Walking has a lot of benefits, we already know that. However, how much should one walk? a recent study among older people revealed that if seniors could achieve a 4,000 steps goal in one to two days in a week, they would lower their risk of early deaths by a quarter.

This study was led by Harvard University, and published in the British Journal of Sports Medicine.

What Did the Study Find About Older People's Health And Walking?

We all know that staying active brings great health benefits. In fact, Health and Me also covered how walking and staying active could lower the risk of dementia. Until now, however, it was unclear how much should one walk.

With this recent study, researchers found that achieving 4,000 steps per day on one or two days a week could lower risk of death and lower risk of cardiovascular disease, (CVD), as compared to not reaching this level on any day.

How Was The Study That Analyzed Older People's Walking And Its Impact On Health Conducted?

The study analyzed 13,547 American women, who were over the age of 62, with the average being 72. All of them were given trackers for seven consecutive days, between 2011 and 2015. These people were followed for over a decade. None of them had heart disease or cancer at the beginning of the study.

While they were being monitored in the end of 2024, 1,756 women died and 781 developed heart disease.

The study found that those who clocked up at least 4,000 steps a day on one or two days of the week had 26% lower risk of death from all causes, and a 27% lower risk of dying from heart diseases. This was as compared to those who did not reach this threshold on any day of the week. The study further saw that those who achieved the step count for three days of the week, their lower risk of death from any cause increased by 40%, however for CVD related deaths, it remained at 27%.

Takeaways And Limitations

The researchers said that while the most important take away was that people would now have an amount to walk. However, it is important to note that the study was observational, with no firm conclusion, and was done only on women, and assessed for only one week.

The researchers agreed that there is no "best" way to take your steps. The key is to just ensure that you are getting your steps in. "A greater number of steps, regardless of daily patterns, is associated with better health outcomes." The study saw that on an average, women took 5,615 steps a day.

While there were limitations, but the researchers still added, "An important translational implication of these findings is that since step volume is the important driver of the inverse associations, there is no ‘better’ or ‘best’ pattern to take steps; individuals can undertake [physical activity] in any preferred pattern (eg ‘slow and steady’ v ‘bunched patterns’) for lower mortality and CVD risk, at least among older women. These findings provide additional evidence for considering including step metrics in the next [physical activity] guidelines, and that ‘bunching’ steps is a viable option for health.”

While exercise is good for the body and mind, it can have special benefits for the liver — a key organ that filters blood, breaks down food, stores energy, and keeps the human body in balance.

In recent years, there has been a significant increase in young patients presenting with poor liver health and related conditions, such as fatty liver and liver fibrosis, among others.

A recent study published in The Lancet Gastroenterology & Hepatology journal showed that the Metabolically Dysfunctional-Associated Steatotic Liver Disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), affected 1.3 billion people around the globe in 2023.

India has also shown a sharp rise in MASLD prevalence, up 23.19 per cent from 1990 to 2023. India’s age-standardized MASLD prevalence rate rose from 10,191 per 100,000 in 1990 to 12,555 per 100,000 in 2023.

The findings show that the spike is increasingly driven by rising metabolic risk factors, including high blood sugar and obesity.

Amid the growing burden, hepatologist Dr Cyriac Abby Philips noted that “the best friend of the liver is muscle”. In a post on social media platform X, Dr Philips, popularly known as Liverdoc, added that “liver listens to your muscles” and shared nine exercises, all backed by clinical trials, that can be included in a daily routine to help boost liver health.

Brisk walking:

According to Dr Philips, brisk walking is the most accessible liver medicine. He noted that "150 min per week cuts liver fat by more than 30 per cent on MRI”. Citing a UK Biobank study of 91,000 people, he added that every extra 1,000 daily steps can lower the risk of developing fatty liver by about 12 per cent.

Moderate-intensity cardio (MICT):

This includes steady jogging, cycling, or swimming at a "can talk, can't sing" pace. Dr Philips stated that 30–45 minutes of MICT exercises for 3–5 days every week for 12 weeks can help reduce liver fat by 2–4 per cent (absolute). It can also significantly lower liver inflammation (enzyme levels), even without weight loss.

