Walking in rhythm: Using the power of music to promote health-enhancing walking

Setting the scenery Introduction Walking intensity and cadence – the scientific evidence (David Rowe) Listen while you walk – music and walking (Allan Hewitt) Using technology and music in an intervention (Maria Faulkner) Discussion

Walking intensity and cadence: The evidence for regulating walking pace David Rowe Reader in Exercise Science Physical Activity for Health Research Group University of Strathclyde david.rowe@strath.ac.uk

Who described walking as ... “… the closest thing to perfect exercise”?

Rationale Usefulness of cadence as a “metric” for monitoring and promoting ambulatory PA Focus on walking (high participation levels, inexpensive, convenient, easy skill level) Definitions: Walking cadence - stepping rate (steps/min) Walking speed – velocity (mph, km/h, m/min) Walking intensity – rate of energy expenditure (VO2 in L/min, METs, kcal/min, “moderate/vigorous”) Music tempo – pulse rate (beats/min)

Walking intervention goals “Steps-only pedometers were tested, and progressive step goals were provided” “The overall goal of the walking program was for participants to increase their mean daily step-count by 3,000 accumulated steps” “The goal was to increase walking activity to a minimum of 90 min per week” “Participants were instructed to set weekly personal walking goals” “[participants] walked around the gym perimeter at 2.5 mph for 60 minutes”

Should we be asking: How many steps? (total physical activity volume)* or ... How many steps per minute? (intensity, variability patterns) * See: Tudor-Locke, C., et al. (2011). How many steps/day are enough? For children and adolescents. International Journal of Behavioral Nutrition and Physical Activity, 8, 78. Tudor-Locke, C., et al. (2011). How many steps/day are enough? For adults. International Journal of Behavioral Nutrition and Physical Activity, 8, 79. Tudor-Locke, C., et al. (2011). How many steps/day are enough? For older adults and special populations. International Journal of Behavioral Nutrition and Physical Activity, 8, 80.

Dose-response – step “volume” B1127 Physiology and Biomechanics Exercise testing lecture Dose-response – step “volume” Source: Ewald et al. (in press), Journal of Physical Activity for Health

Three questions Can we predict energy expenditure (METs) from walking cadence? In different populations Factors affecting – leg length, mode (treadmill/ground) What are people’s interpretations of certain walking instructions, or intensity labels? “Normal”, “slow”, “moderate”, and (most importantly), “brisk” Can people match a prescribed cadence? Sound prompts (metronome or music) Macro-cadence* vs. micro-cadence

The “Healthy Steps” studies Study Pop. N Sex Age Ht Cm WtKg HS I General 75 M/F 18-64 172 ±8.6 76 ±15.5 HS II Inactive 25 20-59 165 ±9.7 78 ±21.5 HS III Amputees 17 31-65 ±10.0 85 ±22.2 HS IV Older 29 F 60-87 158 ±7.6 64 ±11.7

Question 1 Can we predict energy expenditure (METs) from walking cadence? In different populations Factors affecting – leg length, age, walking context (treadmill/overground)

Energy expenditure (METs) Why is it important? “Intensity” Public health recommendations: 5 days x 30 mins “moderate”, or ... Accumulate 150 mins “moderate”, or ... 3 days x 20 mins “vigorous”, or ... Combination of “moderate” and “vigorous” Moderate = 3.0-5.99 METs Vigorous  6.0 METs

Predicting METs from cadence Study Sample Mode 3 METs RSq SEE Tudor-Locke et al. (2005) N = 50 (25 M, 25 F) 18-39 yr TM, walk, run 102 steps/min 80(M) .83 (F) 1.27 MET 1.14 MET Marshall et al. (2009) N = 97 (39 M, 58 F) 18-55 yr TM walk 106 steps/min 35(M) .23 (F) 1.30 MET 1.52 MET Abel et al. (2010) N = 19 (9 M, 10 F) 28.8 ± 6.8 yr TM walk, run 101 steps/min .71 (M) .85 (F) Not reported Beets et al. (2010) N = 20 (9 M, 11 F) 26.4 ± 4.6 yr OG walk 100 steps/min .61 (?) 0.49 MET (?) Rowe et al. (2011) N = 75 (37 M, 38 F) 18-64 yr TM & OG walk 103 steps/min .38 0.69 MET

Source: Tudor-Locke & Rowe (2012), Sports Medicine Predicting METs from cadence Walking data Running data r = .93 Source: Tudor-Locke & Rowe (2012), Sports Medicine

Predicting METs from cadence Source: Rowe & Tudor-Locke (2012), AAHPERD Measurement Symposium - presentation available on request

HS I study (general population) 3 x 4+ min OG trials, metronome-paced Measured VO2 (Cosmed K4b2) Stride-length related measures: Height “Iliac leg length” Standing minus sitting height 10-m stride test (# steps) 10-step test (distance)

Healthy Steps I (Rowe et al., 2011) Range = 23 steps/min, or 690 steps in a 30-min walk target From: Rowe, et al. (2011). Stride rate guidelines for moderate intensity walking. Med Sci Sports Exerc, 43, 312-318

HS IV (Older women) 3 x 4-min TM trials, self-selected “slow”, “moderate”, and “fast” walking speeds VO2 measured in final minute Douglas bag + Oxycon analyzer

Comparison of cadence cutpoints Height (cm) 3 METs 5 METs Rowe et al. Peacock et al. 150 cm 114 104 152 142 160 cm 109 98 147 136 170 cm 92 130 180 cm 99 86 137 125 ≈ 10-13 steps/min difference – at a similar height, older women have higher METs for a given cadence

Question 2 What are people’s interpretations of certain walking instructions, or intensity “labels”? “Normal”, “slow”, “moderate”, and (most importantly), “brisk” “Brisk” – common instruction in walking programs Also, what is typical walking pace during free-living walking?

