PURPOSE: Eccentric exercise training produces positive fitness and health outcomes, but whether this is also the case for descending stair walking (DSW) is unknown. This study investigated the hypothesis that DSW would improve insulin sensitivity, lipid profiles and physical fitness better than ascending stair walking (ASW). METHODS: Elderly (≥60 yr) obese women were placed to either DSW or ASW group (n = 15 per group). An elevator was used to eliminate ascending stairs for DSW, and descending stairs for ASW. Descending stair walking and ASW were performed twice a week for 12 wk by increasing the repetitions gradually. Overnight fasting blood samples were taken 3 d before the first training session and 4 d after the last training session, and analyzed for insulin sensitivity and lipid profile markers. Resting HR, systolic blood pressure, and diastolic blood pressure, bone mineral density, knee extensor maximal voluntary isometric contraction strength and several functional physical fitness measures were taken before and after the intervention. RESULTS: Average HR during DSW (88.6 ± 7.8 bpm) was lower (P < 0.05) than that of ASW (113.7 ± 10.9 bpm). Resting HR (-10%) and systolic blood pressure (-9%) decreased greater after DSW than ASW (-4% for both), and bone mineral density increased (6%) only for DSW (P < 0.05). Decreases in serum triacylglycerols, total and low-density lipoprotein cholesterols, glucose, insulin, homeostasis model assessment and whole blood glycosylated hemoglobin, and increases in high-density lipoprotein cholesterols were greater (P < 0.05) after DSW than ASW. Maximal voluntary isometric contraction strength increased greater for DSW (34%) than ASW (15%), and many of functional physical fitness measures showed greater (P < 0.05) improvement for DSW than ASW. CONCLUSIONS: These results supported the hypothesis and suggest that DSW is an effective exercise intervention for elderly obese women to improve their health and fitness.