Walking to health

Differences in balance control between healthy younger and older adults during steady-state walking

Each year approximately one third of older adults fall and experience extensive musculoskeletal injuries and functional disabilities. An important element in maintaining dynamic balance is the regulation of whole-body angular momentum, which is achieved by proper foot placement with respect to the body center-of-mass as well as generation of appropriate ground reaction forces. Analyzing these quantities in younger and older adults may provide insight into differences in their underlying mechanics for maintaining dynamic balance. This study examined three-dimensional whole-body angular momentum in 13 healthy older (71.8 ± 8.3 years) and 9 younger (23.2 ± 2.8 years) adults walking at their self-selected and fastest-comfortable speeds. The older adults had a significantly higher range of frontal-plane angular momentum compared to the younger adults at both speeds, suggesting poorer mediolateral balance control. This difference was related to the older adults having a wider foot placement with respect to the body center-of-mass, which when combined with the vertical ground reaction force, created a higher destabilizing external moment during single-limb stance that acts to rotate the body towards the contralateral swing leg. To counteract this destabilizing moment, the older adults generated a higher hip abduction moment. There were no differences in the range of sagittal- and transverse-plane angular momentum between age groups at either speed. These results suggest that control of dynamic balance in the frontal-plane is more challenging than in the sagittal-plane for older adults and highlight the importance of proper weight transfer mechanisms and hip abductor force production for maintaining mediolateral balance during walking.

Interest and preferences for physical activity programming and counselling among cancer patients aged over 70 years receiving oncological treatments

OBJECTIVE

The objective of this study is to assess the physical activity interest and preferences of cancer patients aged over 70 years during oncological treatments and to explore how demographic characteristics may modulate preferences.

METHODS

From April to May 2018, this cross-sectional study collected data from self-administered questionnaire regarding physical activity interest and preferences in cancer patients receiving oncological treatments in a regional cancer centre.

RESULTS

A total of 144 patients completed the questionnaire. Two thirds (n = 95) showed interest in participating in dedicated physical activity programme during oncologic treatments. Patients preferred to exercise in group activities, under the supervision of an exercise instructor, once a week, at a moderate intensity, for 30 min session, in a community fitness centre. Women significantly preferred exercises to improve flexibility (p = 0.03) and to receive counselling in a group (p = 0.03), whereas men preferred to practise strength training (p = 0.02) and to receive counselling with brochures (p = 0.02). As age increases, participants were significantly more inclined to practise physical activity to improve their balance (p = 0.01).

CONCLUSION

These preliminary results will facilitate the design of programmes considering current physical activity preferences in older adults with cancer, which could ensure better adherence to physical activity programmes and, in turn, improved health outcomes.

Exercise-Based Interventions in Middle-Aged and Older Adults after Myocardial Infarction: A Systematic Review

This study summarized the relevant literature and aimed to determine the effect of exercise-based interventions after myocardial infarction in middle-aged and older adults. Studies were identified and analyzed according to the PRISMA guidelines. The following electronic databases were used: Google Scholar, PubMed, Mendeley, Science Direct, and Scopus. The identified studies had to be longitudinal, be published in English, have taken place between 2010 and 2020, involve participants who had suffered myocardial infarction, and address different types of exercise-based interventions to be included. Of the 592 relevant studies identified, 20 were included in the qualitative analysis. After analyzing the results obtained, it could be concluded that different types of exercise-based interventions or their combination have a positive effect after myocardial infarction in middle-aged and elderly adults. It can also be suggested that the combination of a cycle ergometer and a treadmill may be the most effective exercise-based intervention. An adequate choice of intensity and volume is crucial, with the optimal duration of the experimental program and the type(s) of exercises adapted to participants after myocardial infarction.

Number of steps and systolic blood pressure: Do work and leisure matter?

The number of steps per day influences blood pressure and health. However, the association between steps at work and leisure and blood pressure is unknown. Thus, we aimed to investigate the association between the domain‐specific number of steps and systolic blood pressure. A thigh‐worn accelerometer was used to measure the steps of 694 workers over 1–5 consecutive days, separated into work and leisure domains using a self‐reported diary. We linearly regressed steps at work, leisure and total day against systolic blood pressure, adjusting for age, sex, body mass index, smoking, and antihypertensive medication. Additionally, we stratified the analyses on job type (blue‐collar or white‐collar). The results of this cross‐sectional analysis indicated a beneficial association between the number of steps (per 2000‐step interval) and systolic blood pressure for the total day (−0.5 mmHg; −1.0 to −0.8, 95% CI, p < 0.05) and work (−0.9 mmHg; −1.5 to −0.4, 95% CI, p < 0.05), but not for leisure (+0.1 mmHg; −0.7 to 0.9, 95% CI, p = 0.75). Blue‐collar workers took almost twice as many steps at work (9143 ± SD3837) as white‐collar workers (5863 ± SD3565) and, after stratification on job type, we observed a beneficial association between the number of steps at work and systolic blood pressure among blue‐collar workers (−1.1 mmHg; −1.7 to −0.4, 95% CI, p < 0.05), but not for white‐collar workers (−0.3 mmHg; −1.7 to 1.1, 95% CI, p = 0.7). These findings indicate that the number of steps at work, particularly among blue‐collar workers, is beneficially associated with systolic blood pressure. Such findings support the potential of work (re)design to promote walking to improve blood pressure.

Effect of Group Contingency Type on Walking: Comparisons of Effectiveness and Cost Efficiency

Group contingency (GC) is an effective and cost-efficient strategy that can be successfully applied to technology-based interventions. This study examined the relative effectiveness and cost efficiency of three types of technology-based group contingencies on walking among adults. Seventy two students were divided into teams of three. Each team was randomly assigned to one of three GC conditions (independent, interdependent, or dependent) and underwent 66 days of technology-based group contingency intervention. Sixty five participants completed the intervention and 61 completed the follow-up assessment 2 months later. Step counts and self-reported walking activity increased after the intervention under all three conditions. The proportion of participants that met the target step counts was significantly higher under the dependent group contingency condition. However, 2 months later, intervention effects were not maintained under any condition. For cost efficiency, the increase in step count per point was significantly higher under the interdependent group contingency condition. Group cohesion and social validity (point satisfaction and point utility) were significantly higher under the dependent group contingency condition. Finally, the clinical implications and limitations of this study are discussed.

Gender-Differentiated Analysis of the Correlation between Active Commuting to School vs. Active Commuting to Extracurricular Physical Activity Practice during Adolescence

Active commuting to school in children and adolescents can help achieve compliance with the World Health Organization (WHO) recommendations for physical activity. This study aimed to evaluate the relationship between the mode of transport used to go to school and the mode of transport used to go to extracurricular sports practice. Multistage random cluster sampling was conducted to include 128 schools with the participation of 11,017 students between the ages of 5 and 19. Participants completed the survey of sports habits designed by the National Sports Council. The results revealed that the mode of transport used to go to school is significantly related to the mode of transport used to go to sports practice. A total of 54.3% of students aged 5 to 19 years walk to school. A total of 23.7% of boys walk and 7.9% bike to extracurricular physical activities vs. 24.1% of girls who walk. The fact that girls only walk to extracurricular physical activities implies that the organized sports activities were nearby. Therefore, it seems crucial to have a wide range of physical activities on offer locally to promote extracurricular physical activity participation for girls.

Participation in Social Activities and Relationship between Walking Habits and Disability Incidence

Identifying the relationship between physical and social activity and disability among community-dwelling older adults may provide important information for implementing tailored interventions to prevent disability progression. The aim of this study was to determine the effect of the number of social activities on the relationship between walking habits and disability incidence in older adults. We included 2873 older adults (mean age, 73.1 years; SD, ±5.9 years) from the National Center for Geriatrics and Gerontology—Study of Geriatric Syndromes. Baseline measurements, including frequencies of physical and social activities, health conditions, physical function, cognitive function, metabolic parameters, and other potential disability risk factors (for example, the number of years of education); monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from baseline. During a mean follow-up of 35.1 months (SD, 6.4 months), 133 participants developed disability. The disability incidence was 19.0 and 27.9 per 1000 person-years for participants who walked more (≥3 times per week) and less (≤3 times per week) frequently, respectively. The potential confounding factor-adjusted disability hazard ratio was 0.67 (95% confidence interval, 0.46 to 0.96; p = 0.030). The relationship between habitual walking and the number of social activities was statistically significant (p = 0.004). The reduction of disability risk by walking was greater among participants with fewer social activities. Habitual walking was associated with disability incidence, with a more pronounced effect among older adults who were less likely to engage in social activities.

