Dog Ownership and Dog Walking to Promote Physical Activity and Health in Patients

Abstract

Lack of physical activity is a significant risk factor for many chronic diseases and conditions and is associated with significant medical costs. Approximately half of adults and more than a third of adolescents and youth in the United States do not achieve recommended levels of physical activity. Effective population-level strategies are needed to promote activities that are practical, accessible, and sustainable and that can reach a large proportion of the population. Dog walking may be such a strategy. Walking is popular, easy, and sustainable and has a low risk of injury. Owning dogs confers many health benefits, and dog walking, in particular, can help promote physical activity and improve health. Physicians and other health care providers can play a unique and integral role in promoting physical activity among patients by recommending dog walking both to dog owners and to non-dog owners as a purposeful, enjoyable, and sustainable form of regular physical activity.

Introduction

Regular physical activity provides a myriad of health and fitness benefits, reduces morbidity and mortality, and reduces medical expenditures. Despite these substantial benefits, most Americans are not physically active at recommended levels. Effective population strategies to increase physical activity are needed. Dog walking, because of its characteristics, may represent such a strategy. This article provides the rationale for dog walking as an effective intervention strategy, explores some of the broader health benefits of dog ownership, and discusses the role that health care providers may have in promoting dog walking to their patients.

Physical Activity and Health

Regular physical activity confers a variety of health benefits, including the prevention and treatment of many chronic diseases and conditions (²⁹). In addition to the health benefits, regular physical activity also results in medical cost savings. Medical expenditures for physically active adults have been estimated to be $1,000 less annually than those for inactive adults (³¹). Annual cost savings of approximately $5 billion could be realized if 10% of the sedentary population in the United States would adopt a walking program (²³).

According to the 2008 Physical Activity Guidelines for Americans, adults need to engage in at least 150 min·wk⁻¹ of moderate-intensity aerobic activity (equivalent to a brisk walk for most people) or 75 min of vigorous-intensity aerobic activity (an intensity at which it would be difficult to carry on a conversation) or an equivalent mix of moderate- and vigorous-intensity aerobic activity (²⁹). Bouts of 10 min of moderate-to-vigorous physical activity (e.g., taking three 10-min walks a day) provide health benefits (¹⁶), and even light activity, defined as less than three metabolic equivalents (METs) (approximately equivalent to three times the amount of energy expenditure at rest), contributes significantly to energy expenditure (²⁸).

Despite the benefits of regular physical activity, much of the U.S. population is not sufficiently active. The prevalence of adults being physically active at sufficient levels is slightly more than 50% (¹⁰). Fewer than 20% of U.S. students in grades 9 to 12 are sufficiently active (³⁹).

Effective Intervention Strategies

Given the numerous and substantial benefits of physical activity, the serious costs of inactivity, and the number of Americans who are not sufficiently active, a critical need exists for effective strategies and interventions to promote and increase regular physical activity (³⁰). These strategies and interventions should be based on theory, evidence of effectiveness, and an understanding of behavior (⁴⁰). They should reach and be applicable to large segments of the population and promote initiation of or increases in physical activity that can be sustained over time (³⁰).

Only about 50% of people who begin formal exercise programs adhere over time; about half drop out within 6 months (²⁷). Lack of adherence has been attributed to the "nonpurposeful" approaches that characterize many formal exercise programs. Nonpurposeful activity is described as activity that does not provide a purpose beyond the inherent value of being physically active or of reaching a fitness or health goal (²⁷). A paradigm shift in the prescription of physical activity to one that is characterized by "purposeful" activity, that which provides meaning or purpose beyond the physical activity per se, has been called for (²⁷). To help individuals engage in and sustain regular physical activity, it is important to understand what motivates, facilitates, and provides meaning and purpose for individuals to be physically active (¹⁵). Several key determinants of physical activity have been identified. Self-efficacy (one's belief in one's ability to perform an activity or engage in a behavior), possessing home fitness equipment, having social support, and having access to enjoyable scenery have all been positively associated with achieving recommended levels of physical activity (³³). Self-efficacy, a key concept of the Health Belief Model theory of behavior change (⁴⁰), has been identified as the most consistent intrapersonal correlate of behavior (³⁷). Social support is also a consistently important interpersonal correlate (³⁷), and having exercise equipment at home or having access to facilities is an environmental correlate (³⁷). Lack of an exercise partner and lack of access to facilities have been among the most significant barriers specifically among older adults (²⁵).

Walking

Walking may offer particular benefits and promise for helping individuals initiate and sustain regular physical activity. An important benefit of walking is that it is accessible to most of the population. This includes people for whom physical activities that have a cost, such as gym membership or organized sports, may be prohibitive. Walking also is accessible to people for whom physical access to facilities, programs, or equipment is limited or nonexistent. Walking is accessible to people of all ages, fitness levels, and abilities and requires no special equipment, programs, training, or facilities. It is simple, can be adapted to individual needs and capacities, and can generally be performed safely even by previously sedentary individuals (²¹). For example, an individual easily can adapt to and vary the frequency, intensity, and duration of walks as needed. Walking has been cited as the most common and popular form of physical activity among adults in the United States (¹¹) and is associated with long-term adherence (²⁶). Although health benefits can be achieved by a variety of physical activities, the 2008 Physical Activity Guidelines for Americans notes specifically that health and fitness benefits are derived from regular brisk walking, particularly for people who have been sedentary or physically active on an infrequent basis (³⁸).

