Walking to health

Bicycle riding, walking, and weight gain in premenopausal women

BACKGROUND

To our knowledge, research has not been conducted on bicycle riding and weight control in comparison with walking. Our objective was to assess the association between bicycle riding and weight control in premenopausal women.

METHODS

This was a 16-year follow-up study of 18,414 women in the Nurses' Health Study II. Weight change between 1989 and 2005 was the primary outcome, and the odds of gaining more than 5% of baseline body weight by 2005 was the secondary outcome.

RESULTS

At baseline, only 39% of participants walked briskly, while only 1.2% bicycled for more than 30 min/d. For a 30-min/d increase in activity between 1989 and 2005, weight gain was significantly less for brisk walking (-1.81 kg; 95% confidence interval [CI], -2.05 to -1.56 kg), bicycling (-1.59 kg; 95% CI, -2.09 to -1.08 kg), and other activities (-1.45 kg; 95% CI, -1.66 to -1.24 kg) but not for slow walking (+0.06 kg; 95% CI, -0.22 to 0.35 kg). Women who reported no bicycling in 1989 and increased to as little as 5 min/d in 2005 gained less weight (-0.74 kg; 95% CI, -1.41 to -0.07 kg; P value for trend, <.01) than those who remained nonbikers. Normal-weight women who bicycled more than 4 h/wk in 2005 had a lower odds of gaining more than 5% of their baseline body weight (odds ratio, 0.74; 95% CI, 0.56 to 0.98) compared with those who reported no bicycling; overweight and obese women had a lower odds at 2 to 3 h/wk (odds ratio, 0.54; 95% CI, 0.34 to 0.86).

CONCLUSIONS

Bicycling, similar to brisk walking, is associated with less weight gain and an inverse dose-response relationship exists, especially among overweight and obese women. Future research should focus on brisk walking and greater time spent bicycling.

An intervention to promote walking amongst the general population based on an 'extended' theory of planned behaviour: a waiting list randomised controlled trial

Theory of planned behaviour (TPB) studies have identified perceived behavioural control (PBC) as the key determinant of walking intentions. The present study investigated whether an intervention designed to alter PBC and create walking plans increased TPB measures concerning walking more, planning and objectively measured walking. One hundred and thirty UK adults participated in a waiting-list randomised controlled trial. The intervention consisted of strategies to boost PBC, plus volitional strategies to enact walking intentions. All TPB constructs were measured, along with self-reported measures of action planning and walking, and an objective pedometer measure of time spent walking. The intervention increased PBC, attitudes, intentions and objectively measured walking from 20 to 32 min a day. The effects of the intervention on intentions and behaviour were mediated by PBC, although the effects on PBC were not mediated by control beliefs. At 6 weeks follow-up, participants maintained their increases in walking. The findings of this study partially support the proposed causal nature of the extended TPB as a framework for developing and evaluating health behaviour change interventions. This is the first study using the TPB to develop, design and evaluate the components of an intervention which increased objectively measured behaviour, with effects mediated by TPB variables.

Influence of brisk walking on appetite, energy intake, and plasma acylated ghrelin

PURPOSE

This study examined the effect of an acute bout of brisk walking on appetite, energy intake, and the appetite-stimulating hormone-acylated ghrelin.

METHODS

Fourteen healthy young males (age 21.9 +/- 0.5 yr, body mass index 23.4 +/- 0.6 kg x m(-2), (.)VO2max 55.9 +/- 1.8 mL x kg(-1) x min(-1); mean +/- SEM) completed two 8-h trials (brisk walking and control) in a randomized counterbalanced fashion. The brisk walking trial commenced with 60 min of subjectively paced brisk walking on a level-motorized treadmill after which participants rested for 7 h. Participants rested for the duration of the control trial. Ad libitum buffet meals were offered twice during main trials (1.5-2 and 5-5.5 h). Appetite (hunger, fullness, satisfaction, and prospective food consumption) was assessed at 30-min intervals throughout. Levels of acylated ghrelin, glucose, insulin, and triacylglycerol were determined from plasma.

RESULTS

Sixty minutes of brisk walking (7.0 +/- 0.1 km x h(-1) yielded a net (exercise minus resting) energy expenditure of 2008 +/- 134 kJ, yet it did not significantly influence appetite, energy/macronutrient intake, or the plasma concentration of acylated ghrelin either during or after exercise(P > 0.05). Participants did not compensate for energy expended during walking, therefore a deficit in energy was induced (1836 kJ, 439 kcal) relative to control.

CONCLUSIONS

This study demonstrates that, despite inducing a moderate energy deficit, an acute bout of subjectively paced brisk walking does not elicit compensatory responses in acylated ghrelin, appetite, or energy intake. This finding lends support for a role of brisk walking in weight management.

The relationship between coping, self-esteem and health on outdoor walking ability among older adults in Norway

Walking is an essential component of outdoor mobility, and recognised as one of the best forms of physical activity for older adults. The purpose of this study is to examine the relationships between socio-demographic factors, coping resources, self-esteem and health status with the outdoor walking ability of people aged 55–79 years living in the community. The hypothesis is that there is a positive association between outdoor walking ability and coping, self-esteem and health status. A nationally-representative sample of 3,069 women and men answered questions regarding socio-demographic attributes, coping resources, self-esteem, health status and outdoor walking ability. The mean age of the respondents was 65.6 years. Around one-half of the sample were women, and around one-half were aged 65 or more years. One-third (32.3%) of the sample were married or cohabiting. Regarding outdoor walking ability, only 0.7 per cent of the respondents were not able to walk at all, and 80.8 per cent could walk at least one kilometre without a pause. Binary logistic multivariate regression analyses showed that those who had good outdoor walking ability (one kilometre or more) were significantly younger than those who did not, and that they were predominantly men, partnered or married, not in paid work, experienced significantly little pain, had better self-reported health and higher perceived coping.

The effectiveness of walking as an intervention for low back pain: a systematic review

As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low-moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP.

Slow postmeal walking reduces postprandial glycemia in middle-aged women

Postprandial blood glucose concentration is a risk factor for the development of cardiovascular diseases and diabetes, even at states well below hyperglycemic levels. A previous study has shown that postmeal exercise of moderate intensity blunts the blood glucose increase after carbohydrate intake (Høstmark et al. Prev. Med. 42(5): 369-371). The objective of the present study was to examine whether even postmeal slow walking would have a similar effect. Fourteen healthy women aged >50 years participated in 3 experiments in a random crossover design: after a carbohydrate-rich meal, either they were seated (control experiment) or they performed slow postmeal walking for 15 min (W15) or 40 min (W40). Blood glucose concentration was determined prior to the meal (fasting), and at 11 time points throughout each experiment. The W15 trial lowered the blood glucose values during walking and delayed the peak blood glucose value (p = 0.003). In W40, the postmeal blood glucose increase during walking was blunted, the peak glucose value was delayed (p = 0.001), and the incremental area under the 2-h blood glucose curve (IAUC) was reduced (p = 0.014). There was a negative relationship between IAUC and walking time (p = 0.016). The individual reducing effect of walking on IAUC correlated strongly with IAUC on the control day (p < 0.001). We conclude that even slow postmeal walking can reduce the blood glucose response to a carbohydrate-rich meal. The magnitude of this effect seems to be related to the duration of walking and to the magnitude of the postprandial blood glucose response when resting after a carbohydrate-rich meal.

