Proposes a new national commitment to walking and formation of walking partnerships and clubs to fight the epidemic of overweight Americans

James Nyberg

Judith Estrine

Robert N. Butler

English

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Walk to a Healthy FutureIntroductionWalking is one of the most effective, enjoyable, and accessible forms of exercise known. Noncompetitive and antigravity, it promotes physical fitness and good health. Walking helps build endurance, enhance muscletone, increase joint flexibility, and strengthen bones. Regular walking contributes to weight loss, which in turn helps prevent or control heart disease, hypertension, diabetes, and other diseases.From earliest recorded history, people have lauded the positive effects of walking, and the pedometer, a device used to accurately measure every step an individual takes, has long been recognized as an effective tool fortracking progress and maintaining motivation. Leonardo da Vinci mayhave designed the prototype when he created a gear-driving device with apendulum arm to move back and forth with every swing of the leg. Threecenturies later, Thomas Jefferson purchased the latest version in Franceand brought it back to America. Pedometers appeared in the commercialmarket in Japan in 1965 under the name Manpo-meter (manpo inJapanese means 10,000 steps), and they have enjoyed great popularityever since.It has been well publicized that, since the mid-1980s, the averageAmerican has gained one to three pounds per year. According to recent survey data from the Centers for Disease Control and Prevention(CDC), almost two-thirds of adults and 15 percent of children wereoverweight or obese in 2000. Inasmuch as we are in the midst of alongevity revolution that will more than double the number of older persons in the next 50 years, we are looking at a significant number of at-risk older people.The importance of living more healthfully as we live longer is abundantly clear. Indeed, if we could make major headway in promoting regular exercise, more people would enjoy greater health and quality of life in their later years.INTERNATIONAL LONGEVITY CENTER–USA60 East 86th StreetNew York, NY 10028212 288 1468 Tel212 288 3132 Faxinfo@ilcusa.orgwww.ilcusa.orgAn Affiliate ofMount Sinai School of MedicineMay–June 2003Issue Brief2 Walk to a Healthy FutureWalk to a Healthy FutureRobert N. Butler, M.D.Judith EstrineJames Nyberg, M.P.A.The Problem of Overweight and Obese AmericansThe growing problem of overweight and obesepeople affects all segments of the U.S. population,young and old. The CDC estimates that more than120 million Americans, or about 64 percent of theadult population, are overweight. Almost 60 million—nearly one-third—are obese. This trend has beenincreasing over the last two decades; the percent ofoverweight children tripled between 1980 and 2000,with children as young as 10 years old developingType II or “old age” diabetes. Particularly troubling isthe likelihood that many of the habits these childrenhave established will carry over into their adult lives.The effects of overweight and obese Americans have a significant impact on the health of our nation. Being overweight, and especially obese,contributes to cardiovascular disease, diabetes,hypertension, sleep apnea, and arthritis, as well as disabilities that relate to bearing excessive weight. Approximately 300,000 annual deaths areattributed to obesity. The incidence of weight-relatedpreventable illnesses among the over-30 populationhas increased, elevating health care costs and reducingworkplace productivity. It has been estimated thatobesity accounts for nearly 10 percent of U.S. healthcare expenditures. In 2001, obesity cost Americans$123 billion, including direct health care costs fordiseases related to obesity and indirect costs such as loss of productivity. These costs are estimated torise to $160 billion by 2010.Lack of exercise is a prime reason for weight gain. Atleast 60 percent of American adults do not exercise atthe government-recommended level of 30 minuteseach day. In fact, 29 percent of American adults do not exercise at all. This despite the fact that physicalactivity is one of the 10 Leading Health Indicatorsidentified by the Department of Health and HumanServices’ Healthy People 2010 reports. It is clear that ournation needs to increase its level of physical activity.Walking to a Healthy FutureWalking is an easy and effective exercise that requiresno training or equipment, and substantial healthbenefits accrue with even 30 minutes of moderatewalking. The Mayo Clinic reports that walking for30 to 60 minutes each day can help people attain thefitness level associated with a longer, healthier life.In a study of Harvard graduates, Mayo Clinicresearchers discovered that men who burned 2,000or more calories a week by walking lived an averageof one to two years longer than those who burnedfewer than 500 calories a week by exercising.Overweight is defined in adults as a body massindex (BMI) between 25 and 29.9 kilograms permeter squared. Obesity is defined for adults as abody mass index above 30 kilograms per metersquared, kg/m2. For example, an adult who is 6 feet tall and weighs 250 pounds would have aBMI of 34. A table with which an individualcan calculate his or her BMI is available atwww.