title: A community-based walking trial to improve neighborhood quality of life in older adults: a multilevel analysis Changes in pain and insulin-like growth factor 1 in fibromyalgia during exercise: the involvement of cerebrospinal inflammatory factors and neuropeptides The effect of walking and vitamin B supplementation on quality of life in community-dwelling adults with mild cognitive impairment: a randomized, controlled trial Does moderate-to-high intensity Nordic walking improve functional capacity and pain in fibromyalgia? A prospective randomized controlled trial Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial Can lay-led walking programmes increase physical activity in middle aged adults? A randomised controlled trial Evaluation of group and self‐directed formats of the Arthritis Foundation's Walk With Ease Program Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only. Blood pressure rise with swimming versus walking in older women: the Sedentary Women Exercise Adherence Trial 2 (SWEAT 2) Effects of a Flexibility and Relaxation Programme, Walking, and Nordic Walking on Parkinson's Disease The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis: A knowledge translation randomized controlled trial: Part II: Clinical outcomes Supervised Walking Groups to Increase Physical Activity in Type 2 Diabetic Patients The effects of physical activity in the acute treatment of bipolar disorder: a pilot study. Walking for exercise--does three times per week influence risk factors in type 2 diabetes? The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women. Implications of small reductions in diastolic blood pressure for primary prevention. Effects of a Walking Program on Attributional Style, Depression, and Self-Esteem in Women Walking with its training effects on the fitness and activity patterns of 79-91 year old females. Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care. Effectiveness of physical activity in reducing pain in patients with fibromyalgia: a blinded randomized clinical trial Women walking for health and fitness. How much is enough? The effects of a walking program on body composition and serum lipids and lipoproteins in overweight women. The Effects of Aerobic Training and Nutrition Education on Functional Performance in Low Socioeconomic Older Adults
abstract: Background : Few studies have considered the neighborhood as a context in which to examine the physical activity and quality of life relationship . Purpose : The goal of this study was to evaluate the effects of a neighborhood walking program on  quality of life among older adults . It was design ed as a r and omized trial involving a multilevel design with neighborhoods corresponding to primary sampling units and residents to secondary units . Methods : Five hundred eighty-two communitydwelling senior residents ( 65 years of age or older ) in neighborhoods in the northeast metropolitan area of Portl and , Oregon , were recruited through telephone , direct mail , and referrals . The walking intervention was delivered at the neighborhood level . Neighborhoods ( N = 56 ) were r and omly assigned to a 6-month , 3 times per week , leader-led walking group activity ( n = 28 ) or an information-only control group ( n = 28 ) . Primary outcome measures included SF-12 ( Physical , Mental summary scores ) and life satisfaction ( SWLS ) ; the secondary outcome measure was neighborhood walking activity , assessed at baseline , 3 months , and 6 months of the study period . Results : Compared to the control neighborhoods , results from multilevel , longitudinal analyses indicated significant improvements in the primary outcomes of SF-12 Physical ( p < .05 ) , SF-12 Mental ( p < .05 ) summary scores , and SWLS ( p < .05 ) , over the course of the 6-month intervention . A significant increase was also observed in the secondary outcome of walking activity ( p < .05 ) . Conclusions : Implementing a neighborhood-based walking program of low to moderate intensity is feasible and beneficial for promoting quality of life among senior residents at a community level Abstract Introduction Fibromyalgia ( FM ) is characterized by chronic pain . Impaired growth hormone responses and reduced serum insulin-like growth factor 1 ( IGF-1 ) are common in FM . The aim was to examine changes in serum IGF-1 , cerebrospinal fluid ( CSF ) , neuropeptides , and cytokines during aerobic exercise in FM patients . Methods In total , 49 patients ( median age , 52 years ) with FM were included in the study . They were r and omized to either the  moderate- to high-intensity Nordic Walking ( NW ) program  ( n = 26 ) or the  supervised low-intensity walking ( LIW ) program  ( n = 23 ) . Patients participated in blood tests before and after 15 weeks of aerobic exercise .  