Interventions to promote walking: A systematic review

Physical inactivity increases the risk of many chronic diseases—notably, coronary heart disease, type 2 diabetes, and cancer of the colon. 

Accumulating 30 minutes of moderate intensity physical activity on most days is enough to provide substantial health benefits, but most adults in the United Kingdom do not currently achieve this. Increasing the population level of physical activity, particularly among the most sedentary, has therefore become a leading aim of contemporary public health policy.

Walking has been described as near perfect exercise. Even walking at a moderate pace of 5 km/hour (3 miles/hour) expends sufficient energy to meet the definition of moderate intensity physical activity.

Compared with many sports and other recreational pursuits, walking is a popular, familiar, convenient, and free form of exercise that can be incorporated into everyday life and sustained into old age.

This systematic review was set up to assess the effects of interventions to promote walking in individuals and populations.  It looked at published and unpublished reports in any language identified by searching 25 electronic databases, by searching websites, reference lists, and existing systematic reviews, and by contacting experts.

They found 19 randomised controlled trials and 29 non-randomised controlled studies. Interventions tailored to people's needs, targeted at the most sedentary or at those most motivated to change, and delivered either at the level of the individual  (brief advice, supported use of pedometers, telecommunications) or household (individualised marketing) or through groups, can encourage people to walk more, although the sustainability, generalisability, and clinical benefits of many of these approaches are uncertain.

Evidence for the effectiveness of interventions applied to workplaces, schools, communities, or areas typically depends on isolated studies or subgroup analysis.

They concluded that the most successful interventions could increase walking among targeted participants by up to 30-60 minutes a week on average, at least in the short term. From a perspective of improving population health, much of the research currently provides evidence of efficacy rather than effectiveness. Nevertheless, interventions to promote walking could contribute substantially towards increasing the activity levels of the most sedentary

Web: Source

Back to top

Physical activity and TV viewing in children

This study was carried out in seven European countries in the period 1985–2002. Methods: The data were collected through questionnaires in the survey ‘Health Behaviour in School-aged Children. A WHO Cross-national study’, using nationally representative samples of 11-, 13-, and 15-year-olds.

Between 1985/86 and 2001/02, a standard set of items was used to measure vigorous physical activity and TV watching in the study. Austria, Finland, Hungary, Norway, Scotland, Sweden, and Wales used these measures in all surveys.

The study found that between 1985/86 and 2001/02, there was a slight increase in Finland in the proportions reporting vigorous physical activity 4 or more times a week, whereas no change was observed for the other countries.

Across all surveys and countries boys were more likely to report regular vigorous physical activity than girls. No clear pattern emerged when examining trends over time in TV watching. Boys reported spending more time watching TV than girls in all countries.

The correlation between the two behaviours at the 1986 and 1998 measurement points was non-significant.

The study concludes that the finding that boys were more likely to report regular vigorous physical activity and TV watching confirms results of previous studies. The present study of seven European countries generally indicates stability or a small increase in physical activity of boys and girls aged 11–15 from the mid-1980s to the early 2000s.

Web: Source

Back to top

Warfarin versus aspirin for stroke prevention

This study looked at warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial

Generally anticoagulants are more effective than antiplatelet agents at reducing stroke risk in patients with atrial fibrillation, but whether this benefit outweighs the increased risk of bleeding in elderly patients is unknown. The study assessed whether warfarin reduced risk of major stroke, arterial embolism, or other intracranial haemorrhage compared with aspirin in elderly patients.

973 patients aged 75 years or over (mean age 81·5 years, SD 4·2) with atrial fibrillation were recruited from primary care and randomly assigned to warfarin (target international normalised ratio 2–3) or aspirin (75 mg per day).

Follow-up was for a mean of 2·7 years. The primary endpoint was fatal or disabling stroke (ischaemic or haemorrhagic), intracranial haemorrhage, or clinically significant arterial embolism. Analysis was by intention to treat.

There were 24 primary events (21 strokes, two other intracranial haemorrhages, and one systemic embolus) in people assigned to warfarin and 48 primary events (44 strokes, one other intracranial haemorrhage, and three systemic emboli) in people assigned to aspirin the yearly risk was 1·8% vs 3·8%, the relative risk 0·48. The absolute yearly risk reduction was 2%. The yearly risk of extracranial haemorrhage was 1·4% (warfarin) versus 1·6% (aspirin) .

This study supported the use of anticoagulation therapy for people aged over 75 who have atrial fibrillation, unless there are contraindications or the patient decides that the benefits are not worth the inconvenience.

Web: Source

Back to top