Speed and exercise intensity of recreational walkers

Classification of moderate-intensity overground walking speed in 21- to 85-year-old adults

The Compendium of Physical Activities reports that walking at 2.5 mph associates with absolutely-defined moderate intensity (i.e., ≥3 metabolic equivalents [METs]). However, it is unclear whether this speed threshold is accurate during overground walking and/or across the adult age-span. This study aimed to identify optimal and heuristic speed thresholds associated with 3 METs during overground walking across age groups. Healthy adults (n = 248, 21-85 years old, 49% women) performed a 5-minute self-paced overground walking trial. Speed was measured using an electronic gait mat, and oxygen uptake was measured using indirect calorimetry and converted to METs. Optimal and heuristic thresholds and classification accuracy metrics were determined and compared using ROC curve analyses. Speed thresholds (95% CIs) associated with 3 METs for the whole sample, young (21-40 years), middle-aged (41-60 years) and older-aged (61-85 years) groups were 1.29 (1.25, 1.33), 1.30 (1,26, 1,35), and 1.25 (1.21, 1.29) m/s, respectively. Overall, 3 mph and 5 km/h performed better than 2.5 mph and 4.5 km/h in balancing both sensitivity and specificity (higher Youden's Indices). Overground walking speeds associated with 3 METs were similar across age groups. A heuristic threshold of 3 mph or 5 km/h may better identify absolutely-defined moderate intensity overground walking.

The Effect of Fatigue on Lower Limb Joint Stiffness at Different Walking Speeds

The aim of this study was to assess the stiffness of each lower limb joint in healthy persons walking at varying speeds when fatigued. The study included 24 subjects (all male; age: 28.16 ± 7.10 years; height: 1.75 ± 0.04 m; weight: 70.62 ± 4.70 kg). A Vicon three-dimensional analysis system and a force plate were used to collect lower extremity kinematic and kinetic data from the participants before and after walking training under various walking situations. Least-squares linear regression equations were utilized to evaluate joint stiffness during single-leg support. Three velocities significantly affected the stiffness of the knee and hip joint (p < 0.001), with a positive correlation. However, ankle joint stiffness was significantly lower only at maximum speed (p < 0.001). Hip stiffness was significantly higher after walking training than that before training (p < 0.001). In contrast, knee stiffness after training was significantly lower than pre-training stiffness in the same walking condition (p < 0.001). Ankle stiffness differed only at maximum speed, and it was significantly higher than pre-training stiffness (p < 0.001). Walking fatigue appeared to change the mechanical properties of the joint. Remarkably, at the maximum walking velocity in exhaustion, when the load on the hip joint was significantly increased, the knee joint’s stiffness decreased, possibly leading to joint instability that results in exercise injury.

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.

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 green tea extract combined with brisk walking on lipid profiles and the liver function in overweight and obese men: A randomized, double-blinded, placebo-control trial

This study was aimed to investigate the effect of green tea extract (GTE) combined with brisk walking on lipid profiles and the liver function in overweight and obese men. Twenty-four participants were randomized to either the GTE group or the placebo group for 12 weeks with a 4-week follow-up. The walking program consisted of four 60-min-sessions/week and all participants were asked to consume two GTE (150mg) or placebo tablets daily. After 12-week intervention, GTE group resulted in a significant difference in the low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels when compared to placebo group (P < 0.01). There was also a significant reduction in the aspartate aminotransferase levels (P < 0.01) in the GTE group, but no change in the placebo group (P >0.05). There was no change in the triglyceride or high-density lipoprotein cholesterol (HDL-C) levels in the placebo group, but a significant reduction was noted in the HDL-C levels in the GTE group (P < 0.05). GTE combined with brisk walking resulted in a significant change in the LDL-C and TC levels, however, a significant reduce in HDL-C in the GTE group. The study has a more positive effect on the liver function than brisk walking alone.

Improving bystander defibrillation in out-of-hospital cardiac arrests at home

Aims:

Most out-of-hospital cardiac arrests occur at home with dismal bystander defibrillation rates. We investigated automated external defibrillator coverage of home arrests, and the proportion potentially reachable with an automated external defibrillator before emergency medical service arrival according to different bystander activation strategies.

Methods and results:

Cardiac arrests in homes (private/nursing/senior homes) in Copenhagen, Denmark (2008–2016) and registered automated external defibrillators (2007–2016), were identified. Automated external defibrillator coverage (distance from arrest to automated external defibrillator) and accessibility at the time of arrest were examined according to route distance to nearest automated external defibrillator and emergency medical service response time. The proportion of arrests reachable with an automated external defibrillator by bystander was calculated using two-way (from patient to automated external defibrillator and back) and one-way (from automated external defibrillator to patient) potential activation strategies. Of 1879 home arrests, automated external defibrillator coverage ≤100 m was low (6.3%) and a two-way bystander could potentially only retrieve an accessible automated external defibrillator before emergency medical service in 31.1% (n=37) of cases. If a bystander only needed to travel one-way to bring an automated external defibrillator (≤100 m, ≤250 m and ≤500 m), 45.4% (n=54/119), 37.1% (n=196/529) and 29.8% (n=350/1174) could potentially be reached before the emergency medical service based on current automated external defibrillator accessibility.

Conclusions:

Few home arrests were reachable with an automated external defibrillator before emergency medical service if bystanders needed to travel from patient to automated external defibrillator and back. However, nearly one-third of arrests ≤500 m of an automated external defibrillator could be reached before emergency medical service arrival if the bystander only needed to travel one-way from the automated external defibrillator to the patient.

Genome-wide association study of self-reported walking pace suggests beneficial effects of brisk walking on health and survival

Walking is a simple form of exercise, widely promoted for its health benefits. Self-reported walking pace has been associated with a range of cardiorespiratory and cancer outcomes, and is a strong predictor of mortality. Here we perform a genome-wide association study of self-reported walking pace in 450,967 European ancestry UK Biobank participants. We identify 70 independent associated loci (P < 5 × 10^-8), 11 of which are novel. We estimate the SNP-based heritability as 13.2% (s.e. = 0.21%), reducing to 8.9% (s.e. = 0.17%) with adjustment for body mass index. Significant genetic correlations are observed with cardiometabolic, respiratory and psychiatric traits, educational attainment and all-cause mortality. Mendelian randomization analyses suggest a potential causal link of increasing walking pace with a lower cardiometabolic risk profile. Given its low heritability and simple measurement, these findings suggest that self-reported walking pace is a pragmatic target for interventions aiming for general benefits on health.