Changes in serum levels of free IGF-1 , pain rating on a 0- to 100-mm scale , pain threshold , and 6-minute walk test ( 6MWT ) were examined . CSF , neuropeptides , matrix metalloproteinase 3 ( MMP-3 ) , and inflammatory cytokines were determined . Nonparametric tests were used for group comparisons and correlation analyses . Results Serum free IGF-1 levels did not change during 15 weeks of exercise between the two groups , although the 6MWT significantly improved in the NW group ( p = 0.033 ) when compared with LIW . Pain did not significantly change in any of the groups , but tended to decrease ( p = 0.052 ) over time in the total group . A tendency toward a correlation was noted between baseline IGF-1 and a decrease of pain in response to exercise ( r = 0.278 ; p = 0.059 ) . When adjusted for age , this tendency disappeared . The change in serum free IGF-1 correlated positively with an alteration in CSF substance P ( SP ) levels ( rs= 0.495 ; p = 0.072 ) , neuropeptide Y ( NPY ) ( rs = 0.802 ; p = 0.001 ) , and pain threshold ( rs = 0.276 ; p = 0.058 ) . Differing CSF SP levels correlated positively to a change in pain threshold ( rs= 0.600 ; p = 0.023 ) , whereas the shift in CSF MMP-3 inversely correlated with an altered pain threshold ( rs= -0.569 ; p = 0.034 ) . Conclusions The baseline level of serum free IGF-1 did not change during high or low intensity of aerobic exercise . Changes in IGF-1 correlated positively with a variation in CSF SP , NPY , and pain threshold . These data indicate a beneficial role of IGF-1 during exercise in FM.Trial registration : Clinical Trials.gov NCT00643006 Objectives To examine the effect of walking and vitamin B supplementation on quality -of-life ( QoL ) in community-dwelling adults with mild cognitive impairment . Methods One year , double-blind , placebo-controlled trial . Participants were r and omized to : ( 1 ) twice-weekly , group-based , moderate-intensity walking program ( n = 77 )  or a light-intensity placebo activity program  ( n = 75 ) ; and ( 2 ) daily vitamin B pills containing 5 mg folic acid , 0.4 mg B12 , 50 mg B6 ( n = 78 ) or placebo pills ( n = 74 ) . QoL was measured at baseline , after six and 12 months using the population -specific Dementia Quality -of-Life ( D-QoL ) to assess overall QoL and the generic Short-Form 12 mental and physical component scales ( SF12-MCS and SF12-PCS ) to assess health-related QoL. Results Baseline levels of QoL were relatively high . Modified intention-to-treat analyses revealed no positive main intervention effect of walking or vitamin supplementation . In both men and women , ratings of D-QoL-belonging and D-QoL-positive affect subscales improved with 0.003 ( P = 0.04 ) and 0.002 points ( P = 0.06 ) with each percent increase in attendance to the walking program . Only in men , SF12-MCS increased with 0.03 points with each percent increase in attendance ( P = 0.08 ) . ConclusionS everal small but significant improvements in QoL were observed with increasing attendance to the walking program . No effect of vitamin B supplementation was observed . Trial Registration International St and ard R and omized Controlled Trial Number Register , 19227688 , http://www.controlled-trials.com/is rct Introduction The objective of this study was to investigate the effects of moderate-to-high intensity Nordic walking ( NW ) on functional capacity and pain in fibromyalgia ( FM ) . Methods A total of 67 women with FM were recruited to the study and r and omized either to moderate-to-high intensity Nordic Walking ( n = 34 , age 48 ± 7.8 years ) or to a control group engaging in supervised low-intensity walking ( LIW , n = 33 , age 50 ± 7.6 years ) . Primary outcomes were the six-minute walk test ( 6MWT ) and the Fibromyalgia Impact Question naire Pain scale ( FIQ Pain ) . Secondary outcomes were : exercise heart rate in a submaximal ergometer bicycle test , the FIQ Physical ( activity limitations ) and the FIQ total score . Results A total of 58 patients completed the post-test . Significantly greater improvement in the 6MWT was found in the NW group ( P = 0.009 ) , as compared with the LIW group . No between-group difference was found for the FIQ Pain ( P = 0.626 ) . A significantly larger decrease in exercise heart rate ( P = 0.020 ) and significantly improved scores on the FIQ Physical ( P = 0.027 ) were found in the NW group as compared with the LIW group . No between-group difference was found for the change in the FIQ total . The effect sizes were moderate for the above mentioned outcomes . Conclusions Moderate-to-high intensity aerobic exercise by means of Nordic walking twice a week for 15 weeks was found to be a feasible mode of exercise , result ing in improved functional capacity and a decreased level of activity limitations . Pain severity did not change over time during the exercise period . Trial registration Clinical trials.gov identifier NCT00643006 Objective : To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment ( MCI ) . Design : R and omised placebo-controlled trial . Setting : General community . Participants : Community-dwelling adults aged 70–80 with MCI . Interventions : The 152 participants were r and omly assigned to two interventions : ( 1 ) a twice-weekly , group-based , moderate-intensity walking programme ( WP , n = 77 ) or a low-intensity placebo activity programme ( n = 75 ) for one year ; and ( 2 ) daily vitamin pill containing 5 mg folic acid , 0.4 mg vitamin B-12 , 50 mg vitamin B-6 ( FA/B12/B6 , n = 78 ) or placebo pill ( n = 74 ) for one year . Outcome measures : Cognitive function , measured with neuropsychological tests at baseline and after six and 12 months . Results : Median session attendance at the exercise programmes ( 25th–75th percentile ) was 63 % ( 2%–81 % ) and median compliance with taking pills ( 25th–75th percentile ) was 100 % ( 99%–100 % ) . Gender was an effect modifier . Intention-to-treat analysis revealed no main intervention effect for either intervention . In women in the WP , attention ( Stroop combination task ) improved by 0.3 seconds ( p = 0.04 ) and memory ( auditory verbal learning test ) by 0.04 words ( p = 0.06 ) with each percentage increase in session attendance . In men attending at least 75 % of the sessions , the WP improved memory ( β 1.5 ( 95 % CI : 0.1 to 3.0 ) words ) . Conclusion : The walking programme and /or FA/B12/B6 supplementation were not effective in improving cognition within one year . The walking programme , however , was efficacious in improving memory in men and memory and attention in women with better adherence . Trial registration : International St and ard R and omised Controlled Trial Number Register , 19227688 , http://www.controlled-trials.com/is rct Study objective : To compare health walks , a community based lay-led walking scheme versus advice only on physical activity  and cardiovascular health status in middle aged adults . Design : R and omised controlled trial with one year follow up . Physical activity was measured by question naire . Other measures included attitudes to exercise , body mass index , cholesterol , aerobic capacity , and blood pressure . Setting : Primary care and community . Participants : 260 men and women aged 40–70 years , taking less than 120 minutes of moderate intensity activity per week . Main results : Seventy three per cent of people completed the trial . Of these , the proportion increasing their activity above 120 minutes of moderate intensity activity per week was 22.6 % in the advice only and 35.7 % in the health walks group at 12 months ( between group difference = 13 % ( 95 % CI 0.003 % to 25.9 % ) p=0.05 ) . Intention to treat analysis , using the last known value for missing cases , demonstrated smaller differences between the groups ( between group difference = 6 % ( 95 % CI −5 % to 16.4 % ) ) with the trend in favour of health walks . There were improvements in the total time spent and number of occasions of moderate intensity activity , and aerobic capacity , but no statistically significant differences between the groups . Other cardiovascular risk factors remained unchanged . Conclusions : There were no significant between group differences in self reported physical activity at 12 month follow up when the analysis was by intention to treat . In people who completed the trial , health walks was more effective than giving advice only in increasing moderate intensity activity above 120 minutes per week To evaluate the effects of a revised 6‐week walking program for adults with arthritis , Walk With Ease ( WWE ) , delivered in 2 formats , instructor‐led group or self‐directed OBJECTIVES To evaluate and compare the effectiveness and cost-effectiveness of a leisure centre-based exercise programme , an instructor-led walking programme and advice-only in patients referred for exercise by their GPs . DESIGN A single-centre , parallel-group , r and omised controlled trial , consisting of three arms , with the primary comparison at 6 months . SETTING Assessment s were carried out at Copthall Leisure Centre in Barnet , an outer London borough , and exercise programmes conducted there and at three other leisure centres and a variety of locations suitable for supervised walking throughout the borough . PARTICIPANTS Participants were aged between 40 and 74 years , not currently physically active and with at least one cardiovascular risk factor . INTERVENTIONS The 943 patients who agreed to participate in the trial were assessed in cohorts and r and omised to one of the following three arms : a 10-week programme of supervised exercise classes , two to three times a week in a local leisure centre ; a 10-week instructor-led walking programme , two to three times a week ; an advice-only control group who received tailored advice and information on physical activity including information on local exercise facilities . After 6 months the control group were rer and omised to one of the other trial arms . Assessment s took place before r and omisation , at 10 weeks ( in a r and om 50 % sub sample of participants ) , 6 months and 1 year in the leisure centre and walking arms . The control participants were similarly assessed up to 6 months and then reassessed at the same intervals as those initially r and omised to the leisure centre and walking groups . MAIN OUTCOME MEASURES The primary outcome measures were changes in self-reported exercise behaviour , blood pressure , total cholesterol and lipid subfractions . Secondary outcomes included changes in anthropometry , cardiorespiratory fitness , flexibility , strength and power , self-reported lifestyle behaviour , general and psychological health status , quality of life and health service usage . The costs of providing and making use of the service were quantified for economic evaluation . RESULTS There was a net increase in the proportion of participants achieving at least 150 minutes per week of at least moderate activity in the sport/leisure and walking categories in all three study groups : at 6 months , the net increases were 13.8 % in the leisure centre group , 11.1 % in the walking group and 7.5 % in the advice-only group . There were significant