Gardening Is Good For Your Health

We certainly feel like we’ve put in a good day’s work, after gardening for hours on end. But is gardening really considered good exercise? For the most part, yes. According to the University of Virginia, gardening rates up there with other moderate to strenuous forms of exercise, like walking and bicycling. It all depends on what gardening task you are doing and for how long. Like any other form of exercise, you have to be active for at least 30 minutes for there to be a benefit.

What Makes Gardening Good Exercise?

While enjoying yourself in the garden, you are also working all the major muscle groups: legs, buttocks, arms, shoulders, neck, back and abdomen. Gardening tasks that use these muscles build strength and burn calories.

Besides the exertion involved, gardening has other pluses that make it a good form of exercise and calorie burning. There can be a great deal of stretching involved with gardening, like reaching for weeds or tall branches, bending to plant and extending a rake. Lifting bags of mulch, pushing wheelbarrows and shoveling all provide resistance training similar to weight lifting, which leads to healthier bones and joints. Yet while doing all this, there is minimal jarring and stress on the body, unlike aerobics or jogging.

Losing Weight by Gardening

Losing weight requires you to burn more calories than you consume and so the amount of weight you’ll lose gardening depends on several factors including your size and the task you are performing.

Some general examples from Iowa State University, below, show how some of the more strenuous gardening tasks can really burn calories.

  • Digging Holes – Men: 197 calories, Women: 150 calories
  • Planting – Men: 177 calories, Women: 135 calories
  • Weeding – Men: 157 calories, Women: 156 calories

The National Institute of Health lists gardening for 30 – 45 minutes in its recommended activities for moderate levels of exercise to combat obesity, along with biking 5 miles in 30 minutes and walking 2 miles in the same time.

More Health Benefits of Gardening

Research is showing that gardening for just 30 minutes daily will help:

  • Increase flexibility
  • Strengthen joints
  • Decrease blood pressure and cholesterol levels
  • Lower your risk for diabetes
  • Slow osteoporosis

Getting the Most Exercise out of Gardening

It takes at least 30 minutes of exercise several days a week, to really receive any health benefits from gardening. However researchers are now saying that you can break that 30 minutes up into shorter active periods throughout the day. As long as each activity lasts at least 8 minutes and is of moderate intensity, when you total them up to 30 minutes per day, you’ll reap the same rewards as if you had been gardening for a half hour straight. So you can do a little weeding in the cool of the morning and go back out to the garden in the evening to prune and trim.

Start slowly, if you’re not used to the exertion. Lift properly, by using your legs. Vary your tasks and your movements and make use of the major muscle groups, to get the most benefit. Aches and pains aren’t necessarily a sign of a good workout. Your muscles may feel tired, but they shouldn’t hurt unless you’re using muscles you haven’t worked in a while or you’re using them wrong.

Gardening isn’t usually enough exercise to forsake your daily walk or swim, but it’s nice to know those tired muscles you feel after turning the compost are actually something good you did for your body and your health. As with any other form of exercise, check with your doctor first, if you’re not used to strenuous exercise. Make sure you incorporate a little stretching before and after gardening and take things slowly in extreme heat. We do garden for the pleasure, after all. Getting in shape and losing weight are just the icing on the cake.


Have Wheels Will Travel

“Have wheels – will travel”.   Cycling is the third most popular recreational activity in the UK with an estimated 3.1 million people riding a bicycle each month.  In the 1980’s the Mountain Bike with its sturdy frame and wide tyres for added stability and durability was introduced, and cycling surged in popularity.   That was when, as an adult I became the proud owner of a bike, and I still love cycling today!  Over the years I have “acquired” other friends cast off bikes, and now my garage houses enough bikes to fit my large or smaller grandchildren and visitors.  We have great fun cycling and exploring the riverside area where I live.

The success of team UK cyclists in the 2012 Olympic Games had a good effect on cycling and highlighted the completive nature of the sport.  The organisers of UK Cycling Events have reported a huge uptake in mass participation events and charity rides since the Olympics.  However the majority of those who re-enter the world of cycling are more likely to do gentler family and social rides than long distance sporting events.  A major retailer reports that vintage style ladies’ bikes designed by Victoria Pendleton, not sporty bikes, are among its best sellers indicating that people are getting on bikes for non-competitive reasons.

As a form of exercise, cycling has broad appeal and most of us from toddlers to pensioners, the able-bodied or people with disabilities can all enjoy cycling.  Cycling is an opportunity to discover places unseen from a car such as woodland paths, unmade tracks, riverside tow paths, and just sometimes – a mountain!  The health benefits are enormous, and all from just pushing pedals around!