Environmental Features Influence Walking Speed: The Effect of Urban Greenery

The study investigated the rarely addressed topic of how visual environmental features can influence walking speed. Young adult participants were asked to walk on a route that leads through areas composed of urban parks and areas with a built environment with a large amount of greenery. Their walking speed was measured in selected sections. The participants walked with a small video camera, and their walk was recorded. The temporal information was derived from the video recordings. Subsequently, the participants evaluated the environmental features of the route by specific spatio-cognitive dimensions of environmental preference. The results show that walking speed in specific sections of the walking route systematically differed and reflected the environmental features. The walking speed was lower in sections with high natural characteristics and a high environmental preference. Noise here was perceived as less annoying than in sections with lower natural characteristics. The results are explained in terms of approach avoidance behavior. The findings are in accordance with environmental preference research that documents various benefits of walking in the natural environment.

Can a 'rewards-for-exercise app' increase physical activity, subjective well-being and sleep quality? An open-label single-arm trial among university staff with low to moderate physical activity levels

BACKGROUND

This study examined the impact of a 'rewards-for-exercise' mobile application on physical activity, subjective well-being and sleep quality among 148 employees in a UK university with low to moderate physical activity levels.

METHODS

A three-month open-label single-arm trial with a one-year follow-up after the end of the trial. Participants used the Sweatcoin application which converted their outdoor steps into a virtual currency used for the purchase of products available at the university campus' outlets, using an in-app marketplace. The primary outcome measure was self-reported physical activity. Secondary measures included device-measured physical activity, subjective well-being (i.e., life satisfaction, positive affect, negative affect), and self-reported sleep quality.

RESULTS

The findings show an increase in self-reported physical activity (d = 0.34), life satisfaction (d = 0.31), positive affect (d = 0.29), and sleep quality (d = 0.22) during the three-month trial period.

CONCLUSION

The study suggests that mobile incentives-for-exercise applications might increase physical activity levels, positive affect, and sleep quality, at least in the short term. The observed changes were not sustained 12 months after the end of the trial.

Muscle metabolic energy costs while modifying propulsive force generation during walking

We pose that an age-related increase in the metabolic cost of walking arises in part from a redistribution of joint power where muscles spanning the hip compensate for insufficient ankle push-off and smaller peak propulsive forces (F_P). Young adults elicit a similar redistribution when walking with smaller F_P via biofeedback. We used targeted F_P biofeedback and musculoskeletal models to estimate the metabolic costs of operating lower limb muscles in young adults walking across a range of F_P. Our simulations support the theory of distal-to-proximal redistribution of joint power as a determinant of increased metabolic cost in older adults during walking.

Latihan Berjalan Kaki terhadap Perbaikan Profil Lipid pada Wanita Dewasa Kelebihan Berat Badan

Background: Overweight and obesity are the accumulation of excess fat accumulation which has become a serious problem at the global level, one of which is an abnormality of the lipid profile (dyslipidemia) which is a trigger for cardiovascular diseases such as heart disease and stroke. Physical inactivity is one of the causes of health problems such as obesity and other metabolic disorders. Walking is a moderate-intensity aerobic physical activity suitable for all ages and has a variety of health benefits, especially in less active obese adults. Objectives: The purpose of this study was to examine and analyze walking exercise against changes in the lipid profile of overweight women Discusion: This study is a literature review conducted through online database searches of Scopus, Google Scholar, PubMed, and Science Direct to examine relevant research results regarding the benefits of walking exercise to improve lipid profile. The results showed that walking exercise was able to reduce levels of TC, TG, LDL, and increase serum HDL in overweight and obese patients if it was done with the recommended intensity, duration, and frequencyConclusions: walking exercise is an aerobic physical activity that is suitable for overweight and obese patients and has the potential to improve lipid profiles. This study is expected to be the basis for recommendations to increase daily physical activity for the prevention of cardiovascular disease.

Mental movements: How long-distance walking influences reflection processes among middle-age and older adults

By providing a distinctive room for reflection, long-distance walks can help people similar to professional counselling. To understand reflection processes' influence on mental health, a framework focusing on personal transformations, specifically through the concept of liminality, can be used. Through nine semi-structured interviews with middle-aged and older long-distance walkers, this study answers the following question: How do middle-aged and older adults experience long-distance walking, and how do their experiences influence their reflective process? Four themes emerged during the analysis: (1) overcoming strain and achieving a sense of capability; (2) simplicity in obligations and having the time to pursue emotionally difficult experiences; (3) solitariness and reflection on oneself; and (4) calmness and embracing thoughts. These findings illustrate how going on long-distance walks may be similar to entering a liminal, or transformational, space. The findings show how long-distance walks can be helpful, or perhaps even therapeutic, in situations where personal transformation is required.

Walking for hypertension

BACKGROUND

Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

OBJECTIVES

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

SEARCH METHODS

We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA

Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

MAIN RESULTS

A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.

Natural or Urban Campus Walks and Vitality in University Students: Exploratory Qualitative Findings from a Pilot Randomised Controlled Study

Despite extensive evidence of the restorative effects of nature, the potential vitalizing effects of connecting with nature are yet understudied, particularly in higher education settings. University students face high levels of stress and anxiety, and may benefit from nature-based interventions that enhance positive states such as vitality. Using preliminary data from a pilot randomized controlled study with qualitative interviews, we explored the psychological experiences associated with a brief walk either in nature or an urban environment in a sample of 13 university students. The qualitative thematic analysis revealed that walking in nature was a more energizing and vitalizing experience than the urban walk. The nature walk was also found to have both affective and cognitive enhancing effects on participants. Our study highlights the usefulness of exploring subjective psychological experiences of interacting with nature, as well as supporting its restorative potential. Implications for further research and interventions are discussed.

Frequency of interruptions to prolonged sitting and postprandial metabolic responses in young, obese, Chinese men

This study aimed to examine the effects of 3-min light-intensity walking every 30 min (3-min) and 6-min light-intensity walking every 60 min (6-min) compared with prolonged sitting (SIT) on the postprandial metabolic responses in young, centrally obese, Chinese men. Twenty-one Chinese men with central obesity (age, 23 ± 4 years; body mass index, 29.8 ± 3.2 kg·m^-2; waist circumference, 98.7 ± 7.1 cm; mean ± SD) underwent three 6-h experiments with a 7-day washout period, SIT, 3-min, and 6-min, in randomized order. Compared with SIT, neither walking condition showed differences in total and net incremental area under the curve (tAUC and iAUC, respectively) for glucose, insulin, nor non-esterified fatty acids. The tAUC and iAUC for triglycerides for the SIT condition (10.8 [9.3, 12.2] and 4.4 [3.7, 5.1] mmol·h·L^-1, respectively; mean [95% confidence interval]) was higher than 3-min (10.4 [9.0, 11.8] and 3.8 [3.3, 4.3] mmol·h·L^-1, respectively, both Ps <0.05) and 6-min (9.6 [8.1, 11.0] and 3.5 [2.9, 4.2] mmol·h·L^-1, respectively, both Ps <0.01) conditions. Interrupting prolonged sitting regardless of frequency-reduced postprandial triglycerides. A higher volume of physical activity may be required to obtain greater glycaemic benefits in young Chinese men with central obesity.

Outdoor Walking Speeds of Apparently Healthy Adults: A Systematic Review and Meta-analysis

BACKGROUND

Walking outdoors can be used by many individuals to meet public health guidelines for moderate-to-vigorous-intensity physical activity. The speed at which adults walk may be a proxy for intensity. Traditional estimates of indoor walking speed are unlikely to reflect self-selected usual or other instructed paces of outdoor walking speed.

OBJECTIVE

To inform estimates of pace-based walking speed of apparently healthy adults in outdoor settings.

METHODS

We searched four electronic databases for articles published in English between January 1970 and March 2019. Studies that reported walking speed (m/s), cadence (steps/min), or intensity (mL/kg/min) of ambulatory, apparently healthy, and community-dwelling adults (> 18 years) were included. Walking speed categories were defined according to the description provided in each study. Meta-analysis was used to synthesise speed, cadence, and intensity data by slow, usual, medium, fast, and maximal pace (where reported).

RESULTS

Thirty-five studies, representing 14,015 participants (6808 women, 5135 men, and 2072 sex not specified), were identified. The mean (95% CI) walking speed for slow, usual, medium, fast, and maximal pace was 0.82 (0.77-0.86), 1.31 (1.27-1.35), 1.47 (1.44-1.49), 1.72 (1.64-1.81), and 1.62 (1.45-1.79) m/s, respectively. Mean cadence (95% CI) for usual and fast paces were 116.65 (114.95-118.35) and 126.75 (121.87-131.63) steps/min, respectively. The mean oxygen consumption (95% CI) for the usual and medium paces was 11.97 (11.69-12.25) and 13.34 (12.94-13.73) mL/kg/min, respectively.

