Wellness
Walking further and faster linked to reduced risk of heart attacks, heart failure, stroke in people with high blood pressure
Compared to a daily step count of 2,300 steps, every extra 1,000 steps was linked to a 17% reduction in the risk of developing a major adverse cardiovascular event (MACE), up to 10,000 steps. Additional steps above 10,000 were associated with a lower risk of stroke.
Analysis of over 36,000 people with high blood pressure has shown that taking more steps, even below the recommended daily target of 10,000 steps, and walking faster, is associated with a significant reduction in the risk of major problems of the heart and blood vessels.
The study, published in the European Journal of Preventive Cardiology, found that compared to a daily step count of 2,300 steps, every extra 1,000 steps was linked to a 17% reduction in the risk of developing a major adverse cardiovascular event (MACE), up to 10,000 steps. Additional steps above 10,000 were associated with a lower risk of stroke.
Approximately 1.28 billion people worldwide are living with high blood pressure, and it places them at increased risk of heart disease (49% increase), stroke (62% increase) and heart failure (77-89% increase). Until now, it has been unclear how much people with high blood pressure need to increase their physical activity in order to see a reduction in their risk of MACE.
Professor Emmanuel Stamatakis, Director of the Mackenzie Wearables Research Hub at the University of Sydney, Australia, who supervised the study, said: “This study is one of the first to demonstrate a dose-response relationship between daily step count and major problems of the heart and blood vessels. In a nutshell, we found that, if you live with high blood pressure, the more you walk with greater intensity, the lower your risk for future serious cardiovascular events.
“These findings support the message that any amount of physical activity is beneficial, even below the widely recommended daily target of 10,000 steps.”
The study analysed data obtained from 32,192 people who had enrolled in a sub-study of the UK Biobank study. They had been diagnosed with high blood pressure and agreed to wear an accelerometer on their wrist for seven consecutive days to measure how far and how fast they walked. Data from the accelerometers was collected between 2013 and 2015. The average age was 64 and the participants were followed up for nearly eight years, providing the researchers with data for 283,001 person-years. During this time 1,935 cases of heart problems or stroke occurred.
In addition to a 17% reduction in overall risk for every extra 1,000 steps a day, the researchers found a 22% reduction in heart failure, 9% reduction in risk of heart attack, and 24% reduction in risk of stroke. This means that every increase of 1,000 steps a day was associated with:
- an average reduction in the absolute risk of MACE of 31.5 events per 10,000 person-years
- an average reduction in the absolute risk of 7.2 heart failure events per 10,000 person-years
- an average reduction in the absolute risk of 9.9 myocardial infarctions (heart attacks) per 10,000 person-years
- an average reduction in the absolute risk of 10.4 strokes per 10,000 person-years.
The average (mean) intensity of the 30 minutes of fastest walking per day was 80 steps a minute and this was associated with a 30% reduced risk of MACE. There was no evidence of harm in people whose 30 minutes of fastest walking or running was over 130 steps a minute.
The researchers found similar results when they looked at 37,350 people without high blood pressure. Every 1,000-step increase in daily step count led to an average lower risk of MACE, heart failure, myocardial infarctions and stroke of 20.2%, 23.2%, 17.9%, and 24.6%, respectively.
Prof. Stamatakis said: “Our findings offer patients accessible and measurable targets for heart health, even below 10,000 steps daily. Clinicians should promote physical activity as standard care, especially in patients with high blood pressure. Our results can inform new, tailored public health recommendations for these patients. Future recommendations on walking in people with high blood pressure could consider promoting higher stepping intensity.”
Strengths of the study include the large number of patients, the use of accelerometers to provide detailed information on numbers of steps and speed, and the use of data from national records in England, Wales and Scotland on deaths and causes of death.
Limitations include the fact that physical activity was measured only when people first joined the study and did not include any subsequent changes in behaviour. In addition, the researchers point out that their findings can show only that there is an association between walking further and faster and better health outcomes, not that it causes these better outcomes. However, they conducted extensive analyses to minimise the risk of what is called ‘reverse causation’ (in which, in this case, health problems could be causing both a reduction in physical activity and an increase in heart disease events). Most UK Biobank participants are White, are less likely to be obese, to smoke or drink alcohol, and to be better educated, and so they may not be representative of the general UK population.
