Tag Archive for: walking

Adaptation: Exercise

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I can’t think of a better example of positive adaptation than exercise. Whether it’s a sport skill, increasing strength, or improving cardiovascular fitness, exercise uses the adaptation principles; the difference is that it’s an intentional act instead of a response to a physical challenge. As an example, let’s use walking or running to improve the fitness of your heart and cardiovascular system as well as every other system involved—which is just about every other system we have.

Let’s begin with how your cardiovascular system would respond to beginning a walking or jogging program. The first walk with a purpose—faster than window shopping and not so fast that you’re stopping to catch your breath every minute—every system in your body is going, “What the heck is going on here?” Your heart may not be used to speeding up like that. The blood isn’t used to traveling that fast. The 5,000 genes that are typically activated when you start to exercise are awake and alert. Your muscles, ligaments, tendons, and stress hormones are challenged, along with the nervous system that controls how the muscles respond to new movement. It’s a mess, but you manage to get through it.

Depending on how hard you pushed yourself, you may feel it. Maybe fatigue a few hours later or sore muscles. That’s why you begin slowly. Save the fastest you’ve ever walked or ran for another time, and get through this first walk.

But by the third walk, your body will start to adapt; your heart rate might not get as high. By the 10th walk, you most likely will be able to maintain a faster pace, but your heart rate may not be as high as the first walk you took at a slower pace. You’re adapting—in fact every system in your body is adapting to the new stress. It will take less effort to do the same work.

You’re not ready for a marathon or maybe even a 5K yet, but exercise is a positive utilization of the adapting ability of your body. You just have to approach it in a systematic way to improve your cardiovascular health.

If you’re the kind of person who needs to see progress to keep going, track your distance, time, heart rate, and so on, but don’t let a few down days discourage you. Sometimes your body needs a bit of time to catch up; stay the course and you’ll soon see improvement again. On the other hand, if you’re the kind of person who hates record-keeping, you’ll still notice improvement—maybe you’ll walk your usual 30 minutes and feel like going another five, or you’ll realize you’re not breathing as hard as you were a month ago. Do what works for you.

I intentionally sent this Memo one day sooner because this is Memorial Day weekend in the U.S. While we celebrate and cherish those who’ve fallen in defense of our country with quiet moments, parades, and fireworks, use the three days to start your fitness program by going for a walk every morning, as long as your physician has no objections to your exercising. By the time you read Tuesday’s memo, you could be on that path to adaptation and a better healthspan than you are right now.

What are you prepared to do today?

        Dr. Chet

Walking for Fitness

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The message from Tuesday’s Memo was that walking over 4,000 steps per day can bring health benefits from several diseases and conditions, and the benefits increase the more steps you take—up to about 12,000 steps, the highest that were recorded in the studies. What I didn’t say was that those were not all workout steps. Some people certainly included their exercise steps within those steps taken when they wore tracking devices, but most totals just reflected a person’s normal activity.

What if you could boost the benefits you get? We know that fitness levels decrease the risk of cardiovascular disease at every age. What if you turned up the intensity of the steps you already take? Research shows fitter people live longer in every age group—even those in their 80s and 90s—so it makes sense to challenge yourself and increase your fitness level.

Three Ways to Boost Fitness While Walking

1. Walk faster. You can be precise and count seconds or steps, or you can pick spots where you have the room and just walk faster. How fast? It depends on your fitness level and orthopedic issues, but a goal could be 5% of your steps in a day. If you averaged 4,000 steps per day, that would be 200 steps broken into 10 segments of 20 steps. You could increase that over time to 10% of your daily steps.

2. Walk up hills. Use the same idea as with walking faster. In my neighborhood, I’m usually going up a hill or down one. I do about 150 steps up a hill as fast as I can and then saunter back to the bottom of the hill. Again, use the same concept as you would with walking faster: time or percentage of total steps.

3. Use the stairs. Every step is a step, but a step bearing your weight is even better. Every floor will have between 10-15 steps between floors. You can even do this in your home. Same logic regarding time or percentage of total steps.

Should You Take a Companion?

