Stepping Towards Better Health: Walking as a Panacea to Chronic Illness Management
By: Dr. Luke Leggo | Doctor of Chiropractic | IG @lukelegs
In a world constantly buzzing with the latest fitness trends, diet fads and “quick fixes,” it can be overwhelming to try and tease out fact from fiction regarding feasible solutions to improving our overall health and well-being. But there may just be a simple, profoundly impactful activity that could be the ticket to unlocking better health and reducing the impact of chronic disease: Walking.
It’s no secret that chronic disease prevalence has been on a steady rise over the years and there are countless epidemiological studies that support this notion. The National Centre for Disease Control and Prevention (CDC) estimated that 6 in 10 Americans live with at least one chronic disease such as cardiovascular disease, stroke, cancer, diabetes, and as of late, mood disorders (major depression most commonly) have been added to this list (CDC, 2023; Geyman 2007). It is estimated that these diseases account for almost 75% of total health care expenditures annually (CDC, 2023; Geyman 2007). The shear growth and economic burden of chronic disease has garnered a lot of attention from the medical community and we are constantly searching for a low cost, high impact solution to help combat, prevent and manage disease. This is where physical activity comes in. It is well documented that increasing engagement in physical activity and limiting sedentary time has significant benefits on our health. This sentiment has been around for a long time and seems straightforward, however we continue to find that a large proportion of the population does not meet the “minimum” physical activity guidelines to maintain optimal health (Murtagh et al., 2010; Rollo et al. 2022). So why is it that we have this information on how to improve our health, but many of us are not taking advantage of it? Barriers.
Have you gone to a healthcare practitioner and been told that you should “exercise” to improve your health? For most, this can be great advice rooted with good intention. However, for many, we leave thinking…”where do we start? What exercise(s) should I do? How will I fit exercise into my schedule — I’m busy enough as is? I don’t have access to a gym and don’t really want to go to a busy gym, nor do I have the finances to support this! I barely have energy at the end of my day to get off the couch, how am I expected to go lift weights?”- You are not alone if you have these thoughts or feelings. These thoughts are extremely common and represent significant barriers to engaging in physical activity. So how do we as healthcare practitioners attempt to remove these barriers and promote exercise that is simple, safe, affordable, accessible and most importantly effective? Brace yourselves folks, walking has entered the chat!
Walking is an activity that is exceptionally well suited to encourage people to move and engage in activity as it requires virtually no equipment, can be performed nearly anywhere and is deemed to be a “low skill” exercise making it accessible and achievable for most groups with very little risk of injury. When you delve into the literature on the effects of walking, the magnitude of the impact on reducing all-cause mortality is eye-opening. There are countless studies that all draw the same conclusion and reliably highlight that walking on a regular basis can significantly diminish the risk of developing a wide array of chronic illnesses (Banach et al.
2023, Murtagh et al. 2010., Noetel et al., 2024, Rollo et al. 2022, Stens et al. 2023). Walking not only reduces your risk of disease, but has additive benefits of improving your cardiovascular function, improving muscle and bone health, improving quality of sleep and has also been linked to improved mood (Banach et al. 2023, Murtagh et al. 2010., Noetel et al., 2024, Rollo et al. 2022, Stens et al. 2023). A recent study out of the British Medical Journal in January 2024 looked at the effect of exercise on treating depression and found that various exercise modalities including walking/jogging, yoga and strength training were comparable to interventions such as psychotherapy and pharmacotherapy (Noetel et al, 2024). This is important as access to pharmacotherapy/psychotherapy is usually reserved for those with a surplus of financial resources and therefore creates a significant barrier to addressing an emerging cause of disability worldwide in major depression (Noetel et al, 2024). This is just another example of how walking can address barriers and have a significant impact on people’s lives. I could go on and on, and cite studies until the cows come home on the multifaceted benefits of walking, but the question that looms is how much walking and how much of a time investment do we need in order to see these benefits?
A recent study put out in October 2023 investigated the relationship of step counts and the influence on reducing the risk of all-cause mortality (essentially death from any cause) and cardiovascular events (Stens et al., 2023). They found that as few as 2517 steps/day led to an 8% reduction in all-cause mortality and optimal health benefits were achieved at approximately 8800 steps/day with a 60% all-cause mortality risk reduction (Stens et al., 2023). Another study put out in August 2023, suggested that the minimum threshold for all-cause risk reduction was 3867 steps/day, and with a 1000 step/day increase you get a 15% reduction risk on all-cause mortality, with 500 steps/day increase you get 7% risk reduction of cardiovascular events (Banach et al., 2023). These studies both highlighted that the more you walk, or the higher the step count, the greater health benefit that you achieve (Banach et al., 2023, Stens et al., 2023). It is estimated that 1000 steps can equate to approximately 10 minutes of walking depending on your cadence (Stens et al., 2023). Therefore, if you aim to walk approximately 20–25 minutes/daily you can achieve a minimum of 8% reduction in all-cause mortality. This is significant and for most could be a game-changer in their journey to better health. Now if 20–25 minutes seems like a lofty goal for you. No worries. Think about chunking that into 5-minute increments throughout the day to make it more palatable. Assess where you can intervene in your own life, think about your current activity level and make small incremental changes for longevity. As Mark Twain said “The secret of getting ahead is getting started.”
