DID YOU KNOW...That Walking has many Health Benefits?

Prepared by John. A. Sawdon M.Sc. Public Education & Special Projects Director,
Cardiac Health Foundation of Canada, April 2018

Introduction

Finally, the promise of warm weather, the emergence of crocus and the gradual return of birds from the south, signals its time to think about heading outdoors. This pull towards the outdoors in many ways’ signals renewal, growth and change. It also provides an opportunity to think about our health and the ways in which we can either improve or restore it. Walking is a key activity that most of us, including those with chronic disease, osteoarthritis, rheumatoid arthritis and fibromyalgia can benefit from (1).

Walking only requires good running shoes, good socks, appropriate dress if walking outdoors and a way of staying hydrated. People walk for many reasons: for pleasure, to experience the outdoors, to socialize, to reduce the effects of chronic health conditions, to manage weight and for many to mitigate the effects of sedentary working lives and lifestyles. Walking reduces fatigue, increases energy, strengthens bones and muscles, and for the most part is injury free (2). The many benefits of walking that have been demonstrated through research include:

  • Nurses Health study of 200,000 women shows that walking 30 minutes a day reduces the risk of coronary heart disease, stroke and type 2 diabetes by 30 to 40%(3);
  • One third of all Heart Attacks and death due to heart disease in middle age woman could be prevented through walking/ Harvard researchers who followed 70,000 women between ages 40 to 65 for 8 years found walkers less likely to die from heart attacks;
  • Another study involving 450,000 men and woman found that walking at a pace of 2 mph for 30 minutes provides protection for the heart;
  • For individuals at an elevated risk from living with type diabetes, walking for 10 minutes helps reduce risk. Another study found that a 15-minute walk after each meal provided better protection than a 45 minute morning walk. This same study found that individuals who are living with type 2 diabetes and walk 4000 steps or 2 miles reduced their increased risk for heart disease;
  • 27 research studies found that walking lowers blood pressure. An Arizona State University study compared brisk walking for 30 minutes against 3 ten-minute walks finding that both lower blood pressure while the 3 ten minute walks reduced blood pressure spikes;
  • Researchers in Lawrence Berkeley National Laboratories studied 150,000 walkers and runners since the 1990’s and found over 6 years that both groups burned equal number of calories and derived equal health benefits including reducing blood pressure, diabetes and heart disease. The walkers however had lower cholesterol levels;
  • The Nurses Health Study which assessed 72,000 women over 8 years found that women who walked the most at a brisk pace for 3 or more hours per week were 35 % less likely to suffer a coronary event such as a heart attack;
  • This same study also found that women who walked 4 hours a week or 35 minutes a day had a 41% lower risk of hip fracture compared to women who only walked one hour per week. Other studies have found that weight bearing activities including walking strengthen bones;
  • Harvard researchers found 12,000 men and women who walk briskly for one hour a day reduced by 50% the impact of obesity promoting genes;
  • In 2013 the American Cancer Society study of 70,000 women found those who walked 7 or more hours a week reduced their risk of developing breast cancer by 14% compared to those who walked 3 hours or less per week. It also found walking reduced anxiety, fatigue and the reoccurrence rates and death due to cancer. A follow up Harvard study of 3,000 women found those who walked 3 to 5 hours a week at a rate of 3 mph after receiving a breast cancer diagnosis were up to 40% less likely to experience negative outcomes;
  • Walking has also been shown to reduce cravings for chocolate and candy compared to non-walkers;
  • Walking for 45 minutes in the morning has been associated with helping individuals fall asleep faster and to have better sleep. This includes those suffering from insomnia (see Northwestern University study of sleep insomnia);
  • A ten-year study from the University of Pittsburgh found that walking 6 miles a week for one year increased hippocampal function by 2 %. This is crucial for memory, the normal is a 1 or 2% loss of hippocampal function for older adults which leads to memory loss;
  • Walking has also been shown by researchers in Portugal to reduce major depression. Researchers found by combining drug treatment with walking 30 to 45 minutes, 5 days a week eliminated symptoms in 26% of individuals with another 21% showing improvement;
  • Research in a 16-year study involving 800,000 individuals has found sitting associated with 34 chronic diseases or conditions. This same study found that you need to be active every 5 minutes of each hour to reduce this burden;
  • Walking lubricates joints and strengthens surrounding muscle to keep them healthy. Walking 5 to 6 miles a week protects you from developing osteoarthritis. If you have arthritis walking reduces the risk of becoming disabled. The Arthritis Foundation has created a walking program called the “Walk with Ease” and provides a self assessment for individuals with osteoarthritis, rheumatoid arthritis and fibromyalgia to consider. While this book calls for you to discuss with your healthcare practitioner what precautions you should take, the Arthritis Foundation encourages individuals to incorporate stretching, cardiovascular aerobics(walking) and strengthening your muscles, tendons and respiratory system in managing your health;(4)
  • Appalachian State University researchers found walking 30 minutes a day,5 days a week increases your life expectancy by up to 4 years:

