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Prescription 2015: Walk This Way

December 2, 2015 Written by JP       [Font too small?]

These days there are more exercise alternatives than ever before. At community pools you can do aquatic aerobics and balance training. Athletic clubs and gyms offer a wide array of classes from Crossfit to Pilates, in addition to mind-body exercises such as Qigong, Tai Chi and various styles of yoga. Even traditional martial arts and boxing are now commonly practiced as novel ways of getting into better shape. From my perspective, this is a very positive trend. Keeping exercise interesting and varied helps a lot people stick to a regular fitness routine.

A reasonable argument can be made that walking is the most natural form of exercise known to mankind. However, it isn’t taken very seriously by a fair share of exercise and health enthusiasts. Ultimately, day-to-day strolling simply doesn’t inspire enough excitement or generate enough of a “burn” to seem like a real workout. If you agree, whether consciously or subconsciously, this blog is for you, because walking is serious medicine indeed.

Cardiovascular Benefits - A study appearing in the November 2015 edition of Circulation reports that walking regularly, at a moderate pace of about 3 miles per hour, lowers the risk of cardiovascular disease and stroke by about half. Recent trials show that bouts of intense walking and simply taking “walking breaks” from sitting improve circulatory/endothelial function and insulin sensitivity, lower hormones (IGF-1 and IGFBP3) associated with cardiovascular risk and reduce elevations in post-meal triglycerides.

Pain Relief - Aches and pains, including chronic back pain, neck pain and fibromyalgia all respond well to walking therapy. What’s more, it doesn’t require a major shift in lifestyle. For instance, one study found that increasing the number of daily steps by 1,000 decreased neck pain by 14%. Another experiment reports that achieving a daily goal of 5,000 steps mitigates a variety of fibromyalgia symptoms. This is particularly interesting because fibromyalgia is frequently treated using medications that affect the body and brain. How is this relevant? A 2013 trial reveals that aerobic exercises, such as walking, elevate the levels of serotonin metabolites. Many antidepressants aim to increase serotonin availability in the brain.

Mental Health - The previously mentioned serotonin finding may explain why walking is now being used to promote psychological well-being. And, don’t assume it’s only helpful for those with minor cases of “the blues”. A publication in the February 2015 issue of the British Journal of Cancer asserts that walking for 40 minutes/day, thrice-weekly, “is a feasible and effective method for managing anxiety and depression in lung cancer survivors”. Another study from this year documents a decline in depression and perceived stress after a 12 week walking program in patients with traumatic brain injuries. Lastly, a fascinating experiment determined that a “happy walking style” encouraged greater improvements in mood than a depressive style gait. This suggests that a “fake it until you make it” attitude potentiates the mental health effects of walking.

My hope is that by now even skeptics are beginning to see the scientific light about the importance of daily walking. However, I’m sure there are some who are reading this that aren’t particularly concerned with cardiovascular risk, pain or mental health issues. Just know that the long list of walking benefits extend to many other health conditions. To name but a few: Constipation due to medication use, COPD, erectile dysfunction and premature pregnancies are all positively influenced by walking. As a bonus, a series of experiments recently discovered that walking, especially outdoors, increases creativity and the “free flow of ideas”. Who couldn’t use more of that?

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Physical Activity and Risk of Coronary Heart Disease and Stroke (link)

Study 2 - Effect of Prolonged Sitting & Breaks in Sitting Time on Endothelial (link)

Study 3 – Intense Walking Exercise Affects Serum IGF-1 and IGFBP3 (link)

Study 4 - Interrupting Sitting Time w/ Regular Walks Attenuates Postprandial (link)

Study 5 - Effects of Aerobic Exercise on Postprandial Carbohydrate and (link)

Study 6 - The Effect of Daily Walking Steps on Preventing Neck & Low Back (link)

Study 7 - Supervised Walking in Comparison w/ Fitness Training for Chronic (link)

Study 8 - Adverse Events Experienced by Participants in a Back Pain Walking (link)

Study 9 - Does Increasing Steps Per Day Predict Improvement in Physical (link)

