Is there evidence that walking groups have health benefits? A systematic review and meta-analysis

Is there evidence that walking groups have health benefits? A systematic review and meta-analysis

Sarah Hanson, Andy Jones

9 November 2014

Regular physical activity positively impacts health potentially offering similar effects to some drug interventions in terms of mortality benefits. Indeed, it has been suggested as an alternative or adjunct to conventional drug therapy. Walking at a pace of 3–5 m/h (5–8 km/h) expends sufficient energy to be classified as moderate intensity2 and is an easy and accessible way of meeting physical activity recommendations.

Systematic reviews and meta-analyses have shown walking to have various health benefits including:

• positive effects on fitness
• fatness and resting blood pressure
• blood pressure control
• weight loss
• depression
• cardiovascular disease risk prevention.

ABSTRACT

Objective

To assess the health benefits of outdoor walking groups.

Design

Systematic review and meta-analysis of walking group interventions examining differences in commonly used physiological, psychological and well-being outcomes between baseline and intervention end.

Data sources

Seven electronic databases, clinical trial registers, grey literature and reference lists in English language up to November 2013.

Eligibility criteria

Adults, group walking outdoors with outcomes directly attributable to the walking intervention.

Results

Forty-two studies were identified involving 1843 participants. There is evidence that walking groups have wide-ranging health benefits. Meta-analysis showed statistically significant reductions in mean difference for systolic blood pressure −3.72 mm Hg (−5.28 to −2.17) and diastolic blood pressure −3.14 mm Hg (−4.15 to −2.13); resting heart rate −2.88 bpm (−4.13 to −1.64); body fat −1.31% (−2.10 to −0.52), body mass index −0.71 kg/m2 (−1.19 to −0.23), total cholesterol −0.11 mmol/L (−0.22 to −0.01) and statistically significant mean increases in VO2max of 2.66 mL/kg/min (1.67 3.65), the SF-36 (physical functioning) score 6.02 (0.51 to 11.53) and a 6 min walk time of 79.6 m (53.37–105.84).

A standardised mean difference showed a reduction in depression scores with an effect size of −0.67 (−0.97 to −0.38). The evidence was less clear for other

outcomes such as waist circumference fasting glucose, SF-36 (mental health) and serum lipids such as highdensity 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.

Open Access

Original Source BJSM

Food Reward Friday

This week's luck winner... soy sauce!!

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Does active commuting improve psychological wellbeing?

Does active commuting improve psychological wellbeing?
Longitudinal evidence from eighteen waves of the British Household Panel Survey

Adam Martin, Yevgeniy Goryakin, Marc Suhrcke

Abstract

Highlights

The aim of this study is to explore the relationship between active travel and psychological wellbeing.

• Impact of commuting behaviour on wellbeing was explored using individual fixed effects analyses.
• Compared to driving, wellbeing was higher when using active travel or public transport.
• Use of active travel reduced the likelihood of two specific GHQ12 psychological symptoms.
• Switching from car driving to active travel improved wellbeing.
• Wellbeing increased with travel time for walkers, but decreased for drivers.

Objective

The aim of this study is to explore the relationship between active travel and psychological wellbeing.

Method

This study used data on 17,985 adult commuters in eighteen waves of the British Household Panel Survey (1991/2–2008/9). Fixed effects regression models were used to investigate how travel mode choice, commuting time and switching to  active travel impacted on overall psychological wellbeing and how (iv.) travel mode choice impacted on specific psychological symptoms included in the General Health Questionnaire.

Results

After accounting for changes in individual-level socioeconomic characteristics and potential confounding variables relating to work, residence and health, significant associations were observed between overall psychological wellbeing (on a 36-point Likert scale) and (i.) active travel (0.185, 95% CI: 0.048 to 0.321) and public transport (0.195, 95% CI: 0.035 to 0.355) when compared to car travel, (ii.) time spent (per 10 minute change) walking (0.083, 95% CI: 0.003 to 0.163) and driving (−0.033, 95% CI: −0.064 to −0.001), and (iii.) switching from car travel to active travel (0.479, 95% CI: 0.199 to 0.758). Active travel was also associated with reductions in the odds of experiencing two specific psychological symptoms when compared to car travel.

Conclusion

The positive psychological wellbeing effects identified in this study should be considered in cost–benefit assessments of interventions seeking to promote active travel



Full article click here (Open Access)

Original source  Michael Evans

Fluffy Teff Flour Pancakes (Gluten-Free and Vegan)

I have a new favourite ingredient and it is called teff flour. Never heard of it before? I hadn't either until I started experimenting with gluten-free baking. There are numerous gluten-free flours out there: oat, buckwheat, sorghum, almond, coconut, corn; the list goes on and on and on. Now, I can't really go into any specifics on why teff flour is so popular other than share my own highly subjective experience: it works great in pancakes. I've had issues in the past with gooey, not properly cooked, gluten-free pancakes and let me tell you, it ain't pretty. But to my great surprise, these ones turned out really light, airy and fluffy! Triple yay!

