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December 18, 1991, Vol 266, No. 23 >
ARTICLE | December 18, 1991

Women Walking for Health and Fitness: Title and subTitle BreakHow Much Is Enough? FREE

John J. Duncan, PhD; Neil F. Gordon, MBBCh, PhD; Chris B. Scott, MS
[+] Author Affiliations

Reprint requests to The Cooper Institute for Aerobics Research, 12330 Preston Rd, Dallas, TX 75230 (Dr Duncan).


JAMA. 1991;266(23):3295-3299. doi:10.1001/jama.1991.03470230053030
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Article
References

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 randomized, 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 randomized 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<.0001) and in a dose-response manner (aerobic walkers>brisk walkers>strollers). In contrast, high-density lipoprotein cholesterol concentrations were not dose related and increased significantly (P<.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.(JAMA. 1991;266:3295-3299)

REFERENCES

1 +
American College of Sports Medicine.  Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc . 1990;;22:265-274.
2 +
Pollock ML, Froelicher VF.  Position stand of the American College of Sports Medicine: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. J Cardiopulmonary Rehabil . 1990;;10:235-245.
3 +
Leon AS, Connett J, Jacobs DR Jr, Rauramaa R.  Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. JAMA . 1987;;258:2388-2395.
4 +
Paffenbarger RSJr, Hyde RT, Wing AL, Hsieh CC.  Physical activity, all-cause mortality and longevity of college alumni. N Engl J Med . 1986;;314: 605-613.
5 +
Wood PD, Stefanick ML.  Exercise, fitness, and atherosclerosis.  In: Bouchard C, Shephard RJ, Stephens T, Sutton JR, McPherson BD, eds. Exercise Fitness, and Health: A Consensus of Current Knowledge . Champaign, Ill: Human Kinetics; 1990;:409-424.
6 +
American Heart Association. Recommendations for human blood pressure determination by sphygmomanometers . Dallas, Tex: American Heart Association; 1987;.
7 +
Assman G, Schriewer H, Schmitz G, Hagele E.  Quantification of high-density lipoprotein cholesterol by precipitation with phosphotungstic acid/ MgCl2. Clin Chem . 1983;;29:2026-2030.
8 +
Friedewald WT, Levy RI, Fredrickson DS.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of preparative ultracentrifuge. Clin Chem . 1972;;18:499-502.
9 +
Siri WE.  Body composition from fluid spaces and density: analysis of methods.  In: Brozek J, Henschel A, eds. Techniques for Measuring Body Composition . Washington, DC: National Academy of Sciences; 1961;:223-244.
10 +
Balke B, Ware RW.  An experimental study of physical fitness on air force personnel. US Armed Forces Med J . 1959;;10:675-688.
11 +
SAS . Version 5. Cary, NC: SAS Institute Inc; 1985;.
12 +
Ryan AJ.  Exercise is medicine. Phys Sports Med . 1983;;11:10.
13 +
Pollock ML, Wilmore JH. Exercise in Health and Disease: Evaluation and Prescription for Prevention and Rehabilitation . 2nd ed. Philadelphia, PA: WB Saunders Co; 1990;:371-484.
14 +
LaPorte RE, Brenes G, Dearwater S, et al.  HDL cholesterol across a spectrum of physical activity from quadriplegia to marathon running. Lancet . 1983;;1:1212-1213.
15 +
Hartung GH, Lally DA, Little JL, Goebert DA.  Blood lipids and aerobic fitness in active and inactive men with disabilities. Med Sci Sports Exerc . 1990;;22:S47. Abstract.
16 +
Rotkis T, Boyden TW, Pamenter RW, Stanforth P, Wilmore J.  High-density lipoprotein cholesterol and body composition of female runners. Metabolism . 1981;;30:994-995.
17 +
Moll ME, Williams RS, Lester RM, Quarfordt SH, Wallace AG.  Cholesterol metabolism in nonobese women. Atherosclerosis . 1979;;34:159-166.
18 +
Lewis S, Haskell WL, Wood PD, Manoogian N, Baily JE, Pereira MB.  Effects of physical activity on weight reduction in obese, middle-aged women. Am J Clin Nutr . 1976;;29:151-156.
19 +
Frey MA, Doerr BM, Laubach LL, Mann BL, Glueck CJ.  Exercise does not change high-density lipoprotein cholesterol in women after 10 weeks of training. Metabolism . 1982;;31:1142-1146.
20 +
Brownell KP, Bachorik PS, Ayerle RS.  Changes in plasma lipid and lipoprotein levels in men and women after a program of moderate exercise. Circulation . 1982;;65:477-484.
21 +
Goldberg L, Elliot DL.  The effect of physical activity on lipid and lipoprotein levels. Med Clin North Am . 1985;;69:41-55.
22 +
Haskell WL.  The influence of exercise training on plasma lipids and lipoproteins in health and disease. Acta Med Scand . 1986;;711( (suppl 711) ):25-37.
23 +
Wood PD, Williams PT, Haskell WL.  Physical activity and high-density lipoproteins.  In: Miller NE, Miller GJ, eds. Clinical and Metabolic Aspects of High Density Lipoproteins . New York, NY: Elsevier Science Publishers; 1984;:133-165.
