The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomised, controlled trials

Anterior chain activation and high intensity gait training to improve walking in an adult with cerebral palsy: a case report

BACKGROUND AND PURPOSE

Adults living with Cerebral Palsy (CP) who are non-ambulatory are at increased risk for falls, contractures, reduced bone density, and pain. There is limited evidence for core strength training, anterior chain activation exercises, or high intensity gait training (HIGT) to improve gait function in adults with CP. The purpose of this case report is to describe the use of anterior chain muscle activation and HIGT to improve walking in a non-ambulatory adult male with quadriplegic CP.

CASE DESCRIPTION

The participant was a 26 y.o. male living with spastic quadriplegic CP with a goal to cross the finish line of an adaptive triathlon while ambulating. The outpatient physiotherapy protocol emphasized anterior chain activation exercises and HIGT to improve strength, gait, and mobility at a frequency of 1-2 times a week for 8 months.

OUTCOMES

The minimal detectable change of 19 points was achieved on the Function in Sitting Test (FIST). The original ambulation goal was exceeded to a maximum of 76 meters overground. The participant was able to walk across the finish line using a gait trainer while supervised at an adaptive triathlon.

CONCLUSIONS

Focusing on anterior chain exercises and HIGT was effective to minimize extensor spasticity by strengthening body flexors allowing improved mobility and gait.

Beyond Nutritional Treatment: Effects of Fitwalking on Physical Capacity and Intestinal Barrier Integrity in BMI-Stratified IBS Patients

Background: Irritable bowel syndrome (IBS) and obesity are associated with intestinal barrier alterations that result in low-grade inflammation. Zonulin and intestinal fatty acid-binding protein (I-FABP) assess gut barrier health, while urinary indican concentrations reflect dysbiosis in the small intestine. Physical activity, such as Fitwalking, aids weight management and improves intestinal permeability. This study assesses the impact of a 12-week Fitwalking program on intestinal barrier health in IBS patients categorized by body mass index (BMI). Methods: Fifty-seven mild IBS patients were categorized as obese (OB = 18), overweight (OW = 24), or normal weight (NW = 15) and assigned to a walking group. Participants walked thrice weekly at moderate intensity for 60 min per session, using the specific Fitwalking technique, supervised by staff. Results: No significant changes in biochemical or anthropometric variables were observed. However, Fitwalking improved the Global Physical Capacity Score (GPCS) by 46%, 48%, and 24% in the NW, OW, and OB groups. Post-intervention, serum zonulin levels notably decreased in OB individuals, suggesting reduced inflammation. OW patients unexpectedly showed increased fecal zonulin levels. OB participants experienced decreased urinary indican levels. Zonulin levels positively correlated with BMI and inversely with GPCS. Conclusions: Regular exercise benefits the intestinal barrier, especially in obese IBS patients. Monitoring zonulin and I-FABP may offer insights into gut barrier integrity and GI injury severity. Future studies should explore longer intervention durations, larger populations, and advanced diagnostic tools to validate findings and investigate the mechanisms behind exercise-induced changes in intestinal permeability and gut health markers.

Effects of low-intensity isometric handgrip training on home blood pressure in hypertensive patients: a randomized controlled trial

We examined if lower intensity isometric handgrip (IHG) training than usual load could significantly reduce home blood pressure (HBP) in treated Japanese hypertensive patients. Sixty patients (mean age, 66.9 years; 44.6% men) with high blood pressure to grade 1 hypertension level were randomly assigned to an IHG or control group. The IHG group performed IHG training for 12 weeks, followed by a 12 weeks of detraining. The control group did not any IHG training. The IHG training comprised four sets of 2-min isometric contractions at 15% of maximum voluntary contraction (MVC) or half than usual, including 1 min of rest between sets, for ≥3 days a week. At the end of the former phase, both morning and evening systolic HBP (HSBP) and evening diastolic HBP (HDBP) were significantly higher than those at baseline in the control group while neither morning nor evening HSBP remained unchanged in the IHG group. Morning HBPs increased at the end of the latter phase than those at the end of the former phase in the IHG group and remained unchanged in the control group. The change (Δ) in morning HSBP from baseline to the end of the former phase was smaller in the IHG group than that in the control group (Δ4.1 mmHg vs. Δ0.0 mmHg, p = 0.05). A similar tendency was observed after adjusting baseline HSBP and seasonal variation (p = 0.06). In conclusion, a 12-week IHG training at 15% of MVC significantly lowered morning HSBP by approximately 4.0 mmHg in treated Japanese hypertensive patients. This study showed that a 12-week IHG training at 15% of MVC lowered morning HSBP by about 4.0 mmHg in treated Japanese hypertensive patients. Continuous low-intensity IHG training may provide a stable hypotensive effect in high blood pressure to grade 1 hypertensive population.

Walking pace is a protective factor for rheumatoid arthritis: a mendelian randomization study

Walking pace is a simple and functional form of exercise and a strong predictor of health, but little is known about its causal association with rheumatoid arthritis. This study aimed to investigate the causal effect of WP on the developing RA using Mendelian randomization analysis. The genetic variation associated with WP was selected as an instrumental variable from the latest genome-wide association studies. Summary-level data for the outcomes were obtained from the corresponding GWAS. The inverse-variance weighted method was used as the primary MR analysis. The results were further tested using a multivariable MR approach based on Bayesian model averaging. Confounders (BMI, SMK, HBP, TD) with close associations with RA were included in the analysis. An observational study with individual data from UK Biobank was performed to reinforce our findings. The MR results indicated the significant inverse associations of WP with the risk of RA (odds ratio (OR), 0.31; 95% confidence interval (CI), 0.15, 0.62; p = 1.05 × 10 -3). After adjusting for the risk factors, the associations for WP and RA did not change substantially. Observational study results demonstrated the same effect of WP on reducing the risk of RA. The Mendelian randomization analysis and observational study provide evidence suggesting that walking pace is a protective factor for rheumatoid arthritis. Given its simple measurement, walking pace may be a pragmatic target for interventions.

Myokine secretion during moderate-intensity physical activity: Dose-response of interleukin 6 to walking duration

During vigorous physical activity, contracting muscles secrete a variety of immunomodulatory and metabolic factors called myokines that perform a variety of functions. Foremost among these is interleukin 6 (IL-6), which increases fatty acid mobilization and stimulates anti-inflammatory cytokine release. Despite being well characterized in vigorous exercise contexts, whether IL-6 is secreted during moderate-intensity activities such as walking is unclear. This is especially pertinent as regular walking is one of the oldest and most common forms of physical activity and comes with a variety of health benefits, which may be coordinated in part by IL-6 signaling. To test the hypothesis that IL-6 release occurs during evolutionarily normal physical activity contexts like long distance walking, we performed a dose-response experiment to test the effect of walking duration on IL-6 secretion. Thirteen participants completed four moderate-intensity walking trials (55% HRmax) of varying durations (30 min, 1 h, 2 h, and 3 h) in a randomized order with intervening washout periods of at least 1 week. Using a linear mixed effects model, we found that IL-6 levels modestly increased during only the 2 h and 3 h walking trials. These results suggest that small frequent increases in IL-6 signaling may be an important mechanism underlying the health benefits of regular walking. Furthermore, this finding raises the possibility that IL-6 secretion is an adaptation to fuel physical activity, especially during periods of negative energy balance.

Effects of High-Intensity Interval Walking on Cognitive and Physical Functions in Older Adults: A Randomized Pilot Study

BACKGROUND

Walking is widely recognized as a prevalent form of daily exercise worldwide. However, fewer studies have explored the health outcomes of different intensities of walking exercise for older adults. Thus, the study aimed to investigate the effects of walking at different exercise intensities on body composition, emotions, cognition, and physical function among older adults.

PURPOSE

This study aimed to investigate the effects of walking at different exercise intensities on body composition, emotions, cognition, and physical function after eight weeks of group walking. Specifically, the study focused on the potential benefits of high-intensity interval walking (HIIW), exploring whether HIIW could have a more positive impact on the physical function and overall health of older adults compared to moderate-intensity continuous walking (MICW).

METHODS

Participants aged 65 years or older were randomly assigned to either HIIW (n=13, 85% HRmax and 55% HRmax, alternating every three minutes) or MICW (n=13, 70% HRmax), engaging in group walking exercises for 30 minutes three times a week. The pre-test and post-test evaluations included body composition, cognition, emotions, and physical function.

