SERVING THE GAME
Play Well April 2, 2021 By Jim Gorant

Golf’s health benefits have never been more well documented, more apparent or more needed

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Photo illustration by John Kuczala

Congratulations to the rest of the world. They finally figured out what golfers have known for going on 500 years: A few hours on the links is a nature walk wrapped in a bond-building exercise stuffed inside a therapy session.

The irony? We have a global pandemic to thank for spreading the joy of golf, as hordes of the quarantine-addled flocked to courses last year, drawn to an outdoor activity that allows them to be social yet safe. Come to find out, those new converts were getting more than an afternoon out of the house.

“Golf is a great mix of exercise, adaptability and mental exertion, but just about everyone can do it,” said Dr. Christopher Klifto, an orthopedic surgeon at Duke Health in Durham, N.C., and an avid golfer. “It requires strength, mobility and conditioning, especially for kids and seniors.”

Some scoff, but Klifto, 40, has little patience for the haters. “I don’t want to hear it,” he said. “I played soccer in college and I do CrossFit, and when I walk 6 miles with a bag on my back, I’m shot at the end. Even in a cart, you still get exercise and mobility. In order to work properly, joints like to move, and golf gives you that.”

When executed properly, the golf swing requires the use of multiple major muscle groups, including the pectorals (chest), deltoids (shoulders), triceps and biceps (arms), latissimus dorsi (back), abdominals, glutes (butt), quadriceps (thighs) and several small muscles in the shins.

“The golf swing is a full-body, dynamic movement, and if you’re off by a degree or two the difference can be huge,” said Tyler Campbell, director of performance at The Golf Performance Center in Ridgefield, Conn. “It’s an athletic movement, and you have to activate all those muscles and have great body control to make it work.”

Getting Around

Then there’s the walking. A few years ago, the notion of taking 10,000 steps a day, as both a means to lose weight and stay healthy, swept across the country faster than you can say “fitness tracker.” At the same time, multiple studies, including one by the American Heart Association, have shown that walking for 30 minutes a day, five days a week helps to lower the risk of chronic illness, including heart disease, high blood pressure, stroke, diabetes, certain cancers and Alzheimer’s disease.

Golf, if nothing else, is a good excuse to take a long walk – or even a series of short ones. And there is evidence that taking the footpath over the cart path is on the rise. The National Golf Foundation recently reported that 35 percent of core golfers said they were walking the course more often than riding a cart. Once again, the pandemic may have helped. 

“A lot of courses restricted players to one person per cart for safety reasons, which meant they would often run out of carts by mid-morning,” said Lee Pace, a North Carolina–based writer whose upcoming book, “Random Walks,” celebrates the joy of hoofing it on the links. “People had to walk, because there weren’t any carts left or because they didn’t want to play alone. Many golfers told me they appreciated the game in a way they hadn’t in years once they started walking.”

Pace noted that venerable Pinehurst Resort now allows golfers to walk — alone, with a caddie or with a push cart — on all its courses at any time, while golf accessory maker Sun Mountain reports that its 2020 push cart sales were 2½ times greater than they were in 2019.

While all that extra perambulation is great, hope is not lost for cart jockeys. The 30-minutes-a-day dictum can be incremental, meaning that five walks of six minutes each is as good as a half-hour in one shot. Recent research, including a 2019 study out of Harvard Medical School, suggests the magic number of daily steps for reduced mortality is not 10,000, but as little as 4,500, although health benefits increase up to 7,500. Riders who don’t park right next to their ball or who walk every fourth fairway are likely still hitting daily walking targets.

“The research is pretty clear,” said Dr. Carol Ewing Garber, the director of the applied physiology program and a professor of movement science at Columbia University. “Even light, not very intense exercise has health benefits.”

The Numbers

That sounds good, but what about the math? Multiple experiments and personal reporting based on fitness tracker data show that walking a full 18 burns between 1,200 and 1,500 calories, depending on the length of the course, the terrain and whether a player carries or uses a push cart. Players riding in a cart obviously get less exercise but still burn about 700 to 800 calories.

Even more intriguing, a 2008 study by the Karolinska Institute in Sweden found that golfers had a 40 percent lower death rate than nongolfers, even when accounting for age, gender and socioeconomic status, which corresponds to a five-year increase in life expectancy. In fact, the increased life expectancy was most pronounced among blue-collar players with low handicaps, and a lower handicap correlated to greater benefits overall. Translation: Better players, i.e. those who typically play more often, saw even greater health benefits.

The researchers acknowledged that off-course factors, including an overall healthier lifestyle, may have played a role, but that could also mean that playing regularly leads to improved habits. 

“A round of golf means being outside for four or five hours, walking at a fast pace for [about 5 miles], something which is known to be good for health," Professor Anders Ahlbom, one of the authors, said at the time.