NewsMakers
Move to quit: Exercise boosts smoking quit rates
Researchers found that people taking part in exercise programs were 15% more likely to achieve continuous abstinence and 21% more likely to report not smoking over a seven-day period, compared with control groups.
A pack-a-day smoker can spend around $14,000 a year on cigarettes, yet despite the financial and health costs, quitting remains one of the most difficult changes many people will ever attempt.
Now, new research from Adelaide University shows that exercise can help people quit smoking by reducing cigarette consumption, easing cravings and improving their chances of quitting.
Researchers found that people taking part in exercise programs were 15% more likely to achieve continuous abstinence and 21% more likely to report not smoking over a seven-day period, compared with control groups.
They also found that exercise could reduce cigarette consumption by two cigarettes per day, and that a single bout of exercise immediately reduced cigarette cravings for up to 30 minutes after exercise.
The systematic review and meta-analysis examined 59 randomised controlled trials involving more than 9000 participants, exploring the effects of both single bouts of exercise and long-term exercise programs on smoking cessation, cravings, withdrawal symptoms and mood.
Globally, tobacco smoking remains the leading preventable cause of premature morbidity and mortality, accounting for about 7 million deaths, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke.
Around the world, e-cigarette use has now reached more than 100 million people.
The researchers say exercise should be viewed as an additional tool that can be used alongside established smoking cessation support.
Lead researcher, Dr Ben Singh said the findings provide smokers with a practical, low-cost tool that can support their quitting journey.
“Quitting smoking is one of the best things a person can do for their health, but it’s also one of the hardest,” Dr Singh said.
“Many smokers want to quit, but the current approaches don’t work for everyone. That’s why we need more strategies that people can incorporate into their daily lives at little or no cost.
“Something as simple as regular exercise can make a meaningful difference to people trying to quit, helping them manage cravings, smoke less and improve their chances of quitting.”
While smoking rates have reduced over the past two decades, demand for e-cigarettes and heated-tobacco products have risen, targeting the younger generation.
Today, 80% of the 1.3 billion tobacco users worldwide live in low- and middle-income countries, yet in contrast, vaping has risen across many OECD countries.
Senior researcher Adelaide University’s Professor Carol Maher said exercise could be used strategically to ward off tobacco cravings.
“Quitting smoking does not have to begin and end with willpower alone,” Prof Maher said.
“Cravings can be difficult to manage, but they often pass. Our review found that even a single bout of exercise can reduce cravings for up to 30 minutes, which may help people get through some of the hardest moments of a quit attempt.
“Exercise should not replace evidence-based quit supports such as counselling and smoking cessation medication, but it may be a practical, low-cost strategy that people can use alongside them.”
The researchers say the next step is to test how exercise can be built into real-world quit programs, including digital, community and clinical services, and to examine whether it can also support people trying to quit vaping, where evidence is currently lacking.
Wellness
Midlife fitness linked to longer, healthier lives
Researchers note that improving fitness during midlife may be a key strategy for promoting healthy aging and preserving quality of life later on, even with modest increases in physical activity.
How fit you are in midlife may help determine not just how long you live, but how many of those years are spent in good health, according to a study published in the JACC, the flagship journal of the American College of Cardiology.
The study found that adults with higher levels of cardiorespiratory fitness in midlife lived longer lives, developed fewer chronic diseases and spent more years free from serious illness compared with those who were less fit.
Cardiorespiratory fitness—how well the heart and lungs supply oxygen during physical activity—is known to reduce the risk of heart disease and early death. This study extends prior research by showing that fitness also plays a meaningful role in healthy aging, defined as years lived without major chronic disease.
The findings indicate that higher fitness in midlife is strongly associated with later onset of chronic disease, lower overall disease burden and longer life expectancy. These benefits were observed in both men and women.
Researchers followed more than 24,500 men and women who were healthy through age 65 and tracked their health outcomes later in life using Medicare data. Fitness was measured earlier in adulthood using a treadmill test, and researchers examined the development of 11 major chronic conditions, including heart disease, diabetes, kidney disease and cancer.