CONCLUSION

These findings provide greater clarity with regard to how various indicators of enacted walking pace, speed, and intensity overlap and how each can be best communicated in the real-world setting to optimise health-related outcomes. Pace-based instructions can be used to support walking in outdoor settings within public health guidelines.

Effects of a single bout of walking on postprandial triglycerides in men of Chinese, European and Japanese descent: a multisite randomised crossover trial

Introduction

Elevated non-fasting triglyceride (TG) concentrations are a risk factor for cardiovascular diseases but can be reduced after acute exercise. Ethnic-based differences in the magnitude of postprandial lipaemia and the extent that acute exercise reduces postprandial TG are poorly characterised across some ethnicities including those of East Asian origin. This paper describes the protocol of a multisite randomised crossover study comparing the effect of acute walking on postprandial TG in two groups of East Asian men with European men.

Methods and analysis

Twenty Japanese, 20 Singaporean Chinese and 20 white British healthy men (21–39 years) recruited from Japan, Singapore and the UK, respectively, will complete two, 2-day trials. Fasted and postprandial venous blood samples and arterial blood pressure measurements will be taken over 6 hours the day after either: (1) 60-min treadmill walking; or (2) a rest day of normal living. The primary outcome is the difference in postprandial TG among ethnic groups after rest and walking. Secondary outcomes include cholesterol, glucose, insulin, ketone bodies, preheparin lipoprotein lipase, C-reactive protein and systolic/diastolic blood pressure.

Ethics and dissemination

The study was approved by the Ethics Review Committee on Research with Human Subjects of Waseda University and the Nanyang Technological University Institutional Review Board. Relevant approval will be obtained from the UK site. Research findings will be disseminated through peer-reviewed journal publication and health conferences.

Trial registration number

UMIN000038625.

Association between objectively measured walking steps and sleep in community-dwelling older adults: A prospective cohort study

Physical inactivity and sleep disturbances are major problems in an ageing society. There is increasing evidence that physical activity is associated with sleep quality. However, the association between daily walking steps and sleep remain unclear. This prospective study examined the relationship between objectively measured daily walking steps and sleep parameters in Japanese community-dwelling older adults. In total, 855 community-dwelling individuals aged 65 and above, with an uninterrupted follow-up from August 2015 to March 2016, were enrolled. The participants wore a wristband sensor for an average of 7.8 days every three months. Multiple linear regression analysis was performed to examine the relationship between daily walking steps and sleep parameters, including the total sleep time, sleep efficiency, time awake after sleep onset (WASO), awakening time count during the night, and naptime. The median (interquartile range, IQR) age of the participants was 73 (69–78) years, with 317 (37.1%) men and 538 (62.9%) women. The median (IQR) educational level was 12 (11–12) years, and the median (IQR) Mini-Mental State Examination score was 29 (27–30) points. The number of daily walking steps showed a positive correlation with sleep efficiency and an inverse correlation with WASO, awakening time count, and naptime, after adjusting for covariates and correcting for the false discovery rate (β = 0.098, 95% confidence interval [CI]: 0.034 to 0.162, p = 0.003; β = −0.107, 95% CI: −0.172 to −0.043, p = 0.001; β = −0.105, 95% CI: −0.17 to −0.04, p = 0.002; and β = −0.31, 95% CI: −0.371 to −0.249, p < 0.001, respectively). Our results can help promote walking as an intervention for preventing sleep disturbances in community-dwelling older adults.

Estimating Walking Speed in the Wild

An individual's physical activity substantially impacts the potential for prevention and recovery from diverse health issues, including cardiovascular diseases. Precise quantification of a patient's level of day-to-day physical activity, which can be characterized by the type, intensity, and duration of movement, is crucial for clinicians. Walking is a primary and fundamental physical activity for most individuals. Walking speed has been shown to correlate with various heart pathologies and overall function. As such, it is often used as a metric to assess health performance. A range of clinical walking tests exist to evaluate gait and inform clinical decision-making. However, these assessments are often short, provide qualitative movement assessments, and are performed in a clinical setting that is not representative of the real-world. Technological advancements in wearable sensing and associated algorithms enable new opportunities to complement in-clinic evaluations of movement during free-living. However, the use of wearable devices to inform clinical decisions presents several challenges, including lack of subject compliance and limited sensor battery life. To bridge the gap between free-living and clinical environments, we propose an approach in which we utilize different wearable sensors at different temporal scales and resolutions. Here, we present a method to accurately estimate gait speed in the free-living environment from a low-power, lightweight accelerometer-based bio-logging tag secured on the thigh. We use high-resolution measurements of gait kinematics to build subject-specific data-driven models to accurately map stride frequencies extracted from the bio-logging system to stride speeds. The model-based estimates of stride speed were evaluated using a long outdoor walk and compared to stride parameters calculated from a foot-worn inertial measurement unit using the zero-velocity update algorithm. The proposed method presents an average concordance correlation coefficient of 0.80 for all subjects, and 97% of the error is within ±0.2m· s -1. The approach presented here provides promising results that can enable clinicians to complement their existing assessments of activity level and fitness with measurements of movement duration and intensity (walking speed) extracted at a week time scale and in the patients' free-living environment.

Active living environments, physical activity and premature cardiometabolic mortality in Canada: a nationwide cohort study

OBJECTIVE

To evaluate sex-specific and age-specific associations of active living environments (ALEs) with premature cardiometabolic mortality.

DESIGN

Population-based retrospective cohort study.

SETTING

Residential neighbourhoods (1000-metre circular buffers from the centroids of dissemination areas) across Canada for which the Canadian ALE Measure was derived, based on intersection density, points of interest and dwelling density.

PARTICIPANTS

249 420 survey respondents from an individual-level record linkage between the Canadian Community Health Survey (2000-2010) and the Canadian Mortality Database until 2011, comprised of older women (65-85 years), older men (65-81 years), middle-aged women (45-64 years) and middle-aged men (45-64 years).

PRIMARY OUTCOME MEASURES

Premature cardiometabolic mortality and average daily energy expenditure attributable to walking. Multivariable proportional hazards regression models were adjusted for age, educational attainment, dissemination area-level median income, smoking status, obesity, the presence of chronic conditions, season of survey response and survey cycle.

RESULTS

Survey respondents contributed a total of 1 451 913 person-years. Greater walking was observed in more favourable ALEs. Walking was associated with lower cardiometabolic death in all groups except for middle-aged men. Favourable ALEs conferred a 22% reduction in death from cardiometabolic causes (HR 0.78, 95% CI 0.63 to 0.97) for older women.

CONCLUSIONS

On average, people walk more in favourable ALEs, regardless of sex and age. With the exception of middle-aged men, walking is associated with lower premature cardiometabolic death. Older women living in neighbourhoods that favour active living live longer.

The association between light intensity physical activity with gait speed in older adults (≥ 50 years). A longitudinal analysis using the English Longitudinal Study of Ageing (ELSA)

AIMS

Fall prevention is an important health consideration for older adults. The benefits of moderate-to-vigorous intensity physical activity (MVPA) for fall prevention are well established. Few studies have explored the association between low intensity physical activity (LPA) and fall risk in older adults over time.

METHODS

Six waves of data from the English Longitudinal Study of Ageing (ELSA) were analysed. The measures of physical activity (PA) intensity were developed using latent class analysis (LCA). Then, the association between PA intensity and gait speed was analysed using a latent growth model (LGM).

RESULTS

Latent class analysis identified three classes of PA-inactive, low intensity, and moderate-vigorous intensity PA. LGM analysis showed that MVPA (Est 1.12, SE 0.05) was associated with a faster gait speed and slower rate of decline over time. LPA (Est 0.96; SE 0.12) was more beneficial than being inactive. Age was found to influence gait speed where MVPA was associated with better gait speed in adults aged ≤ 70 years, and LPA was associated with better gait speed for adults aged ≥ 70 years.

DISCUSSION

Moderate-to-vigorous intensity physical activity maybe more beneficial for older adults and current policy supports this. However, LPA is associated with better gait speed in older adults aged ≥ 70 years and also maybe more achievable for older adults.

CONCLUSION

Therefore, future fall prevention interventions should also include recommendations for LPA for old-older adults (≥ 70 years).

