Skip to main content

Advertisement

Log in

Walking to Health

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 01 August 1997

Summary

Walking is a rhythmic, dynamic, aerobic activity of large skeletal muscles that confers the multifarious benefits of this with minimal adverse effects.

Walking, faster than customary, and regularly in sufficient quantity into the ‘training zone’ of over 70% of maximal heart rate, develops and sustains physical fitness: the cardiovascular capacity and endurance (stamina) for bodily work and movement in everyday life that also provides reserves for meeting exceptional demands. Muscles of the legs, limb girdle and lower trunk are strengthened and the flexibility of their cardinal joints preserved; posture and carriage may improve.

Any amount of walking, and at any pace, expends energy. Hence the potential, long term, of walking for weight control. Dynamic aerobic exercise, as in walking, enhances a multitude of bodily processes that are inherent in skeletal muscle activity, including the metabolism of high density lipoproteins and insulin/ glucose dynamics. Walking is also the most common weight-bearing activity, and there are indications at all ages of an increase in related bone strength.

The pleasurable and therapeutic, psychological and social dimensions of walking, whilst evident, have been surprisingly little studied. Nor has an economic assessment of the benefits and costs of walking been attempted.

Walking is beneficial through engendering improved fitness and/or greater physiological activity and energy turnover. Two main modes of such action are distinguished as: (i) acute, short term effects of the exercise; and (ii) chronic, cumulative adaptations depending on habitual activity over weeks and months.

Walking is often included in studies of exercise in relation to disease but it has seldom been specifically tested. There is, nevertheless, growing evidence of gains in the prevention of heart attack and reduction of total death rates, in the treatment of hypertension, intermittent claudication and musculoskeletal disorders, and in rehabilitation after heart attack and in chronic respiratory disease.

Walking is the most natural activity and the only sustained dynamic aerobic exercise that is common to everyone except for the seriously disabled or very frail. No special skills or equipment are required. Walking is convenient and may be accommodated in occupational and domestic routines. It is self-regulated in intensity, duration and frequency, and, having a low ground impact, is inherently safe.

Unlike so much physical activity, there is little, if any, decline in middle age. It is a year-round, readily repeatable, self-reinforcing, habit-forming activity and the main option for increasing physical activity in sedentary populations.

Present levels of walking are often low. Familiar social inequalities may be evident. There are indications of a serious decline of walking in children, though further surveys of their activity, fitness and health are required. The downside relates to the incidence of fatal and non-fatal road casualties, especially among children and old people, and the deteriorating air quality due to traffic fumes which mounting evidence implicates in the several stages of respiratory disease.

Walking is ideal as a gentle start-up for the sedentary, including the inactive, immobile elderly, bringing a bonus of independence and social well-being. As general policy, a gradual progression is indicated from slow, to regular pace and on to 30 minutes or more of brisk (i.e. 6.4 km/h) walking on most days. These levels should achieve the major gains of activity and health-related fitness without adverse effects. Alternatively, such targets as this can be suggested for personal motivation, clinical practice, and public health.

The average middle-aged person should be able to walk 1.6km comfortably on the level at 6.4 km/h and on a slope of 1 in 20 at 4.8 km/h, however, many cannot do so because of inactivity-induced unfitness. The physiological threshold of ‘comfort’ represents 70% of maximum heart rate. Trials across the age span are required in primary care and community programmes to evaluate such approaches, and the benefits and costs more generally of possible initiatives towards more walking.

Walking, by quantity and pace, is under-researched, particularly in the middleaged and elderly. Randomised controlled trials are required of its physiological effects on blood pressure, thrombogenesis, immune function; and of walking in the prevention and/or treatment of non-insulin dependent (type II) diabetes mellitus, osteoporosis, anxiety and depression and back pain.

Low levels of walking are a major factor in today’s widespread waste of the potential for health and well-being that is due to physical inactivity. This waste is manifest in impaired functional capacities, overweight, disease, disability, premature death and the concomitant human and economic costs. This review seeks to assemble evidence of the health gains of walking as a resource for the multifarious professionals and students, practitioners, investigators and policy makers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marples M. Shanks’ pony: a study of walking. London: JM Dent and Sons, 1959: 30–58 passim

    Google Scholar 

  2. Sutherland DH, Kaufman KR, Moitoza JR. Kinematics of normal walking. In: Rose J, Gamble JG, editors. Human walking. Baltimore: Williams and Wilkins, 1993: 23–44

    Google Scholar 

  3. Wyndham CH, van der Walt WH, van Rensburg AJ, et al. The influence of body weight on energy expenditure during walking on a road and on a treadmill. Int Z Angew Physiol 1971; 29: 285–92

    PubMed  CAS  Google Scholar 

  4. Passmore R, Durnin JVGA. Human energy expenditure. Physiol Rev 1955; 35: 801–40

    PubMed  CAS  Google Scholar 

  5. Thorstensson A, Robertson H. Adaptations to changing speed in human locomotion. Acta Physiol Scand 1987; 131: 211–4

    PubMed  CAS  Google Scholar 

  6. Sports Council and Health Education Authority. National fitness survey: main findings. London: Sports Council and Health Education Authority, 1992

