In this episode of "Unlock the Power of Daily Walking," host JJ Virgin interviews a walking and foot‑health specialist (Speaker E) to unpack why walking is often undervalued and how it can be prescribed like medication. The conversation covers the physiological necessity of daily ambulation, step‑count thresholds linked to specific health outcomes (e.g., a 500‑step increase reduces all‑cause mortality by ~7 %, 3,800 steps lowers dementia risk by 25 %, 5,000 steps cuts depression risk), and the “sweet spot” of 7,000‑9,000 steps per day versus the traditional 10,000‑step myth. They introduce gait speed as a potential sixth vital sign, explaining how a cadence of 130‑135 steps per minute (≈4 mph) predicts lower cancer and dementia risk. Practical strategies are offered: incremental step increases, “movement snacks” such as 10‑minute walks after meals to blunt post‑prandial glucose spikes, and spreading walking throughout the day rather than a single block. The role of weighted vests and “power walking” is discussed, emphasizing that load should follow adequate speed and cadence. The dialogue then shifts to foot‑specific aging concerns—sarcopenia, loss of toe strength, and reduced plantar receptor sensitivity after age 50, especially during menopause—linking these changes to fall risk and proposing simple at‑home assessments. Throughout, the experts stress the need for clinicians to routinely assess step count and gait speed, integrate walking with strength training, and personalize prescriptions based on baseline activity.
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Why do you think that walking is so misunderstood, and what's the, like, the fundamental thing that shocks you the most about that?
I think that it should be on every doctor's prescription pad. If you look at the research of what even a little bit amount of walking does, it literally stimulates every single system in our body. It's— I think what shocks me the most is that we have to have the conversation of trying to convince people to walk more. I know. You know, it's like, it would be like telling a fish they have to swim. As a human being, we are a biped. We have evolved to walk on two feet. So if we think about that as walking is as essential to human survival as things like breathing and sleeping, it becomes this physiological necessity. I like to reframe it like that because it isn't optional. It isn't one of those, well, I walked yesterday, so I don't have to walk today, which is, I think there's the difference between our conversation of strength training versus walking. They're both mandatory.
Right, but you don't have to do, and you shouldn't do resistance training every day, so.
But with walking, the research is, It needs to be consistent. And that's what's so beautiful about it is it's a low to moderate activity that you can do daily that benefit every system in your body. So it, when I'm having discussions with my patients, it is, how much are you walking? What is your step count? What is, that's always part of our treatment plan.
Okay, well, let's talk specific prescriptions on walking. I'll give you an example. I had a client, morbidly obese, and the doctor wanted to put him on testosterone, and he was walking 2,000 steps a day. I'm like, you know, just if you doubled that, that actually is gonna impact your testosterone.
That's right.
So what I'd love to see is like, what is the typical person getting in right now in terms of, and then what's your prescription? And not just how much for the day, but also when, all of that.
I think you have to look at everyone's baseline. So where are they coming in along the walking spectrum? If you have someone that's at 2,000 steps per day, a little bit goes a long way. So if I'm at 2,000 steps per day, increasing by 500 steps per day starts to decrease all-cause mortality by about 7%.
Which is insane. Could you imagine if there was a medication that did that?
That's right.
Right. If you get to 3,800 steps per day, you will start to see reductions in dementia. By not small numbers, that's 25%. We jump up to 5,000, you start to reduce the risks of depression. Taking your baseline and starting to increase. And when you think about how many steps to take in 5 minutes, for example, 5 minutes is about 500 steps. So just to put that into perspective, if you wanted to increase by 1,000 steps per day, you walk for 10 more minutes. That's also like— Doable. Very doable. But the magic, the sweet spot, is anywhere from 7,000 to 9,000 steps per day, which is very different than if you were to Google how many steps, because most resources still will tell you 10,000.
Well, it's the Japanese pedometer company. I mean, I think everybody knows that story, which here's the thing, it's great, it's an even number, it gives people a target to shoot for. I mean, I'd rather them go for 10,000 than 3,000. So from what I see in the research right now, it's somewhere 7,000 and up seems to be the— place to go, but, you know, I always think as long as you're not then, let's say you're going over 10,000 and you're stealing from true exercise. Don't do that either. But I just want people to be aware. And I think if you measure it and monitor it, you'll do it. But I think it's more than just how much, right?
So. There's a law of diminishing return, you know, and I'll have patients that will say, well, I'm walking 15,000 steps a day, which is great. And then my next question to them is, are you strength training?
Right.
And if they say, "No, I don't have time because I'm trying to get 15,000 steps in," that's a very good conversation to say, "Let's dial it back.
And now I've given you more time to explore other things." The other piece I love about walking is that if we really start to monitor it, we can do it all throughout the day.
Yes.
And that's the other piece that's so important is not just trying to do it all at once.
Right. I always say, if you are, let's say you're a runner, and you run for your hour in the beginning of the day, that doesn't excuse you from your walks throughout the day.
I want everyone to hear that because there's actually someone on the internet, I saw it, saying just the opposite. And I'm like, you've gotta be kidding me.