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm.3 Walk to a Healthy FutureJapanese physician Yoshiro Hatano found that most people take between 3,000 and 5,000 steps a day. Studies in both Japan and the United Statesindicate that the average person should take at least 10,000 steps per day, which is about five miles, depending upon one’s stride. This is the equivalent of a strenuous 30-minute workout and can burn between 300 and 500 calories a day, orbetween 2,100 and 3,500 calories a week (dependingupon speed and intensity).Common physical and cognitive declines associatedwith aging, exacerbated by obesity and poor health,can be prevented by simple changes in daily routine.Walking 10,000 steps is a reasonable goal to control weight and maintain aerobic fitness, and it will also help build bone and muscle strength.Assuming consistent food intake, the walker willmaintain or lose weight by walking about 10,000steps, as the energy consumed through food intakeis expended through walking. Furthermore, a routine of walking will decrease cardiovascular disease and hypertension, enhance cognition,and improve sleep. Exercise has been shown to be as effective as selective serotonin receptorinhibitors (i.e., prescription antidepressants) intreating depression, and as effective as metformin(i.e., a drug used to control blood sugar levels) in treating diabetes. Exercise also lowers blood cholesterol levels, reducing or eliminating entirelythe need for cholesterol-lowering statins.Some people use a treadmill to take 10,000 steps aday. Others take advantage of natural opportunitiesto increase their walking by taking the stairs insteadof the escalator or by parking far away from storeentrances—or by walking to the store to begin with!Groups of friends and acquaintances form informalwalking groups, and a number of walking clubs havebeen organized throughout the country. Some sponsorregional year-round, noncompetitive walks for anominal fee.The Benefits of PedometersExperts in the field of behavioral and socialsciences have established the importance of autonomy and self-regulation in maintaining a physically active regimen. Walkers can effectivelymonitor their output by using a pedometer, whichclips unobtrusively onto a belt or waistband andcounts every step they take, providing instant feedback on their daily level of activity. For a smallinvestment (step counters typically cost between $10 and $30), its usefulness is substantial: It is a tracking device continuously collecting current activity, a feedback tool providing immediate information on activity level, and a behavioral cue motivating its owner to be active.Given simple instructions, few adults have problemsrecording their total daily steps on a calendar andresetting the pedometer to zero in preparation forthe next day. Researchers have noted that peoplehave difficulty sticking with other means of measuringand motivating physical activity. Self-report diariesor logs are limited because of difficulty of recall andsubjective interpretations of terms used such as“moderate” and “vigorous” activity. Pedometers takethe guesswork out of measuring a workout, and“steps per day” has become universally adopted as a standard unit of measurement.This is anexample of a pedometer,the ILC StepCounter. It is recommended byGood Housekeepingand was featured in its June 2003 issue.More informationis available at www.ilcusa.org/shop/estore.htm.4 Walk to a Healthy FutureFew studies have been conducted involving head-to-head comparisons of different brands. The mostaccurate brand in one study, a product of theJapanese company the Yamax Corporation (ModelSW-500, Tokyo), recorded within 1 percent of allsteps taken under controlled conditions (walking ona 4.88 km sidewalk course). This particular modelhas been discontinued; however, the company produces other models of varying complexity thatadhere to the same level of quality. Devices withadded features that estimate energy expended and/or distance traveled are also available.Steps That Should Be TakenThe use of pedometers should be encouragedin public and private initiatives at all levels.For example, America on the Move™ (AOTM) is a nationwide campaign designed to promotehealthy eating and active living in order to stopweight gain in America and reduce the manyhealth complications that result from being overweight. AOTM is an initiative of the nonprofit organization the Partnership to Promote Healthy Eating and Active Living.AOTM is based on scientific research and isdesigned to provide education, support, and tools to Americans of all ages to encourage them to take just 2,000 extra steps each day (the equivalent of about one mile), or eat 100fewer calories in order to create a balance between energy expenditure and consumption.This campaign, begun in Colorado as Colorado on the Move™, uses the pedometer as a key tool for attracting and maintaining interest inwalking. The federal