Study 10 - Effects of Physical Exercise on Serum Levels of Serotonin and its (link)

Study 11 - Randomised Controlled Trial on the Effectiveness of Home-Based (link)

Study 12 - A Home-Based Walking Study to Ameliorate Perceived Stress and (link)

Study 13 - How We Walk Affects What We Remember: Gait Modifications (link)

Study 14 - Ground-Based Walking Training Improves Quality of Life and (link)

Study 15 - Aerobic Exercise Improves Gastrointestinal Motility in Psychiatric (link)

Study 16 - A Home-Based Walking Program Improves Erectile Dysfunction (link)

Study 17 - Effects of Walking Exercise During Late Trimester on Pregnancy (link)

Study 18 - Give Your Ideas Some Legs: The Positive Effect of Walking on (link)

Regular Exercise Reduces Stress Hormone Levels

Source: PLoS One. 2015 Nov 3;10(11):e0141970. (link)

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12 Comments & Updates to “Prescription 2015: Walk This Way”

  1. JP Says:

    Updated 12/02/15:

    http://www.hindawi.com/journals/ecam/2015/614783/

    Evid Based Complement Alternat Med. 2015;2015:614783.

    Sense of Well-Being in Patients with Fibromyalgia: Aerobic Exercise Program in a Mature Forest-A Pilot Study.

    Background and Objective. Most patients with fibromyalgia benefit from different forms of physical exercise. Studies show that exercise can help restore the body’s neurochemical balance and that it triggers a positive emotional state. So, regular exercise can help reduce anxiety, stress, and depression. The aim of this study was to analyze the benefits of moderate aerobic exercise when walking in two types of forests, young and mature, and to assess anxiety, sleep, pain, and well-being in patients with fibromyalgia. Secondary objectives included assessing (i) whether there were differences in temperature, sound, and moisture, (ii) whether there was an improvement in emotional control, and (iii) whether there was an improvement in health (reduction in pain) and in physical and mental relaxation.

    Patients and Methods. A study involving walking through two types of forests (mature and young) was performed. A total of 30 patients were randomly assigned to two groups, mature and young forests. The participants were administered the following tests: the Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR) at baseline and the end-point of the study, the State-Trait Anxiety Inventory (STAI) after each walk, and a series of questions regarding symptomatic evolution. Several physiological parameters were registered.

    Results. FIQR baseline and end-point scores indicated a significant decrease in the symptomatic subscale of the FIQ (SD = 21.7; z = -2.4; p = 0.041). The within-group analysis revealed that differences were significant with respect to days of intense pain, insomnia, and days of well-being only in the group assigned to the mature forest, not in the group assigned to the young forest. No differences were found with respect to anxiety.

    Conclusions. Although the main aim of this research was not achieved, as the results revealed no differences between the groups in the two forest types, authors could confirm that an aerobic exercise program consisting of walking through a mature forest can provide the subjective perception of having less days of pain and insomnia and more days of wellness, in patients with fibromyalgia.

    Be well!

    JP

  2. JP Says:

    Updated 12/02/15:

    http://ehp.niehs.nih.gov/wp-content/uploads/advpub/2015/11/ehp.1510425.acco.pdf

    Environ Health Perspect. 2015 Nov 8.

    Moving to a Highly Walkable Neighborhood and Incidence of Hypertension: A Propensity-Score Matched Cohort Study.

    BACKGROUND: The impact of moving to a neighborhood more conducive to utilitarian walking on the risk of incident hypertension is uncertain.

    OBJECTIVE: Our study aims to examine the effect of moving to a highly walkable neighborhood on the risk of incident hypertension.

    METHODS: A population-based propensity-score matched cohort study design was used based on the Ontario population from the Canadian Community Health Survey (2001-2010). Participants were adults aged 20 years or older who moved from a low walkability neighborhood (defined as any neighborhood with a Walk Score<90) to either a high (Walk Score≥90) or another low walkability neighborhood. The incidence of hypertension was assessed by linking the cohort to administrative health databases using a validated algorithm. Propensity-score matched Cox proportional hazard models were used. Annual health examination was used as a control event.