Cycling is suitable for people of all ages and abilities, including those with back problems or weight problems, since the body weight is supported during exercise.   It builds stronger leg muscles, (quadriceps and calf), back, arm, neck muscles, it also strengthens our hearts, expands our lungs and improves our circulation.   Unless you are being competitive, cycling is a low-impact type of exercise, so it’s easier on your joints than running or other high-impact aerobic activities.

But it still helps you get into shape!   For example, an hour’s ride will burn up 400 – 650 calories, will tone your legs and bottom and keep you looking and feeling good. If  you ride up hills or off-road, you’ll also work your upper body, and cycling hard and fast is superb aerobic exercise  resulting in a fitter heart and more efficient lungs. The best way to build your cardiovascular fitness on your bike is to ride for at least 150 minutes every week.  To achieve this you could cycle to work a few days during the week or do a couple of shorter rides, with a longer ride at the weekend.  You’ll soon feel the benefits.

Nowadays thousands, young and old don “go faster stripes” to race off on their bikes at high speed in search of fitness and fun.  However we need to keep safe and wearing a cycling helmet is essential, to prevent head injuries if we fall off.  Don’t be tempted to buy a second-hand helmet, it may be damaged and not protect you properly. You should replace your helmet every five years.  When buying check that the helmet is:

  • Marked with the British Standard (BS EN 1078:1997)
  • Fits snugly, positioned squarely on your head
  • Sits just above your eyebrows (not tilted back or tipped forwards)
  • Fastens securely by straps (not twisted) with just enough room for two fingers between chin and strap.

If you intend to cycle at night it’s compulsory to have a white front light, a red rear light and a red rear reflector.   For your further safety you should have amber/yellow pedal reflectors front and back on each pedal.

With these safety precautions in place it’s time to go! If possible miss out cycling on busy roads with dirty vehicles belching out fumes, or if you have to take that particular route, wear a mask.  Whatever your speed a spin outdoors has the added advantage of fresh air, so no matter what the weather is like, get up and go out!  If it’s wet and windy, dress in suitable clothing, don your helmet and be off, the fresh air will clear your head and immediately life begins to look brighter.

Cycling can lift our spirits and will help us put our problems into perspective.  The freedom we feel with the wind blowing on our cheeks, gives us time to identify solutions and put our lives back on track. Cycling is one of the easiest ways to fit exercise into your daily routine because it’s also a form of transport.  It saves you money and is good for the environment.  So don’t delay “on yer bike” and get those wheels turning!


Osteoporosis – Bone Booster Exercises


My Bone Boosters programme consists of a set of easy movements designed specifically to strengthen and preserve bone thickness.  They are exercises you can do in your everyday life, around your home or workplace or in the garden. You need no more than 20-30 minutes a day, for three days a week, though we do ask that you build up to this slowly to avoid possible injury or over-tiring.

Bone Boosters are intended especially for women of 40-plus who are approaching the menopause, but the earlier you start incorporating them into your life, the better.  There is also a special Osteo-Relief section of exercises for those who already suffer from osteoporosis.

But before you start this or any exercise programme, please check with your doctor if you suffer from heart disease, have high blood-pressure, joint problems, back problems, if you are very overweight, have any serious illness, or are convalescing.

If you already have osteoporosis, do not attempt the main Bone Boosters section and, check with your doctor before starting on the special Osteo-Relief.

It is essential that you check the support and equipment you will be using before performing any of the following exercises in your home or even out in the garden, to make sure they are strong enough to take your weight.

How much exercise should we do?

To be effective exercise must be done on a regular basis.   Some physical activity should be undertaken for an hour at least once a week, but preferably more often, up to 5 times a week.  Ideally a generally more active lifestyle must be aimed for, because all exercise and activity is good for us – but inactivity isn’t.

Why is weight bearing exercise so beneficial?

We know that it’s a natural process for women (and men) to lose some density from bone after about the age of 35.  Research over the past 10 years or so has shown that through regular, weight-bearing exercise it is possible to prevent some of the dramatic loss which often occurs in women over 50.   This is largely due to the fall in levels of the female hormone oestrogen at the time of the menopause (or earlier if there has been a premature menopause brought about by hysterectomy).  Genetic inheritance and other factors can also contribute to bone loss.

