–40 minutes of walking, and a 5-minute cool-down.
Control Group: Participants maintained their usual lifestyle without structured exercise.
Outcome Measures: Assessments were conducted at baseline and post-intervention, including:
- Functional Mobility: 2-min Step Test, 30-s Chair Stand Test, Timed Up and Go (TUG), Figure-of-8 Walking Test, sit-and-reach, and grip strength.
- Anthropometrics: Body composition (fat mass, percent body fat, skeletal muscle mass, BMI) and waist circumference.
- Cardiometabolic Markers: Blood pressure, fasting plasma glucose, and lipid profiles (total cholesterol, HDL-C, LDL-C, triglycerides).
Statistical Analysis: Data were analyzed using a two-way repeated-measures analysis of covariance (ANCOVA) with age as a covariate to control for baseline imbalances. Significance was set at $p < 0.05$ .

Key Results
The study observed significant Group $\times$ Time interactions for specific functional and anthropometric outcomes, but not for cardiometabolic markers.

Mobility-Related Functional Outcomes:
- 2-min Step Test: The barefoot group showed a significant increase in performance (from $113.33 \pm 8.03$ to $126.33 \pm 10.68$ repetitions), while the control group declined ( $95.85 \pm 13.37$ to $91.00 \pm 13.67$ ). This yielded the largest interaction effect ( $F=15.878, p<0.001$ , partial $\eta^2 = 0.419$ ).
- 30-s Chair Stand Test: Significant interaction ( $F=6.606, p=0.017$ ), with the barefoot group improving from $21.83$ to $28.67$ repetitions.
- Figure-of-8 Walking Test: Significant interaction ( $F=6.506, p=0.018$ ), indicating improved complex directional walking speed in the barefoot group.
- Non-Significant Functional Outcomes: No significant interactions were found for the Timed Up and Go (TUG) test, sit-and-reach flexibility, or grip strength.
Body Composition and Waist Circumference:
- Significant Group $\times$ Time interactions were observed for body fat mass ( $p=0.025$ ), percent body fat ( $p=0.039$ ), and waist circumference ( $p=0.005$ ).
- In the barefoot group, waist circumference decreased ($81.88$ to $80.50$ cm), whereas it increased in the control group ($86.46$ to $91.15$ cm). Changes in body fat mass were driven largely by an increase in the control group rather than a substantial decrease in the barefoot group.
- No significant interactions were found for skeletal muscle mass or BMI.
Cardiometabolic Markers:
- No significant Group $\times$ Time interactions were observed for systolic or diastolic blood pressure, fasting plasma glucose, total cholesterol, HDL-C, LDL-C, or triglycerides.

Key Contributions and Significance
The primary contribution of this study is the identification of selective benefits associated with a community-based barefoot walking program. The authors conclude that the intervention corresponded to improvements in functional aerobic endurance, lower-body functional strength, and complex directional walking, alongside favorable changes in specific anthropometric measures (waist circumference and body fat indicators).

However, the paper explicitly notes that the intervention did not produce a clear cardiometabolic response. The authors emphasize that the observed functional gains were confined to specific domains rather than extending across all measured health indicators.

Limitations and Cautions
The paper maintains a modest tone regarding causal inference due to several methodological constraints:

Non-Randomized Allocation: Baseline differences existed between groups (e.g., the barefoot group was younger and had lower BMI), which, despite statistical adjustment for age, introduces potential confounding.
Lack of Comparator: The absence of a conventional shod-walking control group prevents the isolation of "barefoot" effects from the general effects of walking, surface characteristics, or the supervised nature of the program.
Short Duration: The 10-week period may have been insufficient to elicit changes in certain biomarkers like blood lipids or glucose.
Mechanistic Gaps: The study did not measure plantar sensation, foot strength, or gait biomechanics, leaving the physiological mechanisms of the observed improvements unverified.

Conclusion
The study suggests that a 10-week supervised barefoot walking program on sand and gravel surfaces can enhance specific mobility-related functions and selected anthropometric measures in older adults. However, the authors state that randomized controlled trials including a conventional shod-walking comparator are necessary to confirm these findings and establish causal relationships.

Technical Summary: A 10-Week Community-Based Barefoot Walking Program

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