PREVENTING CHRONIC DISEASE

PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY

Volume 16, E66 MAY 2019

ORIGINAL RESEARCH

Walking as an Opportunity for Cardiovascular

Disease Prevention
John D. Omura, MD1; Emily N. Ussery, PhD1; Fleetwood Loustalot, PhD2;
Janet E. Fulton, PhD1; Susan A. Carlson, PhD1

Accessible Version: www.cdc.gov/pcd/issues/2019/18_0690.htm Methods

Suggested citation for this article: Omura JD, Ussery EN, Nationally representative data on walking from participants (N =
Loustalot F, Fulton JE, Carlson SA. Walking as an Opportunity 29,742) in the 2015 National Health Interview Survey Cancer
for Cardiovascular Disease Prevention. Prev Chronic Dis 2019; Control Supplement were analyzed. We estimated prevalence of
16:180690. DOI: https://doi.org/10.5888/pcd16.180690. 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
PEER REVIEWED obesity plus 1 or more additional risk factors); or having CVD.
We defined additional risk factors as diabetes, high cholesterol, or
Summary hypertension. Odds ratios were estimated by using logistic regres-
What is already known on this topic? sion models adjusted for respondent characteristics.
Increasing physical activity among adults at risk for or with cardiovascular
disease (CVD) can help prevent and manage the disease, and walking is Results
an easy way for most adults to avoid inactivity and increase physical activ- Prevalence of any walking decreased with increasing CVD risk
ity levels. However, the prevalence of walking among people at various de-
grees of CVD risk is unknown. (no CVD/not at risk, 66.6%; at risk: overweight or has obesity
What is added by this report? with 1 risk factor, 63.0%; with 2 risk factors, 59.5%; with 3 risk
The prevalence of any walking decreases with increasing CVD risk, even
factors, 53.6%; has CVD, 50.2%). After adjusting for respondent
after adjusting for demographic characteristics. Similar patterns are ob- characteristics, the odds of any walking and leisure walking de-
served for leisure walking but not for transportation walking. creased with increasing CVD risk. However, CVD risk was not as-
What are the implications for public health practice? sociated with walking for transportation.
Promoting walking, especially among adults at high risk, may present an
important opportunity for encouraging active lifestyles for CVD prevention Conclusions
and management.
Promoting walking may be a way to help adults avoid inactivity
and encourage an active lifestyle for CVD prevention and manage-
Abstract ment.

Introduction
Introduction
Cardiovascular disease (CVD) is the leading cause of death in the Cardiovascular disease (CVD) is the leading cause of death in the
United States, and increasing physical activity can help prevent United States, and physical inactivity is an important modifiable
and manage disease. Walking is an easy way for most adults to be risk factor (1). Increasing physical activity among adults at risk for
more active and may help people at risk for CVD avoid inactivity, or with CVD can help prevent and manage disease (1). The Phys-
increase their physical activity levels, and improve their cardiovas- ical Activity Guidelines for Americans , second edition
cular health. To guide efforts that promote walking for CVD pre- (Guidelines), suggests that regular physical activity can help im-
vention and management, we estimated the prevalence of walking prove quality of life for people with chronic health conditions and
among US adults by CVD risk status. reduce their risk of developing new conditions (2). The Guidelines
recommend that adults with chronic conditions be physically act-
ive on a regular basis: adults with chronic conditions who are able

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health
and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

www.cdc.gov/pcd/issues/2019/18_0690.htm • Centers for Disease Control and Prevention 1

PREVENTING CHRONIC DISEASE VOLUME 16, E66
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY MAY 2019