High-intensity interval training (HIIT)

This includes short hard bursts, like burpees, jumping jacks, etc. He recommended four minutes of these exercises “at 85–95 per cent max heart rate”.

Repeating the exercise 4 times a day can “cut liver fat by 16–37 per cent, improve heart function,” in 12 weeks, the Liverdoc said. He added that the exercise regimen “matches steady cardio in half the time”.

Sprint interval training (SIT)

SITs are shorter and harder under 15-minute sessions of squat punches, knee hovers, and chair squats. “Six weeks of these can reduce intrahepatic triglycerides by 12 per cent and visceral fat by 17 per cent in men with fatty liver (MASLD),” said Dr Philips, adding that it gives the “biggest liver benefits for the smallest time spent”.

Resistance/strength training

This includes weights or bodyweight, such as squats, presses, rows, and pulldowns. Dr Philips recommended 3 sets of these exercises three times a week for about 40–45 min.

It can “reduce liver fat independent of weight loss, uniquely lowers liver enzyme, and is the single most important exercise for cirrhosis patients to prevent muscle loss (sarcopenia),” he said.

Combined aerobic + resistance

The Liverdoc stated that this combination is the gold standard for exercises. He noted that “network meta-analyses rank this combination as the number one for improving triglycerides, LDL, and total cholesterol in patients with fatty liver (MASLD) - better than either alone”.

Yoga (Hatha/ Surya Namaskar)

Dr Philips noted that classical yoga is not useful for liver health as it is not aerobic and vouched for the modernized versions.

“Eight to 12 weeks or 3 sessions/week of asanas like Surya Namaskar, Ardha Matsyendrasana, Paschimottanasana, Naukasana can help improve liver tests, insulin resistance, and fatty liver grade - especially in patients with type 2 diabetes plus fatty liver disease,” he said.

Pilates and core work

“Eight weeks of pilates can help reduce body weight, body fat, liver enzymes, and liver fat on ultrasound,” said Liverdoc. He called it a joint-friendly option for people who can't run or lift heavy.

Tai Chi / Qigong

The Chinese exercise is a low-impact mind-body movement. About 30–60 min of these three times a week can help “improve glucose control, insulin sensitivity, and balance/ stability, muscle tone," Dr. Philips said.

He noted that this form of exercise is “gentle enough for older patients, those with early decompensated cirrhosis, or people with poor cardiorespiratory fitness”.

Exercise In Cirrhosis

Dr Philips said that even advanced liver disease can respond well to exercise treatment.

Citing randomized trials, he stated that “combined aerobic plus resistance training cuts serious events (death, major complications) from 12.3 per cent to 5.6 per cent”. It also “prevents the muscle wasting that drives death events in cirrhosis patients”.

“Make physical activity your number one preference to maintain liver health and reduce liver disease,” Dr Philips said.

For many working professionals, going to the gym often feels like a luxury. Their days begin early and end late—rushing for buses and metros, juggling deadlines, presentations, meetings, and endless reports.

So when they are diagnosed with conditions like diabetes or high blood pressure, the most practical and affordable option left is walking. Another common step is cutting down on sugar in tea and coffee. While these are good starting points, these may not be enough.

Calling them "most frustrating", Dr. Sudhir Kumar, Neurologist at Apollo Hospital, Hyderabad noted that such "patients are losing a battle they think they are winning".

"Every day, I see patients with obesity, Type 2 Diabetes, or hypertension who tell me: 'I walk every morning, Doctor'. 'I do all the household work.' 'I have stopped adding sugar to my tea'," said Dr Kumar, in a post on social media platform X.

He also cited these as "dangerous health misconceptions", wherein the patients feel they have done their part, but "their blood work and body composition tell a different story".

Popularly known as the Hyderabad doctor on X, the noted neurologist shared some evidence-based reality of why "walking and quitting sugar" may not be enough.

