Intensive interventions can increase walking behavior, according to the results of a review reported in the July issue of Medicine & Science in Sports & Exercise.
"Walking is the most prevalent and preferred method of physical activity for both work and leisure purposes, thus making it a prime target for physical activity promotion interventions," write David M. Williams, PhD, from Brown Medical School and The Miriam Hospital, Centers for Behavioral and Preventive Medicine, in Providence, Rhode Island, and colleagues. "Although researchers have made great strides in understanding the impact of physical activity on biological mechanisms that influence the natural history of chronic diseases, the current challenge is to continue to develop intervention programs that successfully target the psychological and the social–ecological mechanisms."
A search of the literature identified 14 randomized controlled trials of interventions targeting and evaluating walking behavior. Intensive interventions can increase walking behavior in self-selected samples vs controls, even during follow-up periods as long as 10 years. The review also showed that brief telephone reminders seemed to be as effective as longer, more in-depth telephone counseling.
Despite the need for additional trials, the individual studies reviewed supported the efficacy of prescriptions to walk 5 to 7 vs 3 to 5 days per week and at a moderate (vs vigorous) intensity pace. The reviewers report no differences in total walking minutes for a prescription of single or multiple daily episodes of walking.
"Mediated interventions delivering physical activity promotion materials through non–face-to-face channels may be ideal for delivering walking promotion interventions and have shown efficacy in promoting overall physical activity, especially when theory-based and individually tailored," the reviewers write. "Mass media campaigns targeting broader audiences, including those who may not intend to increase their physical activity, have been successful at increasing knowledge and awareness about physical activity but are often too diffuse to successfully impact individual behavior change. Incorporating individually tailored programs into broader mass media campaigns may be an important next step, and the Internet could be a useful vehicle."
Limitations of this review include relative scarcity of randomized controlled trials of walking interventions. Limitations of the interventions include relatively high costs associated with initial development of expert systems and Web sites and the need for additional research to successfully market and deliver these programs to the population as a whole.
"Despite these challenges, theory driven, mediated physical activity promotion programs show excellent promise for increasing walking behavior on a public-health scale," the reviewers conclude.
The National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute supported this study.
Med Sci Sports Exerc. 2008;40:S567-S573.
Clinical Context
Walking is the most prevalent and preferred method of physical activity for both work and leisure purposes, thus making it a prime target for physical activity promotion interventions. Surveillance estimates among US adults report 50% walking at least 3 days per weeks for 30 minutes per occasion or approximately 1.5 hours per week. Overall, 80% of US adults report walking for 10 minutes at a time on at least 1 day per week. The impact of physical activity on the natural history of chronic diseases is well known; the current challenge is to continue to develop intervention programs that target the psychological and the social-ecologic mechanisms that moderate the adoption and the maintenance of physical activity.
The aim of this report was to review studies of walking promotion interventions.
Study Highlights
After searching in PubMed and PsychINFO databases for studies from 1980 forward, the reviewers identified 14 randomized controlled trials and tested interventions specifically targeting and assessing walking behavior.
Results show that among self-selected samples, intensive interventions can increase walking behavior relative to controls. One trial demonstrated long-term maintenance of walking increases among healthy women.
Brief telephone prompts appear to be as effective as more substantial telephone counseling.
More research is needed to determine the efficacy of pedometers as a motivational tool, including potential moderators such as age, sex, and goal type.
Although more research is needed, individual studies support prescriptions to walk 5 to 7 vs 3 to 5 days per week and at a moderate (vs vigorous) intensity pace, with no differences in total walking minutes when single or multiple daily walking bouts are prescribed.
Mediated interventions delivering physical activity promotion materials through non–face-to-face channels may be ideal for delivering walking promotion interventions and have shown efficacy in promoting overall physical activity, especially when theory based and individually tailored.
Mass media campaigns targeting broader audiences, including those who may not intend to increase their physical activity, have been successful at increasing knowledge and awareness about physical activity but are often too diffuse to successfully affect individual behavioral change.
Incorporating individually tailored programs into broader mass media campaigns may be an important next step, and the Internet could be a useful vehicle. However, additional research is needed to successfully market and deliver these programs on a population level.
Pearls for Practice
Although walking has been proven to be associated with numerous health benefits, 80% of US adults report walking only 10 minutes at a time at least 1 day per week.
Findings from studies examining various components of walking interventions have shown that brief telephone prompts may be helpful in increasing walking behavior and that prescribing moderate-intensity walking 5 to 7 days per week may be the most effective method to increase minutes of walking.
Reviewed by Ramaz Mitaishvili, MD