The current global state of movement and physical activity - the health and economic costs of the inactive phenotype

Physical inactivity is one of the major contributing factors to the global pandemic of non-communicable diseases. Unfortunately, low levels of habitual movement and physical activity (PA) are seen in an increasing proportion of populations across low- and middle-income countries and high-income countries alike. This new normal - the inactive phenotype - is a significant contributor to multiple health and economic costs. Here we provide a brief historical overview of societal declines in PA, roughly consistent with major transitions in PA and nutrition in recent decades. This is followed by a synthesis of research evidence linking inactivity with poor health outcomes and prevention approaches needed to impact a perpetuation of poor lifestyle behaviors. A major focus of the paper is on the economic/health costs and the reduction of the inactive phenotype. In summary, we demonstrate that the consequences of insufficient PA are manifold, and if sustained, impact short and long-term health and quality of life, along with substantial economic costs.

Selected characteristics and injury patterns by age group among pedestrians treated in North Carolina emergency departments

OBJECTIVE

The objective of this study was to describe pedestrian demographic characteristics, crash characteristics, selected health outcomes, and injury patterns by age using linked North Carolina (NC) crash-emergency department (ED) visit data for the period October 1, 2010, to September 30, 2015.

METHODS

This was a descriptive epidemiologic study. To examine both crash and health outcomes, NC pedestrian crash records were linked to statewide NC ED visit records using hierarchical deterministic methods. Pearson chi-square tests were used to compare the frequencies of pedestrians treated in NC EDs by sex, race/ethnicity, crash location, rurality, estimated driver speed at impact, ambient light, hospitalization/death, location of injury, and nature of injury, stratified by the following age groups: 0-14, 15-24, 25-64, and ≥65 years.

RESULTS

Most pedestrians treated in NC EDs were male (57.5%), except among adults ≥65 years old (47.5%). Over half of all injured pedestrians aged 0-14 (52.6%) and 15-24 (50.5%) years were Black/African American, and 70.8% of injured pedestrians ≥65 years were white. Among pedestrians aged 25-64 years, no single racial/ethnic group was the majority. Though most pedestrians were injured on trafficways (71.7%) and at speeds ≤35 mph (80.1%), adults ≥65 years were less likely to be involved in on-trafficway crashes (51.0%) and pedestrians aged 15-24 years were more likely to be involved in >35 mph crashes (22.9%) compared to other age groups. Most pedestrians were injured under daylight conditions (56.9%). Regarding selected health outcomes, the highest frequency of hospitalization/death was for pedestrians aged ≥65 years (26.3%), compared to those aged 0-14 years (18.8%) and 15-64 years (12.4%). In terms of location of injury, 0- to 14-year-olds had the highest proportion of head injuries (39.5%), and adults ≥65 years of age had the highest proportion of spinal column/vertebral column (12.6%) and upper extremity injuries (33.2%). For nature of injury, 0- to 14-year-olds had the highest proportion of traumatic brain injuries (11.4%) and superficial wounds and contusions (62.8%). Adults aged ≥65 years had the highest proportion of open wounds/amputations and fractures (16.1%). Adults aged 25-64 years had the highest proportion of strains/sprains/dislocations (18.7%).

CONCLUSIONS

There were considerable differences in demographic characteristics, crash characteristics, frequency of hospitalization/death, and injury patterns by age group. It is important to design streets and implement transportation policies and programs that improve safety for all pedestrians.

The effects of step-count monitoring interventions on physical activity: systematic review and meta-analysis of community-based randomised controlled trials in adults

Background

Step-count monitors (pedometers, body-worn trackers and smartphone applications) can increase walking, helping to tackle physical inactivity. We aimed to assess the effect of step-count monitors on physical activity (PA) in randomised controlled trials (RCTs) amongst community-dwelling adults; including longer-term effects, differences between step-count monitors, and between intervention components.

Methods

Systematic literature searches in seven databases identified RCTs in healthy adults, or those at risk of disease, published between January 2000–April 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. Outcome was mean differences (MD) with 95% confidence intervals (CI) in steps at follow-up between treatment and control groups. Our preferred outcome measure was from studies with follow-up steps adjusted for baseline steps (change studies); but we also included studies reporting follow-up differences only (end-point studies). Multivariate-meta-analysis used random-effect estimates at different time-points for change studies only. Meta-regression compared effects of different step-count monitors and intervention components amongst all studies at ≤4 months.

Results

Of 12,491 records identified, 70 RCTs (at generally low risk of bias) were included, with 57 trials (16,355 participants) included in meta-analyses: 32 provided change from baseline data; 25 provided end-point only. Multivariate meta-analysis of the 32 change studies demonstrated step-counts favoured intervention groups: MD of 1126 steps/day 95%CI [787, 1466] at ≤4 months, 1050 steps/day [602, 1498] at 6 months, 464 steps/day [301, 626] at 1 year, 121 steps/day [− 64, 306] at 2 years and 434 steps/day [191, 676] at 3–4 years. Meta-regression of the 57 trials at ≤4 months demonstrated in mutually-adjusted analyses that: end-point were similar to change studies (+ 257 steps/day [− 417, 931]); body-worn trackers/smartphone applications were less effective than pedometers (− 834 steps/day [− 1542, − 126]); and interventions providing additional counselling/incentives were not better than those without (− 812 steps/day [− 1503, − 122]).

Conclusions

Step-count monitoring leads to short and long-term step-count increases, with no evidence that either body-worn trackers/smartphone applications, or additional counselling/incentives offer further benefit over simpler pedometer-based interventions. Simple step-count monitoring interventions should be prioritised to address the public health physical inactivity challenge.

Systematic review registration

PROSPERO number CRD42017075810.

Sustainable Mobility: A Review of Possible Actions and Policies

In this paper, a review of the main actions and policies that can be implemented to promote sustainable mobility is proposed. The work aims to provide a broad, albeit necessarily not exhaustive, analysis of the main studies and research that from different points of view have focused on sustainable mobility. The structure of the paper enables the reader to easily identify the topics covered and the studies related to them, so as to guide him/her to the related in-depth studies. In the first part of the paper, there is a preliminary analysis of the concept of sustainable mobility, the main transport policies implemented by the European Union and the USA, and the main statistical data useful to analyze the problem. Next, the main policies that can promote sustainable mobility are examined, classifying them into three topics: Environmental, socio-economic, and technological. Many of the policies and actions examined could be classified into more than one of the three categories used; for each of them, there is a description and the main literature work on which the topic can be analyzed in more detail. The paper concludes with a discussion on the results obtained and the prospects for research.

Uphill walking at iso-efficiency speeds

Uphill walking gait has been extensively studied, but the optimal uphill speed able to enhance the metabolic demand without increasing fatigability has so far received little attention. Therefore, the aim of this study was to assess the metabolic/kinematic demand at constant speed (6 km·h^-1 G0 level, G2 2% uphill, G7 7% uphill) and at iso-efficiency speeds (G2IES 5.2 km·h^-1 2% uphill and G7IES 3.9 km·h^-1 7% uphill). For this aim, physically active women (n:24, Age 33.40 ± 4.97 years, BMI 21.62 ± 2.06 kg/m^-2) after an 8-min warm-up were studied on a treadmill for 10' for every walking condition with a 5' rest in between. Average heart rate (AVG-HR), rating of perceived exertion (RPE) and kinematic variables (stance time, swing time, stride length, stride cycle, stride-length variability, stride-cycle variability and internal work) were studied. Modifications in stance time, stride length and stride cycle (p<0.005), and lower internal-work values (p<0.001) occurred in G7IES in comparison to the other conditions. Swing time was significantly modified only in G7IES compared to G0 and G7 (p<0.001 and p<0.005, respectively). Stride-length variability and stride-cycle variability were higher in G7IES compared to the other conditions (p<0.001). G7 induced the highest AVG-HR (p<0.005) and RPE (p<0.001) compared to the other conditions. This study demonstrates that by applying the equation for uphill walking gait, it is possible to maintain a similar metabolic demand and RPE at iso-efficiency speeds during uphill compared to level walking, inducing at the same time a modification of the kinematic parameters of walking gait performed at the same slope condition.

Urban Parks as Green Buffers During the COVID-19 Pandemic

In many parts of the world, concerns about the COVID-19 pandemic and city quarantine policy have led to a general decline in the physical and mental health of residents due to insufficient social interaction. These adverse effects can cause potential public health risks. Ways to alleviate the adverse impact of the pandemic and meet social interaction needs must be widely addressed. This survey was conducted from 1–5 April 2020; it collected 386 responses from residents of Chengdu, China, during the pandemic based on an online survey questionnaire. The results indicate that most of the residents believe their health status is poor, and that they do not experience adequate social contact with others. Most of the respondents indicated no difference in mental health, while a few reported differences in their physical health and social interaction levels. Visiting urban parks can significantly improve overall health and assist in meeting individuals’ social interaction needs. Although residents have reduced the frequency of visits during the pandemic, even once a week can be beneficial. This paper emphasizes the critical role of urban parks during the pandemic period from the perspective of the urban building environment. The conclusion affirms that urban parks and large outdoor, open spaces can provide residents with a place for safe outdoor activities and social interaction in a green environment during a pandemic, as well as serve as a buffer area to maintain favorable health and quality of life.