    Google Scholar 

  7. Malakous SL, Araujo J, Thomas TR. Energy expenditure during walking with hand weights. Physician Sports Med 1987; 46: 139–48

    Google Scholar 

  8. Porcari J, McCarron R, Kline G, et al. Is fast walking an adequate aerobic training stimulus for 30- to 69-year-old men and women? Physician Sportsmed 1987; 15: 119–29

    Google Scholar 

  9. Himann JE, Cuningham DA, Rechnitzer PA, et al. Age-related changes in speed of walking. Med Sci Sports Exerc 1988; 20: 161–6

    PubMed  CAS  Google Scholar 

  10. Duncan JJ, Gordon NF, Scott CB. Women walking for health and fitness. How much is enough? JAMA 1991; 266: 3295–9

    PubMed  CAS  Google Scholar 

  11. Faulkner JA, Heighenhauser GF, Schork MA. The cardiac output-oxygen uptake in men during graded bicycle ergometry. Med Sci Sports 1977; 9: 148–54

    PubMed  CAS  Google Scholar 

  12. American College of Sports Medicine guidelines for exercise testing and prescription, 5th ed. Baltimore: Williams and Wilkins, 1995

  13. Hagberg JM. Effect of training on the decline of VO2max with aging. Fed Proc 1987; 46: 1830–3

    PubMed  CAS  Google Scholar 

  14. Åstrand P-O, Rodahl K. Textbook of work physiology. Physiological bases of exercise, 3rd ed. New York: McGraw Hill, 1986: 189

    Google Scholar 

  15. Hardman AE, Jones PRM, Norgan NG, et al. Brisk walking improves endurance fitness without changing body fatness in previously sedentary women. Eur J Appl Physiol 1992: 354–9

    Google Scholar 

  16. Stensel DJ, Brooke-Wavell K, Hardman AE, et al. The influence of a one-year programme of brisk walking on endurance fitness and body composition in previously sedentary men aged 42–59 years. Eur J Appl Physiol 1994; 68: 531–7

    CAS  Google Scholar 

  17. Pollock ML, Miller HS, Janeway R, et al. Effects of walking on body composition and cardiovascular function of middleaged men. J Appl Physiol 1971; 30: 126–30

    PubMed  CAS  Google Scholar 

  18. Jetté M, Sidney K, Campbell J. Effects of a twelve-week walking programme on maximal and submaximal work output indices in sedentary middle-aged men and women. J Sports Med Phys Fitness 1988; 28: 59–66

    PubMed  Google Scholar 

  19. Santiago MC, Alexander JF, Stull GA, et al. Physiological responses of sedentary women to a 20-week conditioning program of walking or jogging. Scand J Sports Sci 1987; 9: 33–9

    Google Scholar 

  20. Suter E, Marti B, Gutzwiller F. Jogging or walking — comparison of health effects. Ann Epidemiol 1994; 4: 375–81

    PubMed  CAS  Google Scholar 

  21. Kline GM, Porcari JP, Hintermeister R, et al. Estimation of VO2max from a one-mile track walk, gender, age, and body weight. Med Sci Sports Exerc 1987; 19: 253–9

    PubMed  CAS  Google Scholar 

  22. Oja P, Laukkanen R, Pasanen M, et al. A 2-km walking test for assessing cardiorespiratory fitness in healthy adults. Int J Sports Med 1991; 12: 356–62

    PubMed  CAS  Google Scholar 

  23. Oja P, Tuxworth B, editors. Eurofit for adults. Strasbourg: Council of Europe, 1995: 41–45 passim

    Google Scholar 

  24. Mitchell JH, Raven PB. Cardiovascular adaptations to physical activity. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health. Champaign (IL): Human Kinetics Publishers, 1994

    Google Scholar 

  25. Davies CTM, Thompson MW. Aerobic performance of female and male ultramarathon athletes. Eur J Appl Physiol 1979; 41: 233–45

    CAS  Google Scholar 

  26. Williams C. The biological basis of aptitude; the endurance runner. J Biosoc Sci 1981; Suppl. 7: 103–12

    Google Scholar 

  27. Hardman AE, Williams C, Wootton SA. The influence of shortterm endurance training on maximum oxygen uptake, submaximum endurance and the ability to perform brief, maximal exercise. J Sports Sci 1986; 4: 109–16

    PubMed  CAS  Google Scholar 

  28. Holloszy JO, Coyle EF. Adaptations of skeletal muscle to endurance exercise and their metabolic consequences. J Appl Physiol 1984; 56: 831–4

    PubMed  CAS  Google Scholar 

  29. Nachemson AL, Mayer TG. Exercise, fitness and back pain. In: Bouchard C, Shephard RJ, Stephens T, et al., editors. Exereise, fitness and health. Champaign (IL): Human Kinetics, 1990: 529–46

