Walking as an intervention for good psychological health: number of steps or just enjoyment?

I'm once again returning to the topic of walking for health on this blog (see here) and some rather intriguing findings reported by Karen Hallam and colleagues [1] suggesting that adoption of a 100-day 10,000 steps a day program might have some bearing on aspects of mental and psychological health and wellbeing. But there's a bit of a twist...

The activity program in question was something called Stepathlon which, from what I gather, is a corporate initiative to promote health and fitness among employees. I might add that some employees in some occupations probably don't need such initiatives (see here). Various steps (pardon the pun!) are listed on the Stepathlon website including 'forming a team of 5 with your colleagues', getting yourself a pedometer or other fitness tracker that measures steps and then uploading your daily data on to their platform where it is compared with other groups across the world.

Hallam et al report results for nearly 2000 participants based on 'de-identified' data; also including participant reports based on the completion of the "short form of the Depression, Anxiety Stress Scales (DASS)" and the "Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)." The various strands of data were analysed, correlated and the like.

Results: "The results of this study highlight some psychological and wellbeing benefits of being engaged in work based 10,000 step programs." The authors talk about observing a nearly 9% reduction in stress levels, 8% reduction in 'signs of depression' and a 5% reduction in anxiety when comparing pre-program with post-program data. They add: "This reinforces the benefits of this type of exercise regimen as playing a small yet significant role in improving mental as well as physical health."

But...

Things were not however completely straight-forward as the authors also talk about a "lack of a dose response" in terms of the number of steps completed and those psychological health and well being parameters being assessed. This could denote a few things: (a) participation in a program that encourages walking - walking in a group setting - may be beneficial irrespective of the number of steps that are actually taken, and/or (b) the wide variability in the number of daily steps taken over the course of the program - remember it lasted 100 days - scuppers any chance of getting meaningful correlation data between walking and psychological health. Indeed on that last point, authors mention that future work should really take into account things like the self-report nature of uploading daily activity levels and also the fact that within the sample there were "clearly individuals who were more active before commencing the program" and for whom such an intervention might not be all that effective given their already raised starting activity levels.

Still, I do think that this is a good piece of research that should encourage further investigation. Aside from the significant physical health benefits associated with getting more active, I'd also like to think that such a program could be further adapted for various groups, particularly when things like stress, depression and anxiety are considered a part of the clinical picture. Autism springs to mind as one such avenue for further study, based on various evidence [2] including result similarly using the DASS-21 tool. Indeed, on another blogging occasion where I critically discussed the suggestion that "
autism acceptance could contribute to mental health in autism" (see here) again based on DASS scores, I wonder if a group walking 'intervention' (although I'm not so sure about medicalising such an activity) could also be the topic of more study too, added to other research?

And finally... bearing in mind that exercise might have some nootropic value for some (see here and see this recent study [3]), it seems that much of the chatter about sitting around video game playing fostering "a broad range of cognitive abilities such as visual processing, attention, spatial ability, and cognitive control" is not readily supported by the current peer-reviewed evidence...

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[1] Hallam K. et al. “Happy feet”: evaluating the benefits of a 100-day 10,000 step challenge on mental health and wellbeing. BMC Psychiatry. 2018; 18: 19.

[2] Nah YH. et al. Brief Report: Screening Adults with Autism Spectrum Disorder for Anxiety and Depression. J Autism Dev Disord. 2017 Dec 2.

[3] Gmiąt A. et al. Improvement of cognitive functions in response to a regular Nordic walking training in elderly women - A change dependent on the training experience. Exp Gerontol. 2018 Feb 9. pii: S0531-5565(17)30663-0.

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Stepping into big data: who in the world walks the most each day?

With some journalistic flair, the BBC headline titled: 'Do you live in the world's least active country?'' caught my eye recently, discussing the findings reported by Tim Althoff and colleagues [1] (the first edition of their headline mentioned 'laziest' over 'least active'!)

The name of the research game was to analyse captured data on some "68 million days of minute-by-minute step recordings from 717, 527 anonymized users of the Argus smartphone application developed by Azumio." Said data spanned over 100 countries around the world, although researchers chose to zoom in on 46 countries where at least 1000 people had downloaded the app.

Results suggested that there were some quite considerable differences in steps per day according to the country data analysed and also variables such as gender/sex. Participants in Hong Kong for example, irrespective of gender, were top of the walking chart clocking up an average of 6800 steps per day. At the opposite end of the steps per day spectrum, those in Indonesia averaged just 3500 steps per day. The average number of steps per day across all the data analysed was round about the 5000 mark. There are some other potentially important snippets of information also included in the Althoff paper - the concept of 'activity inequality' - but I'm gonna stick with the steps per day data on this occasion.

A few times before on this blog I've talked about steps per day and walking patterns (see here and see here for examples) and what they might mean for health and wellbeing. Being partial to wearing an actigraph day-to-day, I see walking as part of the my own exercise regime and am a fan of things like the 10,000 steps a day challenge. Not least that as well as aiding in maintaining good physical health, there may be various other benefits from walking as part of a consistent exercise regime. Accepting that there may be various reasons why people don't walk perhaps as much as they should - health issues, age, environment and 'walkability' of the environment, etc - I am a little disappointed with the observations emerging from the Althoff paper insofar as how sedentary many people worldwide seemed to be. Yes, the current data was based on an app and so may have a degree of error in terms of it's recording capability (including whether a phone was carried with a person throughout the day or when engaging in other physical activities) but the average steps being counted per day seem to be quite a bit lower than many experts are advising for maintaining optimal health.