    RESULTS: Among the 1057 propensity-score matched pairs there was a significantly lower risk of incident hypertension in the low to high vs. the low to low walkability groups (hazard ratio, 0.46; 95% confidence interval (CI), 0.26 to 0.81, p<0.01). The crude hypertension incidence rates were 18.0 per 1000 person-years (95% CI: 11.6, 24.8) among the low to low walkability movers compared to 8.6 per 1000 person-years (95% CI: 5.3, 12.7) among the low to high walkability movers (p<0.001). There were no significant differences in the hazard of annual health examination between the two mover groups.

    CONCLUSIONS: Moving to a highly walkable neighborhood was associated with a significantly lower risk of incident hypertension. Future research should assess whether specific attributes of walkable neighborhoods (e.g. amenities, density, land-use mix) may be driving this relationship.

    Be well!

    JP

  3. JP Says:

    Updated 12/02/15:

    http://www.hindawi.com/journals/ecam/2015/976123/

    Evid Based Complement Alternat Med. 2015;2015:976123.

    Effects of Tai Chi and Walking Exercises on Weight Loss, Metabolic Syndrome Parameters, and Bone Mineral Density: A Cluster Randomized Controlled Trial.

    Tai Chi and walking are both moderate-intensity physical activity (PA) that can be easily practiced in daily life. The objective of the study was to determine the effects of these two PAs on weight loss, metabolic syndrome parameters, and bone mineral density (BMD) in Chinese adults. We randomized 374 middle-aged subjects (45.8 ± 5.3 years) into 12-week training (45 minutes per day, 5 days per week) of Tai Chi (n = 124) or self-paced walking (n = 121) or control group (n = 129). On average, Tai Chi and walking groups lost 0.50 and 0.76 kg of body weight and 0.47 and 0.59 kg of fat mass after intervention, respectively. The between-group difference of waist circumference (WC) and fasting blood glucose (FBG) was -3.7 cm and -0.18 mmol/L for Tai Chi versus control and -4.1 cm and -0.22 mmol/L for walking versus control. No significant differences were observed regarding lean mass, blood pressure, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and BMD compared to control. Change in lean mass, not fat mass or total weight loss, was significantly correlated to the change in BMD. Our results suggest that both of these two PAs can produce moderate weight loss and significantly improve the WC and FBG in Hong Kong Chinese adults, with no additional effects on BMD.

    Be well!

    JP

  4. JP Says:

    Updated 1/18/16:

    http://www.tandfonline.com/doi/abs/10.3109/13697137.2015.1123240?journalCode=icmt20

    Climacteric. 2016 Jan 12:1-5.

    Impact of pedometer-based walking on menopausal women’s sleep quality: a randomized controlled trial.

    Objective: Sleep disturbances are one of the most common psycho-physiological issues among postmenopausal women. This study was designed to evaluate the impact of walking with a pedometer on the sleep quality of postmenopausal Iranian women.

    Methods: This randomized, controlled trial was conducted on 112 women who were randomly assigned to two groups. The women in the intervention group (n = 56) were asked to walk with a pedometer each day for 12 weeks and to increase their walking distance by 500 steps per week. A sociodemographic instrument and the Pittsburgh Sleep Quality Index were used to collect data. Sleep quality was measured at baseline, 4, 8, and 12 weeks after intervention. The control group (n = 56) did not receive any intervention.

    Results: After 12 weeks, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction improved to a significantly greater extent in the intervention group than in the control group (p < 0.05). The total sleep quality score was significantly higher in the intervention group than in the control group (0.64 vs. 0.98, p = 0.001).

    Conclusion: This study showed that walking with a pedometer is an easy and cost-effective way to improve the quality of sleep among postmenopausal women. Use of this method in public health centers is recommended.

    Be well!

    JP

  5. JP Says:

    Updated 02/27/16:

    http://www.ncbi.nlm.nih.gov/pubmed/26917992

    Int J MS Care. 2016 Jan-Feb;18(1):1-8.

