walking: your life may depend on it! judith a. flohr, ph.d. professor, kinesiology

Walking: Your Life May Depend on It!

Judith A. Flohr, Ph.D.

Professor, Kinesiology

Walking: Your Life May Depend on It!Overview

Women: Risk for Chronic Diseases Cardiovascular Disease Breast Cancer Osteoporosis

How Many Miles Must One Walk to Reduce the Risk?

Women: Risk for Chronic DiseasesCardiovascular Disease

High Blood Pressure Smoking Cholesterol Overweight Diabetes Physical Inactivity

Women: Risk for Chronic DiseasesCardiovascular Disease-Hypertension

Category Systolic(mmHg) Diastolic (mmHg)Prehypertensive 120-139 80-89Hypertensive 140 90Hypertension

Mild 140-159 90-99Moderate 160-179 100-109Severe 180-209 110-119Very Severe > 210 > 120

Women: Risk for Chronic DiseasesCardiovascular Disease-Smoking

0

0.5

1

1.5

2

2.5

3

3.5

4

Non-Smoker1/ 2 pack/ day1 pack/ day> 1 pack/ day

Albany Chicago Chicago Framingham Tecumseh

CH

D M

orta

lity

Rat

ios

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

150 170 200 240 250 290

Total Cholesterol mg/dL

Rel

ativ

e R

isk

Relative Risk of Death, Compared to Lowest Level of Cholesterol

Bray, 2000 inPhysical Activity and Obesity

Women: Risk for Chronic Diseases

Cardiovascular Disease-Cholesterol

Women: Risk for Chronic DiseasesCardiovascular Disease

Blood Level (mg/dL) What it Means Total Cholesterol

< 200 Desirable200-239 Borderline high 240 High

LDL (“Bad” Cholesterol)< 100 Optimal100-129 Near Optimal130-159 Borderline High160-189 High> 190 Very High

Women: Risk for Chronic DiseasesCardiovascular Disease- Cholesterol

Blood Level (mg/dL) What it Means Triglycerides

< 150 Acceptable150-199 Borderline high 200 High

HDL (“Good” Cholesterol)< 40 Low40-59 Acceptable 60 Optimal

Women: Risk for Chronic DiseasesCardiovascular Disease Overweight

0

0.5

1

1.5

2

2.5

3

80 90 100 110 120 130 140 150 160

MenWomen

Relative Weight % of cohort average

Mor

tali

ty r

atio

Women: Risk for Chronic DiseasesCardiovascular Disease-Overweight

Effect of weight gain since age 18

0

1

2

3

4

5

6

19.1 19.1-20.3

20.4-21.5

21.6-23.2

>23.3-5 or more

+5.0-10.9

+ 20 or more

-5 or more-4.9- +4.9+5.0-10.911. - 19.9+ 20 or more

Body Mass Index (kg/m2) at 18 yrs

Relative risk

Weight gain (kgs)2.2 lbs = kg

Women: Risk for Chronic DiseasesCardiovascular Disease-C-Reactive Protein

Physicians Health Study high levels of C-reactive protein

are at risk for stroke and heart attack even if they don't have traditional risk factors like smoking, high cholesterol and obesity.

Healthy postmenopausal women C-reactive protein and 11 other substances. The one-fourth with the highest C-reactive protein

levels were 4.4 times more likely to have had a heart attack or other heart trouble than the one-fourth with the lowest levels.


Ford, Earl (2002) Does Exercise Reduce Inflammation? Physical Activity and C-Reactive Protein Among U.S. Adults Epidemiology 2002:13(5): 561-568.

Sample 13, 748, Leisure time physical activity was inversely associated

with C-reactive protein concentration in a dose-response manner.

Thus, the results from this study support findings from other studies that physical activity favorably affects concentrations of acute phase reactants.