Dog Ownership and Dog Walking

Walking dogs can help promote engagement in and adherence to regular physical activity (^6,9,17,32,36). In fact, simply owning dogs confers health benefits and reduces medical costs (²⁰). Dog owners are more likely to survive after having a heart attack than those without pets (¹⁷). Owning a dog can help to lower blood pressure, triglyceride, and cholesterol levels (³). Scientists in Australia found that pet owners were healthier and made fewer visits to their doctor than those without pets, resulting in a savings of $988 million in health care costs during 1 yr (¹⁹). In Germany, people who owned pets were healthier and made 15% fewer doctor visits (²⁰). Dog ownership also contributes to better emotional and psychological health (⁷). Pet ownership improves morale, particularly among older adults (²⁴), and can reduce anxiety, depression, and social isolation and increase physical activity (⁷). Acquiring a dog has been shown to result in the discontinuation of drugs and to contribute significantly to cardiovascular and mental health (³⁵). In addition to the array of health benefits of dog ownership, a growing body of literature suggests that dog walking can increase physical activity (¹⁴). Most studies that have examined the relationship between dog walking and physical activity have been cross-sectional in design, indicating a need for additional longitudinal and intervention studies. However, the few longitudinal studies conducted to date also found that having or acquiring a dog was associated with increased physical activity (^32,36).

A cross-sectional study in Australia found that dog owners who walked their dogs walked on an average of 18 min·wk⁻¹ more than non-dog owners (⁶). Findings from a longitudinal study in the United Kingdom showed that adults who adopted dogs subsequently got significantly more exercise than either adults who adopted cats or adults without pets. This significant difference persisted 6 and 10 months later (³²).

Dog walking not only may help individuals initiate, increase, and sustain regular physical activity but also may help people meet the recommended levels of physical activity (¹⁸). Findings from a longitudinal study in the United States showed that among older adults, 58.5% of dog owners who walked their dogs met physical activity recommendations of 150 min·wk⁻¹ through walking, compared with 19.8% of dog owners who did not walk their dogs (³⁶). Three years later, the dog walkers were twice as likely to achieve that same level of physical activity as either dog owners who did not walk their dogs or non-dog owners (³⁶). In addition, dog walkers had faster usual and rapid walking speeds than dog owners who did not walk their dogs, a benefit of particular importance to older adults in terms of maintaining mobility (³⁶). An analysis of data from the National Household Travel Survey in the United States showed that, in 1 d, nearly 43% of dog walkers accumulated at least 30 min of physical activity from walks lasting at least 10 min each (¹⁸). In Canada, dog owners exceeded recommended levels of physical activity through dog walking, walking an average of 5 h·wk⁻¹, compared with 3 h for non-dog owners (⁹). A series of case studies found that individuals who walked dogs reported participation in purposeful physical activity from between 5 and 79 yr and walking between 3 and 8 miles·d⁻¹, with a minimum frequency of 5 d·wk⁻¹ in each case (²⁷). Walking a dog at a moderate intensity for 60 min·d⁻¹, which is recommended for most healthy dogs (²²), would result in the dog walkers exceeding current guidelines for moderate physical activity. Even if walking the dog is at a light level of intensity (<3 METs), health benefits are gained (³). A recent review of the literature noted increasing evidence to suggest that dog owners are more physically active than non-dog owners largely through walking their dogs; however, as many as about half of dog owners are not physically active with their dogs (¹⁸), offering an opportunity to intervene on a significant number of dog owners.

The effect of dog ownership on increased physical activity among dog owners may be due to several factors. Evidence suggests that dogs can provide motivation and social support for walking (¹⁸). The Guide to Community Preventive Services recommends social support interventions in community settings as an evidence-based intervention strategy (³⁴). Social support can be provided by creating expectations, contracting with oneself or someone else, and/or by being an exercise buddy (³⁴). Dogs can provide social support by virtue of expecting to be walked and by being an exercise companion (^9,27).