And because walking is [typically] free and can be undertaken by most people, I'd personally like to see a bigger push from Governments and the like to get more people back into walking...

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[1] Althoff T. et al. Large-scale physical activity data reveal worldwide activity inequality. Nature. 2017. 10 July.

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I would walk 500 miles... or maybe just 8 miles (a day).

"Desk-bound workers should ‘walk EIGHT miles a day’ to slash risk of heart attacks or stroke" went one headline talking about the findings reported by William Tigbe and colleagues [1]. Drawing on data from over 110 postal workers - "(55 office-workers, 5 women, and 56 walking/delivery-workers, 10 women)" - who wore "activPAL physical activity monitors for seven days", researchers observed some potentially important trends.

Alongside wearing their activity monitors, participants were also assessed on the basis of weight, height, and blood pressure; also providing blood samples pertinent to analyses for cholesterol and triglycerides. Such collected data were used to assess cardiovascular risk based on the PROCAM risk calculator.

Results: those who were described as office workers and had a 'desk job' were generally larger at the waist and showed a slightly larger body mass index (BMI) score. They were also deemed to have an elevated risk of cardiovascular disease (over 10 years) compared with the walking/delivery workers. These observations were discussed in terms of the sedentary behaviours associated with their desk job. By contrast, those who delivered post (i.e. were active for large parts of the day) fared quite a bit better than their desk-bound colleagues, bearing in mind that all study participants were fairly healthy to begin with in terms of being non-smokers for example and not being in current receipt of blood pressure or glucose lowering medicines at time of study.

The 'walk 8 miles a day' headline that followed the Tigbe study was derived from the observation(s) that: "Those with no metabolic syndrome features walked >15 000 steps/day, or spent >7 h/day upright." Metabolic syndrome refers to a collection of symptoms - "a combination of diabetes, high blood pressure and obesity" - that increases the risk of adverse events associated with cardiovascular (dys)function. It seems that being active, or at least not being sedentary, is important for our health - a shocker indeed!

I've covered some of the other research in this area before (see here and see here for examples) and so the Tigbe results really don't come as a surprise. The strengths of the study are multiple in terms of objective measuring of activity (not reliant on the 'how much activity/exercise did you do today' type questionnaires) and all those biochemical measurements taken for participants to complement such findings. Yes, the sample size is OK but not particularly large and yes, these were pretty healthy participants to start with, but the results are nonetheless important.

Obviously one has to be a little careful so as not to imply that being active is the only thing that leads to good health and wellbeing. Science has already heard about how 'you can't outrun a bad diet' [2] and for some people, walking 15,000 steps every day or even standing up for 7 hours a day is going to be a big ask. But as part of a package of 'interventions' to potentially ward off metabolic syndrome or related issues [3], the idea that we should all be quite a bit more active is one that really should be given a lot more consideration...

Music to close, and with the title to this post, what else could I offer?

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[1] Tigbe WW. et al. Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. Int J Obes (Lond). 2017 Jan 31.

[2] Malhotra A. et al. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med. 2015 Aug;49(15):967-8.

[3] Alexander DD. et al. A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk. Mayo Clinic Proceedings. 2017; 92: 15-29.

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Tigbe WW, Granat MH, Sattar N, & Lean ME (2017). Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. International journal of obesity (2005) PMID: 28138134

How many steps a day should I be walking?

Granted, this entry is a slight departure from the usual material to be found on this blog, but I'm going to post it nevertheless. I'm a big fan of walking. I know that probably sounds a little bit obvious, but I'm actually referring to the use of walking as a tool to keeping in shape rather than just getting from A to B.

Tudor-Locke C. et al (2011) Int J Behav Nutr Phys Act.

Here in the UK (and perhaps beyond) there is quite a lot of chatter about the '10,000 steps a day' challenge (see here) and how walking seems to confer quite a lot of physical (and potentially psychological) benefits.

I know it might seem a little arbitrary to say that we should all be working towards 10,000 steps (as many of our health standards seem to be) but there is some evidence emerging that the magic number of 10,000 might be an important standard*.

Anyhow, I stumbled across the paper by Catrine Tudor-Locke and colleagues** (open-access here) who seems to be quite an important name in the area of 10,000 steps. The paper as you'll see talks about how various ages and genders seem to vary in their daily step count and onwards produce some kind of population normative standards.

It's an interesting review but what particularly took my attention in these days of infographics was the picture attached (which can be found here that I've reproduced with all rights reserved to the authors and publishing journal).

There's not too much more for me to say about it aside from 10,000 steps is a nice universal number to aim for but bear in mind this figure might not reflect the daily goal for everyone. It's also interesting that as we age so our step count goes down, which to me at least, suggests that we should all be living life a little more like when we were children (from a walking perspective).

So, with my blogging caveats of not giving medical or clinical advice in full working order, don't be afraid to put on a comfy pair of walking shoes or trainers and go and enjoy the fresh air with a pedometer if you choose or with the knowledge that 10 minutes of fairly brisk walking is equivalent to about 1000 steps...

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* Tudor-Locke C. & Bassett DR Jr. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004;34(1):1-8.

** Tudor-Locke C. et al. How many steps/day are enough? for children and adolescents. Int J Behav Nutr Phys Act. 2011 Jul 28;8:78.

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Tudor-Locke C, Craig CL, Beets MW, Belton S, Cardon GM, Duncan S, Hatano Y, Lubans DR, Olds TS, Raustorp A, Rowe DA, Spence JC, Tanaka S, & Blair SN (2011). How many steps/day are enough? for children and adolescents. The international journal of behavioral nutrition and physical activity, 8 PMID: 21798014