    Google Scholar 

  30. Haskell WL. Health consequences of physical activity: understanding and challenges regarding dose-response. Med Sci Sports Exerc 1994; 26: 649–60

    PubMed  CAS  Google Scholar 

  31. Holland B, Welch AA, Unwin ID, et al. McCance and Widdowson’s ‘The composition of foods’. London: Royal Society of Chemistry and the Ministry of Agriculture, Fisheries and Food, 1991

    Google Scholar 

  32. Garrow JS. Obesity and related diseases. Edinburgh: Churchill Livingstone, 1988

    Google Scholar 

  33. Garrow JS. Obesity. In: Garrow JS, James WPT, editors. Human nutrition and dietetics, 9th ed. Edinburgh: Churchill Livingstone, 1993: 465–79

    Google Scholar 

  34. Royal College of Physicians. Obesity. J Royal Coll Physicians Lond 1983; 17: 5–65

    Google Scholar 

  35. Health survey for England. London: HMSO, 1991: 48; 1993: 48; 1994: 128, 242, 261

  36. Kuczmarski RJ, Flegal KM, Campbell SM, et al. Increasing prevalence of overweight among U.S. adults: the national health and nutrition examination surveys. JAMA 1994; 272: 205–11

    PubMed  CAS  Google Scholar 

  37. Hinkelman LL, Nieman DC. The effects of a walking programme on body composition and serum lipids and lipoproteins in overweight women. J Sports Med Phys Fitness 1993; 33: 49–58

    Google Scholar 

  38. Haskell WL. Dose-response relationship between physical activity and disease risk factors. In: Oja P, Telema R, editors. Sport for all. Amsterdam: Elsevier Science Publications, 1991: 125–33

    Google Scholar 

  39. Ballor DL, Keesey RE. A meta-analysis of the factors affecting exercise-induced changes in body mass, fat mass and fat-free mass in males and females. Int J Obes 1991; 15: 717–26

    PubMed  CAS  Google Scholar 

  40. Leon AS, Conrad J, Hunninghake DB, et al. Effects of a vigorous walking program on body composition, and carbohydrate and lipid metabolism of obese young men. Am J Clin Nutr 1979; 33: 1776–87

    Google Scholar 

  41. Fentem PH, Bassey EJ, Turnbull NB. The new case for exercise. London: Sports Council and Health Education Authority, 1988

    Google Scholar 

  42. Royal College of Physicians. Medical aspects of exercise. London: Royal College of Physicians, 1991

    Google Scholar 

  43. Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health. Champaign (IL): Human Kinetics Publishers, 1994

    Google Scholar 

  44. McAuley E, Jacobson L. Self-efficacy and exercise participation in sedentary adult females. Am J Health Promot 1991; 5: 185–91

    PubMed  CAS  Google Scholar 

  45. McAuley E. Physical activity and psychosocial outcomes. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness, and health. Champaign (IL): Human Kinetics Publishers, 1994

    Google Scholar 

  46. Saris WHM. Physiological aspects of exercise in weight cycling. Am J Clin Nutr 1989; 49: 1099–104

    PubMed  CAS  Google Scholar 

  47. Haskell WL. Dose-response issues from a biological perspective. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness and health. Champaign (IL): Human Kinetics Publishers, 1994: 1030–9

    Google Scholar 

  48. Blair SN, Kohl HW, Paffenbarger RS, et al. Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 1989; 262: 2395–401

    PubMed  CAS  Google Scholar 

  49. Blair SN, Kampert JB, Kohl HW, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996; 276: 205–10

    PubMed  CAS  Google Scholar 

  50. Young A, Dinan S. Fitness for older people. BMJ 1994; 309: 331–4

    PubMed  CAS  Google Scholar 

  51. Frändin K, Grimby G, Mellström D, et al. Walking habits and health-related factors in a 70-year-old population. Gerontology 1991; 37: 281–8

    PubMed  Google Scholar 

  52. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. N Engl J Med 1995; 332: 767–73

    PubMed  CAS  Google Scholar 

  53. Dargen-Molina P, Favier F, Grandjean H, et al. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996; 348: 145–9

    Google Scholar 

  54. Fiatorone MA, O’Neill F, Doyle Ryan N, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–75

    Google Scholar 

  55. Hagberg JM, Graves JE, Linacher M. Cardiovascular responses of 70–79 year old men and women to exercise training. J Appl Physiol 1989; 66: 2589–94

    PubMed  CAS  Google Scholar 

  56. Cononie CC, Graves JE, Pollock ML, et al. Effect of exercise training on blood pressure in 70- to 79-yr-old men and women. Med Sci Sports Exerc 1991; 23: 505–11

    PubMed  CAS  Google Scholar 

  57. Pollock ML, Carroll JF, Graves JE, et al. Injuries and adherence to walk/jog and resistance training programs in the elderly. Med Sci Sports Exerc 1991; 23: 1194–200