RESULTS

The two-minute step test showed significant improvements over time (p<0.0001) and time-group interaction (p=0.004), and sit and reach showed significant changes over time (p<0.0001). The independent T-test showed significant differences between the HIIW and MICW groups (two-minute step test: t (24)=1.80, p=0.04; sit and reach test: t (19)=3.65, p<0.001) at post-measurement. Additionally, no significant differences were found in body composition (weight, p=0.74; body mass index (BMI), p=0.35; body fat mass, p=0.45; skeletal muscle mass (SMM), p=0.77), emotions (geriatric depression scale (GDS), p=0.79; quality of life (QOL), p=0.54; Pittsburgh Sleep Quality Index, p=0.24), and cognitive function (CoSAS total score, p=0.25) between the HIIW and MICW groups after exercise. Grip strength, balance, 30-second chair stand, back scratch, and eight-foot up and go tests showed no significant effects in the time-group interaction.

CONCLUSION

Regular HIIW exercise has positive effects on physical functions such as cardiorespiratory endurance and flexibility in older adults, indicating the potential for establishing a foundation for developing customized exercise programs in the future.

How to Promote Walking in Women with Fibromyalgia: A Look at Catastrophizing, Goal Conflict, and Avoidance from a Self-Emotional Regulatory Perspective

The aim of this study was twofold: to explore the concordance between two measures of physical activity (accelerometer and IPAQ) among female fibromyalgia (FM) patients, as well as to examine the impact of psychosocial variables (catastrophism, activity avoidance) on walking among these patients. Helplessness, activity avoidance, and commitment to physical activity were evaluated in 132 FM women. After the first assessment, an accelerometer was placed by a psychologist on each participant for seven consecutive days. Eight days later, accelerometers were collected, and participants were evaluated again using the IPAQ. Two models were tested to analyze mediation and a moderated mediation effect. The mediating role of activity avoidance between helplessness and minutes walked was corroborated regarding the objective measure of walking. The effect of helplessness on minutes walked during a week was mediated by activity avoidance and assessed by accelerometers. Cognitive variables played a contextual role when trying to promote exercise. Activity avoidance must be understood as a key variable in physical activity promotion, specifically in the promotion of walking with the aim to do exercise in individuals with FM.

The Walking and Lifestyle Coaching (WALC) Program for University Students: A Pilot Study

Background: The purpose of this study was to evaluate the implementation of the 3-week Walking and Lifestyle Coaching (WALC) program with university college students to promote health behavior change and reduce chronic disease risk. Methods: During the 3-week WALC program, students received weekly peer health and wellness coaching while engaging in a 30-minute walk throughout campus. Each week, physical activity was directly measured using pedometers, and self-report physical activity behavior, steps, and daily reflections were reported using a self-monitoring journal. At baseline and follow-up, students completed biometrics screening, mental health questionnaires, and the Cooper 1.5 mile walk test to evaluate cardiovascular fitness. Results: A total of 35 college students participated in the WALC program. The mean daily steps number of steps during the WALC program was 6315 (SD = 2073.16). Only 25/35 participants reported steps for the entire WALC program (71.43%). There was not a statistically significant difference in generalized anxiety, perceived stress, depression, quality of life, or self-compassion. There was a slight decline in body fat percentage, although not statistically significant. There was an average improvement of 89 seconds on the 1.5-mile walk/run test. Discussion: The WALC program was developed to be inclusive, feasible, and a mechanism to synergize campus resources to collaborate on behalf of student wellness. It is necessary for this program to be utilized on university campuses in diverse geographical regions (i.e., rural, urban, or suburban), with diverse students (i.e., racially, ethnically, gender-identity, and religious affiliation.), and with universities of all sizes and funding levels. Future research could consider the use of a control group as well as an online self-monitoring journal.

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

Background

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

Results

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Conclusions

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia

BACKGROUND

With an increasing proportion of older adults and the associated risk of Alzheimer's Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs.

METHODS

This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives.

DISCUSSION

This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).

Efficacy of StepAdd, a Personalized mHealth Intervention Based on Social Cognitive Theory to Increase Physical Activity Among Patients With Type 2 Diabetes Mellitus: Protocol for a Randomized Controlled Trial

BACKGROUND

Increasing physical activity improves glycemic control in patients with type 2 diabetes (T2D). Mobile health (mHealth) interventions have been proven to increase exercise, but engagement often fades with time. As the use of health behavior theory in mHealth design can increase effectiveness, we developed StepAdd, an mHealth intervention based on the constructs of social cognitive theory (SCT). StepAdd improves exercise behavior self-efficacy and self-regulation through the use of goal-setting, barrier-identifying, and barrier-coping strategies, as well as automatic feedback functions. A single-arm pilot study of StepAdd among 33 patients with T2D showed a large increase in step count (mean change of 4714, SD 3638 daily steps or +86.7%), along with strong improvements in BMI (mean change of -0.3 kg/m2) and hemoglobin A1c level (mean change of -0.79 percentage points).

OBJECTIVE

In this study, we aim to investigate the efficacy and safety of StepAdd, an mHealth exercise support system for patients with T2D, via a large, long, and controlled follow-up to the pilot study.

METHODS

This is a randomized, open-label, multicenter study targeting 160 patients with T2D from 5 institutions in Japan with a 24-week intervention. The intervention group will record daily step counts, body weight, and blood pressure using the SCT-based mobile app, StepAdd, and receive feedback about these measurements. In addition, they will set weekly step count goals, identify personal barriers to walking, and define strategies to overcome these barriers. The control group will record daily step counts, body weight, and blood pressure using a non-SCT-based placebo app. Both groups will receive monthly consultations with a physician who will advise patients regarding lifestyle modifications and use of the app. The 24-week intervention period will be followed by a 12-week observational period to investigate the sustainability of the intervention's effects. The primary outcome is between-group difference in the change in hemoglobin A1c values at 24 weeks. The secondary outcomes include other health measures, measurements of steps, measurements of other behavior changes, and assessments of app use. The trial began in January 2023 and is intended to be completed in December 2025.

RESULTS

As of September 5, 2023, we had recruited 44 patients. We expect the trial to be completed by October 8, 2025, with the follow-up observation period being completed by December 31, 2025.

CONCLUSIONS

This trial will provide important evidence about the efficacy of an SCT-based mHealth intervention in improving physical activities and glycemic control in patients with T2D. If this study proves the intervention to be effective and safe, it could be a key step toward the integration of mHealth as part of the standard treatment received by patients with T2D in Japan.

TRIAL REGISTRATION

Japan Registry of Clinical Trials (JRCT) jRCT2032220603; https://rctportal.niph.go.jp/en/detail?trial_id=jRCT2032220603.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53514.

The multifaceted benefits of walking for healthy aging: from Blue Zones to molecular mechanisms

Physical activity, including walking, has numerous health benefits in older adults, supported by a plethora of observational and interventional studies. Walking decreases the risk or severity of various health outcomes such as cardiovascular and cerebrovascular diseases, type 2 diabetes mellitus, cognitive impairment and dementia, while also improving mental well-being, sleep, and longevity. Dose-response relationships for walking duration and intensity are established for adverse cardiovascular outcomes. Walking's favorable effects on cardiovascular risk factors are attributed to its impact on circulatory, cardiopulmonary, and immune function. Meeting current physical activity guidelines by walking briskly for 30 min per day for 5 days can reduce the risk of several age-associated diseases. Additionally, low-intensity physical exercise, including walking, exerts anti-aging effects and helps prevent age-related diseases, making it a powerful tool for promoting healthy aging. This is exemplified by the lifestyles of individuals in Blue Zones, regions of the world with the highest concentration of centenarians. Walking and other low-intensity physical activities contribute significantly to the longevity of individuals in these regions, with walking being an integral part of their daily lives. Thus, incorporating walking into daily routines and encouraging walking-based physical activity interventions can be an effective strategy for promoting healthy aging and improving health outcomes in all populations. The goal of this review is to provide an overview of the vast and consistent evidence supporting the health benefits of physical activity, with a specific focus on walking, and to discuss the impact of walking on various health outcomes, including the prevention of age-related diseases. Furthermore, this review will delve into the evidence on the impact of walking and low-intensity physical activity on specific molecular and cellular mechanisms of aging, providing insights into the underlying biological mechanisms through which walking exerts its beneficial anti-aging effects.

