Walking for health: Continuing professional development

Walking is one of the most popular, easiest and safest forms of physical activity. It helps you look good and feel good with more vitality and energy, and makes you less prone to illness and disease. It has long been known that walking is good for us, and there are many health benefits.

However, it is perhaps only in the past 50 years that a wealth of scientific evidence has been accumulated that helps to explain exactly how the body responds and adapts to regular walking. Studies worldwide1, 2 have now confirmed that walking can:

  • Reduce the risk of coronary heart disease and stroke

  • Lower blood pressure

  • Reduce high cholesterol and improve blood lipid profile

  • Reduce body fat

  • Enhance mental wellbeing

  • Help to reduce stress

  • Fortify the immune system, making you less prone to illness and disease

  • Help you sleep better

  • Increase bone density, helping to prevent osteoporosis

  • Help osteoarthritis

  • Reduce the risk of certain cancers, notably colon cancer

  • Reduce the risk of Type-2 dia­betes

  • Improve flexibility and co-ordination, reducing the risk of falls, particularly as you get older

  • Help to maintain healthy lung function

  • Give you more energy/vitality.

Regular moderate, aerobic exercise is strongly associated with reduced mortality rates for both older and younger adults3 – in other words, walkers live longer. In particular, walking has a marked effect on heart disease and circulatory problems. Fit and active individuals have around half the risk of succumbing to a heart attack or stroke compared to unfit, inactive people. This level of risk is similar to that of smoking, high blood pressure or high cholesterol in causing heart disease. Indeed, in developed countries, physical inactivity is now the second most important risk factor for ill health after smoking.4

Fit and active walkers are also less likely to fall and suffer injuries such as hip fractures because the bones get stronger, joints improve their range of movement, and muscles are more toned and flexible. Fit walkers are also less prone to depression and anxiety, tend to sleep well, and are better able to control their body weight than their unfit counterparts. Walking has also been shown to improve self-esteem, relieve symptoms of depression and anxiety, and improve mood. Walking, particularly in pleasant surroundings and with other ­people, offers many opportunities for relaxation and social contact.

In the UK, Health Walks are springing up across the country, organised by a wide range of groups such as the government’s Health Development Agency (HDA), the Rambler’s Association, UK Sport, British Heart Foundation, Countryside Agency, and even corporate institutions that recognise the importance of good health and wellbeing to productivity in the workplace.

School ‘walking buses’ are now proving a popular way to get groups of children to walk to school each morning quickly and safely under the guidance of trained adult supervisors. It’s a great alternative to the school run in the car. The idea was developed by the Living Streets campaign in collaboration with schools and health authorities, and is a perfect fit with the government’s aim to reduce road traffic congestion and provide safe walking routes.

Many employers are also recognising the enormous benefits of walking to health and wellbeing – as well as to the productivity of their employees – with numerous ‘walking at work’ initiatives being introduced. This may take the form of casual or organised lunchtime walks, introducing walking routes around the corporate buildings and grounds, ‘workplace walking buses’, or ‘walking meetings’ – where the meeting takes place with the group or committee on the move. You can now even purchase a treadmill workstation, comprising a computer, keyboard and treadmill.

The Paths to Health Project is another example of a new scheme which was jointly created by the British Heart Foundation and the Paths for All Partnership, and it receives funding support from the New Opportunities Fund, Scottish Natural Heritage and NHS Health Scotland. The project maintains close working links with the Walking the Way to Health Initiative in England, which was developed by the British Heart Foundation and the Countryside Agency.

Exercise on prescription has been available in the UK for some time – but now, at least one health authority has adopted a scheme that offers dogs on prescription.

Under this innovative scheme –‘Pups – not Pills’– GPs in the Lewisham Primary Care Trust will give patients who are regularly hospitalised grants of up to £1,000 to spend on pets, pet food and veterinary bills. This allows them to buy a dog, in the hope that it will keep them out of hospital by providing an incentive to walk more outdoors. Caring for a pet not only gets patients exercising on a daily basis, but also helps to reduce stress and stave off depression and many other ailments through the acts of stroking and talking to the animal – a fact well known to the charity Pets as Therapy.

In Europe, the World Health Organisation European Network for Promoting Health-Enhancing Physical Activity (HEPA) has taken its ‘Walk for Health’ campaign to the UK, the Netherlands, France, Ireland, Denmark, Belgium, Poland, Austria and Germany. Brisk walking is an integral part of Euro­Action – a five-year, pan-European, preventive health programme organised by the European Cardiology Society, and promoted by nurse practitioners in health clinics across the EU.5 Already this large-scale, randomised controlled trial is reporting improvements in health and fitness among the thousands of 50 to 80-year-olds at whom it is targeted.