How much Walking is enough?
The Canadian Physical Activity Guidelines which is now posted on the CSEP or Canadian Society for Exercise Physiology suggests that adults 18 to 64 years and those over 65 years accumulate 150 minutes of moderate to vigorous intensity aerobic physical activity in bouts of 10 minutes or more. (5) In a review of 22 studies those who walked vigorously and longer reduce their risk of heart disease. These guidelines reinforced by recommendations from Arthritis Foundation also recommend two or more strength training sessions per week in reducing chronic disease.

Should I Consult My Doctor First?
Before starting any type of exercise including “Walking” you need to assess your risk. If you have any injuries or a chronic or unstable health condition including heart disease, respiratory ailments(asthma, COPD), high blood pressure, joint or bone disease(osteoporosis, osteoarthritis, rheumatoid arthritis, fibromyalgia), a neurological illness or diabetes that will interfere with walking-stretching-strength exercises contact your Doctor. This should include both an examination and guidance on an exercise prescription. If you experience any chest pains, shortness of breath, or dizziness consult with your Doctor first before beginning any exercise. There are a few tools that can be helpful for you in determining whether you are ready to exercise, the Canadian tool is “Get Active Questionnaire” developed by the Canadian Society for Exercise Physiology (www.csep.ca/home). The American tool which has been used extensively in Canada as well is the Physical Activity Readiness Questionnaire (PAR-Q). A copy of this latter questionnaire can be downloaded from (www.health.harvard.edu/PAR-Q). (6)

Ok, I have answered the questionnaire, what is my next step?
Now that you have decided to walk as your aerobic activity, you need to start slowly. The Arthritis Foundation‘s program Walk with Ease, suggests if you haven’t exercised previously, start by walking for minutes. Initially this could be one minute at a time, increased to ten minutes, then two ten minute sessions and finally three ten minute sessions, one after each meal. The Walk with Ease program suggests you should be able to walk ten minutes. If you cannot walk or have fallen and have a fear of falling again, The Book of Balance by Lex Gonzales PT, DPT (7) offers an excellent program that will lead to walking again. This program has 6 levels and includes sitting exercises in level 1 & 2, it is progressive in nature and has illustrative exercises that provide step by step guidance.

Buy a good pair of shoes and socks:
To get personal service and to get help in selecting a good walking shoe, go to a specialty running store. In Canada we have the Running Room among other shoe stores. A shoe with cushioning and support is a must. To get the best fit go late in the day. Your foot swells, thus if you have been up moving around all day, your foot will be measured appropriately. Even though you are going to walk, get a good pair of fitted running shoes. Also allow for one finger width between the end of the big toe and the end of the shoe. Look for shoes that bend easily at the ball of the foot and avoid big heels. Make certain you have socks that you are going to use in your shoes when you walk. Avoid cotton socks and if possible buy athletic socks. Also remember to replace running shoes; the informal guideline is replacing your running shoes around the 500 mile mark. If you do 3 miles a day, 5 days a week this means around the 35th week you should be replacing your current walking/running shoes.