An observational pilot evaluation of the Walk with Ease program for reducing fall risk among older adults

BACKGROUND

Physical activity is an effective method of reducing fall risk among older adults. Previous evaluations of the six-week Walk with Ease (WWE) program have documented benefits to functional outcomes, but the potential effects on reducing fall risk have not been evaluated. This pilot study evaluates outcomes of a community delivered WWE program for potential suitability as a fall risk reduction program.

METHODS

A total of 59 older adults (age > 60) enrolled in a group version of WWE delivered by trained community-based leaders. Complete data (pre- and post-program) from functional fitness tests and behavioral instruments were obtained from 41 participants (aged 74.4 ± 6.6 years, 70% female). Functional outcomes included the 10-foot timed up and go (TUG), 30-second chair stand (CST) and 4-stage balance test (BT) included as part of STEADI, as well as a two-minute step test (ST) and normal gait speed test (GST). Survey assessments included STEADI fall risk screening, self-reported physical activity, and fear of falling measures. Analyses focused on reporting pre-post effect sizes, but paired t-tests were used to test statistical significance of differences.

RESULTS

Improvements in functional performance approached significance for both CST (d = 0.31, p = 0.06) and ST (d = 0.26, p = 0.12), but all other tests were nonsignificant. Survey results demonstrated significant increases in self-reported walking (d = 0.54, p = 0.02) and moderate-to-vigorous physical activity (MVPA; d = 0.56, p = 0.004), but perceived fear of falling and overall fall risk scores had smaller, non-significant, effects (d ranging from 0.01 to 0.31). Stratified analysis suggested that participants screened at an elevated risk for falls at baseline consistently had larger effects on all functional and survey assessments, though the analysis was underpowered to test significance.

CONCLUSIONS

Walk with Ease participation significantly increased self-reported physical activity but did not significantly improve physical function or reduce fall risk. However, consistently larger effect sizes among participants screened as at-risk for falls suggest that the program may be beneficial for those with elevated risk for falls or functional limitations. Further research is needed to document the consistency of these effects among participants with elevated fall risk status.

Enhanced Physical Capacity and Gastrointestinal Symptom Improvement in Southern Italian IBS Patients following Three Months of Moderate Aerobic Exercise

Moderate-intensity aerobic exercise improves gastrointestinal (GI) health and alleviates irritable bowel syndrome (IBS) symptoms. This study explored its effects on physical capacity (PC) and IBS symptoms in 40 patients from Southern Italy (11 males, 29 females; 52.10 ± 7.72 years). The exercise program involved moderate-intensity aerobic exercise (60/75% of HRmax) for at least 180 min per week. Before and after the intervention, participants completed the IBS-SSS questionnaire to assess IBS symptoms, reported their physical activity levels, and underwent field tests to evaluate PC. PC was quantified as the Global Physical Capacity Score (GPCS). A total of 38 subjects (21 males, 17 females; 53.71 ± 7.27 years) without lower GI symptoms served as a No IBS group. No significant differences were found between IBS patients and No IBS subjects, except for the symptom score, as expected. After the exercise, all participants experienced significant improvements in both IBS symptoms and PC. Higher PC levels correlated with greater benefits in IBS symptomatology, especially with GPCS reaching above-average values. Engaging in moderate-intensity aerobic exercise for at least 180 min per week positively impacts IBS symptoms and PC. Monitoring GPCS in IBS patients provides insights into the connection between physical activity and symptom severity, aiding healthcare professionals in tailoring effective treatment plans.

Long-Term Exposure to Walkable Residential Neighborhoods and Risk of Obesity-Related Cancer in the New York University Women's Health Study (NYUWHS)

BACKGROUND

Living in neighborhoods with higher levels of walkability has been associated with a reduced risk of obesity and higher levels of physical activity. Obesity has been linked to increased risk of 13 cancers in women. However, long-term prospective studies of neighborhood walkability and risk for obesity-related cancer are scarce.

OBJECTIVES

We evaluated the association between long-term average neighborhood walkability and obesity-related cancer risk in women.

METHODS

The New York University Women's Health Study (NYUWHS) is a prospective cohort with 14,274 women recruited between 1985 and 1991 in New York City and followed over nearly three decades. We geocoded residential addresses for each participant throughout follow-up and calculated an average annual measure of neighborhood walkability across years of follow-up using data on population density and accessibility to destinations associated with geocoded residential addresses. We used ICD-9 codes to characterize first primary obesity-related cancers and employed Cox proportional hazards models to assess the association between average neighborhood walkability and risk of overall and site-specific obesity-related cancers.

RESULTS

Residing in neighborhoods with a higher walkability level was associated with a reduced risk of overall and site-specific obesity-related cancers. The hazards ratios associated with a 1-standard deviation increase in average annual neighborhood walkability were 0.88 (95% CI: 0.85, 0.93) for overall obesity-related cancer, 0.89 (95% CI: 0.84, 0.95) for postmenopausal breast cancer, 0.82 (95% CI: 0.68, 0.99) for ovarian cancer, 0.87 (95% CI: 0.76, 0.99) for endometrial cancer, and 0.68 (95% CI: 0.49, 0.94) for multiple myeloma, adjusting for potential confounders at both the individual and neighborhood level. The association between neighborhood walkability and risk of overall obesity-related cancer was stronger among women living in neighborhoods with higher levels of poverty compared with women living in areas with lower poverty levels (p Interaction = 0.006 ).

DISCUSSION

Our study highlights a potential protective role of neighborhood walkability in preventing obesity-related cancers in women. https://doi.org/10.1289/EHP11538.

Neighborhood walkability and sex steroid hormone levels in women

BACKGROUND

Neighborhood walkability (NW) has been linked to increased physical activity, which in turn is associated with lower concentrations of sex hormones and higher concentration of SHBG in women. However, no study has directly examined the association of NW with female sex hormone levels.

OBJECTIVE

We conducted a cross-sectional study to evaluate the association between NW and circulating levels of sex hormones and SHBG in pre- and post-menopausal women.

METHODS

We included 797 premenopausal and 618 postmenopausal women from the New York University Women's Health Study (NYUWHS) who were healthy controls in previous nested case-control studies in which sex hormones (androstenedione, testosterone, DHEAS, estradiol and estrone) and SHBG had been measured in serum at enrollment. Baseline residential addresses were geo-coded and the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) was calculated. Generalized Estimating Equations were used to assess the association between BEH-NWI and sex hormone and SHBG concentrations adjusting for individual- and neighborhood-level factors.

RESULTS

In premenopausal women, a one standard deviation (SD) increment in BEH-NWI was associated with a 3.5% (95% CI 0.9%-6.1%) lower DHEAS concentration. In postmenopausal women, a one SD increment in BEH-NWI was related to an 8.5% (95% CI 5.4%-11.5%) lower level of DHEAS, a 3.7% (95% CI 0.5%-6.8%) lower level of testosterone, a 1.8% (95% CI 0.5%-3.0%) lower level of estrone, and a 4.2% (95% CI 2.7%-5.7%) higher level of SHBG. However, the associations with respect to DHEAS and estrone became apparent only after adjusting for neighborhood-level variables. Sensitivity analyses using fixed effects meta-analysis and inverse probability weighting accounting for potential selection bias yielded similar results.

CONCLUSION

Our findings suggest that NW is associated with lower concentrations of androgens and estrone, and increased SHBG, in postmenopausal women, and lower levels of DHEAS in premenopausal women.

The neighbourhood built environment and health-related fitness: a narrative systematic review

Background

There is increasing evidence demonstrating the importance of the neighbourhood built environment in supporting physical activity. Physical activity provides numerous health benefits including improvements in health-related fitness (i.e., muscular, cardiorespiratory, motor, and morphological fitness). Emerging evidence also suggests that the neighbourhood built environment is associated with health-related fitness. Our aim was to summarize evidence on the associations between the neighbourhood built environment and components of health-related fitness in adults.

Methods

We undertook a systematic review following PRISMA guidelines. Our data sources included electronic searches in MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, Environment Complete, ProQuest Dissertations and Theses, and Transport Research International Documentation from inception to March 2021. Our eligibility criteria consisted of observational and experimental studies estimating associations between the neighbourhood built environment and health-related fitness among healthy adults (age ≥ 18 years). Eligible studies included objective or self-reported measures of the neighbourhood built environment and included either objective or self-reported measures of health-related fitness. Data extraction included study design, sample characteristics, measured neighbourhood built environment characteristics, and measured components of health-related fitness. We used individual Joanna Briggs Institute study checklists based on identified study designs. Our primary outcome measure was components of health-related fitness (muscular; cardiorespiratory; motor, and morphological fitness).

