Walking as an Opportunity for Cardiovascular Disease Prevention

John D. Omura, MD; Emily N. Ussery, PhD; Fleetwood Loustalot, PhD; Janet E. Fulton, PhD; Susan A. Carlson, PhD


Prev Chronic Dis. 2019;16(5):e66 

In This Article

Abstract and Introduction


Introduction: Cardiovascular disease (CVD) is the leading cause of death in the United States, and increasing physical activity can help prevent and manage disease. Walking is an easy way for most adults to be more active and may help people at risk for CVD avoid inactivity, increase their physical activity levels, and improve their cardiovascular health. To guide efforts that promote walking for CVD prevention and management, we estimated the prevalence of walking among US adults by CVD risk status.

Methods: Nationally representative data on walking from participants (N = 29,742) in the 2015 National Health Interview Survey Cancer Control Supplement were analyzed. We estimated prevalence of walking (ie, any, transportation, and leisure) overall and by CVD status. We defined CVD status as either not having CVD and not at risk for CVD; being at risk for CVD (overweight or having obesity plus 1 or more additional risk factors); or having CVD. We defined additional risk factors as diabetes, high cholesterol, or hypertension. Odds ratios were estimated by using logistic regression models adjusted for respondent characteristics.

Results: Prevalence of any walking decreased with increasing CVD risk (no CVD/not at risk, 66.6%; at risk: overweight or has obesity with 1 risk factor, 63.0%; with 2 risk factors, 59.5%; with 3 risk factors, 53.6%; has CVD, 50.2%). After adjusting for respondent characteristics, the odds of any walking and leisure walking decreased with increasing CVD risk. However, CVD risk was not associated with walking for transportation.

Conclusions: Promoting walking may be a way to help adults avoid inactivity and encourage an active lifestyle for CVD prevention and management.


Cardiovascular disease (CVD) is the leading cause of death in the United States, and physical inactivity is an important modifiable risk factor.[1] Increasing physical activity among adults at risk for or with CVD can help prevent and manage disease.[1] The Physical Activity Guidelines for Americans, second edition (Guidelines), suggests that regular physical activity can help improve quality of life for people with chronic health conditions and reduce their risk of developing new conditions.[2] The Guidelines recommend that adults with chronic conditions be physically active on a regular basis: adults with chronic conditions who are able should do at least 150 to 300 minutes of moderate-intensity aerobic physical activity a week or 75 to 150 minutes of vigorous-intensity activity or an equivalent combination of both.[2] The review of scientific evidence supporting the Guidelines affirmed a well-established relationship between regular physical activity and cardiovascular health.[3,4] Everyone can gain cardiovascular health benefits from physical activity.[4] Some physical activity is better than none, and more physical activity is even better.[2]

Recognizing the benefits of healthy behaviors, including physical activity for CVD prevention, the US Preventive Services Task Force (USPSTF) recommends that health care providers offer or refer adults who are overweight or have obesity and have additional CVD risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention.[5] More than 1 in 3 US adults is considered part of this at-risk population, and almost 1 in 5 is at risk and does not meet the aerobic component of the Guidelines.[2,6] Walking has been associated with meeting the aerobic component of the Guidelines.[2,7] Walking is an easy way for most adults to initiate or increase physical activity in their daily routines.[8] Consequently, walking may present an opportunity for promoting physical activity among those at high risk for CVD, offering a simple way to avoid inactivity and increase physical activity.

Physical activity, including walking and other forms of active transportation, promotes cardiovascular health.[3] Previous studies showed that adults with CVD are less likely to be physically active than healthy adults,[9–11] although to our knowledge no study has examined walking as a form of physical activity. In addition, previous studies have largely demonstrated the positive effect of walking and active transportation on improving individual cardiovascular risk factors such as hypertension, body mass index (BMI, weight in kilograms divided by height in meters squared), and diabetes as well as cardiovascular disease end points such as incident coronary heart disease, stroke, and death.[12–14] However, to our knowledge, no study has examined the prevalence of walking among people at increasing levels of cardiovascular risk and disease. To provide health care providers with information about the prevalence of walking among US adults by CVD risk status, the objectives of this study were 1) to estimate the national prevalence of walking, including different types of walking, among US adults at discrete levels of cardiovascular risk and disease; and 2) to examine the association between the degree of cardiovascular risk and disease with any walking and with walking for leisure and transportation. We examined walking for leisure and transportation separately because previous research has demonstrated that different types of walking have unique facilitating factors and associated barriers.[8,15–18] Thus, understanding which types of walking are more or less prevalent in these populations can help to inform future interventions.