should do at least 150 to 300 minutes of moderate-intensity aer- demonstrated that different types of walking have unique facilitat-
obic physical activity a week or 75 to 150 minutes of vigorous-in- ing factors and associated barriers (8,15–18). Thus, understanding
tensity activity or an equivalent combination of both (2). The re- which types of walking are more or less prevalent in these popula-
view of scientific evidence supporting the Guidelines affirmed a tions can help to inform future interventions.
well-established relationship between regular physical activity and
cardiovascular health (3,4). Everyone can gain cardiovascular Methods
health benefits from physical activity (4). Some physical activity is
better than none, and more physical activity is even better (2). Study sample
Recognizing the benefits of healthy behaviors, including physical The National Health Interview Survey (NHIS) is a continuous,
activity for CVD prevention, the US Preventive Services Task cross-sectional survey of US households representative of the ci-
Force (USPSTF) recommends that health care providers offer or vilian, noninstitutionalized population and is administered by in-
refer adults who are overweight or have obesity and have addition- person interviews (19). NHIS consists of a core questionnaire that
al CVD risk factors to intensive behavioral counseling interven- collects basic health and demographic information for all family
tions to promote a healthful diet and physical activity for CVD members in a sampled household and periodic questionnaire sup-
prevention (5). More than 1 in 3 US adults is considered part of plements that address special topics. Questions on walking for
this at-risk population, and almost 1 in 5 is at risk and does not leisure and transportation were asked of 1 randomly selected adult
meet the aerobic component of the Guidelines (2,6). Walking has aged 18 or older per sampled household in the 2015 NHIS Cancer
been associated with meeting the aerobic component of the Control Supplement. The sample adult response rate was 55.2%.
Guidelines (2,7). Walking is an easy way for most adults to initi- From the initial total sample of 33,672, respondents were ex-
ate or increase physical activity in their daily routines (8). Con- cluded if they were missing data on walking (1,916), health-re-
sequently, walking may present an opportunity for promoting lated characteristics (1,000), or demographic characteristics (172).
physical activity among those at high risk for CVD, offering a In addition, respondents who reported being unable to walk were
simple way to avoid inactivity and increase physical activity. excluded (842). The final analytic sample was 29,742 adults.
Physical activity, including walking and other forms of active Measures
transportation, promotes cardiovascular health (3). Previous stud-
ies showed that adults with CVD are less likely to be physically Transportation walking was defined as a yes response to the ques-
active than healthy adults (9–11), although to our knowledge no tion, “During the past 7 days, did you walk to get someplace that
study has examined walking as a form of physical activity. In ad- took you at least 10 minutes?” Leisure walking was defined as a
dition, previous studies have largely demonstrated the positive ef- yes response to the question, “During the past 7 days, did you
fect of walking and active transportation on improving individual walk for at least 10 minutes [for fun, relaxation, exercise, or to
cardiovascular risk factors such as hypertension, body mass index walk the dog]?” Any walking was defined as participating in
(BMI, weight in kilograms divided by height in meters squared), either transportation or leisure walking.
and diabetes as well as cardiovascular disease end points such as
incident coronary heart disease, stroke, and death (12–14). We assessed sex, age, race/ethnicity, education level, region of
However, to our knowledge, no study has examined the preval- residence, current smoking status, BMI category, and hyperten-
ence of walking among people at increasing levels of cardiovascu- sion, hyperlipidemia, diabetes, myocardial infarction, and stroke
lar risk and disease. To provide health care providers with inform- status. BMI was calculated for each respondent on the basis of
ation about the prevalence of walking among US adults by CVD self-reported weight and height. Respondents were categorized as
risk status, the objectives of this study were 1) to estimate the na- underweight or normal weight (BMI <25), overweight (BMI
tional prevalence of walking, including different types of walking, 25–<30), or having obesity (BMI ≥30) (20). Respondents were
among US adults at discrete levels of cardiovascular risk and dis- defined as having hypertension, hyperlipidemia, diabetes, myocar-
ease; and 2) to examine the association between the degree of car- dial infarction, or stroke if they responded yes to questions asking
diovascular risk and disease with any walking and with walking if they had ever been told by a doctor or other health professional
for leisure and transportation. We examined walking for leisure that they had hypertension (also called high blood pressure), high
and transportation separately because previous research has cholesterol, diabetes or sugar diabetes (other than during preg-
nancy), heart attack (also called myocardial infarction), or stroke.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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PREVENTING CHRONIC DISEASE VOLUME 16, E66
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Respondent characteristics were used to categorize respondents in- had no CVD and were not at risk was 66.6%; for those who were
to various categories based on CVD status. Respondents were overweight or had obesity with 1 risk factor, 63.0%; for those with
defined as having CVD if they had a reported history of stroke or 2 risk factors, 59.5%; for those with 3 risk factors, 53.6%; and for
myocardial infarction. They were defined as being at risk of CVD those with CVD, 50.2%.
if they were overweight or had obesity and had 1, 2, or 3 addition-
al risk factors defined by the USPSTF (hypertension, hyperlip-
idemia, or diabetes) (5). Respondents who fell into neither of these
categories were defined as having no CVD and not at risk for
CVD.