Results

Twenty-seven studies (sample sizes = 28 to 419,562; 2002 to 2020) met the eligibility criteria. Neighbourhood destinations were the most consistent built environment correlate across all components of health-related fitness. The greatest number of significant associations was found between the neighbourhood built environment and morphological fitness while the lowest number of associations was found for motor fitness. The neighbourhood built environment was consistently associated with health-related fitness in studies that adjusted for physical activity.

Conclusion

The neighbourhood built environment is associated with health-related fitness in adults and these associations may be independent of physical activity. Longitudinal studies that adjust for physical activity (including resistance training) and sedentary behaviour, and residential self-selection are needed to obtain rigorous causal evidence for the link between the neighbourhood built environment and health-related fitness.

Trial registration

Protocol registration: PROSPERO number CRD42020179807.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01359-0.

Impact of land use and food environment on risk of type 2 diabetes: A national study of veterans, 2008-2018

BACKGROUND

Large-scale longitudinal studies evaluating influences of the built environment on risk for type 2 diabetes (T2D) are scarce, and findings have been inconsistent.

OBJECTIVE

To evaluate whether land use environment (LUE), a proxy of neighborhood walkability, is associated with T2D risk across different US community types, and to assess whether the association is modified by food environment.

METHODS

The Veteran's Administration Diabetes Risk (VADR) study is a retrospective cohort of diabetes-free US veteran patients enrolled in VA primary care facilities nationwide from January 1, 2008, to December 31, 2016, and followed longitudinally through December 31, 2018. A total of 4,096,629 patients had baseline addresses available in electronic health records that were geocoded and assigned a census tract-level LUE score. LUE scores were divided into quartiles, where a higher score indicated higher neighborhood walkability levels. New diagnoses for T2D were identified using a published computable phenotype. Adjusted time-to-event analyses using piecewise exponential models were fit within four strata of community types (higher-density urban, lower-density urban, suburban/small town, and rural). We also evaluated effect modification by tract-level food environment measures within each stratum.

RESULTS

In adjusted analyses, higher LUE had a protective effect on T2D risk in rural and suburban/small town communities (linear quartile trend test p-value <0.001). However, in lower density urban communities, higher LUE increased T2D risk (linear quartile trend test p-value <0.001) and no association was found in higher density urban communities (linear quartile trend test p-value = 0.317). Particularly strong protective effects were observed for veterans living in suburban/small towns with more supermarkets and more walkable spaces (p-interaction = 0.001).

CONCLUSION

Among veterans, LUE may influence T2D risk, particularly in rural and suburban communities. Food environment may modify the association between LUE and T2D.

Profiles of Wellbeing in Soft and Hard Mountain Hikers

The aim of the study was to analyze the wellbeing profiles in a group of Polish mountain hikers. The study involved 242 young people (M = 23.50; SD = 4.40) who completed various wellbeing scales: The Oxford Happiness Questionnaire (OHQ), Meaning of Life Questionnaire (MLQ), Positive and Negative Affect Scale (PANAS), Time Satisfaction Scale (TSS), Hope Scale, General Self-Efficiency Scale, Ego Resiliency Scale, Revised Life Orientation Test (LOT-R), and Adventure-Seeking Behavior Scale. Cluster analyses revealed two types of mountain hikers: hard adventure hikers and soft adventure hikers, with different profiles of subjective wellbeing. Hard adventure hikers most often revealed high levels of life satisfaction, control of life, meaning of life, and positive emotions, along with low levels of negative emotions. Moreover, these hikers revealed high levels of satisfaction in various time perspectives (past, present, and future) and a high level of psychological capital. On the other hand, soft adventure hikers most often revealed an average level of satisfaction with life, control of life, and positive emotions, average satisfaction in the past and present time perspective, and average levels of psychological capital. Soft adventure hikers also revealed higher levels of negative emotions and satisfaction in the future time perspective. The present research indicated that mountain hikers are not a homogenous group. The profiles of wellbeing in the hikers varied depending on the type of stimulating behavior in a natural environment.

Leading the way together: a cluster randomised controlled trial of the 5R Shared Leadership Program in older adult walking groups

BACKGROUND

With a rapidly ageing society, healthy ageing has become a key challenge. Engagement in physical activity, and particularly walking, is a key strategy that contributes to healthy ageing amongst older adults. The purpose of the present study was to evaluate the efficacy of a group walking program for older adults that incorporates the 5R Shared Leadership Program (5R^S). By implementing a structure of shared leadership and strengthening peer leaders' identity leadership, 5R^S aims to cultivate a shared social identity amongst participants, which has in other contexts been associated with greater performance and well-being.

METHODS

A cluster randomised controlled trial was conducted to test the efficacy of the 5R^S group walking program on group identification, group cohesion, walking activity, and well-being, compared to a regular group walking program for older adults. Nineteen older adult walking groups (i.e., the clusters; N = 503; M_age = 69.23 years, SD = 6.68) all participated in a 12-week structured group walking program. Nine walking groups (n = 304) were randomly assigned to the intervention in which participants received the 5R^S program in addition to regular group walking.

RESULTS

5R^S was successful in strengthening the identity leadership qualities of the appointed peer leaders. Multilevel regressions showed that 5R^S succeeded in increasing group cohesion and walking activity to a greater extent than a regular group walking program, while participants' group identification and well-being increased to a similar extent in both conditions. Furthermore, structural equation modelling revealed that group identification mediated the impact of peer leaders' identity leadership on group cohesion and well-being (but not walking activity).

CONCLUSION

By harnessing the capacity of the group and its peer leaders, the 5R^S program offers a promising intervention to engage older adults in physical activity.

TRIAL REGISTRATION

The study was retrospectively registered as clinical trial on 9 September 2021 ( NCT05038423 ).

Effectiveness of a Worksite-Based Lifestyle Intervention on Employees' Obesity Control and Prevention in China: A Group Randomized Experimental Study

Background: This study was to culturally adapt a lifestyle intervention for employees’ obesity control and prevention using a participatory process, and evaluate the effectiveness of the project at worksites. Methods: A group randomized experimental study included four worksites (two intervention, two control) in the Yangtze River Delta in China was conducted. A total of 388 participants (216 in the intervention worksites and 172 in the control worksites) were finally recruited from 955 employees at the four worksites (464 in the intervention worksites and 491 in the control worksites). The final evaluation was completed by two hundred and seventy-eight employees (159 in the intervention worksites and 119 in the control worksites, respectively). Data of demographic information, weight, BMI, waist circumference, hip circumference and weight-related behaviors including diary behaviors and physical activities were collected before and after a 12-month intervention and analyzed using descriptive statistics, t-test, chi-square test, linear mixed regression and logistic mixed regression. Results: Although the intervention worksites had a reduction in body mass index (23.21 to 22.95, p < 0.01), hip circumference (95.97 to 95.28, p = 0.03) and waist-to-height ratio (0.49 to 0.48, p = 0.01), the differential changes compared to those of the control group were not statistically significant. The frequency of sweet beverages (−1.81, 95%CI: −0.52, −3.11), frequency of vegetable intake (5.66, 95%CI: 1.59, 9.74), daily servings of vegetables (0.53, 95%CI: 0.24, 0.82), frequency of fruit intake (3.68, 95%CI: 1.25, 6.12), daily servings of fruit (0.26, 95%CI: 0.44, 0.92), daily servings of vegetables and fruit (0.79, 95%CI: 0.43, 1.16), daily steps (863.19, 95%CI: 161.42, 1564.97) and self-efficacy to change physical activity (OR = 1.91, 95%CI: 1.02,3.60) were more improved in the intervention group than were those measures in the control group. Conclusions: The worksite-based lifestyle intervention project for obesity control and prevention improved several employees’ dietary behaviors and physical activities at worksites in China in a short time. Long-term intervention with larger samples in more worksites should be further examined.