A validation study of the use of smartphones and wrist-worn ActiGraphs to measure physical activity at different levels of intensity and step rates in older people

BACKGROUND

Physical activity promotes healthy ageing in older people. Accurate measurement of physical activity in free-living environment is important in evaluating physical activity interventions.

RESEARCH QUESTION

What is the criterion validity of 1)an ActiGraph to identify physical activity at different intensity levels and 2)an ActiGraph and a smartphone to measure step rate?

METHODS

Community-dwelling older people aged≥60 were recruited. The index tests were using ActiGraph worn in different positions (i.e.,both wrists and hip) to measure physical activity intensity and step rate and using smartphone (i.e., Samsung J2 pro and Google Fit) worn in different positions (i.e.,trousers pocket and waist pouch) to measure the step rate. The reference standards were using indirect calorimetry (i.e.,CosMedK4b 2) to measure physical activity intensity and using direct observation for step rate. Subjects were exposed in different physical activity intensity levels (i.e.,sedentary:MET < 1.5,light: MET = 1.5-2.99, moderate:MET = 3.0-6.0, vigorous:MET>6) and step rates through walking on a treadmill at different speeds (i.e.,2-8 km) for approximately 30 min. Spearman's rho, ROC analysis, and percentage error were employed to report the criterion validity.

RESULTS

31 participants completed the tests. ActiGraphs worn in different body positions could significantly differentiate physical activity intensity at the levels of "light- or-above" (VM cut-off = 279.5-1959.1,AUC = 0.932-0.954), "moderate-or-above" (VM cut- off = 1051.0-4212.9,AUC = 0.918-0.932), and "vigorous" (VM cut-off = 3335.4-5093.0, AUC = 0.890-0.907) well with different cut-off points identified. The step rate measured by direct observation correlated significantly with ActiGraph and smartphone (rho = 0.415-0.791). Both ActiGraph and smartphone at different positions generally underestimated the step rate (%error= -20.5,-30.3).

SIGNIFICANCE

A wrist-worn ActiGraph can accurately identify different physical activity intensity levels in older people, but lower cut-off points in older people should be adopted. To measure step rate, a hip-mounted ActiGraph is preferable than a wrist- worn one. A smartphone employing Google Fit generally underestimates step rate but it gives a relatively more accurate estimation of step rate when the older people walk at a speed of 4-8 km/h.

Validity of traditional physical activity intensity calibration methods and the feasibility of self-paced walking and running on individualised calibration of physical activity intensity in children

There are no practical and valid methods for the assessment of individualised physical activity (PA) intensity in observational studies. Therefore, we investigated the validity of commonly used metabolic equivalent of tasks (METs) and pre-determined PA intensity classification methods against individualised PA intensity classification in 35 children 7–11-years-of-age. Then, we studied validity of mean amplitude deviation (MAD) measured by accelerometry during self-paced walking and running in assessment of individualised PA intensity. Individualised moderate PA (MPA) was defined as V̇O₂ ≥ 40% of V̇O_2reserve and V̇O₂ < ventilatory threshold (VT) and vigorous PA (VPA) as V̇O₂ ≥ VT. We classified > 3–6 (or alternatively > 4–7) METs as MPA and > 6 (> 7) METs as VPA. Task intensities were classified according to previous calibration studies. MET-categories correctly identified 25.9–83.3% of light PA, 85.9–90.3% of MPA, and 56.7–82.2% of VPA. Task-specific categories correctly classified 53.7% of light PA, 90.6% of MPA, and 57.8% of VPA. MAD during self-paced walking discriminated MVPA from light PA (sensitivity = 67.4, specificity = 88.0) and MAD during self-paced running discriminated VPA from MPA (sensitivity = 78.8, specificity = 79.3). In conclusion, commonly used methods may misclassify PA intensity in children. MAD during self-paced running may provide a novel and practical method for determining individualised VPA intensity in children.

Effects of Tai Chi Chuan and Brisk Walking Exercise on Balance Ability in Elderly Women: A Randomized Controlled Trial

This study aims to investigate the effects of Tai Chi Chuan (TCC) and brisk walking (BW) on balance and training duration for the two exercises to significantly improve balance. A total of 48 elderly women were randomly divided into three groups. The TCC and BW groups completed a 60-min intervention training program with five sessions weekly for 16 weeks. Single-leg standing balance was tested every 4 weeks. Results showed that all the variables with eyes open improved on the eighth week (p < .05) in the TCC group and on the 12th week (p < .01) in the BW group. All variables with eyes closed improved on the 12th week (p < .01) in the TCC group and on the 16th week (p < .05) in the BW group. The results showed that 12 and 16 weeks of TCC and BW, respectively were essential to improve balance with eyes closed among the women aged 60-70 years.

Detraining effects of regular Tai Chi exercise on postural control ability in older women: A randomized controlled trial

BACKGROUND/OBJECTIVE

This study aimed to investigate the training and detraining effects of Tai Chi (TC) on postural control ability in single leg stance (SLS) by conducting a single-blind randomized controlled trial.

METHOD

Forty-eight older women were randomly divided into the TC, brisk walking (BW), and control(C) groups by using computer-generated program. The participants completed a 16-week intervention training and 8-week detraining program. Postural control ability in SLS was tested at the baseline, 16 t h, 20 t h, and 24 t h weeks. The primary outcomes included single-leg stance time (Time) and secondary outcomes included maximal displacement of the center of pressure (COP) in the anterior-posterior (AP) direction (D-ap), maximal displacement of the COP in the medial-lateral (ML) direction (D-ml), total length of the COP trajectories (Lng), and 95% confidence ellipse area of the COP movements (area), mean AP total excursion velocities (V-ap), and mean ML total excursion velocities (V-ml).