    Effects of Single Bouts of Walking Exercise and Yoga on Acute Mood Symptoms in People with Multiple Sclerosis.

    BACKGROUND: Little is known about the acute or immediate effects of walking exercise and yoga on mood in people with multiple sclerosis (MS). Such an examination is important for identifying an exercise modality for inclusion in exercise-training interventions that yields mood benefits in MS. We examined the effects of single bouts of treadmill walking and yoga compared with a quiet, seated-rest control condition on acute mood symptoms in MS.

    METHODS: Twenty-four participants with MS completed 20 minutes of treadmill walking, yoga, or quiet rest in a randomized, counterbalanced order with 1 week between sessions. Participants completed the Profile of Mood States questionnaire before and immediately after each condition. Total mood disturbance (TMD) and the six subscales of the Profile of Mood States were analyzed using repeated-measures analysis of variance and paired-samples t tests.

    RESULTS: There was a significant condition × time interaction on TMD scores (ηp (2) = 0.13). Walking and yoga conditions yielded comparable reductions in TMD scores. There was a significant condition × time interaction on vigor (ηp (2) = 0.23) whereby walking but not yoga yielded an improvement in vigor. There was a significant main effect of time on anger, confusion, depression, and tension (P < .05) but not on fatigue.

    CONCLUSIONS: Walking and yoga yielded similar improvements in overall acute mood symptoms, and walking improved feelings of vigor. These effects should be further investigated in long-term exercise-training studies.

    Be well!

    JP

  6. JP Says:

    Updated 03/09/16:

    http://www.mdpi.com/1660-4601/13/3/280/htm

    Int J Environ Res Public Health. 2016 Mar 3;13(3).

    A Lunchtime Walk in Nature Enhances Restoration of Autonomic Control during Night-Time Sleep: Results from a Preliminary Study.

    Walking within nature (Green Exercise) has been shown to immediately enhance mental well-being but less is known about the impact on physiology and longer lasting effects. Heart rate variability (HRV) gives an indication of autonomic control of the heart, in particular vagal activity, with reduced HRV identified as a risk factor for cardiovascular disease. Night-time HRV allows vagal activity to be assessed whilst minimizing confounding influences of physical and mental activity. The aim of this study was to investigate whether a lunchtime walk in nature increases night-time HRV. Participants (n = 13) attended on two occasions to walk a 1.8 km route through a built or a natural environment. Pace was similar between the two walks. HRV was measured during sleep using a RR interval sensor (eMotion sensor) and was assessed at 1-2 h after participants noted that they had fallen asleep. Markers for vagal activity were significantly greater after the walk in nature compared to the built walk. Lunchtime walks in nature-based environments may provide a greater restorative effect as shown by vagal activity than equivalent built walks. Nature walks may improve essential recovery during night-time sleep, potentially enhancing physiological health.

    Be well!

    JP

  7. JP Says:

    Updated 04/20/16:

    https://www.sciencedaily.com/releases/2016/04/160420162947.htm

    Senior adults can see health benefits from dog ownership

    Date: April 20, 2016

    Source: University of Missouri Health

    Summary: Among adults 60 years of age or more, walking is the most common form of leisure-time physical activity because it is self-paced, low impact and does not require equipment. Researchers have determined that older adults who also are pet owners benefit from the bonds they form with their canine companions.

    Be well!

    JP

  8. JP Says:

    Updated 05/27/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27225602

    BMC Geriatr. 2016 May 25;16:110.

    Efficacy of treadmill exercises on arterial blood oxygenation, oxygen consumption and walking distance in healthy elderly people: a controlled trial.

    BACKGROUND: Regular physical exercise and healthy lifestyle can improve aerobic power of the elderly, although lung capacity gradually deteriorates with age. The aims of the study are: a) to evaluate the therapeutic effect of a treadmill exercise program on arterial blood oxygenation (SaO2), maximum oxygen consumption (VO2max) and maximum walking distance (MWD) in healthy elderly people; b) to examine the outcome of the program at a supervised short-term and at an unsupervised long-term.