Communal therapeutic mobility in group walking: A meta-ethnography

Increased attention to links between walking, health and wellbeing have contributed to a growth in the number of walking groups meeting on a regular basis to offer short, social walks. Walking group interventions are known to increase physical activity and to have wide-ranging health benefits, and there is evidence that drop out is generally low. The aim of this paper is to synthesise qualitative research on experiences and perceptions of group walking in order to develop a new conceptual understanding of the group walking experience. We conducted a systematic search of the literature and identified 22 such studies which we synthesised using meta-ethnography. Included studies were conducted in the UK, USA, Australia and Ireland. Most reported research was undertaken with outdoor walking groups, some of which catered specifically for people who shared a disease experience or a disability. A smaller number of studies examined indoor mall walking groups, while two looked at perceptions of non-participants of group walking as a potential activity. From the original constructs identified in the papers we derived five higher order constructs: seeking and enjoying health and fitness, attachment to walking, providing purpose and confidence, mobile companionship and a peaceful and contemplative shared respite from everyday life. We argue that participating in a walking group provides a set of experiences that together constitute a specific form of shared or communal therapeutic mobility that is not simply the accumulation of the constructs we have outlined. Rather, we suggest that an initial instrumental and disciplinary focus on health and fitness is transformed through the experience of group walking into a shared meaningful and enjoyable practice; an emergent communal therapeutic mobility, which recruits and retains large numbers of group walkers. However, this communal therapeutic mobility is not equally accessible to all.

Walking together: women with the severe symptoms of menopause propose a platform for a walking program; outcome from focus groups

Background

Menopause and midlife are stages in a woman’s life that can be marked by debilitating symptoms and increasing risks for cancer, cardiovascular, metabolic, and bone health issues. Walking represents a simple, low cost, and widely accessible activity with proven health benefits, though its therapeutic effect on alleviating menopause symptoms is not well characterized. Women are generally not opposed to exercise programs; however, increasing or maintaining exercise levels remains a challenge. We undertook a qualitative descriptive study to explore features of a walking program that would be conductive to menopausal women’s participation, as well as to inform the development of such a program.

Methods

We conducted focus groups with women recruited from two menopause clinics and who suffered from moderate to severe menopause symptoms. The focus groups were audio recorded and transcribed. Women were prompted to talk about their menopause experience and exercise practice and how they would envision a walking exercise program that would keep them engaged. Qualitative content analysis was used to analyze the data and to identify characteristics of a walking exercise program.

Results

Twenty women participated in 5 focus groups. Women were very interested in trying walking as a means of staying healthy and possibly reducing menopause symptoms. Four major characteristics emerged as important for a walking program: (a) sensitivity to health realities of menopausal women, (b) inclusivity of various needs/levels of physical ability, (c) attentiveness to the need for mutual social support, (d) flexibility in planning of locations and scheduling.

A restricted social network platform with features catering to women in menopause was suggested as suitable to initiate and sustain an adequate walking program.

Conclusions

The findings of this study will be essential in designing a program that would be attractive for women to start and maintain a walking habit. The program would assist in elucidating whether walking is a useful and valuable alternative therapy for menopausal symptoms and, ultimately, might help women staying fit in midlife and postmenopausal.

Can we walk away from cardiovascular disease risk or do we have to 'huff and puff'? A cross-sectional compositional accelerometer data analysis among adults and older adults in the Copenhagen City Heart Study

Background

It is unclear whether walking can decrease cardiovascular disease (CVD) risk or if high intensity physical activity (HIPA) is needed, and whether the association is modified by age. We investigated how sedentary behaviour, walking, and HIPA, were associated with systolic blood pressure (SBP), waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C) among adults and older adults in a general population sample using compositional data analysis. Specifically, the measure of association was quantified by reallocating time between sedentary behaviour and 1) walking, and 2) HIPA.

Methods

Cross-sectional data from the fifth examination of the Copenhagen City Heart Study was used. Using the software Acti4, we estimated daily time spent in physical behaviours from accelerometer data worn 24 h/day for 7 days (i.e., right frontal thigh and iliac crest; median wear time: 6 days, 23.8 h/day). SBP, WC, and LDL-C were measured during a physical examination. Inclusion criteria were ≥ 5 days with ≥16 h of accelerometer recordings per day, and no use of antihypertensives, diuretics or cholesterol lowering medicine. The 24-h physical behaviour composition consisted of sedentary behaviour, standing, moving, walking, HIPA (i.e., sum of climbing stairs, running, cycling, and rowing), and time in bed. We used fitted values from linear regression models to predict the difference in outcome given the investigated time reallocations relative to the group-specific mean composition.

Results

Among 1053 eligible participants, we found an interaction between the physical behaviour composition and age. Age-stratified analyses (i.e., </≥65 years; 773 adults, 280 older adults) indicated that less sedentary behaviour and more walking was associated with lower SBP among older adults only. For less sedentary behaviour and more HIPA, the results i) indicated an association with a lower SBP irrespective of age, ii) showed an association with a smaller WC among adults, and iii) showed an association with a lower LDL-C in both age groups.

Conclusions

Less sedentary behaviour and more walking seems to be associated with lower CVD risk among older adults, while HIPA types are associated with lower risk among adults. Therefore, to reduce CVD risk, the modifying effect of age should be considered in future physical activity-promoting initiatives.

Correlates of walking among disadvantaged groups: A systematic review

Socioeconomically disadvantaged groups are less likely to be physically active. Walking is important to public health, therefore understanding correlates of walking will inform the development of targeted interventions. The aim of this systematic review was to examine the correlates of walking among socioeconomically disadvantaged adults. PubMed/MEDLINE and Scopus were searched up to February 2020 and titles/abstracts and full-texts were screened against eligibility criteria. Methodological quality was assessed. Correlates were synthesized when two or more comparisons were available. 35 studies were selected for synthesis. 21 examined overall walking, 16 examined leisure-time walking and 9 examined walking for transport (8 examined two or more types of walking). Employment status, home ownership, self-rated health, density or number of social ties, perceived neighborhood aesthetics, perceived walkability and perceived individual safety were positively associated with overall walking. Social support for physical activity from friends and family and perceived individual safety were positively associated with leisure-time walking. Objective walkability, perceived walkability and perceived individual safety were positively associated with walking for transport. Most studies were cross-sectional, did not report response rates and used a validated measure of physical activity. Strategies to improve self-rated health, social ties, neighborhood aesthetics, walkability and perceptions of individual safety should be the focus of interventions that aim to improve walking among socioeconomically disadvantaged groups. Recommendations for future studies include the need to focus on leisure-time walking and walking for transport; the correlates of walking in males; prospective longitudinal designs; psychological, cognitive and emotional variables; and social, behavioral attributes and skills.

Which Components of a Smartphone Walking App Help Users to Reach Personalized Step Goals? Results From an Optimization Trial

BACKGROUND

The Assistant to Lift your Level of activitY (Ally) app is a smartphone application that combines financial incentives with chatbot-guided interventions to encourage users to reach personalized daily step goals.

PURPOSE

To evaluate the effects of incentives, weekly planning, and daily self-monitoring prompts that were used as intervention components as part of the Ally app.

METHODS

We conducted an 8 week optimization trial with n = 274 insurees of a health insurance company in Switzerland. At baseline, participants were randomized to different incentive conditions (cash incentives vs. charity incentives vs. no incentives). Over the course of the study, participants were randomized weekly to different planning conditions (action planning vs. coping planning vs. no planning) and daily to receiving or not receiving a self-monitoring prompt. Primary outcome was the achievement of personalized daily step goals.

RESULTS

Study participants were more active and healthier than the general Swiss population. Daily cash incentives increased step-goal achievement by 8.1%, 95% confidence interval (CI): [2.1, 14.1] and, only in the no-incentive control group, action planning increased step-goal achievement by 5.8%, 95% CI: [1.2, 10.4]. Charity incentives, self-monitoring prompts, and coping planning did not affect physical activity. Engagement with planning interventions and self-monitoring prompts was low and 30% of participants stopped using the app over the course of the study.

