Yale School of Medicine researcher, Dr. F. Perry Wilson, MD talks about the pace of walking may make all the difference to better your health.
Interview conducted by Ivanhoe Broadcast News in 2022.
We’re talking about 10,000 steps, how did that all get started? The thought that 10,000 steps is our daily goal.
WILSON: It’s really been an evolution over the past two decades where research started coming out that found that sedentary lifestyles, people who spend more time sitting, like many of us do in front of computers or behind a desk in an office had higher risks of heart disease, heart attack, stroke, and even cancer. And it looked initially like people who got up and around more had lower risk of that. And soon some early studies started to suggest that there were what are sometimes called threshold effects that hitting higher numbers of steps and 10,000 turned out to be one of these thresholds, that also was a nice round number, seemed to identify a group of people who had substantially lower risk of cardiovascular disease and death. And I think in part because that number is nice and round. And of course, our pedometers have gotten so much better over the past 20 years. Now everything, your phone tracks your steps, your watch tracks your steps. It’s been much easier to keep track, 10,000 really got into the zeitgeist of people who are concerned about their own wellness and health. But it’s a little problematic as well because for some people, 10,000 just seems unachievable.
Is it a case where people who are already concerned about their health are making the point of getting to the 10,000 steps so they’re already healthier as opposed to everyone starting to hit that 10,000 threshold?
WILSON: Yeah, of course. So with every lifestyle behavior, there’s always this concern that people who are healthier are already going to do that thing more often. And it could be walking or running or exercising or taking vitamins or using sunscreen. This applies all over the place. It’s called the healthy-user effect. And it’s certainly something that researchers need to worry about. Now, researchers are aware of this and so what they do is statistical adjustments in these studies that account for things like age and comorbidities and prior diagnoses and oftentimes things like lab values and vital signs and blood pressures. So they really try to untangle this through the use of statistics. It’s not perfect. And I think anyone would say that we can’t be 100 percent certain that if you increase your steps, it is truly going to decrease the risk of heart attack. That being said, it’s very clear that people who increase their steps feel better. It’s clear that it’s a very low-risk intervention. It costs nothing. It’s easy to do if you can find a few minutes here and there to take a walk. And the bulk of evidence really does suggest that in the long-term, it’s going to help you. Not conclusively proven the way you might with a new pharmaceutical drug and a big randomized controlled trial, but the weight of the evidence says it’s helpful and because the risk is so low, it seems like a good idea.
You had mentioned something interesting, a few steps here or there. Is it okay to break them up over the day? Is it as a slow stroll around the house, just as good as going out for a walk at lunch or do your steps matter? The way you take your steps matter?
WILSON: Yeah, it’s really interesting. It seems like steps matter. There was a great study that came out in September of 2022 from JAMA Internal Medicine, which was one of the largest studies and most detailed to look at this across more than 80,000 people in the United Kingdom who are followed up for at least seven years oftentimes much more than that to see what happen to them. And what they found were a couple of interesting things. One, they found that the type of step does matter. They found that if you can walk a little faster, a slightly more brisk pace, even at the same number of steps, was associated with a lower risk of death from heart disease and cancer. So it’s not a bad idea if you’re walking. Ambling is nice and I think enjoying nature is really nice, but a slightly brisker pace, maybe even to the point where you feel it, you’re breathing a little bit heavier might be better for you. They also found that how closely those steps are clumped together matters. So for example, if you’re getting your 3,000 steps a day in a bunch of little packets, walking from your desk to the water cooler and then from your desk to the copying machine and from your couch to the refrigerator not as good as getting those 3,000 steps in a more continuous pattern. For instance, leaving on your lunch break and taking a 15-minute walk around the block. So stringing those steps together probably because it increases the heart rate a little bit, increases the breathing is even better for you. So step- the type of step really does matter.
What about going over 10,000? Is there, if you could do 10,000, gee, should I now shoot for 12 or 15,000? Should you continually try to increase or at what point do the benefits max out?
WILSON: We don’t really know. Part of the problem is that there aren’t that many people who go above 10,000 steps. It’s five miles a day. That’s a fair amount. And the people that go over because there’s not too many of them, it’s a little hard to tell how going up to 15,000 or 20,000 might affect us mere mortals. But one thing I really tell all of my patients that has come out that’s so important is that 10,000 is not in itself a magic number. So again, this large study from the UK showed even people getting 1,000 steps a day. So really not very much at all. Even people getting a 1,000 steps a day had lower risk of cardiovascular disease and cancer than people getting 500 steps a day. And 2,000 have lower risk than 1,000 and 3,000 lower risk than 2,000. In other words, more is better. So I don’t want people to be discouraged looking at 10,000 and saying, oh my gosh, if I can hit that, I shouldn’t even try because really the data suggests that any movement, any getting up and moving around is going to reduce your risk in the long-term.
What do you tell your patients? Do you give them tips to get started so that they don’t get discouraged? Are there three things that you tell them?
WILSON: Yeah, absolutely. So, the first thing is I want to give my patients the equipment to be able to know how many steps they are getting. Most people aren’t counting it in their head. Unfortunately, that’s so easy right now. It’s just a matter of often showing people on their smartphone where the app is that’s tracking their steps. Some people like to get a fitness tracker, like a Fitbit, or an Apple Watch and that can be really useful too. A lot of those devices have social networks built in. We found that’s incredibly effective at getting people up and walking if they can see how much their friends and family are walking. You don’t want to get too competitive. Not everyone wants to opt into this. But a lot of times there’s just a little bit of encouragement to say we’re doing this as a family, we’re doing this as a friend group. We’re all going to get 5,000 steps at least today. And then finally, I tell them to listen to their own bodies. I don’t like people pushing themselves to an arbitrary threshold when that might be too much for them. So I want them to feel what their heart feels like beating, feel how their breathing is, feel how their legs are. Are they feeling strong enough to keep going? Taking a walk is very low-risk. But especially for some of my patients who are older, potentially more frail, I don’t want anyone getting tired and falling down. So listen to your body. Try to get up, try to move, but don’t push it too hard and just gradually increase until you’re at a comfortable place.
Is there a good rule of thumb for increasing every week? Is it like two percent more, five percent more than you did the week before, does it depend?
WILSON: It really depends. And I don’t want people to always continue to increase because there’s not much data that beyond that 10,000 limit we know you’re going to get much more benefit. So I just ask people to do what they can. Oftentimes it’s less the actual number of steps and more what they’re doing with it. So if they tell me, I walk around the block once a day, I’ll say can you walk around the block twice a day? Can we move up to that next level and see where we go?
With a lot of the trackers or with your phone in the pocket, are there some movements that you’re getting credit for that aren’t really helping your health? For example, I swear my husband shakes his leg and that’s why he spends 4,000 steps every day more than mine. These aren’t foolproof ways of measuring, are they?
WILSON: No, they certainly aren’t. And different devices have different sensitivities in terms of actually counting those steps. And so some dedicated step tracking devices, dedicated pedometers are actually quite good, have sophisticated hardware to rule out the tapping of the foot or you’re going on a bumpy road or things like that. But they’re getting better and better, even just the ones in your phone and the things like the Fitbit, Apple Watch, or the WHOOP strap. They continually get better and are getting more and more accurate. And as I tell people, if it’s your behavior to be tapping your foot, well, then you’re going to take that into account. And if you see what your normal level of steps is, whatever it is, try to go a little bit higher than that.
END OF INTERVIEW
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