Where to Walk?
Now that we have identified some of the benefits to walking, where should we walk? As a recovering heart patient who experienced a double bypass surgery along with a cardio-ablation for both Atrial Fibrillation and Atrial Flutter, the first step is start slowly. For me this involved being able to slide out of bed holding my heart pillow to my chest and making it to the bathroom. Next it meant ability to walk up my stairs, then slowly being able to go next door, then two houses down the street and finally to the corner and back. From here it meant having ability to walk around my block, then two blocks and finally 8 blocks and back. With this ability I graduated to a small in-door mall. As I continued to walk and increased my capacity I graduated to a much larger mall. This approach created a foundation of walking that ultimately led me to my cardiac rehabilitation program. For anyone who has at three risk factors for heart disease or who has suffered a heart attack, and if you have not attended a cardiac rehabilitation program ask your Doctor about a potential referral to this program. This program which is sponsored within most provinces of Canada provides a safe and supervised approach to aerobic exercise along with symptom management, medication and vital sign monitoring along with nutrition education and counseling for potential anxiety and or depression. If you are lucky enough to be eligible for this program or a diabetes exercise program, a cancer rehabilitation program, a COPD exercise program, or as previously referred the Arthritis Foundation “Walk with Ease” program, take full advantage of this opportunity. Your participation in such a program will increase your capacity and will to exercise on a daily basis.

If you haven’t been to a structured program mentioned above then you might consider walking in the following spaces:

  • Outdoor options: when considering outdoor options it is wise to ensure wherever you walk it is on level ground. The Arthritis Foundation identified the following Levels which categorizes walking surfaces.
    1. Level 1: Flat, firm surfaces such as school tracks, streets with sidewalks, inside shopping malls, fitness trails, and indoor tracks and fitness clubs. This lessens impact on knees, hips and provides greater stability for balance
    2. Level II: Surface includes sand, gravel or soft earth and includes some inclines or stairs. Greater impact on balance and knees, hips
    3. Level III: Uneven ground with loose gravel, sand and includes stairs, hills. Most difficult terrain for balance and high impact on knees, hips. (8)

Recommendation is to stay on Level 1 terrain as you choose where to walk. The next piece to consider is “What type of Walking will you Do?” If you haven’t been exercising for some time or not at all, the suggestion is start with every day or leisure walking. The Harvard Health Publication suggests when you do walk to either get a pedometer or an activity monitor and that you use this guide to establish walking goals for yourself.

  • Less than 5,000 steps daily =sedentary
  • 5,000 to 7499 steps a day =low activity
  • 7500 to 9999 steps a day= somewhat active lifestyle

The suggestion is to set a goal for yourself and then gradually to increase week by week the number of steps you take. The Health benefit goal is to set a target of 10,000 steps, if you have not been walking steadily this will be overwhelming. The key to walking is to find a friend or a social walking group and to set modest targets and stick with this. Besides having good running shoes, be certain to take water with you and an energy bar in case you need a snack. You will soon see improvements in your energy, less fatigue and the will to increase the number of steps you take daily.

Safety Tips for Walking:
A few safety reminders are often helpful as you embark on your walking journey. The first is, knowing the area you are going to walk. This means scouting the area before you decide to walk. Be certain to carry ID and your cell phone in case of your own emergency or one you happen to come upon. Always have enough cash to buy a bottle of water in case you become dehydrated. If you are walking on the road, always face the traffic so you see what is coming. If you are taking your headphones and listening to music, try to only wear one ear bud, this allows you to hear other noises. Wear brightly coloured clothing and glow in the dark clothing if walking at night. As a rule try to avoid walking at night and do not engage in extended walks alone after dark.

Be certain to warm up and cool down after your walk. If you experience a shortness of breath, pains in your chest, upper body discomfort, aching, burning, tightness, extreme fullness or pressure, fainting or loss of consciousness, wheezing or severe pain in joints, muscles or tendons stop. If you are in distress call 911 right away and do not delay. If you have been walking and experience pain in your joints or muscles 2 hours after your walk, see your Doctor before exercising or walking again.

