Commentary

Walking has been described as a perfect exercise: it is familiar and convenient and can be sustained into old age.1 A recent commentary suggested that low intensity exercise such as walking improves health and probably improves metabolic control and other health parameters.2 The meta-analysis by Murphy et al provides much needed evidence concerning the effect of walking on cardiovascular risk factors.

The methodology for this meta-analysis was well detailed, but restricting the literature search to only 2 databases was a limitation, as was the mixed quality of the primary studies. Some of the methodological problems included small sample sizes, high dropout rates, and a lack of intention-to-treat analyses. Notwithstanding these issues, the results suggest that walking is associated with increased cardiovascular fitness and small decrements in weight, percent body fat, and body mass index. These findings parallel those reported in a recent Cochrane review, which found that promoting physical activity (including walking) increased fitness.3 However, another Cochrane review reported mixed findings for the effect of exercise on weight loss.4 Quantification of the effect of walking on cardiovascular risk factors is important because previous trials lacked assessment of health gains.

Interventions to encourage walking have been shown to increase the amount of walking by up to 30–60 min/wk on average.5 Taken in context with the review by Murphy et al, the combined findings suggest that efforts need to be targeted toward increasing walking in everyday life, with a challenge to develop environments that promote walking and reduce reliance on motor vehicles. Nurses in clinical practice need to encourage walking as a form of exercise, particularly among more sedentary populations (eg, women >14 y of age) and those at risk of cardiovascular disease.