Compared with people who had low fitness levels, those with high fitness in midlife experienced clear benefits later in life. On average, they developed chronic diseases at least 1.5 years later, had fewer total conditions and lived longer overall. These patterns were seen in both men and women and across different ages, body weights and smoking histories.
Importantly, the study emphasizes health span—not just lifespan—highlighting that fitness helps people live more of their lives in good health, not simply live longer with disease.
The findings also underscore the public health value of physical activity, as cardiorespiratory fitness can be improved through regular movement such as brisk walking, cycling or other aerobic exercise.
Researchers note that improving fitness during midlife may be a key strategy for promoting healthy aging and preserving quality of life later on, even with modest increases in physical activity.
Wellness
Adding resistance training improves strength and aerobic fitness, better for heart health
Aerobic training and resistance training independently improve aerobic fitness, walking distance, muscle strength, and HRQoL.
Heart failure affects more than 64 million people worldwide (1%–3% in the general adult population) and its prevalence is projected to increase. This condition is commonly categorized into 2 main types: heart failure with reduced ejection fraction (HFrEF; where the heart is too weak to pump enough blood to meet the body’s needs) and heart failure with preserved ejection fraction (HFpEF; where the heart becomes stiff and cannot relax sufficiently to fill with enough blood).
Regardless of type, heart failure is a life-threatening condition characterized by low exercise tolerance, progressive functional decline, reduced health-related quality of life (HRQoL), and a high risk of hospitalizations, morbidity, and mortality. The study led by Tasuku Terada was published in the Journal of Sport and Health Science.
Previous studies have shown that aerobic training and resistance training independently improve aerobic fitness, walking distance, muscle strength, and HRQoL. Some studies have also demonstrated superior benefits of high-intensity interval training (HIIT) on aerobic fitness and cardiac function in patients with heart failure when compared to traditionally used moderate-intensity continuous training.
However, despite the well-established benefits of each exercise modality, the effects of combining aerobic training and muscle strength training (i.e., combined training) compared to the routinely recommended aerobic training alone were not clear in patients with heart failure. In this study, the researchers compared the effects of combined training and aerobic training alone on aerobic fitness, muscle strength, and HRQoL in patients with heart failure. These comparisons were made while accounting for heart failure classifications (i.e., HFrEF or HFpEF), total exercise duration (i.e., matched or unmatched exercise session duration between combined and aerobic training alone), and exercise type (e.g., HIIT).
The researchers systematically searched databases for studies directly comparing the effects of combined training and aerobic training alone on aerobic fitness, walk test distance, muscle strength, and HRQoL in patients with heart failure. Of 13,965 studies they screened, 15 studies were included (466 patients with HFrEF (89%) and 60 with HFpEF (11%); 17% female).
Pooled analyses showed that, in HFrEF, combined training increased aerobic fitness, walk test distance, and upper body muscle strength more than aerobic training alone. The superior effects of combined training on aerobic fitness and walking distance were retained when exercise session duration was matched between the two exercise modalities, indicating that combined training has a greater impact on these measures independent of total exercise duration. HIIT combined with muscle strength training also increased aerobic fitness more than HIIT alone.
No differences were found between combined and aerobic training alone in lower body muscle strength or HRQoL. Overall adherence to combined training was high or comparable to that of aerobic training alone.
Similarly, dropout rates in the combined training group were comparable to those in aerobic training alone, and no notable differences in the risk of adverse events were observed.
To summarise, in predominantly male patients with HFrEF, combined training yielded greater improvements in aerobic fitness, walking distance, and upper body muscle strength than aerobic training alone. These results highlight that, when prescribing exercise for a fixed time frame, allocating time to both aerobic training and muscle strength training may be a more effective strategy for improving aerobic fitness in patients with HFrEF.
Additionally, because HIIT may improve aerobic fitness more effectively while requiring less time than moderate-intensity continuous training, combining HIIT with muscle strength training may offer a time-efficient approach to improve aerobic fitness in patients with HFrEF.
Considering the absence of notable differences in adherence or adverse events, these findings support that replacing part of aerobic training with muscle strength training may be an effective strategy for patients with HFrEF to increase aerobic fitness, walking distance, and muscle strength, all of which are important predictors of better prognosis in patients with heart failure. Further evidence is needed to clarify the effects of combined training in HFpEF.
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