Danesh, et.al. (2004) Moderate increase

“The new findings call into question the clinical value of measuring CRP as a predictor of the risk of CHD and indicate that further research is needed to clarify the place of this approach in clinical medicine.” (Tall, NEJM p.1450, 2004)

Women: Risk for Chronic DiseasesCardiovascular Disease - Blockage

Heart Disease in MenBlockages tend to be in thelarge arteries

Heart Disease in WomenWomen also develop blockages in large arteries but appear more likely than men to develop“microvascular disease”- blockages in the small arteries

Women: Risk for Chronic DiseasesCardiovascular Disease - Plaques

Heart Disease in Men Plaque often builds to form Large blockages easily spottedBy standard tests

Heart Disease in WomenPlaque is often diffused along the lining of the arteries and blood vessels

Women: Risk for Chronic DiseasesCardiovascular Disease – blood vessel malfunction

Heart Disease in Women Endothelium-inner lining

of vessels Normal constriction and

dilation Malfunction

No dilation or Collapse momentarily, or Abrasion-lining erodes Increased risk of heart

attack

Spasms

!!

Women: Risk for Chronic DiseasesCardiovascular Disease – Heart Attack

• Women Heart Attacks• Women -heart attacks 10-20 years

later than men

• A woman’s heart attack is likely to be fatal.

• Many women do not experience feel-pain in the chest and arm

• Heart attacks in women may have more to do with spasms than blocked arteries.

How Many Miles Must You Walk?

Age Adjusted Relative Risk of Cardiovascular Disease According to Energy Expenditure from Walking

1

0.85

0.7 0.660.55

1 1

0.670.73

0.65

0

0.2

0.4

0.6

0.8

1

WHITE Women Black Women

0 0.1-2.5 2.6-5.0 5.1-10. > 10.0

Age

-Ad

just

ed R

elat

ive

Ris

k o

f C

ard

iova

scu

lar

Dis

ease

Energy Expenditure from walking (MET hr/week)

Manson, JE. Walking compared with vigorous exerciseFor the prevention of cardiovascular events in women. N Engl J Med, Vol 347 (10) 716-725. September 2002

Physical Activity MET h-wkWalking @ 3.5 mph = 4 METs x 1.5 hr/wk = 6 MET hr/week

Association of Walking and Vigorous Exercise with Age Adjusted Relative Risk of CVD

1

0.780.71 0.70.72

0.49

0.67

0.430.37

00.1

0.20.3

0.40.5

0.60.70.8

0.91

< 2.5 2.6-10 >10

0 min/wk1-100 min/wk>100 min/wk

Energy Expenditure from Walking (MET hr/week)

Age

Ad

just

ed R

elat

ive

Ris

k o

f C

VD

Manson, JE. Walking compared with vigorous exerciseFor the prevention of cardiovascular events in women. N Engl J Med, Vol 347 (10) 716-725. September 2002

Multivariate Relative Risk of CVD and Relative Risk Adjusted for Age and Walking Time, According to Walking Pace

1 11.071.06

0.73

0.86

0.57

0.76

0.4

0.58

0

0.2

0.4

0.6

0.8

1

1.2

Rare/Never <2 mph 2 to 3 mph 3 to 4 mph >4 mph

Adjusted for ageand walkingtime, P for trend<.001Multivariate, Pfor trend=.002

Walking Pace (mph) among WalkersRel

ativ

e R

isk

of

Car

dio

vasc

ula

r D

isea

se

US Mortality, 2001

Source: US Mortality Public Use Data Tape 2001, National Center for Health Statistics, Centers for Disease Control and Prevention, 2003.

1. Heart Diseases 700,142 29.0

2. Cancer 553,768 22.9

3. Cerebrovascular diseases 163,538 6.8

4. Chronic lower respiratory diseases 123,013 5.1

5. Accidents (Unintentional injuries) 101,537 4.2

6. Diabetes mellitus 71,372 3.0

7. Influenza and Pneumonia 62,034 2.6

8. Alzheimer’s disease 53,852 2.2

9. Nephritis 39,480 1.6

10. Septicemia 32,238 1.3

Rank Cause of Death No. of deaths

% of all deaths

Cancer Incidence Rates* for Women, US, 1975-2000

*Age-adjusted to the 1970 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1973-1998, Division of Cancer Control and Population Sciences, National Cancer Institute, 2001.

