Exercise and Cardiovascular Risk Reduction: Can’t Run? Then Walk

August 27, 2013

Equivalent energy expended while walking vs running translates into comparable risk reduction for incident hypertension, elevated cholesterol, and diabetes.

At my age (please don’t ask!), the thought of running for cardiovascular risk reduction is not appealing. My joints will not allow it. However, walking is a different story. In fact, the Centers for Disease Control and Prevention, American Heart Association, and the American College of Sports Medicine are in the walking camp as well. But I have always wondered, “Do you really get as much bang for your buck when you walk instead of run” as our mothers suggested? How about other forms of exercise (swimming to protect ailing joints, for example)? Let’s look at the data.

Two substantial studies lend themselves to analysis of our question: the National Runners’ Health Study 2 and the National Walkers’ Health Study were evaluated by Williams and colleagues.1 The size of each cohort is impressive-33,060 runners and 15,945 walkers. Equivalent energy (the “key” words) expended while walking versus running translated into comparable risk reductions for incident hypertension, elevated cholesterol, and diabetes. Running decreased the risks for incident hypertension, 4.2%; elevated cholesterol, 4.3%; diabetes mellitus, 12.1%; and, coronary heart disease, 4.5% per metabolic equivalent hours per day (METh/d). The corresponding values for walking were: 7.2%, 7.0%, 12.3%, and 9.3%. Furthermore, if, unlike Aristotle, you do not believe in moderation, doubling, tripling, and quadrupling the recommended exercise dose led to incremental further reductions in these risks. To provide an order of magnitude, we are talking about 450 to 750 METh minutes per week. 

When other varieties of exercise (such as strength training) were compared [GREG: To What?] similar outcomes were produced. Unfortunately, there was limited statistical power regarding coronary events based on numbers of persons for these outcome measures. Despite this limitation, similarity between running and walking was again suggested for myocardial infarctions, bypass grafting, angioplasties, and angina.

There are many significant take-home messages here to pass along to your patients: You do not need to pay for a membership to walk (but please be careful in winter ice and snow). You do not need expensive equipment to derive a measurable benefit either. If you have arthritis, you may be able to walk when you cannot run. If arthritis precludes walking as well, then swimming will fill the bill. Remember, it is the amount of MET minutes per week that counts, not how they are achieved.

Exercise is exercise. It does not need to be flashy or painful to help.

If the thought of running or lifting weights has transformed your patients-or you-into a couch potato, do not despair. There are other ways to skin this exercise cat!   

1. Williams PT, Thompson PD. Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction. Arterioscler Thromb Vasc Biol. 2013;33:1085-1091. (Abstract)