RESULTS

Significant within-group difference compared with the baseline and between-groups difference compared with control group were found at 16 t h, 20 t h, and 24 t h weeks in the TC group and at the 16 t h and 20 t h weeks in the BW group in all the primary and secondary outcomes. Most of secondary outcomes including Lng, D-ml, V-ml, Area increased significantly at the 24 t h week compared with that at the 16 t h week in BW group.

CONCLUSIONS

TC was effective in improving postural control ability and maintaining intervention gains, and was recommended as an appropriate exercise to prevent falls in the older adults.

Effects of Backpack Load and Trekking Poles on Energy Expenditure During Field Track Walking

This study evaluates the effects of the use of backpack load and trekking poles on field track walking energy expenditure. Twenty male volunteer pole walkers (age: 22.70±2.89 years; body mass: 77.90±11.19 kg; height: 1.77±0.06 m; percentage of body fat: 14.6±6.0%) walked at a self-selected pace on a pedestrian field track over a period of more than six months. Each subject was examined at random based on four walking conditions: non-poles and non-load, with poles and non-load, non-poles and with load, with poles and with load. Heart rate, oxygen uptake and energy expenditure were continuously recorded by a portable telemetric system. Non-load walking speed was lower during walking with poles when compared with no poles ( p ≤0.05). Oxygen uptake, energy expenditure and heart rate varied significantly across different conditions. Our results suggest that the use of trekking poles does not influence energy expenditure when walking without an additional load, but it can have an effect during backpack load walking. Moreover, our results indicate that the use of trekking poles may not be helpful to lower the exertion perceived by the subjects when walking with an additional load.

Relation of pedometer steps count & self reported physical activity with health indices in middle aged adults

OBJECTIVE

To describe the relationship between daily physical activity (steps/day and self report method) and health indices. Also to observe relationship between daily physical activity and existence of any prior sign of metabolic syndrome in middle aged adults of 40-60 years. A secondary objective was to observe relation between objective (steps/day) and subjective (IPAQ) measure of physical activity.

METHOD

145 subjects were recruited from residential colony of New Delhi, India and their health indices (waist circumference, hip circumference, waist hip ratio, blood pressure, resting heart rate), and presence of any sign of metabolic syndrome were noted down. Their daily physical activity was determined by pedometer (steps/day) and IPAQ (self report). Steps/day was compared with self reported physical activity, presence of any prior sign of metabolic syndrome, and health indices.

RESULT

The average steps/day was 3226±1558 for females (n=76) and 4273±2530 for males (n=69). IPAQ results were inversely related with WHR (p=0.046, r=-0.166), RHR (p=0.020, r=-0.193) and signs of metabolic syndrome (p=0.017, r=-0.198). Pedometer determined physical activity was inversely related with prior signs of metabolic syndrome present (p=0.041, r=-0.170). Pedometer determined steps/day were positively correlated with self-reported physical activity (p<0.001, r=0.56).

CONCLUSION

Main findings suggested that fewer steps/day and METS are associated with more components of the metabolic syndrome. Prior signs of metabolic syndrome were mainly present in females. Majority of participants were sedentary, showed high resting heart rate, high waist hip ratio and more number of sign of metabolic syndrome.

Association of "Weekend Warrior" and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality

IMPORTANCE

More research is required to clarify the association between physical activity and health in "weekend warriors" who perform all their exercise in 1 or 2 sessions per week.

OBJECTIVE

To investigate associations between the weekend warrior and other physical activity patterns and the risks for all-cause, cardiovascular disease (CVD), and cancer mortality.

DESIGN, SETTING, AND PARTICIPANTS

This pooled analysis of household-based surveillance studies included 11 cohorts of respondents to the Health Survey for England and Scottish Health Survey with prospective linkage to mortality records. Respondents 40 years or older were included in the analysis. Data were collected from 1994 to 2012 and analyzed in 2016.

EXPOSURES

Self-reported leisure time physical activity, with activity patterns defined as inactive (reporting no moderate- or vigorous-intensity activities), insufficiently active (reporting <150 min/wk in moderate-intensity and <75 min/wk in vigorous-intensity activities), weekend warrior (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from 1 or 2 sessions), and regularly active (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from ≥3 sessions). The insufficiently active participants were also characterized by physical activity frequency.

MAIN OUTCOMES AND MEASURES

All-cause, CVD, and cancer mortality ascertained from death certificates.

RESULTS

Among the 63 591 adult respondents (45.9% male; 44.1% female; mean [SD] age, 58.6 [11.9] years), 8802 deaths from all causes, 2780 deaths from CVD, and 2526 from cancer occurred during 561 159 person-years of follow-up. Compared with the inactive participants, the hazard ratio (HR) for all-cause mortality was 0.66 (95% CI, 0.62-0.72) in insufficiently active participants who reported 1 to 2 sessions per week, 0.70 (95% CI, 0.60-0.82) in weekend warrior participants, and 0.65 (95% CI, 0.58-0.73) in regularly active participants. Compared with the inactive participants, the HR for CVD mortality was 0.60 (95% CI, 0.52-0.69) in insufficiently active participants who reported 1 or 2 sessions per week, 0.60 (95% CI, 0.45-0.82) in weekend warrior participants, and 0.59 (95% CI, 0.48-0.73) in regularly active participants. Compared with the inactive participants, the HR for cancer mortality was 0.83 (95% CI, 0.73-0.94) in insufficiently active participants who reported 1 or 2 sessions per week, 0.82 (95% CI, 0.63-1.06) in weekend warrior participants, and 0.79 (95% CI, 0.66-0.94) in regularly active participants.

CONCLUSIONS AND RELEVANCE

Weekend warrior and other leisure time physical activity patterns characterized by 1 or 2 sessions per week may be sufficient to reduce all-cause, CVD, and cancer mortality risks regardless of adherence to prevailing physical activity guidelines.

