, Volume 23, Issue 5, pp 306-332
Date: 09 Oct 2012

Walking to Health

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Summary

Walking is a rhythmic, dynamic, aerobic activity of large skeletal muscles that confers the multifarious benefits of this with minimal adverse effects.

Walking, faster than customary, and regularly in sufficient quantity into the ‘training zone’ of over 70% of maximal heart rate, develops and sustains physical fitness: the cardiovascular capacity and endurance (stamina) for bodily work and movement in everyday life that also provides reserves for meeting exceptional demands. Muscles of the legs, limb girdle and lower trunk are strengthened and the flexibility of their cardinal joints preserved; posture and carriage may improve.

Any amount of walking, and at any pace, expends energy. Hence the potential, long term, of walking for weight control. Dynamic aerobic exercise, as in walking, enhances a multitude of bodily processes that are inherent in skeletal muscle activity, including the metabolism of high density lipoproteins and insulin/ glucose dynamics. Walking is also the most common weight-bearing activity, and there are indications at all ages of an increase in related bone strength.

The pleasurable and therapeutic, psychological and social dimensions of walking, whilst evident, have been surprisingly little studied. Nor has an economic assessment of the benefits and costs of walking been attempted.

Walking is beneficial through engendering improved fitness and/or greater physiological activity and energy turnover. Two main modes of such action are distinguished as: (i) acute, short term effects of the exercise; and (ii) chronic, cumulative adaptations depending on habitual activity over weeks and months.

Walking is often included in studies of exercise in relation to disease but it has seldom been specifically tested. There is, nevertheless, growing evidence of gains in the prevention of heart attack and reduction of total death rates, in the treatment of hypertension, intermittent claudication and musculoskeletal disorders, and in rehabilitation after heart attack and in chronic respiratory disease.

Walking is the most natural activity and the only sustained dynamic aerobic exercise that is common to everyone except for the seriously disabled or very frail. No special skills or equipment are required. Walking is convenient and may be accommodated in occupational and domestic routines. It is self-regulated in intensity, duration and frequency, and, having a low ground impact, is inherently safe.

Unlike so much physical activity, there is little, if any, decline in middle age. It is a year-round, readily repeatable, self-reinforcing, habit-forming activity and the main option for increasing physical activity in sedentary populations.

Present levels of walking are often low. Familiar social inequalities may be evident. There are indications of a serious decline of walking in children, though further surveys of their activity, fitness and health are required. The downside relates to the incidence of fatal and non-fatal road casualties, especially among children and old people, and the deteriorating air quality due to traffic fumes which mounting evidence implicates in the several stages of respiratory disease.

Walking is ideal as a gentle start-up for the sedentary, including the inactive, immobile elderly, bringing a bonus of independence and social well-being. As general policy, a gradual progression is indicated from slow, to regular pace and on to 30 minutes or more of brisk (i.e. 6.4 km/h) walking on most days. These levels should achieve the major gains of activity and health-related fitness without adverse effects. Alternatively, such targets as this can be suggested for personal motivation, clinical practice, and public health.

The average middle-aged person should be able to walk 1.6km comfortably on the level at 6.4 km/h and on a slope of 1 in 20 at 4.8 km/h, however, many cannot do so because of inactivity-induced unfitness. The physiological threshold of ‘comfort’ represents 70% of maximum heart rate. Trials across the age span are required in primary care and community programmes to evaluate such approaches, and the benefits and costs more generally of possible initiatives towards more walking.

Walking, by quantity and pace, is under-researched, particularly in the middleaged and elderly. Randomised controlled trials are required of its physiological effects on blood pressure, thrombogenesis, immune function; and of walking in the prevention and/or treatment of non-insulin dependent (type II) diabetes mellitus, osteoporosis, anxiety and depression and back pain.

Low levels of walking are a major factor in today’s widespread waste of the potential for health and well-being that is due to physical inactivity. This waste is manifest in impaired functional capacities, overweight, disease, disability, premature death and the concomitant human and economic costs. This review seeks to assemble evidence of the health gains of walking as a resource for the multifarious professionals and students, practitioners, investigators and policy makers.

An erratum to this article is available at http://dx.doi.org/10.1007/BF03257359.