Investigation of a UK biobank cohort reveals causal associations of self-reported walking pace with telomere length

Walking pace is a simple and functional form of movement and a strong predictor of health status, but the nature of its association with leucocyte telomere length (LTL) is unclear. Here we investigate whether walking pace is associated with LTL, which is causally associated with several chronic diseases and has been proposed as a marker of biological age. Analyses were conducted in 405,981 UK Biobank participants. We show that steady/average and brisk walkers had significantly longer LTL compared with slow walkers, with accelerometer-assessed measures of physical activity further supporting this through an association between LTL and habitual activity intensity, but not with total amount of activity. Bi-directional mendelian randomisation analyses suggest a causal link between walking pace and LTL, but not the other way around. A faster walking pace may be causally associated with longer LTL, which could help explain some of the beneficial effects of brisk walking on health status. Given its simple measurement and low heritability, self-reported walking pace may be a pragmatic target for interventions.

Effects of walking in individuals with prehypertension and stage 1 hypertension in India: a randomised controlled trial

Background/Aims

Physical activity, such as walking, is a cheap approach with a low risk of injury that can be used in daily life. The aim of this study was to determine the effects of low impact aerobic exercise training on resting blood pressure in patients with prehypertension and stage 1 hypertension specifically for people in India.

Methods

A total of 63 sedentary adults with prehypertension and stage 1 hypertension participated in the study. All sedentary adults were randomly allocated to either the study group (aerobic training) (n=30) or the control group (n=33). Those in the study group walked for 30 minutes, three times a week for 8 weeks at an intensity of 60–75% of their target heart rate. The control group received no training but followed their usual prescribed medication and diet. The primary outcomes of systolic blood pressure and diastolic blood pressure were measured at the end of every 2 weeks for 8 weeks. Secondary outcomes of pulse pressure, mean arterial pressure and pulse rate were calculated.

Results

Significant changes in various outcome measures in the study group were noted (systolic blood pressure=7.30 mmHg (95% confidence interval [CI] 2.14 to 3.00; P=0.001); diastolic blood pressure=6.50 mmHg (95% CI 1.23 to 4.04; pulse pressure=0.000; mean arterial pressure=6.77 mmHg (95% CI 1.46 to 3.84; P=0.000) and pulse rate=6.90 bpm (95% CI 1.73 to 3.43; P=0.000) when compared with those in the control group, who had non-significant changes.

Conclusions

The findings of the present study concluded that aerobic exercise training improves blood pressure.

Effects of Tai-Chi and Running Exercises on Cardiorespiratory Fitness and Biomarkers in Sedentary Middle-Aged Males: A 24-Week Supervised Training Study

This study examined the effectiveness of Tai-Chi and running exercises on cardiorespiratory fitness and biomarkers in sedentary middle-aged adults under 24 weeks of supervised training. Methods Thirty-six healthy middle-aged adults (55.6 ± 5.3 yr) were randomly assigned into Tai-Chi, running and control groups. During a 24-week training period, the Tai-Chi and running groups were asked to perform exercises for 60 min/day and 5 days/week, which were supervised by Tai-Chi and running instructors throughout. Resting heart rate, lean mass, blood pressure and blood lipids were measured, and cardiorespiratory fitness (VO2max, Vmax and Peak heart rate) was assessed at the baseline and the 12- and 24-week interventions. Results Compared to the no-exercise control group, both the Tai-Chi and running groups significantly decreased resting heart rate, diastolic blood pressure and cardiorespiratory fitness and increased lean mass across the training session (p < 0.05). Compared to the Tai-Chi group, the running group showed greater improvement in VO2max and Vmax (p < 0.05) and reduced triglyceride and low-density lipoprotein cholesterol (p < 0.05). Conclusion Both Tai-Chi and running exercise showed beneficial effects on cardiorespiratory fitness and enhanced health-related outcomes in middle-aged adults. Although Tai-Chi exercises were less effective in VO2max than running, Tai-Chi may be considered as a plausible alternative to running exercises that can be achieved in the indoor-based setting.

Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

A Method for Behavior Change Support by Controlling Psychological Effects on Walking Motivation Caused by Step Count Log Competition System

Systems presenting information that encourages competition by using rankings and scores (hereafter referred to as competition information) have become widespread to support behavioral change. However, users without high levels of motivation, such as behavior change support targets, do not necessarily benefit from competition information. In this study, we propose a method to control the psychological effects caused by competition information to support behavior change. We implemented a competition information presentation system using step counts logs to support increasing one’s daily steps. We designed two patterns of competition information considering psychological effects. One is likely to have good effects, using three mechanisms to easily obtain results corresponding to the effort, make closely matched rivals with similar abilities, and pay attention to a small number of rivals. The other is unlikely to have positive effects and may potentially even have negative ones, using a mechanism that brings about the opposite results of the former pattern. We evaluated 42 participants with low levels of motivation over six weeks. The results showed that the former information pattern increased participants’ step counts by about 1000 steps per day, and the latter information pattern did not lead to an increase. We confirmed the feasibility of the proposed method and discussed the possibility of the appropriate use and potential abuse of such techniques for manipulating motivation. Our study can be helpful in designing a competition information presentation system considering psychological effects.

Liveable residential space, residential density, and hypertension in Hong Kong: A population-based cohort study

BACKGROUND

Hypertension is a leading preventable risk factor of chronic disease and all-cause mortality. Housing is a fundamental social determinant of health. Yet, little is known about the impacts of liveable residential space and density on hypertension.

METHODS AND FINDINGS

This retrospective observational study (median follow-up of 2.2 years) leveraged the FAMILY Cohort, a large territory-wide cohort in Hong Kong, Special Administrative Region, People's Republic of China to quantify associations of objectively measured liveable space and residential density with blood pressure outcomes among adults aged ≥16 years. Blood pressure outcomes comprised diastolic blood pressure (DBP), systolic blood pressure (SBP), mean arterial pressure (MAP), and hypertension. Liveable space was measured as residential floor area, and density was assessed using the number of residential units per building block and neighborhood residential unit density within predefined catchments. Multivariable regression models examined associations of liveable floor area and residential density with prevalent and incident hypertension. We investigated effect modifications by age, sex, income, employment status, and housing type. Propensity score matching was further employed to match a subset of participants who moved to smaller residences at follow-up with equivalent controls who did not move, and generalized linear models examined the impact of moving to smaller residences upon blood pressure outcomes. Our fully adjusted models of prevalent hypertension outcomes comprised 30,439 participants at baseline, while 13,895 participants were available for incident models at follow-up. We found that each interquartile range (IQR) increment in liveable floor area was associated with lower DBP (beta [β] = -0.269 mm Hg, 95% confidence interval [CI]: -0.419 to -0.118, p < 0.001), SBP (β = -0.317 mm Hg, -0.551 to -0.084, p = 0.008), MAP (β = -0.285 mm Hg, -0.451 to -0.119 with p < 0.001), and prevalent hypertension (odds ratio [OR] = 0.955, 0.918 to 0.993, p = 0.022) at baseline. Each IQR increment in residential units per building block was associated with higher DBP (β = 0.477 mm Hg, 0.212 to 0.742, p = <0.001), SBP (β = 0.750 mm Hg, 0.322 to 1.177, p = <0.001), MAP (β = 0.568 mm Hg, 0.269 to 0.866, p < 0.001), and prevalent hypertension (OR = 1.091, 1.024 to 1.162, p = 0.007). Each IQR increase in neighborhood residential density within 0.5-mi street catchment was associated with lower DBP (β = -0.289 mm Hg, -0.441 to -0.137, p = <0.001), SBP (β = -0.411 mm Hg, -0.655 to -0.168, p < 0.001), MAP (β = -0.330 mm Hg, -0.501 to -0.159, p = <0.001), and lower prevalent hypertension (OR = 0.933, 0.899 to 0.969, p < 0.001). In the longitudinal analyses, each IQR increment in liveable floor area was associated with lower DBP (β = -0.237 mm Hg, -0.431 to -0.043, p = 0.016), MAP (β = -0.244 mm Hg, -0.444 to -0.043, p = 0.017), and incident hypertension (adjusted OR = 0.909, 0.836 to 0.988, p = 0.025). The inverse associations between larger liveable area and blood pressure outcomes were more pronounced among women and those residing in public housing. In the propensity-matched analysis, participants moving to residences of lower liveable floor area were associated with higher odds of incident hypertension in reference to those who did not move (OR = 1.623, 1.173 to 2.199, p = 0.002). The major limitations of the study are unmeasured residual confounding and loss to follow-up.