Walking capacities in multiple sclerosis measured by global positioning system odometer

We used a global positioning satellite technology odometer to determine the maximum objective walking distance capacity (MOWD) of patients with multiple sclerosis (MS). The MOWD correlated with Expanded Disability Status Scale (EDSS) score (r2 =0.41; P < 0.0001), the MSWS-12 scale (r2 = 0.46; P < 0.0001), time to walk 10 m (r2 = 0.51; P < 0.02) and walking speed (r2 =0.75; P < 0.001). Limitation of walking capacities was measurable up to 4550 m, strikingly above the 500-m limit of the EDSS. This objective odometer is a promising tool for evaluation and follow-up of patients with MS. Multiple Sclerosis 2007; 13: 220–223. http://msj.sagepub.com

VELOCIDADE AUTOSSELECIONADA E IDEAL DA CAMINHADA DE AMPUTADOS TRANSFEMORAIS: SOLO E ESTEIRA

RESUMO Introdução: A velocidade de progressão é, em geral, determinada em pesquisas na área da locomoção. Objetivo: Comparar as medidas de velocidade autosselecionada no solo, na esteira rolante e a velocidade ideal estimada pelo número de Froude em sujeitos amputados transfemorais. Método: Primeiramente foi determinada a velocidade no solo; em seguida, realizou-se o teste na esteira, e a velocidade ideal foi estimada a partir dos dados antropométricos. Todos os sujeitos utilizavam joelho hidráulico e pé em fibra de carbono. Para comparação entre as velocidades foi realizada ANOVA de duas vias. Resultados: A velocidade autosselecionada na esteira foi menor (22%) do que no solo. Tanto a velocidade autosselecionada na esteira como a do solo foram 44% e 22% menores do que a velocidade ideal estimada, respectivamente. Conclusão: As velocidades analisadas no presente estudo foram diferentes, provavelmente, devido à variação dos parâmetros cinemáticos.

Predicting metabolic rate during level and uphill outdoor walking using a low-cost GPS receiver

The objective of this study was to assess the accuracy of using speed and grade data obtained from a low-cost global positioning system (GPS) receiver to estimate metabolic rate (MR) during level and uphill outdoor walking. Thirty young, healthy adults performed randomized outdoor walking for 6-min periods at 2.0, 3.5, and 5.0 km/h and on three different grades: 1) level walking, 2) uphill walking on a 3.7% mean grade, and 3) uphill walking on a 10.8% mean grade. The reference MR [metabolic equivalents (METs) and oxygen uptake (V̇o2)] values were obtained using a portable metabolic system. The speed and grade were obtained using a low-cost GPS receiver (1-Hz recording). The GPS grade (Δ altitude/distance walked) was calculated using both uncorrected GPS altitude data and GPS altitude data corrected with map projection software. The accuracy of predictions using reference speed and grade (actual[SPEED/GRADE]) data was high [R(2) = 0.85, root-mean-square error (RMSE) = 0.68 MET]. The accuracy decreased when GPS speed and uncorrected grade (GPS[UNCORRECTED]) data were used, although it remained substantial (R(2) = 0.66, RMSE = 1.00 MET). The accuracy was greatly improved when the GPS speed and corrected grade (GPS[CORRECTED]) data were used (R(2) = 0.82, RMSE = 0.79 MET). Published predictive equations for walking MR were also cross-validated using actual or GPS speed and grade data when appropriate. The prediction accuracy was very close when either actual[SPEED/GRADE] values or GPS[CORRECTED] values (for level and uphill combined) or GPS speed values (for level walking only) were used. These results offer promising research and clinical applications related to the assessment of energy expenditure during free-living walking.

Walking groups in socioeconomically deprived communities: A qualitative study using photo elicitation

Walking groups can benefit health but uptake is more likely amongst those who are socially well-situated and need them least. This study worked with a new walking group in a community in England with poor health and socio-economic indicators to understand non-participation and barriers to involvement. It used a qualitative approach. Participant generated photographs captured the physical and social environments in which they walked and these were used with semi-structured interviews to inductively explore walking group participation and the wider social context of walking. We found that prior to joining there were low expectations of any health benefit and walking groups were not viewed as ‘proper’ activity. The group format and social expectations presented a barrier to joining. Having joined participants described a developing awareness of the health benefits of walking. The shared sense of achieving health goals with others sustained the group rather than socialising, per se. We suggest that walking group participation is a complex social practice. Promoting walking groups as a social activity for this group of people may well have been counter-productive.

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Photo-elicited interviews explored physical and social environments for walking.

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Group walking was not viewed as effective exercise with health benefits.

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Group format and social expectations represented a barrier to these participants.

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The walking group was sustained by achievement of goals rather than sociability.

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Promoting walking groups as a social activity can be counter-productive.

Active Commuting Behaviors in a Nordic Metropolitan Setting in Relation to Modality, Gender, and Health Recommendations

Active commuting between home and place of work or study is often cited as an interesting source of physical activity in a public health perspective. However, knowledge about these behaviors is meager. This was therefore studied in adult active commuters (n = 1872) in Greater Stockholm, Sweden, a Nordic metropolitan setting. They received questionnaires and individually adjusted maps to draw their normal commuting route. Three different modality groups were identified in men and women: single-mode cyclists and pedestrians (those who only cycle or walk, respectively) and dual-mode commuters (those who alternately walk or cycle). Some gender differences were observed in trip distances, frequencies, and velocities. A large majority of the commuting trip durations met the minimum health recommendation of at least 10-minute-long activity bouts. The median single-mode pedestrians and dual-mode commuters met or were close to the recommended weekly physical activity levels of at least 150 minutes most of the year, whereas the single-mode cyclists did so only during spring-mid-fall. A high total number of trips per year (range of medians: 230-390) adds to the value in a health perspective. To fully grasp active commuting behaviors in future studies, both walking and cycling should be assessed over different seasons and ideally over the whole year.

The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials

OBJECTIVE

To conduct a systematic review and meta-analysis of randomised control trials that examined the effect of walking on risk factors for cardiovascular disease.

METHODS

Four electronic databases and reference lists were searched (Jan 1971-June 2012). Two authors identified randomised control trials of interventions ≥ 4 weeks in duration that included at least one group with walking as the only treatment and a no-exercise comparator group. Participants were inactive at baseline. Pooled results were reported as weighted mean treatment effects and 95% confidence intervals using a random effects model.