Statistical analysis
Prevalence and 95% confidence intervals (CIs) of walking (any,
transportation, and leisure) were examined overall, by CVD status,
and by respondent characteristics. Adjusted Wald tests, pairwise t
tests, and orthogonal polynomial contrasts were used to identify
significant differences and trends where appropriate. Logistic re-
gression analyses adjusting for respondent characteristics (ie, sex,
age group, race/ethnicity, education, region of residence, and cur-
rent smoking status) were conducted to examine the odds of any,
leisure, and transportation walking by CVD status. In addition,
analyses were conducted to assess trends limited only to those
without CVD. Sampling weights provided by the National Center
Figure. Prevalence of walking among US adults by cardiovascular disease
for Health Statistics were applied to produce nationally represent- status, National Health Interview Survey, 2015 (N = 29,742). Excludes
ative estimates, and results were deemed significant at P < .05. We respondents unable to walk (n = 842). Error bars represent the upper and
performed analyses in 2018 by using SUDAAN Version 11.0 (Re- lower bounds of the 95% confidence interval. Risk factors were hypertension,
hyperlipidemia, or diabetes. Significant linear trends by cardiovascular
search Triangle Institute) to account for the complex sample disease status (P < .05) were observed for any walking, leisure walking, and
design. transportation walking.

Results After adjusting for respondent characteristics, the association

Our sample was 51% women, and 53% were aged 45 or older. between any walking and leisure walking and CVD risk remained,
Most were non-Hispanic white (65%) and had at least some col- and the adjusted odds of any walking and leisure walking de-
lege education (63%), and the largest proportion were in the South creased linearly with increasing CVD risk (Table 2). For example,
Census region (37%) (Table 1). Most (67%) adults had no CVD when compared with adults with no CVD and not at risk, the ad-
and were not at risk. The prevalence of adults at risk who were justed odds ratio (AOR) of leisure walking among those who were
overweight or had obesity with 1 risk factor was 15.7%; with 2 overweight or had obesity and 1 risk factor was 0.87 (95% confid-
risk factors, 9.1%; and with 3 risk factors, 3.4%. The prevalence ence interval [CI], 0.80–0.95); with 2 risk factors, AOR 0.81 (95%
of adults with CVD was 4.7%. CI, 0.72–0.92); with 3 risk factors, AOR 0.72 (95% CI,
0.61–0.84); and with CVD, AOR 0.66 (95% CI, 0.58–0.76). These
Overall, the prevalence of walking was 64% for any walking, 53% linear trends by CVD status were observed even after removing
for leisure walking, and 33% for transportation walking (Table 1). respondents with CVD. The adjusted odds of transportation walk-
Significant differences in prevalence of any, leisure, and transport- ing also decreased linearly with increasing CVD risk; however,
ation walking were observed for all characteristics, except for any this trend was no longer significant after removing respondents
walking by sex. In addition, prevalence of any, leisure, and trans- with CVD. The adjusted odds of transportation walking was only
portation walking decreased linearly with increasing BMI and was lower among those with CVD compared with those with no CVD
lower among adults with diabetes, hyperlipidemia, hypertension, and not at risk (AOR, 0.74; 95% CI, 0.63–0.88).
myocardial infarction, and stroke than among those without. In
unadjusted analyses, the prevalence of any, leisure, and transporta-
tion walking decreased linearly with increasing CVD risk (Figure).
For example, the prevalence of any walking among adults who

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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PREVENTING CHRONIC DISEASE VOLUME 16, E66
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY MAY 2019

