Walking versus running for hypertension, cholesterol, and diabetes mellitus risk reduction

Abstract

Objective: To test whether equivalent energy expenditure by moderate-intensity (eg, walking) and vigorous-intensity exercise (eg, running) provides equivalent health benefits.

Approach and results: We used the National Runners' (n=33 060) and Walkers' (n=15 945) Health Study cohorts to examine the effect of differences in exercise mode and thereby exercise intensity on coronary heart disease (CHD) risk factors. Baseline expenditure (metabolic equivant hours per day [METh/d]) was compared with self-reported, physician-diagnosed incident hypertension, hypercholesterolemia, diabetes mellitus, and CHD during 6.2 years follow-up. Running significantly decreased the risks for incident hypertension by 4.2% (P<10(-7)), hypercholesterolemia by 4.3% (P<10(-14)), diabetes mellitus by 12.1% (P<10(-5)), and CHD by 4.5% per METh/d (P=0.05). The corresponding reductions for walking were 7.2% (P<10(-6)), 7.0% (P<10(-8)), 12.3% (P<10(-4)), and 9.3% (P=0.01). Relative to <1.8 METh/d, the risk reductions for 1.8 to 3.6, 3.6 to 5.4, 5.4 to 7.2, and ≥7.2 METh/d were as follows: (1) 10.1%, 17.7%, 25.1%, and 34.9% from running and 14.0%, 23.8%, 21.8%, and 38.3% from walking for hypercholesterolemia; (2) 19.7%, 19.4%, 26.8%, and 39.8% from running and 14.7%, 19.1%, 23.6%, and 13.3% from walking for hypertension; and (3) 43.5%, 44.1%, 47.7%, and 68.2% from running, and 34.1%, 44.2% and 23.6% from walking for diabetes mellitus (walking >5.4 METh/d excluded for too few cases). The risk reductions were not significantly different for running than walking for diabetes mellitus (P=0.94), hypertension (P=0.06), or CHD (P=0.26), and only marginally greater for walking than running for hypercholesterolemia (P=0.04).

Conclusions: Equivalent energy expenditures by moderate (walking) and vigorous (running) exercise produced similar risk reductions for hypertension, hypercholesterolemia, diabetes mellitus, and possibly CHD.

Figure 1

Reduction in the risks for hypertension, hypercholesterolemia, and diabetes vs. baseline METhr/d energy expended by walking or running. Energy expenditure (X-axis) is categorized in terms of the upper limit of the minimum recommended physical activity levels (750 METmin/wk=1.8 METhr/d [2]), e.g., 1 to 2-fold higher activity covers from 1.8 to 3.6 METhr/d, etc. The average energy expended by runners and walkers within each interval were 314 and 371 METmin/wk for <1-fold of the recommended levels (<1.8 METhr/d), respectively, 1208 and 1108 METmin/wk for 1 to 2-fold (1.8 to 3.6 METhr/d), respectively, 1927 and 1845 METmin/wk for 2- to 3-fold (3.6 to 5.4 METhr/d), respectively, 2684 and 2587 METmin/wk for 3- to 4-fold (5.4 to 7.2 METhr/d), respectively, and 4197 and 3436 METmin/wk for ≥4-fold (≥7.2 METhr/d). Analyses performed separately in runners and walkers, adjusted for age, sex, race, smoking, prior CHD, and intakes of red meat, fruit, and alcohol. Incident diabetes in walkers excluded for 3- to 4-fold and ≥4-fold due to the small number of cases. Error bars represent 95% confidence intervals. Significant levels relative to the least active runners and walkers coded: * P<0.05; † P<0.01, ‡ P<0.001, and § P<0.0001.

Figure 2

Reduction in CHD risks per METhr/d energy expended by walking or running. Error bars represent 95% confidence intervals. Significant levels relative to the least active runners and walkers coded: * P<0.05; † P<0.01, ‡ P<0.001, and § P<0.0001.