RESULTS

32 articles reported the effects of walking interventions on cardiovascular disease risk factors. Walking increased aerobic capacity (3.04 mL/kg/min, 95% CI 2.48 to 3.60) and reduced systolic (-3.58 mm Hg, 95% CI -5.19 to -1.97) and diastolic (-1.54 mm Hg, 95% CI -2.83 to -0.26) blood pressure, waist circumference (-1.51 cm, 95% CI -2.34 to -0.68), weight (-1.37 kg, 95% CI -1.75 to -1.00), percentage body fat (-1.22%, 95% CI -1.70 to -0.73) and body mass index (-0.53 kg/m(2), 95% CI -0.72 to -0.35) but failed to alter blood lipids.

CONCLUSIONS

Walking interventions improve many risk factors for cardiovascular disease. This underscores the central role of walking in physical activity for health promotion.

How far from home? The locations of physical activity in an urban U.S. setting

Little is known about where physical activity (PA) occurs, or whether different demographic groups accumulate PA in different locations.

METHOD

Objective data on PA and location from 611 adults over 7days were collected in King County, WA in 2008-2009. The relative amounts of time spent in sedentary-to-low and moderate-to-vigorous PA (MVPA) were quantified at three locations: "home" (<125m from geocoded home locations); "near" home (125-1666m, defining the home neighborhood); and "away" from home (>1666m). Differences in MVPA by demographics and location were examined. The percent of daily time in MVPA was estimated using a mixed model adjusted for location, sex, age, race/ethnicity, employment, education, BMI, and income.

RESULTS

Most MVPA time occurred in nonhome locations, and disproportionately "near" home; this location was associated with 16.46% greater time in MVPA, compared to at-home activity (p<0.001), whereas more time spent at "away" locations was associated with 3.74% greater time in MVPA (p<0.001). Location was found to be a predictor of MVPA independent of demographic factors.

CONCLUSION

A large proportion of MVPA time is spent at "near" locations, corresponding to the home neighborhood studied in previous PA research. "Away" locations also host time spent in MVPA and should be the focus of future research.

Impact of walking on glycemic control and other cardiovascular risk factors in type 2 diabetes: a meta-analysis

Background

Walking is the most popular and most preferred exercise among type 2 diabetes patients, yet compelling evidence regarding its beneficial effects on cardiovascular risk factors is still lacking. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the association between walking and glycemic control and other cardiovascular risk factors in type 2 diabetes patients.

Methods

Three databases were searched up to August 2014. English-language RCTs were eligible for inclusion if they had assessed the walking effects (duration ≥8 weeks) on glycemic control or other cardiovascular risk factors among type 2 diabetes patients. Data were pooled using a random-effects model. Subgroup analyses based on supervision status and meta-regression analyses of variables regarding characteristics of participants and walking were performed to investigate their association with glycemic control.

Results

Eighteen studies involving 20 RCTs (866 participants) were included. Walking significantly decreased glycosylated haemoglobin A1c (HbA1c) by 0.50% (95% confidence intervals [CI]: −0.78% to −0.21%). Supervised walking was associated with a pronounced decrease in HbA1c (WMD −0.58%, 95% CI: −0.93% to −0.23%), whereas non-supervised walking was not. Further subgroup analysis suggested non-supervised walking using motivational strategies is also effective in decreasing HbA1c (WMD −0.53%, 95% CI: −1.05% to −0.02%). Effects of covariates on HbA1c change were generally unclear. For other cardiovascular risk factors, walking significantly reduced body mass index (BMI) and lowered diastolic blood pressure (DBP), but non-significantly lowered systolic blood pressure (SBP), or changed high-density or low-density lipoprotein cholesterol levels.

Conclusions

This meta-analysis supports that walking decreases HbA1c among type 2 diabetes patients. Supervision or the use of motivational strategies should be suggested when prescribed walking to ensure optimal glycemic control. Walking also reduces BMI and lowers DBP, however, it remains insufficient regarding the association of walking with lowered SBP or improved lipoprotein profiles.

Trial Registration

PROSPERO CRD42014009515

Acute affective responses to prescribed and self-selected exercise sessions in adolescent girls: an observational study

Background

Positive affective responses can lead to improved adherence to exercise. This study sought to examine the affective responses and exercise intensity of self-selected exercise in adolescent girls.

Methods

An observational study where twenty seven females (Age M = 14.6 ± 0.8 years) completed three 20-minute exercise sessions (2 self-selected and 1 prescribed intensity) and a graded exercise test. The intensity of the prescribed session was matched to the first self-selected session. Intensity, affective responses and ratings of perceived exertion were recorded throughout the sessions and differences examined. Repeated measures ANOVAs were conducted to examine differences.

Results

There were no significant differences in intensity between the prescribed and self-selected sessions, but affective responses were significantly more positive (p < .01) during the self-selected session. Ratings of perceived exertion were significantly lower (p < .01) during the self-selected session than the prescribed session. On average participants worked at 72% V˙O2 peak; well within the intensity recommended by the American College of Sports Medicine.

Conclusion

Even though the intensity did not differ between the self-selected and prescribed sessions, there was a significant impact on affective responses, with more positive affective responses being elicited in the self-selected session. This highlights the importance of autonomy and self-paced exercise for affective responses and may have potential long-term implications for adherence.

Association between physical activity and psychological status among Saudi female students

BACKGROUND

Physical inactivity is common among Saudi females. Many variables are associated with different levels of mental health, including physical activity. This study was designed to determine the correlation between 3 weeks of improved physical activity and psychological factors such as insomnia, depression and attention span.

METHODS

Seventy-six female students, of mean age 20.9 ± 1.4 years, were analyzed. Insomnia, depression and attention were subjectively assessed using the Insomnia Severity Index (ISI), the Beck Depression Inventory (BDI), and the Attention Span Test (AST), respectively. Each subject was given a pedometers and advised to walk at least 6000 steps per day for 3 weeks. Psychological status was assessed before and after the 3 weeks and compared using paired sample t-tests. Pearson correlation was used to determine the association between physical health and psychological factors.