    METHODS: A prospective, not-randomized controlled intervention trial (NRCT) was conducted. Eighty participants were allocated into two homogeneous groups (training group, TG, n = 40; control group, CG, n = 40). Each group consisted of 20 men and 20 women. Pre-intervention measures of SaO2, VO2max and MWD were taken of each participant 1-week before the training program to establish the baseline. Also, during the training program, the participants were followed up at the 12, 30 and 48th week. The exercise program consisted of walking on a treadmill with fixed 0 % grade of inclination 3 times weekly for 48 weeks; the first 12 weeks were supervised and the remaining 36 weeks of the program were unsupervised. Participants in the control group were encouraged to walk twice a week during 45 min, and received standard recommendations for proper health.

    RESULTS: Related to the baseline, the SaO2, VO2max, and MWD is greater in the intervention group at the 12(th) (p <.001), 30(th) (p <.001) and 48(th) week (p <.001). Compared with the control group, there was also a significant improvement of SaO2, VO2max, and MWD valuesin the intervention group (p <.001) at the 12(th) (p <.001), 30(th) (p <.001) and 48(th) week (p <.001). Supervised intervention shows greater improvement of SaO2, VO2max, and MWD values than in the unsupervised one.

    CONCLUSION: These results show that performing moderate exercise, specifically walking 3 days a week, is highly recommended for healthy older people, improving aerobic power.

    Be well!

    JP

  9. JP Says:

    Updated 06/06/16:

    http://www.complementarytherapiesinmedicine.com/article/S0965-2299%2816%2930034-6/abstract

    Complement Ther Med. 2016 Jun;26:92-7.

    Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes.

    OBJECTIVE: To investigate and compare the effects of Buddhist walking meditation and traditional walking on glycemic control and vascular function in patients with type 2 diabetes mellitus.

    METHODS: Twenty three patients with type 2 diabetes (50-75 years) were randomly allocated into traditional walking exercise (WE; n=11) or Buddhism-based walking meditation exercise (WM; n=12). Both groups performed a 12-week exercise program that consisted of walking on the treadmill at exercise intensity of 50-70% maximum heart rate for 30min/session, 3 times/week. In the WM training program, the participants performed walking on the treadmill while concentrated on foot stepping by voiced “Budd” and “Dha” with each foot step that contacted the floor to practice mindfulness while walking.

    RESULTS: After 12 weeks, maximal oxygen consumption increased and fasting blood glucose level decreased significantly in both groups (p<0.05). Significant decrease in HbA1c and both systolic and diastolic blood pressure were observed only in the WM group. Flow-mediated dilatation increased significantly (p<0.05) in both exercise groups but arterial stiffness was improved only in the WM group. Blood cortisol level was reduced (p<0.05) only in the WM group.

    CONCLUSION: Buddhist walking meditation exercise produced a multitude of favorable effects, often superior to traditional walking program, in patients with type 2 diabetes.

    Be well!

    JP

  10. JP Says:

    Updated 09/27/16:

    http://iopscience.iop.org/article/10.1088/0967-3334/37/10/1872/meta;jsessionid=8372B3A652E37461CC983F9CEA652E57.c1.iopscience.cld.iop.org

    Physiol Meas. 2016 Sep 21;37(10):1872-1884.

    Walking in hospital is associated with a shorter length of stay in older medical inpatients.

    Evidence suggests that inactivity during a hospital stay is associated with poor health outcomes in older medical inpatients. We aimed to estimate the associations of average daily step-count (walking) in hospital with physical performance and length of stay in this population. Medical in-patients aged ⩾65 years, premorbidly mobile, with an anticipated length of stay ⩾3 d, were recruited. Measurements included average daily step-count, continuously recorded until discharge, or for a maximum of 7 d (Stepwatch Activity Monitor); co-morbidity (CIRS-G); frailty (SHARE F-I); and baseline and end-of-study physical performance (short physical performance battery). Linear regression models were used to estimate associations between step-count and end-of-study physical performance or length of stay. Length of stay was log transformed in the first model, and step-count was log transformed in both models. Similar models were used to adjust for potential confounders. Data from 154 patients (mean 77 years, SD 7.4) were analysed. The unadjusted models estimated for each unit increase in the natural log of step-count, the natural log of length of stay decreased by 0.18 (95% CI  -0.27 to  -0.09). After adjustment of potential confounders, while the strength of the inverse association was attenuated, it remained significant (β log(steps)  =  -0.15, 95%CI  -0.26 to  -0.03). The back-transformed result suggested that a 50% increase in step-count was associated with a 6% shorter length of stay. There was no apparent association between step-count and end-of-study physical performance once baseline physical performance was adjusted for. The results indicate that step-count is independently associated with hospital length of stay, and merits further investigation.

