Blog post by Bernadette Keefe MD
Introduction
WALKING
Definition:To move at a regular and fairly slow pace by lifting and setting down each foot in turn, never having both feet off the ground at once.
Synonyms: stroll, saunter, amble, trudge, plod, dawdle, hike, tramp, tromp, slog, stomp, trek, march, stride, sashay, glide, troop, patrol, wander, ramble, tread, prowl, promenade, roam, traipse
–Wikipedia
“What if a simple act could change the world?” – Born to Walk: The Transformative Power of the Pedestrian Life
Born to Walk – Trailer
Walking for Health
The U.S. Surgeon General regularly announces public health campaigns, “Calls to Action”, which are deemed particularly important for the overall health of the nation. A “Call to Action” is defined as “a science-based document to stimulate action nationwide to solve a major public health problem”.
For 2015, the U.S. Surgeon General, Dr. Vivek H. Murthy chose walking as the focus, when he announced the ‘Step It Up’ campaign. The ‘Step It Up’ campaign was designed to promote walking and walkable communities. Here is the video which accompanied the launch:
The Surgeon General, Dr. Murthy, stated in the opening paragraph of his executive summary: Step It Up: The Surgeon General’s Call to Promote Walking and Walkable Communities
One out of every two U.S. adults is living with a chronic disease, such as heart disease, cancer, or diabetes. These diseases contribute to disability, premature death, and health care costs. Increasing people’s physical activity levels will significantly reduce their risk of chronic diseases and related risk factors. Because physical activity has numerous other health benefits—such as supporting positive mental health and healthy aging—it is one of the most important actions people can take to improve their overall health.
The following summary paragraph from Wikipedia highlights the many, varied health benefits of walking:
Regular, brisk exercise of any kind can improve confidence, stamina, energy, weight control and life expectancy and reduce stress. It can also reduce the risk of coronary heart disease, strokes, diabetes, high blood pressure, bowel cancer and osteoporosis. Scientific studies have also shown that walking, besides its physical benefits, is also beneficial for the mind, improving memory skills, learning ability, concentration and abstract reasoning, as well as ameliorating spirits.
Sustained walking sessions for a minimum period of thirty to sixty minutes a day, five days a week, with the correct walking posture, reduce health risks and have various overall health benefits, such as reducing the chances of cancer, type 2 diabetes, heart disease, anxiety and depression. Life expectancy is also increased even for individuals suffering from obesity or high blood pressure. Walking also improves bone health, especially strengthening the hip bone, and lowering the harmful low-density lipoprotein, and raising the useful high-density lipoprotein. Studies have found that walking may also help prevent dementia and Alzheimer’s.
Walking is straightforward, accessible to many, and can be incorporated into most lifestyles. No gym membership is required, and proper footwear is the only gear needed. As to the latter point, walking or running shoes need not be fancy, custom or expensive. As Dr. Howard Luks @hjluks states in his review of the subject:
“It appears that you should simply choose the shoe that feels most comfortable to you. Purchase your shoes at a store that will allow you to run in many different shoes. Ignore suggestions based on the overall appearance of your foot, and go with your gut… or foot in this case. Probably the best advice of all is to have a few different pairs of shoes… By alternating your shoes, you will spread the force of your running a little differently in each shoes, thus minimizing the risk of injury by staying in one shoe… and focusing the stress in one area day in and day out.”
Despite the above health benefits, walking, alone, is not a panacea. As the saying goes: “You Can’t Outrun Obesity” (Amy Luke and Richard Cooper, International Journal of Epidemiology)
Weight loss is primarily accomplished by an excellent diet, especially minimal sugar and matching caloric intake with energy expended (physical activity). However, for general health purposes, a healthy diet must be paired with daily exercise. While the U.S. guidelines are 30 minutes per day of exercise, the UK National Health Service (NHS) has a more robust, and realistic, recommendation of 300 minutes of active exercise per week or 43 minutes per day. Examples of active exercise include brisk walking, or playing a sport.
Brisk walking is considered to be, on average, a speed of 4 miles per hour. Routine walking is, on average, 3 miles per hour depending on fitness levels. One can calculate their rate by using a routine fitness tracker and establishing the number of active steps and time it takes to cover 1 mile. Once you know that value, plan your exercise routine with an optimal target of 60 minutes of active exercise, 5 days per week. The following tracker analysis is likely for a taller person, with 10,000 steps accomplishing 5 miles. (My 10,000 steps gets me just a little over 4 miles.)