Weight-bearing exercises or movements that use the bodies own weight will help preserve and even build bone, but the effect only occurs when the weight is repeatedly exerted. Muscles that are attached to either end of the bone force it to twist and bend in response to strike action and jarring movements.  This stress-strengthening effect on bone is boosted if sufficient calcium and Vitamin D are available in the diet – more on this in our chapter on nutrition……

Simple brisk walking, skipping or running all use a hard, vibrating strike action with the weight of the upper body borne by the spine hips, legs and feet.  A push up uses whole body weight and can strengthen shoulders arms and wrists.  Studies by Dr Joan Bassey at the University of Nottingham Medical School Nottingham showed that pre-menopausal women who were encouraged to do a series of little jumps for a controlled period of time on a regular basis, significantly increased the bone density of their ankles, knees and femoral head.

Can you target specific bones?

Introducing additional weights can target specific bones still further.  For example, exercising with dumb-bells puts extra demand on the arms and wrists.  So too does carrying heavy bags of shopping (as long as you keep a straight back and don’t stoop).  Lifting household objects, like heavy cooking pots or the vacuum cleaner, has a similar Bone-Boosting effect.   However care must be taken when carrying awkward and heavy objects to avoid a falls that might cause a fracture.  Twisting off the tight lid of a jar helps wrists and forearms too.

Once you’ve followed my bone boosting exercise programme you will be able to adapt other everyday objects and activities and turn them into your own Bone Boosters.

My Bone Boosters programme targets hips, wrists, and spine particularly, these being most vulnerable to the painful, crippling and sometimes fatal fractures caused as a result of osteoporosis.  So go ahead, enjoy the sessions and make them part of your life.   And may the power they bring be with you.


Before you begin my special Bone Boosters exercise plan it is essential to warm-up by putting your major joints through their natural range of movement.  This will help to maintain mobility, warm up major muscles and raise the pulse.  By adding some stretches to your warm up you will be ready and prepared to continue exercising without the risk of injury.  But the less fit you are, the longer your warm-up needs to be.  An average warm-up should take 5-10 minutes.


So, let’s make a start.  You need to be wearing loose, comfortable clothes and sports shoes if possible.  Clear enough space and use furniture and fittings around the house, like tables, chairs, banisters and the kitchen sink, for support.  Or better still you could exercise outside in the fresh air.  But before performing any exercises in your home or garden, it is essential to check that the support is secure and strong enough to take your weight, and that the ground surface you are working on isn’t wet or slippery.  Don’t exercise until at least an hour after meals, and keep drinking water near at hand to avoid becoming dehydrated.


Check your posture by standing with your feet comfortably apart, your shoulders back but down and relaxed.  (Don’t poke your head forward.) Pull in your tummy muscles, tighten your bottom and tuck your tail under.  This will tilt your pelvis forward.  Your knees should be soft (relaxed).


To mobilise wrists sit in your chair or stand up.  Tuck your elbows into your waist or place them on a table for support and simply circle your hands, working the wrists first 8 times in one direction, then 8 times in the other direction.

3.      WINDMILL

To mobilise shoulders and release tension, place your fingertips on your shoulders.  Bring your elbows together in front of you, then take them up, and back, and draw imaginary circles with your elbows, pulling your shoulder blades apart.   8 times clockwise then 8 times anti-clockwise.

4.      HEAD ROLL

To mobilise neck and release tension, look over your right shoulder with chin parallel to floor.  Slowly drop your chin to your chest and roll it on around to look over your left shoulder.  Return your chin to your chest and roll back up to the right side.  Continue with control, 8 times. Do not roll your head backwards.


To mobilise ankles and toes, stand with your feet comfortably apart, hands on your hips or hold on to a table unit or chair back for support.  Place the toes of your right foot on the ground.  Keep them in place, heel up.  Circle your ankle 8 times clockwise, then 8 times anti-clockwise.  Repeat with your left foot.

6.      SIDE TWIST

To mobilise your upper body, stand with your feet apart, lift your arms up to shoulder level.  Bend your elbows and bring your fingertips together.  Keep your hips facing forward and twist your upper body and head around to the right side only.  Come back to face centre, then take your upper body around and look to the left.  Repeat 8 times.

7.      SIDE REACH

To mobilise the sides of your body, stand with your feet apart and knees relaxed.  With your right arm, reach up and over your head, bending your left knee.  Bring your arm down and transfer your weight on to your right leg and reach up and over with your left hand.   (As if you are climbing up a rope.)  Repeat 8 times to alternate sides.

