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From a public health perspective, physical activity is really important. In fact, physical inactivity is estimated to contribute towards almost one in 10 premature deaths from coronary heart disease
and one in six deaths from any cause.
Physical activity is known to have many benefits, not all of them to do with physical health: it can improve mental health, reduce the risk of depression, and in older adults, improve cognitive function.
A clear message
The message to increase levels of physical activity seems to be getting through to the general public. The findings of a health survey for England conducted in 2021 found that 70 per cent of men and 59 per cent of women managed to get at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week. But for those without either the inclination or time to achieve these goals, simply going for a walk is a suitable means of reducing their risk of cardiovascular disease. In fact, one comprehensive analysis suggests that walking reduces the risk of dying from any cause by around 11 per cent.
Motivation to move
When advising customers in the pharmacy, what’s the best way to motivate those who don’t currently achieve the recommended levels of physical activity?
One approach is to use self-monitoring – a component in the psychological technique known as ‘control theory’. This is the principle that is incorporated into wearable technologies like smart watches.
The basic idea is that a person receives feedback on their current performance and the difference between this and their pre-defined target. For example, imagine someone is trying to walk 10,000 steps a day and so far, they have only achieved 6,000. Knowledge of this difference then encourages a behaviour change – i.e. further walking, in an attempt to reach their 10,000 step goal.
While the need to achieve 10,000 steps a day has become ingrained into our collective consciousness, there is no factual basis for this figure. The idea was first proposed in 1964, prior to the Tokyo Olympics. The choice of the number 10,000 was actually an arbitrary figure and was chosen simply because the Japanese character for 10,000 () looks rather like a person walking.
“Getting 7,000 steps a day seems to be the sweet spot for optimal health”
Step counts and health benefits
A major study, published in The Lancet Public Health, conducted a systematic review and meta-analysis. It included 57 studies and looked at eight different health outcomes. The results suggested that compared with getting only 2,000 steps per day, achieving 7,000 reduced the risk of all-cause mortality by 47 per cent. In addition, the risk of a cancer-related death fell by 37 per cent and there was a 14 per cent lower risk of developing type 2 diabetes. There were also significant reductions in the risk of developing depression, falls and dementia.
Among those who achieved 10,000-steps a day, there was a 10 per cent lower risk of death from any cause compared with 7,000 steps, but the benefits on other outcomes such as cancer-related deaths did not really differ from the 7,000 step figures.
Although these results suggest potentially large health benefits from walking, it is important to realise that most of the included studies only measured step counts either at a single point in time or over a few days, which might not capture how walking patterns could change over time.
Another limitation is that too few of the studies included people with a chronic health condition, so the results are unlikely to reflect most pharmacy patients.
Finally, the step model failed to consider the impact of non-weight bearing exercises such as cycling, swimming and rowing or even weight-training, all of which also have health benefits.
What does this tell us?
Despite the limitations of this study, we can say that encouraging people to go for a walk is good for their health. Moreover, while getting 7,000 steps a day seems to be the sweet spot for optimal health benefits, there are still benefits to be had from a smaller step count – 4,000 steps a day still reduces the risk of death by 36 per cent compared to getting only 2,000 steps, for instance.
Current UK physical activity guidelines do not include a daily step count target, but The Lancet study findings represent a significant public health message. Incorporating a benchmark number of daily steps in addition to the current recommended time of 150 minutes of physical activity might be of value.
The Lancet research does have real world implications. For pharmacy staff, the key public health message is to encourage patients to go for a walk more often and for as long as possible and not to become fixated on achieving a specific target number of steps every day.
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