Perhaps the most value in walking is the fact that it is not sitting. There are significant negative health effects caused by our sedentary lifestyle and we must be creative about reducing sitting time and adding extra movement in our personal workflow. A nice first step is planning ahead and incorporating times for brisk walking. Walking meetings, walking more in one’s daily commute to work, ditching the car, parking further away from destinations, having walking shoes handy, taking walking lunches, and planning weekend ‘family and friends’ walks, are all ways to incorporate enjoyable daily walking into our lives.
Even when older, more infirm and physically limited, walking speed matters. In an article from the Journal of the American Medical Association (JAMA), gait speed was predictive of longevity or, alternatively, early mortality, in older persons. Gait speeds below o.6 meters per second or about 1.3 miles per hour were associated with earlier mortality. They offered the following description of why this makes sense:
Why would gait speed predict survival? Walking requires energy, movement control, and support and places demands on multiple organ systems, including the heart, lungs, circulatory, nervous, and musculoskeletal systems. Slowing gait may reflect both damaged systems and a high-energy cost of walking. Gait speed could be considered a simple and accessible summary indicator of vitality because it integrates known and unrecognized disturbances in multiple organ systems, many of which affect survival. In addition, decreasing mobility may induce a vicious cycle of reduced physical activity and deconditioning that has a direct effect on health and survival.
The predictive value of gait speed is a fascinating result. In many ways our walking pace is a reflection of the sum total of prior life activity. Gait speed also mirrors our comfort with postural balance while moving. With increased activity, and strong, balanced posture, we become acclimated to a faster walking speed, which, over time, we incorporate naturally.
Barriers to Walking
I highly recommend a read of Antonia Malchik’s in AEON, titled The End of Walking: Step by step Americans are sacrificing the right to walk. In the piece, she covers the changes that we have allowed to happen, over time, which have created an unfriendly environment for pedestrians.
Both urban and rural infrastructures pose barriers to walking.
Our car centric culture has contributed greatly to the degradation of the pedestrian environment. City streets, rural roads, and our nations highways, have all been designed to favor the efficiency of automobile travel, with little regard to the pedestrian. We are left with an environment where most people need a car, or public transportation, to access their daily needs. Only the most privileged are able to live in truly ‘walkable’ communities, and can readily access safe and attractive venues to enjoy walking. Many ‘make do’ with the inadequate and unsafe infrastructure in place, in order to continue to walk. However, pedestrian deaths are rising.
Cities and towns are adopting a major strategy to remedy the degradation of pedestrian spaces by instituting the model of ‘complete streets’. In this concept each mode of transport is separated from the other, according to function and speed. Details differ, depending on the particular locale, but in general, the most vulnerable travelers, pedestrians, occupy the most protected environment, the sidewalk. Cycling lanes are nestled between the sidewalk and a line of parked cars. Dedicated automobile lanes are narrowed to allow space for these additions. This narrowing has the further effect of slowing the lane speed, and pedestrian deaths.
Controlling speed in each of the dedicated lanes is a safety measure. Note the shocking statistics of pedestrian deaths at increasing automobile speeds: 20, 30 and 40 miles per hour.
Unfortunately, walking is an unaffordable luxury to many adults. Walkable communities are defined as those that afford safe physical access to most daily necessities within a ‘walkable’ distance, one mile or so, from home. Such areas in cities, and towns, are usually the most expensive to live in, as they are in high demand, and in short supply. Rural areas have their own challenges to ‘walkability’, in that large travel distances limit access by foot.
Additionally, there are personal factors, other than the challenging infrastructure, which preclude daily walking for many people. A large number of adults in the U.S. have limited time and energy to devote to walking. This could be due to multiple jobs, single parenthood, family obligations, and long commutes. For some, poor health and fitness limits their ability to make walking a daily, pleasurable experience. There are also people who might have balance issues, slower gait, or pain with movement, who may find outdoor walking environments difficult and comfortable. The ‘mall-walking’ movement has filled an important need for such persons.
