walking: your life may depend on it! judith a. flohr, ph.d. professor, kinesiology
TRANSCRIPT
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.
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 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.
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)
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.
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 ?
Women: Risk for Chronic DiseasesBreast Cancer
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
Women: Risk for Chronic DiseasesBreast Cancer
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
Women: Risk for Chronic DiseasesOsteoporosis
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
Women: Risk for Chronic DiseasesOsteoporosis
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
Women: Risk for Chronic DiseasesOsteoporosis
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