Effects of interval walking on physical fitness in middle-aged individuals

The purpose of this study is to examine the effects of a 3-month interval walking program on peak aerobic capacity and cardiovascular risk factors in middle-aged sedentary individuals. Participants were divided into 2 groups: a nontraining control group (n = 17) and an interval walking training group (n = 29). Participants in the interval walking training group were instructed to perform 5 or more sets of 3-min low-intensity walking interspersed by 3-min of moderate to high-intensity walking (>70% of peak aerobic capacity) on 4 or more days/week. Measurements of peak aerobic capacity, blood pressure, blood lipids, and glucose concentration were performed before and after training. Twenty-six individuals completed the interval walking program averaging 4 days/week for 34 min, of which 16 min were moderate to high-intensity walking, with a total energy expenditure of 776 kcal/week. Three months of interval walking increased peak aerobic capacity (from 20.4 ± 3.0 to 26.0 ± 5.2 mL/kg/min; P < .001) and reduced resting systolic blood pressure (127 ± 11 to 119 ± 11 mm Hg; P = .01). There was an inverse correlation between initial level and training-induced changes in glucose, HbA1c, high-density lipoprotein, and low-density lipoprotein. Conversely, 3 months of nontraining did not improve physical fitness or cardiovascular risk factors. Very modest amounts of aerobic exercise involving brief periods of interspersed higher intensity exercise can significantly increase peak aerobic capacity and reduce resting systolic blood pressure in middle-aged sedentary individuals and contribute to a normalization of cardiovascular risk factors in individuals with elevated initial values.

Can a motivational intervention overcome an unsupportive environment for walking--findings from the Step-by-Step Study

BACKGROUND

Interventions to promote walking have rarely examined how their effects varied by the attributes of the physical environment.

PURPOSE

The purpose of this study is to examine whether perceptions of environmental walkability predicted change in walking behavior following an individual-based intervention to promote walking and whether the intervention buffered the effects of unsupportive environment for walking.

METHODS

Inactive adults (aged 30-65 years, 85% women) who completed a 3-month randomized control trial comparing the effect of a single mail-out of a theoretically based self-help walking program (WP, n = 102); the same program plus a pedometer (WPP, n = 105); and a "no-treatment" control group (C, n = 107). Measures included change in self-reported walking time for all purposes and in the proportion of people reporting regular walking (i.e., > or =150 min/week and > or =5 sessions/wk). Perceptions of environmental esthetics, safety from crime, proximity to destinations, access to walking facilities, traffic, streetlights, connectivity, and hilliness were assessed at baseline and dichotomized into "low" or "high" by the median score. Covariates were social support, self-efficacy, intention to change behavior, and sociodemographic characteristics.

RESULTS

Adjusting for baseline walking, significant covariates, and study groups, walking time at follow-up was lower if streetlights or esthetics were perceived to be "low" (-24% and -22%, respectively) compared with "high" (p < 0.05). In "low" esthetic conditions, those in the WPP were significantly more likely than controls to increase total walking time (Exp (b) = 2.53, p < 0.01) and to undertake regular walking (OR = 5.85, 95% CI 2.60-12.2), whereas in esthetically pleasing environments, the between-group differences were nonsignificant.

CONCLUSIONS

Walkability attributes can influence individual-based walking programs. Some environmental barriers for walking can be overcome by motivational aids.

What sense do people make of a theory of planned behaviour questionnaire?: a think-aloud study

This study aimed to understand the processes of interpretation of, and responses to, the task of completing a theory of planned behaviour (TPB) questionnaire. Forty-five adults verbalized their thoughts while completing a full TPB questionnaire on walking behaviour. On average, participants' verbalizations indicated around 16 problems with the 52 questions. Further, problems as identified from verbalizations were associated with increased endorsement of the middle option on the questionnaire. Normative and intention questions were found to be particularly problematic. The current standardized method to develop TPB measures systematically yields problematic questions, as indicated by both talk and questionnaire responses.

Economic evaluation of the direct healthcare cost savings resulting from the use of walking interventions to prevent coronary heart disease in Australia

Coronary heart disease (CHD) is the leading cause of death in Australia. Direct healthcare costs of CHD exceed those of any other disease. The purpose of this study was to evaluate the direct healthcare cost savings resulting from walking interventions to prevent CHD in Australia. A meta-analysis was performed to quantify the efficacy of walking interventions in preventing CHD. The etiologic fraction and other mathematical models were applied to quantify the cost savings resulting from walking interventions to prevent CHD. The net direct healthcare cost savings in CHD prevention resulting from 30 min of normal walking a day for 5-7 days a week by the sufficient walking population were estimated at AU$126.73 million in 2004. The cost savings could increase to $419.90 million if all the inactive adult Australians engaged in 1 h of normal walking a day for 5-7 days a week. Given its low injury risk and high adherence, walking should be advocated as a key population-based primary intervention strategy for CHD prevention and healthcare cost reduction.

An alternative design for small-scale school health experiments: does daily walking produce benefits in physical performance of school children?

BACKGROUND

The mainstream randomized clinical trial is not always feasible in a school setting. There might be practical and ethical issues that make dividing school classes into an intervention and a control group impossible or undesirable, and there is a need to explore the validity of alternative designs and analyses.

METHODS

An alternative to a randomized clinical trial in a physical performance experiment at a school is introduced and evaluated. The before-intervention data are utilized as control data for the intervention data in addition to adjust for pre-intervention differences. The strict class year structure of school data makes this possible. In a rural school in inland Norway, all school children joined the project of walking in a rugged terrain outside school for 20 min every school day during one school year. Measurements of low back static endurance, hamstrings flexibility, standing balance and cardiovascular fitness were made before and after the intervention. As intervention and 'aging' were confounded, the special use of the pre-intervention data, 'age-adjusted', is proposed to solve this issue. A comparison with having an independent control group is performed.

RESULTS

The alternative analysing method is judged to yield valid results without having an independent control group. The age-adjusted analyses showed 11% increase in low back static endurance, 8% increase in hamstrings flexibility, 69% increase in balance and 6-13% increase in cardiovascular fitness. The effects were largest among those children who had the lowest performances before the intervention.

CONCLUSION

The introduced statistical methods display that, in a school population, evaluations from an experiment can be made without an independent control group. A 20-min walk during school time for 1 year seemed to improve physical performance.

Effects of Nordic Walking training on exercise capacity and fitness in men participating in early, short-term inpatient cardiac rehabilitation after an acute coronary syndrome — a controlled trial

Objective: To investigate the effects of Nordic Walking training supplemental to a standard, early rehabilitation programme on exercise capacity and physical fitness in men after an acute coronary syndrome.