CONCLUSIONS

We disentangled the association of micro-, meso-, and macrolevel residential densities with hypertension and found that higher liveable floor area and neighborhood scale residential density were associated with lower odds of hypertension. These findings suggest adequate housing in the form of provisioning of sufficient liveable space and optimizing residential density at the building block, and neighborhood levels should be investigated as a potential population-wide preventive strategy for lowering hypertension and associated chronic diseases.

Effects of Isometric Handgrip Training on Home Blood Pressure Measurements in Hypertensive Patients: A Randomized Crossover Study

Objective We aimed to examine the effects of isometric handgrip (IHG) training on home blood pressure (BP) levels in hypertensive Japanese patients undergoing treatment. Methods Fifty-three hypertensive patients (mean age, 61.7 years; 56.6% men) with a home systolic BP ≥135 mmHg and/or a home diastolic BP ≥85 mmHg were randomly assigned to either group A or B. As per the crossover design, group A performed 8 weeks of IHG training, followed by an equivalent training-free, control period, while the reverse protocol was performed by group B. The baseline characteristics were similar between both groups. The individualized daily IHG training comprised four sets of 2-min isometric contractions at 30% of the individual's maximum voluntary contraction capacity, including 1 min of rest between sets, for ≥3 days/week. The outcome measure was morning and evening home BP readings taken over the last 2 weeks of the training and control periods. Results A combined data analysis for both groups showed that IHG training was significantly associated with the lowering of both systolic and diastolic BP in the morning (137.9±9.3 vs. 135.3±9.5 mmHg, p=0.007 and 83.0±9.5 vs. 81.2±9.3 mmHg, p<0.001, respectively) and evening (130.0±10.7 vs. 127.6±10.1 mmHg, p=0.003 and 75.8±10.4 vs. 73.8±9.2 mmHg, p<0.001, respectively), while no significant change was observed after the control period. A larger increase in the maximum grip strength due to IHG training was associated with greater BP reductions. Conclusion An 8-week period of IHG training significantly lowered both the morning and evening home BP in hypertensive Japanese patients undergoing treatment.

The association between self-perceived walking pace with the incidence of hypertension: the 'Seguimiento Universidad de Navarra' cohort

OBJECTIVE

Although available evidence supports the protective effects of walking on hypertension - a major risk factor for cardiovascular disease and stroke - more information is needed in determining whether walking pace independently provides additional hypertension risk reductions. This prospective study determined the association between self-reported walking pace and the incidence of hypertension in the 'Seguimiento Universidad de Navarra' (SUN) cohort in Spain.

METHODS

Our population sample consisted of 15 357 university graduates initially free of chronic disease or hypertension. During an average follow-up time of 10.9 years, 1673 incident cases of hypertension were observed. Hazard ratios and 95% confidence intervals (95% CIs) for hypertension risk of each walking pace [slow (reference), normal, brisk and very brisk] were estimated using Cox regression models, adjusted for multiple possible confounders. Data were collected from 1999 to 2019, and analysed in 2020.

RESULTS

Participants who walked at a very brisk pace at baseline had a substantially lower risk of developing hypertension during follow-up than those who walked at a slow pace (multivariable-adjusted hazard ratio: 0.64; 95% CI: 0.41-0.99). Inverse associations were observed also for normal (HR: 0.64; 95% CI: 0.46-0.90) and brisk walking pace (0.69; 95% CI: 0.50-0.97) as compared to slow pace, independent of other risk factors.

CONCLUSION

Our results support that an increase in walking pace, even slightly, is inversely associated with the development of hypertension, independent of total time spent walking and other factors associated with hypertension.

Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension

Treatment of hypertension and its complications remains a major ongoing health care challenge. Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of the population will have hypertension. Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality. Hence, current international guidelines on cardiovascular disease prevention provide generic advice to increase aerobic activity, but physiological responses differ with blood pressure (BP) level, and greater reductions in BP across a population may be achievable with more personalized advice. We performed a systematic review of meta-analyses to determine whether there was sufficient evidence for a scientific Consensus Document reporting how exercise prescription could be personalized for BP control. The document discusses the findings of 34 meta-analyses on BP-lowering effects of aerobic endurance training, dynamic resistance training as well as isometric resistance training in patients with hypertension, high-normal, and individuals with normal BP. As a main finding, there was sufficient evidence from the meta-review, based on the estimated range of exercise-induced BP reduction, the number of randomized controlled trials, and the quality score, to propose that type of exercise can be prescribed according to initial BP level, although considerable research gaps remain. Therefore, this evidence-based Consensus Document proposes further work to encourage and develop more frequent use of personalized exercise prescription to optimize lifestyle interventions for the prevention and treatment of hypertension.

A Fitness App for Monitoring Walking Behavior and Perception (Runkeeper): Mixed Methods Pilot Study

BACKGROUND

Physical activity has a strong positive impact on both physical and mental health, and public health interventions often encourage walking as a means to promote physical activity. Social connectivity, such as that among spouses, families, friends, and colleagues, highly influences physical activity. Although technology-based interventions have some influence on human behavior, they have not been fully implemented and evaluated for their influence on walking through social connectivity.

OBJECTIVE

We aimed to pilot-test the organization of neighborhood walking clubs and use of a mobile app (Runkeeper) to encourage social connectedness and neighborhood cohesion, as well as to increase physical activity.

METHODS

We used a convenience sampling method to recruit 46 adults from an urban location in Greater Boston, Massachusetts. We assigned participants to teams based on their geographic location and neighborhood and required them to use the app (Runkeeper). Participants completed 2 self-administered web-based surveys before and after the intervention period. The surveys included standard measures to evaluate physical activity, social connectedness, perceived social support, and neighborhood cohesion (Buckner Neighborhood Cohesion Scale) before and after the intervention. Following the intervention, we randomly selected 14 participants to participate in postintervention, in-depth phone interviews to gain an understanding of their experiences.

RESULTS

This study was approved by the institutional review board in June 2018 and funded in January 2018. Recruitment started in May 2019 and lasted for 2 months. Data were collected from July 2019 to January 2020. In this study, Runkeeper was of limited feasibility as an app for measuring physical activity or promoting social connectedness. Data from the app recorded sparse and uneven walking behaviors among the participants. Qualitative interviews revealed that users experienced difficulties in using the settings and features of the app. In the questionnaire, there was no change between pre-post assessments in walking minutes (b=-.79; 95% CI -4.0 to 2.4; P=.63) or miles (b=-.07; 95% CI -0.15 to 0.01; P=.09). We observed a pre-post increase in social connectedness and a decrease in neighborhood cohesion. Both quantitative and qualitative results indicated that the psychosocial aspects of walking motivated the participants and helped them relieve stress. Interview results showed that participants felt a greater virtual connection in their assigned groups and enhanced connections with friends and family members.

CONCLUSIONS

Our study found that Runkeeper created a virtual connection among walking group members and its data sharing and ranking motivated walking. Participants felt that walking improved their mental health, helped to relieve stress, and made them feel more connected with friends or family members. In future studies, it will be important to use an app that integrates with a wearable physical activity device. There is also a need to develop and test intervention components that might be more effective in fostering neighborhood cohesion.

Effects of a Real-Life Park-Based Physical Activity Interventional Program on Cardiovascular Risk and Physical Fitness

INTRODUCTION

Regular physical activity (PA) practice is a way to combat cardiovascular disease, and a PA interventional program, including individualized prescription of walking with limited supervision of execution, may be a strategy to be applied in public parks. Thus, our study tested the effects of a real-world program like this on cardiovascular risk and cardiorespiratory fitness (CF) of the users of a public park.

METHODS

Data came from the Exercise and Heart Project, a real-life park-based PA interventional program. The study phases were 1) a preintervention evaluation; 2) the individualized prescription of PA; 3) the supervision of the first practice sessions; 4) the unsupervised execution of the prescription; and 5) a postintervention evaluation.

RESULTS

Data from 152 participants (mainly women and aged 40 to 80 years) were analyzed. The intervention significantly increased CF (mean [standard deviation], 99 [19] steps vs 110 [21] steps, P < .001) and reduced body mass index, waist circumference, and systolic blood pressure, decreasing global cardiovascular risk (mean [standard deviation], 0.15 [2.84] vs -0.52 [2.60]; P < .001). The effects of intervention on cardiovascular risk were not different between the participants with low and high initial CF or PA levels.