Benefits of Walking

Evidence of Benefit

We monitor the evidence base for the benefits and harms of walking and funded two comprehensive reviews which are reproduced below. In 2012 William Buckland, the Director of the National Campaign for Walking produced a report for Public Health England and the Ramblers which reinforced the strength of the evidence base – the evidence is very strong that the benefits are considerable and the risks negligible

HEALTH BENEFITS OF WALKING – THE EVIDENCE BASE                                Prepared by Nick Cavill and Charlie Foster
For the National Campaign for Walking funded by the Department of Health, NHS London and Knowledge Into Action
Version Author Date  Comment
1.0 Charlie Foster & Nick Cavill 25/6/2008  
2.0 Charlie Foster & Nick Cavill 21/2/2009 2 papers by Allender added

HEALTH BENEFITS OF WALKING – THE EVIDENCE BASE                                                                     “Walking is the nearest activity to perfect exercise”. Professor J Morris and Dr Adrianne Hardman, 1997[i] 

 1. Introduction

There is now overwhelming evidence about the associations between regular physical activity and a reduction in risk of death, and risk of major diseases like CVD, stroke and diabetes. It contributes to well being and is essential for good health. The considerable evidence base for the links between physical activity and health were reported in the Chief Medical Officer’s (CMO) report[ii].

In many studies, walking is merged with other activities to generate an overall composite measure of physical activity. As walking is one of the most common types of physical activity, we could refer to the evidence that links total physical activity to health outcomes assume that it can be extrapolated to walking. However, there is now sufficient evidence on the independent benefits of walking to health outcomes.

In this report we therefore do not rely solely on evidence about the relationship between physical activity and health and apply that to walking. Wherever possible, we rely on evidence that specifically links walking and health outcomes.

2. The impact of walking on fitness, strength, flexibility and stability of joints

Walking gently stresses the body’s key systems (heart and lungs, muscles, joints and circulation). This stress leads to the body adapting to accommodate the increased demands on it – i.e. becoming fitter. Walking stresses the body at a level that is considered very beneficial to overall health and fitness but is within the reach and ability of all adults and children.

It is important to remember that walking at 3 mph uses up only 30% of the maximum energy consumption of a person aged 25. But, as this decreases by 10% a decade, a person aged 75 walking at the same speed uses up 60% of his / her maximum energy. This principle is central to walking advice or prescription.

Brisk walking can improve cardiovascular fitness[iii]. Even 10-minute brisk walks can increase fitness. One study reported that women walking continuously for 30 minutes on 5 days a week had almost identical increases in fitness as women who split their 30 minutes into three 10-minute walks[iv]. Some younger men and most other adults would improve their fitness if they took up regular brisk walking[v].

We have estimated that encouraging the adult population to walk at 3 mph instead of their slower usual pace would be sufficient to improve their levels of cardiovascular fitness. This message would be appropriate for approximately 6.3 million English adults or 23% of all adults aged 16-74 years (using data from the 1990 National Fitness Survey[vi]. Figure 6 illustrates this.

Figure 6: Average levels of fitness for both genders at different age groups with the reach of brisk walking and its potential impact on improving fitness

Brisk walking would improve fitness for these adults

As muscle strength declines with aging, regular brisk walking can maintain functional capacity and muscle strength. For both men and women there is a strong relationship between stronger muscle strength and brisker preferred walking speed[vii].

Walking and other physical activities can increase joint range of motion, particularly for older adults. Stronger muscles, joints and general flexibility developed and maintained by walking can reduce the likelihood of fallsii. The risks of injury by participating in walking are extremely small[viii].

 3. Mortality and walking

Walking more can bring substantial benefit to health. This benefit is quantified by comparing the risk of specific diseases between people who walk with people who don’t walk. There is a clear dose-response relationship between walking and all-cause mortality[ix]. A physical activity energy expenditure of 500-1,000 kcals per week (about 6-12 miles of walking for an average-weight individual, compatible with the current physical activity recommendations for adults) reduces the risk of premature death by 20-30%ii.

From a public health perspective, helping people to move from a low level of walking to increasing walking levels will produce the greatest reduction in risk. These considerable health benefits hold for both women and men and are evident even up to the age of 80 years. The reduction in relative risk of mortality for adults walking more than 12.4 miles per week compared to adults who walked less than 3 miles per week is 16%[x].

Regular walking across the life course (from childhood to old age) will reduce risk of disease and pre-mature deathi. Figure 7 shows the difference in risk between an active / regular walker and less active / non-walker. The top line (unhealthy non-walker) shows the negative and cumulative effects of inactivity, low fitness and a higher risk of premature illness across the life course.