If you think about it just from, if you take it to the conversation of walking after you eat. So that's one of the best times to walk is within 10 to 30 minutes after you eat. Depending upon what you eat, you have an increase in your blood glucose. So we know that when we have activity after we eat, we have the pancreas and muscle contraction that's grabbing the glucose out of the bloodstream and putting it into cells to be utilized. So if you get your 1 hour in in the morning and then you're sedentary throughout the day and you're just sitting after you eat, the pancreas is working hard. Mm-hmm. The pancreas doesn't like that. So having these options of these movement snacks, we talk about that a lot in the book, different snacks that you can do with walking being one of them, 10 minutes after you eat, it is the lowest hanging fruit that we can do and so easily accessible.
And what about weighted vests? Yes or no?
Yes. I think that depending upon where people are, when you add a weighted vest, you're adding more loads. So for someone who's trying to get into increase their heart rate, Or they want to put more load through their system. Absolutely. It can be a great way to what we call amp up walking. We talk about power training and strength training and weighted walking, which can be— that weighted walking can be very beneficial for people. But for some, it's also— that might not be your entry point, which is also fine. So it depends on where you sit along that spectrum.
It wouldn't seem like that would be a great entry point for anyone. It seemed like something you do once you got this going.
Another thing to consider would be speed before adding load, because walking gait speed is very important. And in the book, we talk about how it has been discussed as being the sixth vital sign. So what I mean by that is when you go to the doctor, you get your temperature taken, your blood pressure, and if there's something wrong with your five vital signs, then it's a red flag to the physician saying, we might want to look into this. This could be a problem for something. And what they have looked at was walking gait speed, because when someone is walking slower, so their cadence is slower, it can be a predictor of things like dementia up to 7 years in advance. We could look at why are they walking slower? Is it a balance issue? Is it a strength issue? And these are all proactive measures that you can say, okay, let's, let's take a timeout and figure this out. So before I would say, go ahead and start adding weight, how efficient is your walking? Can you walk for 30 minutes at a brisk pace? And if you look at the research, that's about 3.5 to 4.0 miles per hour, which is not slow.
4 miles per hour, I'm gonna make it easy, a mile every 15 minutes. Yep. And that would be easy to track on with you, with whatever fitness tracker you have. So is that the easiest way for someone at home to check their gait speed, or is there another test you like? Because let's be honest, that's kind of my beef right now is no one's checking muscle quality, sarcopenia. No one's looking at these things. So likely they're not getting tested for gait speed at their doctor's office.
No. Step count too. How many steps are you taking per minute? So about 130 to 135 steps per minute.
Hmm, okay.
And when you add in hills, I live in Colorado, I'm at about 8,000 feet of elevation.
We're in Florida. 8,000 feet of elevation.
And these are different conversations, but that gait speed is important. And, you know, to maintain 4.0 or 135 steps per minute for 30 minutes, which is also, you know, we get into some fun numbers about reducing cancer risks at those numbers. I think people would find it a little more challenging than it sounds.
Yeah, that is one thing I've lived half time, like California and Florida have been both my, I go back and forth and gosh, I miss the hiking.
Yeah.
Whenever we're anywhere where we can hike, we are out there hiking. Yeah. So even though I'm hiking on my sore foot, I still do it.
Oh, we're gonna have to talk about that.
We are getting to it. I would love to talk about menopause. I've never heard anyone talk about this, menopause and feet. And the reason I'm asking about this is I was out to dinner the other night and my girlfriend was talking about her tender feet. I go, tell me about your tender feet because I have the foot expert coming on the show. So tell me about this. And she said, well, my grandmother had it too, or maybe her mother. She said it started like 2 years ago, right when she was going through menopause, right? She's not on hormones, not doing anything. Now she has these tender feet. And when she gets up in the morning, she does like, ow, ow, ow, ow, ow. I'm like, oh my gosh. And you're just living with this? What is going on? So is that something that's a hormonal shift? What's going on there?
I think if we looked at this first from big picture, we're all aware of sarcopenia. And how we lose muscle mass as we age.
She's very fit, by the way, and exercises all the time.
You have to consider that that also happens at the foot. Your foot also loses strength. Your toe strength declines. When we look at sensory awareness and perception, these are some fun numbers. When you turn 50, the receptors on the bottoms of the feet that are designed to gather information, keep us upright and balanced, it takes 25% more pressure to stimulate those receptors.
Okay, wait, hold, hold on. Because I hear all these things, of course I always think, but not for me. Why is that? I mean, if you were really active, would that still be the same amount? Is that just aging?
And it's aging. It's— this is what happens when we age. We lose sensation in our feet and we lose strength. But the good news about that is that if we have these conversations that we're having, then these are the types of things we can work on. It's proactive, not reactive. If you do nothing, when, as when you turn 80, for example, that number jumps up to 75% more pressure necessary. So we shouldn't be asking ourselves, wow, there's a lot of falls. Why are all these falls happening? I come from looking at this from the bottom up, saying, why would we not pay attention to the one part of our bodies that are supposed to feel the ground to keep us upright and balanced?
Why are we not talking about this? I mean, why, why do you hear about falls and you hear about strengthening your quads and, and you never hear this piece, which makes so much sense.
Yeah. If you were to— this is a good kind of at-home test. If you were to stand up next to a wall and keep your body straight and try to lean into the wall as far as you can to get your nose as close to the wall as you can without kind of pitching at the hip. What you should feel stop you are your toes. It's your toes pressing into the ground that prevent this forward progression. When you look at falls, the majority of them can happen at the initiation of gait. So when I start walking forward, so if I can't feel my toes, if I don't have my strength there, then it's an indicator, it can be a predictor of falls. Uh, Karen Mickel has done a lot of research on this and it's fascinating to me.
