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Physical inactivity is estimated to contribute towards almost one in 10 premature deaths from coronary heart disease and one in six deaths from any cause.
Physical activity, of course, has plenty of benefits: it can improve mental health, reduce the risk of depression and, in older adults, improve cognitive function and even lower the risk of falls in those with mobility problems.
The message to increase levels of physical activity seems to be getting through to the public. The findings of a health survey for England in 2021 found that 70% of men and 59% of women managed at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week.
However, for those either without the inclination or sufficient time to achieve these goals, simply going for a walk is a suitable means of reducing the risk of cardiovascular disease. In fact, one comprehensive analysis suggests that walking reduces the risk of dying from any cause by around 11%.
Motivation to move
But what is the best approach to motivate those who don’t currently achieve the currently recommended levels of physical activity?
One approach is to use self-monitoring, which is a component of the psychological technique known as control theory. It is this principle that is incorporated into wearable technologies like smart watches. The basic idea is that an individual receives feedback on their current performance, and the difference between this and their pre-defined target.
Imagine someone is trying to walk 10,000 steps per day and, so far, they have only achieved 6,000. Knowledge of this difference then encourages a behaviour change i.e. further walking, in an attempt to reach their 10,000-step goal.
Although the need to achieve 10,000 steps a day has become ingrained into our collective consciousness, there is no factual basis to this figure. The idea was first proposed in 1964 prior to the Tokyo Olympics. The choice of the number 10,000 was actually an arbitrary figure and selected simply because the Japanese character for 10,000 (万) looks rather like a person walking.
The new study, published in The Lancet Public Health, is a systematic review and meta-analysis. It included 57 studies and looked at eight different health outcomes. The results suggested that, compared to achieving only 2,000 steps per day, managing 7,000 reduced the risk of all-cause mortality by 47%.
In addition, the risk of cancer-related death was reduced by 37% and there was a 14% lower risk of developing type 2 diabetes. There were also significant reductions in the risk of developing depression, falls and dementia.
Among those who achieved the desired 10,000 steps a day, there was a 10% lower risk of death from any cause compared with 7,000 steps. However, the benefits on other outcomes such as cancer-related deaths didn’t really differ from the 7,000-step target.
Although these results suggest potentially large health benefits from walking, it is important to realise that most of the included studies only measured step counts either at a single point in time or over a few days, which might not capture how walking patterns might change over time.
Another limitation is that too few of the studies included patients with chronic health conditions, so are unlikely to reflect most pharmacy patients. Finally, the step model failed to consider the impact of non-weight bearing exercises such as cycling, swimming and rowing, or even weight-training – all of which also have health benefits.
Study implications
Despite these limitations, encouraging people to go for a walk is good for their health. Moreover, while achieving 7,000 steps a day seems to be the sweet spot for optimal health benefits, there are still benefits to a smaller step count – 4,000 steps a day, for example, still reduces the risk of death by 36% compared to doing only 2,000 steps.
Current physical activity guidelines don’t include a daily step count target, but the Lancet study represents a significant public health message. Incorporating a benchmark number of daily steps in addition to the currently recommended 150 minutes of weekly physical activity might be of value and adopted for use as a measure of physical activity.
For pharmacy teams, the key public health message is to encourage patients to go for a walk more often and for as long as possible – and not to become fixated on achieving a specific numerical target.
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