So from what I can understand, teff is an ancient grain that has been used in Eastern Africa for ages. Ethiopians and Eritreans use the flour to make their special, sourdough flatbread called Injeera. Like many other seeds and grains, teff has an excellent nutrient profile. It's high in calcium, iron, zinc and many other vital trace minerals and provides all of the 8 essential amino acids. Also, for some reason it makes for an awesome gluten-free flour substitute which is the main reason I use it. Because pancakes, you know.

You can find teff flour in health food stores, the gluten-free section in many conventional grocery stores and online. (Try this one, from Bob's Red Mill, for example. You can get up to $10 off your first herb.com order using my promo code "PWF503"). Hope this recipe works as well for you as it did for me!

Pancakes:

- 1/4 cup oat or buckwheat flour

- 1/4 cup white teff flour (same nutritional stats as the dark one, just two different colours!)

- 1/3 cup unsweetened applesauce

- 3 tbsp - 1/4 cup unsweetened almond milk

- 1/4 tsp baking soda

- 1/2 tsp baking powder

- Optional: 1 tbsp granulated sweetener of choice (I use a sugar alcohol called erythritol which I absolutely love!)

- 1 tsp apple cider vinegar

Toppings:

Anything you want really, here are a few suggestions:

- Fresh fruit and/or berries

- Drizzle of maple syrup

- Coconut chips and raw cacao nibs

How to:
1. Combine all the dry ingredients in a bowl and make sure that the baking powder and soda are evenly divided throughout the mix.
2. Add the applesauce and almond milk and stir well. Let sit for a few minutes to thicken.
3. Pre-heat a non-stick frying pan or a regular frying pan with a spoonful of coconut oil over medium to low heat.
4. Add the apple cider vinegar to the rest of the batter right before cooking.
5. Fry small spoonfuls of the batter for a couple of minutes on each side. Don't make them too big/thick, they might not cook through!
6. Serve with toppings of your choice!

Cheat Meals are a Part of My Healthy Lifestyle

Yes,  I am a cheater of fabulous quality splurges and I like to re-define the term as a "treat meal".  I do not believe that having a fresh baked brownie now and then is cheating on my fitness program.  I eat healthy the majority of the time and follow a 90/10 rule where I consume a wide variety of good carbs, lean proteins and healthy fats 90% of the time and allowing 10% for indulgences like a glass of wine or chocolate.

I will even apply the 80/20 rule where I eat healthy foods 80% of the time and allowing 20% to splurge on foods not on my typical menu.  This comes in handy when on vacation or during the holidays.  It is realistic to want things that are considered "bad" and I am not immune to those cravings.  I will not turn down a piece of my Mom's home baked pie or biscuits with butter and honey ... are you kidding me?

Pizza is a Coveted Cheat Meal

When I do partake in something nutritionally naughty it has to be quality.  I will not be diving into Twinkies or Ding-Dongs, or any processed junk food.  I will indulge in home baked goods, whole wheat pastas, granola, chocolate and frozen yogurt on hot days. I do eat lean burgers and home made pizza as well.  When I do cheat, I still want to be in control of the quality of the food.  I also do not believe in gorging or having a free ticket on a cheat day to binge on thousands of calories.  That is defeating the purpose of a splurge meal or day.

I do not plan a "treat day" but go by my cravings.  If I want something, I enjoy it and move on.  I work hard, eat clean 80 to 90 percent of the time and know that eating a slice of berry pie Ala mode is not going to break my fitness bank.  I will indeed savor every bite of my indulgence and eat slowly.  I do that anyway, but especially with a food I have been craving.  This works for me, but may not work for you.

Having treat meals are always a personal choice as there are physiological and psychological issues to consider.  Those suffering with emotional disorders that surround food may not be good candidates for treat meals and should be under the guidance of a physician and at the very least a support group.  Also, newbie fitness adapters may not be able to manage treat meals just yet and succumb to past triggers and old behaviors.  Medical issues like diabetes requires food monitoring and certain treats may not be in their best interest.

I utilize treat meals for a balance in life and to enjoy everything about being a fit person.  I do not teach or live eating boiled fish and broccoli all the time and think that is going to sustain me.  I am smart in my treats and know when to stop.  I enjoy one or two times per week some sort of sweet treat or fun meal and still maintain my physique.  What it comes down to is the approach to the treat meal or day and not using it as a reward for being deprived all week.  Eating healthy should not feel like a burden or deprivation where looking forward to treat day to derail efforts occurs.  If that is the case, a review of your current nutrition plan needs to happen.  An eating plan that feels like crap will not last and send anyone running back to unhealthy eating habits.  Life is too short not to eat healthy and it is also too short not to enjoy some splurges along the way.

