To Avoid Being Frail: Walk Briskly

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1:03The final word on the things that matter. This is the last show with David Cooper. I'm sure you've been told that walking is good for you, and you've got to get that golden rule of 10,000 steps a day in. The new research suggests how fast you walk matters a lot too. Scientists followed older adults who were frail or at risk of becoming frail and found the doing higher intensity walking in that group showed greater improvements in several measures of physical function. Could picking up the pace be a simple way to fight back against frailty? Let's answer that question here with Margaret Danilovic, a physical therapy and human movement sciences researcher. Margaret, welcome to the show. Thanks for having me. All right, walking intensity and frailty, walk me through the study that takes a look at both and tries to correlate or connect them both. Yeah, so to date, really exercise is the number one recommended intervention and treatment

2:08for people that have frailty. But we don't really actually know what that prescription should look like. So people have kind of guidelines in the literature around 10,000 steps per day or 150 minutes. But for most people, especially those with frailty, that is just completely sort of unachievable. So we really sought out to say if we know that exercise is the best treatment for frailty, how should we actually think about something that's doable for older adults and is going to drive changes in their frailty status? Over some of the things you looked at. Yeah, so we looked at intensity as like the key piece to really drive changes in frailty. And it was extremely simple. We simply told people, walk faster. So we looked at pre-fraile and fraile older adults who were in living in retirement communities. We gave them sort of a personal trainer. One of our research assistants walked with them three times a week for four months.

3:13Our control group kind of followed public health guidelines. Just go out and walk at a casual speed. Our intervention group, our high intensity group, was prompted to say, walk as fast as you safely can. And so that change in speed drove up a significant change in their heart rate and in their rating of how hard they were working. So they were working at a sort of moderate to really vigorous intensity. And what we found is that frailty actually responds to that intensive exercise. In our intense kind of exercise group, 70% of participants had a change in their frailty status at the conclusion of the study. Frailty is one of those words that I kind of know, but how do you measure it? I kind of just know it intuitively. Oh, this person looks frail. This person doesn't. What does it actually mean for someone to be frail? Yeah, totally. So I think most people have that sort of picture in their mind of someone who's really thin,

4:13they're crouched over an assistive device. They're really kind of struggling. We look at frailty as a true geriatric syndrome that has a number of different constructs that are true to the syndrome. So people have low levels of physical activity. They have fatigue and exhaustion. They walk slow. They have a lot of weakness. They might even have changes in their weight unintentional. But really the thing that kind of is the presenting sort of factor in frailty is that people have a low physiologic reserve. So I would think about this like your ATM. If you have a low balance in your ATM and you take out even a small amount, it has a huge impact on you. And the same is true for people with frailty. And they have that low physiologic reserve. They don't have as much capacity to do day to day activities. So we see people who take a shower and they're exhausted because the act of standing and going

5:15through those kind of motions just drains their physiologic reserve. So our approach really was to say older adults love to walk. You can do it anywhere. You don't need any equipment. And let's use that as a way to really drive improvements in people's reserve. What surprised me here is when I think of like walking briskly and getting the health benefits of all that, I think of it as more preventative. Like if I do that when I'm 60, when I enter my 70s and 80s, I'll be in great shape. But what I'm hearing is it's never too late to start walking briskly. Never too late. And I think that's really the one of the primary findings from our study is we have to kind of get away from this notion that frailties inevitable with older age and there's nothing you can do about it. The average age of our participants was nearly 80 and two thirds of them walked with a walker or a cane. So really what we're showing is like anybody can kind of participate in these types of interventions. And it's not about turning like someone's grandma into a marathoner.

6:18It's about really thinking about what is more intense activity for you. And so for our participants, it was really about just simply walking faster. Your research is a real pain in my, you know what, because my girlfriend is like a race walker and she's always like keep up, keep up, keep up. Now what I'm hearing is walking briskly and we go for a walk every Monday night. It's our little routine. Sort of like walk date night. I need to keep up with her rather than tell her to slow down is what I'm hearing. You totally do. Like that's the key. Like push yourself, drive that physiologic reserve. And you know, I think this is something we can think about kind of across the lifespan as a way to, you know, prevent frailty but also treat it once it does happen. So for an older person or even I'm 40, like somebody doesn't really exercise that much. What is a good starting point here? How can they benefit from what you've learned? Yeah. So what we looked at really specifically was the number of steps per minute that someone takes. So you can find that if you even adjust your steps per minute by 11 steps, you can have

7:23significant improvements in your physical function. So how do you do this? You know, set a one minute stopwatch and count the number of steps you take in a minute with your usual walking speed. Like that is you are what we would call your walking cadence, the number of steps per minute. And then try to beat that, you know, walk a little faster. In our study, you know, we had our participants doing 45 minute sessions, but for everyday life, you know, as you're parking the car and walking to the grocery store, walk faster. As you're shopping, walk faster. It's that just kind of putting those motions into every day that you're doing and challenging your brain to kind of push yourself a little bit more with your mobility. So it's speed, not distance necessarily. Does that mean the kind of 10,000 steps a day health guideline? Not that that would be bad, but it's kind of dead. Is it more just walk briskly for a certain amount of time? Don't fuss too much about the number of steps.

8:24Yeah. So, you know, I think when we think about kind of guidelines like that, 10,000 steps, that's really thinking about physical activity volume, the amount of total activity that you're taking. And that's great. Like we think there's benefit to that. And truly in our study, the control group, the people who focused more on volume, just walking at a casual speed, they had improvements in their frailty as well. So it's definitely good to go out and walk that amount. But for most people, especially older adults, they just can't achieve that. And so our suggestion is if you're thinking about what you really want to spend your time doing from an exercise perspective, intensity is probably the way to go. Margaret, I've really enjoyed this chat. Thanks for coming on the show. I am going to take a walk, a brisk one after this program. Love it. Margaret Dandelovich is a physical therapy and human movement sciences researcher. The phone rings. It's your bank.

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