CONCLUSIONS

Daily cash incentives increased physical activity in the short term. Planning interventions and self-monitoring prompts require revision before they can be included in future versions of the app. Selection effects and engagement can be important challenges for physical-activity apps.

CLINICAL TRIAL INFORMATION

This study was registered on ClinicalTrials.gov, NCT03384550.

Sedentarism, Physical Activity, Steps, and Neurotrophic Factors in Obese Children

PURPOSE

This study aimed to examine the associations of sedentary time, physical activity (PA) and step-related behaviors with neurotrophic growth factors.

METHODS

A total of 97 children with overweight/obesity age 8 to 11 yr participated in this study. Sedentary time, PA, and steps were measured by GT3X+ accelerometers in hip and nondominant wrist. Estimates of light, moderate, vigorous, and moderate-to-vigorous PA (MVPA) were obtained. Steps per daytime, peak 60-, 30-, and 1-min cadence were computed. The time accumulated (min·d) in different cadence bands of steps was also computed from hip accelerometer. Plasma levels of brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin growth factor-1 (IGF-1) were determined by the XMap technology (Luminex IS 100/200 system, Luminex Corporation, Austin, TX).

RESULTS

Light PA, moderate PA, MVPA, and the peak 60-min cadence were positively related with BDNF concentrations (all P < 0.05), and only light PA to VEGF (P = 0.048). No association was observed for IGF-1 (P > 0.05). The associations of light PA with BDNF and VEGF disappeared (all P > 0.05) after performing analyses with nondominant wrist-placement data. However, moderate PA and MVPA remained significantly associated with BDNF (both P < 0.05). The time accumulated in cadence bands of 40 to 59 steps per day and 60 to 79 steps per day (i.e., walking at slow pace) was positively associated with plasma BDNF (all P < 0.05).

CONCLUSIONS

In conclusion, PA is positively related to plasma BDNF, whereas no relationship was observed for VEGF or IGF-1. Higher amounts of time spent in slow walking cadence bands could increment BDNF levels. Exercise-based randomized controlled trials in children with overweight/obesity should be carried out to better understand the influence of PA behaviors on the neurotrophic factors.

What does real-world walking mean to people with stroke? An interpretive descriptive study

Purpose: Understanding personal experiences of real-world walking for stroke survivors could assist clinicians to tailor interventions to their clients' specific needs. We explored the research questions: "What does real-world walking mean to people after stroke and how do they think it can be better?"Method: Using an Interpretive Descriptive methodology, we purposively sampled eight stroke survivors who reported difficulty walking in the real-world. We sought diversity on key participant characteristics. Participants were interviewed using a semi-structured guide. Data were analysed with thematic analysis.Results: Many found real-world walking, particularly in the outdoors, created opportunities for freedom from dependence and a visible step by step progress, which generated hope for future recovery. Conversely, when participants did not experience sufficient progress, they expressed negative emotions. Participants strove to overcome challenges to their walking goals using everyday routines, planning skills, and confidence building experiences to motivate themselves. They also drew on, and extended, social resources highlighting the relational aspects of real-world walking.Conclusions: Walking in their real-world provided a meaningful, desirable, but challenging goal for participants that required significant emotional effort. Successful progress in real-world walking builds confidence and hope and can contribute to psychological wellbeing by providing opportunities for successful mastery and social connectedness.IMPLICATIONS FOR REHABILITATIONReal-world settings can be unpredictable which makes walking in the real-world after stroke demanding.Positive experiences of walking in the real-world can provide significant psychological benefits to stroke survivors.Many survivors need to carefully concentrate on the act of walking in outdoor settings.Pre-planning routes, confidence-building experiences and developing daily routines may help patients overcome these challenges.

[Development and Effects of Smartphone App-Based Walking Exercise Program for Taxi Drivers: Based on Bandura's Self Efficacy Theory]

PURPOSE

The purpose of this study was to examine the effects of smart-phone app-based walking exercise programs for taxi drivers on self-efficacy and outcome expectations for exercise, health-related quality of life, walking as an exercise, and physiological indexes.

METHODS

A nonequivalent control group with a pre-post-test design was used. The subjects were recruited in G metropolitan city. Subjects were assigned to the experimental (n=31) or control groups (n=30). The smart phone app-based walking exercise program consisted of educations via the app, twelve short message services, and one individual telephone counseling session, which was spread over 12 weeks.

RESULTS

Self-efficacy, outcome expectations, and health-related quality of life had significantly higher pre-post test differences in scores in the experimental group. Additionally, blood pressure, body mass index, and waist circumference had significantly decreased pre-post-test difference levels in the experimental group. Walking as an exercise (which consisted of days walked, number of steps walked, and amount of time walked) had significantly increased in the experimental group after 7~12 weeks in the period following the intervention program rather than 1~6 weeks after the program.

CONCLUSION

The smart phone app-based walking exercise program based on the self-efficacy theory demonstrates a significant effect on improving self-efficacy, outcome expectations physical activities, and health-related quality of life for taxi drivers. Therefore, it is recommended to actively use the program as a tool to promote self-efficacy, physical activities, and health behaviors in taxi drivers.

A study protocol for a clustered randomised controlled trial to evaluate the effectiveness of a peer-led school-based walking intervention on adolescent girls' physical activity: the Walking In ScHools (WISH) study

Background

Adolescent girls in the UK and Ireland are failing to meet current physical activity guidelines. Physical activity behaviours track from childhood to adulthood and it is important that adolescent girls are provided with opportunities to be physically active. Walking has been a central focus for physical activity promotion in adults and may effectively increase physical activity levels among younger people. Following on from a pilot feasibility trial, the purpose of this cluster randomised controlled trial (c-RCT) is to evaluate the effectiveness of a novel, low-cost, peer-led school-based walking intervention delivered across the school year at increasing physical activity levels of adolescent girls.

Methods

The Walking In ScHools (WISH) Study is a school-based c-RCT conducted with girls aged 12–14 years from eighteen schools across the Border Region of Ireland / Northern Ireland. Following baseline data collection, schools will be randomly allocated to intervention or control group. In intervention schools, female pupils aged 15–18 years will be invited to train as walk leaders and will lead younger pupils in 10–15 min walks before school, at break and lunch recess. All walks will take place in school grounds and pupils will be encouraged to participate in as many walks as possible each week. The intervention will be delivered for the whole school year (minimum 20–22 weeks). The primary outcome measure is accelerometer-measured total physical activity (counts per minute) (end of intervention). Secondary outcomes will include time spent in sedentary behaviour, light, moderate and vigorous intensity physical activity, anthropometry measures, social media usage and sleep. A mixed-methods process evaluation will also be undertaken.

Discussion

The WISH Study will examine the effectiveness of a low-cost, school-based, peer-led walking intervention in increasing physical activity in adolescent girls when delivered across the school year. If the intervention increases physical activity, it would benefit adolescent girls in the defined target area with potential for wider adoption by schools across the UK and Ireland.

Trial registration

ISRCTN; ISRCTN12847782; Registered 2nd July 2019.

Walking in Natural Environments as Geriatrician’s Recommendation for Fall Prevention: Preliminary Outcomes from the “Passiata Day” Model

Background: The Geriatric Unit of the University of Palermo developed the “Passiata Day” model, a green exercise intervention consisting of a one-hour walk, once/week, in a city park. The purpose of this study was to assess body balance in older people who walked regularly compared to sedentary people. Methods: 106 older people (75 women and 31 men; mean age: 72.3 ± 8.2 years) without fall history were invited to participate voluntarily in this natural environment walking program. After six months, both the participants who had taken part regularly in the walk (i.e., the physical activity group (PAG; n = 72; 54 women and 18 men; mean age: 70.7 ± 7.2 years)), and who had not accepted to be included in the outdoor walking program (i.e., the sedentary group (SG; n = 34; 21 women and 13 men; mean age: 75.5 ± 9.4 years)), performed a stabilometric test with open eyes (OE) and with closed eyes (CE). Results: Our preliminary results showed significant differences between groups on the ellipse sway area both in the OE (p < 0.05) and in CE condition (p < 0.01). Moreover, we found a significant difference on sway along the frontal plane both in the OE (p < 0.05) and in the CE condition (p < 0.01), and on sway along the sagittal plane for the test with CE (p < 0.01). Conclusion: Based on our preliminary findings, we suggest that walking regularly in an outdoor setting could lead to a greater body balance in older people and could be recommended by geriatricians for preventing the risk of falls. The next step will be to investigate the effect of an experimental outdoor walking program structured in terms of intensity, frequency and volume.

Non-vehicle commuting in Italy: need for ergonomic action for women's lower limbs?

