Volume 11, Number 7
In my teaching with medical students and residents, I emphasize talking less and listening more. At least with behavioral matters, patients themselves have much more knowledge about their own habits, challenges, environment, motivation, and concerns than can their health care providers.
As it turns out, asking patients a few questions about their own health status can potentially lead to better predictions about their health prospects than can laboratory values or medical tests. A study just published in The Lancet examined nearly 500,000 individuals in the United Kingdom and found that self-reported health status and self-reported walking speed were better predictors of 5-year mortality (likelihood of dying within five years of any cause) than were biological or physical measures (e.g., blood work, lung function, blood pressure, pulse rate, body shape and size, and body fat). Walking speed better predicted mortality than did smoking habits or other lifestyle behaviors. The individuals in the study ranged in age from 37 to 73 years old.
The question participants were asked about walking speed was quite simple: “How would you describe your usual walking pace?” The response options were slow pace (less than 3 miles per hour), steady average pace (between 3-4 miles per hour), or fast pace (more than 4 miles per hour). Of course, reporting a slow walking pace was associated with a higher risk of death. Similarly, the question about self-reported health was simple: “In general how would you rate your overall health?” Response options here were excellent, good, fair, or poor.
This isn’t the only study that has found a link between gait speed and mortality. A study published in PLOS ONE in 2013 followed approximately 39,000 recreational walkers in the United States (National Walkers Health Study) and revealed an increased risk of death (from all causes) associated with each additional minute per mile of walking pace. Participants were followed for approximately 9 years. The risk was especially high for a pace of 24 minutes per mile or greater (i.e., 2.5 miles per hour or less). Data from the Whitehall II study (longitudinal study in the United Kingdom), published in Age in 2013, similarly indicated that persons with a slower walking pace were more likely to die over the 6 year follow-up period. Furthermore, this investigation found that markers of inflammation (e.g., C-reactive protein, interleukin-6), associated with a range of illnesses, were higher among those with a slower walking speed. All three of the mentioned studies are noteworthy in that they examined middle-age persons, rather than elderly individuals (in which walking speed had previously been established as an important health indicator).
According to the Centers for Disease Control and Prevention (CDC), as of 2010 approximately 60% of adults in the United States walked at least 10 minutes in the previous week. However, less than half of adults are getting the recommended 150 minutes per week of moderate intensity aerobic activity, such as fast-pace walking. There is certainly a need for improvement.
Walking is good for health. Walking faster (but safely) is even better.
NOTE: If you are between the ages of 40-70 and would like to learn your health prospects for the next five years according to data from the Lancet study, you can complete the questions on the Risk Calculator at www.ubble.co.uk.by