Sadly, children are even more affected by our current built environments. Unsafe neighborhoods, with poor infrastructure, hamper their walks to school and their ability to play, and freely explore their communities. Roads without shoulders, fast city traffic, and in general, our automobile centric culture, create countless hazards. The following video highlights the dangers for children, around the world, as they try to negotiate an unsafe physical environment that is not tailored to them.
Strategies to Create Walkable Environments
Towns and cities, who wish to create more effective, pleasing, walking environments, conduct ‘walking audits”. A walking audit is an assessment of the walkability or pedestrian access of the physical environment. The assessment will commonly use the The Pedestrian Environment Review System (PERS) audit tool. The aim of the tool is to be inclusive and objective, and has, as its purpose, to evaluate the physical environment from the end user perspective of a vulnerable pedestrian.
This last point is worth mentioning. Vulnerable pedestrian and mobility assisted travelers encompass a wide range of individuals including, pregnant mothers (due to poor balance), toddlers, the older person using a walker or cane, the wheelchair user, and individuals whose walking or traveling pace may be slowed, or gait unsteady. The walking audit evaluates sidewalk presence and conditions, crosswalks, signaling and signage, and safety. If performed at night, an audit will evaluate features such as lighting and safety.
Rural communities are also embracing creative strategies to bring daily walking into their residents’ lives. In an article about the Northeast Iowa public schools, the following initiatives are mentioned: walking school buses and bicycle trains chaperoned by parents, bike rodeos to teach bicycle safety and road skills, and the practice of remote drop-offs. A remote drop-off is like a park-and-ride: parents meet in a parking lot and walk their children the remainder of the way to school.
Inclusive walking has even penetrated areas more remote from our living quarters. Local and government parks, and private initiatives are creating paths that are accessible to the universal user, those individuals who need mobile assistance. Technology has stepped up to answer some of the specialized needs associated with the ‘off –road’ accessible experience with more robust walkers and wheelchairs. Modern lower leg prosthetics can be made specifically suitable for rougher terrain. Convertible devices are being created to allow rest when needed. Examples of accessibility in nature are below: clockwise from left: all-terrain wheeled walker, agile wheel chair, universal path, amputee runner with prosthetic.
The ‘Rails to Trails’ conversion initiative provides universal access to some of the most beautiful areas of the United States. The ‘Rails to Trails’ conservancy is a private initiative which partners with local communities to convert unused rail lines to ‘walkable’ spaces. These paths which are accessible to bikers, personal wheeled devices and pedestrians. Below is a serene video of a conversion in the town of Jim Thorpe PA.
An innovative Ohio cardiologist, a walker by nature, was dismayed by the difficulties people had incorporating exercise in their lives. As a response he decided to provide mentorship and companionship by starting “Walk with A Doc”. Every Saturday he meets with his patients (and others) to take a 60 minute walk. These walks became so popular that he formalized the movement. Today, there are over 155 “Walk with A Doc” locations.
Walking can even provide entertainment! The ancient art of Chinese stilt walking is still kept alive today. Below is an image of a group of working farmers, many of them older, taken before an event.
In conclusion, we walk because we are created to. We walk because it is good for us. We walk because it delights us! Now, with gorgeous urban ‘street art’, we have additional visual pleasures!
Please join the #hcldr weekly tweetchat on Tuesday March 1st 2016 at 8:30pm ET (for your local time click here) where we will be discussing:
T1 What are the personal and environmental barriers to daily walking in your life, your community?
T2 Is walkability a right regardless of geographic location, socio-economic status, or age?
T3 How can we bring back a safe ‘Walk to School’ day for our children?
T4 Are you ‘transported’ spiritually, mentally, or emotionally, when you take your daily walk or run?
References
Introduction
Rubinstein, Dan, and Kevin Patterson. Born to Walk: The Transformative Power of a Pedestrian Act. N.p.: n.p., n.d. Print.