Read my latest article on Cheat Meals: Good or Bad? on About.com and also grab some Cheat Meal Ideas of coveted comfort foods gone healthy.

Thanks for stopping by my Blog and I look forward to responding to your comments.  Subscribe below and don't miss out on my free updates!

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Darla Leal, Fit Over 50

Stay Healthy,
Darla

The Potential of Community Health Workers (CHWs)

He was among the highest.

Utilizers of healthcare services, that is. 

I had the pleasure of talking to a physician who is leading a group of community health workers (CHWs) assigned to taking care of dozens of patients like this.  Burdened by decades of multiple chronic conditions, patients like him are typically struggling with myriad complications of chronic illness, side effects from numerous medications, mental illness, extreme poverty and homelessness.  The result is an endless cycle of emergency room visits, admissions, discharges and more emergency room visits.

According to the physician I talked to, these highest utilizers don't need more physician care; us docs can only do so much with an office visit. They also don't need health insurance, because they already have it. 

What these patients really need are resources that can help bridge the aspirations of health reform and the reality of the street.

The Population Health Blog agrees. In its professional career, it saw plenty of insured people with access to health care who were still unable to get better.  They didn't need more of the PHB, they needed..... help, in the form of monitoring, education, coaching, encouragement and advice.

Enter this timely article by Dr. Kangovi and colleagues appearing in the June 11 issue of the New England Journal.  It's a good primer on the long history of CHWs and the work that will be necessary to mainsteam them into health reform.  
 
CHW-based programs in the U.S. have been around since the 1960s. They typically focus on the indigent, are modest in scope, and have been funded "hand-to-mouth" by community organizations.  However, they've also been used to facilitate insurance enrollment, support "Medicaid Health Homes" and provide preventive and screening services on a regional basis. 

The PHB believes, however, that their greatest value proposition may be in supporting interventions for high utilizing patients under Medicaid waiver arrangements or in managed care programs. By coordinating alternatives to the emergency room revolving doors, CHWs can save taxpayers a lot of money.

Dr. Kangovi et al describe five barriers to the widespread adoption of CHWs:

1) Insufficient integration with traditional providers - But the good news is that CHWs can now use the shared data and remote electronic communication of health information technology to extend the reach of the non-physician (e.g. nurses, social workers) members of a medical home.

2) Fragmented health care systems - But the good news is that health care organizations are slowly being forced out into the communities that surround them. CHWs are waiting.

3) Lack of treatment protocols - But the good news is that this is an emerging science. Some on-line resources already exist.

4) High worker turnover - the authors cite one Harlem program that lost a third of their workers over a matter of months.  The good news is that there are ways to identify "keepers" who will find the CHW career to be satisfying.

5) Low quality published evidence - But the good news is that the volume and the quality of published research is going up.  Even better news is that that will help inform accreditation programs.

That high utilizer mentioned above?  The PHB learned that his last encounter with the health care system was in a primary care provider's office, in the company of a CHW.

Image from Wikipedia

Apps Will Astonish

"Now this is meaningful use!"

In case you think the future for healthcare apps will be characterized by health information technology (HIT) "dead zones" of free downloads, fun gadgetry and vacuous consumerism with nothing to show for it, you should take a look at  this article appearing in the peer-reviewed journal Cell Systems. 

If authors Kenneth Mandl, Joshua Mandel and Isaac Kohane are even half right, "apps" could truly revolutionize HIT.  They argue that a superimposed "apps layer" ecosystem will demolish the "walled gardens" of EHRs and allow for true information sharing across clinics, systems and regions.

And that's just for starters.

As the Population Health Blog understands it, "Application Programming Interfaces" (or "APIs") will enable multiple third party apps to bridge to legacy EHRs.  That, in turn, will catalyze the creation of newer and better user experiences that reconcile doc and patient preferences with the current clunky one-size-fits-all EHRs. 

The result?

1. A "mash up" of "risks, trends and trajectories" with external data sources, telehealth and decision support systems. Why should a patient with cancer and his/her oncologist use the same computer operating environment as a patient and a dermatologist dealing with a rash?  Even better, apps can be easily substituted if a better one comes along.

2. Never mind ICD-9 or ICD-10, apps will be the "afferent limb" that links your unique genetic and phenotypic "diagnosis code" to the efferent limb of tailored treatment protocols.

3. Apps can collect and arrange the data from numerous devices at scale that not only allow for treatment compliance or disease management outside of the clinic, but the early identification of an emerging epidemic or medication side effects.

To achieve this, the authors recommend the EHR manufacturers not only retool, but adopt a uniform and open source approach to API development. Purchasers of EHRs consider should consider the future of APIs in their requests for proposals (RFPs).  They also recommend that research funding be directed toward apps that can operate across multiple information platforms. It would also help if there was a "seal of approval" process for app development that wasn't too closely tied to industry or too tied up in the regulatory miasma of government.