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control andPopulation Sciences, National Cancer Institute, 2003.

0

50

100

150

200

25019

75

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

Breast

Lung

Uterine corpus

Ovary

Rate Per 100,000

Colon & rectum

Women: Risk for Chronic DiseasesBreast Cancer

Risk Factors You Cannot Change Sex Age Genetics

(mutations of BRCA1, BRCA2)

Family History Personal history Previous abnormal breast

biopsy Menstrual periods

Early menarche < 12 Late menopause > 55

Lifestyle Related Factors Children

No children, First child after 30 yr

Oral contraceptives? Hormone Replacement

Therapy (HRT) Alcohol 2-5 drinks/day Obesity (esp. > menopause) High Fat Diet?

Physical Activity Environmental Pollution Smoking ?


0

200

400

600

800

1000

1200

Age 18 Age 35 Age 50

No Strenous PAYes Srenous PA

# of cases

Risk of Breast Cancer According to Past Participation in Strenuous Physical Activity (PA) at Ages 18, 35, 50 Years.

McTiernan, A. et al. JAMA Vol. 290 (10):1331-1336

74,171 women age 40-79Followed 4.7 years


0

100

200

300

400

500

none < 5MET-h/wk

5.1-10METhr/wk

10.1-20

METhr/wk

20.1-40

METhr/wk

> 40METhr/wk

McTiernan, A. et al. JAMA Vol. 290 (10):1331-1336

# of cases

74,171 women age 40-79Followed 4.7 years

MET hr/wk=Walk speed 2-3 mph = 3 METSWalk hours/ week = 5MET hr/week = 15

People with osteoporosis do not just die;they slowly break apart.” - Linda Johnson

Women: Risk for Chronic DiseasesOsteoporosis

Women: Risk for Chronic DiseasesOsteoporosis-Risk factors

Female Age Estrogen Deficiency Caucasian/Asian race Low Weight or BMI Diet Low in Calcium

Alcohol Abuse

Inactivity Muscle Weakness Family History Smoking History of Prior

Fracture


0

5

10

15

20

25

30

LowestThird

MiddleThird

Highestthird

0-23--4

> = 5

Clinical Risk Factors IndependentlyPredict Hip Fracture Risk

Hip

Fra

ctu

re R

ate

(per

100

0 w

omen

yea

rs)

Cummings et al. NEJM 332(12):767-773, 1995

Risk Factors


Lifetime Risk of Hip Fracture at Age 50

Women MenCurrent estimate 13.9% 4.6%

Adjusting for improvingLife expectancy 22.7% 11.1%

Adjusting for increasingHip fracture incidence 34.9% 17.0%

30 minutes or more of moderate physical activityon most, preferably all, days of the week

Weight bearingexercises such as walking

Strength training2 to 3 times per week

Balance training

for falls prevention


Physical Activity Recommendations(50+ years of age)

Summary

“Lifelong physical activity promotes health and well-being for women throughout the lifecycle. Exercise benefits include the prevention of many common disorders such as heart disease, high blood pressure, non-insulin dependent diabetes, osteoporosis, and cancers of the breast, colon, and reproductive organs. Regular physical activity contributes to lifelong weight control and functional independence in old age.

SummaryPhysical Activity

Mental health benefits include psychological well being, the alleviation of depression,and improved body image. Education regarding the benefits of physical activity must be accompanied by access to enjoyable physical activity opportunities for girls and women of all ages and socioeconomic backgrounds.”

Brehm, B.A. & J. G. Iannotta J. Hlth. Educ. Vol 29(2) p. 89

walking: your life may depend on it! judith a. flohr, ph.d. professor, kinesiology

Documents

high slide

risk of chd

optimal slide

high cholesterol

kinesiology slide

obesity women

traditional risk factors

overview women