CONCLUSION

The proposed real-life park-based PA interventional program decreased cardiovascular risk of the participants independently of their initial PA or CF levels.

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.

"It's Better Together": A Nested Longitudinal Study Examining the Benefits of Walking Regularly With Peers Versus Primarily Alone in Older Adults

The authors examined whether purposeful walking with peers at least once a week contributes to better behavioral and health outcomes in older adults than primarily walking alone. The authors used a longitudinal cohort design and recruited participants aged 60 years and older (N = 136) at the start of a 16-week walking intervention. Participants who walked on average at least once a week in the final 8 weeks of the intervention were included in the analysis (N = 79; 66 females, Mage [SD] = 77.73 [6.91]). The authors found that autonomous motivation, walking self-efficacy, functional capacity, body fat, and physical activity improved more in the walking with peers group compared with the walking alone group, after controlling for whether participants lived alone/with others and their health status. The results extend current literature by providing longitudinal evidence for the added benefits of regular peer-accompanied walking in older adults and highlight the importance of investing in peer-supported interventions.

Associations between objectively-measured and self-reported neighbourhood walkability on adherence and steps during an internet-delivered pedometer intervention

BACKGROUND

Accumulating evidence suggests that the built environment is associated with physical activity. The extent to which the built environment may support adherence to physical activity interventions is unclear. The aim of this study was to investigate whether the neighbourhood built environment constrains or facilitates adherence and steps taken during a 12-week internet-delivered pedometer-based physical activity intervention (UWALK).

METHOD

The study was undertaken in Calgary (Canada) between May 2016 and August 2017. Inactive adults (n = 573) completed a telephone survey measuring sociodemographic characteristics and perceived neighbourhood walkability. Following the survey, participants were mailed a pedometer and instructions for joining UWALK. Participants were asked to report their daily pedometer steps into the online program on a weekly basis for 12 weeks (84 days). Walk Score® estimated objective neighbourhood walkability and the Neighbourhood Environment Walkability Scale-Abbreviated (NEWS-A) measured participants self-reported neighbourhood walkability. Regression models estimated covariate-adjusted associations of objective and self-reported walkability with: 1) adherence to the UWALK intervention (count of days with steps reported and count of days with 10000 steps reported), and; 2) average daily pedometer steps.

RESULTS

On average, participants undertook 8565 (SD = 3030) steps per day, reported steps on 67 (SD = 22.3) of the 84 days, and achieved ≥10000 steps on 22 (SD = 20.5) of the 84 days. Adjusting for covariates, a one-unit increase in self-reported walkability was associated on average with 45.76 (95CI 14.91, 76.61) more daily pedometer steps. Walk Score® was not significantly associated with steps. Neither objective nor self-reported walkability were significantly associated with the UWALK adherence outcomes.

CONCLUSION

The neighbourhood built environment may support pedometer-measured physical activity but may not influence adherence to pedometer interventions. Perceived walkability may be more important than objectively-measured walkability in supporting physical activity during pedometer interventions.

Chronic Effect of Fatmax Training on Body Weight, Fat Mass, and Cardiorespiratory Fitness in Obese Subjects: A Meta-Analysis of Randomized Clinical Trials

Exercise training performed at the maximal fat oxidation intensity (FMT) stands out as a potential treatment of overweight and obesity. This work is a meta-analysis of randomized clinical trials of studies about the effect of FMT on fat mass and maximal oxygen consumption using PubMed, SCOPUS, EBSCOhost, and ScienceDirect as databases. Two independent reviewers selected 11 trials from 356 publications identified by the following keywords: fatmax, lipoxmax, maximal fat oxidation, peak of fat oxidation, physical training, physical exercise, body fat (BF), fat mass, overweight, and obesity. The risk of bias was assessed following the Cochrane Guidelines. The pooled mean difference was computed for each outcome with the random-effects model and the inverse-variance method. The meta-analysis was performed with the RevMan software v 5.3, and the heterogeneity across studies by the I². The statistical significance was accepted at p < 0.05. Results showed that the FMT reduced body weight (MD = -4.30 kg, p < 0.01, I² = 0%), fat mass (MD = -4.03 kg, p < 0.01, I² = 0%), and waist circumference (MD = -3.34 cm, p < 0.01). Fat-free mass remains unchanged (MD = 0.08 kg, p = 0.85), but maximal oxygen consumption increased (MD = 2.96 mL∙kg^-1∙min^-1, p < 0.01, I² = 0%). We conclude that FMT at short and medium-term (eight to twenty weeks) reduces body weight and BF, increasing cardiovascular fitness in low physical fitness people with obesity.

Visceral adiposity and liver fat as mediators of the association between cardiorespiratory fitness and plasma glucose-insulin homeostasis

Cardiorespiratory fitness (CRF) is positively associated with insulin sensitivity, whereas excessive levels of visceral adipose tissue (AT) and liver fat (LF) are both associated with insulin resistance and impaired plasma glucose-insulin homeostasis. To what extent levels of visceral AT and LF content contribute to the relationship between CRF and indices of plasma glucose-insulin homeostasis is uncertain. Our objective was to explore the interactions among CRF, visceral AT, and LF with glucose tolerance/insulin levels in asymptomatic and apparently healthy individuals. CRF was measured in 135 women and 177 men with a maximal treadmill graded exercise test. Indices of plasma glucose-insulin homeostasis were derived from a 3-h oral glucose tolerance test (OGTT) performed in the morning after a 12-h fast. Visceral AT levels and LF content were measured using magnetic resonance imaging and spectroscopy. For any given CRF level, women presented significantly lower visceral AT and LF than men as well as lower homeostasis model assessment of insulin resistance (HOMA-IR) and plasma glucose-insulin levels during the OGTT compared with men. In both sexes, there were significant negative correlations between CRF and HOMA-IR as well as glucose and insulin levels measured during the OGTT. Both glucose and insulin levels during the OGTT correlated positively with visceral AT and LF. In women and men, being in the top CRF tertile was associated with low levels of visceral AT and LF. Multivariable linear regression analyses suggested that visceral AT and LF were plausible mediators of the association between CRF and indices of plasma glucose-insulin homeostasis.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL TRIAL INFORMATION

This study was registered on ClinicalTrials.gov, NCT03384550.

The Physiological, Physical, and Biomechanical Demands of Walking Football: Implications for Exercise Prescription and Future Research in Older Adults

The aim of this investigation was to profile the physiological, physical, and biomechanical responses during walking football. A total of 17 male participants (aged 66 ± 6 years) participated. Heart rate; blood lactate; accelerometer variables (biomechanical load [PlayerLoad™], changes of direction); and rating of perceived exertion were measured. Participants mean percentage of maximum heart rate was 76 ± 6% during the sessions, with rating of perceived exertion across all sessions at 13 ± 2. Blood lactate increased by ∼157% from presession (1.24 ± 0.4 mmol/L) to postsession (3.19 ± 1.7 mmol/L; p ≤ .0005). PlayerLoad™ values of 353 ± 67 arbitrary units were observed, as well as ∼100 changes of direction per session. In conclusion, walking football is a moderate- to vigorous-intensity activity. The longitudinal health benefits of walking football remain to be elucidated, particularly on bone health, cardiovascular fitness, and social and mental well-being.

Can consumer wearable activity tracker-based interventions improve physical activity and cardiometabolic health in patients with chronic diseases? A systematic review and meta-analysis of randomised controlled trials

Background

To date, it is unclear if consumer wearable activity trackers (CWATs), with or without behaviour multi-component strategies, effectively improve adherence to physical activity and health outcomes under free living conditions in populations with chronic diseases. Therefore, we systematically evaluated the efficacy of CWAT-based interventions to promote physical activity levels and cardiometabolic health in populations with chronic diseases.

Methods

Randomised controlled trials were collected from five bibliographic databases (PubMed, Embase, Web of Science, The Cochrane Central Register of Controlled Trials and CINAHL). Studies were eligible for inclusion if they evaluated a CWAT-based counselling intervention versus control intervention among patients with chronic respiratory diseases, type 2 diabetes mellitus, cardiovascular diseases, overweight/obesity, cognitive disorders, or sedentary older adults. Data were pooled using a random-effects model.