4. Prevention of diseases and risk factors for disease

Walking reduces the risk of many diseases.

The benefits of physical activity can be gained from activities that can be incorporated into everyday life, such as regular brisk walking…Physical activity does not need to be vigorous to confer protectioniv


Figure 8: Schematic representation of the dose-response relationship between walking and physical activity level and risk of diseaseii

Walking and recovery from illness

Walking is now commonly recommended by doctors as part of recovery from illness or post operative. For example using walking as an exercise therapy can improve long term conditions such as for people with peripheral vascular disease[xi].

 5. Long-term conditions

There are 15 million people in England with a long-term condition[xii]. These conditions account for 80% of the NHS Budget, 80% of GP workload and 60% of hospital inpatient activity. Those over 75 years of age make up 7.6% of the population. 75% of these have a long-term condition.

The main long-term conditions seen in primary care respond to physical activity both in prevention and treatment. These are outlined below:

Coronary Heart Disease

  • CHD causes over 101,000 deaths per year, one in five deaths in men and one in six deaths in women. It causes 20% and 11% of premature deaths in men and women respectively.
  • There are 2.6 million people living with CHD (i.e. angina, MI) in the UK.
  • The total cost of CHD to the economy is £7.9 billion, with 45% due to direct healthcare costs, 40% in productivity losses and 16% due to the costs of informal care.[xiii]

The cost of ischaemic heart disease to the NHS due to physical inactivity has been estimated at 23% of a total spend of £2.3 billion[xiv]. The Foresight report [xv] estimates direct NHS costs of CHD in 2007 to be £3.9 billion, suggesting the total NHS cost of CHD due to physical inactivity to be just over £1 billion.

The effect of walking on CHD is as follows[xvi]:

  • Increased maximal oxygen consumption
  • Relief of angina symptoms
  • Increased heart rate variability
  • Reduces Blood Pressure
  • Reduces body fat
  • Increases fibrinolysis
  • Increases levels of HDL
  • Improves glucose-insulin dynamics.
  • Improved psychological wellbeing
  • Protection from triggering an MI from vigorous activity >6 METS

For a healthy, young or middle-aged person, walking at a ‘normal’ to ‘brisk’ walking pace is enough to reduce the risk of cardiovascular disease and to improve risk factors for cardiovascular diseaseii.

Walking more than four hours per week reduces the risk of hospitalisation for cardiovascular disease by 30% compared to walking less than one hour per week[xvii]. The incidence of CHD is halved by walking over 1.5 miles a day in men compared to men who walked less distance per day[xviii]. Women who walked for exercise for about hours per week enjoyed a 35% reduction in their risk of CHD events compared to women who walked infrequently[xix].

Brisk walking of more than 3.5 hours a week may slow an atheroma, and walking five hours a week may slowly reverse its formation[xx].

Regular brisk risk walking reduces diastolic blood pressure but appears to have no effect on systolic blood pressureii.

Brisk walking for 8-15 miles per week for 6-9 months can increase good cholesterol levels (HDL) and reduce triglyceride levels in the blood[xxi]. Regular stair climbing has been reported to cause increases in HDL cholesterol, and a reduced ratio of total cholesterol to HDL cholesterol[xxii].

Heart Failure

  • There are about 900,000 people with heart failure in the UK, with a steep increase in age from 1% in those under 65 to 15% of those over 85[xxiii].
  • The total cost of treating heart failure in the NHS is £628.6 million, with the 86,000 hospital admissions accounting for over 60% of these costs[xxiv].
  • There are over 7.6 million GP consultations every year for heart failure, costing £103 million[xxv].

Most of the symptoms of heart failure are due to poor perfusion in the peripheral muscles secondary to limited cardiac output. Exercise limitation is usually from leg weakness due to lactate accumulation, leading to shortness of breath because of resulting acidosis. Regular walking therefore improves the peripheral muscle metabolism more than it affects the cardiac output. Regular walking as part of a rehabilitation programme significantly enhances quality of life, helps to retain independence and reduces hospital admissions.


  • There are 68,400 strokes each year in the UK, causing 55,000 deaths and costing the NHS £1.36 billion.
  • Patients who have had a stroke are usually highly de-conditioned, with half the average VO2 maximum.

After a stroke regular walking can increase self-selected walking speed, reduce dependence on external aids (so maintaining independence), and reduce fatigue.

One study reported a decreased risk for stroke across increasing categories of walking pace in women[xxvi].