RESULTS

Improvements in scores on the ISI (from 7.22 ± 3.06 to 4.09 ± 2.80), BDI (from 8.88 ± 3.13 to 3.98 ± 2.74) and AST (from 63.86 ± 3.06 to 77.27 ± 11.33) were observed after 3 weeks. Physical activity was negatively correlated with ISI (r = -0.74) and BDI (r = -0. 78) and positively correlated with AST (r = 0.69).

CONCLUSION

Improved physical activity can be useful in managing insomnia, depression and attention. In female Saudi students, higher levels of physical activity were associated with improved mental health.

Accumulated brisk walking reduces arterial stiffness in overweight adults: evidence from a randomized control trial

Arterial stiffness is a major contributor to the development of atherosclerosis and consequently cardiovascular disease. This study aimed to examine whether 6 months of accumulated (3 × 10 minutes, 5 days/week) brisk walking was sufficient to reduce arterial stiffness in sedentary, overweight individuals. Seventy-seven individuals (19 men, 58 women; age, 30-55 years) were randomly allocated to one of three groups; two groups completed 30 minutes of accumulated walking with either monthly or weekly telephone support; the third group (control) performed stretching exercises. The walking groups were combined and telephone support included as a covariate. Anthropometry, blood pressure (BP), blood lipids, pulse wave velocity (PWV), and NOx (surrogate marker for nitric oxide) were measured at baseline, post-intervention and 4 months post-intervention. No changes were observed for anthropometry, BP, or lipids. However, at the end of the intervention, there was a decrease in PWV (P < .001) accompanied by an increase in NOx (P < .001), with changes maintained 4 months post-intervention. A strong negative correlation between PWV and NOx was also observed (P < .001; r = -0.65). A lifestyle approach to meeting current physical activity guidelines results in favorable alterations in arterial function in overweight individuals.

Whole-body glucose oxidation rate during prolonged exercise in type 1 diabetic patients under usual life conditions

OBJECTIVE

Fuel oxidation during exercise was studied in type 1 insulin-dependent (T1DM) patients mainly under quite constant insulin and glycemia; these protocols, however, likely do not reflect patients' usual metabolic conditions. The glucose oxidation rate (GLUox) in T1DM patients under usual life conditions was thus investigated during prolonged exercise (3-h) and its behavior was described mathematically.

MATERIALS/METHODS

Whole-body GLUox was determined in eight T1DM patients (4/8 M; aged 35-59 years) and eight well-matched healthy subjects. Venous blood was drawn prior to and every 30 min until the end of exercise; glycemia, insulin, cortisol, and growth hormone concentrations were determined. Oxygen consumption, carbon dioxide production, and ventilation were measured at rest and thereafter every 30 min of the exercise. To prevent hypoglycemia, patients were given fruit fudge (93% sucrose) prior to / during exercise.

RESULTS

Insulin concentration and glycemia were significantly higher in patients across the entire exercise period (group effect, p<0.001 for both). GLUox decreased significantly with increasing exercise duration (time effect, p<0.001), but no significant difference was detected between the two groups (group effect, p=NS). GLUox, expressed as the percentage of the starting value, was described by an exponential function showing a time constant of 90 min (n=96; mean corrected R(2)=0.666).

CONCLUSIONS

GLUox in T1DM patients was not significantly different from the rate observed in the control subjects. The function describing the time course of GLUox may be useful to correct an estimated GLUox for the duration of exercise and help T1DM patients avoiding exercise-induced glycemic imbalances.

Reliability and validity of heart rate variability threshold assessment during an incremental shuttle-walk test in middle-aged and older adults

Studies on the assessment of heart rate variability threshold (HRVT) during walking are scarce. We determined the reliability and validity of HRVT assessment during the incremental shuttle walk test (ISWT) in healthy subjects. Thirty-one participants aged 57 ± 9 years (17 females) performed 3 ISWTs. During the 1st and 2nd ISWTs, instantaneous heart rate variability was calculated every 30 s and HRVT was measured. Walking velocity at HRVT in these tests (WV-HRVT1 and WV-HRVT2) was registered. During the 3rd ISWT, physiological responses were assessed. The ventilatory equivalents were used to determine ventilatory threshold (VT) and the WV at VT (WV-VT) was recorded. The difference between WV-HRVT1 and WV-HRVT2 was not statistically significant (median and interquartile range = 4.8; 4.8 to 5.4 vs 4.8; 4.2 to 5.4 km/h); the correlation between WV-HRVT1 and WV-HRVT2 was significant (r = 0.84); the intraclass correlation coefficient was high (0.92; 0.82 to 0.96), and the agreement was acceptable (-0.08 km/h; -0.92 to 0.87). The difference between WV-VT and WV-HRVT2 was not statistically significant (4.8; 4.8 to 5.4 vs 4.8; 4.2 to 5.4 km/h) and the agreement was acceptable (0.04 km/h; -1.28 to 1.36). HRVT assessment during walking is a reliable measure and permits the estimation of VT in adults. We suggest the use of the ISWT for the assessment of exercise capacity in middle-aged and older adults.

Evaluation of inactive adults' ability to maintain a moderate-intensity walking pace

OBJECTIVES

To determine self-selected brisk walking pace in currently inactive adults and investigate the efficacy of rhythmic auditory stimuli to regulate moderate intensity walking.

DESIGN

A single-sample controlled laboratory design.

METHODS

Currently inactive adults (N=25; 76% female; age=34±13yr) completed a moderate intensity treadmill walking trial, during which cadence and steady-state O2 were measured. Participants then completed a 10-min self-paced "brisk" walk followed by a 10-min moderate-paced walk, prompted by a clip-on metronome matched to the treadmill cadence. Data were analyzed using RM t-test, Cohen's d, Bland-Altman plot, and one-way RM ANOVA.

RESULTS

Mean energy expenditure and cadence during the treadmill trial were 3.88±0.53METs and 114±8stepsmin(-1). During self-paced brisk walking cadence was 124±8stepsmin(-1). Cadence during metronome-paced walking was slower for all participants (114±8stepsmin(-1); p<0.05, d=1.23). From the Bland-Altman plots, 23 participants walked within ±3stepsmin(-1) of the metronome cadence, and the other 2 participants were within ±10stepsmin(-1). There were no significant differences (p>0.05) among the minute-by-minute cadences across the 10min of either condition.