    PubMed  CAS  Google Scholar 

  58. Franklin BA, Blair SN, Haskell WL, et al. Exercise and cardiac complications. Do the benefits outweigh the risks? Physician Sportsmed 1994; 22: 56–68

    Google Scholar 

  59. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402–7

    PubMed  CAS  Google Scholar 

  60. Lanyon LE. Using functional loading to influence bone mass and architecture: objectives, mechanisms and relationship with estrogen of the mechanically adaptive process in bone. Bone 1996; 18: 37S–43S

    PubMed  CAS  Google Scholar 

  61. Lau E, Donnan S, Barker DJP, et al. Physical activity and calcium intake in fracture of the proximal femur in Hong Kong. BMJ 1988; 297: 441–3

    Google Scholar 

  62. Krall EA, Dawson-Hughes B. Walking is related to bone density and rate of bone loss. Am J Med 1994; 96: 20–6

    PubMed  CAS  Google Scholar 

  63. Uusi-Rasi K, Nygård C-H, Oja P, et al. Walking at work and bone mineral density of premenopausal women. Osteoporos Int 1994; 4: 336–40

    PubMed  CAS  Google Scholar 

  64. Nelson ME, Fisher EC, Dilmanian FA, et al. A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Am J Clin Nutr 1991; 53: 1304–11

    PubMed  CAS  Google Scholar 

  65. Cavanaugh DJ, Cann CE. Brisk walking does not stop bone loss in postmenopausal women. Bone 1988; 9: 201–4

    PubMed  CAS  Google Scholar 

  66. Martin D, Notelovitz M. Effects of aerobic training on bone mineral density of postmenopausal women. Bone 1993; 8: 931–6

    CAS  Google Scholar 

  67. Hatori M, Hasegawa A, Adachi H, et al. The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women. Calcif Tissue Int 1993; 52: 411–4

    PubMed  CAS  Google Scholar 

  68. Brooke-Wavell K, Jones PRM, Hardman AE. Brisk walking reduces bone loss in postmenopausal women. Clin Sci 1997; 92: 75–80

    PubMed  CAS  Google Scholar 

  69. Grisso J, Kelsey J, Strom B, et al. Risk factors for falls as a cause of hip fracture in women. N Engl J Med 1991; 324: 1326–31

    PubMed  CAS  Google Scholar 

  70. Judge JO, Lindsey C, Underwood M, et al. Balance improvements in older women: effects of exercise training. Phys Ther 1993; 73: 254–65

    PubMed  CAS  Google Scholar 

  71. Kännel WB. Metabolic risk factors for coronary artery disease in women: perspective from the Framingham study. Am Heart J 1987; 114: 413–9

    PubMed  Google Scholar 

  72. Tucker LA, Friedman GM. Walking and serum cholesterol in adults. Am J Public Health 1990; 80: 1111–3

    PubMed  CAS  Google Scholar 

  73. Palank EA, Hargreaves EH. The benefits of walking the golf course. Physician Sportsmed 1990; 18: 77–80

    Google Scholar 

  74. Stensel DS, Hardman AE, Brooke-Wavell K, et al. Brisk walking and serum lipoprotein variables in formerly sedentary men aged 42 to 59 years. Clin Sci 1993; 85: 701–8

    PubMed  CAS  Google Scholar 

  75. Wood PD, Stefanick ML, Williams PT, et al. The effects on plasma lipoproteins of a prudent weight-reducing diet with or without exercise, in overweight men and women. N Engl J Med 1991; 325: 461–6

    PubMed  CAS  Google Scholar 

  76. Hardman AE, Hudson A, Jones PRM, et al. Brisk walking and plasma high density lipoprotein cholesterol in previously sedentary women. BMJ 1989; 299: 1204–5

    PubMed  CAS  Google Scholar 

  77. Cauley JA, Kriska AM, LaPorte RE, et al. A two-year randomized exercise trial in older women: effects on HDL-cholesterol. Atherosclerosis 1987; 66: 247–58

    PubMed  CAS  Google Scholar 

  78. Aldred HE, Perry I, Hardman AE. The effect of a single bout of brisk walking on postprandial lipemia in normolipidemic young adults. Metabolism 1994; 43: 836–41

    PubMed  CAS  Google Scholar 

  79. Richter EA, Turcotte L, Hespel P, et al. Metabolic responses to exercise. Effects of endurance training and implications for diabetes. Diabetes Care 1992; 15Suppl. 4: 1767–75

    PubMed  CAS  Google Scholar 

  80. Lillioja S, Mott DM, Spraul M, et al. Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 1988–92

    PubMed  CAS  Google Scholar 

  81. Helmrich SP, Ragland DR, Leung RW, et al. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991; 325: 147–52

    PubMed  CAS  Google Scholar 

  82. Lynch J, Helmrich SP, Lakka TA, et al. Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men. Arch Intern Med 1996; 156: 1307–14