    Be well!

    JP

  11. JP Says:

    Updated 11/15/16:

    http://www.bodyworkmovementtherapies.com/article/S1360-8592(16)30048-1/abstract

    J Bodyw Mov Ther. 2016 Oct;20(4):751-760.

    Older adult Alexander Technique practitioners walk differently than healthy age-matched controls.

    The Alexander Technique (AT) seeks to eliminate harmful patterns of tension that interfere with the control of posture and movement and in doing so, it may serve as a viable intervention method for increasing gait efficacy in older adults. The purpose of this study was to compare the comfortable pace gait kinematics of older AT practitioners with those of healthy, age-matched controls. Participants were six licensed AT practitioners and seven healthy age-matched controls between the ages of 61-76. During the stance phase, AT participants exhibited significantly greater ankle stance range of motion (ROM) and plantar flexion at toe off, as well as lower ROM of the trunk and head compared to controls. During the swing phase, the AT practitioners had significantly increased hip and knee flexion and a trend toward significantly increased dorsiflexion. The findings suggest that the older AT practitioners walked with gait patterns more similar to those found in the literature for younger adults. These promising results highlight the need for further research to assess the AT’s potential role as an intervention method for ameliorating the deleterious changes in gait that occur with aging.

    Be well!

    JP

  12. JP Says:

    Updated 12/14/16:

    https://www.ncbi.nlm.nih.gov/pubmed/27942207

    Clin Interv Aging. 2016 Nov 30;11:1763-1771.

    Effects of short-term Nordic walking training on sarcopenia-related parameters in women with low bone mass: a preliminary study.

    BACKGROUND: Several studies have demonstrated the positive effects of physical activity on skeletal muscle mass and muscle strength in women with osteoporosis. However, the impact of Nordic walking training on sarcopenia-related parameters in women with low bone mass remains unknown. Therefore, the purpose of this study was to evaluate the impact of 12 weeks of Nordic walking training on skeletal muscle index, muscle strength, functional mobility, and functional performance in women with low bone mass.

    MATERIALS AND METHODS: The participants were 45 women, aged 63-79 years, with osteopenia or osteoporosis. The subjects were randomly assigned either to an experimental group (12 weeks of Nordic walking training, three times a week) or to a control group. Skeletal muscle mass and other body composition factors were measured with octapolar bioimpedance InBody 720 analyser. Knee extensor and flexor isometric muscle strength were measured using Biodex System 4 Pro™ dynamometers. This study also used a SAEHAN Digital Hand Dynamometer to measure handgrip muscle strength. The timed up-and-go test was used to measure functional mobility, and the 6-minute walk test was used to measure functional performance.

    RESULTS: Short-term Nordic walking training induced a significant increase in skeletal muscle mass (P=0.007), skeletal muscle index (P=0.007), strength index of the knee extensor (P=0.016), flexor (P<0.001), functional mobility (P<0.001), and functional performance (P<0.001) and a significant decrease in body mass (P=0<006), body mass index (P<0.001), and percent body fat (P<0.001) in participants. Regarding handgrip muscle strength, no improvement was registered (P=0.315). No significant changes in any of the analyzed parameters were observed in the control group.

    CONCLUSION: Overall, short-term Nordic walking training induces positive changes in knee muscle strength and functional performance in women with low bone mass. This finding could be applied in clinical practice for intervention programs in women with osteopenia and osteoporosis.

    Be well!

    JP

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