Most patients who have had a stroke will be encouraged to walk through their physiotherapy-led rehabilitation. There appears to be less structured walking programme for stroke patients. NICE will publish guidelines on stroke rehabilitation in 2009


  • There are 2.2 million people with diabetes in England (4.48% of the population) [xxvii]
  • This will increase to 3.6 million by 2025 (64% increase)
  • Half this increase is from the rise in obesity.

The effects of walking on diabetes include:

  • Improvement in blood sugar control
  • Improved insulin sensitivity
  • Reduction in body fat
  • Cardiovascular protection
  • Stress reduction (Stress can disrupt diabetes control by increasing counter-regulatory hormones, ketones and free fatty acids)
  • Prevention of diabetes in those at high risk[xxviii].

Walking and cycling levels are also associated with reduced risk of type 2 diabetes: those who walk or cycle more are less likely to get type 2 diabetes[xxix]. Walking and other changes can be a better option for helping to manage diabetes in some patients than drugs. The lifestyle changes in diet and increases in daily walking were found to be more effective in reducing the incidence of type 2 diabetes than treatment with the drug metformin (58% versus 31% reduction in risk)[xxx].

Chronic Obstructive Pulmonary Disease (COPD)

  • 900,000 people have a diagnosis of COPD, with half as many again living with COPD without a diagnosis.[xxxi]
  • There are 109,000 COPD admissions, contributing to one million bed days costing the NHS £600 million, with a total cost to the NHS of about £1 billion.
  • COPD causes 24 million lost working days per year.

COPD patients who undertake more walking halve their risk of being admitted as an emergency admission.[xxxii] NICE guidance requires that all COPD patients who can walk attend Pulmonary Rehabilitation (PR). Patients in PR are recommended to walk regularly but there are only isolated schemes that link with organised walking groups. Regular exercise in groups reduces breathlessness and anxiety and increases confidence and independence.

Depression and Anxiety

  • Every day, 25,000 people see their GP with a psychological problem.
  • 7% of the population suffer from Depression and Anxiety at any one time.
  • In 2005, 27.7 million antidepressant prescriptions were written in England, costing £338 million.
  • The cost of depression in lost economic output is £12 billion a year[xxxiii].
  • There is doubt whether most anti depressants are any better than Placebo.[xxxiv]

The Chief Medical Officer states that ‘Physical activity is effective in the treatment of clinical depression and can be as successful as psychotherapy or medication’ii.

NICE recommends that patients with mild depression follow a structured and supervised exercise programme of up to three sessions per week of moderate duration (45 minutes to one hour) for between 10 and 12 weeks. Walking might contribute to this type of regime[xxxv].

Walking can improve self-esteem, relieve symptoms of depression and anxiety, and improve mood[xxxvi]. There is an inverse relationship between daily walking and the reporting of depressive symptoms[xxxvii]. Shorter bouts (10-15 minutes) of brisk walking can induce significant positive changes in mood.


  • Osteoarthritis of the knee and hip is the single most important cause of disability in retirement years, affecting up to 25% of those over 65.
  • The annual cost of treatment to the NHS is £675 million.
  • There are 36 million days lost due to osteoarthritis, costing the economy £3.2 billion in lost earnings.

Regular walking to build up the quadriceps muscles and help reduce weight is the cornerstone of both preventing and reducing symptoms of osteoarthritis of the hip and knee. Three 40-minute walks a week may help to halt the progression of knee osteoarthritis[xxxviii]. Regular walking and other moderate physical activities may be associated with a lower risk of subsequent osteoarthritis, especially among women.[xxxix]

Ironically, most GPs we spoke to said that the most frequent reason why overweight patients with osteoarthritis of the knee could not walk more was because of pain.


  • 24% of the population is obese and by 2050 60% of males and 50% of females will be obese.
  • In men, 18% of social class I and 28% in social class V are obese.
  • In women 10% of social class I and 25% in social class V are obese.
  • The current NHS cost is £1 billion with a projection of £6.5 billion in 2050.
  • The wider cost of obesity is £7 billion, rising to £45.5 billion in 2050.

Obesity is associated with diabetes, hypertension, asthma, osteoarthritis, depression and hyperlipidaemia. All of these are independently improved by regular walking.

Walking uses up about 100kCal per mile regardless of pace. Abdominal weight gain has been reported to be less than peripheral gain for women who walked >4 hours a week than women who walk less than 2 hours.

Below two hours a week walking there appears to be no weight loss.

Walking one hour a day for five days a week at 50-70% VO2 max can promote regional fat loss in the abdominal sites[xl]. This is critical in reducing the risk of diabetes and coronary heart disease. Overall weight may change little as lean body mass increases with exercise. Brisk walking reduces BMI and body weight,and also reduces body compositionii.