Calorie maps

Innovative maps indicating walking routes and the calories burned in walking them.

Aberystwyth – Free from TIC. Tel 01970 612125, e-mail aberystwythtic@ceredigion.gov.uk 

Liverpool – Free from Travelwise. Tel 0151 330 1253, website www.gotravelwise.com

Port Talbot – Calorie-mapped trails at Afan Forest Park. Tel 01639 850564, e-mail tanya.dykes@forestry.gsi.gov.uk

Rhyl – Contact the Footloose co-ordinator. Tel 01745 356 197

Treherbert – Calorie-mapped trails at Penpych Woodland Park. Tel 01639 850564, e-mail tanya.dykes@forestry.gsi.gov.uk

Control of body weight occurs when the calories taken in as food are balanced with the calories expended through walking and other physical activities. The key issue for weight control is maximising the total volume of calories used (at any intensity) and combining this with healthy eating.

Walking or jogging a mile burns up about 100-120 calories of energy – the heavier you are, the more calories you burn – almost independent of pace. This is particularly important for the less fit and overweight since the higher the pace, the greater the risk of injury. So distance matters. A two-mile daily walk will burn around 200-240 calories, or around 1,400-1,880 calories per week (that is equivalent to about 1/2lb fat loss a week, or 2lbs of fat loss a month) – a great way to lose weight, and gain all the other health benefits as well. Walking also alters fat metabolism so that fat is burned up instead of sugars, helping to reduce weight. To help with this, the Ramblers Association now publishes ‘Calorie maps’ (see box) showing the number of calories burned per walk.

Stress relief

Regular exercise is one of the best physical stress-reduction techniques available. It helps to relax tense muscles and helps you to sleep. Exercise speeds up the flow of blood through your brain and causes the release of chemicals called endorphins which give you a feeling of happiness and well­being. Exercise is also wonderfully distracting, helping to ease tension and forget about your worries for a time.

Since the early 1980s, numerous studies have shown that physically active individuals suffer less from stress and stress-associated illnesses than the non-active.6 Exercise helps to lower anxiety and is equivalent to other non-pharmaceutical interventions in its effectiveness.7 Those who are physically active are less likely to develop depression, and the anti-depressant effect of exercise can be equal to psychotherapy.8 Exercise can improve a person’s physical self-worth and other important self-­perceptions such as body image. Having exercise goals that relate to personal performance and improvement is also associated with high positive emotion and improved mood.

The best way to achieve an increase in positive mood appears to be via moderate intensity exercise, such as brisk walking. High intensity exercise often leads to an increase in tension, anxiety and fatigue. Also, if the exercise intensity is too low, less mood modification occurs (Barabasz, 1991). While exercising indoors is clearly beneficial, the advantages of an outdoor lifestyle have recently been backed by overwhelming medical evidence, and regular outdoor exercise is now thought to be a major factor in the prevention of heart disease, strokes, high blood pressure, arthritis, stress and depression. The important thing to remember is that exercise should be fun – if you do not enjoy it, then you probably won’t keep doing it.

Numer of steps per activity

Sedentary Under 5,000 steps/day

Low active 5,000-7,499 steps/day(typical daily average)

Moderately active7,500-9,999 steps/day

Very active10,000 steps/day

Highly active12,500+ steps/day

10,000 steps a day

Around 40 years ago, Japanese physiologists developed the idea that walking 10,000 steps a day will help you keep fit and healthy without the need for additional exercise. Other countries leapt on this concept with many international programmes.

The recent UK Move4Health campaign was fronted by 13 MPs who monitored their daily steps using pedometers. Dr Howard Stoate, chairman of the All-Party Parliamentary Group on Obesity, came out tops with an astonishing 18, 483 steps per day – but then, he was training for the London Marathon. Public health minister Melanie Johnson demonstrated the greatest overall improvement in daily activity levels over the course of a week.

Most of us walk around 4,000 steps a day without even thinking about it. Those who sit at a desk all day do around 2,000, while those who walk as part of their work, such as nurses, will walk around 8,000 steps per day. 10,000 steps is around five miles, and will burn about 500 calories (see box).

