When it comes to health and fitness, the magic pill may not be a pill at all. It may be something much harder to swallow.
Many U.S. health professionals are adopting the decades-old directive of a Japanese researcher who said adults need to go for a long walk - 10,000 steps - nearly every day of the week.
Children and people aiming to lose weight need more steps, and seniors need fewer. Other factors, such as medical conditions, also complicate the generic one-size-fits-all approach. But it's tough to find someone in the health arena who doesn't think more walking would benefit a lot of hearts, bones, muscles and even psyches.
And considering the American obsession with setting goals, counting numbers and instant rewards, it's no wonder exercise gurus are pushing 10,000-step-a-day programs. Research also seems to show that goal-setting works.
"People need fast feedback," said Anne Williams, who helps manage walking programs for the University of Maryland Medical Center.
"We have ATMs, fast food, instant messaging," she said. "Feedback from their scale may take time, but if they look at their step counter, it tells them daily, even hourly, how close they are to meeting their goal."
Williams and others say most adults don't get enough exercise.
Government researchers estimate that 40 percent of adults get no leisure-time physical activity. And about 60 percent of adults are overweight or obese, with 300,000 dying each year from weight-related problems such as Type 2 diabetes, cancer and strokes. Weight also contributes to arthritis, breathing problems and depression.
The U.S. surgeon general recommends walking and other exercise to reverse the statistics.
Goals can motivate people to get moving, said Williams, also a registered nurse and manager of the medical center's Patient Resource Center. The center sponsors an annual program for thousands of people, companies, churches and others called Get Fit Maryland, in which adults pay a small fee for a pedometer, little prizes and information on reaching 10,000 steps a day. A kids program that promotes 12,000 steps a day is free.
Programs like these jibe with exercise guidelines from the surgeon general's office, which says most adults need 30 minutes of moderate activity a day on top of their regular activity. The office has not specifically endorsed 10,000 steps, though many groups have begun using the number as a general goal.
Most people can reach 10,000 steps with a 30-minute walk plus their regular activity, though many need to work up to it, Williams said. She said she's found previously that sedentary people often don't get more than 2,000 steps a day. She recommends those people and those with health problems consult their doctors before starting any exercise plan.
There is growing evidence that having a specific goal like 10,000 daily steps helps increase the amount people exercise.
A recent study by Stanford University researchers published in the Journal of the American Medical Association showed that those adopting the 10,000-step goal increased the number of steps they took by 27 percent.
A 2005 study by American College of Sports Medicine, a professional organization, showed that women with pedometers and a goal of 10,000 steps per day walked more than those with a goal of a brisk, 30-minute walk.
The generally accepted conversion rate for 10,000 steps is about five miles, though some believe it's closer to four. At an average pace of 15 minutes to 20 minutes per mile, it would take up to one hour and 40 minutes to reach the goal, if done at once.
That meshes with a study conducted by San Diego State University and Arizona State University for the American College of Sports Medicine that concluded that most people could cover 3,000 steps in 30 minutes at a moderate pace, where the person feels exertion but can talk comfortably.
Some walkers said the step goal has not just gotten them into shape, it's been a life saver.
Vikky Bates, a contract administrator for the University of Maryland Medical System, signed up for Get Fit Maryland two years ago because she hadn't been exercising. During registration, organizers also discovered she had dangerously high blood pressure.
Now on medication, she has changed her eating habits and walks diligently every day. She's joined a group that hoofs it around Camden Yards.
"I'm fine now," she said on a recent afternoon, with 7,100 steps already logged. "I'm amazed at how easy it's become to get 10,000 steps on my pedometer. ... Who knows, without it, I may not even be here today."
Ray Scott, a 51-year-old who works in systems engineering for the medical center, said he also wasn't exercising regularly until he clipped on his pedometer. He said he's begun walking more at work - the medical center has marked trails inside to encourage employees, patients and their families to do more exercising. But he prefers to log his steps on walks with his wife and dog.
"The pedometer definitely makes me more aware of how far I've gone," he said. "I used to go between 6,000 and 8,000. Then I got up to 8,000 to 10,000. ... Now, I usually get between 10,000 and 12,000 steps a day."
