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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Walking Interventions: Relevant to Clinicians and Health Policy Makers
A small change in walking habits can yield a significant health benefit
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charles j mayer, Seattle, King Family Physician, University of Washington and Group Health Cooperative
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I applaud the Annal’s recent article by Richardson, “ A Meta-Analysis of Pedometer-Based Walking Interventions and Weight Loss” for it demonstrates how a thoughtful research question can lead to a practical clinical tool and a public health policy aid. This well done, analytically complicated review found that one could lose a modest amount of weight, about 1 pound every 10 weeks, by walking 20-40 minutes a day, regardless of diet.1 Considering that walking is by far the most common and acceptable form of physical activity for Americans, Richardson’s results becomes a very practical matter for health care providers.2 Clinicians have watched their patients weight yo-yo up and down often while following the latest fad diet. Providers have come to learn that most diets work for weight loss, but have been less clear of the role that walking played in losing and maintaining weight loss. We now have more information to share with patients that support the common sense measure: adding regular physical activity in the form of walking will likely slowly and steadily assist any weight loss program. From a public health perspective, Richardson’s study may have more importance. Besser showed that those who use public transportation walk on average 19 minutes and meet the surgeon general’s recommendations for physical activity 29% of the time.3 Other studies demonstrate that residents from communities with higher density, greater street connectivity, and more land use mix, report more rates of walking for utilitarian purposes than neighborhoods without these features.4 We also know that countries that place more resources towards building an environment that supports more walking and bicycling, are likely healthier, walk more and have lower rates of pedestrian fatalities.5 Richardson’s study encourages a continued examination of our public health policies that effect the built environment and promote more walking. 1. Richardson CR, Newton TL, Abraham JJ, Sen A, Jimbo M, Swartz AM. A meta-analysis of pedometer-based walking interventions and weight loss. Ann Fam Med. Jan-Feb 2008;6(1):69-77. 2. Simpson ME, Serdula M, Galuska DA, et al. Walking trends among U.S. adults: the Behavioral Risk Factor Surveillance System, 1987-2000. Am J Prev Med. Aug 2003;25(2):95-100. 3. Besser LM, Dannenberg AL. Walking to public transit: steps to help meet physical activity recommendations. Am J Prev Med. Nov 2005;29(4):273-280. 4. Saelens BE, Sallis JF, Frank LD. Environmental correlates of walking and cycling: findings from the transportation, urban design, and planning literatures. Ann Behav Med. Spring 2003;25(2):80-91. 5. Pucher J, Dijkstra L. Promoting safe walking and cycling to improve public health: lessons from The Netherlands and Germany. Am J Public Health. Sep 2003;93(9):1509-1516. Competing interests: None declared |
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David E. Goodrich, EdD, Ann Arbor, USA Health Services Research Fellow
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While many physicians may hold skeptical beliefs about the efficacy of pedometer-based walking programs to confer significant health benefits, the meta-analytical review performed by Dr. Caroline Richardson and colleagues provides intriguing new evidence that modest increases in daily walking can help individuals lose weight. Although the review was limited by the small number of published cohort trials and randomized controlled trials on this topic, results were consistent across the studies reviewed that pedometer-based walking programs do in fact cause small but significant reductions in weight without dietary intervention. It is important to interpret this finding in the broader scheme of patient care. Obesity experts like Dr. James O. Hill have observed that the average weight gain for an American adult is 1.8 to 2.0 pounds per year.1 Creeping rates of overweight and obesity have increased the complexity of treating patients in family practice due to the increased prevalence of weight- related chronic disease and disability. Dr. Hill asserts that this trend can be countered by helping individuals make lifestyle changes that cause an extra 100 kcal per day to be burned through either increased energy expenditure or reduced dietary intake. He estimates that encouraging people to simply increase their daily walking levels by as little as 15-20 minutes (1 mile or 2,000 -2,500 steps) can accomplish this goal. Similarly, authors from the Studies Targeting Risk Reduction Interventions through Defined Exercise (STRRIDE) trial concluded that most individuals could maintain or lose weight by aiming for a minimal goal of achieving 8 miles per week of moderate intensity exercise (i.e., walking).2 The review by Richardson and colleagues provides physicians with compelling evidence to recommend walking to patients as an obesity prevention strategy. Sedentary patients who are either overweight or obese are at greater risk for increased disease morbidity and mortality, but stand to benefit most by moving to a moderately active lifestyle.3 Walking is a convenient and safe form of activity advocated by most medical organizations even for many patients considered high risk.4 Pedometers are an inexpensive tool to help formerly sedentary patients become mindful of their daily walking levels by providing self-monitoring feedback that can lead to more realistic and effective goals to increase activity levels. For more information to improve your ability to provide exercise prescriptions, please take note of the new resource offered by the American College of Sports Medicine and the American Medical Association, Exercise is Medicine™.5 References 1. Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the environment: where do we go from here? Science. 2003;299(5608):853-855. 2. Slentz CA, Houmard JA, Kraus WE. Modest exercise prevents the progressive disease associated with physical inactivity. Exerc Sport Sci Rev. Jan 2007;35(1):18-23. 3. Blair SN, Brodney S. Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. Med Sci Sports Exerc. Nov 1999;31(11 Suppl):S646-662. 4. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation. 2002;106:1883-1892. 5. http://www.exerciseismedicine.org Competing interests: None declared |
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