By Kim Smith, MA, RCEP, PYT | ECU Health
“National Walking Day,” traditionally the first Wednesday in April, was introduced by the American Heart Association in 2007 as a way to promote 30 minutes of walking per day. Both National Walking Day and National Walking Month – observed in May – are public health initiatives to encourage physical activity and a healthy lifestyle through the simple act of walking for exercise. Yet 15 years later, the share of the adult population reporting regular physical activity still falls below 30%.
Walking is something we do so often we usually think very little of it. It’s a means to an end. A way to get things done. An afterthought, at best, for many people. However, this humble form of exercise is the whole package: familiar, low cost, portable, accessible and relevant to everyday function. Unfortunately, this has not been enough to turn the tide of inactivity.
Mayo Clinic reports walking can help manage weight and also prevent or manage chronic diseases such as heart disease, diabetes and cancer. It can help strengthen bones while improving endurance, energy, mood and balance. Walking can also boost the immune system and reduce stress. Again, sadly, these benefits are still not enough to motivate the masses. Walking is a healthy activity when performed regularly. So why don’t more people do it?
Walk the Walk, and Talk the Talk
If we learned anything through the pandemic, it’s that we’re highly social beings. We need connection with others like we need air, food, and water. We take this connection for granted until it is no longer available to us. In the exercise field, as in medicine, connection is relevant – whether it be the professional therapeutic relationship or the informal social support structures that our patients rely on to thrive. Social connection matters. That is where walking can really shine.
As a form of exercise, walking is well suited to help us cultivate connection with others. It is one of the easiest exercises to perform with others. People can walk and talk, enjoying each other’s company as well as the physical movement itself. When my husband and I walk together, sometimes we chat it up about work or the kids. Other times we are quiet and reflective, although we are walking together. Our pets get in on the act as well and love to walk with us. We stop and chat with neighbors, visit with other dog walkers, enjoy the outdoors and de-stress together. We look forward to this shared time several days per week.
Researchers have only recently begun to study the impact of exercising alone versus with others on health status. A large 2016 study was based on the Japan Gerontological Evaluation Study (JAGES), which included more than 21,000 subjects. Investigators found that increased frequency of exercise with others was associated with higher subjective health status than for subjects that solely exercised alone, and this was independent of exercise volume.
Might we change the tide of inactivity with walking clubs or groups? Churches are a great spot to encourage walking groups. Senior centers would also blossom with walking programs available. However, the older population is not the only one that needs to be targeted. Young families would benefit, as would their children. Instead of having field day once per year, more opportunities for active social gatherings for the entire family would be beneficial. How can we provide support and encouragement for these endeavors? Instead of showing up for the Heart Walk once per year, is there space to start a walking club at or near your facility that would be open to the community for anyone who would like to participate? What would that look like?
The ‘Connection’ to Cardiopulmonary Rehab
Walking clubs aside, how can we apply this idea in the rehab setting? First of all, encouraging patients to find an exercise buddy is always a good idea. They can encourage each other, and it gives them something to look forward to once they complete the program and no longer have the rehab staff to support and encourage them. Additionally, talking with patients about daily step count is an important move in the right direction.
Until recently, there was scant evidence to support the 10,000-steps-per-day goal that was widely recommended. A recent meta-analysis of 15 international studies was published in The Lancet in March 2022. The analysis included 47,000 people and showed progressively decreasing risk of mortality among adults aged 60 and older as steps per day increased up to 6,000-8,000 steps. For adults younger than 60, 8,000-10,000 steps per day was where mortality began to plateau. This is the first time we’ve had data to help make confident recommendations for daily step goals with any population.
Many of our patients now have smartphones. Step count information is available in the Google Fit app on Android or in the health or fitness apps on an iPhone. It may come as a surprise to some users how much or how little they actually move on a daily basis. Patients can begin by tracking their steps for a few days or a week. Are they just performing activities of daily life and nothing more with a meager 500-1,000 steps per day? Or are they living a full life, able to do the things they want and need to do on a regular basis with 5,000, 8,000 or more steps each day? Are they isolated and/or fearful of falling or having a health crisis? Steps per day are almost like another vital sign. It says so much that we can’t see or assess in a relatively short, face-to-face appointment.
Once average steps per day have been established, the patient can set small goals to increase steps by about 10% every week or two, until they are walking 6,000-8,000 steps daily if they are 60 years or older, or 8,000-10,000 steps a day if they are younger than 60. This will help slowly establish sustainable levels of activity that can lead to great benefit. By tracking steps per day, we can also individualize exercise goals in a more refined and substantial way that the patient can continue with on their own once their rehab is complete.
Walking is a great form of exercise. The real deal. The entire package. Add in connecting with others by walking with other people, and you layer in accountability, positive reinforcement through relationship building, stress proofing through social support and so much more. People who exercise with a buddy are more likely to do it, enjoy it, do it some more and feel better for it! That may be where the real magic lies. How can we cultivate more opportunities for walking together through community-based walking groups or clubs at local churches, senior centers, or schools, mall walking groups, neighborhood walking groups or other ideas? Walking is important not only for our physical health but could be a link to support mental and emotional health as well. National Walking Month is a great excuse to celebrate the wonder that we can use such a simple and elegant solution to address complex and deep-rooted issues in our society: inactivity and the ever-important need for true social connection.
Kimberly N. Smith, a Clinical Exercise Physiologist at ECU Health in Greenville, North Carolina, has worked in cardiovascular and pulmonary rehabilitation since 2002.
Paluch, A., et al. (2022) Daily steps and all cause mortality: a meta analysis of 15 international cohorts. Lancet Public Health. March; 7(3): e219-e228. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9289978/pdf/nihms-1787838.pdf
Kanamori, S. et al. (2016). Exercising alone versus with others and associations with subjective health status in older Japanese: The JAGES Cohort Study. Scientific Reports, 6: 39151. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5156899/
Walking: Trim your waistline, improve your health. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/walking/art-20046261