As a clinician, I try to empower all of the people that I am fortunate enough to work with to try and move, whatever that may look like for them. Often times, walking is the highlight of our discussion, because if I haven’t convinced you yet — It’s good for you! Here are some general strategies to help implement walking into your daily routine.
1. As I already alluded to, start small. A 5–10-minute walk can go a long way -and as we highlighted- can still have impact. As this becomes routine, gradually increase your time spent walking or try to increase the intervals (5–10 minutes, 2–3x/day). Implementmovement “microbreaks” or small scheduled 1–5-minute movement breaks while you’re at work — take advantage of this on your lunch break — instead of sitting at your desk scrolling social platforms — go for a cruise outside (if you enjoy your socials time — you can walk and scroll, but try to peek up from time to time to avoid injury). The cumulative effect of walking will continue to chip away at your risk of all-cause mortality and before you know it you will be well above the 8800 steps/day. The point is, it doesn’t have to be “formal” exercise, it can be informal — make it fun.
2. Make walking a social event. This piggy backs off the point of making it fun and enjoyable. If you have a friend, or group of friends, that typically get together for coffees/drinks/book clubs — every once in a while, suggest going for a walk and bring your refreshments with you — you will be surprised how far you go when you get lost in conversation about the latest Love is Blind episode or you need to vent about stressful situations. Alternatively, if you are “peopled out,” you can always tune in to a podcast/music playlist/meditation, what have you — use walking as an opportunity for some “you time” to clear your head — For me this rings true! It’s all about making walking something you enjoy, rather than a task you need to get done. Think, “I don’t have to walk; I get to walk”
3. Use technology to your advantage — most of us now carry devices that have built in pedometers (step counters). Turn this feature on and create a log of your progress. There are many free apps available for this and it can be really rewarding to see where you started and where you are currently at. Again, this comes back to goal setting — starting small, working your way up at your own pace! You can also implement setting alarms on your phone to remind yourself to get moving — see point #1 on microbreaks!
4. Enjoy the flexibility of walking — it doesn’t always have to be in nature or exploring paths — that may not be for everyone — make it unique to you — If you enjoy the mall — go shopping or window shopping if your tight on funds.
Ultimately, the next time you think of exercise or physical activity or you’re in an appointment and get told “you need to exercise more,” I want you to reflect on what that means to you. Maybe we don’t need to think that exercise is all about “getting ripped” and spending countless hours in the gym. Don’t get me wrong, I’m all for this if that’s your goal. But if that doesn’t resonate with you, maybe we want to shift our focus to informal physical activity and get out for a walk or just move — knowing that your journey to better health starts with a step.
If after reading this you still feel lost, have questions or would like further guidance on how you can take steps to improve your health, I’d love to chat with you. Thanks for reading everyone. Let’s get moving!
References
Banach M, Lewek J, Surma S, Penson PE, Sahebkar A, Martin SS, Bajraktari G, Henein MY, Reiner Ž, Bielecka-Dąbrowa A, Bytyçi I. The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. Eur J Prev Cardiol. 2023 Dec 21;30(18):1975–1985. doi: 10.1093/eurjpc/zwad229. Erratum in: Eur J Prev Cardiol. 2023 Aug 18;: PMID: 37555441.
Coronavirus disease 2019. (2023, August 30). Centers for Disease Control and Prevention.
https://www.cdc.gov/chronicdisease/index.htm
Geyman J. P. (2007). Disease management: panacea, another false hope, or something in between? Annals of family medicine, 5(3), 257–260. https://doi.org/10.1370/afm.649
Murtagh, E. M., Murphy, M. H., & Boone-Heinonen, J. (2010). Walking: the first steps in cardiovascular disease prevention. Current opinion in cardiology, 25(5), 490–496. https://doi.org/10.1097/HCO.0b013e32833ce972
Noetel M, Sanders T, Gallardo-Gamez D, Taylor P, del pozo cruz B, van den Hoek D et al. Effect of exercise for depression: systematic review and network meta-analysis of randomized controlled trials. BMJ. 2024 Jan 15; 384. Doi; 10.1136/bmj-2023–075847
Rollo S, Lang JJ, Roberts KC, Bang F, Carson V, Chaput JP, Colley RC, Janssen I, Tremblay MS. Health associations with meeting the Canadian 24-hour movement guidelines for adults: Results from the Canadian Health Measures Survey. Health Rep. 2022 Jan 19;33(1):16–26. doi: 10.25318/82- 003-x202200100002-eng. PMID: 35050558.
Stens NA, Bakker EA, Mañas A, Buffart LM, Ortega FB, Lee DC, Thompson PD, Thijssen DHJ, Eijsvogels TMH. Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events. J Am Coll Cardiol. 2023 Oct 10;82(15):1483–1494. doi: 10.1016/j.jacc.2023.07.029. Epub 2023 Sep 6. PMID: 37676198.