Design: A controlled trial.

Setting: Cardiac rehabilitation service of a provincial hospital.

Subjects: Eighty men 2—3 weeks after an acute coronary syndrome, with good exercise tolerance.

Interventions: Three-week, inpatient cardiac rehabilitation programme (control group) supplemented with Nordic Walking (Nordic Walking group), or with traditional walking training (walking training group).

Main measures: Exercise capacity was assessed as peak energy cost (in metabolic equivalents) in symptom-limited treadmill exercise test, and physical fitness with the Fullerton Functional Fitness Test.

Results: Exercise capacity after the rehabilitation programme was higher in the Nordic Walking group than in the control group (10.8 ± 1.8 versus 9.2 ± 2.2 metabolic equivalents, P =0.025). The improvement in exercise capacity in the Nordic Walking group was higher than in the control group (1.8 ± 1.5 versus 0.7 ± 1.4 metabolic equivalents, P =0.002). In contrast to the control group, the results of all components of the Fullerton test improved in the Nordic Walking and walking training groups. After the programme, lower body endurance, and dynamic balance were significantly better in the Nordic Walking group in comparison with the walking training and control groups, and upper body endurance was significantly better in the Nordic Walking and walking training groups than in the control group.

Conclusions: Nordic Walking may improve exercise capacity, lower body endurance and coordination of movements in patients with good exercise tolerance participating in early, short-term rehabilitation after an acute coronary syndrome.

The effects of a 12-week walking program on community-dwelling older adults

Walking is a popular and easily accessible form of physical activity. However, walking instruction for older adults is based on the evidence gathered from younger populations. This study evaluated walking conditions, strength, balance, and subjective health status after a 12-week walking-training program in community-dwelling adults > 65-years-old. Participants walked 1,921 m (3,158.88 steps) in 26.69 min with a heart rate of 114 beats/min. An analysis of covariance to adjust for previous exercise habits, pretest strength, and subjective health status revealed significant differences in strength and in subjective physical and mental health status between experimental and control groups. This study identified the effects of the walking-training program on community-dwelling elderly adults without changing their previous physical activities.

Walking on prescription: the utility of a pedometer pack for increasing physical activity in primary care

OBJECTIVE

This study used a multi-method approach to examine the effectiveness of a pedometer-based intervention delivered by health professionals for increasing walking.

METHODS

Pedometer packs were distributed to 374 patients who undertook a 12-week walking programme. Changes in walking were assessed at three months (using self-reported step-counts [n=139] and questionnaire data [n=104]) and at six months (using patient questionnaire data [n=112]). Qualitative data were collected at both time points to identify underlying mechanisms.

RESULTS

After 12 weeks patients had increased their step-counts by 4532 steps/day (p<.001) and at six months were achieving 2977 more steps/day (equivalent to around 30 min/day) than at baseline. Over half the patients reported achieving this target on at least 5 days/week. Qualitative data indicated that the pedometer pack was perceived to be most effective when patients were ready to change and when ongoing support was made available.

CONCLUSION

These findings support the use of pedometer-based interventions in primary care and suggest that the pedometer pack could lead to sustainable changes in walking. Further investigation, using a randomised controlled trial design, is warranted.

PRACTICE IMPLICATIONS

Provision of social support and accurate identification of patient readiness to change are important considerations in future implementation of the intervention.

Implementation of a walking school bus: lessons learned

BACKGROUND

Obesity is rapidly becoming the most common chronic medical condition affecting children. To address this crisis, an Albuquerque, New Mexico, elementary school partnered with University of New Mexico researchers and conducted a Walking School Bus (WSB). The purpose of this article is to examine the feasibility of implementing a WSB.

METHODS

This pilot study featured 2 WSBs conducted for 10 weeks with kindergarten through fifth-grade students from a predominantly Hispanic elementary school. Qualitative and quantitative data, including coordinator field notes, attendance records, surveys of student and parent satisfaction, and a focus group, were used to evaluate feasibility.

RESULTS

Student and adult participants expressed a high degree of enthusiasm regarding their involvement in the WSB. Participants uniformly indicated that the WSB provided a supportive and safe environment to promote social interaction and physical activity. Conducting a WSB in an urban, underserved school district is feasible but requires attention to ensure participants' involvement and safety. In particular, it is recommended to begin the planning process early to enhance investment from key stakeholders.

CONCLUSION

Effective, low-cost interventions are increasingly desired as solutions to the problem of obesity. The WSB has emerged as a promising strategy to address obesity and encourage partnerships across different social levels. Further research is necessary to assess the logistical challenges associated with conducting a large-scale WSB trial and whether such efforts lead to reductions in obesity risk factors.

Compliance with physical activity guidelines in a group of UK-based postal workers using an objective monitoring technique

Compliance with physical activity (PA) recommendations was assessed using objective PA monitoring of ambulatory activity, in two healthy groups of individuals with active and sedentary occupations. The study showed generally low compliance with the guidelines (53% with 10,000 steps a day; 10% with 30 min of moderate activity a day; and 1% with 30 min of moderate activity a day in bouts of at least 10 min (ACSM)). Adherence to guidelines decreased as more rigorous conditions were applied to the PA data. Use of an objective monitor revealed that health enhancing bouts of activity were performed in periods of approximately 1-min duration, which may be due to unavoidable environmental interruptions. These bouts of activity are much shorter than those advocated in the ACSM guidelines, raising questions regarding how actual behaviour, based on objective monitoring, can be reconciled with guidelines based on self-reported PA.

Acute exercise modulates cigarette cravings and brain activation in response to smoking-related images: an fMRI study

RATIONALE

Substances of misuse (such as nicotine) are associated with increases in activation within the mesocorticolimbic brain system, a system thought to mediate the rewarding effects of drugs of abuse. Pharmacological treatments have been designed to reduce cigarette cravings during temporary abstinence. Exercise has been found to be an effective tool for controlling cigarette cravings.

OBJECTIVE

The objective of this study is to assess the effect of exercise on regional brain activation in response to smoking-related images during temporary nicotine abstinence.

METHOD

In a randomized crossover design, regular smokers (n = 10) undertook an exercise (10 min moderate-intensity stationary cycling) and control (passive seating for same duration) session, following 15 h of nicotine abstinence. Following treatments, participants entered a functional Magnetic Resonance Imaging (fMRI) scanner. Subjects viewed a random series of smoking and neutral images for 3 s, with an average inter-stimulus-interval (ISI) of 10 s. Self-reported cravings were assessed at baseline, mid-, and post-treatments.

RESULTS

A significant interaction effect (time by group) was found, with self-reported cravings lower during and following exercise. During control scanning, significant activation was recorded in areas associated with reward (caudate nucleus), motivation (orbitofrontal cortex) and visuo-spatial attention (parietal lobe, parahippocampal, and fusiform gyrus). Post-exercise scanning showed hypo-activation in these areas with a concomitant shift of activation towards areas identified in the 'brain default mode' (Broadmanns Area 10).

