Tag Archive for: walking

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

Exercise Your Heart, Part 1

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In my opinion, the single most important thing you can do to be able to live life at your best is to exercise your heart. Every day. You don’t have to run marathons; you don’t ever need to run at all. You just need to train your heart every day. I’ve broken it down into two components that I’ll call baseline and reserve.

The aerobic baseline for your heart is just that: the level of fitness you need to accomplish every day tasks. The baseline will be different based on your age, your initial fitness level, and what your everyday activities are. That’s as simple as walking across a room and as challenging as being a laborer on a construction site or moving furniture up five flights of stairs.

If there are no orthopedic issues, the simplest exercise is walking or it could be long-distance running or bike riding. The goal is to get your heart rate elevated enough to cause the heart to beat faster than it does when resting. That trains the heart in more ways than I can explain.

The simplest way to describe how to do it’s this way. Walk fast enough so that you have to take a deep breath once in a while but you can carry on a conversation. If you can’t talk, slow it down. But if you can sing, that’s too slow. You can use that across every aerobic type of exercise from aerobics to Zumba. The goal is at least 30 minutes most days of the week.

You also need a reserve and I’ll talk about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Is the 10,000-Steps Goal a Myth?

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One of the things many people do for fitness is try to get 10,000 steps per day. Researchers recently wanted to know whether that many steps really gives a person any health advantage, because the concept of 10,000 steps per day wasn’t based on any real science—it came from a Japanese company who invented a wearable step counter in 1965 and just made up a number that sounds good.

Researchers analyzed data from 16,741 older women who agreed to wear a step counter at least 10 hours per day for at least four days a week during waking hours. They divided the subjects into quartiles based on the number of steps per day. After four years of follow-up, they discovered that hazard ratios declined as the number of steps per day increased. No real surprise there. What was surprising was that there were no additional benefits after 7,500 steps per day; in fact, the mortality began to decline with as little as 4,400 steps per day.

Is the goal of 10,000 steps per day a myth? Not in my opinion; most of us are too sedentary most of the time. The mean age of the subjects in this study was 72. It may be that younger women need more steps to impact mortality because they have potentially more years to live; then maybe after reaching 72, they can scale back. Hard to say. But they looked at mortality only; 10,000 steps per day may have benefits they didn’t examine.

I would have thought walking intensity might have had an impact, but it didn’t in this study. However, another recently published study may provide more insight, especially as it relates to obesity. We’ll take a look on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019. doi:10.1001/jamainternmed.2019.0899.

Exercise Intuitively

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The age of Jane Austen’s England was much different from the current age; going for a two-hour walk seems almost a fantasy in today’s world. Being figuratively chained to a desk or some manner of work that doesn’t provide freedom of movement seems to be the norm. When it’s time to walk, we must accomplish the most in the shortest time available. Our schedules simply don’t provide the freedom to do more.

Or do we just not look for opportunities in our day where can stretch at our desks, go outside and take a series of deep breaths, take the stairs instead of the elevator? We tend to categorize what we do in specific ways: “This is the time to exercise and we have xx minutes to get it done.” Has it helped our society much? How fit is the average American?

Based on Kozlowski’s background for his books, he found that the average person in that time could typically walk seven miles at a stretch. They did not seem to count steps and they rested when they felt like it. In Pride and Prejudice, Lizzie Bennet seems to spend the afternoons tramping around outside whenever possible. (And for the record, Paula is a long-time aficionado of Jane Austen and insists the 1995 BBC version is the definitive Pride and Prejudice for its casting, costumes, and success in capturing the spirit of the original book.)

All that walking wasn’t what we call exercise today, but it was effective. Maybe it’s our attitude toward exercise that needs adjusting. Where can you find opportunities to move in your day?

What are you prepared to do today?

        Dr. Chet

Reference: https://wapo.st/2UeaSiZ

Observations from the Road: Fitness vs. a Healthy Heart

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As I finish my observations from my last trip, I’m on another trip to Austin to do another seminar. I’m sure I’ll have other things to talk about because I’m always looking and listening.

During my run a week ago in Denver, I repeatedly passed two women who were out for an early morning walk. They carried on a conversation the entire time. I think that’s great; having a walking or running buddy or group can get you moving on those days when you don’t want to, and sometimes the gossip is what gets . . .

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