Several studies have pointed out that walking or undertaking household chores is better than a sedentary behavior. However, neither can be a "substitute for strength training", Dr. Kumar said.

Although walking can burn a few calories, "strength training builds the 'engine' that burns glucose even while you sleep".

"If you are not lifting weights or doing resistance training at least twice a week, your insulin resistance will likely persist, regardless of your step count", he said.

Speaking to HealthandMe, Dr. Manisha Arora, Director - Internal Medicine at the CK Birla Hospital, Delhi, explained that cutting sugar and walking are good first steps, but they do not solve the problem of diabetes and high blood pressure.

"Insulin resistance, inflammation, and loss of muscle all contribute to these diseases. Light walking may help, but the intensity and duration of exercise are also important," he added.

What Is Strength Training?

Strength training exercises force muscles to contract against an external force, such as body weight, dumbbells, or bands. Common examples include

• squats,
• lunges,
• step-ups,
• push-ups,
• planks.

Strength training helps

• Decrease insulin resistance
• Lower blood pressure
• Improve cognitive function
• Reduce systemic inflammation
• Protect against neurodegenerative diseases like Alzheimer’s.

Focus On Protein Leverage

Dr. Kumar further mentioned the diet trap that most people fall into, that is., cutting out sweets and sugar, while loading up the plate with carbohydrate-rich foods such as rice, roti, and poha — 80 percent — and zero protein content.

"Refined carbohydrates (even without added sugar) spike insulin similarly to sugar," he said, calling "no sugar as the bare minimum".

The doctor noted that "a protein-deficient diet can lead to muscle loss and increase hunger".

To lower blood sugar levels, the experts urged to cut down on other foods, such as

• refined carbohydrates,
• processed foods,
• low-fiber foods.

"Focus on protein leverage. Prioritize 1.2g to 1.5g of protein per kg of body weight. When you hit your protein goals, your craving for carbs naturally drops," Dr. Kumar said.

To see the real change in blood sugar and BP levels, he advised people to "add two days of resistance training (bodyweight, bands, or weights)", instead of "just walking",.

The neurologist also recommended "starting the meal with protein paneer, eggs, sprouts, lean meat, and to eat carbs last, and in smaller portions".

In addition, a diet high in protein and fiber from whole grains, fruits, and nuts can also help control blood sugar levels.

"The most successful approach to controlling blood sugar results from combining aerobic exercise with strength training, along with balanced nutrition," said Dr Arora.

We often assume that having a “normal weight” automatically means being healthy. While body weight is an important parameter, it represents only a small part of overall health. True health is far more complex than what a number on the weighing scale can convey.

Understanding The Limitations Of BMI

Body Mass Index (BMI) is widely used to classify individuals based on their weight relative to height. However, it does not differentiate between fat and muscle. As a result, someone may fall within the normal BMI range yet still have high body fat and low muscle mass, a condition known as “normal weight obesity.” Such individuals may appear healthy but remain at risk for metabolic disorders.

Why Is Body Composition Important?

Body composition analysis offers deeper insight by evaluating fat, muscle mass, and their distribution in the body. A combination of low muscle mass and excess body fat, especially around internal organs, can increase disease risk, even when overall weight appears normal.

The role of fat distribution:

All body fat is not the same. Where fat is stored matters significantly. The waist-to-height ratio is now considered a more reliable indicator than BMI, as it reflects fat distribution. A ratio above 0.5 is associated with a higher risk of conditions such as type 2 diabetes, cardiovascular diseases, and even increased mortality.

Looking beyond numbers:

Health cannot be defined by numbers alone. Factors like physical activity, nutrition, stress levels, and sleep quality play an equally critical role. Even individuals with a normal weight can experience poor metabolic health due to inadequate sleep or chronic stress.

The bigger perspective:

Good health is not just about appearance or weight, it is the result of multiple factors working together. It reflects a balance between internal processes and external lifestyle choices.

In essence, being of normal weight does not necessarily mean being healthy. To truly stay well, it is important to look beyond weight and consider the broader picture of health.