05/06/2013 04:54 pm ET Updated Jul 06, 2013

Could Having a Valet Be Bad for Your Heart?

I spend time in a city where people often have their cars parked by a valet. Indeed, I was told that if valet service was not offered at events, people would not come. "But there are parking garages only blocks away," I protested. "Can't they walk a few blocks?"

The answer was an overwhelming, "No!"

I thought of this while scanning a summary of a major study looking at the impact of running and walking on various measures of health such as blood pressure, cholesterol, diabetes, and heart disease. The study, recently released online in the journal of Arteriosclerosis, Thrombosis and Vascular Biology, reported the same health benefits for walkers and runners if they expended the same amount of energy while exercising. [1] This study, which lasted six years, enrolled 33,060 runners and 15,045 walkers who were dedicated to exercising. Records were kept of the amount of metabolic energy ("MET") expended by the volunteers when they were running or briskly walking, and then comparatively analyzed.

The results of the study are good and bad news for those of us who wonder what type of exercise is best for our health. Runners and walkers whose exercise used up the same METs had the low risk of developing diabetes and cardiovascular problems. That is the good news. But the sort of bad news is that runners expended more energy per unit mile they ran than walkers covering the same distance, and this translated into better health outcomes.

The reason for this discrepancy is that running is a less efficient way of moving, and so mile for mile, the runner burns up more energy than the walker. (Unless the walker is dragging a Great Dane or stubborn dachshund on a leash.) According to one of the authors, Paul Williams, a walker would have to cover 4.3 miles at a brisk pace to use the same amount of METs as a person running three miles.

What this study seems to say is that if your exercise of choice is walking, it has to be more than a stroll around the block if substantial health benefits are to be achieved. Indeed, the walk ought to be fast and long for the exercise to produce, over time, a substantial decrease in the risk of cardiovascular problems or diabetes.

But who is going to spend two or three hours a day walking? Obviously even the dedicated walkers in the study did not spend the extra time walking necessary to use up as much energy as the runners did in a shorter amount of time.

And what about those who would not even consider walking more than a block or two to their destination? Those, who like many residents of Los Angeles, for example, insist on having a valet drive their cars to the parking garage so they don't have to walk. Or people all over the country that pull up to the door of the restaurant, or the mall to avoid more steps than necessary? I see this even with well-meaning friends who always offer me a ride home after a lecture or meeting and are surprised when I refuse, saying that it is only a 10 or 15 minute walk.

The results of this major study are compelling as predictors of health risk. Yet how can they be translated into behavioral change? There has to be a cultural shift away from instant convenience, e.g., the valet, or saving a few minutes of time (the ride rather than the walk) or comfort. Rather than being annoyed at having to walk a few blocks because you couldn't park your car next to the door of the restaurant, be pleased at yet another opportunity to rack up a higher MET and consequently burn a few calories.

Moreover, if we are going to suggest dedicated walking as the exercise of choice for health benefits, then it has to have some pleasurable aspects to it. Otherwise it will be abandoned as a passing fancy. Here are some ways of making walking tolerable, and perhaps even enjoyable:

1. Map out your route using Google map or other GPS supported directions. Know how far you are going and when it is time to go further, use your GPS or map to plan another longer route. You are not a goldfish restricted to moving around in the equivalent of a glass bowl.

2. Consider buying walking sticks. They should come with rubber bottoms so they hit the pavement softly and give you support. The length has to be adjustable and the hand holds comfortable. Walking sticks, aka hiking poles, make your arms move as well as your legs, are useful for going up and down hills (this is why hikers use them), and for older walkers help with balance. Also, they make you look athletic.

3. Triumph over walking boredom by walking with a friend, chatting on the phone with people whom you otherwise do not have time to call during the work day, or listening to lectures or books on your iPod. (I listened to an excellent lecture course on the history of the Civil War while dragging the aforementioned dachshund on his daily rounds.)

4. Activate a pedometer on your phone, iPod or wrist device so you really know how many miles you have covered.

5. Remind yourself to keep up the pace... for a healthy heart you must walk briskly.

6. Take water and dress appropriately. A small knapsack is useful for holding layers that you take off as you get warm or put on if the weather should suddenly change.

Or simply enjoy. Turn off your phone and enjoy the fresh air.