Pedometers are now very popular and can be purchased very cheaply. A pedometer will count your steps when activated and clipped to your waist. Primarily they count the number of steps you take, but they can also include extra features such as measuring distance walked, time taken and calories burned.

Brisk is best

Pedometers encourage us to do more physical activity – such as climbing stairs, moving around the house or office or walking around the park – but they do not give particular guidelines on pace. While walking at any pace is good for us, far more aerobic benefits are reaped from moderately-vigorous physical activity – in other words, brisk walking. A simple way to work out how briskly you should walk is to aim to walk fast without over-exertion. You should just about be able to hold a conversation while you are walking – the ‘talk test’.

For the more technically minded, you could monitor your heart rate during exercise and aim to walk in your ‘heart rate training zone’. To calculate this, take your age away from 220. Then try to walk so that your heart rate is above 50% of this figure. So for example, a 40-year-old would be aiming to have a heart rate of at least 90 beats per minute (Walking Heart Rate = (220 – 40) x 0.5).

Even a 10-minute walk can increase fitness, provided that it is brisk enough. One study at Loughborough University9 found that women walking continuously for 30 minutes five days a week had almost identical increases in fitness as women who split their 30 minutes into three 10-minute walks. Perhaps even more encouraging was that the ‘short walkers’ lost more weight and reported greater reductions in waist circumference than the ‘long walkers’. Brisk is best – walk fast without over-exertion.

Regular walking, like all aerobic exercise, can have a dramatic effect on cardio-respiratory fitness, or ‘aerobic capacity’. Regular exercise carried out three times a week for 30 minutes or more at the right intensity will result in increased aerobic fitness. The intensity of walking for fitness benefits varies according to the age and fitness of the individual.

However, please remember that while walking is one of the safest and most risk-free exercises, more strenuous activities such as fell- and mountain-walking can be extremely physically demanding and therefore not suitable for all of us – particularly if there is an underlying medical condition which may be exacerbated by exhaustive exercise.

Motivational effects

Devices such as pedometers and pulse monitors which give feedback on your performance help you set goals and monitor your own performance both during exercise and when you have completed a session. This can be highly motivational.

For example, in response to the Move4Health 10,000 steps a day project, the MPs were very positive in their responses. Public health minister Melanie Johnson commented: “Wearing the pedometer has certainly motivated me to walk more. It’s resulted in me making a conscious effort to walk more on the days where previously I might have spent most of my time sat in meetings or stuck behind my desk. This experience has really shown me the value of the initiative we launched last October which enabled GPs to provide pedometers on prescription to encourage people to make changes to their lifestyles.”

Tessa Jowell, secretary of state for culture, media and sport, commented: “I have thoroughly enjoyed taking part in the pedometer project. It has certainly motivated me to be more active over the past week, by taking the stairs instead of the lift, or by walking rather than going by car. By showing how much walking we actually do, we can become our own personal trainers to reach the 10,000-step target.”

Walking has been described by health professionals as the perfect exercise to gain the benefits of being more physically active. It requires no special equipment or expense, and is the ideal way for most people to become more active. Seven in 10 people in the UK are not physically active enough to benefit their health, and there are numerous initiatives and opportunities for us all to get on the move. The great outdoors offers so much in terms of health, fitness and pleasure. According to the Department of Health,1 a 30-minute brisk walk on most – preferably all – days of the week will do wonders for your health and wellbeing, which in turn will increase productivity and please employers.

Professor Kevin Sykes PhD, MSc is director of the Postgraduate Centre for Exercise & Nutrition Science, University of Chester

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1 Department of Health (2004). At least five a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer, London

2 British Heart Foundation (2001) Walking the Way to Health Newsletter 5.

3 US Dept of Health and Human Services 1996, Physical Activity and Health: A report of the Surgeon General

4 WHO (2002) Physical activity through transport as part of daily activities

5 www.ehnheart.org

6 Brown, J. (1991). Staying Fit and Staying Well: Physical fitness as a moderator of life stress. Journal of Personality and Social Psychology 60 (4) 555-561.

7 Chantal, G and Taylor, A. (1999) Exercise as a stress management tool. Stress News October 1999 Vol.11 No.4

8 Cox, R. (1998). Sport Psychology. Concepts and Applications. 4th edition. WCB/McGraw Hill, USA.

9 Murphy, M and Hardman, A E. (1998) ‘Training effects of short and long bouts of brisk walking in sedentary women’ in Medicine and Science in Sports and Exercise 30:1:152-7.

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