Improve Your Health: Walking is the Best Medicine

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Walking is an accessible and low-impact form of physical activity that has many positive impacts on short-term and long-term health, and can cause improved outcomes. It is universally accessible, requires little skill or equipment, and has a low risk of injury.

Improved Body Composition and Fitness

A meta-analysis by Murphy et al1 included 24 randomized controlled trials of sedentary, but otherwise healthy individuals, who undertook walking as the only intervention showed statistically significant relative reduction of body weight (-1.4%), BMI (-1.1%), waist circumference (-3.55cm), and percent body fat (-1.9%) compared to control groups. The average length of the walking protocols was 34.9 weeks with an average frequency of 4.4 days per week for an average duration of 38.3 minutes. Although the reduction in body weight is modest, it highlights walking as an important strategy to prevent age-related weight gain which reduces the risk of cardiovascular disease.2, 3

Another meta-analysis by Hanson et al4 examined group walking programs and reported an average increase of VO2 max of 2.66 ml/kg/min, increased physical functioning scores and improved 6 minute walk times. This review included 42 studies of group walking with an average duration ranging from three weeks to one year, ranging in intensity from low to brisk walking, with some studies including high intensity walking intervals.

Decreased Blood Pressure and Cardiovascular Risk

The previously mentioned meta-analysis by Murphy et al1 included 6 studies that found walking alone made a statistically significant average reduction of diastolic blood pressure by 1.54 mmHg. The Hanson meta-analysis4 showed that walking in a group or with a partner may provide even greater health benefits than walking solo. This meta-analysis showed reductions in diastolic and systolic blood pressure of 3.14 mmHg and 3.72 mmHg respectively. Along with being statistically significant these results are clinically significant, as reductions in diastolic blood pressure by 2 mmHg can reduce the risk of coronary artery disease by 6% and stroke and transient ischemic attacks by 15%.5 More evidence of the important public health benefits of maintaining a lower blood pressure were demonstrated in an observational study of one million adults, where 2 mmHg lower systolic blood pressure translated into a 10% lower stroke mortality rate and reduced mortality from other causes by 7% in a middle-aged population.6

An elevated non-HDL cholesterol is a major risk factor for cardiovascular disease. A meta-analysis of 22 randomized control trials from 948 subjects showed a significant decrease in non-HDL cholesterol of 4% after participating in a walking programs ranging from 10-75 minutes per day an average of 4.9 days per week.7

Diabetics are at higher risk of adverse cardiac outcomes, and a study by Fritz et al 8 examined the effects of walking on cardiovascular risk factors in type 2 diabetics. The results showed that an exercise prescription including walking for 45-60 minutes three times per week showed reductions in systolic blood pressure (-7.6 mmHg), diastolic blood pressure (-4.3 mmHg) body mass index (-0.6 km/m2), and total plasma cholesterol (-0.6 mmol/L).

lowered blood pressure from walking

Improved Glycemic Control in Diabetes

Acute blood glucose control is crucial to reduce the risk of microvascular complications in type 2 diabetes, and walking has been shown to decrease postprandial blood glucose levels in individuals with type 2 diabetes.

Mendes et al9 compared the effects of high intensity interval training (HIIT) and moderate intensity continuous training (MICT) to no training on postprandial blood glucose levels in a randomized crossover trial of 15 participants with type 2 diabetes. The HIIT group included a 40-minute treadmill walking session (5 min warm up, 5 times alternating 3 min at 70% heart rate reserve (HRR), 5 min cool-down), and the MICT protocol included a 40-minute treadmill walking session (5 min warm up, 30 minutes at 50% HRR, 5 min cool-down). Both walking protocols showed statistically significant decreases in blood glucose measurements during and after exercise, though the HIIT walking protocol produced superior results. Type 2 diabetics may experience more benefit from a specific walking program containing intervals of high intensity walking.

Improved Mental Health Outcomes

Walking has a large, statistically significant effect on the symptoms of depression in various populations that is comparable to other forms of aerobic and non-aerobic exercise.10 A systematic review from 2013 examined three large, long-term prospective studies that evaluated the role of walking in preventing depression. The studies included a 10-year follow up of nearly 50,000 women in the Nurse’s Health study analyzing the effect of physical activity on depressive symptoms,11 the effect of leisure-time physical activity in the Black Women’s Health Study12 and an 8-year follow up study of walking for preventing depression in elderly Asian men.13 All three studies found a protective effect of walking against depressive symptoms.

