Walking: Your Life May Depend on It

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Walking Your Life May Depend on It!

• Judith A. Flohr, Ph.D.
• Professor, Kinesiology

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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?

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Women Risk for Chronic DiseasesCardiovascular
Disease

• High Blood Pressure
• Smoking
• Cholesterol
• Overweight
• Diabetes
• Physical Inactivity

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Women Risk for Chronic DiseasesCardiovascular
Disease-Hypertension
Category Systolic(mmHg) Diastolic
(mmHg) Prehypertensive 120-139 80-89 Hypertensive
140 90 Hypertension Mild 140-159 90-99 Mod
erate 160-179 100-109 Severe 180-209 110-119
Very Severe gt 210 gt 120
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Women Risk for Chronic DiseasesCardiovascular
Disease-Smoking
CHD Mortality Ratios
Albany Chicago Chicago Framingham Tecumseh
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Women Risk for Chronic DiseasesCardiovascular
Disease-Cholesterol
Relative Risk of Death, Compared to Lowest Level
of Cholesterol
Relative Risk
Total Cholesterol mg/dL
Bray, 2000 in Physical Activity and Obesity
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Women Risk for Chronic DiseasesCardiovascular
Disease

• Blood Level (mg/dL) What it Means
• Total Cholesterol
• lt 200 Desirable
• 200-239 Borderline high
• ? 240 High
• LDL (Bad Cholesterol)
• lt 100 Optimal
• 100-129 Near Optimal
• 130-159 Borderline High
• 160-189 High
• gt 190 Very High

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Women Risk for Chronic DiseasesCardiovascular
Disease- Cholesterol

• Blood Level (mg/dL) What it Means
• Triglycerides
• lt 150 Acceptable
• 150-199 Borderline high
• ? 200 High
• HDL (Good Cholesterol)
• lt 40 Low
• 40-59 Acceptable
• ? 60 Optimal

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Women Risk for Chronic DiseasesCardiovascular
Disease Overweight
Mortality ratio
Relative Weight of cohort average
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Women Risk for Chronic DiseasesCardiovascular
Disease-Overweight
Effect of weight gain since age 18
Relative risk
Weight gain (kgs) 2.2 lbs kg
Body Mass Index (kg/m2) at 18 yrs
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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.

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Women Risk for Chronic DiseasesCardiovascular
Disease-C-Reactive Protein

• Ford, Earl (2002) Does Exercise Reduce
  Inflammation? Physical Activity and C-Reactive
  Protein Among U.S. Adults Epidemiology
  200213(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.

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Women Risk for Chronic DiseasesCardiovascular
Disease-C-Reactive Protein

• 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)

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Women Risk for Chronic DiseasesCardiovascular
Disease - Blockage
Heart Disease in Women Women also develop
blockages in large arteries but appear more
likely than men to develop microvascular
disease- blockages in the small arteries
Heart Disease in Men Blockages tend to be in
the large arteries
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Women Risk for Chronic DiseasesCardiovascular
Disease - Plaques
Heart Disease in Women Plaque is often diffused
along the lining of the arteries and blood
vessels

Heart Disease in Men Plaque often builds to form
Large blockages easily spotted By standard tests
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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
!
!
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Women Risk for Chronic DiseasesCardiovascular
Disease Heart Attack

• Women Heart Attacks
• Women -heart attacks 10-20 years later than men
• A womans 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.

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How Many Miles Must You Walk?
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Age Adjusted Relative Risk of Cardiovascular
Disease According to Energy Expenditure from
Walking
Energy Expenditure from walking (MET hr/week)
Age-Adjusted Relative Risk of Cardiovascular
Disease
Physical Activity MET h-wk Walking _at_ 3.5 mph 4
METs x 1.5 hr/wk 6 MET hr/week
Manson, JE. Walking compared with vigorous
exercise For the prevention of cardiovascular
events in women. N Engl J Med, Vol 347 (10)
716-725. September 2002
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Association of Walking and Vigorous Exercise with
Age Adjusted Relative Risk of CVD
Age Adjusted Relative Risk of CVD
Energy Expenditure from Walking (MET hr/week)
Manson, JE. Walking compared with vigorous
exercise For the prevention of cardiovascular
events in women. N Engl J Med, Vol 347 (10)
716-725. September 2002
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Multivariate Relative Risk of CVD and Relative
Risk Adjusted for Age and Walking Time, According
to Walking Pace
Relative Risk of Cardiovascular Disease
Walking Pace (mph) among Walkers
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US Mortality, 2001
Rank
Cause of Death
No. of deaths
of all deaths

• 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. Alzheimers disease 53,852 2.2
• 9. Nephritis 39,480 1.6

Source US Mortality Public Use Data Tape 2001,
National Center for Health Statistics, Centers
for Disease Control and Prevention, 2003.
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Cancer Incidence Rates for Women, US, 1975-2000
Rate Per 100,000
Breast
Colon rectum
Lung
Uterine corpus
Ovary
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 and Population Sciences, National
Cancer Institute, 2003.
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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 lt 12
• Late menopause gt 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. gt menopause)
• High Fat Diet?
• Physical Activity
• Environmental Pollution
• Smoking ?

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Women Risk for Chronic DiseasesBreast Cancer
74,171 women age 40-79 Followed 4.7 years
Risk of Breast Cancer According to Past
Participation in Strenuous Physical Activity
(PA) at Ages 18, 35, 50 Years.
of cases
McTiernan, A. et al. JAMA Vol. 290 (10)1331-1336
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Women Risk for Chronic DiseasesBreast Cancer
74,171 women age 40-79 Followed 4.7 years
of cases
MET hr/wk Walk speed 2-3 mph 3 METS Walk
hours/ week 5 MET hr/week 15
McTiernan, A. et al. JAMA Vol. 290 (10)1331-1336
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Women Risk for Chronic DiseasesOsteoporosis
People with osteoporosis do not just diethey
slowly break apart. - Linda Johnson
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Women Risk for Chronic DiseasesOsteoporosis
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Women Risk for Chronic DiseasesOsteoporosis-Risk
factors

• Alcohol Abuse
• Inactivity
• Muscle Weakness
• Family History
• Smoking
• History of Prior Fracture

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

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Women Risk for Chronic DiseasesOsteoporosis
Clinical Risk Factors Independently Predict Hip
Fracture Risk
Hip Fracture Rate (per 1000 women years)
Risk Factors
Cummings et al. NEJM 332(12)767-773, 1995
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Women Risk for Chronic DiseasesOsteoporosis
Lifetime Risk of Hip Fracture at Age
50 Women Men Current estimate 13.9
4.6 Adjusting for improving Life
expectancy 22.7 11.1 Adjusting for
increasing Hip fracture incidence 34.9 17.0
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Women Risk for Chronic DiseasesOsteoporosis
Physical Activity Recommendations (50 years of
age)
Balance training for falls prevention
Strength training 2 to 3 times per week
Weight bearing exercises such as walking
30 minutes or more of moderate physical
activity on most, preferably all, days of the week
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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.

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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
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