Walking clubs
As I mentioned earlier walking has numerous health benefits including extending your life. A great way to stay enthused and motivated as a walker is to recruit a friend or to join a walking club. If a club does not exist in your area, you and your friend might consider starting a walking club. ActNowBC has created an excellent Walking Program Resource Guide at www.bcrpa.bc.ca ( 9). Another excellent resource is the Wales pedometer challenge which provides a daily chart that will help with establishing walking goals at www.walespedometerchallenge.org.uk. The Walkingsite.com offer tips on walking from beginner through to experienced

walkers. It includes warm up exercises, food tips, treadmill walking and six week programs that you can follow. Another excellent resource is the America Walks at < a href="https://americawalks.org/">https://americawalks.org. Once you have figured out that walking is for you and you are committed to this practise we encourage you to connect with World Walking. This organization was influenced by a group of recovering heart patients and provides walking tours of Italy, Spain and various countries. This group also sponsors a blog about walking and can be reached at https://worldwalking.org/walks.

Conclusion: In a systematic review and meta-analysis study the evidence is clear that outdoor walking groups have significant health benefits. Statistical evidence was found in a range of health measures including systolic and diastolic blood pressure, resting heart rate, body fat, BMI, total cholesterol, VO2max, depression, 6-min walk time, and quality of life for physical functioning. Given the benefits of walking, we encourage you to get started today.(10) We hope this article has provided more information and resources that support your commitment to adopting a healthy lifestyle. If you have questions or want us to address a different topic, let us know. If you found this article helpful also let us know by sending a note to jsawdon@cardiachealth.ca.

References:

  1. The Arthritis Foundation, Walk with Ease, @2018 Library congress PCN: 2002100858 ISBN: 978-0-692-63011-2
  2. ActNowBC, British Columbia Recreation and Parks Association “Walking Program Resource Guide; www.bcrpa.bc.ca/walking@2006
  3. Harvard Medical School, Curfman Greg D.; Skerrett Patrick, J; Walking for Health a Special Report: Why this simple form of activity could be your best health insurance Harvard Health Publications, Harvard Medical School, 10 Shattuck Street, 2nd floor, Boston, MA 02115-6011"> www.health.harvard.edu
  4. Arthritis Foundation Walk with Ease, 2018
  5. Canadian Society for Exercise Physiology 2017, Canadian Physical Activity Guidelines for adults 18-64years, Canadian Physical Activity Guidelines for older adults – 65 years & older, www.csep.ca/guidelines
  6. Physical Activity Readiness Questionnaire(PAR-Q), www.health.harvard.edu/PAR-Q;
  7. Gonzales Lex, PT, DPT; The Book of Balance: Rehab secrets to improve your balance and decrease your risk of falling; Copyright:@2018 60HealthandREHAB, LLC; ISBN-book-9781985646483; ISBN-ebook-198564648X
  8. Arthritis Foundation Walk with Ease
  9. ActNowBC, British Columbia Recreation and Parks Association “Walking Program Resource Guide; www.bcrpa.bc.ca/walking@2006
  10. Hanson Sarah, Jones Andy; Is there evidence that walking groups have health benefits? A systematic review and meta-analysis BRJ Sports Meidicne 2015; 49:710-715.doi:10.1136/bjsports-2014-094157
  11. Greendale,Gail A., Barret-Connor Elizabeth, Edelstein Sharon, Ingles Sue, Hale Robert; Lifetime Leisure Exercise and Ospteoporosis The Rancho Bernardo Study ; American Journal of Epidemiology, Volime 141, Issue10 15 May 1995, pages 951-959 https://doi.org/10.1093/oxfordjournals.aje.a117362
  12. Victoria State Government; Walking for Good Health-Better health channel; https://www.betterhealth.vic.gov.au/health/healthyliving/walking-for-good-health
  13. Biswas Charushila; Top 20 Health Benefits of Walking Daily; https://www.stylecraze.com/articles/best-benefits-of-walking/#gref
  14. The Walking Site @by the Walkingsite.com 198-2017
  15. Walk21; International Charter for Walking, Rodney.tolley@walk21.com September 2006

The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advice. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.