CONCLUSIONS

Energy expenditure during 2.7mph treadmill walking was higher than 3 METs. Inactive adults walk at a higher cadence during "brisk" walking, compared to walking at a metronome-guided moderate pace. While the natural walking pace of inactive adults was at an intensity known to produce health benefits, and was maintained for 10min, the use of rhythmic auditory feedback is an effective method for regulating walking at a prescribed intensity in inactive adults.

Can we teach moderate intensity activity? Adult perception of moderate intensity walking

OBJECTIVES

To investigate how people determine the intensity of their physical activity, respond to instruction, and their understanding of moderate intensity walking.

DESIGN

Experimental.

METHODS

Forty nine regular walkers had their walking speed, heart rate and rate of perceived exertion measured during their normal walking behaviour, when instructed to walk at a moderate intensity, and after provision of feedback on how to meet moderate intensity walking.

RESULTS

Although moderate intensity walking was generally perceived as too low to be beneficial, walking speed was the best variable matched across all experiments for moderate intensity (83.7%, 67.3% and 93.9%), followed by heart rate, with a large proportion of participants responding favourably to instruction relating to heart rate and speed to meet moderate intensity walking. Rate of perceived exertion was a poor reflector of walking intensity.

CONCLUSION

Most participants naturally selected a walking intensity that elicits moderate intensity and when instructed to walk at moderate intensity, the intensity is more vigorous. Attempting to match speed and heart rate limits for moderate intensity reduced the intensity perceived by participants.

Physical activity, walking and leanness: an analysis of the Northern Ireland Sport and Physical Activity Survey (SAPAS)

OBJECTIVE

To report on the contribution walking makes to total weekly physical activity and the relationship between the volume and intensity of walking and leanness in a representative sample of the Northern Ireland population.

METHOD

4563 adults participated in this cross-sectional survey of physical activity behaviour. Self-reported height and weight was used to determine inverse body mass index (iBMI) as a measure of leanness. Data across all domains of physical activity including self-reported volume and intensity of walking (in bouts of 10 min or more) were analysed to determine their contribution to leanness using ANCOVA, having controlled for age, gender, socio-economic and smoking status.

RESULTS

Over 68% of the participants reported walking >10 minutes during the previous week but only 24% report walking at a brisk or fast pace. Time walking at a brisk or fast pace for personal transport was identified as having the strongest positive association with being lean (F(1,4256)=10.45, β=0.051 cm(2) kg(-1) min(-1) (SE=0.016),P=0.001).

CONCLUSIONS

In addition to increasing the amount of walking and the percentage of people walking regularly, public health messages encouraging an increase in walking pace may be valuable to increase the proportion of the population meeting physical activity guidelines and gaining associated health benefits.

Do overweight and obese individuals select a "moderate intensity" workload when asked to do so?

The purpose of this study was (1) to determine if overweight/obese individuals (age 26-50 y) would self-select moderate exercise intensity when asked to do so and (2) to determine how this self-selected workload compared to exercising at a workload (60% peak aerobic capacity) that is known to provide cardioprotective health benefits. Oxygen consumption (VO(2)) and energy expenditure were measured in 33 men/women (BMI ≥ 27 kg/m(2)) who completed two 30 min walking bouts: (1) self-selected walking pace on an indoor track and (2) prescribed exercise pace (60% VO(2) peak) on a treadmill. The data revealed that (1) the prescribed intensity was 6% higher than the self-selected pace and elicited a higher energy expenditure (P < 0.05) than the self-selected pace (+83 kJ); (2) overweight subjects walked at a slightly lower percentage of VO(2) peak than the obese subjects (P < 0.05); (3) men walked at a lower percentage of VO(2) peak than the women (P < 0.05). In conclusion when asked to walk at a moderate intensity, overweight/obese individuals tended to select a lower workload in the "moderate intensity" range which could be maintained for 30 min; however, a higher intensity which would be more cardioprotective could not be maintained for 30 min by most individuals.

Effect of α-lipoic acid and exercise training on cardiovascular disease risk in obesity with impaired glucose tolerance

Obese subjects with impaired glucose tolerance (IGT) are more susceptible than healthy individuals to oxidative stress and cardiovascular disease. This randomised controlled investigation was designed to test the hypothesis that α-lipoic acid supplementation and exercise training may elicit favourable clinical changes in obese subjects with IGT. All data were collected from 24 obese (BMI ≥ 30 kg/m²) IGT patients. Following participant randomisation into two groups, fasting venous blood samples were obtained at baseline, and before and following intervention. The first group consisted of 12 participants who completed a 12 week control phase followed by 12 weeks of chronic exercise at 65% HR_max for 30 minutes a day, 5 days per week, while ingesting 1 gram per day of α-lipoic acid for 12 weeks. The second group consisted of 12 participants who completed the same 12 week control phase, but this was followed by 12 weeks of 1 gram per day of α-lipoic acid supplementation only (no exercise). The main findings show a comparatively greater rate of low density lipoprotein (LDL) oxidation in the group consisting of α-lipoic acid only (p < 0.05 vs. pre intervention), although total oxidant status was lower post intervention (p < 0.05 vs. baseline) in this group. However, exercise and α-lipoic acid in combination attenuates LDL oxidation. Furthermore, in the α-lipoic acid supplement plus exercise training group, total antioxidant capacity was significantly increased (p < 0.05 vs. baseline and pre intervention). Body fat percentage and waist and hip circumference decreased following exercise training (p < 0.05 vs. post intervention). There were no selective treatment differences for a range of other clinical outcomes including glycaemic regulation (p > 0.05). These findings report that α-lipoic acid ingestion may increase the atherogenicity of LDL when ingested in isolation of exercise, suggesting that in IGT the use of this antioxidant treatment does not ameliorate metabolic disturbances, but instead may detrimentally contribute to the pathogenesis of atherosclerosis and development of CVD. However, when α-lipoic acid is combined with exercise, this atherogenic effect is abolished.