As with many pursuits, though, frequency is a factor. “Unfortunately, doing extra one day won’t make up for being sedentary the rest of the week,” said geriatrician Dr. Richard W. Besdine, a professor of medicine and public health at Brown University. Based on the Swedish research and the 30-minute, five-day walking goal, the ultimate prescription for better health through golf might be walking nine holes four times a week rather than 18 once or twice a week.

But who has time to play four nines a week?

Retiring Types

Often, retirees do, and they might also be the ones with the most to gain. “Many aspects of golf resonate with the perspective I give on successful aging: remaining active, being social and getting outside,” said Besdine.

As further support for the 30-by-5 program, he cites a recent study of people over 65 complaining of memory loss. One segment of the group began the prescribed walking program while the other segment maintained its previous lifestyle. The walkers not only showed no further deterioration, they actually improved on memory tests over time.

The benefits go beyond walking. “With aging, bones and muscles get weaker over time,” said Columbia’s Garber. “Swinging a club can help maintain the amount of muscle and strength. It also contributes to keeping the joints mobile, which helps fight arthritis.”

Falling down is the No. 1 cause of injury and death for senior citizens, according to the CDC, and golf can help prevent such spills. Hitting the ball, playing from uneven lies and walking up inclines to teeing grounds and greens activate the core muscles, which play a prominent role in balance. “Playing golf gives you the skills and assets you need to age gracefully,” said Klifto, the orthopedic surgeon.

Junior Circuit

Between 1978 and 2016 the childhood obesity rate in America jumped from 5 percent to 18.5 percent, and it now affects almost 14 million kids, according to the CDC. The rate has slowed in the last 15 years, but it’s still rising, and while there are multiple causes, inactivity is a major culprit. “Most pediatricians agree that children are spending too much time online,” said Dr. Jocelyn Wittstein, a professor of orthopedic surgery and sports medicine at Duke. “Studies show it’s up to more than an hour a day. Sports can be an outlet.”

The upside for kids extends beyond weight loss and cardio training to more nuanced areas of development. Using those core muscles improves posture, and simply being upright, especially while swinging and carrying a bag, puts healthy stress on bones, helping to build density and strength. “Loading the skeleton in general is important at those ages,” said Campbell, who works mostly with juniors at The Performance Center. “We give them guidance on how to do it safely.”

The sequence of movements that makes up a swing help build coordination, develop the nervous system and create a sense of body awareness, according to Campbell. Playing golf promotes confidence and resilience, too.

“How do you carry yourself? How do you bounce back when things go bad?” Campbell said. “When kids are still emotionally developing, those things can be hard to comprehend, and golf helps them learn to deal with them.”

Well, Well, Well

Beyond the strictly physical benefits, there is a greater realm of general wellness that encompasses everything from self-esteem to mental health to the meaning of life. “Why do you think there are so many spiritual books written about golf?” said Dr. Gio Valiante, a psychiatrist who has worked with Jack Nicklaus, Jordan Speith and numerous other tour pros. “The game is a mirror. It reveals us and allows us a chance to work on ourselves.”

Even sticking to the more physiological aspects of wellness, golf scores well. Studies in Japan and the U.S. have shown that walking in nature can reduce brain stress, lower levels of stress hormones in the body, boost the immune system and alter neural networks in ways that counteract anxiety and depression. One study even showed high levels of, and higher activity among, cancer fighting cells in cancer patients after walking outdoors. “Countless studies show there are psychological, cognitive and emotional benefits,” said Valiante.

Numerous studies have also shown that spending time with others and having an active network of social interactions makes people healthier and happier. “Human beings are social by nature,” said Valiante. “Golf makes you vulnerable, and being vulnerable in front of other people really bonds you.”

More than anything, though, golf can provide a sense of purpose. Playing and practicing is more engaging than going for a 30-minute run, which encourages people to stick with the game and play more often. “As we get older it gets harder to find meaning in what we do,” said Valiante, “but watch a 70-year-old try to make a 3-foot putt and see how much he cares.”

If from no one else, take it from golf’s own doctor, Alister MacKenzie, designer of Augusta National, Cypress Point and Royal Melbourne.

“One of the reasons why I decided to give up medicine and take to golf architecture was my firm conviction of the extraordinary influence on health of pleasurable excitement, especially when combined with fresh air and exercise,” wrote MacKenzie, who trained as a surgeon. “How frequently have I, with great difficulty, persuaded patients who were never off my doorstep to take up golf, and how rarely, if ever, have I seen them in my consulting room again.”

Author Jim Gorant spent 14 years as a senior editor of Sports Illustrated magazine. His work has appeared in a variety of publications, including GQ, Men's Journal and Popular Science, and he is the author of the New York Times bestseller, "The Lost Dogs: Michael Vick's Dogs and Their Tale of Rescue and Redemption."