Walking in the Prevention of

Coronary Heart Disease

Prepared by
Don Hall, DrPH, CHES
A Presentation of LifeLong Health
Physical Activity Level and
Risk of Heart Attack
Nurses Health Study,
72,488 women followed
for 8 years
The risk of heart attack
decreased with increasing
levels of physical activity
Heart attack risk dropped
over 50% in the most
active women (top 20%
compared to bottom 20%)
1.00
0.77
0.65
0.54
0.46
0
0.2
0.4
0.6
0.8
1
1st 2nd 3rd 4th 5th
Quintile of
physical
activity
Little activity High activity
Relative
Risk
NEJM, p.650, Aug. 26, 99
Relative Risk of Heart Attack by Quintile of
Physical Activity and Smoking Status
1.00
0.84 0.86
0.78
0.68
0.23
0.2
0.17 0.17
0.15
0
0.2
0.4
0.6
0.8
1
1st 2nd 3rd 4th 5th
Never Past Current
Relative
Risk
Least active Most active
Physical Activity Level
NEJM, Aug. 26, 99
Relative Risk of Heart Attack by Quintile of
Physical Activity and Body Mass Index
1.00
0.88
0.82
0.65
0.69
0.79
0.71
0.65 0.64
0.54
0
0.2
0.4
0.6
0.8
1
1st 2nd 3rd 4th 5th
BMI <= 29 BM > 29
Relative
Risk
Least active Most active
Physical Activity Level
NEJM, Aug. 26, 99
Relative Risk of Heart Attack by Quintile of
Physical Activity and Family History of CHD
1.00
0.87
0.75
0.66
0.58
0.48
0.44
0.41
0.38
0.34
0
0.2
0.4
0.6
0.8
1
1st 2nd 3rd 4th 5th
No fam. Hx Fam. Hx
Relative
Risk
Least active Most active
Physical Activity Level
NEJM, Aug. 26, 99
Walking Pace and Relative
Risk of a Heart Attack
Walking pace was
another important
determinant of risk of
heart attack
Women who walked at
a moderate pace
reduced risk by 25%
Women who walked
briskly reduced risk
by 36%
1.00
0.75
0.64
0.00
0.20
0.40
0.60
0.80
1.00
<2 mph 2 to 2.9
mph
3+ mph
NEJM, Aug. 26, 99
Summary
In this study, the reduction in risk of heart attack from
brisk walking or vigorous activity were similar when
total energy expenditures were similar
Women who walk briskly for 3 or more hours per
week can reduce their risk of a heart attack by 30 to
40%
The researchers concluded that, one-third of coronary
events (heart attacks) among middle-aged women in
the United States are attributable to physical
inactivity
NEJM, Aug. 26, 99
Walking is Good Medicine
When the weather will permit, all who can
possibly do so ought to walk in the open air
every day, summer and winter.
A walk, even in winter, would be more
beneficial to the health than all medicine the
doctors may prescribe.
E.G. White, Counsels on Health, page 53, 1870