government’s USA on theMove initiative encouraging older people to walk also advocates the use of step counters. Even informalwalking clubs should consider using them.A wealth of literature has been written in Japaneseabout pedometer-assessed physical activity, which is a potential source of important scientific and practical information. To date, these papers have not been translated; thus contents are inaccessible tomost North American researchers and practitioners.Support for the translation and review of Japanese-language literature would greatly contribute to ourunderstanding and use of the pedometer.In addition, further research involving pedometersneeds to be undertaken, including additional investigations of the relationship between steps per day and health benefits and the development ofprogram theories for different populations to obtainmaximum benefit from the device.AfterwordAccording to Thomas Jefferson, who purportedlywalked four miles a day, the purpose of walking “is to relax the mind.” He writes: “You should therefore not permit yourself to even think while youwalk but divert yourself by the objects surroundingyou. Walking is the best possible exercise. Habituateyourself to walk very far. The Europeans value themselves on having subdued the horse to the usesof man; but I doubt whether we have not lost morethan we have gained, by the use of this animal. . . .There is no habit you will value so much as that ofwalking without fatigue.”Robert N. Butler, M.D., is president and CEO of the International Longevity Center-USA.Judith Estrine is executive editor.James Nyberg, M.P.A., is director of government relations.5 Walk to a Healthy FutureReferencesBassett DR, Ainsworth BE, Leggett SR, et al. 1996.Accuracy of five electronic pedometers for measuringdistance walked. Med Sci Sports Exerc 28: 1071–1077.Centers for Disease Control and Prevention,National Center for Health Statistics. NationalHealth and Nutrition Examination Survey 1999–2000.October 2002.Hatano Y. 1993. Use of the pedometer for promotingdaily walking exercise. International Council for Health,Physical Education, and Recreation Sport and Dance29: 4–8.Hill JO, Wyatt HR, Reed GW, Peters JC. 2003.Obesity and the environment: where do we go from here? Science 299: 853–855.Mayo Clinic Health Information. 2001. Walk yourway to fitness. Rochester, Minn.: Mayo Foundationfor Medical Education and Research.Partnership to Promote Healthy Eating and ActiveLiving (www.ppheal.org) and America on the Move™(www.americaonthemove.org).President’s Council on Physical Fitness and Sports.2002. Taking steps toward increased physical activity: using pedometers to measure and motivate.Research Digest 3 (17) June.U.S. Department of Health and Human Services.Healthy People 2010. Understanding and improvinghealth and objectives for improving health. 2nd ed.2 vols. Washington, D.C.: U.S. Government PrintingOffice. November 2000. www.healthypeople.gov/document.Copyright © 2003 International Longevity Center–USA, Ltd. All rights reserved. IB10-2003The International Longevity Center–USA(ILC–USA) is a not-for-profit, nonpartisanresearch, education, and policy organizationwhose mission is to help individuals and societiesaddress longevity and population aging inpositive and productive ways, and highlight olderpeople’s productivity and contributions to their families and society as a whole.The organization is part of a multinationalresearch and education consortium, whichincludes centers in the United States, Japan,Great Britain, France, and the DominicanRepublic. These centers work bothautonomously and collaboratively to studyhow greater life expectancy and increasedproportions of older people impact nationsaround the world.Other ILC Issue Briefs include:Social Security: Investment in Family ProtectionOld and Poor in AmericaLifelong Learning in Norway: An Experiment in ProgressPreparing for an Aging Nation:The Need for Academic GeriatriciansThe Digital Opportunity Investment Trust (DO IT):Using Information Technology to Prepare foran Older AmericaOld and Poor in New York CityClinical Trials and Older Persons:The Need for Greater RepresentationEmergency Preparedness for Older PeopleTreating Alzheimer’s: Accelerating Drug Discovery and DevelopmentINTERNATIONAL LONGEVITY CENTER–USABoard of DirectorsLaurance S. Rockefeller, Honorary ChairRobert N. Butler, M.D.Mary CarswellChristine K. Cassel, M.D.Everette E. Dennis, Ph.D.Susan W. DryfoosLloyd FrankAnnie GlennSenator John GlennLawrence K. GrossmanRaymond L. HandlanRobert D. HormatsTasneem Ismailji, M.D.Rose Kleiner (1925-2001)Linda P. LambertMax Link, Ph.D., ChairWilliam C. MartinEvelyn Stefansson NefStanley B. Prusiner, M.D.Albert L. Siu, M.D., M.S.P.H.Joseph E. SmithJackson T. Stephens, Jr.Catharine R. Stimpson, Ph.D.James H. StoneWilliam D. Zabel, Esq.Mel ZuckermanJohn F. ZweigILC INTERNATIONAL CENTERSDirectorsRobert N. Butler, M.D.ILC–USA Shigeo MoriokaILC–JapanFrançoise Forette, M.D.ILC–FranceBaroness Sally GreengrossILC–United KingdomRosy Pereyra Ariza, M.D.ILC–Dominican Republic

Walk to a Healthy Future

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