In a mediator analysis of dog walking, the construct of dog obligation was found to act as a mediator between dog ownership and physical activity; that is, having a sense of obligation or responsibility to walk the dog was a key mediator in the relationship between dog ownership and physical activity (⁹). The Theory of Planned Behavior constructs of intention and perceived behavioral control explained 13% of the variance in walking behavior with an additional 11% variance in walking behavior explained by dog obligation (⁹). Further, dog obligation had an effect on walking independent of intention (⁹). The authors concluded that acquiring a dog should be explored as an intervention to get people to be more physically active (⁹). A series of case studies revealed that dog walkers walked on a daily basis primarily because their dogs needed the exercise (²⁷). Walking with a dog can increase feelings of safety and security, perhaps particularly important to women and older adults (⁵). Walking a dog provides purposeful physical activity, i.e., activity that has a purpose aside from the inherent value of being active or the achievement of a particular health or fitness goal (²⁷). In a sense, dogs might be considered a type of readily accessible "exercise equipment in the home," which has been shown to be an important determinant of being physically active (³⁷). All taken together, dogs may increase physical activity by increasing self-efficacy for walking, through providing enjoyment, social support, a sense of safety and purpose, increased social contact, and a regularly accessible opportunity to be active (^5,27). An important determinant of physical activity is having access to opportunities to be active. Dog walking is accessible to a large proportion of the U.S. population (¹). According to the American Pet Products Association 2009 to 2010 National Pet Owners Survey, there are approximately 77.5 million dogs in U.S. households (¹). Thirty-nine percent of U.S. households include one dog; 24% include two dogs (¹). Dogs and other pets are becoming increasingly valued members of households (¹). As an example, pet expenditures in the United States have grown from $17 billion in 1994 to approximately $47.7 billion in 2010 (¹). These expenditures extend beyond food, shelter, and medical expenses to include birthday and holiday presents, pet fashion, traveling equipment, technology, and alternative therapies and services such as massage, yoga, and acupuncture (¹). Despite pets becoming increasingly valued family members, as many as 50% of dog owners do not walk their dogs (¹⁴). This is important to address not only in terms of the owner's physical activity but also in terms of the physical activity and health of the dogs (^2,4). Dog walking is important for dogs' health. Dogs are facing an obesity epidemic like that of people (⁴). It is estimated that 34 million dogs are overweight or obese and are facing many of the same health consequences as humans (⁴). Dogs need exercise not only to burn calories but also to stimulate their minds and keep healthy overall (²). Exercise also can help dogs avoid boredom, thus helping to avoid destructive behaviors (²).

Role of Health Care Providers

Health care settings are uniquely positioned to reach and influence a significant proportion of the population on a regular and long-term basis. In 2009, 83% of adults and 91.5% of children had contact with a health care professional (¹³). Approximately 956 million visits were made to physician offices in 2008; 60.5% of which were made to primary care physicians. Approximately 320 visits were made per 100 persons (¹²). Physicians and other health care providers, as part of the health care system, are a major and trusted source of health information. In this role, they can and should reinforce public health messages. Recent data suggest that nearly two-thirds of patients would be more interested in being physically active if advised by their doctor (⁸). Given the proportion of the population that visits health care providers on a regular basis, health care settings provide an opportunity for substantial reach and influence on a regular basis across the lifespan. Key components of the Exercise is Medicine® initiative include not only patient physical activity assessment but also recommendation and referral of patients to opportunities for physical activity in the community. These opportunities should include activities that can be undertaken without the need for special programs, training, or equipment. Within health care settings, physicians and/or other health care professionals need to be able to make simple, short physical activity recommendations to patients that do not require them to have extensive subject matter expertise in physical activity and that require minimal time during patient visits. Providers need to be able to make recommendations that are safe, effective, widely applicable, and widely accessible and to which patients can adhere (²⁷). Physicians and other health care providers can play a unique and important role in increasing physical activity by recommending dog walking to their patients who have dogs. Encouraging dog owners who walk their dogs to walk more or encouraging dog owners who do not walk their dogs to walk them has the potential to reach and provide substantial health benefits for a large number of both humans and canines. Even many individuals with chronic diseases or related risk factors can safely walk dogs at a light or moderate intensity. During patient visits, health care providers can ask if the patient owns a dog and, if so, ask the dog's name (which can be charted and referred to in subsequent visits). The owner's physical activity also can be assessed and charted, and where appropriate, the patient can be advised to initiate or increase walking with his or her dog. For patients who do not or cannot have dogs, opportunities still exist for dog walking. Walking a neighbor's dog, walking the dog for a person unable to walk his or her own dog, and volunteering to walk dogs at local shelters or for rescue groups are examples. In addition, for patients without dogs who have the necessary resources and who clearly understand and are prepared for the responsibilities and long-term commitment required of pet ownership, adopting a dog might be a consideration.

Conclusions

Lack of physical activity is a significant risk factor for many chronic diseases and conditions and is associated with significant medical costs. Approximately half of adults and more than a third of adolescents and youth in the United States do not meet recommended levels of physical activity. Effective population-level strategies to promote activities that are practical, accessible, and sustainable and that can reach a large proportion of the population are needed. Dog walking, because of its several important characteristics, may be such a strategy. Walking is popular, easy, sustainable, and associated with a low risk of injury. Owning dogs confers many health benefits, and dog walking, in particular, can help promote physical activity and improve health. Physicians and other health care providers can play a unique and integral role in promoting physical activity among patients by recommending dog walking to both dog owners and non-dog owners as a purposeful, enjoyable, and sustainable form of regular physical activity.

Acknowledgment

The conclusions in this report are those of the author and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.