Taking Steps to a Healthier Nation: Increasing Physical Activity Through Walking.

Physical activity offers many benefits to health, whether it be preventing disease, contributing to emotional and cognitive health, or helping to maintain independence later in life.1,2 Many consider it the “wonder drug” of health promotion. And while the benefits are multiple, the behavior is simple. People only need to be active for at least 150 minutes a week for adults and 60 minutes a day for school-age youth.2 It can even occur in short bouts, lasting at least 10 minutes. Unfortunately, only one-half of adults3 and about onequarter of high school students4 are sufficiently active to realize the health benefits of physical activity. To improve population levels of physical activity, an increase in walking may be an important place to start. In this supplement, titled “Walking and Walkability: Approaches to Increase Physical Activity and Improve Health,” the selected authors turn their attention to walking as the most common and preferred activity for many teens and adults. Watson et al report that 54% of US women and 41% of men cite walking as their most common activity during the past month.5 Similarly, Song et al report that walking was the most frequently reported physical activity among US high school students.6 The selected articles highlight several key strategies to promote walking in the United States. These strategies can be grouped into 2 major areas. The first strategy calls for improving the physical environment to support walking, such as having safe streets with sidewalks and crosswalks or attractive areas to walk, including nearby trails or parks. The second strategy recognizes the role of personal motivation for walking which may include walking the dog or walking to nearby destinations, such as public transit, stores, or schools. Other motivating factors can include social support, such as when friends or family walk together on a regular basis or when they use a step counter and a daily step goal. Indeed, combining these supports may substantially increase walking, such as reported by Rote et al, where social media support, pedometer use, and a steps goal used in combination increased walking in young women approximately 1.5 miles per day over a standard walking intervention.7 One important implication from this set of articles is the need to partner with sectors beyond traditional public health. Foremost among these sectors are transportation, land use, and community design. Working with community planners and transportation engineers to ensure that new or renovated streets improve access for all users regardless of whether they drive, walk, or bike can promote physical activity. Use of public transportation also has been shown to increase walking,8 and from a public health perspective, investments in transit are best made in population centers with the greatest need and population density.9,10 Finally, mixed land-use designs that include housing, transportation, and other destinations, such as stores and restaurants that are in close proximity to one another, are environments that promote walking.11 Improving health may not be on the minds of urban planners, although walkable communities are highly desirable destinations for housing, shopping, employment, and leisure-time pursuits. Thus, public health may be able to find like-minded partners in sectors such as business and industry. To help make such alliances work optimally, some State Health Departments, such as Indiana, have hired a fulltime transportation planner to build partnerships and help translate the 2 worlds of public health and community planning. A broad movement is underway to increase physical activity levels and walking in the U.S. Many organizations have banded together to execute a cross-sectoral strategy to increase physical activity through the National Physical Activity Plan.12,13 Through multiple collaborative partnerships, the Every Body Walk! Collaborative is building a national walking movement to increase walking by helping communities become walkable.14 In addition, there is great interest from the U.S. Surgeon General, Vice Admiral Vivek Murthy, to create safe opportunities for all Americans to participate in physical activity and walking. At his April 2015 swearing in as Surgeon General, Vice Admiral Murthy provided his vision for the “Great American Community,” where “every man, woman, and child can go for a walk, ride a bike, play sports, and move in spaces that are safe.” He also announced that his first Call to Action would highlight “how city planners, employers, and community leaders can ensure that the places where we live and work promote walking and physical activity while also leveling the playing field so that no one is left behind.” Taken together, the findings from the current supplement contribute to the growing enthusiasm to improve physical activity and walking and, importantly, further inform the science base on physical activity, walking, and walkable communities. The health benefits and resulting medical care savings of physical activity are impressive.15 Further, these benefits are accrued regardless of age, weight, or existing health challenges.2 Other cobenefits of regular physical activity, such as improved academic16,17 and job performance,18 increased community cohesion,19 and reduced air pollution,20–22 offer additional reasons for many partners to coalesce around physical activity. However, unlocking these benefits will require achieving widespread and sustained levels of physical activity. As reflected in this supplement, the field will continue to monitor rates of physical activity and develop effective interventions to increase it, but ultimately communities, states, and the nation will need to act on this information to help their residents be physically active.