reductions in systolic and diastolic blood pressure in all groups at each assessment point compared with baseline . There were also significant and sustained improvements in cardiorespiratory fitness and leg extensor power , and small reductions in total and low-density lipoprotein cholesterol in all groups , but there were no consistent differences between the groups for any parameter over time . All three groups showed improvement in anxiety and mental well-being scores 6 months after the beginning of the trial . Leisure centre and walking groups maintained this improvement at 1 year . There were no differences between groups . Costs to the participants amounted to pound 100 for the leisure centre scheme and pound 84 for the walking scheme , while provider costs were pound 186 and pound 92 , respectively . Changes in overall Short Form 36 scores were small and advice only appeared the most cost-effective intervention . CONCLUSIONS The results of this trial suggest that referral for tailored advice , supported by written material s , including details of locally available facilities , supplemented by detailed assessment s may be effective in increasing physical activity . The inclusion of supervised exercise classes or walks as a formal component of the scheme may not be more effective than the provision of information about their availability . On cost-effectiveness grounds , assessment and advice alone from an exercise specialist may be appropriate to initiate action in the first instance . Subsidised schemes may be best concentrated on patients at higher absolute risk , or with specific conditions for which particular programmes may be beneficial . Walking appears to be as effective as leisure centre classes and is cheaper . Efforts should be directed towards maintenance of increased activity , with proven measures such as telephone support . Further research should include an up date d meta- analysis of published exercise interventions using the st and ardised mean difference approach Objective Swimming is often recommended in the prevention and treatment of  hypertension . Few studies have investigated the effect of swimming training on blood pressure ( BP ) . Our objective was to evaluate 6 months of supervised moderate swimming or walking on BP in previously sedentary , normotensive , older women . Design Women aged 50–70 years ( n = 116 ) were r and omly assigned to a supervised 6-month swimming or walking programme . They were further r and omized to receive usual care or a behavioural intervention package . Methods Exercise comprised 3 sessions/week with a warm-up , cool down , and 30-min of moderate intensity walking or swimming . BP was recorded for 20 min supine , and 5 min st and ing . Assessment s were made at 0 and 6 months . Results At baseline , mean supine BP ( ± SD ) was 115.7 ± 1.3/66.8 ± 0.7 mmHg . Swimming  improved swim distance by 78.1 m ( 29.3 % ) [ 95 % confidence interval ( CI ) ; 66.7 , 89.4 ] and walk time by 0.58 min ( 3.8 % ) ( 0.41 , 0.74 ) . Walking decreased walk time by 1.0 min ( 6.5 % ) ( 0.81 , 1.19 ) . After adjustment for initial BP , age , hypertension treatment status and change in weight , swimming increased supine and st and ing systolic BP relative to walking by 4.4 mmHg ( 1.2 , 7.5 ) ( P = 0.008 ) and 6.0 mmHg ( 2.6 , 9.5 ) ( P = 0.001 ) , respectively . Supine and st and ing diastolic BP increased by 1.4 mmHg ( −0.14 , 3.0 ) ( P = 0.07 ) and 1.8 mmHg ( −0.02 , 3.5 ) ( P = 0.05 ) , respectively . Conclusion Relative to moderately paced walking , regular swimming significantly elevates BP in previously sedentary , normotensive , older women . This finding may have important implication s for exercise prescription in older subjects Symptoms of Parkinson 's disease ( PD ) progress despite optimized medical treatment . The present study investigated the effects of a flexibility and relaxation programme , walking , and Nordic walking ( NW ) on walking speed , stride length , stride length variability , Parkinson-specific disability ( UPDRS ) , and health-related quality of life ( PDQ 39 ) .  90 PD patients were r and omly allocated to the 3 treatment groups . Patients participated in a 6-month study with 3 exercise sessions per week , each lasting 70 min . Assessment after completion of the training showed that pain was reduced in all groups , and balance and health-related quality of life were improved . Furthermore , walking , and Nordic walking improved stride length , gait variability , maximal walking speed , exercise capacity at submaximal level , and PD disease-specific disability on the UPDRS in addition . Nordic walking was superior to the flexibility and relaxation programme and walking in improving postural stability , stride length , gait pattern and gait variability . No significant injuries occurred during the training . All patients of the Nordic walking group continued Nordic walking after completing the study Background Osteoarthritis ( OA ) is the most common joint disorder in the world , as it is appears to be prevalent among 80 % of individuals over the age of 75 . Although physical activities such as walking have been scientifically proven to improve physical function and arthritic symptoms , individuals with OA tend to adopt a sedentary lifestyle . There is therefore a need to improve