CONCLUSION

The study confirms previous evidence that a single session of exercise can reduce cigarette cravings, and for the first time provides evidence of a shift in regional activation in response to smoking cues.

Quantifying the dose-response of walking in reducing coronary heart disease risk: meta-analysis

The evidence for the efficacy of walking in reducing the risk of and preventing coronary heart disease (CHD) is not completely understood. This meta-analysis aimed to quantify the dose-response relationship between walking and CHD risk reduction for both men and women in the general population. Studies on walking and CHD primary prevention between 1954 and 2007 were identified through Medline, SportDiscus and the Cochrane Database of Systematic Reviews. Random-effect meta-regression models were used to pool the relative risks from individual studies. A total of 11 prospective cohort studies and one randomized control trial study met the inclusion criteria, with 295,177 participants free of CHD at baseline and 7,094 cases at follow-up. The meta-analysis indicated that an increment of approximately 30 min of normal walking a day for 5 days a week was associated with 19% CHD risk reduction (95% CI = 14-23%; P-heterogeneity = 0.56; I (2) = 0%). We found no evidence of heterogeneity between subgroups of studies defined by gender (P = 0.67); age of the study population (P = 0.52); or follow-up duration (P = 0.77). The meta-analysis showed that the risk for developing CHD decreases as walking dose increases. Walking should be prescribed as an evidence-based effective exercise modality for CHD prevention in the general population.

The effect of a 12 week walking intervention on markers of insulin resistance and systemic inflammation

OBJECTIVES

The purpose of the present study was to determine whether a community-based walking intervention, using pedometers, is effective in reducing systemic inflammatory markers.

METHODS

Participants (age=49(8.9)) were recruited in Glasgow, United Kingdom, from August to December 2006 and were randomly assigned to a control (n=24; 6 males, no change in walking) and intervention group (n=24; 5 males gradually increasing walking by 3000 steps/day on 5 days of the week). Blood samples were collected at baseline, and after 12 weeks, and analysed for glucose, insulin, high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), soluble IL-6 receptor (sIL-6R), tumour necrosis factor-alpha (TNF-alpha) and soluble TNF receptors I and II (sTNFR1 and sTNFRII).

RESULTS

In the control group baseline step counts were 6356 (2953) steps/day and did not change (P>0.05) after 12 weeks, 6709 (2918) steps/day. The intervention group increased (P<0.001) step count from 6682 (3761) steps/day at baseline to 10182 (4081) steps/day at 12 weeks. Over the 12 week period there was no change in any other variables measured, in either control or intervention group.

CONCLUSION

We conclude that the current community-based intervention did not affect systemic markers of inflammation or insulin sensitivity.

Change in work day step counts, wellbeing and job performance in Catalan university employees: a randomised controlled trial

Using a randomised controlled trial design, this feasibility study assessed the impact of two walking interventions on quality of life (QoL) and job performance of Catalan university employees.

A convenience sample of 70 employees completed baseline and intervention measures of step counts (Yamax SW 200 pedometer), wellbeing (SF-12 questionnaire) and work performance (Work Limitations Questionnaire) over 9 weeks. Before intervention, baseline step counts (five working days) were used to randomly allocate participants to a control ( n = 26), “walking routes” ( n = 19) and “walking while working” ( n = 25) groups. Intervention effects were evaluated by calculating differences between pre-intervention and intervention data. One-way ANOVA was used to examine differences between groups.

No significant group differences were found for changes in work-day step counts, QoL or work performance. When data from the two intervention groups were pooled ( n = 44) there was a significant increase in step counts (+659 steps/day; n = 12; p < 0.01) among participants classified as `Sedentary—Low active' (0—7499 steps/day) at baseline. In contrast there was a significant decrease (—637 steps/day; p < 0.05) in those initially categorised as `Active' (> 10,000 steps/day; n = 21) and no change in those categorised as `Moderately Active' (7500—9999, n = 11). The `Sedentary—Low activity' group showed consistently greater improvements in QoL and work performance scores than the Moderate and Active groups.

Initially low active participants showed the greatest increase in step counts and improved QoL and work productivity profiles. These data indicate the potential for improving QoL and job productivity through workplace walking in inactive Catalan employees.

The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial

Background

Recent systematic reviews have suggested that pedometers may be effective motivational tools to promote walking. However, studies tend to be of a relatively short duration, with small clinical based samples. Further research is required to demonstrate their effectiveness in adequately powered, community based studies.

Objective

Using a randomized controlled trial design, this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts, self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations.

Method

Sixty-three women and 16 men (49.2 years ± 8.8) were randomly assigned to either an intervention (physical activity consultation and 12-week pedometer-based walking program) or control (no action) group. Measures for step-counts, 7-day physical activity recall, affect, quality of life (n = 79), body mass, BMI, % body fat, waist and hip circumference (n = 76), systolic/diastolic blood pressure, total cholesterol and HDL cholesterol (n = 66) were taken at baseline and week 12. Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data.

Results

Significant increases were found in the intervention group for step-counts (p < .001), time spent in leisure walking (p = .02) and positive affect (p = .027). Significant decreases were found in this group for time spent in weekday (p = .003), weekend (p = .001) and total sitting (p = .001) with no corresponding changes in the control group. No significant changes in any other health outcomes were found in either group. In comparison with the control group at week 12, the intervention group reported a significantly greater number of minutes spent in leisure time (p = .008), occupational (p = .045) and total walking (p = .03), and significantly fewer minutes in time spent in weekend (p = .003) and total sitting (p = .022).

Conclusion

A pedometer-based walking program, incorporating a physical activity consultation, is effective in promoting walking and improving positive affect over 12 weeks in community based individuals. The discussion examines possible explanations for the lack of significant changes in health outcomes. Continued follow-up of this study will examine adherence to the intervention and possible resulting effects on health outcomes.

Environmental determinants of active travel in youth: a review and framework for future research

BACKGROUND

Many youth fail to meet the recommended guidelines for physical activity. Walking and cycling, forms of active travel, have the potential to contribute significantly towards overall physical activity levels. Recent research examining the associations between physical activity and the environment has shown that environmental factors play a role in determining behaviour in children and adolescents. However, links between the environment and active travel have received less attention.

METHODS

Twenty four studies were identified which examined the associations between the environment (perceived or objectively measured) and active travel among youth aged 5-18 years. Findings were categorised according to the location of the environmental measure examined; attributes of the neighbourhood, destination and the route between home and destination.

RESULTS

Results from the reviewed studies indicated that youth active travel is positively associated with social interactions, facilities to assist active travel and urban form in the neighbourhood as well as shorter route length and road safety en-route. A conceptual framework is presented which highlights the associations between active travel behaviours and environmental factors, drawing upon both existing and hypothesised relationships.

CONCLUSION

We provide a review of the available literature and present a novel theoretical framework that integrates the environment into the wider decision making process around travel choices for children and adolescents. Further work should explore associations where gaps in understanding have been identified, and account for the main moderators of behaviour so hypothesised associations can be confirmed.