Brisk walking speed Study Design Pop’n Speed Murtagh et al. (2002) Outdoor park, 18.6 metre section of path 82 recreational walkers 3.5 mph (95% CI = 2.7-4.3 mph). Parise et al. (2002) 1 km “there and back” path 212 older adults who reported regularly walking briskly for exercise 3.0 mph (range = 2.2 mph to 4.3 mph). Taylor et al. (2010) 1 km level path (mix of concrete and grass) 10 participants in a long-term walking intervention 7 of 10 participants walked faster than 3.0 mph (Note: Moderate intensity speed [3 METs] ≈ 2.7 mph)

Pedestrian walking cadence 8 covert observation studies of pedestrian walking Generally > moderate cadence (means ranged from 104 steps/min to 125 steps/min) Some methodologically good Short distances Habitual walkers …? “Purposive” walking (walking “to get somewhere” – work, college, etc.) Source: Tudor-Locke & Rowe (2012), Sports Medicine

Healthy Steps II (inactive) Two overground trials (“brisk”, and “prescribed moderate”) “prescribed moderate” was guided by metronome with tempo set from treadmill trial at 2.7 mph Indoor circular track 10+ mins

Healthy Steps II (“brisk”) ALL > 100 steps/min

Healthy Steps II (prescribed “moderate”) 91% > 100 steps/min

Healthy Steps II (inactive)

Self-selected “brisk” cadence: NS effect for time F(1,9) = 1. 10, p = Self-selected “brisk” cadence: NS effect for time F(1,9) = 1.10, p = .35 Mean speed = 3.62 mph Metronome-guided “moderate” cadence: NS effect for time F(1,9) = 1.19, p = .31 Mean speed = 3.14 mph

Healthy Steps III (trans-tibial amputees) Two overground trials (“brisk”, and “prescribed moderate”) “prescribed moderate” was guided by digital music with tempo set from treadmill trial at  3 METs) Indoor circular track 5+ mins

Healthy Steps III (trans-tibial amputees) 92% > 100 steps/min

Healthy Steps III (trans-tibial amputees)

Healthy Steps III (trans-tibial amputees)

Question 3 Can people match a prescribed cadence? Sound prompts (metronome or music)? Macro-cadence* vs. micro-cadence (gait symmetry, synchronicity, etc.)

Healthy Steps II (sedentary) Source: Rowe et al. (2013), Journal of Science and Medicine in Sports

Healthy Steps III (trans-tibial amputees) Source: Rowe et al. (2013), Journal of Physical Activity for Health

Healthy Steps IV (older women) Source: Peacock et al. (in revision), Journal of Aging and Physical Activity

“Healthy Steps” summary Energy expenditure (METs) can be estimated relatively accurately from cadence Variables to consider: Height/leg length; age; treadmill vs. overground Various populations (inactive, old, adults with TTA) voluntarily walk above 3 METs when asked to walk briskly And can maintain for reasonable bouts of time [in quasi-lab conditions] Most people can match the tempo of an auditory signal If the tempo of the signal is “reasonable”

Where to next?

Evolution of the mobile phone B1127 Physiology and Biomechanics Exercise testing lecture Evolution of the mobile phone

Where to now (and next)? Use of music to monitor and promote “healthy” walking behaviors General population Clinical/gait training (stroke, Parkinsons, CP) Ubiquitous mobile technology Prompts Feedback Ergogenic effects of music User studies Cognitive and affective tolerance for tempo manipulation

(time for one question or comment during changeover) … Thank you! (time for one question or comment during changeover) … david.rowe@strath.ac.uk

“The 5 Apps” “Accelerometer capture” “Stepper” Time-stamped recording of triaxial accelerometer output “Stepper” Activity points feedback “Preloaded” (“Playlist commander”) Collects accelerometer data synchronously with a preloaded music (or other) soundtrack “Playlist logger” Logs music choices “Tapper” For recording events (and timing of events)

Conclusions – food for thought Advantages of cadence over accelerometer counts: Much more agreement between studies as to a reasonable cadence cut point versus the accelerometer threshold “battleground” Even considering inter-instrument (dis)agreement at low/high ends, within healthy cadence range (80-140 steps/min; 2.7+ mph), instruments seem to measure relatively consistently and accurately Cadence metric can be compared across instruments (activity counts cannot) Cadence is much more user-friendly Cadence is grounded in free-living behaviour

Looking even further ahead Application of cadence in the real world: Investigation of cadence parameters and health outcomes “Acceptability” of music-guided walking Medium- and long-term adherence to music-guided walking programs (vs. self-paced)