A 2013 systematic review examined modes and settings of physical activity to treat depression.14 The authors concluded that indoor or outdoor walking were effective in the treatment of depression. The most effective programs included three to four sessions weekly for a duration of 30-40 minutes at a subjectively moderate pace over a period of at least nine weeks.

Forest walking may provide further mental health benefits to walkers and has been shown as an effective method for coping with stress. In a 2018 study, Song et al15 instructed 581 participants to walk pre-determined courses through the forest (test) or city (control) for just 15 minutes. The results showed that the forest group reported decreased levels of negative emotions and moods including “depression-dejection,” “tension-anxiety,” anger-hostility,” “fatigue,” and “confusion” and increased levels of the positive mood of “vigour” compared to the control group. Participants with higher anxiety levels reported the largest reduction in the feeling of “depression-dejection” after walking through forest areas.

Smiling from improved mental health

Integrative Cancer Care

Walking may be an important tool to help treat anxiety and depression in cancer patients. A study of 116 patients with lung cancer demonstrated significant improvements in anxiety levels and depression scores after three and six months of moderate-intensity walking for 40 minutes per day, three days a week.16

A meta-analysis of nine randomized control trials involving 599 patients showed that moderate-intensity walking significantly improved sleep in people with Cancer.17 Compared to walking plus an exercise program, walking only produced similar effects in sleep improvement. The authors’ findings support the inclusion of walking into the multifaceted approaches to managing sleep in cancer patients. Another study of 1,918 participants primarily with breast cancer found that walking was more effective than yoga in improving sleep disturbance for these patients.18

The most common adverse effect of Cancer patients undergoing chemotherapy is fatigue. A study of 159 women undergoing chemotherapy for breast cancer was conducted to observe the effect of a 12-week home-based walking program on fatigue levels. At the end of the 12-week intervention, the walking group had lower fatigue levels when compared to the control group.19

A 12-week walking program was also implemented in a study of 91 cancer survivors, where pedometers were supplied along with an online walking program.20 The results showed improvements in in physical fitness, systolic blood pressure, diastolic blood pressure, waist girth, mental health, social functioning, and general health. Pedometer interventions may be important for maintaining the health of cancer survivors, who are at increased risk of developing physical and psychological health problems.

Improved Osteoarthritis and Better Quality of Life

Osteoarthritis is the most common joint disorder affecting the elderly. Individuals with osteoarthritis tend to develop a sedentary lifestyle, which increases their risk for chronic disease such as coronary heart disease, diabetes, hypertension, obesity, and osteoporosis.21 The American College of Rheumatology recommends self-directed walking programs for non-pharmacologic management of OA, and the use of walking aids, or insoles if necessary, for improved walking function.22

Brosseau et al23 conducted a study of 222 participants with mild to moderate OA of the knee to observe the effects of a supervised community-based aerobic walking program (SCAWP) on clinical and quality of life outcomes. The walking program lasted 12 months, and the participants were divided into three groups: supervised walking only, supervised walking plus behavioural intervention (goal setting, follow-up phone calls), or self-directed walking. All the groups received informational pamphlets on the benefits of walking for OA. All three groups showed similar improvements in quality of life and clinical scores of arthritis pain, walking and bending, household tasks, stiffness and 6-minute walking tests compared to baseline measurements. The self-directed group, however, showed increased adherence at 18-month follow-ups. The authors concluded that a walking program along with patient education can be used to manage the clinical and improved quality of life outcomes of OA.

Improved Bone and Muscle Strength

A recent review demonstrated physical exercise has been shown to be an important factor for increasing osteogenesis in osteoporotic patients. Walking alone was not shown to increase bone mass, but it is able to limit its progressive loss.24 Ideally, patients with osteoporosis combine weight-bearing aerobic exercises such as walking with strength and resistance exercises to maintain and improve bone mass.