Discussion investigating the underlying factors influencing these associations

and how volume of walking differs by CVD risk (22) may help
Overall, only two-thirds of adults reported any walking for at least explain the various relationships we observed and inform effect-
10 minutes during the past 7 days. Our study found that the preval- ive strategies to promote walking for multiple purposes, espe-
ence of any walking was lower among adults with higher degrees cially among people at various levels of CVD risk.
of CVD risk, and this association remained after adjusting for
Clinical interventions that promote physical activity can help pre-
demographic characteristics. Although similar patterns were ob-
vent CVD. For example, the USPSTF recommends that health
served for leisure walking and CVD risk, they were not observed
care providers offer or refer adults who are overweight or have
for transportation walking. Promoting walking, especially among
obesity and have additional CVD risk factors to intensive behavi-
adults at high risk, may present an important opportunity for en-
oral counseling interventions to promote a healthful diet and phys-
couraging an active lifestyle for CVD prevention and manage-
ical activity for CVD prevention (5). More than 1 in 3 US adults is
ment.
eligible for this intensive behavioral counseling, and almost 1 in 5
Our study is unique in that we examined participation in walking US adults is both eligible and does not meet the guideline for aer-
among adults with discrete levels of CVD risk. A study using obic physical activity from the Guidelines (2,6). Despite this po-
2014 NHIS data examined the prevalence of adults who reported tential for a population-level health effect, compliance with this
sufficient volume (≥150 minutes/week) of aerobic leisure-time USPSTF recommendation remains low. In 2015, fewer than 1 in
physical activity by chronic disease status (9). This prevalence was 10 primary care providers both discussed physical activity with
found to be lower among participants with obesity, hyperlip- most of their at-risk patients and referred them to intensive behavi-
idemia, hypertension, diabetes, myocardial infarction, and stroke oral counseling (2,23). Primary care providers encounter several
than among apparently healthy adults (9). In addition, a study us- barriers to physical activity counseling (24–27), including a belief
ing data from the 2007–2008 and 2009–2010 cycles of the Nation- that patients will not participate in physical activity (23).
al Health and Nutrition Examination Survey found that engaging However, walking may offer these providers a more appealing op-
in active transportation was associated with more favorable cardi- tion for promoting physical activity among this high-risk group,
ovascular risk factor profiles, including lower BMI, smaller waist because walking is an easy way for most adults to incorporate
circumference, and lower odds of hypertension and diabetes (21). more physical activity into their daily routines (8). Additional re-
Although these studies provide a general overview of physical search assessing providers’ attitudes toward walking and the up-
activity among adults with or at risk for CVD, to our knowledge take of walking among patients at risk for CVD would aid in un-
no study has examined walking as a source of physical activity derstanding the potential effect of walking on improving physical
among people with varying degrees of CVD risk. Our findings activity among this high risk population.
identify an opportunity for promoting walking as a form of physic-
Many strategies can be implemented in communities to promote
al activity among these high-risk groups. Future studies may also
walking that can benefit all adults, including those at risk for
assess the effect of walking frequency and intensity and the inter-
CVD. For example, communities can improve walkability by
action of other forms of aerobic and muscle-strengthening physic-
designing communities that make it safe and easy for all people to
al activity on the relationships observed in our study.
walk (8,15). In 2016, the Community Preventive Services Task
We observed decreasing odds of any walking and leisure walking Force recommended built environment approaches combining
with increasing CVD risk, which remained after adjusting for re- transportation system interventions with land use and environ-
spondent characteristics. This finding is likely explained in part by mental design to increase physical activity (28). In addition, vari-
the known relationship between low levels of physical activity and ous sectors can promote programs and policies to support walking
increased CVD and CVD risk (1). This inverse relationship identi- where people live, learn, work, and play and provide information
fies an opportunity to promote leisure walking among those at to encourage walking. Promoting walking at the community level
high risk for CVD to help them avoid inactivity and increase their may benefit everyone and can contribute to CVD prevention
participation in overall physical activity to prevent the develop- through increased physical activity.
ment and progression of CVD. However, CVD risk was not asso-
This study has several limitations. Data were self-reported and
ciated with transportation walking, which was also the least com-
may be subject to recall and social desirability biases (29). Data
mon type of walking reported. These differing relationships by
were also cross-sectional, making it difficult to rule out reverse
walking type may be due in part to distinct reasons for walking,
causality. In addition, about 6% of survey respondents did not re-
such as participating in leisure walking to improve health or for
port on their walking behaviors. NHIS does not assess intensity of
personal interaction and social involvement (8). Future research
walking, and we were unable to assess whether the walking repor-

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the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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PREVENTING CHRONIC DISEASE VOLUME 16, E66
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the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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Tables
Table 1. Sample Characteristics and Prevalence of Walking Among US Adults, National Health Interview Survey, 2015a