Any walking will help children and young adults to maintain energy balance[xli]. Any consistent movement of body weight by regular walking or stair-climbing will contribute to energy expenditure and may help with weight management.

Obesity is the single most common reason for GPs to refer patients for walking schemes and exercise referral schemes.

Walking and Cancer

Fewer studies have examined this relationship compared to other diseases, and the majority has only looked at physical activity rather than walking alone. However there is evidence that physical inactivity is associated with increased risk of colonic, breast (postmenopausal) and endometrium cancer. A faster reported walking pace was associated with a reduced risk of colorectal cancer in men compared to men with a slower walking pace than others[xlii].

6. Walking and children’s health

The Chief Medical Officer has pointed out that there is a strong justification for encouraging young people to be physically active. Physical activity provides an important vehicle for play and recreation, learning physical and social skills,

developing creative intelligence and stimulating growth and fitness.

However, there is relatively little direct evidence (compared with adults) linking physical inactivity in children with childhood health outcomes. The chronic diseases described above require long incubation periods, and children and adolescents very rarely have lifestyle-related diseases such as hypertension, diabetes, osteoporosis or cardiovascular disease.

Promotion of physical activity and walking in childhood does have strong justification however. It:

  • Promotes healthy growth and development of the musculoskeletal and cardio-respiratory systems
  • Helps maintain energy balance and hence healthy weight
  • Lowers risk of hypertension and high cholesterol
  • Generates opportunities for social interaction, achievement and mental well-being.

Walking is an excellent activity for all of these benefits. In addition, it may be that walking patterns track better into adulthood than do sport and leisure pursuits.

7. Economic value of walking

There is currently no economic evaluation of walking.

WHO has recently published guidance on including health effects in economic appraisals of transport interventions[xliii]. This was designed primarily to help transport economists estimate the mortality (and therefore economic) benefits of interventions that increased walking and cycling (such as new footpaths, policies or programmes). The rationale for this work is that 35% of all energy demand is from transport and 80% of this is in road transport. The transport sector is projected to be responsible for 90% of the increase in CO2 emissions until 2010.

The WHO guidance covered walking and cycling but the subsequent Excel model focused only on cycling. WHO is now proposing to extend this model to include walking to provide a practical tool that can be used at local, national and international level to make the case for walking.

This represents an opportunity to strengthen the approach taken to provide an economic appraisal and provide a strong, evidence-based arguments to advocate walking to key policy-makers.

[i] Hardman AE, Morris JN. Walking to health. British Journal of Sports Medicine 1998 Jun;32(2):184

[ii] Department of Health (2004). At least five a week: a report from the Chief Medical Officer. London, Department of Health.

[iii] Murphy MH, Nevill AM, Murtagh EM, Holder RL. The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomized, controlled trials. Preventive Medicine 2007; 44:377-385.

[iv] M Murphy and A E Hardman 1998, ‘Training effects of short and long bouts of brisk walking in sedentary women’ in Medicine and Science in Sports and Exercise 30:1:152-7

[v] Killoran AJ, Fentem P, Caspersen C. Moving on: an international perspectives on promoting physical activity. London: Health Education Authority, 1994.

[vi] Sports Council, Health Education Authority, 1992. Allied Dunbar national fitness survey. Health Education Authority, London.

[vii] American College of Sports Medicine. Exercise and Physical Activity for Older Adults. Medicine & Science in Sports & Exercise 1998.

[viii] Sandolin J, Santavirta, Lattila R, Vuolle P, Sarna S. Sport injuries in a large urban population: Occurrence and epidemiological aspects. International Journal of Sports Medicine 1988; 9:61-66.

[ix] Lee IM, Skerrett PJ. Physical activity and all cause mortality: what is the dose-response relation? Medicine and Science in Sports and Exercise 2001; 33: S459-S471; discussion S493-S494.

[x] Lee I, Paffenbarger R. Physical activity and stroke incidence: the Harvard Alumni Health Study. Stroke 1998;29:2049-54.

[xi] Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. Journal of the American Medical Association 1995; 274: 975-980.

[xii] Our Health, Our Care, Our Say (2006) Department of Health

[xiii] Allender S, Peto V, Scarborough P,  Kaur A, Rayner M. Coronary heart disease statistics 2008. London: British Heart Foundation, 2008.

[xiv]Allender S, Foster C, Scarborough P, Rayner M. The burden of physical activity related ill health in the UK. Journal of Epidemiology and Community Health 2007; 61:344-348.

