a special program of the National Emergency Medicine Association (NEMA) 

Week 619.7

Guest Dr. Mark Lenet, president, American Podiatric Medical Association

Topic Walking; benefits and pitfalls

Host/Producer Steve Girard

NEMA Aside from swimming, walking is the best and least hazardous exercise...

especially for older folks trying to get fit and flexible, and stay that way. In two recent studies, walking was shown to lower the risk of cancer and heart disease...and in general, prolong life. One of the studies, conducted in Helsinki, Finland, showed taking six half hour walks each month seemed to cut risk of death by 44 percent, compared with a more sedentary twin...and even occasional exercisers were 30 percent less likely to die. With spring about to be sprung, and with much better weather ahead for much of the country...itÕs time for all of us to hit the trail for better overall health. With us today is Dr. Mark Lenet, president of the American Podiatric Medical Association...Doctor, how do we determine how far to walk...and how quickly we should cover the ground?

LENET ThatÕs the most basic and important question that one needs to give consideration to, because a lot depends, obviously, on their age and overall physical build. Walking should be considered one of the healthiest activities. The length of time one undertakes an average walk should be based on how they feel overall. We should aim for doing 20 minutes, three times a week...would be most appropriate for good exercise in the...with an attempt to increase the overall heart flow, as far as cardiovascular effects. And I think that at a steady pace over a 20 minute period, one would be able to maintain that type of effect to the body. So, it certainly is advantageous to go with that as your minimum. Granted, certain people are unable to, especially elderly or people that are extremely overweight, and of course we would obviously recommend a shorter period with the understanding of trying to build their pace and length of time goes on.

NEMA With running, thereÕs a technique that enables you to get the benefits of the exercise without putting too much stress on the feet, ankles, shins and knees...I imagine itÕs the same with walking; some tips on how to avoid that stress...

LENET Oh, absolutely. I guess the rule of thumb would be...if you try to figure out the amount of strides one would can count the number of steps that youÕre taking. And if youÕre taking a fifteen second period...fifteen steps, youÕre figuring about 2 miles an hour. And if youÕre stride is bringing you 23 steps in that 15 second period, then obviously, youÕre increasing that pace...and also increasing the amount of miles youÕd be walking, and that would be about 3 miles in an hour.

NEMA IÕve heard that if you can get your walking pace up to just over 4 miles an hour, it will give aeriobic and health benefits that equal running....

LENET Yes...yes, thatÕs a tremendous pace. If you can do 4 point 2 miles an hour and still be walking, in fact that would be just getting ready to go into a light jog. Your talking about a mile every 15 minutes.

NEMA But when you get into that jog mode...thereÕs a greater force involved, with more stress...especially for older folks.

LENET question, because the dynamics of force become that much greater. You know, I think the public really needs to understand that they will benefit as greatly from the walk and the stride of the walk, then they would from the force of the jogging. And overall, for their body, if theyÕre not really familiar with or aware of exactly what is happening to the overall structure, whether it be the hips, the knees and the ankle area...which obviously are taking on the greatest amount of force and even to the extent of punishment with jogging, they wonÕt neccessarily get that type of response from walking. ItÕll be a little easier on the body overall.

NEMA What are some of the common injuries that can stop someone, especially the older folks, from getting the full benefits of walking...some of the pitfalls they can avoid.

LENET The pitfalls would be...first of all, respiratory. If you find that you are breathing a little heavily, that means that youÕre doing it at a pace thatÕs too excessive for your condition. So you need to back off a bit, and build yourself up to the point where you can walk at a normal pace that will allow you to have normal breathing, and yet appreciate the fact that you are starting to increase your heart rate slightly. The other pitfalls would be not understanding what youÕre own physical condition may be in regard to the lower extremities, and if thereÕs any imbalance that may be present, then you can early signs of irritation...whether it be in the knee, or the ankle or the foot area itself, by improper balance relationship between the body and the ground. One way to avoid that, of course, is that if you feel or realize that thereÕs any unneccessary strain occurring, then it would be appropriate for a podiatrist to evaluate that to determine, if in fact, that imbalance relates to what is...a common term is pronation when the foot is htting the ground and rolls inwardly, and then puts an undo imbalanced strain to that area, and then progresses to the lower leg itself. And then, over the long haul, with that type of imbalance, one would experience some form of fatigue, some irritation, even some arch pain...where one would refer to planarfaschiitis, which is an inflammation of the arch itself, and when that occurs and you evaluate the individual, and make that determination that the imbalance is present, then the use of a simple orthotic would be appropriate...because it would balance the foot more appropriately, and allow for a normal, even force to occur when one is walking.

NEMA Even when people know a bit about the benefits of walking...many donÕt know about its effects in lowering health risks in the areas of heart disease and cancer...

LENET No question. They donÕt see that because they just assume that walking is not truly an exercise, and they just see it as a normal, daily activity...and if youÕre not doing something strenous, youÕre not really helping the body out. The truth of the matter is, as we said earlier, the walking exercise is one of the better...itÕs less traumatic to the body, and at a normal pace, itÕs going to afford you the cardiovascular effects that will be helpful to you in the long run...which can be advantageous in risk of death from heart disease, risk of death even from cancer...thereÕs been all kinds of studies that have shown that type of activity can be very helpful in prolonging life.

NEMA What about the type of shoes to use when walking....

LENET Well, IÕm definitely an advocate, when it comes to any type of physical activity, to make sure that youÕre gear...running gear, walking gear, or whatever the activity might appropriate for the sport. And hereÕs a situation where the better products really have value to them because of the means in which theyÕre constructed. So, first thing I tell everybody is not to go out and buy just any old tennis shoe, and go take a walk. ThereÕs a reason for why the walking shoes are constructed the way they are, and thereÕs a reason why the jogging shoes are constructed the way they are. If youÕre going to do a walking activity, then you should stick with a good walking shoe. Now, we have a program at the American Podiatric Medical Association that has the seal of approval to it....that weÕve had a number of evaluations that have been given to various products, and once that evaluation is completed, if itÕs acceptable, we will give the company that seal, and they can use it for their product. And there are a number of jogging shoes and walking shoes that have received ...actually itÕs the APMA seal of acceptance for their shoe. So, I think that when one sees that, they can be more comfortable to realize that there has been an evaluation of that particular shoe, and that it is recommended for that particular activity. Of course, not every shoe - recommended or not - is always going to be the best for that individual because a lot has to do with the way it fits...the foot shape and size, and how an individual may accomodate a different product. So, I think itÕs important for each individual, when theyÕre fitted for a shoe, to be fitted by a professional...and to be able to walk around in the shoe, even around the store or at home first, and accept that the shoe is comfortable. One should not buy a shoe with the thinking that, Ò Well, IÕm going to work it in...IÕm going to break in the shoe...itÕll feel better even if itÕs a little tight now, a little stiff right now..Ó It should feel relatively correct from the moment you put the shoe on at the store, otherwise itÕs not the right shoe for you.

NEMA I understand your organization has a book of tips on getting started and staying healthy through walking....

LENET One can obtain that by calling 1-800-foot-care, which is the line to the American Podiatric Medical Association, and can ask for the information and brochures on walking, and weÕll be glad to send that to them.

NEMA Our thanks to Dr. Mark Lenet of Baltimore, president of the American Podiatric Medical Association. You donÕt have to join a club and hit the aerobic dance floor to get the benefits of can just put on a good pair of walking shoes, find a safe stretch of ground, and cover it briskly...that will go a long way toward improving your fitness, and reducing your risk of heart disease and even cancer. Three times a week, a half hour at a time...if it sounds easy, itÕs because it is.

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