Contrary to the testimonials, however, the government and some professionals still endorse only the 30-minutes-a-day plan and not the 10,000-step goal.
William Haskell, a professor at Stanford University's School of Medicine, was one of them. He is the lead author on the latest exercise guidelines for the American College of Sports Medicine. His recommendations were similar to the surgeon general's because he said studies showed that 30 minutes of moderate exercise or even three 10-minute bouts contributed to good health.
There wasn't much evidence showing that shorter stints were beneficial, and many 10,000- steppers might get their exercise too piecemeal, he said.
But he said he's warming to the step goal as new research is conducted and seems to show people need sustained bouts of walking to reach 10,000 steps by day's end.
"I'm not telling people not to have the goal," he said. "We know being sedentary is a major health risk,and anything that can get people up, whether it's 30 minutes a day or 10,000 steps, is good. Whatever works best for you is the way to go."
Greg Freitag, an exercise physiologist at the Johns Hopkins Weight Management Center, agrees that goals should fit the individual.
For example, losing weight requires at least 2,000 more steps, and boosting cardiovascular health needs more intensity fewer days of the week. Further, those with longer strides might need fewer steps because they cover more ground with each step and "work" harder.
But Freitag said he supports the 10,000-step goal because it has gotten more people exercising.
"The thing about goals is that they should be specific and measurable," he said. "But 10,000 is a nice goal, an obtainable goal that most everyone can do."
TAKING STEPS How many steps roughly equal a mile? The rule of thumb is 2,000 steps per mile (10,000 steps equals five miles).
CHANGING YOUR LIFESTYLE
More than 60 percent of adults are overweight or obese, and many health professionals promote walking for general good health and as the cure for expanding waistlines. Here are some iips for starting a walking program:
Those who are sedentary or have health issues should see a doctor first and start slow.
Buy a pedometer. Don't go too cheap because they can be less accurate, but skip the expensive extras such as global positional systems and hit-or-miss calorie counters. A good range is $15 to $45. Give them a test run before using.
Pedometers need to be clipped securely on a waistband. Log normal steps for a few days and average to get a baseline. Then add about 10 percent more a week.
Look for ways to add steps during the day, like parking at the back of the lot or using a restroom farther away. Take the stairs.
Find a friend or club to exercise with after work or on weekends, or make it a regular family activity, to establish a habit. Those who prefer solo walking can listen to something motivating like music or recorded books.
Seek out a program that involves professionals such as Get Fit Maryland (getfitmaryland.org), sponsored by the University of Maryland Medical Center, the UM School of Medicine and Merritt Athletic Clubs.
Don't forget to drink extra water and not sugary soda. Bring a bottle along, especially when it's warm.
If you'd rather jog, then jog. It burns more calories during the same time. Pedometers don't work well with many other activities, or if the person is not wearing shoes.
Per the surgeon general's recommendation, make time most days for 30 minutes of continuous, moderate exercise, where a person feels exertion but can talk comfortably. Two 15-minute bouts, or three 10-minute sessions, also provide health benefits.
If it's too cold outside, walk at a gym or shopping mall. Check with mall management, because some places allow groups after-hours.
For those without a pedometer, 10,000 steps equals about five miles. Map a regular route, or a new course for variety, by using the car's odometer on streets or an online tool such as Gmaps Pedometer (gmap-pedometer.com).
Source: Sun research
Walking the most
The large cities with the highest percentage of employees who walk to work are:
1. Boston (12.5 percent)
2. Washington (10 percent)
3. San Francisco (9.6 percent)
4. New York (9.4 percent)
5. Philadelphia (8.1 percent)
6. (tie) Honolulu, Seattle (6.9 percent)
8. Minneapolis (5.8 percent)
9. Chicago (5.5 percent)
10. Baltimore (5.4 percent)
And at least?
The large cities with the lowest percentage of workers who walk to work are Arlington, Texas (0.9 percent); Fort Worth, Texas (1.1 percent); and Oklahoma City (1.4 percent).
[Source: HR.BLR.com, a human resources Web site]