Could a 20-minute daily walk help reduce disparities?

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Adults who are older, female, Black, or have disabilities may be more at risk of cardiovascular health problems. Mascot/Getty Images
  • A new scientific statement from the American Heart Association documents a lack of physical activity opportunities for many people.
  • Many people facing barriers to exercise are also in groups that are at especially high risk of cardiovascular disease (CVD).
  • The statement says that a simple 20-minute walk may be one way to begin addressing CVD risk disparities.
  • Experts and the American Heart Association (AHA) support greater involvement by healthcare providers in patients’ exercise habits, along with more equitable infrastructure support from local and national government entities.

It is common knowledge at this point that exercise — including brisk walking — is important for one’s health, especially cardiovascular health. Some people, however, face significant barriers to getting sufficient exercise. There is a disproportionate incidence of cardiovascular disease among such people.

The American Heart Association (AHA) recently released a scientific statement intended to help address disparities in opportunities for exercise to improve cardiovascular health for all Americans.

The AHA suggests that even a short, 20-minute brisk walk each day can help people maintain cardiovascular health.

Less than one in four adults partake in the recommended 150 minutes a week of moderate physical activity.

People at higher cardiovascular risk include older people, people with disabilities, Black people, people with lower socioeconomic status living in both urban and rural areas, and people with mental health challenges such as depression.

Calling on physicians and other healthcare providers, legislators, and governmental agencies, the AHA envisions a broad coalition working together to provide more equitable investments in health. This includes prioritizing individuals’ activity levels and allocating more resources to help those in high risk groups make physical activity a part of their everyday lives.

The AHA’s scientific statement is published in the journal circulation.

Obesity, hypertension, diabetes, high cholesterol, and smoking are linked to higher incidences of CVD.

Making things worse, CVD risk factors are also associated with a lack of physical activity for people who have them, adding yet another risk factor.

According to the AHA, there is strong evidence that people with obesity, hypertension, and diabetes do not get enough heart-healthy exercise.

On the other hand, research findings are inconsistent or insufficient, the statement says, for concluding that high cholesterol and smoking also inhibit physical activity.

There are also various other obstacles that inhibit a healthy lifestyle among groups at high risk of CVD. The AHA highlights urban and rural areas, as different as they are, as environments where it may be more difficult to, for example, go for a walk than it might be.

“The greatest barriers to physical activities, such as walking, in rural or urban areas are a lack of sidewalks, places to walk to (parks, green spaces, malls, etc.), walking access to public transportation stops, safe walking routes, and in certain areas of the country, unhealthy levels of air pollution and/or extreme temperatures,” said Dr. Paul Arciero, a professor in the Health and Human Physiological Sciences Department at Skidmore College, who was not involved in the study.

Dr. I-Min Lee, professor of medicine at Harvard Medical School, who was not involved in the study, also said:

“Limited access to recreational facilities, lack of sidewalks, [and] weather — can’t change this — in rural areas. Similar to urban areas, plus lack of infrastructure such as walking access to transit stops and bicycle lanes.”

“Personal care physicians and other healthcare personnel play a pivotal role in bridging the gap between the scientifically proven health benefits of walking and patient outcomes regarding adherence/compliance with exercise recommendations such as walking,” pointed out Dr. Arciero.

He said healthcare providers should pay more attention to patients’ physical activity habits than they might already do.

“Always ask your patients about what they are doing, and encourage any level of physical activity. Physicians themselves also need to be physically active — not only to set a good example, but also so that they can personally understand the barriers that exist.”
—Dr. I Min Lee

A doctor might say, for example,“I don’t always feel like exercising, but I ‘force’ myself to do it because I know it is healthy for me. And, I am always glad I did it after the fact,” Dr. Lee suggested.

Beyond the doctor’s office, said Dr. Arciero, healthcare providers should help patients reach activity goals when on their own:

“They must engage patients in the benefits of physical activity and inform them of resources, including free access to public spaces, referrals to fitness professionals, and free or low-cost physical activity groups and memberships.”

“Given only ~20% of the adult population currently meets the exercise recommendations, with much lower levels among the groups identified above, there is a clear need for more aggressive legislation and education at both the local and national level,” noted Dr. Arciero.

“Research shows that group-based programs (such as low income) involving community members together with community leaders have proven to be very effective,” he said.

He added that it is important that sports organizations such as the American College of Sports Medicine and the US Preventive Services Task Force follow evidence-based recommendations from leading healthcare organizations.

Dr. Lee advocated for “regular physical education in schools, insurance to cover counseling for physical activity, support for physical activity in the workplace, and dedicated bike lanes.”

Beyond that, dr. Arciero expressed hope for healthcare legislation that includes coverage for preventive services.

He said that local and national legislation “should include a multidimensional approach including individualized interventions using mobile (wearable) technologies, clinic- and community-based programs, as well as group-based programs.”

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