knowledge translation in order to influence individuals to adopt effective self-management interventions , such as an adapted walking program . Methods A single-blind , r and omized control trial was conducted . Subjects ( n = 222 ) were r and omized to one of three knowledge translation groups : 1 ) Walking and Behavioural intervention ( WB ) ( 18 males , 57 females ) which included the supervised community-based aerobic walking program combined with a behavioural intervention and an educational pamphlet on the benefits of walking ;  2 )  Walking intervention ( W ) ( 24 males , 57 females ) wherein participants only received the supervised community-based aerobic walking program intervention and the educational pamphlet ; 3 ) Self-directed control ( C ) ( 32 males , 52 females ) wherein participants only received the educational pamphlet . One-way analyses of variance were used to test for differences in quality of life , adherence , confidence , and clinical outcomes among the study groups at each 3 month assessment during the 12-month intervention period and 6-month follow-up period . Results The clinical and quality of life outcomes improved among participants in each of the three comparative groups . However , there were few statistically significant differences observed for quality of life and clinical outcomes at long-term measurements at 12-months end of intervention and at 6- months post intervention ( 18-month follow-up ) . Outcome results varied among the three groups . Conclusion The three groups were equivalent when determining the effectiveness of knowledge uptake and improvements in quality of life and other clinical outcomes . OA can be managed through the implementation of a proven effective walking program in existing community-based walking clubs . Trial registration Current Controlled Trials OBJECTIVE To evaluate the impact of an exercise program organized into supervised walking groups in subjects with type 2 diabetes . RESEARCH DESIGN AND METHODS Fifty-nine diabetic subjects were r and omized to a control group receiving st and ard lifestyle recommendations or an intervention group assigned to three supervised walking sessions per week and counseling .  Changes in metabolic features , weight , 6-min walk test , prescription of antidiabetic medications , and overall physical activity were assessed . RESULTS Functional capacity and overall physical activity were higher in the intervention group , whereas metabolic changes were not different between groups after 4 months . However , in subjects who attended at least 50 % of scheduled walking sessions , changes in A1C and fasting glucose were greater than in control subjects . Discontinuation or reduction of antidiabetic drugs occurred in 33 % of these patients versus 5 % of control subjects ( P < 0.05 ) . CONCLUSIONS Supervised walking may be beneficial in diabetic subjects , but metabolic improvement requires adequate compliance BACKGROUND Physical activity has demonstrated efficacy in depression and anxiety , but its potential in the management of bipolar disorder is yet unexplored . This study is a pilot investigation into the effectiveness of an adjunctive walking program in the acute treatment of  bipolar disorder  . METHODS This is a retrospective cohort study of all patients admitted over a 24-month period to a private psychiatric unit with a primary diagnosis of bipolar disorder ( ICD-10 ) . All patients were invited to participate voluntarily in a walking group during their admissions . Those who reliably attended the walking group ( participants ) were compared against those who did not attend ( non- participants ) , using the clinician-rated Clinical Global Impression Severity ( CGI-S ) and Improvement ( CGI-I ) scales and the self-reported 21-item Depression Anxiety Stress Scales ( DASS ) as primary outcome measures . RESULTS There were 24 admissions for participants and 74 admissions for non- participants . The two groups did not differ significantly in patient demographics or admission CGI and DASS measures , except for a lower DASS Stress subscore for participants ( p=0.049 ) . At discharge , the inter-group differences in CGI measures remained non-significant , but participants had significantly lower scores than non- participants for DASS ( p=0.005 ) and all its subscales ( Depression p=0.048 , Anxiety p=0.002 , Stress p=0.01 ) . LIMITATIONS Method ological limitations include a retrospective design , small sample size , lack of r and omisation or control , and indirect measure of manic symptoms . CONCLUSIONS The results of this trial provide preliminary support for a therapeutic role of physical activity in bipolar disorder , and warrant further investigation with r and omised controlled trials In order to assess the effects of regular walking on metabolic control and cardiovascular risk factors in type 2 diabetes 26 patients from one primary care clinic , aged 60.0+/-7.3 years , participated in a walking program during 4 months . Prescribed exercise was walking for 45 - 60 min three times weekly . A control group of 26 patients from a neighboring primary care clinic , aged 59.3+/-6.2 years , received no exercise instructions . Thus , r and omization was not performed . There were no improvements of blood pressure , body mass index , physical fitness , glycated hemoglobin A1c , fasting plasma glucose or insulin by intention-to-treat analysis . Seventeen patients in the intervention group increased their physical activity and improved systolic blood pressure ; -7.6 mmHg ( -15 to -0.2 ) , diastolic blood pressure ; -4.3 mmHg ( -7.4 to -1.2 ) , body mass index ; -0.6 kg/m2 ( -1.1 to -0.1 ) and total plasma cholesterol ; -0.6 mmol/l ( -0.9 to -0.3 ) , ( mean difference , with 95 % CI ) . We could observe no effects on glucose metabolism in either group . Our results suggest that an increase of regular physical activity  equivalent to 45 min of walking 3 days/week may suffice to improve systolic and diastolic blood pressure , lipid metabolism and BMI in patients with type 2 diabetes The purpose of the research project was to examine the effects of exercise , social support and depression on postnatal women who reported experiencing postnatal depression . A 12-week r and omized , controlled trial was conducted investigating the effects of an exercise intervention group ( a pram-walking programme for mothers and their babies ) compared to a social support group ( non-structured sessions , similar to a playgroup ) .  Participants in both groups had given birth in the past 12 months . Pretest data of physical fitness and structured question naires were compared to post-test effects . The primary outcomes were to reduce the depressive symptomatology and improve fitness levels of participants in the pram-walking group . Secondary outcomes were to improve the social support levels of the participants in both groups and explore women 's views about the programmes . It was hypothesized that the pram-walking group participants would improve their feelings of depression and fitness levels compared to the social support group , but that both groups would improve their perceived levels of social support . The results showed that mothers in the pram-walking intervention group improved their fitness levels and reduced their level of depressive symptomatology significantly more than the social support group . There were no significant changes to social support levels for both groups . Therefore , a direct association between improvement in fitness was related to improvement in depression for the pram-walking group . However , it is also suggested that other factors in combination with improvements in fitness influenced improvements in depression levels . It is recommended that pram-walking programmes for mothers with postnatal depression be implemented as pilot research into existing available services OBJECTIVES To estimate the impact of small reductions in the population distribution of diastolic blood pressure ( DBP ) , such as those potentially achievable by population -wide lifestyle modification , on incidence of coronary heart disease ( CHD ) and stroke . DESIGN Published data from the Framingham Heart Study , a longitudinal cohort study , and from the National Health and Nutrition Examination Survey II , a national population survey , were used to examine the impact of a population -wide strategy aim ed at reducing DBP by an average of 2 mm Hg in a population including normotensive subjects . SETTING / PARTICIPANTS White men and women aged 35 to 64 years in the United States . MAIN OUTCOME MEASURES Incidence of CHD and stroke , including transient ischemic attacks ( TIAs ) . RESULTS Data from overviews of observational studies and r and omized trials suggest that a 2-mm Hg reduction in DBP would result in a 17 % decrease in the prevalence of hypertension as well as a 6 % reduction in the risk of CHD and a 15 % reduction in risk of stroke and TIAs . From an application of these results to US white men and women aged 35 to 64 years , it is estimated that a successful population intervention alone could reduce CHD incidence more than could medical treatment for all those with a DBP of 95 mm Hg or higher . It could prevent 84 % of the number prevented by medical treatment for all those with a DBP of 90 mm Hg or higher . For stroke ( including TIAs ) , a population -wide 2-mm Hg reduction could prevent 93 % of events prevented by medical treatment for those with a DBP of 95 mm Hg or higher and 69 % of events for treatment for those with a DBP of 90 mm Hg or higher . A combination strategy of both a population reduction in DBP and targeted medical intervention is most effective and could double or triple the impact of medical treatment alone . Adding a population -based intervention to existing levels of hypertension treatment could prevent an estimated additional 67,000 CHD events ( 6 % ) and 34,000 stroke and TIA events ( 13 % ) annually among all those aged 35 to 64 years in the United States . CONCLUSIONS A small reduction of 2 mm Hg in DBP in the mean of the population distribution , in addition to medical treatment , could have a great public health impact on the number of CHD and stroke events prevented . Whether such DBP reductions can be achieved in the population through lifestyle interventions , in particular through sodium reduction , depends on the results of ongoing primary prevention trials as well as the cooperation of the food industry , government agencies , and health education professionals Few controlled studies describe the psychological effects of a walking program on non clinical , premenopausal