Walking may also improve lower body muscle mass and strength in older adults. A study by Ozaki et al compared the effects of a 17-week walking program to a 17-week stair climbing program on muscle thickness, strength and walking performance.25 The walking program included 8 weeks of continuous walking (faster pace than usual for 20-25 mins, 3 days per week) and 9 weeks of interval walking (5-8 sets of 3 min high intensity walking, followed by 2 mins low intensity). The results showed that 17 weeks of a walking program can increase thigh muscle size and strength for older adults, and that an added stair-climbing program provides little additional benefits.

Improved Sleep

It is well known that physical activity has been shown to improve sleep,26 and although walking is low intensity, it has been shown to have improved sleep quality and duration. A four-week study by Sullivan-Bisson et al27 examined the relationship between daily steps and sleep quality and duration. Participants who took more daily steps reported improved sleep, with a stronger relationship to quality than duration.

better nights sleep

Improved Parkinson’s Disease Outcomes

When it comes to Parkinson’s Disease, Nordic walking has been shown to improve functional outcomes. Nordic walking involves the use of poles adapted from cross-country ski poles to activate upper body muscles that would not be used during normal walking. A study comparing the effects of Nordic walking and free walking in Parkinson’s patients showed that both improved balance performance, but Nordic walking significantly improved the unified scaled of Parkinson disease scale (UPDRS), timed up and go at self-selected speed (TUGSS) and timed up and go at forced speed (TUGFS) when compared with free walking.28

Improved Cognitive Health

Walking has been shown to improve cognitive health outcomes in older women. Weuve et al 29 reporting on the Nurses’ Health Study showed that women who performed the equivalent of walking at an easy pace for at least 1.5 hours per week scored higher on tests of general cognition compared with those who walked less than 40 minutes per week. Less cognitive decline was also observed in women who were more active.

A study looking at the effects of walking interventions on older sedentary individuals showed improvements in gait speed in all participants.30 Those participants with diabetes also showed improvements in global cognitive function and memory.

Better Digestion

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder, for which pharmaceutical treatment has limited efficacy. A study of 35 adults with IBS observed the effects of yoga or a walking program on GI symptoms.31 The results showed that both interventions improved IBS symptoms, including visceral sensitivity, overall GI symptoms, negative affect and state anxiety. GI symptoms in the walking group continued to decrease after a six-month follow-up, while the yoga group returned to pre-treatment levels.

A review of 28 studies on physical activity interventions in inflammatory bowel disease (IBD) showed that physical activity reduced the risk of developing IBD and the risk of future exacerbations.32 The most common physical activity intervention was walking, and positive improvements included improved quality of life, mental health, sleep quality, GI symptoms, fatigue, and cardiovascular fitness.

Interestingly, a small crossover study of 12 participants with gastro-esophageal reflux disease (GERD) showed that walking and chewing gum as separate interventions after meals decreased post-prandial reflux symptoms.33

Decreased Intraocular Pressure in Glaucoma

A prospective study of 1387 participants from the National Health and Nutrition Examination Survey (NHANES) was conducted to determine the effects of physical activity on the incidence of glaucoma. The results showed that increased exercise intensity was associated with decreased odds of glaucoma, and those who spent most of the day standing or walking versus sitting had 58% decreased odds of developing glaucoma.34

Another study of healthy participants showed that a brisk walk as short as one kilometre reduced intraocular pressure from an average of 16.0 mmHg at baseline to 14.6 mmHg after the walking intervention.35

 

walking for health

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References:

1 Murphy, M. H., Nevill, A. M., Murtagh, E. M., & Holder, R. L. (2007). The effect of walking on fitness, fatness and resting blood pressure: A meta-analysis of randomised, controlled trials. Preventive Medicine, 44(5), 377–385. doi:10.1016/j.ypmed.2006.12.008

2 Lavie, C., Milani, R., 1997. Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients. Am. J. Cardiol. 79, 397–401.

3 Christou, D.D., Gentile, C.L., DeSouza, C.A., Seals, D.R., Gates, P.E., 2005. Fatness is a better predictor of cardiovascular disease risk factor profile than aerobic fitness in healthy men. Circulation 111, 1904–1914.

4 Hanson, S., & Jones, A. (2015). Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. British Journal of Sports Medicine, 49(11), 710–715. doi:10.1136/bjsports-2014-094157

5 Cook NR, Cohen J, Hebert PR, Taylor JO, Hennekens CH. Implications of small reductions in diastolic blood pressure for primary prevention. Arch Intern Med. 1995 Apr 10;155(7):701-9. PMID: 7695458.