    PubMed  CAS  Google Scholar 

  83. Reaven GM. Syndrome X: 6 years later. J Intern Med 1994; 236Suppl. 736: 13–22

    Google Scholar 

  84. Braun B, Zimmermann MB, Kretchmer N. Effects of exercise intensity on insulin sensitivity in women with non-insulin-dependent diabetes mellitus. J Appl Physiol 1995; 78: 300–6

    PubMed  CAS  Google Scholar 

  85. Paffenbarger RS, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 1978; 108: 161–75

    PubMed  Google Scholar 

  86. Morris JN, Clayton DG, Everitt MG, et al. Exercise in leisure time: coronary attack and death rates. Br Heart J 1990; 63: 325–34

    PubMed  CAS  Google Scholar 

  87. Morris JN. Recent history of coronary disease. Lancet 1951; I: 1–7

    Google Scholar 

  88. Morris JN. Recent history of coronary disease. Lancet 1951; I: 69–73

    Google Scholar 

  89. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischaemic death. N Engl J Med 1984; 310: 1137–40

    PubMed  CAS  Google Scholar 

  90. Connelly JB, Cooper JA, Meade TW. Strenuous exercise, plasma fibrinogen, and factor VII activity. Br Heart J 1992; 67: 351–4

    PubMed  CAS  Google Scholar 

  91. Elwood PC, Yarnell JWG, Pickering J, et al. Exercise, fibrinogen, and other risk factors for ischaemic heart disease. Caerphilly Prospective Heart Disease Study. Br Heart J 1993; 69: 183–7

    PubMed  CAS  Google Scholar 

  92. Meade TW, Ruddock V, Stirling Y, et al. Fibrinolytic activity, clotting factors and long term incidence of ischaemic heart disease in the Northwick Park Heart Study. Lancet 1993; 342: 1076–9

    PubMed  CAS  Google Scholar 

  93. Stratton JR, Chandler WL, Schwartz RS, et al. Effects of physical conditioning on fibrinolytic variables and fibrinogen in young and old healthy adults. Circulation 1991; 83: 1692–7

    PubMed  CAS  Google Scholar 

  94. Neiman DC. Exercise, upper respiratory tract infection, and the immune system. Med Sci Sports Exerc 1994; 26: 128–39

    Google Scholar 

  95. Neiman DC, Nehlsen-Cannarella SL, Markoff PA, et al. The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. Int J Sports Med 1990; 11: 467–73

    Google Scholar 

  96. Neiman DC, Henson DA, Gusewitch G, et al. Physical activity and immune function in elderly women. Med Sci Sports Exerc 1993; 25: 823–31

    Google Scholar 

  97. MacKinnon LT. Current challenges and future expectations in exercise immunology: back to the future. Med Sci Sports Exerc 1994; 26: 191–4

    PubMed  CAS  Google Scholar 

  98. Consensus statement. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity, fitness, and health. Champaign (IL): Human Kinetics Publishers, 1994: 64

  99. Kingwell BA, Jennings GL. Effects of walking and other exercise programs upon blood pressure in normal subjects. Med J Aust 1993; 158: 234–8

    PubMed  CAS  Google Scholar 

  100. Hagberg JM, Montain SJ, Martin WH, et al. Effect of exercise training in 60- 69-year-old persons with essential hypertension. Am J Cardiol 1989; 64: 348–53

    PubMed  CAS  Google Scholar 

  101. Arroll B, Beaglehole R. Does physical activity lower blood pressure: a critical review of the clinical trials. J Clin Epidemiol 1992; 45: 439–47

    PubMed  CAS  Google Scholar 

  102. Levy D. Have expert panel guidelines kept pace with new concepts in hypertension? Lancet 1995; 346: 1112

    PubMed  CAS  Google Scholar 

  103. WHO Expert Committee. Hypertension control [report]. Geneva: WHO, 1996: passim

    Google Scholar 

  104. Paffenbarger RS, Wing AL, Hyde RT, et al. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol 1983; 117: 247–57

    Google Scholar 

  105. Department of Health. The health of the nation. London: HMSO, 1992: 56

    Google Scholar 

  106. Wallace AD. Walking, literature and English culture. Oxford: Clarendon Press, 1994: 229–31

    Google Scholar 

  107. Robinson JC. The walk: notes on a romantic image. Norman: University of Oklahoma Press, 1989

    Google Scholar 

  108. Stephens T. Physical activity and mental health in the United States and Canada: evidence from four population surveys. Prev Med 1988; 17: 35–47

    PubMed  CAS  Google Scholar 

  109. King AC, Taylor CB, Haskell WL, et al. Influences of regular aerobic exercise on psychological health: a randomised controlled trial of healthy middle-aged adults. Health Psychol 1989; 8: 305–24

    PubMed  CAS  Google Scholar 

  110. Raglin JS. Exercise and mental health: beneficial and detrimental effects. Sports Med 1990; 9: 323–9

    PubMed  CAS  Google Scholar 

  111. Morgan WP. Sports psychology in exercise science and sports medicine. In: 40th anniversary lectures. Indianapolis: American College of Sports Medicine, 1994

    Google Scholar 

  112. US Surgeon General, Departments of Health and Human Services, Centers for Disease Control and Prevention. Physical activity and health: a report of the Surgeon General. Atlanta (GA): CDC 1996: 75, 125, 135, 177, 209

    Google Scholar 

  113. Dishman RK. Psychological effects of exercise for disease resistance and health promotion. In: Watson RR, Eisenger M, editors. Exercise and disease. Boca Raton (FL): CRC Press, 1992: 180–207

    Google Scholar 

  114. Dienstbier RA. Behavioral correlates of sympathoadrenal reactivity: the toughness model. Med Sci Sports Exerc 1991; 23: 846–52

    PubMed  CAS  Google Scholar 

  115. Frändin K, Johannesson K, Grimby G. Physical activity as part of an intervention program for elderly persons in Göteborg. Scand J Med Sci Sports 1992; 2: 218–24

    Google Scholar 

  116. Dickens C. Night walks. In: the uncommercial traveller. 1867/8: Chapter XIII

    Google Scholar 

  117. Powell KE, Thompson PD, Casperson CJ, et al. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987; 8: 253–87

    PubMed  CAS  Google Scholar 

  118. Leon AS. Physical activity and risk of ischaemic heart disease. In: Oja P, Telema R, editors. Sport for all. Amsterdam: Elsevier, 1991: 251–64

    Google Scholar 

  119. Morris JN. Exercise in the prevention of coronary heart disease: today’s best buy in public health. Med Sci Sports Exerc 1994; 26: 807–14

    PubMed  CAS  Google Scholar 

  120. Morris JN. Exercise versus heart attack: questioning the consensus? Res Q Exerc Sport 1996; 67: 216–20

    PubMed  CAS  Google Scholar 

  121. Blair SN, Connelly JC. How much physical activity should we do? The case for moderate amounts and intensities of physical activity. Res Q Exerc Sport 1996; 67: 193–205

    PubMed  CAS  Google Scholar 

  122. Paffenbarger RS, Lee I-M. Physical activity and fitness for health and longevity. Res Q Exerc Sport 1996; 67 (3 Suppl.): 11–28

    Google Scholar 

  123. Morris JN, Everitt MG, Pollard R, et al. Vigorous exercise in leisure-time: protection against coronary heart disease. Lancet 1980; II: 1207–10

    Google Scholar 

  124. Morris JN. Exercise vs heart attack: history of a hypothesis. In: Marmot M, Elliot P, editors. Coronary heart disease epidemiology. Oxford: Oxford University Press, 1992: 242–55

    Google Scholar 

  125. Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25: 71–80

    PubMed  CAS  Google Scholar 

  126. Shaper AG, Wannamethee G. Physical activity and ischaemic heart disease in middle-aged British men. Br Heart J 1991; 66: 384–94

    PubMed  CAS  Google Scholar 

  127. Morris JN, Heady JA, Raffle PAB, et al. Coronary heart disease and physical activity of work. Lancet 1953; II: 1053–7, 1111-20

    Google Scholar 

  128. Occupational mortality. Decennial Supplement, 1979–80, 1982–83. London: HMSO, 1986

  129. Occupational Health. Decennial Supplement Series DS No. 10. Longitudinal Study. London: HMSO, 1995

    Google Scholar 

  130. Cook TC, LaPorte RE, Washburn RA, et al. Chronic low level physical activity as a determinant of high density lipoprotein cholesterol and subfractions. Med Sci Sports Exerc 1986; 18: 653–7

    PubMed  CAS  Google Scholar 

  131. Paffenbarger RS. 40 years of progress: physical activity, fitness and health. American College of Sports Medicine: 40th anniversary lectures. Indianapolis: ACSM, 1994: 93–109

    Google Scholar 

  132. Lemaitre RN, Heckbert SR, Psaty BM, et al. Leisure-time physical activity and the risk of nonfatal myocardial infarction in postmenopausal women. Arch Intern Med 1995; 155: 2302–8

    PubMed  CAS  Google Scholar 

  133. La Croix AZ, Leveille SG, Hecht JA, et al. Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? J Am Geriatr Soc 1996; 44: 113–120

    Google Scholar 

  134. Clausen JP. Circulatory adjustments to dynamic exercise and effect of physical training on normal subjects and in patients with coronary artery disease. Prog Cardiovasc Dis 1976; 18: 459–95

    PubMed  CAS  Google Scholar 

  135. Worcester MC, Hare DL, Oliver RG, et al. Early programmes of high and low intensity exercise and quality of life after acute myocardial infarction. BMJ 1993; 307: 1244–7

    PubMed  CAS  Google Scholar 

  136. Rehabilitation after cardiovascular disease. Geneva: WHO, 1993. (WHO Technical Report Series; 831)

  137. Kavanagh T, Myers MG, Baigrie RS. Quality of life and cardiorespiratory function in chronic heart failure: effects of 12 months’ aerobic training. heart 1996; 76: 42–9

    PubMed  CAS  Google Scholar 

  138. Housley E. Treating claudication in five words. BMJ 1988; 296: 1483–4

    PubMed  CAS  Google Scholar 

  139. Mannarino E, Pasqualini L, Menna M, et al. Effects of physical training on peripheral vascular disease: a controlled study. Angiology 1989; 40: 6–10

    Google Scholar 

  140. Lundgren F, Dahllöf AG, Scherstén T, et al. Muscle adaptation in patients with peripheral arterial insufficiency. Clin Sci 1989; 77: 485–93

    PubMed  CAS  Google Scholar 

  141. Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta analysis. JAMA 1995; 274: 975–80

    PubMed  CAS  Google Scholar 

  142. Kovar PA, Allengrante JP, Mackenzie CR, et al. Supervised fitness walking in patients with oseoarthritis of the knee. Ann Intern Med 1992; 116: 529–34

    PubMed  CAS  Google Scholar 

  143. Young A. Exercise physiology in general practice. In: Åstrand P-O, Grimby G, editors. Physical activity in health and disease. Stockholm: Almqvist and Wiskells, 1986: 227–32

    Google Scholar 

  144. Pitetti KH. Introduction: exercise capacities and adaptations of people with chronic disabilities: current research, future directions, and widespread applicability. Med Sci Sports Exerc 1993; 25: 421–2

    PubMed  CAS  Google Scholar 

  145. Iliffe S, Tai SS, Gould M, et al. Prescribing exercise in general practice. BMJ 1994; 309: 494–5

    PubMed  CAS  Google Scholar 

  146. Lookinland S, Harms J. Comparison of health-promotive behaviours among seniors. Soc Sci Health 1996; 2: 147–61

    Google Scholar 

  147. Rejeski WJ, Brawley LR, Schumaker SA. Physical activity and health-related quality of life. Exerc Sports Sci Rev 1996; 24: 71–108

    CAS  Google Scholar 

  148. Weg JG. Therapeutic exercise in patients with chronic obstructive pulmonary disease. In: Wenger NK, editor. Exercise and the heart. Philadelphia: FA Davis, 1985: 261–74

    Google Scholar 

  149. Cockcroft A, Berry G, Brown EB, et al. Psychological changes during a controlled trial of rehabilitation in chronic respiratory disability. Thorax 1982; 37: 413–6

    PubMed  CAS  Google Scholar 

  150. Lacasse Y, Wong E, Ginyatt, et al. Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease. Lancet 1996; 348: 1115–9

    PubMed  CAS  Google Scholar 

  151. Amis M. Money. London: Cape, 1984: 160–1

    Google Scholar 

  152. Hillman M, editor. Children, transport and the quality of life. London: Policy Studies Institute, 1993

    Google Scholar 

  153. Roberts I, Norton R, Taua B. Child pedestrian injury rates: the importance of ‘exposure to risk’ relating to socioeconomic and ethnic differences in Auckland, New Zealand. J Epidemiol Community Health 1996; 50: 162–5

    PubMed  CAS  Google Scholar 

  154. Department of Transport. National travel survey: 1992–4. London: HMSO, 1995

    Google Scholar 

  155. Roberts I, Power C. Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991. BMJ 1996; 313: 784–6

    PubMed  CAS  Google Scholar 

  156. Morris JN. Ten years and little further on. Lancet 1990; 336: 491–3

    PubMed  CAS  Google Scholar 

  157. Armstrong N, Balding J, Gentle P, et al. Patterns of physical activity among 11–16 year old British children. BMJ 1990; 301: 203–5

    PubMed  CAS  Google Scholar 

  158. Riddoch CJ, Murphy NM, Nichols A, et al. The Northern Ireland health and fitness survey (of children). Belfast: The Queen’s University, 1990

    Google Scholar 

  159. Durnin JVGA. Physical activity levels: past and present. In: Norgan NG, editor. Physical activity and health. Cambridge: Cambridge University Press, 1992: 20–7

    Google Scholar 

  160. Morris JN. In: Children’s exercise, health and fitness. London: Sports Council, 1988

    Google Scholar 

  161. International Road Traffic and Accident Base. Paris: OECD, 1996

  162. The Qualilty of Urban Air Review Group. Urban Air Quality in the UK. London: Department of the Environment, 1993

    Google Scholar 

  163. Schwartz J, Anderson R. Health effects of air pollution from traffic ozone and paniculate matter. In: Fletcher T, McMichael AJ, editors. Health at the crossroads. Chichester: Wiley, 1997: 61–85

    Google Scholar 

  164. Department of Health Committee on the Medical Effects of Air Pollutants. Asthma and outdoor air pollution. London: HMSO, 1995

    Google Scholar 

  165. Ponkä A, Virtainen M. Low level air pollution and hospital admissions for cardiac and cerebrovascular diseases in Helsinki. Am J Public Health 1996; 86: 1273–80

    PubMed  Google Scholar 

  166. Green M. Air pollution and health. BMJ 1995; 311: 401–2

    PubMed  CAS  Google Scholar 

  167. Dockery DW, Pope CA, Xu X. An association between air pollution and mortality in six US cities. N Engl J Med 1993; 329: 1753–9

    PubMed  CAS  Google Scholar 

  168. Seaton A, MacNee W, Donaldson K, et al. Pariculate air pollution and acute health effects. Lancet 1995; 345: 176–8

    PubMed  CAS  Google Scholar 

  169. Adams WC. Effects of ozone exposure at ambient air pollution episode levels on exercise performance. Sports Med 1987; 4(6): 395–424

    PubMed  CAS  Google Scholar 

  170. Follinsbee LJ. Ambient air pollution and endurance performance. In: Shephard RJ, Åstrand P-O, editors. Endurance in sport. Oxford: Blackwell Scientific, 1992: 479–86

    Google Scholar 

  171. Holmson G, Festing S. Air quality and health. London: Friends of the Earth, 1991

    Google Scholar 

  172. Ayres J. Asthma and the atmosphere. Patients should be given practical advice on how to deal with episodes of severe air pollution. BMJ 1994; 309: 619–20

    PubMed  CAS  Google Scholar 

  173. 18th Report of the Royal Commission on Environmental Pollution, Transport and the Environment. London: HMSO, 1994: 249–50

  174. National Consumer Council. What’s wrong with walking? London: HMSO, 1987: 49–64

    Google Scholar 

  175. David HG, Freedman LS. Injuries caused by tripping over paving stones: an unappreciated problem. BMJ 1990; 300: 784–5

    PubMed  CAS  Google Scholar 

  176. Blair SN, Kohl HW, Barlow CE, et al. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995; 273: 1093–8

    PubMed  CAS  Google Scholar 

  177. General Household Survey 1987; 1990. London: HMSO, 1993; 1995

  178. Siegel PZ, Brackbill RM, Heath GW. The epidemiology of walking for exercise: implications for promoting activity among sedentary groups. Am J Public Health 1995; 85: 706–10

    PubMed  CAS  Google Scholar 

  179. Morris JN. Implications for public health. In: Exercise, health and medicine. London: Sports Council, 1984: 59–60

    Google Scholar 

  180. Morris JN. Epidemiology and prevention. Milbank Mem Fund Q 1982; 60: 1–16

    CAS  Google Scholar 

  181. Hillsdon M, Thorogood M. A systematic review of physical activity promotion strategies. Br J Sports Med 1996; 30: 84–9

    PubMed  CAS  Google Scholar 

  182. Morris JN. Exercise, health and medicine. BMJ 1983; 286: 1597–8

    PubMed  CAS  Google Scholar 

  183. Shephard RJ. Aerobic fitness and health. Champaign (IL): Human Kinetics Publishers, 1994: 85–8

    Google Scholar 

  184. Casperson CJ, Merritt RK, Stephens T. International physical activity patterns. In: Dishman RK, editor. Advances in exercise adherence and public health. In press

  185. Department of Health. More people, more active, more often: physical activity in England [consultation paper]. London: Department of Health, 1995

    Google Scholar 

  186. U.S. Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Alexandria (VA): Virginia International Medical Publishing, 1996: 611–24

    Google Scholar 

  187. DeBusk RF, Stenestrand U, Sheehan M, et al. Training effects of long versus short bouts of exercise in healthy subjects. Am J Cardiol 1990; 65: 1010–3

    PubMed  CAS  Google Scholar 

  188. Jakicic JM, Wing RR, Butler BA, et al. Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Int J Obes 1995; 19: 893–901

    CAS  Google Scholar 

  189. Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. N Engl J Med 1993; 329: 1677–83

    PubMed  CAS  Google Scholar 

  190. Willich SN, Lewis M, Löwel H, et al. Physical exertion as a trigger of acute myocardial infarction. N Engl J Med 1993; 329: 1684–90

    PubMed  CAS  Google Scholar 

  191. Lakka TA, Venäläinen JM, Raurama R, et al. Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men. N Engl J Med 1994; 330: 1549–54

    PubMed  CAS  Google Scholar 

  192. Biddle SJH. Exercise psychology. Sports Sci Rev 1992; 1: 79–92

    Google Scholar 

  193. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Am Psychol 1992; 47: 1102–13

    PubMed  CAS  Google Scholar 

  194. Armstrong C, Sallis J, Hovell M, et al. Stages of change, self-efficacy and the adoption of vigorous exericse. J Sports Exerc Psych 1993; 15: 390–402

    Google Scholar 

  195. Patrick K, Sallis JF, Long B, et al. Pace: physician-based assessment and counselling for exercise. Physician Sportsmed. In press

  196. Trevelyan GM. Walking. In: Clio, a muse and other essays. London: Longman, Green and Co., 1913: 56

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/BF03257359.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morris, J.N., Hardman, A.E. Walking to Health. Sports Med 23, 306–332 (1997). https://doi.org/10.2165/00007256-199723050-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199723050-00004

Keywords

Navigation