Walking to wellness in an ageing sedentary university community: design, method and protocol

BACKGROUND

Older workers are less physically active and have a higher rate and cost of injury than younger workers and so have reduced work-ability. Concurrently, sedentary behaviour in the workplace, in transport and in the home is increasing and has harmful health effects. Walking is a familiar, convenient, and free form of health-enhancing physical activity that can be integrated into working life and sustained into older age however workplace walking programs targeted at older workers have not been evaluated.

PURPOSE

We designed a randomised-controlled trial to evaluate the impact of a phased individually-tailored 10-week walking program on work-day steps, health status and work-ability of employees at an Australian university with an ageing sedentary workforce.

METHODS

A convenience sample of 154 academic and administrative employees aged 45-70 years will be recruited and randomly allocated to either an experimental (walking) group or control (maintain usual activity) group. Participants will be provided with a pedometer and complete measures for step count, % body fat, waist circumference, blood pressure, self-reported physical activity, psychological wellbeing and work-ability, at baseline and end-intervention. 'Walkers' will select approaches tailored to their individual preference, psychological characteristics or life circumstances. Two distinct intervention phases will target adoption (weeks 2-5) and adherence (weeks 7-12) using 'Stages of Behaviour Change' principles. An ANOVA will test for effect of treatment on outcome with the baseline value entered as a covariate.

DISCUSSION

This study will test whether tailoring worksite walking is an effective means of promoting health-enhancing physical activity in ageing sedentary workers.

Walking: the first steps in cardiovascular disease prevention

PURPOSE OF REVIEW

Health professionals are presented with the challenge of prescribing physical activity that is likely to be sustained by the sedentary majority. Walking is eminently suited to physical activity prescription for inactive individuals as it is accessible to men and women of all ages and social groups and poses little risk of injury. This paper reviews recent evidence of the health benefits of walking and promotion of walking behavior.

RECENT FINDINGS

Large observational studies consistently show associations between walking and cardiovascular disease endpoints over long periods of follow-up. Intervention studies further support the health benefits of walking, showing improvements in clinical biomarkers and measures after shorter periods of follow-up. Walking appears to have cardiovascular disease-related health benefits in younger, middle-aged, and older men and women, in both healthy and patient populations. Pedometer-based, mobile phone-based, and computer-based programs are effective in increasing walking levels. Neighborhood and workplace amenities and programs may be important supports for walking behaviors.

SUMMARY

Walking has the potential to play a key role in the primary and secondary prevention of cardiovascular disease. Clinicians can prescribe walking to assist patients meet physical activity recommendations and help identify supports available to the patient.

The effect of walking intervention on blood pressure control: a systematic review

BACKGROUND

Hypertension is a major public health problem and a key risk factor of cardiovascular diseases. Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. However the optimal characteristics for a physical activity programme remain open to debate. Walking is recommended by healthcare professionals as a form of exercise for controlling hypertension and nurses find it difficult to provide advice about this form of physical activity. Studies testing the effect of walking on blood pressure have produced inconsistent findings.

OBJECTIVES

To systematically review the evidence for the effectiveness of walking intervention on blood pressure.

METHODS

A systematic search of the literature was conducted using a range of electronic and evidence-based databases to identify studies. Criteria for study inclusion were a randomised controlled trial design with a non-intervention control group; study samples were aged 16 years and over; the intervention was predominantly focused on walking and blood pressure was an outcome. Data extraction and quality appraisal were carried out independently by two reviewers; a third reviewer was consulted when needed.

RESULTS

A total of 27 randomised controlled trials were included and nine of the 27 trials found an effect of walking intervention on blood pressure control. Walking intervention tends to be effective from studies with larger sample size. A beneficial effect of walking on blood pressure tended to employ moderate to high-intensity walking and a longer intervention period than those trials not showing the effect.

CONCLUSIONS

The results of this review provide evidence of the beneficial effects of walking on lowering blood pressure. Recommendations on lowering blood pressure with a walking activity should address the issue of walking intensity to achieve a beneficial effect on lowering blood pressure. Future research investigating the effect of walking intensity on blood pressure levels and rigorous design of walking interventions to achieve better adherence and methodological quality is required.

Steps to Better Cardiovascular Health: How Many Steps Does It Take to Achieve Good Health and How Confident Are We in This Number?

Pedometers and other types of step-counting devices are growing in popularity with both researchers and practitioners. The focus of this article is on describing the most recent pedometer-related advances in terms of cardiovascular health. The emergent body of evidence suggests that pedometer-determined physical activity is related to a number of cardiovascular health outcomes and that intervention participants can realize modest changes in body mass index and blood pressure. Taking into consideration individual baseline values, tailored messages congruent with public health recommendations should promote incremental increases in steps/day on the order of an extra 3,000 to 4,000 (approximately 30 min) of at least moderate intensity and taken in at least 10-minute bouts. Additional health benefits accrue with greater increases. Of course, even more benefits are possible from engaging in vigorous physical activity, but this seems less appealing for most people. Pedometer-based guidelines are not intended to supplant existing public health recommendations, but rather supplement them.

Exposing college students to exercise: the Training Interventions and Genetics of Exercise Response (TIGER) study

OBJECTIVE

The Training Interventions and Genetics of Exercise Response (TIGER) study is an exercise program designed to introduce sedentary college students to regular physical activity and to identify genetic factors that influence response to exercise.

PARTICIPANTS

A multiracial/ethnic cohort (N = 1,567; 39% male), age 18 to 35 years, participated in the study.

METHODS

Subjects underwent 30 weeks of exercise training, 3 days/week, for 40 minutes at 65% to 85% of age- and gender-predicted maximum heart rate reserve. Multiple measures of body size/composition, heart rate, and blood pressure were obtained.

RESULTS

A total of 1,567 participants, (39% male), age 18 to 35 years, participated in the TIGER study. The prevalence of overweight/obesity in participants was 48.0%/19.3% in non-Hispanic Whites, 55.3%/24.2% in Hispanic Whites, 54.9%/25.4% in African Americans, and 38.3%/11.3% in Asians. Average within-semester retention was 68%, but overall retention (30 weeks, 2 semesters) was 20%.

CONCLUSIONS

The TIGER study represents an efficacious strategy for introducing college-aged individuals to regular aerobic exercise.

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.