6 Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903–13.

7 Kelley GA, Kelley KS, Tran ZV. Walking and Non-HDL-C in adults: a meta-analysis of randomized controlled trials. Prev Cardiol. 2005 Spring;8(2):102-7. doi: 10.1111/j.1520-037x.2005.3474.x. PMID: 15860986; PMCID: PMC2447860.

8 Fritz, T., Wändell, P., Åberg, H., & Engfeldt, P. (2006). Walking for exercise—does three times per week influence risk factors in type 2 diabetes? Diabetes Research and Clinical Practice, 71(1), 21–27. doi:10.1016/j.diabres.2005.06.002.

9 Mendes R, Sousa N, Themudo-Barata JL, Reis VM. High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in Middle-Aged and Older Patients with Type 2 Diabetes: A Randomized Controlled Crossover 8. Trial of the Acute Effects of Treadmill Walking on Glycemic Control. Int J Environ Res Public Health. 2019 Oct 28;16(21):4163. doi: 10.3390/ijerph16214163. PMID: 31661946; PMCID: PMC6862460.

10 Robertson R, Robertson A, Jepson R, et al. Walking for depression or depressive symptoms: A systematic review and meta-analysis. Mental Health and Physical Activity 2012;5:66-75.

11 Lucas M, Mekary R, Pan A, et al. Relation between clinical depression risk and physical 1 activity and time spent watching television in older women: a 10-year prospective 2 follow-up study. Am J Epidemiol 2011;174(9):1017-27.

12 Wise LA, Adams-Campbell LL, Palmer JR, et al. Leisure time physical activity in relation to depressive symptoms in the Black Women’s Health Study. Ann Behav Med 5 2006;32(1):68-76.

13 Smith TL, Masaki KH, Fong K, et al. Effect of walking distance on 8-year incident depressive symptoms in elderly men with and without chronic disease: the Honolulu-Asia Aging Study. J Am Geriatr Soc 2010;58(8):1447-52.

14 Stanton R, Reaburn P. Exercise and the treatment of depression: a review of the exercise program variables. Journal of Science and Medicine in Sport 2014;17(2):177-82.

15 Song C, Ikei H, Park BJ, Lee J, Kagawa T, Miyazaki Y. Psychological Benefits of Walking through Forest Areas [published correction appears in Int J Environ Res Public Health. 2020 Feb 18;17(4):]. Int J Environ Res Public Health. 2018;15(12):2804. Published 2018 Dec 10. doi:10.3390/ijerph15122804

16 Chen HM, Tsai CM, Wu YC, Lin KC, Lin CC. Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer. Br J Cancer. 2015 Feb 3;112(3):438-45. doi: 10.1038/bjc.2014.612. Epub 2014 Dec 9. PMID: 25490525; PMCID: PMC4453645.

17 Chiu HY, Huang HC, Chen PY, Hou WH, Tsai PS. Walking improves sleep in individuals with cancer: a meta-analysis of randomized, controlled trials. Oncol Nurs Forum. 2015 Mar;42(2):E54-62. doi: 10.1188/15.ONF.E54-E62. PMID: 25806892.

18 Tang MF, Chiu HY, Xu X, Kwok JY, Cheung DST, Chen CY, Lin CC. Walking is more effective than yoga at reducing sleep disturbance in cancer patients: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2019 Oct;47:1-8. doi: 10.1016/j.smrv.2019.05.003. Epub 2019 May 24. PMID: 31207341.

19 Huang HP, Wen FH, Yang TY, Lin YC, Tsai JC, Shun SC, Jane SW, Chen ML. The effect of a 12-week home-based walking program on reducing fatigue in women with breast cancer undergoing chemotherapy: A randomized controlled study. Int J Nurs Stud. 2019 Nov;99:103376. doi: 10.1016/j.ijnurstu.2019.06.007. Epub 2019 Jun 21. PMID: 31442785.

20 Frensham LJ, Parfitt G, Dollman J. Effect of a 12-Week Online Walking Intervention on Health and Quality of Life in Cancer Survivors: A Quasi-Randomized Controlled Trial. Int J Environ Res Public Health. 2018 Sep 21;15(10):2081. doi: 10.3390/ijerph15102081. PMID: 30248943; PMCID: PMC6210292.