Born To Walk – Video https://www.youtube.com/watch?v=4MKJ_yVLIAg
A Need To Walk https://medium.com/message/a-need-to-walk-ba8c06927e88#.nshmuv4r3
Why these nine famous thinkers walked so much http://www.marksdailyapple.com/why-these-nine-famous-thinkers-walked-so-much/#axzz3zwkat9fv
Health
Step It Up: The Surgeon General’s Call to Promote Walking and Walkable Communities http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/exec-summary.html
Surgeon General Says Step It Up – Video https://www.youtube.com/watch?v=z9LJYmc2EAY
Running Shoes: How Do You Choose The Right One? http://www.howardluksmd.com/orthopedic-social-media/running-shoes-how-do-you-choose-the-right-one/
Physical activity does not influence obesity risk: time to clarify the public message (International Journal of Epidemiology ) https://ije.oxfordjournals.org/content/42/6/1831.full
You Can’t Outrun Obesity: Study Says Exercise Doesn’t Help Weight Loss http://mashable.com/2015/04/23/obesity-exercise-uk-study/#v6T92TPVVkqh
Walking: Your Steps To Health http://www.health.harvard.edu/newsletter_article/Walking-Your-steps-to-health
The Health Hazards of Sitting https://www.washingtonpost.com/apps/g/page/national/the-health-hazards-of-sitting/750/
Gait Speed and Survival in Older Adults http://jama.jamanetwork.com/article.aspx?articleid=644554
What Is The Single Best Exercise http://www.nytimes.com/2011/04/17/magazine/mag-17exercise-t.html?_r=0
Walking Exercises to Improve Balance and Agility https://www.youtube.com/watch?v=y2_526dTTPw
Social Justice Issues
Step by Step, Americans are sacrificing the right to walk https://aeon.co/essays/step-by-step-americans-are-sacrificing-the-right-to-walk
Live in A Walkable Neighborhood? You Get to be Thinner and Healthier http://www.fastcoexist.com/3054231/live-in-a-walkable-neighborhood-you-get-to-be-thinner-and-more-healthy
A Good Place For Everyone To Walk http://americawalks.org/wp-content/uploads/2015/10/low-income-walk-story.EBWC_.walljasper.pdf
Benefits of Walking Are So Huge, Let’s Make Sure Everyone Can Do It http://www.commondreams.org/views/2015/12/08/benefits-walking-are-so-huge-lets-make-sure-everyone-can-do-it
Social Justice Issues Related to Walking and Bicycling http://www.pedbikeinfo.org/data/factsheet_social.cfm
The Built Environment
What is walkability? http://communitybuilders.org/walkability/
The Pedestrian Environment Review System https://en.wikipedia.org/wiki/Walking_audit#Pedestrian_Environment_Review_System
Dangerous By Design http://www.smartgrowthamerica.org/documents/dangerous-by-design-2014/dangerous-by-design-2014.pdf
TEDMED -2013 How an obese town lost a million pounds http://www.ted.com/talks/mick_cornett_how_an_obese_town_lost_a_million_pounds
The Death and The Life of Great American Cities https://en.wikipedia.org/wiki/The_Death_and_Life_of_Great_American_Cities
Jane’s Walks http://janeswalk.org/
Sidewalk Biking http://www.bike.cornell.edu/pdfs/Sidewalk_biking_FAQ.pdf
Creative Strategies
CNN Hero Dr. David Sabgir: Walk with a Doc https://www.youtube.com/watch?v=dRK6Mw6eGvw
Getting Rural Kids Walking and Biking: A Case Study from Northeast Iowa http://usa.streetsblog.org/2014/07/22/getting-rural-kids-walking-and-biking-a-case-study-from-northeast-iowa/
The Rails To Trails Conservancy http://www.railstotrails.org/
Long Distance Trails in the United States https://en.wikipedia.org/wiki/Long-distance_trails_in_the_United_States
World’s Best Hikes: 20 Dream Trails http://adventure.nationalgeographic.com/adventure/trips/best-trails/worlds-best-hikes-dream-trails/#/tour-du-mount-blanc-best-hikes_68721_600x450.jpg
Walks with Wheelchairs (UK) http://walkswithwheelchairs.com/
Practice Makes Perfect The Art of Stilt Walking http://www.theworldofchinese.com/2013/05/practice-makes-perfect-the-art-of-stilt-walking/
Resources
Complete Streets Fundamentals http://www.smartgrowthamerica.org/complete-streets/complete-streets-fundamentals/complete-streets-faq
Active Living Research – Promoting Activity Friendly Communities http://activelivingresearch.org/ActiveTravelreview?sf19874632=1
Moving Towards Active Transportation: How Policies Can Encourage Walking and Bicycling http://activelivingresearch.org/sites/default/files/ALR_Review_ActiveTransport_January2016.pdf
The Walk with A Doc Initiative http://walkwithadoc.org/who-we-are/