Environmental determinants of active travel in youth: a review and framework for future research

Background

Many youth fail to meet the recommended guidelines for physical activity. Walking and cycling, forms of active travel, have the potential to contribute significantly towards overall physical activity levels. Recent research examining the associations between physical activity and the environment has shown that environmental factors play a role in determining behaviour in children and adolescents. However, links between the environment and active travel have received less attention.

Methods

Twenty four studies were identified which examined the associations between the environment (perceived or objectively measured) and active travel among youth aged 5–18 years. Findings were categorised according to the location of the environmental measure examined; attributes of the neighbourhood, destination and the route between home and destination.

Results

Results from the reviewed studies indicated that youth active travel is positively associated with social interactions, facilities to assist active travel and urban form in the neighbourhood as well as shorter route length and road safety en-route. A conceptual framework is presented which highlights the associations between active travel behaviours and environmental factors, drawing upon both existing and hypothesised relationships.

Conclusion

We provide a review of the available literature and present a novel theoretical framework that integrates the environment into the wider decision making process around travel choices for children and adolescents. Further work should explore associations where gaps in understanding have been identified, and account for the main moderators of behaviour so hypothesised associations can be confirmed.

A prospective study of age-specific physical activity and premenopausal breast cancer

BACKGROUND

Physical activity has been consistently associated with lower risk of postmenopausal breast cancer, but its relationship with premenopausal breast cancer is unclear. We investigated whether physical activity is associated with reduced incidence of premenopausal breast cancer, and, if so, what age period and intensity of activity are critical.

METHODS

A total of 64,777 premenopausal women in the Nurses' Health Study II reported, starting on the 1997 questionnaire, their leisure-time physical activity from age 12 to current age. Cox regression models were used to examine the relationship between physical activity, categorized by age period (adolescence, adulthood, and lifetime) and intensity (strenuous, moderate, walking, and total), and risk of invasive premenopausal breast cancer.

RESULTS

During 6 years of follow-up, 550 premenopausal women developed breast cancer. The strongest associations were for total leisure-time activity during participants' lifetimes rather than for any one intensity or age period. Active women engaging in 39 or more metabolic equivalent hours per week (MET-h/wk) of total activity on average during their lifetime had a 23% lower risk of premenopausal breast cancer (relative risk = 0.77; 95% confidence interval = 0.64 to 0.93) than women reporting less activity. This level of total activity is equivalent to 3.25 h/wk of running or 13 h/wk of walking. The age-adjusted incidence rates of breast cancer for the highest (> or = 54 MET-h/wk) and lowest (< 21 MET-h/wk) total lifetime physical activity categories were 136 and 194 per 100 000 person-years, respectively. High levels of physical activity during ages 12-22 years contributed most strongly to the association.

CONCLUSIONS

Leisure-time physical activity was associated with a reduced risk for premenopausal breast cancer in this cohort. Premenopausal women regularly engaging in high amounts of physical activity during both adolescence and adulthood may derive the most benefit.

Four-week pedometer-determined activity patterns in normal-weight, overweight and obese adults

OBJECTIVE

To assess pedometer-determined ambulatory activity in normal-weight, overweight and obese UK adults.

METHODS

Eighty-six normal-weight (BMI <25 kg/m(2)) (age=34+/-12.1 years), 91 overweight (BMI 25-29.9 kg/m(2)) (age=40.6+/-13.6 years) and 75 obese (BMI >or= 30 kg/m(2)) (age=41.2+/-12.4 years) participants, from the East Midlands, provided 4 weeks of continuous pedometer-determined activity data, during the winter in 2006. Activity levels and patterns were assessed for all three groups.

RESULTS

The normal-weight group had a significantly higher mean step count (10247 steps/day) than the overweight (9095 steps/day) and obese (8102 steps/day) participants (p<0.05). No differences in step counts were observed between the overweight and obese groups. A consistent reduction in activity was observed on Sundays in all groups, with this reduction being two-fold greater in the overweight and obese groups (approximately 2000 steps/day) when compared with the normal-weight group (approximately 1000 steps/day).

CONCLUSIONS

With the increasing prevalence of obesity in the UK, changes in the activity levels of those at risk are needed. The issuing of pedometers to overweight and obese individuals, with the instruction to increase their ambulatory activity on all days of the week, with particular emphasis on Sunday activity, could be a good starting point in tackling the problem of obesity in the UK.

Walking, vigorous physical activity, and markers of hemostasis and inflammation in healthy men and women

The impact of walking on cardiovascular health, as compared with vigorous physical activity, remains controversial. We performed a cross-sectional analysis including 185 healthy participants drawn from the Whitehall II epidemiological cohort to examine whether there is an independent association between walking and markers of hemostasis and inflammation after controlling for vigorous physical activity. Blood was drawn for the assessment of von Willebrand factor antigen (vWF), fibrinogen, interleukin (IL)-6, IL-1 receptor antagonist (IL-1ra), and tumor necrosis factor-alpha (TNF-alpha). Self-reported levels and types of physical activity were recorded, including time spent walking per week and frequency of participation in vigorous physical activity. Multiple linear regression analyses, adjusted for age, body mass index, blood pressure, gender, smoking, alcohol, grade of employment, and frequency of vigorous physical activity revealed that time spent walking was inversely related to vWF (beta=-0.13, P=0.086), fibrinogen (beta=-0.16, P=0.016), IL-6 (beta=-0.12, P=0.087), and TNF-alpha (beta=-0.16, P=0.039). In addition, vigorous activity was inversely associated with hemostatic markers but not with inflammatory cytokines. Regular walking is associated with lower levels of hemostatic and inflammatory markers independently of vigorous physical activity in healthy men and women.

An exploration of walking behaviour--an interpretative phenomenological approach

The aim of this study was to provide a rich and detailed account of participants' experiences of walking using the qualitative method of interpretative phenomenological analysis. Participants were a snowball sample of 10 members of the UK general public, aged 25-35 years, with equal numbers of males and females. Participants reported walking as not being "proper" exercise, and that it is not a goal in itself. Factors that participants cited as making walking easier included the functionality of walking for transport, contextual factors of social support and psychological benefits. Perceived lack of time was cited as an inhibitory barrier to walking. Participants' perceptions of walking were incongruent with current health promotion campaigns. There is a need to address the misconception that walking is not proper exercise. The traditional focus of walking promotion campaigns concerns beliefs about the benefits of walking on health. People engage in healthy behaviour for reasons other than to be healthy. Interventions to promote walking should consider targeting the psychological meaning and value of walking, in addition to beliefs about health.

Defining a minimum income for healthy living (MIHL): older age, England

BACKGROUND

Worldwide biomedical and social research is providing evidence on the personal requirements for health and well-being. Assessment of the minimum personal costs entailed in meeting these requirements is important for the definition of 'poverty'. Barriers to health must arise if income is below this level. We demonstrate the principle of such assessment for people aged 65 years plus without significant disability living independently in England.