21 Macera CA, Hootman JM, Sniezek JE. Major public health benefits of physical activity. Arthritis Rheum. 2003;49(1):122–128. doi: 10.1002/art.10907.

22 Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012 Apr;64(4):465-74. doi: 10.1002/acr.21596. PMID: 22563589.

23 Brosseau L, Wells GA, Kenny GP, et al. The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis: a knowledge translation randomized controlled trial: part II: clinical outcomes. BMC Public Health. 2012;12:1073. Published 2012 Dec 12. doi:10.1186/1471-2458-12-1073

24 Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. Biomed Res Int. 2018 Dec 23;2018:4840531. doi: 10.1155/2018/4840531. PMID: 30671455; PMCID: PMC6323511.

25 Ozaki H, Nakagata T, Yoshihara T, Kitada T, Natsume T, Ishihara Y, Deng P, Kobayashi H, Machida S, Naito H. Effects of Progressive Walking and Stair-Climbing Training Program on Muscle Size and Strength of the Lower Body in Untrained Older Adults. J Sports Sci Med. 2019 Nov 19;18(4):722-728. PMID: 31827357; PMCID: PMC6873118.

26 Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: A meta-analytic review. J Behav Med. 2015;38(3):427–449. doi:10.1007/sl0865-015-9617-6.

27 Sullivan Bisson AN, Robinson SA, Lachman ME. Walk to a better night of sleep: testing the relationship between physical activity and sleep. Sleep Health. 2019 Oct;5(5):487-494. doi: 10.1016/j.sleh.2019.06.003. Epub 2019 Jul 2 PMID: 31358470; PMCID: PMC6801055.

28 Monteiro, E. P., Franzoni, L. T., Cubillos, D. M., de Oliveira Fagundes, A., Carvalho, A. R., Oliveira, H. B., … Peyré-Tartaruga, L. A. (2016). Effects of Nordic walking training on functional parameters in Parkinson’s disease: a randomized controlled clinical trial. Scandinavian Journal of Medicine & Science in Sports, 27(3), 351–358. doi:10.1111/sms.12652

29 Weuve J, Kang JH, Manson JE, Breteler MM, Ware JH, Grodstein F. Physical activity, including walking, and cognitive function in older women. JAMA. 2004 Sep 22;292(12):1454-61. doi: 10.1001/jama.292.12.1454. PMID: 15383516.

30 Espeland MA, Lipska K, Miller ME, Rushing J, Cohen RA, Verghese J, McDermott MM, King AC, Strotmeyer ES, Blair SN, Pahor M, Reid K, Demons J, Kritchevsky SB; LIFE Study Investigators. Effects of Physical Activity Intervention on Physical and Cognitive Function in Sedentary Adults With and Without Diabetes. J Gerontol A Biol Sci Med Sci. 2017 Jun 1;72(6):861-866. doi: 10.1093/gerona/glw179. PMID: 27590629; PMCID: PMC6075086.

31 Shahabi L, Naliboff BD, Shapiro D. Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study. Psychol Health Med. 2016;21(2):176-88. doi: 10.1080/13548506.2015.1051557. Epub 2015 Jun 18. PMID: 26086986.

32 Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res. 2021 Jan 22. doi: 10.5217/ir.2020.00049. Epub ahead of print. PMID: 33472342.

33 Avidan B, Sonnenberg A, Schnell TG, Sontag SJ. Walking and chewing reduce postprandial acid reflux. Aliment Pharmacol Ther. 2001 Feb;15(2):151-5. doi: 10.1046/j.1365-2036.2001.00902.x. PMID: 11148431.

34 Tseng VL, Yu F, Coleman AL. Association between Exercise Intensity and Glaucoma in the National Health and Nutrition Examination Survey. Ophthalmol Glaucoma. 2020 Sep-Oct;3(5):393-402. doi: 10.1016/j.ogla.2020.06.001. Epub 2020 Jun 7. PMID: 32741639.

35 Hamilton-Maxwell KE, Feeney L. Walking for a short distance at a brisk pace reduces intraocular pressure by a clinically significant amount. J Glaucoma. 2012 Aug;21(6):421-5. doi: 10.1097/IJG.0b013e31821826d0. PMID: 21499122.

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