"If you are in a bad mood, go for a walk. If you are still in a bad mood, go for another walk". These words are attributed to Hippocrates, the father of medicine and originator of the oath that all doctors recite on graduation. A good walk on a fine day certainly can feel like medicine for the soul, but can it do more than that? During this National Walking Month, Consultant Cardiologist, Dr Simon Pearse, talks to you about the benefits of walking and the different ways that you can incorporate walking into a busy lifestyle.

From the early domestication of horses, the invention of the wheel, and certainly since the advent of cars, walking has become progressively less obligatory as a means to get around. Walking anything more than a short distance is relatively easy to avoid for most, particularly in a city like London.

Walking has gone from being an essential chore for survival to, almost, a lifestyle choice or leisure activity. The virtues of a good walk are taught to successive generations and, with the addition of smartphones and pedometers, the holy grail of '10,000 steps per day' has become a ritual for many. Doctors often advise patients to do more exercise as part of the treatment of a condition, and to prevent conditions such as diabetes, obesity and heart disease developing, but what is the evidence for this? What type of exercise is best and how much?

Is there a problem with being sedentary?

There is now strong evidence that a sedentary lifestyle is associated with an increased risk of many health problems. Interestingly, the medical profession has not always held this view. For much of the 19th and early 20th centuries, bed-rest was considered the best way to combat almost any illness.  Indeed, research was done to determine if the "folly of undue exertion" was associated with reduced life-expectancy. This mostly compared Oxbridge sportsmen with their "intellectual" peers and (thankfully) failed to show that exercise reduced life-expectancy. 

More recently, research has highlighted the risks of inactivity in greater detail and across a broader population. Your risk of coronary heart disease (angina or myocardial infarction/heart attack) is up to a third greater if you lead an inactive lifestyle compared with a more active one. The evidence is similarly compelling for heart failure, type 2 diabetes and several common cancers. The health benefits of eliminating inactivity in a population are as great as eliminating obesity and almost as great as stopping smoking.  In the UK, we are amongst the most inactive in Europe and it is estimated that the average person in the UK would live around 1 year longer if they eliminated excess inactivity. 

Does walking help lower my risk of disease?

Yes. Walking is in many ways the perfect exercise - it is accessible to most, can be incorporated into daily routines, carries a low risk of injury, requires no specialist equipment other than a good pair of shoes and, when done briskly, is of a moderate but sustainable exercise intensity. Studies comparing those who walk for at least 30 minutes a day for 5 days a week have shown that, compared to sedentary peers, walkers have a 20% lower risk of coronary heart disease. Another study found that active women were almost half as likely to develop coronary disease compared to the inactive. Walking also reduces your blood pressure, helps with weight loss, reduced body fat and improves fitness. There is also evidence that it helps with depression and anxiety. 

Walking at an average speed burns off 250-300 calories per hour for someone of average size, but this increases significantly on slopes or stairs. The intensity of exercise involved in walking is in the ‘fat burn’ zone familiar to gym-goers and so walking more can be a valuable aid to losing weight, particularly as, perhaps unlike going to the gym, it is relatively simple to do on a daily basis.

Do you really need 10,000 steps per day?

This is a challenging question to answer, as it will vary depending on your fitness level, age and health conditions, as well as the other exercise you do. Generally, the evidence suggests that the 'more-the-merrier', up to a point. Interestingly, very high levels of exercise may carry a higher risk of health problems, but this only applies to the most extreme athletes and the data are far from conclusive. 

Based on the evidence, the World Health Organisation (WHO 2020) recommend the following for adults:

• All adults should undertake regular physical activity
• Aim for 150-300 minutes (2.5-5 hours) of moderate-intensity exercise (such as walking) per week. 
• In addition, you can do muscle-strengthening exercises at least twice a week.

Interestingly, the target of 10,000 steps per day is entirely arbitrary – it is said to have been invented by a Japanese pedometer company as a marketing tool following the 1964 Tokyo Olympics.

In fact, to achieve the WHO goals, you need to get to around 6-7,000 steps per day, but this does vary depending on the length of the stride and how quickly you walk. To put this in context, however, the average person in the UK manages around 4000 steps per day currently.

How can you go about walking more?

Everyone will have different ways in which they can increase their step count. It will very much depend on your lifestyle, time, age, health, work, location and many other things. The key is to find a way that works for you. If you are busy with commitments such as work or childcare, then fitting walking in to your routine so that it doesn’t take extra time will be important. If you have more time, then ensuring it is enjoyable so that you are consistently motivated is vital.

We know that a sedentary lifestyle increases the risk of several serious conditions including heart disease, diabetes and cancer, and moderate-intensity exercise such as walking can reduce your risk of these conditions.

 A few tips to help you get walking

Here are a few things that you can do to incorporate more walking into your day to day life:

• Aim to do 2.5 to 5 hours of brisk walking per week
• Get off of the bus a few stops early, or park further away from your destination
• Take the stairs rather than the lift
• Organize regular walks with friends or family
• Find a way to walk that fits with your lifestyle.
• Try to address health issues that prevent you from walking as you would like
• Any exercise is better than no exercise!

If you are concerned about symptoms or need further information on Cardiovascular Health, you can speak to one of our Cardiac Physiologists, call us on 020 8949 9020 or fill on our online form.