Years ago, Paula’s cousin decided to improve his fitness, so he’d go out for a walk every evening. He’s not a scary guy but he lives in a nice neighborhood, and several times he was questioned by police patrolling the area. So he got a dog to take with him on his evening walks—and he was never questioned again.

The Bottom Line

Walking is a great form of exercise, and we’ve seen the benefits from the research on mortality and morbidity, but examining the walking speed in those studies shows that most steps taken by most people were between two and three mph. That’s pretty slow. We also know that being fitter increases benefits regardless of age. If you get your doctor’s permission to exercise more strenuously, adding some type of higher intensity challenges one or two times a week can increase your fitness level without spending any more time than you currently are.

What are you prepared to do today?

        Dr. Chet

References:
1. Lancet Public Health 2025; 10: e668–81
2. JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.0899.
3. JACC. 2022. Fitness and Mortality. https://doi.org/10.1016/j.jacc.2022.05.031

Research Update on Walking

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Questioning prevailing thought and dogma are always a good idea in my opinion. Last week’s look at eggs put the issue of dietary cholesterol and LDL-cholesterol in perspective.

This week we’re going to look at the concept of 10,000 steps per day as the number required to get health benefits. This first came up in 2019 when a research group looked for a relationship between walking and all-cause mortality in an elderly group of subjects. There was, and they found that about 7,500 steps per day were needed to see a benefit. (The 10,000 steps as initially promoted was actually a marketing ploy, as I wrote about back then.)

This time, researchers wanted to expand the examining all-cause mortality to include the following:

  • Cardiovascular disease incidence
  • Cardiovascular disease mortality
  • Cancer incidence
  • Cancer mortality
  • Type 2 diabetes symptoms
  • Dementia
  • Depressive symptoms
  • Falls

They used meta-analyses to combine the results from over 60 studies and presented the results in hazard ratios. Every cause of mortality and morbidity decreased once they reached 4,000 steps per day. The benefits continued with additional steps; they slowed down at over 7,000 steps per day but continued to improve.

There were interesting differences between morbidity and mortality. While walking lowered the hazard ratio of cardiovascular disease mortality by 47% or more, it only reduced the hazard ratio of getting cardiovascular disease by 25%. Taken to an extreme, you might still have a heart attack, but you won’t die from it. There were similar results for cancer; the incidence was reduced by only 5%, but mortality was reduced by 34%.

Even though they weren’t randomized controlled trials, I think that’s phenomenal. But could you juice the results even more? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Lancet Public Health 2025; 10: e668–81
2. JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.0899.

Walking and Lower Back Pain

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At some point, most of us experience lower back pain. Many people use walking as their mode of exercise—could walking contribute to the development of lower back pain? A recent study examined the rate of lower back pain and walking.

Researchers tracked over 11,000 participants in the Norwegian HUNT study. To qualify, the subjects could not have had any back pain prior to being included in the study. The initial testing period included wearing an accelerometer during each test period as well as a questionnaire related to lower back pain. The tests were repeated and the subjects were tracked for just over four years, and 1,659 subjects developed lower back pain.

The subjects were grouped into quartiles by number of minutes walked per day for the analysis, and there was an inverse relationship between the risk of lower back pain and both walking intensity and minutes walked. Simply stated, the more a person walked, the lower the rate of lower back pain. The more energy expended by walking faster, the risk of back pain was lower.

The lesson for people 20 and older? If you don’t have any orthopedic obstacles, the more time spent walking as well as the higher the speed of the walking, the lower your risk of developing lower back pain. Just like the vegetable and fruit challenge, which I hope got more people to eat more plant products, walking 30–45 minutes per day most days a week can get you fitter as well as reduce the risk of back pain. The path to better health may just be a simple walk a day, and the great thing is that it’s a multigenerational activity. Walking as a family sets an example for the kids that exercise is something everybody does, and you’ll be setting them up for a healthier life.

If you’re new to walking, remember the talk test. If you have to take deeper breaths but can still carry on a conversation, that’s just about right. If you’re sucking wind so much that you’re gasping for air, that’s too much exertion for beginners. However, if you can sing, that’s not hard enough.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Network Open. 2025;8(6):e2515592. doi:10.1001/jamanetworkopen.2025.15592

Back Pain: A Potential Solution

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Back pain is a leading cause of work-loss days according to the Georgetown University Heath Policy Institute; that’s true in just about every high-income country. Finding a solution to reduce back pain occurrence not only reduces lost wages but also improves the quality of life of the individual.