Type of Walking, % (95% Confidence Interval)

b c d
Characteristic Sample Size (%) Any Leisure Transportation
Total 29,742 (100) 64.2 (63.3–65.1) 53.0 (52.1–54.0) 32.6 (31.7–33.4)
Sex
Male 13,618 (49.4) 63.6 (62.4–64.9) 51.2 (50.0–52.5) 35.3 (34.1–36.6)
Female 16,124 (50.7) 64.7 (63.6–65.8) 54.8 (53.6–56.0) 29.9 (28.8–30.9)
Age, y
18–24 2,673 (12.8) 65.7 (62.9–68.4) 49.5 (46.7–52.2) 41.0 (38.0–44.0)
25–34 5,223 (17.9) 67.7 (65.9–69.4) 56.4 (54.5–58.2) 35.1 (33.3–37.0)
35–44 4,743 (16.7) 66.0 (63.9–68.0) 55.0 (52.9–57.1) 33.5 (31.6–35.5)
45–64 9,954 (34.1) 64.4 (63.0–65.9) 53.8 (52.3–55.4) 31.5 (30.1–32.8)
≥65 7,149 (18.5) 57.5 (55.9–59.1)e 49.0 (47.4–50.6)f 25.4 (24.0–26.8)g
Race/ethnicity
White, non-Hispanic 18,565 (65.2) 64.9 (63.8–66.0) 55.0 (53.8–56.1) 31.0 (29.9–32.1)
Black, non-Hispanic 3,815 (11.4) 57.7 (55.3–60.1) 43.7 (41.3–46.2) 35.0 (32.7–37.3)
Hispanic 4,951 (15.7) 62.7 (60.8–64.5) 49.6 (47.7–51.4) 34.5 (32.6–36.4)
Other 2,411 (7.7) 70.5 (68.0–72.8) 57.5 (55.0–60.1) 38.1 (35.4–40.9)
Education
Less than high school diploma 3,968 (12.2) 53.9 (51.8–56.0) 41.6 (39.4–43.8) 32.4 (30.4–34.4)
High school diploma 7,365 (24.5) 56.4 (54.7–58.0) 46.0 (44.2–47.7) 27.0 (25.5–28.4)
Some college 9,292 (31.3) 63.3 (61.9–64.8) 51.6 (50.1–53.1) 31.0 (29.6–32.5)
College graduate 9,117 (32.0) 74.9 (73.6–76.1)e 64.1 (62.7–65.5)e 38.4 (36.9–40.0)e
Region
Northeast 4,872 (17.2) 67.2 (65.2–69.1) 51.6 (49.3–54.0) 41.0 (38.9–43.2)
Midwest 6,275 (22.3) 62.2 (60.4–63.9) 52.3 (50.4–54.1) 29.5 (27.8–31.2)
South 10,172 (37.0) 59.7 (58.1–61.3) 50.1 (48.5–51.7) 27.4 (25.9–29.0)
West 8,423 (23.5) 70.9 (68.9–72.7) 59.3 (57.4–61.3) 37.4 (35.6–39.1)
Current smoker
Yes 4,784 (14.9) 55.9 (54.0–57.8) 44.1 (42.2–46.0) 30.6 (28.8–32.4)
No 24,958 (85.1) 65.6 (64.7–66.5) 54.6 (53.6–55.6) 32.9 (32.0–33.8)
a
Excludes respondents unable to walk (n = 842).
b
All characteristics were significantly associated with the prevalence of any, leisure, and transportation walking (P < .05 based on adjusted Wald tests), except for
the association between any walking and sex (P = .18).
c
Sample sizes are unweighted.
d
Percentages are weighted and may not add to 100% because of rounding.
e
Significant linear and quadratic trends (P < .05). Demonstrates nonlinear variation in addition to an overall increase or decrease.
f
Significant quadratic trend (P < .05).
g
Significant linear trend (P < .05).
h
Body mass index (weight in kilograms divided by height in meters squared) estimates were calculated from self-reported weight and height. Underweight and nor-
mal weight = BMI <25, overweight = BMI 25.0–29.9, and has obesity = BMI ≥30.
(continued on next page)

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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(continued)
Table 1. Sample Characteristics and Prevalence of Walking Among US Adults, National Health Interview Survey, 2015a