[xv] Tackling Obesities: Future Choices – Modelling Future trends in obesity & their impact on Health. A Foresight report for Government Office for Science.

[xvi] ACSM’s Exercise management for persons with chronic diseases and disabilities. Durstine JL Moore GE 2002.

[xvii] LaCroix AZ, Leveille SG, hecht JA, Grothaus LC, Wagner EH. Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? Journal of American Geriatric Society 1996; 44: 113-120.

[xviii] Hakim AA, Curb JD, Petrovitch H, Rodriguez BL, Yano K, Ross GW, White LR, Abbott RD. Effects of walking on cornary heart disease in elderly men: The Honolulu Hart Program. Circulation 1999;100:9-13.

[xix] Manson JE, Hu FB, Rich-Edwards JW, Colditz GA, Stampfer MJ, Willet WC, Speizer FE, Hennekens CH. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. New England Journal of Medicine 1999; 341:650-658.

[xx] Hambrecht R, Niebauer J, Marburger C, Grunze M, Kalberer B, Hauer K, Schlierf G, Kubler W, Schuler G. (1993) Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol; 22 (2):478-9.

[xxi] Dishman RK, Washburn RA, Heath GW. Physical activity epidemiology. Champaign, Human Kinetics 2004.

[xxii] Boreham CA, Wallace WF, Nevill A. Training effects of accumulated daily stair-climbing exercise in previously sedentary young women. Preventive Medicine 2000; 30: 277- 281.

[xxiii] Ellis C, Gnani S and Majeed A (2001) Prevalence and management of heart failure in general Practice in England and Wales 1994-1998. Health Statistics Quarterly 11: 17-24.

[xxiv] DH (2002) Hospital Episode Statistics 2000-2001

[xxv] Gnani S et al (2001) Health Statistics Quarterly; Netten et al (1999) PSSRU, University of Kent.

[xxvi] Hu FB, Stampfer MJ, Colditz GA, Ascherio A, Rexrode KM, Willett WC, et al. Physical activity and risk of stroke in women. Journal of the American Medical Association 2000; 283: 2961-2967.

[xxvii] Yorkshire and Humber PHO. Diabetes – key facts, Yorkshire and Humber PHO, 2005.

[xxviii] ACSM’s Exercise Management for persons with Chronic Diseases and disabilities. Human Kinetics 2002.

[xxix] Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women. Journal of the American Medical Association 1999; 282: 1433-1439.

[xxx] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention of metformin. New England Journal of Medicine 2002; 346: 393- 403.

[xxxi] NICE Guidelines on COPD management. Thorax 2004;59(suppl 1); 1-232.

[xxxii] Garcia-Aymerich J, Farrer E, et al Risk factors of readmission to hospital for a COPD exacerbation: A Prospective Study. Thorax 2003;58:100-105.

[xxxiii] LSE The Depression Report The Centre for Economic Performance’s Mental Health Policy Group June 2006

[xxxiv] Moncrieff J, Kirsch I Efficacy of antidepressants in adults. BMJ 2005, 331 155-9

[xxxv] NICE. Depression, NICE Guideline, Second Consultation. London: NHS, 2003, p19, 21.

[xxxvi] See MIND at

[xxxvii] Mobily, K. E., L. M. Rubenstein, J. H. Lemke, M. W. O’Hara, and R. B. WALLACE. Walking and depression in a cohort of older adults: the Iowa 65+ rural health study. J. Aging Physiol. Activ. 4:119-135, 1996

[xxxviii] Ettinger Jr WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). Journal of the American Medical Association 1997; 277: 25-31.

[xxxix] Rogers LQ, Macera CA, Hootman JM, Ainsworth BE, Blair SN. The association between joint stress from physical activity and self-reported osteoarthritis: an analysis of the Cooper Clinic data. Osteoarthritis and Cartilage 2002; 10: 617-622.

[xl] ACSM Exercise Management for persons with chronic diseases and disabilities Ch 23

[xli] The Health of Children and Young People 2003. Chapter 4: Physical Activity

[xlii] Davey Smith G, Shipley M, Batty G et al. Physical activity and cause-specific mortality in the Whitehall study. Public Health 2000;114:308-315.

[xliii] Cavill N, Kahlmeier S, Rutter H, Racioppi F, Oja P. (2008) Economic assessment of Transport Infrastructure and Policies: Methodological guidance on the economic appraisal of Health effects related to Walking and cycling. Rome. World health organization. Http://