women . This experiment measured the effects of an 8–wk . walking program on female volunteers ( N = 27 ) age 29 to 50 years ( M = 37.4 ) r and omly assigned to a supervised walking group vs a nonwalking group . A repeated- measures , multivariate design was used to analyze blood pressure , resting heart rate , timed mile walk , and scores on self-esteem , depression , and attributional style . The walking group showed significant improvement in the timed mile walk , diastolic blood pressure , and rated self-esteem BACKGROUND Information is lacking about the physiological and psychosocial effects of exercise among very old persons . AIM To investigate the effect of a twice-weekly , six-month progressive walking programme on 38 healthy women in their ninth decade , for evidence of the benefits of exercise . METHODS Aerobic fitness , blood pressure , skinfold thickness and habitual activity patterns were studied in a r and omised controlled trial . Women were chosen , as this is a group of increasing demographic importance for which studies are lacking . RESULTS The training group and control group were not significantly different at baseline . However , after six months of progressive exercise the training group showed lower resting ( p < 0.05 ) and working ( p < 0.005 ) heart rates compared with non-exercising controls . ANCOVA analyses indicated higher scores for the training group compared with the control group for Maximum Current Activity and Normative Impairment Index ( both p < 0.001 ) , which are both components of the Habitual Activity Profile . Morale also significantly improved within the training group ( p < 0.01 ) . CONCLUSIONS These data show the trainability of very old women and the positive impact a low frequency , progressive exercise programme can have on cardiorespiratory fitness and daily living activity patterns . Such improvements are likely to be indicative of an enhanced outlook for independence BACKGROUND Over the last 10 years ' exercise referral schemes ' have been popular even though the evidence for effectiveness of any one-to-one intervention in primary care is deficient . We report the results of a primary care based one-to-one intervention that compared the effect of two communication styles with a no-intervention control group on self-reported physical activity at 12 months . METHODS In all , 1658 middle-aged men and women were r and omly assigned to 30 minutes of brief negotiation or direct advice in primary care or a no-intervention control group . The main outcome was self-reported physical activity at 12 months . Secondary outcome measures included change in blood pressure and body mass index . RESULTS Intention-to-treat analysis revealed no significant differences in physical activity between groups . Brief negotiation group participants who completed the study increased their physical activity significantly more than controls . There was no change in body mass index in any group . The brief negotiation group produced a greater reduction in diastolic blood pressure than direct advice . CONCLUSION If patients whose health may benefit from increased physical activity seek advice in primary care , 20 - 30 minutes of brief negotiation to increase physical activity is probably more effective than similar attempts to persuade or coerce . However , blanket physical activity promotion in primary care is not effective . The most effective way of increasing physical activity in primary care has yet to be determined The purpose of this study was to evaluate and compare the effectiveness of muscle-strengthening exercises ( MS ) and a walking program ( WA ) in reducing pain in patients with fibromyalgia . Ninety women , 30–55 years of age , diagnosed with fibromyalgia according to the American College of Rheumatology 1990 criteria , were r and omized into 3 groups : WA Group , MS Group , and control group . Pain ( visual analog scale ) was evaluated as the primary outcome . Physical functioning ( Fibromyalgia Impact Question naire , FIQ ) , health-related quality of life ( Short-Form 36 Health Survey , SF-36 ) , and use of medication were evaluated as secondary outcomes . Assessment s were performed at baseline , 8 , 16 , and 28 weeks . Intention-to-treat and efficacy analyses were conducted . Sixty-eight patients completed the treatment protocol . All 3 groups showed improvement after the 16-week treatment compared to baseline . At the 28-week follow-up , pain reduction was similar for the WA and MS groups ( P = 0.39 ) , but different from the control group ( P = 0.01 ) . At the end of the treatment , 80 % of subjects in the control group took pain medication , but only 46.7 % in the WA and 41.4 % in the MS  groups . Mean FIQ total scores were lower for the WA and MS groups ( P = 0.96 ) compared with the control group ( P < 0.01 ) . Patients in the WA and MS groups reported higher scores ( better health status ) than controls in almost all SF-36 subscales . MS was as effective as WA in reducing pain regarding all study variables ; however , symptoms management during the follow-up period was more efficient in the WA group OBJECTIVE We studied whether the quantity and quality of walking necessary to decrease the risk of cardiovascular disease among women differed substantially from that required to improve