Researchers in Australia wanted to find out whether a walking and educational program would reduce the recurrence of lower back pain resulting in medical treatment. They selected only patients who had lower back pain of undetermined origin; 701 patients were randomly assigned to the control group and experimental group. Both groups received the educational program. The experimental groups also received coaching on a walking program that they were to perform on their own. The goal was to walk 30 minutes per day, five days per week, but the program was adjusted to accommodate individual needs depending on initial fitness levels.

The results were interesting but not unexpected, in my opinion: those subjects in the walking group were 28% less likely to have a reoccurrence. Even better, the time to the next lower back pain event was about twice as long in the walking group, a median of 208 days versus 112 days in the control group. The researchers also found that the quality-of-life index they used was better in the walkers and that the walking program was cost effective compared to conventional treatment.

Lower back pain is something most of us experience at some point in time; wouldn’t it be great to go more than 200 days until your next episode? While some can be issues with nerves and vertebrae, at least some have no real cause other than weakness and tightness in muscles. With some basic core exercises and walking most days of the week, the solution just might be found on the sidewalk or pavement right outside your front door. Just make sure you get professional guidance before you start.

What are you prepared to do today?

        Dr. Chet

References:
1. https://hpi.georgetown.edu/backpain/
2. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(24)00755-4.pdf

Blue Zones: Keep Moving

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Continuing our look at the lessons from Secrets of the Blue Zones, the next point that stood out to me was that everyone was physically active. I mentioned tai chi, but that’s organized activity. The Blue Zone secret is that the people were physically active throughout their day.

In some zones, they tended to gardens for part of the day. Or they got together in groups to prepare food. They didn’t stop at the grocery to pick up a rotisserie chicken and a bag of salad—they butchered the chicken, plucked the feathers, put it on the spit, turned the spit, and so on. Bread was made from scratch and pasta as well.

One scene struck me: the people who lived in Sardinia were always walking either uphill or downhill to visit friends, to go to the market, to church, or to get an espresso. In general, people who lived to 100 never really stopped physical activity.

In more modern areas such as Loma Linda and Singapore, there were parks and walking paths close by. However, whenever they could, they walked to get where they were going.

Did they also do more conventional workouts, alone or in groups? Absolutely, but the real key is that they moved throughout their day. Conventional exercise is important for a lot of reasons; for example, Paula sent me a quote yesterday that sedentary middle-aged Japanese women found that 16 weeks of regular exercise improved the elasticity and structure of their skin.

If you’re serious about living well regardless of age, find a way to move more every day.

What are you prepared to do today?

        Dr. Chet

Walking for Exercise Again

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How did you do with the Summer Kickoff Challenge? Let’s start with exercise. Did you get at least a 15-minute walk or some other activity done—especially if you’ve been sedentary? As I said last week, this was my first attempt at walking with a purpose since my knee replacement surgery. Of course I’ve been walking around the house and doing spring yardwork, but walking to exercise is different: heel through toe, step after step, keeping some form of pace.

I have a half-mile loop across the street from my house. The first day, I finished two laps in 19:12. I didn’t really notice anything unusual in terms of pain or discomfort the rest of the day. I walked the reverse route the next morning; I was a little stiff but finished in 18:34. The rest of the day was miserable—every muscle in my lower body was stiff and sore. All of that and I was never even breathing hard during the walk! I took the next day off to stretch and let the muscles recover.

How did you do? Let me know, especially if you changed your mode of exercise. Why would walking have such a dramatic effect when we’ve been exercising with other modes for so long? That was the topic of the very first Super Bowl webinar I ever did, and I’ll tell you that on Saturday.

What are you prepared to do today?

        Dr. Chet

High-Intensity Walking Is Better for Peripheral Artery Disease

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As I said in Tuesday’s memo, high-intensity walking was better than low-intensity walking in terms of physical measurements after one year; subjects were able to cover more distance in a six-minute walk and they were able to walk for a longer period of time on a treadmill. Another important outcome was that there was no damage to muscle fibers in response to the high-intensity walking as was found in other studies.