METHODS

Current best evidence on the needs for healthy living was derived for nutrition, physical activity, housing, psychosocial relations/social inclusion, getting about, medical care and hygiene. We used conclusions of expert reviews, published research and where necessary, our judgement. This knowledge was translated into presumptively acceptable ways of living for the specified population. Current corresponding minimal personal costs were assessed from familiar low cost retailers/suppliers or, where unavoidable, from national data on the expenditure of low-income older people.

RESULTS

Minimum income requirements for healthy living, MIHL, for this population in England is 50% greater than the state pension. It is also appreciably greater than the official minimum income safety floor (after means testing), the Pension Credit Guarantee; that will also have to meet any extra costs of disability.

CONCLUSION

Objective evidence-based assessment of MIHL now is practicable but not presently as a basis of health and social policy in the UK or elsewhere apparently. Such assessment could also be an operational criterion of poverty and society's minimum income standards. The results suggest that inadequate income currently could be a barrier to healthy living for older people in England.

Interventions to promote walking: systematic review

OBJECTIVE

To assess the effects of interventions to promote walking in individuals and populations.

DESIGN

Systematic review.

DATA SOURCES

Published and unpublished reports in any language identified by searching 25 electronic databases, by searching websites, reference lists, and existing systematic reviews, and by contacting experts.

REVIEW METHODS

Systematic search for and appraisal of controlled before and after studies of the effects of any type of intervention on how much people walk, the distribution of effects on walking between social groups, and any associated effects on overall physical activity, fitness, risk factors for disease, health, and wellbeing.

RESULTS

We included 19 randomised controlled trials and 29 non-randomised controlled studies. Interventions tailored to people's needs, targeted at the most sedentary or at those most motivated to change, and delivered either at the level of the individual (brief advice, supported use of pedometers, telecommunications) or household (individualised marketing) or through groups, can encourage people to walk more, although the sustainability, generalisability, and clinical benefits of many of these approaches are uncertain. Evidence for the effectiveness of interventions applied to workplaces, schools, communities, or areas typically depends on isolated studies or subgroup analysis.

CONCLUSIONS

The most successful interventions could increase walking among targeted participants by up to 30-60 minutes a week on average, at least in the short term. From a perspective of improving population health, much of the research currently provides evidence of efficacy rather than effectiveness. Nevertheless, interventions to promote walking could contribute substantially towards increasing the activity levels of the most sedentary.

Successful long-term weight maintenance: a 2-year follow-up

OBJECTIVE

To find factors associated with successful weight maintenance (WM) in overweight and obese subjects after a very low-calorie diet (VLCD).

RESEARCH METHODS AND PROCEDURES

Subjects (133) followed a VLCD (2.1 MJ/d) for 6 weeks in a free-living situation. Of these, 103 subjects (age, 49.6 +/- 9.7 years; BMI, 30.9 +/- 3.8 kg/m(2)) completed the following 2-year WM period. Body weight (BW), body composition, leptin concentration, attitude toward eating, and physical activity were determined right before (t0) and after (t1) the VLCD, after 3 months (t2), after 1 year (t3), after 1.5 years (t4), and after 2 years (t5).

RESULTS

BW loss during VLCD was 7.2 +/- 3.1 kg. After 2 years, follow-up BW regain was 69.0 +/- 98.4%. After 2 years of WM, 13 subjects were successful (<10% BW regain), and 90 were unsuccessful (>10% BW regain). At baseline, these groups were significantly different in BMI (33.7 +/- 4.7 vs. 30.5 +/- 3.5 kg/m(2), respectively; p < 0.05) and fat mass (38.3 +/- 9.8 vs. 32.1 +/- 8.3 kg, p < 0.05). Successful subjects increased their dietary restraint significantly more during the whole study period (dietary restraint score, -4.9 +/- 4.4 vs. -2.1 +/- 3.8). Furthermore, %BW regain was associated with the amount of percentage body fat lost during VLCD, which indicates that the more fat lost, the better the WM, suggesting a fat free mass-sparing effect.

DISCUSSION

Characteristics such as the ability to increase dietary restraint and maintain this high level of restraint, fat free mass sparing, and a relatively high baseline BMI and fat mass were associated with successful long-term WM (<10% regain after 2 years).

Perceived barriers to walking in the neighbourhood environment and change in physical activity levels over 12 months

OBJECTIVES

To investigate whether, and to what extent, perceived barriers to neighbourhood walking (BTNW) may be associated with physical activity levels.

DESIGN

Prospective survey with 12-month follow-up.

SUBJECTS AND METHODS

750 people attending walking schemes throughout England and Scotland; 551 completed the follow-up. independent variables were demographic characteristics, examples of possible "external" barriers to walking-for example, "worries about personal safety", and one item concerning ill health. The main outcome measures were "metabolic equivalent" (MET) hours' walking and overall physical activity in the preceding week.

RESULTS

Baseline and follow-up demographic characteristics were similar and physical activity levels generally high. Leisure walking changed little over 12 months, while total physical activity levels reduced significantly from a mean (SD) of 71.26 (78.14) MET hours per week at baseline to 59.57 (181.40) at the 12-month follow-up (p<0.001). External BTNW cited between baseline and 12 months increased significantly from a mean (SD) of 1.24 (1.61) at baseline to 1.43 (1.72) at the 12-month follow-up (p<0.001); only "worries about personal safety" reduced. A significant association was found between citing a health-related BTNW and the total number of external BTNW that were reported at baseline. The strength of this association increased over 12 months. Neither changes in reporting external BTNW that occurred over 12 months (increased vs decreased, vs unchanged) nor changes in the presence of a health-related BTNW were significantly related to levels of leisure walking and overall physical activity (MET hours in the preceding week) over the same period.

CONCLUSION

Among older people who attended walking schemes, having a health problem that restricted walking had a detrimental influence on people's perceptions about external BTNW, which increased over time. Actual levels of walking and overall physical activity levels did not appear to be significantly affected by this.

Personal, social and environmental determinants of educational inequalities in walking: a multilevel study

OBJECTIVE

To investigate the contribution of personal, social and environmental factors to mediating socioeconomic (educational) inequalities in women's leisure-time walking and walking for transport.

METHODS

A community sample of 1282 women provided survey data on walking for leisure and transport; educational level; enjoyment of, and self-efficacy for, walking; physical activity barriers and intentions; social support for physical activity; sporting/recreational club membership; dog ownership; and perceived environmental aesthetics and safety. These data were linked with objective environmental data on the density of public open space and walking tracks in the women's local neighbourhood, coastal proximity and street connectivity.

RESULTS

Multilevel modelling showed that different personal, social and environmental factors were associated with walking for leisure and walking for transport. Variables from all three domains explained (mediated) educational inequalities in leisure-time walking, including neighbourhood walking tracks; coastal proximity; friends' social support; dog ownership; self-efficacy, enjoyment and intentions. On the other hand, few of the variables examined explained educational variations in walking for transport, exceptions being neighbourhood, coastal proximity, street connectivity and social support from family.