cardiorespiratory fitness . DESIGN A r and omized , controlled , dose-response clinical trial with a follow-up of 24 weeks . SETTING A private , nonprofit biomedical research facility . PARTICIPANTS One hundred two sedentary premenopausal women , 20 to 40 years of age , were r and omized to one of four treatment groups ; 59 completed the study  ( 16 aerobic walkers [ 8.0-km/h group ] , 12 brisk walkers [ 6.4-km/h group ] , 18 strollers [ 4.8-km/h group ] , and 13 sedentary controls ) . Eighty-one percent were white , 17 % black , and 2 % Hispanic . INTERVENTION Intervention groups walked 4.8 km per day , 5 days per week at 8.0 km/h , 6.4 km/h , or 4.8 km/h on a tartan-surfaced , 1.6-km track for 24 weeks . MAIN OUTCOME MEASURES Fitness ( determined by maximal oxygen uptake ) and cardiovascular risk factors ( determined by resting blood pressure and serum lipid and lipoprotein levels ) . RESULTS As compared with controls , maximal oxygen uptake increased significantly ( P less than .0001 ) and in a dose-response manner ( aerobic walkers greater than brisk walkers greater than strollers ) . In contrast , high-density lipoprotein cholesterol concentrations were not dose related and increased significantly ( P less than .05 ) and to the same extent among women who experienced considerable improvements in their physical fitness ( 8.0-km/h group , + 0.08 mmol/L ) and those who had only minimal improvements in fitness ( 4.8-km/h group , + 0.08 mmol/L ) . High-density lipoprotein cholesterol also increased among the 6.4-km/h group , but did not attain statistical significance ( + 0.06 mmol/L ; P = .06 ) . Dietary patterns revealed no significant differences among groups . CONCLUSION Thus , we conclude that vigorous exercise is not necessary for women to obtain meaningful improvements in their lipoprotein profile . Walking at intensities that do not have a major impact on cardiorespiratory fitness may nonetheless produce equally favorable changes in the cardiovascular risk profile Few prospect i ve studies have been conducted with women to examine the effects of walking on body composition and serum lipid profiles .  Overweight women were r and omly assigned to either an exercise EX  ( no. 18 ) or a nonexercise NEX ( no. 18 ) group . The EX group participated in five 45 min sessions/week of brisk walking at 62 + /- 2 % VO2max for 15 weeks . Statistical analysis ( 2 x 3 repeated measures ANOVA ) revealed that the pattern of change in total body weight [ F(2.68 ) = 6.65 , p = 0.002 ] but not body fat percentage , was significantly different between EX and NEX groups ; NEX subjects had a 1.6 + /- 0.5 kg gain in contrast to no change in EX subjects . The pattern of change in serum triglycerides , total cholesterol , and LDL-C was not significantly different between groups . The interaction statistic for HDL-C , however , was significant [ Pillais Trace ( 2.33 ) = 3.73 , p = 0.035 ] with HDL-C tending to rise in the NEX group in contrast to a small decrease in the EX group . Change in kilocalorie intake was positively correlated with change in HDL-C , total cholesterol , and body weight . Change in body weight also correlated positively with change in HDL-C. Our findings suggest that moderate exercise training alone may not be a sufficient stimulus to affect body composition and serum lipid profiles favorably in overweight women Purpose : To describe the population in terms of risk for disability and compare the effects of a walking intervention and nutrition education intervention on risk modification and functional performance in lower socioeconomic older adults using a r and omized controlled study . Methods : Twenty‐six community‐dwelling older adults aged 60 and older were r and omly assigned to a 16‐week walking exercise group or a nutrition education control group .  Peak aerobic capacity and physical function were measured at baseline and post intervention . Physical function was measured using the Medical Outcomes Study Short Form Health Survey Physical Function subscale , Short Physical Performance Battery , Physical Performance Test , and Continuous Scale Physical Functional Performance 10 item test ( CS‐PFP10 ) . Results : Eighty‐five percent of the participants were at risk for pre clinical disability of which 50 % were at risk for moderate disability . The walking exercise group significantly improved in peak aerobic capacity ( 18.9 % ) , physical function ( 25 % ) using the CS‐PFP10 compared to the control group . Conclusion : These findings highlight the importance of physical activity and indicate that walking , a simple exercise that can be done without specialized exercise leader or equipment can significantly increase peak aerobic capacity and physical function in just 4 months
target: There is evidence that walking groups have wide-ranging health benefits .
  The evidence was less clear for other outcomes such as waist circumference fasting glucose , SF-36 ( mental health ) and serum lipids such as high-density lipids .
  There were no notable adverse side effects reported in any of the studies .
  CONCLUSIONS Walking groups are effective and safe with good adherence and wide-ranging health benefits .
  They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity
background: OBJECTIVE To assess the health benefits of  outdoor walking groups .