INTRODUCTION

The aim of this paper is to examine gender differences in the occurrence of accidents among workers while walking to or from their workplace (non-vehicle commuting accidents). We have previously found that the lower limb is more often injured at work among women, compared to men, so the paper concentrates on lower limb injuries.

METHODS

Using the records of the National Institute for Insurance against Injuries at Work (INAIL), we focused on the non-vehicle commuting accidents of women and men recognized as work-related for the period 2013-2017. In particular, we examined the gender difference by work sector and type of trauma suffered with particular attention to lower limb injuries.

RESULTS

The rate of non-vehicle commuting accidents (n. 60,936) among women was significantly higher than for men (1.29‰ vs 0.40‰ men, p < 0.001) for the period studied. Lower limb injuries (50.5% for women and 43.7% for men, p < 0.001) constituted the large majority of these injuries. In particular, dislocation of the ankle (78% for women vs 65.5% for men, p < 0.001), bruise of the knee (71.2% for women vs 54.9% for men, p < 0.001) and fracture of the foot (41% for women vs 33.6% for men, p < 0.001) were all significantly higher among women. The work sectors with higher injury rates were: Transport and Warehouse, Public Administration, Health and care services and Wholesale and retail trade. This result may be due to wear and tear from conditions at work. The women injured were on the average, a decade older than men (50-59 vs 40-49 years old).

CONCLUSIONS

Non-vehicle commuting represents an important, albeight neglected, preventable risk for women workers, causing lower limb trauma particularly at the ankle, the foot and the knee. These areas may be particularly injure-prone among women in specific sectors, due to the work environment. Effective prevention of these injuries requires gender-oriented ergonomic actions at work and in the commuting environment.

Associations Between Social and Physical Environments and Older Adults' Walking for Transportation and Recreation

This study examined the associations between physical environment, social environment, and walking for transportation and recreation among older adults in Hong Kong. Cross-sectional data from 450 older adults (79 years or younger [71.9%], female [79.7%]) from 18 districts in Hong Kong were used. The participants' perceptions of their physical and social environments were collected and their walking behaviors were self-reported. The results revealed that positive physical environment-facilitators and social environments were associated with increased total walking. Only positive physical environment-facilitators were associated with increased walking for transportation, and physical and social environments had no notable effect on walking for recreation. These findings suggest that policymakers and walking intervention designers should develop strategies to enhance physical and social environments to promote total walking and walking for transportation.

The association of leisure-time physical activity and walking during commuting to work with depressive symptoms among Japanese workers: A cross-sectional study

OBJECTIVE

To examine whether the cross-sectional association of leisure-time physical activity and walking during commuting to work with depressive symptoms depends on the level of work-related physical activity among Japanese workers.

METHODS

Participants were 2024 workers aged 19-69 years in two manufacturing companies in Japan. Leisure-time physical activity and walking during commuting to work were ascertained via a self-administered questionnaire. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. The odds ratio (OR) of depressive symptoms (CES-D score ≥16) was estimated by using multiple logistic regression with adjustment for covariates.

RESULTS

Leisure-time physical activity was inversely associated with depressive symptoms; multivariable-adjusted ORs (95% confidence intervals) of having depressive symptoms for leisure-time physical activity were 1.00 (reference), 0.85 (0.64, 1.12), 0.69 (0.51, 0.94), and 0.59 (0.44, 0.80) for 0, >0 to <3.0, 3.0 to <10.0, and ≥10.0 MET-h/wk, respectively (P for trend <.001). This inverse trend for leisure-time physical activity was clearer among individuals who had low physical activity at workplace (less than 7.0 MET-h/d). For walking to work, such an inverse association was not observed.

CONCLUSION

Leisure-time physical activity was associated with fewer depressive symptoms, especially in workers with low work-related physical activity.

Real-Time Auditory Feedback-Induced Adaptation to Walking Among Seniors Using the Heel2Toe Sensor: Proof-of-Concept Study

Background

Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first.

Objective

This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor.

Methods

A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience.

Results

All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping.

Conclusions

Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated.

Changes in physical activity predict changes in a comprehensive model of balance in older community-dwelling adults. A longitudinal analysis of the TILDA study

Objective:

Falls due to poor balance can cause injury, disability, and death in older adults. The relationship between free-living physical activity (PA) and balance over time is poorly understood. The aim of this study is to explore the association between PA and balance in older adults over time

Methods:

Using two waves of data from the TILDA study (n=8,504 participants) a structural equation model was used to identify a composite measure of balance that incorporated measures of Timed Up and Go; handgrip strength; Mini Mental State Exam; vision; hearing; and steadiness. The patterns of change in PA and balance were then compared over time (controlling for covariates)

Results:

The results showed that one extra metabolic equivalent of task (MET) minute of PA improves balance by 4% over one week (Est=-0.10, SE=0.12), and by 5% cumulatively over two years (Est=-0.13, SE=0.02). Medication, alcohol consumption, sex, age, fear of falling, education, pain, and problems performing activities of daily living (ADL) were risk factors for balance

Conclusion:

This study provides a novel and robust model that should guide comprehensive balance assessment. PA promotion should engage older adults in more free-living PA that may be more relevant to them.

Enhanced motivational interviewing for reducing weight and increasing physical activity in adults with high cardiovascular risk: the MOVE IT three-arm RCT

BACKGROUND

Motivational interviewing (MI) enhanced with behaviour change techniques (BCTs) and deployed by health trainers targeting multiple risk factors for cardiovascular disease (CVD) may be more effective than interventions targeting a single risk factor.

OBJECTIVES

The clinical effectiveness and cost-effectiveness of an enhanced lifestyle motivational interviewing intervention for patients at high risk of CVD in group settings versus individual settings and usual care (UC) in reducing weight and increasing physical activity (PA) were tested.

DESIGN

This was a three-arm, single-blind, parallel randomised controlled trial.

SETTING

A total of 135 general practices across all 12 South London Clinical Commissioning Groups were recruited.

PARTICIPANTS

A total of 1742 participants aged 40-74 years with a ≥ 20.0% risk of a CVD event in the following 10 years were randomised.

INTERVENTIONS

The intervention was designed to integrate MI and cognitive-behavioural therapy (CBT), delivered by trained healthy lifestyle facilitators in 10 sessions over 1 year, in group or individual format. The control group received UC.

RANDOMISATION

Simple randomisation was used with computer-generated randomisation blocks. In each block, 10 participants were randomised to the group, individual or UC arm in a 4 : 3 : 3 ratio. Researchers were blind to the allocation.

MAIN OUTCOME MEASURES

The primary outcomes are change in weight (kg) from baseline and change in PA (average number of steps per day over 1 week) from baseline at the 24-month follow-up, with an interim follow-up at 12 months. An economic evaluation estimates the relative cost-effectiveness of each intervention. Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score.

RESULTS

The mean age of participants was 69.75 years (standard deviation 4.11 years), 85.5% were male and 89.4% were white. At the 24-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA [mean 70.05 steps, 95% confidence interval (CI) -288 to 147.9 steps, and mean 7.24 steps, 95% CI -224.01 to 238.5 steps, respectively] or in reducing weight (mean -0.03 kg, 95% CI -0.49 to 0.44 kg, and mean -0.42 kg, 95% CI -0.93 to 0.09 kg, respectively). At the 12-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA (mean 131.1 steps, 95% CI -85.28 to 347.48 steps, and mean 210.22 steps, 95% CI -19.46 to 439.91 steps, respectively), but there were reductions in weight for the group and individual intervention arms compared with UC (mean -0.52 kg, 95% CI -0.90 to -0.13 kg, and mean -0.55 kg, 95% CI -0.95 to -0.14 kg, respectively). The group intervention arm was not more effective than the individual intervention arm in improving outcomes at either follow-up point. The group and individual interventions were not cost-effective.

CONCLUSIONS

Enhanced MI, in group or individual formats, targeted at members of the general population with high CVD risk is not effective in reducing weight or increasing PA compared with UC. Future work should focus on ensuring objective evidence of high competency in BCTs, identifying those with modifiable factors for CVD risk and improving engagement of patients and primary care.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN84864870.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 69. See the NIHR Journals Library website for further project information. This research was part-funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.

Translating a walking intervention for health professional delivery within primary care: A mixed-methods treatment fidelity assessment

Objectives

Existing fidelity studies of physical activity interventions are limited in methodological quality and rigour, particularly those delivered by health care providers in clinical settings. The present study aimed to enhance and assess the fidelity of a walking intervention delivered by health care providers within general practice in line with the NIH Behavior Change Consortium treatment fidelity framework.

Design

Two practice nurses and six health care assistants delivered a theory‐based walking intervention to 63 patients in their own practices. A cross‐sectional mixed‐methods study assessed fidelity related to treatment delivery and treatment receipt, from the perspectives of health care providers and patients.