24 +
Manninen V, Elo MO, Frick MH, et al.  Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA . 1988;;260:641-651.
25 +
Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW.  Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA . 1989;;262:2395-2401.
26 +
Wood PD, Stefanick ML, Dreon DM, et al.  Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med . 1988;; 319:1173-1179.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
American College of Sports Medicine.  Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc . 1990;;22:265-274.
2 +
Pollock ML, Froelicher VF.  Position stand of the American College of Sports Medicine: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. J Cardiopulmonary Rehabil . 1990;;10:235-245.
3 +
Leon AS, Connett J, Jacobs DR Jr, Rauramaa R.  Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. JAMA . 1987;;258:2388-2395.
4 +
Paffenbarger RSJr, Hyde RT, Wing AL, Hsieh CC.  Physical activity, all-cause mortality and longevity of college alumni. N Engl J Med . 1986;;314: 605-613.
5 +
Wood PD, Stefanick ML.  Exercise, fitness, and atherosclerosis.  In: Bouchard C, Shephard RJ, Stephens T, Sutton JR, McPherson BD, eds. Exercise Fitness, and Health: A Consensus of Current Knowledge . Champaign, Ill: Human Kinetics; 1990;:409-424.
6 +
American Heart Association. Recommendations for human blood pressure determination by sphygmomanometers . Dallas, Tex: American Heart Association; 1987;.
7 +
Assman G, Schriewer H, Schmitz G, Hagele E.  Quantification of high-density lipoprotein cholesterol by precipitation with phosphotungstic acid/ MgCl2. Clin Chem . 1983;;29:2026-2030.
8 +
Friedewald WT, Levy RI, Fredrickson DS.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of preparative ultracentrifuge. Clin Chem . 1972;;18:499-502.
9 +
Siri WE.  Body composition from fluid spaces and density: analysis of methods.  In: Brozek J, Henschel A, eds. Techniques for Measuring Body Composition . Washington, DC: National Academy of Sciences; 1961;:223-244.
10 +
Balke B, Ware RW.  An experimental study of physical fitness on air force personnel. US Armed Forces Med J . 1959;;10:675-688.
11 +
SAS . Version 5. Cary, NC: SAS Institute Inc; 1985;.
12 +
Ryan AJ.  Exercise is medicine. Phys Sports Med . 1983;;11:10.
13 +
Pollock ML, Wilmore JH. Exercise in Health and Disease: Evaluation and Prescription for Prevention and Rehabilitation . 2nd ed. Philadelphia, PA: WB Saunders Co; 1990;:371-484.
14 +
LaPorte RE, Brenes G, Dearwater S, et al.  HDL cholesterol across a spectrum of physical activity from quadriplegia to marathon running. Lancet . 1983;;1:1212-1213.
15 +
Hartung GH, Lally DA, Little JL, Goebert DA.  Blood lipids and aerobic fitness in active and inactive men with disabilities. Med Sci Sports Exerc . 1990;;22:S47. Abstract.
16 +
Rotkis T, Boyden TW, Pamenter RW, Stanforth P, Wilmore J.  High-density lipoprotein cholesterol and body composition of female runners. Metabolism . 1981;;30:994-995.
17 +
Moll ME, Williams RS, Lester RM, Quarfordt SH, Wallace AG.  Cholesterol metabolism in nonobese women. Atherosclerosis . 1979;;34:159-166.
18 +
Lewis S, Haskell WL, Wood PD, Manoogian N, Baily JE, Pereira MB.  Effects of physical activity on weight reduction in obese, middle-aged women. Am J Clin Nutr . 1976;;29:151-156.
19 +
Frey MA, Doerr BM, Laubach LL, Mann BL, Glueck CJ.  Exercise does not change high-density lipoprotein cholesterol in women after 10 weeks of training. Metabolism . 1982;;31:1142-1146.
20 +
Brownell KP, Bachorik PS, Ayerle RS.  Changes in plasma lipid and lipoprotein levels in men and women after a program of moderate exercise. Circulation . 1982;;65:477-484.
21 +
Goldberg L, Elliot DL.  The effect of physical activity on lipid and lipoprotein levels. Med Clin North Am . 1985;;69:41-55.
22 +
Haskell WL.  The influence of exercise training on plasma lipids and lipoproteins in health and disease. Acta Med Scand . 1986;;711( (suppl 711) ):25-37.
23 +
Wood PD, Williams PT, Haskell WL.  Physical activity and high-density lipoproteins.  In: Miller NE, Miller GJ, eds. Clinical and Metabolic Aspects of High Density Lipoproteins . New York, NY: Elsevier Science Publishers; 1984;:133-165.
24 +
Manninen V, Elo MO, Frick MH, et al.  Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA . 1988;;260:641-651.
25 +
Blair SN, Kohl HW III, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW.  Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA . 1989;;262:2395-2401.
26 +
Wood PD, Stefanick ML, Dreon DM, et al.  Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. N Engl J Med . 1988;; 319:1173-1179.

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