CONCLUSIONS

Public health initiatives aimed at promoting, and reducing educational inequalities in, leisure-time walking should incorporate a focus on environmental strategies, such as advocating for neighbourhood walking tracks, as well as personal and social factors. Further investigation is required to better understand the pathways by which education might influence walking for transport.

Are beliefs elicited biased by question order? A theory of planned behaviour belief elicitation study about walking in the UK general population

OBJECTIVES

To elicit salient beliefs about walking for an average of 30 minutes per day, with the aims of investigating whether the order of Theory of Planned Behaviour (TPB) belief elicitation questions affects the number and types of beliefs elicited and whether affective and instrumental questions elicit different beliefs.

DESIGN

A 3 x 2 x 2 x 2 mixed factorial design was employed, with order of behavioural, normative and control questions, and affective and instrumental questions as between-subjects variables, and affective/instrumental and positive/negative questions as within-subjects variables.

METHOD

Quota sampling with regards to age and gender (N=180) was employed to obtain a sample that was broadly representative of the adult general population.

RESULTS

The order in which behavioural, normative and control beliefs were asked had little impact on the number or type of beliefs elicited. The affective/instrumental attitude distinction was supported. Few differences were apparent between older and younger respondents and between men and women.

CONCLUSION

TPB belief elicitation studies are not biased by order effects. Interventions to promote walking should consider targeting affective beliefs, e.g. stress relief, in addition to beliefs about health, which is the traditional focus of health campaigns. Given the similarities in beliefs across demographic groups, 'one size fits all' interventions to promote walking are appropriate.

Contrôle attentionnel de la stabilité posturale chez la personne âgée institutionnalisée : effets d'un programme d'activité physique

OBJECTIVE

We aimed to examine the effect of a physical activity program on postural sway and on the attentional control of postural abilities in elderly frail adults.

METHOD

Twelve older adults (age 81.4+/-9 years) institutionalised in a geriatric care institution participated in the physical activity program posture-balance-mobility (PBM) twice a week (1 hour per session) for 12 weeks. We analysed stabilometric data for surface and length of the center of pressure (COP) sway, with eyes open and eyes closed, under single-task and dual-task conditions on a firm floor before and after the training program. During the static postural evaluation and under the dual-task condition, subjects performed an attention-demanding cognitive task, the random number generation task.

RESULTS

Only the length of COP sway was more important under the dual-task condition than under the single-task condition (p=0.05). At baseline, cognitive performance was significantly weaker under the dual-task condition (standing) than under the single-task condition (seated), with eyes closed but not eyes open (p<0.05). However, after the training program, the performance of the cognitive task did not significantly differ between the dual-task condition with eyes closed and the single-task condition with eyes closed.

CONCLUSION

The training program allowed elderly subjects to improve their ability to perform an attention-demanding cognitive task while standing still, in particular with their eyes closed. Although balance seemed to be less stable under the dual-task condition than under the single-task condition, these results could be interpreted as an improvement of the attentional control of postural stability.

Truncus endurance, hip and ankle mobility and aerobic fitness in 15-year-old Norwegian adolescents in 1968 and 1997

This study compared the physical performance of adolescents in 1997 and 1968. The material included 1329 15-year-old Norwegian adolescents in Akershus county in Norway in 1968, and 1105 15-year-old adolescents in the same region in 1997. The investigations were supervised by the same conductor on both occasions, and used identical physical tests. The test battery included dynamic endurance of abdominal and low back muscles, hip flexion, ankle dorsiflexion and aerobic fitness. Compared with 1968, low back extension endurance in 1997 was almost 10% lower in both genders, the endurance of the abdominal muscles was 4.8% poorer among boys and 8.1% higher among girls and the ratio between abdominal and low back extension endurance was 11.8% higher among boys and 26.4% higher in girls. Compared with 1968, hip flexion in 1997 was 8.3% higher in girls, while ankle dorsiflexion and aerobic fitness in boys were 15% and 13.4% poorer, and 4.8% poorer and 2.5% higher in girls, respectively. The data indicate a general decline during one generation in physical performance among boys, a decline in low back endurance, truncus balance and ankle mobility among girls and in a higher abdominal endurance among girls.

Self-guided brisk walking training with or without poles: a randomized-controlled trial in middle-aged women

Walking with poles (Nordic walking, NW) has become popular. We compared training responses of brisk walking (W) or NW on cardiorespiratory and neuromuscular fitness. We randomized 121 non-obese sedentary women (aged 50-60) to an NW or W group (NWG, WG), to train 40 min four times weekly for 13 weeks. Intensity was based on subjective perception of exertion. Cardiorespiratory performance was assessed in four levels corresponding to 50%, 65%, 80% and 100% of peak VO(2). Fifty-four NWG and 53 WG subjects completed the study. The mean intensity was about 50% of heart rate (HR) reserve. The baseline peak VO(2) was 25.8 (SD 3.9) mL/min/kg. Both groups improved peak VO(2) similarly (NWG 2.5 mL/min/kg, 95% confidence interval (CI) 1.9-3.3; WG 2.6, CI 1.9-3.3). In the submaximal stages while walking with or without poles, HR and lactate decreased after training in both groups, but the changes were not statistically significantly different between the groups. Of the neuromuscular tests after training, the only significant difference between the groups was in the leg strength in the one-leg squat, favoring WG. In conclusion, both training modes improved similarly health-enhancing physical fitness, and they were feasible and safe.

High intensity deep water training can improve aerobic power in elderly women

Deep water running with wet vest is a safe form of exercise for elderly with mobility limitations. However, it is not known to what extent their aerobic power may be improved. Therefore, the aim was to assess the effects of high intensity deep water interval training with vest in elderly women. Twenty-nine healthy women 69 +/- 4 years old participated. They performed a graded maximal exercise test on the cycle ergometer. They were randomly assigned to a control or to a training group. A submaximal exercise test on the cycle ergometer was executed only by the training group. They trained in deep water running/walking wearing a vest two times a week for 8 weeks. The target heart rate was 75% of maximal heart rate and the training consisted of several short working periods and resting intervals. After the intervention the heart rate at rest was 8% lower for the training group (P<0.01). Their heart rate at submaximal exercise was 3% less (P<0.01), their maximal oxygen uptake was raised by 10% (P<0.01), and their maximal ventilation was increased 14% (P<0.01). The values for the control group were unaltered after the period of intervention. In conclusion, high intensity deep water running with vest improves submaximal work capacity, maximal aerobic power, and maximal ventilation with the effects transferable to land-based activities in elderly women.

Long-term changes in leisure time walking, moderate and vigorous exercise: Were they influenced by the national physical activity guidelines?