Methods

All providers received training and demonstrated delivery competence prior to the trial. Delivery of intervention content was coded from audio‐recordings using a standardized checklist. Qualitative interviews with 12 patients were conducted to assess patient perspectives of treatment receipt and analysed using framework analysis.

Results

Overall, 78% of intervention components were delivered as per the protocol (range 36–91%), with greater fidelity for components requiring active engagement from patients (e.g., completion of worksheets). The qualitative data highlighted differences in patients’ comprehension of specific intervention components. Understanding of, and engagement with, motivational components aimed at improving self‐efficacy was poorer than for volitional planning components.

Conclusions

High levels of fidelity of delivery were demonstrated. However, patient‐, provider‐, and component‐level factors impacted on treatment delivery and receipt. We recommend that methods for the enhancement and assessment of treatment fidelity are consistently implemented to enhance the rigour of physical activity intervention research.

Cadence-based Classification of Minimally Moderate Intensity During Overground Walking in 21- to 40-Year-Old Adults

BACKGROUND

A walking cadence of ≥100 steps/min corresponds to minimally moderate intensity, absolutely defined as ≥3 metabolic equivalents (METs). This threshold has primarily been calibrated during treadmill walking. There is a need to determine the classification accuracy of this cadence threshold to predict intensity during overground walking.

METHODS

In this laboratory-based cross-sectional investigation, participants (N = 75, 49.3% women, age 21-40 y) performed a single 5-minute overground (hallway) walking trial at a self-selected preferred pace. Steps accumulated during each trial were hand tallied and converted to cadence (steps/min). Oxygen uptake was measured using indirect calorimetry and converted to METs. The classification accuracy (sensitivity, specificity, overall accuracy, and positive predictive value) of ≥100 steps/min to predict ≥3 METs was calculated.

RESULTS

A cadence threshold of ≥100 steps/min yielded an overall accuracy (combined sensitivity and specificity) of 73.3% for predicting minimally moderate intensity. Moreover, for individuals walking at a cadence ≥100 steps/min, the probability (positive predictive value) of achieving minimally moderate intensity was 80.3%.

CONCLUSIONS

Although primarily developed using treadmill-based protocols, a cadence threshold of ≥100 steps/min for young adults appears to be a valid heuristic value (evidence-based, rounded, practical) associated with minimally moderate intensity during overground walking performed at a self-selected preferred pace.

Real World, Real People: Can We Assess Walking on a Treadmill to Establish Step Count Recommendations in Adolescents?

BACKGROUND

Currently, it is not known how much walking should be advocated for good health in an adolescent population. Step count recommendations for minimum time in moderate-intensity activity have been translated predominantly from treadmill walking.

PURPOSE

To compare the energy cost of walking on a treadmill with overground walking in adolescent girls.

METHODS

A total of 26 adolescent girls undertook resting metabolic measurements for individual determination of 1 metabolic equivalent using indirect calorimetry. Energy expenditure was subsequently assessed during treadmill and overground walking at slow, moderate, and fast walking speeds for 4 to 6 minutes. Treadmill step rates were matched overground using a metronome.

RESULTS

The energy cost of treadmill walking was found to be significantly greater than and not equivalent to overground walking at 133 steps per minute; (equivalent to the fast walking pace): V˙O2 3.90 (2.78-5.01), P < .001, mean absolute percentage error (MAPE) = 18.18%, and metabolic equivalent 0.77 (0.54-1.00), P < .001, MAPE = 18.16%. The oxygen cost per step (V˙O2 mL·step-1) was significantly greater and not equivalent on the treadmill at 120 and 133 steps per minute: 0.43 (0.12-0.56), P < .05, MAPE = 10.12% versus 1.40 (1.01-1.76), P < .001, MAPE = 17.64%, respectively.

CONCLUSION

The results suggest that there is a difference in energy cost per step of walking on a treadmill and overground at the same step rate. This should be considered when utilizing the treadmill in energy expenditure studies. Studies which aim to provide step recommendations should focus on overground walking where most walking activity is adopted.

Walking Pace Is Associated with Lower Risk of All-Cause and Cause-Specific Mortality

PURPOSE

Walking pace is associated with all-cause and cardiovascular disease (CVD) mortality. Whether this association extends to other health outcomes and whether it is independent of total amount of time walked are currently unknown. Therefore, the aim of this study was to investigate whether usual walking pace is associated with a range of health outcomes.

METHODS

UK Biobank participants (318,185 [54%] women) age 40 to 69 yr were included. Walking pace and total walking time were self-reported. The outcomes comprised: all-cause mortality as well as incidence and mortality from CVD, respiratory disease and cancer. The associations were investigated using Cox proportional hazard models.

RESULTS

Over a mean of 5.0 yr [ranging from 3.3 to 7.8], 5890 participants died, 18,568 developed CVD, 5430 respiratory disease and 19,234 cancer. In a fully adjusted model, compared to slow pace walkers, men and women, respectively, with a brisk pace having lower risk of mortality from all-causes (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.69-0.90 and HR, 0.73; 95% CI, 0.62-0.85), CVD (HR, 0.62; 95% CI, 0.50-0.76 and HR, 0.80; 95% CI, 0.73-0.88), respiratory disease (HR, 0.58; 95% CI, 0.43-0.78 and HR, 0.66; 95% CI, 0.57-0.77), chronic obstructive pulmonary disease (HR, 0.26; 95% CI, 0.12-0.56 and HR, 0.28; 95% CI, 0.16-0.49). No associations were found for all-cause cancer, colorectal, and breast cancer. However, brisk walking was associated with a higher risk of prostate cancer.

CONCLUSIONS

Walking pace is associated with lower risk of a wide range of important health conditions, independently of overall time spent walking.

Time spent cycling, walking, running, standing and sedentary: a cross-sectional analysis of accelerometer-data from 1670 adults in the Copenhagen City Heart Study : Physical behaviours among 1670 Copenhageners

Background

Information about how much time adults spend cycling, walking and running can be used for planning and evaluating initiatives for active, healthy societies. The objectives of this study were to describe how much time adult Copenhageners cycle, walk, run, stand and spend sedentary using accelerometers, and to describe differences between population groups.

Methods

In the fifth examination of the Copenhagen City Heart Study, 2335 individuals gave consent to wear accelerometers (skin-attached; right thigh and iliac crest; 24 h/day, 7 consecutive days) of which 1670 fulfilled our inclusion criteria (≥16 h/day for ≥5 days; median wear time: 23.8 h/day). Daily time spent cycling, walking, running, standing and sedentary was derived from accelerometer-based data using the Acti4 software, and differences between sex, age groups, level of education and BMI were investigated using Kruskal-Wallis rank sum tests.

Results

Among those cycling (61%), the median cycling time was 8.3 min/day. The median time walking, running, standing and sedentary was 82.6, 0.1, 182.5 and 579.1 min/day, respectively. About 88% walked fast (i.e., ≥100 steps/min) ≥30 min/day. The shortest duration and lowest prevalence of cycling, walking and running were found among older individuals, those with a low level of education, and individuals being overweight or obese.

Conclusions

We found a long duration and high prevalence of cycling and walking, but also that many adult Copenhageners spent much time sedentary. Population groups with low participation in physical activities such as cycling and walking should be targeted in future initiatives towards an active, healthy society.

State-of-the-art research in robotic hip exoskeletons: A general review

Ageing population is now a global challenge, where physical deterioration is the common feature in elderly people. In addition, the diseases, such as spinal cord injury, stroke, and injury, could cause a partial or total loss of the ability of human locomotion. Thus, assistance is necessary for them to perform safe activities of daily living. Robotic hip exoskeletons are able to support ambulatory functions in elderly people and provide rehabilitation for the patients with gait impairments. They can also augment human performance during normal walking, loaded walking, and manual handling of heavy-duty tasks by providing assistive force/torque. In this article, a systematic review of robotic hip exoskeletons is presented, where biomechanics of the human hip joint, pathological gait pattern, and common approaches to the design of robotic hip exoskeletons are described. Finally, limitations of the available robotic hip exoskeletons and their possible future directions are discussed, which could serve a useful reference for the engineers and researchers to develop robotic hip exoskeletons with practical and plausible applications in geriatric orthopaedics.

The translational potential of this article

The past decade has witnessed a remarkable progress in research and development of robotic hip exoskeletons. Our aim is to summarize recent developments of robotic hip exoskeletons for the engineers, clinician scientists and rehabilitation personnel to develop efficient robotic hip exoskeletons for practical and plausible applications.