Results

After deduplication 8147 were identified of which 35 studies met inclusion criteria (chronic respiratory diseases: 7, type 2 diabetes mellitus: 12, cardiovascular diseases: 6, overweight/obesity: 3, cognitive disorders: 1, sedentary older adults: 6). Compared to control groups, CWAT-based interventions significantly increased physical activity by 2123 steps per day (95% confidence interval [CI], [1605–2641]; p < 0.001). In addition, CWAT-based interventions in these populations significantly decreased systolic blood pressure (− 3.79 mm Hg; 95% CI: [− 4.53, − 3.04] mm Hg; p < 0.001), waist circumference (− 0.99 cm; 95% CI: [− 1.48, − 0.50] cm; p < 0.001) and low-density lipoprotein cholesterol concentration (− 5.70 mg/dl; 95% CI: [− 9.24, − 2.15] mg/dl; p = 0.002).

Conclusion

CWAT-based interventions increase physical activity and have beneficial effects on important health-related outcomes such as systolic blood pressure, waist circumference and LDL cholesterol concentration in patients with chronic diseases.

A Data-Driven Framework for Walkability Measurement with Open Data: A Case Study of Triple Cities, New York

Walking is the most common, environment-friendly, and inexpensive type of physical activity. To perform in-depth walkability analysis, one option is to objectively evaluate different aspects of built environment related to walkability. In this study, we proposed a computational framework for walkability measurement using open data. Three major steps of this framework include the web scrapping of publicly available online data, determining varying weights of variables, and generating a synthetic walkability index. The results suggest three major conclusions. First, the proposed framework provides an explicit mechanism for walkability measurement. Second, the synthetic walkability index from this framework is comparable to Walk Score, and it tends to have a slightly higher sensitivity, especially in highly walkable areas in urban core. Third, this framework was effectively applied in a metropolitan area that contains three small cities that together represent a small, old shrinking region, which extends the topical area in the literature. This framework has the potential to quantify walkability in any city, especially cities with a small population where walkability has rarely been studied, or those having no quantification indicator. For such areas, researchers can calculate the synthetic walkability index based on this framework, to assist urban planners, community leaders, health officials, and policymakers in their practices to improve the walking environment of their communities.

Evaluation of Step-Counting Interventions Differing on Intensity Messages

BACKGROUND

Step-counting interventions with discrepant intensity emphases may elicit different effects.

METHODS

A total of 120 sedentary/low-active, postmenopausal women were randomly assigned to one of the following 3 groups: (1) 10,000 steps per day (with no emphasis on walking intensity/speed/cadence; basic intervention, 49 completers), (2) 10,000 steps per day and at least 30 minutes in moderate intensity (ie, at a cadence of at least 100 steps per minute; enhanced intervention, 47 completers), or (3) a control group (19 completers). NL-1000-determined steps and active minutes (a device-specific indicator of time at moderate+ intensity) were collected as process variables during the 12-week intervention. Outcome variables included systolic and diastolic blood pressure, anthropometric measurements, fasting blood glucose and insulin, flow-mediated dilation, gait speed, and ActiGraph GT3X+-determined physical activity and sedentary behavior.

RESULTS

The "basic group" increased 5173 to 9602 steps per day and 9.2 to 30.2 active minutes per day. The "enhanced group" similarly increased 5061 to 10,508 steps per day and 8.7 to 38.8 active minutes per day. The only significant change over time for clinical variables was body mass index.

CONCLUSIONS

Interventions that use simple step-counters can achieve elevated volume and intensity of daily physical activity, regardless of emphasis on intensity. Despite this, few clinical outcomes were apparent in this sample of postmenopausal women with generally normal or controlled hypertension.

Association between glycemic state and pulmonary function and effect of walking as a protective factor in subjects with diabetes mellitus

Background

Several population-based studies have shown that individuals with type 2 diabetes mellitus (T2DM) have decreased pulmonary function. Moreover, impaired pulmonary function is associated with all-cause mortality in T2DM. We investigated the association between glycemic state and pulmonary function and evaluated the role of walking as protective factor in subjects with diabetes using a nationwide, population-based, cross-sectional survey.

Methods

The study included 17,542 subjects: 2,195 with diabetes, 4,042 with prediabetes, and 11,305 with normal glucose tolerance. Furthermore, 1,770 subjects with available data on walking exercise were divided into three groups according to weekly exercise time: <150, 150-300, and ≥ 300 min/week.

Results

The diabetes group had reduced pulmonary function, particularly forced vital capacity (FVC) (P<0.001), and a decrease in pulmonary function was observed in the subjects with prediabetes (P<0.001). The walking exercise analysis revealed that the percentage of predicted FVC (P=0.001) and percentage of predicted forced expiratory volume in 1 s (P=0.021) were highest in the subjects with diabetes who walked ≥300 min/week after adjustment for age, sex, body mass index, and waist circumference (WC) measurements.

Conclusions

Pulmonary function was significantly associated with walking exercise in diabetic patients, and walking ≥300 min/week may have a preventive effect against pulmonary dysfunction in subjects with diabetes.

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

Objectives

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

Design

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

Methods

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

Results

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

Conclusions

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The effects of home-based stair and normal walking exercises on lower extremity functional ability, fall risk factors, and cardiovascular health risk factors in middle-aged older women

The purpose of this study was to exam 12 weeks of stair and normal walking effects on lower extremity functional ability and cardiovascular health risk factors in middle-aged older women. Twenty-four subjects were assigned either to the stair walking group (SWG, 57.40±6.11 years, n=10) or the normal walking group (NWG, 57.28±16.83 years, n= 14). They performed exercises 3 times per week, 60 min per day for 12 weeks. Lower extremity functional ability (lower extremity muscular strength, walking speed, active and static balance ability, and agility) and cardiovascular health risk factors were compared by time and groups using a two-way repeated analysis of variance and mean values were compared within group using paired t-test. As results, significant time differences were found in lower extremity muscular strength, walking speed and active balance; no time and group interactions were found. Also, significant time differences were found in systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, fasting glucose. Significant time and group interactions were found in body fat. In addition, significant time differences within the groups were found in lower extremity muscular strength, walking speed, active balance in SWG and NWG; systolic blood pressure in SWG; systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, and fasting glucose in NWG. These results indicated that home-based stair and normal walking exercises can be utilized to improve lower extremity functional ability and cardiovascular health risk factors in middle-aged and older women.

Gait quality and velocity influences activity tracker accuracy in individuals post-stroke

Objective: Fitbit Zip™ (FBZ) is a low-cost user-friendly device that could help motivate individuals post-stroke to increase their physical activity. However, inaccuracy in step counts from altered gait variables could cause dissatisfaction and reduce compliance. The aim of this study was to determine the influence of gait variables on the concurrent validity of the FBZ. Method: In a cross-sectional study, 19 community-dwelling stroke survivors (mean 66 (SD 8) years)  wore a FBZ at the non-paretic hip, and were videoed completing a six minute walk test (6MWT). Steps recorded by the FBZ were compared against the criterion standard of manually counted steps from video-recordings. Spatio-temporal gait parameters were calculated, and gait quality was assessed using the Wisconsin Gait Analysis (WGA) tool. Concurrent validity of FBZ was determined using Kendall's Tau correlation coefficient. Linear regression analysis determined the association between gait parameters, quality, and FBZ accuracy. Results: A very strong correlation was observed between the FBZ steps and manual counting (τ = 0.80, p < .001). Step difference demonstrated significant negative association with gait velocity (R² = 0.35, B = -59.94, p = .007), and positive association with WGA score (R² = 0.69, B = 4.59, p < .001), indicating poor FBZ accuracy in participants with lower speed (≤0.8m/s) and poor gait quality (WGA score>16). Conclusions: FBZ is an accurate measure of step activity in independent ambulators with stroke walking at speeds > 0.8m/s, but accuracy can be compromised with lower speed and poor gait quality. Clinicians should consider gait velocity and quality before advising FBZ as a motivational tool to increase physical activity in individuals post-stroke.

Walk This Way: Our Perspective on Challenges and Opportunities for Extension Statewide Walking Promotion Programs

Evidence-based walking programs exist and some have been tailored specifically for the national Cooperative Extension System; however, program outcomes and translational challenges and successes are underreported. This has presented a challenge to scaling the best-fit intervention for walking promotion within this national system. Here, we describe existing open-access walking programs as well as implications for improving the fit and sustainability of this intervention type within the system. Our experience provides suggestions for pragmatic data collection, infrastructure to support pragmatic data collection, and novel ways to disseminate best practices, as well as considerations for de-implementing what is not working.