Background. Many commercially available pedometers undercount, especially at slower speeds. We examined the effects of age, obesity, and self-selected walking speed on pedometer accuracy. We also compared the accuracy of piezoelectric and spring-levered pedometers at slow walking speeds. Methods. Study 1: 259 subjects walked on a motorized treadmill at two self-selected walking speeds. Steps were counted using a spring-levered pedometer. Study 2: 32 subjects walked on a motorized treadmill at slow walking (1.0-2.6 MPH) speeds. Steps were counted using spring-levered and piezoelectric pedometers. Results. Study 1: self-selected walking speed and pedometer accuracy decreased with increasing age, weight, and body mass index (BMI). Accuracy was 71% below 2.0 MPH, 74-91% between 2.0 and 3.0 MPH, and 96% above 3.0 MPH. Decreased accuracy was best predicted by increasing age. Study 2: between 1.8 and 2.0 MPH, the accuracy of the piezoelectric pedometer (>97%) exceeded that of the spring-levered pedometers (52-95%). Even at 1.0 MPH, accuracy of the piezoelectric pedometer (56.4 ± 33.8%) was superior to the spring-levered pedometers (7-20%). Conclusion. Accuracy of all pedometers tested exceeded 96% at speeds 3.0 MPH, but decreased at slower walking speeds. In individuals that naturally ambulate at slower walking speeds (e.g., elderly), we recommend the use of more sensitive (e.g., piezoelectric) pedometers. © 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved.