The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Can Older Adults Walk Their Way to a Lower Risk of Premature Death?

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Wednesday, Apr 11, 2018

Current physical activity guidelines call for at least 150 minutes of moderate intensity aerobic activity or at least 75 minutes of vigorous intensity aerobic activity each week. Most health-conscious individuals are aware that meeting these guidelines leads to a variety of benefits including a decreased risk of developing or dying from several chronic conditions such as coronary heart disease, heart failure, stroke, type 2 diabetes, and some forms of cancer. Although these benefits have been common knowledge for some time, the majority of American adults do not meet the physical activity guidelines; with older adults even less likely to meet them than younger adults. In fact, only about one-third of adults ages 65 and older meet the minimum recommendations. As the median age of the U.S. population increases, the cost of health care for this older population will increase to a much greater extent than the younger population. It is thus important to identify strategies that will lead to healthy aging in the older population.                   

For ambulatory individuals, walking is a form of physical activity that is free, does not require specific training, and can be done almost anywhere. However, very few studies have examined the relationship between walking and mortality risk in older adults. Accordingly, data from the American Cancer Society’s Cancer Prevention Study was recently published. In 1999, 62178 men and 77077 women with an average age of 70 years completed a comprehensive survey about background and lifestyle habits, as well as personal and family history of chronic disease.

The survey included detailed questions about physical activity. The most important of these questions was as follows: During the past year, what was your average total time per week spent in each of the following activities: walking, jogging/running, lap swimming, tennis/racquetball, bicycling/exercise machines, aerobics/calisthenics, and dancing? Response choices for each activity were: none, 1-19 minutes, 20-59 minutes,1 hour, 1-1.5 hours, 2-3 hours, 4-6 hours, 7-10 hours, or >11 hours. The intensity of each activity was also assessed; for walking the choices were: slow (<2 mph), average (2-2.9 mph), brisk (3-3.9 mph), and very brisk (>4mph).

The sample was then followed for an average of 13 years, during which time 24,688 men and 18,933 women died. When performing the data analyses, researchers carefully took into consideration other factors that might have affected the results such as smoking, body mass index, diet, education level, and personal history of chronic disease. About 6% of men and 7% of women reported no physical activity at baseline. This inactive group was more likely to be lower educated, obese, smoke cigarettes, have diabetes, and less likely to consume fruits and vegetables. Among those in the study who were physically active, 47% of men and 49% of women walked as their only form of activity. Figure 1 below shows the risk of all-cause mortality among four groups, with the emphasis on ‘walking only’ for the three groups who were active.  

As shown in the Figure, the researchers chose to use the group who walked but did not meet current PA guidelines (Group 2) as the referent. This simply means that the remaining 3 groups will be compared with Group 2. Group 1 (no physical activity) had a 26% greater mortality risk than Group 2. Thus, even though Group 2 did not meet minimal physical activity guidelines, they still had a substantially lower mortality risk than Group 1. Group 3, which met 1 to 2 times the recommendations, had a 20% lower mortality risk than Group 2. Group 4, which met double the recommendations, had a slightly greater reduction in risk as compared to Group 3.  

So, for older individuals who choose walking as their sole form of physical activity, the greatest ‘bang for the buck’ in terms of reducing all-cause mortality risk is accumulating between 2-6 hours per week. This study clearly shows that walking, a simple and free activity that can be done almost anywhere, has great potential for improving the health and quality of life for older adults. It would not be unreasonable to assume that this would have a significant and favorable effect on health care costs as well.    

Patel, A., Hildebrand, J., Leach, C., Campbell, P., Doyle, C., Shuval, K., wang, Y., Gapstur, S. Walking in relation to mortality in a large prospective cohort of older U.S. adults. (2017). Am J Prev Med. 1016/j.amepre.2017.08.019

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