There are a couple of other factors I think were significant about this study. Let’s take a look.

High-Intensity Walking Saved Time

High-intensity walkers performed better on the physical tests in spite of the fact that they actually exercised half the time as the low-intensity walkers. I think that that’s a solid positive for people who really dislike exercise because they will save time: more benefit in a shorter period of time.

Even though there was a similar improvement in subjective quality of life assessments, what we don’t know is whether each individual session was more painful for the higher-intensity walkers.

Subjects Were Coached the Entire Year

The primary difference between high-intensity and low-intensity walkers was pain. Both the high-intensity and low-intensity walkers had assigned coaches who could track progress through the subjects’ accelerometer readings. Having done a similar type of study myself, it’s important that people can get answers to their questions, especially related to the significance of pain versus discomfort, and therefore push on. I believe subjects also feel obligated to a person, their coach, more strongly than to the study itself.

While it would be very difficult as a public health initiative, I think the approach would work for any type of physical-limiting condition whether it was cardiac rehabilitation, type 2 diabetes, or as in this case, PAD.

The Bottom Line

This analysis of high-intensity versus low-intensity walking for PAD might seem to be narrow in focus; after all, most of you probably don’t have PAD. But the greater question to me is determining what will be more effective to help recovery or even prevent disease from occurring. If high-intensity exercise can be beneficial for people with severe PAD, then there’s no question that it can be beneficial for just about everyone. And the key is coaching: having someone available to encourage you when you need it and to answer questions when they become important to you.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. 2021;325(13):1266-1276. doi:10.1001/jama.2021.2536.

Exercise for Peripheral Artery Disease

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Peripheral arterial disease (PAD) is a narrowing of the arteries in the arms or legs, usually caused by the build-up of plaque similar to what can happen in the arteries of the heart or the neck. The result is pain in the muscles of the legs, sometimes mild, other times severe. As you might expect, the harder you exercise, the more potential for pain. Termed “intermittent claudication,” it can reduce mobility, or rather, the desire to be mobile.

Higher-intensity exercise such as fast walking is typically avoided due to the resulting pain. The prevailing recommendation is slow walking. But as several studies have determined, people won’t do it because it hurts. So why recommend it?

Researchers from several universities across the U.S. recruited over 300 subjects with a mean age of 69 to participate in a yearlong study on the effects of low-intensity versus high-intensity walking. This was a massive undertaking due to the extensive training and coaching for all subjects. I won’t keep you hanging until Saturday: the high-intensity walkers did better on physical tests than the low-intensity walkers or the control group. But there was one other critical point, and I’ll talk about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA. 2021;325(13):1266-1276. doi:10.1001/jama.2021.2536.

Exercise Your Heart, Part 2

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Did you ever have to hurry to catch a connecting flight? Walk fast or maybe even jog? Were you able to do it?

How about carrying a child who weighs 45 pounds for a quarter mile because she’s hurt her foot? Could you do it?

That’s where your heart reserve comes in: facing challenges that put your heart to the test. Everyday training helps, but getting fitter is also important for those occasions when you need more. If your physician says you can do it, interval training is the solution to building a reserve.

Intervals have been around for decades, and they became a fad with something called High Intensity Interval Training (HIIT). They’re the same thing except that HIIT is supposed to replace all other aerobic exercise to save time. I’m sorry, but it’s just not enough. Doing well on a fitness test isn’t the same as living.

The idea is to exercise as fast as you’re able for 30 to 60 seconds, then rest for one or two minutes, sometimes even more. Repeat the cycle eight to twelve times and you’re done. For some people, walking faster for 30 seconds is enough; for others turning up the intensity on a bike to the highest level for 60 seconds would be the intensity. It doesn’t matter your level when you begin; it will help you build a reserve for challenges. That’s something we all need. Again, you have to check with your physician before exercising to build a baseline or a reserve. It’s one of the keys to living every day.

Think we’re done with exercise? Nope. We’ll turn to those other muscles next week.

What are you prepared to do today?

        Dr. Chet