The purpose of this study was to examine the cardiovascular responses to water treadmill walking at 2.0 mph (3.2 km/hr), 2.5 mph (4.0 km/hr), and 3.0 mph (4.8 km/hr) in older adults. Responses to water treadmill walking in 92 degrees F (33 degrees C) water were compared with responses to land treadmill walking at 70 degrees F (21 degrees C) ambient temperature. After an accommodation period, participants performed 5-min bouts of walking at each speed on 2 occasions. Oxygen consumption (VO2), heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) were significantly higher during therapeutic water treadmill walking than during land treadmill walking. Furthermore, VO2, HR, and RPE measures significantly increased with each speed increase during both land and water treadmill walking. SBP significantly increased with each speed during water treadmill walking but not land treadmill walking. Thus, it is imperative to monitor HR and blood pressure for safety during this mode of activity for older adults.