Type of Walking, % (95% Confidence Interval)

b c d
Characteristic Sample Size (%) Any Leisure Transportation
h
Body mass index category
Underweight or normal weight 10,521 (36.4) 68.3 (67.0–69.6) 56.5 (55.1–57.8) 36.4 (35.0–37.9)
Overweight 10,128 (33.8) 64.2 (62.8–65.5) 53.7 (52.3–55.1) 31.0 (29.8–32.2)
Has obesity 9,093 (29.8) 59.2 (57.7–60.6) 48.0 (46.6–49.5) 29.6 (28.2–30.9)
Diabetes
Yes 3,563 (10.7) 54.2 (51.9–56.4) 44.0 (41.8–46.3) 25.6 (23.7–27.6)
No 26,179 (89.3) 65.4 (64.4–66.3) 54.1 (53.1–55.1) 33.4 (32.4–34.4)
Hyperlipidemia
Yes 8,575 (27.2) 61.6 (60.3–63.0) 51.3 (49.8–52.8) 29.6 (28.3–30.9)
No 21,167 (72.8) 65.1 (64.1–66.1) 53.7 (52.6–54.8) 33.7 (32.6–34.7)
Hypertension
Yes 8,857 (26.2) 57.9 (56.5–59.3) 48.0 (46.5–49.5) 27.7 (26.4–29.1)
No 20,885 (73.8) 66.4 (65.4–67.4) 54.8 (53.7–55.9) 34.3 (33.2–35.4)
Myocardial infarction
Yes 1,027 (2.9) 52.0 (47.8–56.2) 43.4 (39.4–47.5) 22.2 (18.9–25.9)
No 28,715 (97.1) 64.5 (63.6–65.4) 53.3 (52.4–54.3) 32.9 (32.0–33.8)
Stroke
Yes 897 (2.4) 47.0 (42.5–51.6) 37.8 (33.5–42.2) 23.2 (19.7–27.0)
No 28,845 (97.6) 64.6 (63.7–65.5) 53.4 (52.4–54.4) 32.8 (31.9–33.7)
a
Excludes respondents unable to walk (n = 842).
b
All characteristics were significantly associated with the prevalence of any, leisure, and transportation walking (P < .05 based on adjusted Wald tests), except for
the association between any walking and sex (P = .18).
c
Sample sizes are unweighted.
d
Percentages are weighted and may not add to 100% because of rounding.
e
Significant linear and quadratic trends (P < .05). Demonstrates nonlinear variation in addition to an overall increase or decrease.
f
Significant quadratic trend (P < .05).
g
Significant linear trend (P < .05).
h
Body mass index (weight in kilograms divided by height in meters squared) estimates were calculated from self-reported weight and height. Underweight and nor-
mal weight = BMI <25, overweight = BMI 25.0–29.9, and has obesity = BMI ≥30.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

8 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2019/18_0690.htm

PREVENTING CHRONIC DISEASE VOLUME 16, E66
PUBLIC HEALTH RESEARCH, PRACTICE, AND POLICY MAY 2019

Table 2. Adjusted Odds Ratiosa of Walking Among US Adults (N = 29,742), National Health Interview Survey, 2015b

Type of Walking, Adjusted Odds Ratio (95% Confidence Interval)

c
Cardiovascular Disease Status Any Leisure Transportation
No cardiovascular disease and not at risk 1 [Reference]
At risk: overweight or has obesity and 1 risk factor 0.89 (0.81–0.97) 0.87 (0.80–0.95) 0.94 (0.84–1.04)
At risk: overweight or has obesity and 2 risk factors 0.84 (0.74–0.94) 0.81 (0.72–0.92) 0.97 (0.85–1.11)
At risk: overweight or has obesity and 3 risk factors 0.72 (0.61–0.85) 0.72 (0.61–0.84) 0.86 (0.72–1.03)
d d
Has cardiovascular disease 0.65 (0.56–0.74) 0.66 (0.58–0.76) 0.74 (0.63–0.88)d
a
Logistic regression model adjusted for sex, age group, race/ethnicity, education level, region of residence, and current smoking status.
b
Excludes respondents unable to walk (n = 842).
c
Cardiovascular disease status category definitions: 1) has cardiovascular disease (history of stroke or coronary heart disease); 2) at risk (overweight or had
obesity and one or more additional risk factors [hypertension, hyperlipidemia, or diabetes]); and 3) no cardiovascular disease and not at risk (all others who did not
fall into the other 2 categories).
d
Significant linear trend (P < .05). Analyses were also conducted to assess trends limited only to those without cardiovascular disease. In these analyses, signific-
ant linear trends were still observed for any walking and leisure walking, but not for transportation walking.

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services,
the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

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