Data from the Australian Bureau of Statistics three cross-sectional National Health Surveys, conducted in 1989-1990, 1995-1996 and 2000, were used to examine long-term population responses to the 1996 physical activity (PA) recommendations. Past 2-week recall of the number of times and total minutes spent walking for recreation or sport, and doing moderate and vigorous exercise, were averaged for 1 week to create a measure of 'sufficiently active': >or=5 weekly sessions of >or=150 min/week of at least moderate-intensity activity. With the exception of adults aged>60 years, from 1989 to 2000, there were increases in the prevalence of walking (+8%) and in moderate-intensity exercise (+4%), resulting in a significant decline (-6%) in the proportion of those reporting no leisure-time exercise. Participation in vigorous exercise remained unchanged. There was a 'population shift' in median minutes and sessions of walking from 1995 to 2000, but the prevalence of regular walking (>or=5 times and >or=150 min/week) remained unchanged. A small but significant increase (+2%) in the proportion of adults who met the PA recommendations was noted mainly for men under 60 years and for women aged 45-59 years. The proportion meeting the PA recommendations declined significantly in the most socioeconomically disadvantaged area. These data provide evidence contrary to the observed declines in PA documented by the Active Australia surveillance in the late 1990s. The population may have responded to the 1996 concept of moderate-intensity exercise mainly by walking, but sustainable promotional efforts will be required to build on these gains in the forthcoming decades.

The Relationship between Daily Steps and Body Composition in Postmenopausal Women

PURPOSE

The purpose of this study was to examine the relationship between pedometer-determined physical activity (PA) measured in steps per day and adiposity in postmenopausal women.

METHODS

Ninety-three women aged 60.9 +/- 5.8 years participated in the study. Relative body fatness was determined by the measurement of height, body mass, percent body fat, trunk fat, and waist and hip circumference. Each subject wore a pedometer for 14 days after testing to measure daily steps. Correlation coefficients were calculated to examine the relationship between average steps per day and adiposity variables. Subjects were grouped according to PA tertiles. ANCOVA, with age as the covariate, was used to determine whether adiposity varied across activity groups.

RESULTS

Significant inverse associations (p < 0.001) were found between average steps per day and all adiposity variables (r ranging from -0.487 to -0.368). Relationships remained significant after controlling for the influence of age and caloric intake. Also, there was a significant difference in adiposity variables among PA tertiles, with higher values found in the less active groups.

CONCLUSIONS

We demonstrated that postmenopausal women who take more daily steps have more favorable adiposity profiles. Additionally, the average body mass index (BMI) of the women in the active category (accumulating an average of 10,023 +/- 240 steps per day) was in the recommended range (24.1 +/- 0.9 kg/m(2)).

Cardiocirculatory and metabolic responses at different walking intensities

OBJECTIVES

Although walking is a common physical activity, scientifically based training guidelines using standardised tests have not been established. Therefore this explorative study investigated the cardiovascular and metabolic load resulting from different walking intensities derived from maximal velocity (Vmax) during an incremental treadmill walking test.

METHODS

Oxygen uptake, heart rate (HR), blood concentrations of lactate and catecholamines, and rating of perceived exertion were recorded in 16 recreational athletes (mean (SD) age 53 (9) years) during three 30 minute walking trials at 70%, 80%, and 90% of Vmax (V70, V80, and V90) attained during an incremental treadmill walking test.

RESULTS

Mean (SD) oxygen uptake was 18.2 (2.3), 22.3 (3.1), and 29.3 (5.0) ml/min/kg at V70, V80, and V90 respectively (p<0.001). V70 led to a mean HR of 110 (9) beats/min (66% HRmax), V80 to 124 (9) beats/min (75% HRmax), and V90 to 152 (13) beats/min (93% HRmax) (p<0.001). Mean (SD) lactate concentrations were 1.1 (0.2), 1.8 (0.6), and 3.9 (2.0) mmol/l at V70, V80, and V90 respectively (p<0.001). There were no significant differences between catecholamine concentrations at the different intensities. Rating of perceived exertion was 10 (2) at V70, 12 (2) at V80, and 15 (2) at V90. Twelve subjects reported muscular complaints during exercise at V90 but not at V70 and V80.

CONCLUSIONS

Intensity and heart rate prescriptions for walking training can be derived from an incremental treadmill walking test. The cardiovascular and metabolic reactions observed suggest that V80 is the most efficient workload for training in recreational athletes. Further studies are needed to confirm these findings.

Effects of daily exercise on blood pressure, plasma glucose, and obesity measures in 55–64-year-old obese Asian Indian men: The Calcutta longitudinal study

The present longitudinal study was undertaken to study the effect of brisk walking on blood pressure, plasma glucose, and obesity measures in 55-64-year-old obese Asian Indian men. A total of 45 obese (body mass index > or =25 kg/m(2)) men took part in the study. They were monitored for 20 weeks. Obesity measures, blood pressure, fasting plasma glucose (FPG), and 30 min of brisk walking were recorded for each participant. Brisk walking was defined as 2 km of walking by 30 min with moderate sweating. A general linear model (GLM) repeated-measures analysis procedure with Scheffé's post hoc test revealed that group I (up to 5 weeks of exercise) had significantly greater means compared to groups II (6-10 weeks), III (11-15 weeks), and IV (16-20 weeks) for body mass index (P < 0.01), waist-hip ratio (P < 0.001), percent body fat (P < 0.05), systolic blood pressure (P < 0.001), diastolic blood pressure (P < 0.001), and FPG (P < 0.001), whereas group I had a significantly lower mean than groups II, III, and IV for frequency of brisk walking (P < 0.01). It was also observed that change in Delta blood pressure and Delta FPG had a significant positive association with Delta obesity measures, independent of age effect. Therefore, brisk walking is recommended to lower blood pressure, blood glucose, and obesity (particularly central obesity) in middle-aged obese individuals.

Enhancing theoretical fidelity: an e-mail-based walking program demonstration

PURPOSE

To examine the extent to which theoretical fidelity, or precision in replicating theory-based recommendations, influenced the effectiveness of two walking programs based on social cognitive theory (SCT).

DESIGN

Two-group randomized controlled trial.

SETTING

College town in Virginia.

SUBJECTS

Sixty-one sedentary adult women.

INTERVENTION

Two 12-week e-mail-based walking programs were compared. The high fidelity program was designed to more precisely follow SCT recommendations for operationalizing mastery procedures than the low fidelity program, which was designed to simulate how mastery procedures were operationalized in most existing SCT-based physical activity programs. Treatment contact and walking prescription were controlled across groups.

MEASURES

The 1-mile walk test of physical fitness and SCT measures were completed at baseline and posttest. Self-reported walking quantity was assessed at baseline, posttest, and 1-year follow-up. Walking logs were completed during the program. Process evaluation measures were completed at posttest.

RESULTS

Fifty women completed the study. The high fidelity group improved more than twice as much as the low fidelity group on 1-mile walk test time (86 vs. 32 seconds, p < .05), goal setting (p < .05), and positive outcome expectations (p < .05) and reported greater program satisfaction (p < .01).

CONCLUSION

Theoretical fidelity could advance the quality of physical activity interventions, which have often shown small effects.