Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events

Abstract

Background

The minimal and optimal daily step counts for health improvements remain unclear.

Objectives

A meta-analysis was performed to quantify dose-response associations of objectively measured step count metrics in the general population.

Methods

Electronic databases were searched from inception to October 2022. Primary outcomes included all-cause mortality and incident cardiovascular disease (CVD). Study results were analyzed using generalized least squares and random-effects models.

Results

In total, 111,309 individuals from 12 studies were included. Significant risk reductions were observed at 2,517 steps/d for all-cause mortality (adjusted HR [aHR]: 0.92; 95% CI: 0.84-0.999) and 2,735 steps/d for incident CVD (aHR: 0.89; 95% CI: 0.79-0.999) compared with 2,000 steps/d (reference). Additional steps resulted in nonlinear risk reductions of all-cause mortality and incident CVD with an optimal dose at 8,763 (aHR: 0.40; 95% CI: 0.38-0.43) and 7,126 steps/d (aHR: 0.49; 95% CI: 0.45-0.55), respectively. Increments from a low to an intermediate or a high cadence were independently associated with risk reductions of all-cause mortality. Sex did not influence the dose-response associations, but after stratification for assessment device and wear location, pronounced risk reductions were observed for hip-worn accelerometers compared with pedometers and wrist-worn accelerometers.

Conclusions

As few as about 2,600 and about 2,800 steps/d yield significant mortality and CVD benefits, with progressive risk reductions up to about 8,800 and about 7,200 steps/d, respectively. Additional mortality benefits were found at a moderate to high vs a low step cadence. These findings can extend contemporary physical activity prescriptions given the easy-to-understand concept of step count. (Dose-Response Relationship Between Daily Step Count and Health Outcomes: A Systematic Review and Meta-Analyses; CRD42021244747)

Central Illustration

Section snippets

Methods

This systematic review was performed according to the Meta-Analysis of Observational Studies in Epidemiology checklist²⁰ and registered in the PROSPERO database (CRD42021244747).

Study selection

The systematic search identified 5,414 potential studies: 2,856 from PubMed and 2,558 from EMBASE (Figure 1). A total of 1,078 were duplicates, and 4,307 papers were excluded on the basis of title and abstract, leaving 29 papers that were screened for eligibility. Fifteen papers did not meet the inclusion criteria after reading the full text, and 2 papers^30,31 were excluded because of insufficient data, leaving 12 studies for inclusion. One study³² shared unpublished data on the association

Discussion

Our meta-analyses quantified the dose-response association of objectively measured daily step count metrics with all-cause mortality and incident CVD in the general population. Minimal doses of 2,517 and 2,735 steps/d were associated with an 8% reduction in all-cause mortality and an 11% reduction in CVD risk, respectively, compared with individuals accumulating 2,000 steps/d. The optimal doses were found at 8,763 steps/d for all-cause mortality (ie, 60% risk reduction) and 7,126 steps/d for

Conclusions

Lower risk for all-cause mortality and incident CVD may already be experienced after about 2,600 and about 2,800 steps/d, respectively. Additional increments of 1,000 steps/d (about 10 minutes of walking) enhance risk reductions in a nonlinear fashion. Optimal health benefits were achieved at about 8,800 steps/d for all-cause mortality and about 7,200 steps/d for incident CVD. A higher cadence provides additional health benefits beyond total step volume. As health benefits of daily steps were

Funding Support and Author Disclosures

Dr Ortega’s research activity on this topic is supported by grant PID2020-120249RB-I00 funded by MCIN/AEI/10.13039/501100011033 and by the Andalusian Government (Junta de Andalucía, Plan Andaluz de Investigación, reference P20_00124). Dr Bakker has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement 101064851. Dr Mañas is hired through a contract of Requalification “Margarita Salas” funded by the University of

Acknowledgment

The authors thank Dr Gerjon Hannink (Department of Evidence-Based Surgery, Radboud University Medical Center) for his statistical expertise and help during the analyses.

References (57)

https://doi.org/10.1016/j.jacc.2023.07.029

• D-c Lee et al.Leisure-time running reduces all-cause and cardiovascular mortality riskJ Am Coll Cardiol(2014)
• T.M. Eijsvogels et al.Exercise at the extremes: the amount of exercise to reduce cardiovascular eventsJ Am Coll Cardiol(2016)
• E. Fortune et al.Validity of using tri-axial accelerometers to measure human movement—part II: step counts at a wide range of gait velocitiesMed Eng Phys(2014)
• E.C. Lefferts et al.Associations of total and aerobic steps with the prevalence and incidence of frailty in older adults with hypertensionProg Cardiovasc Dis(2021)
• A.E. Paluch et al.Daily steps and all-cause mortality: a meta-analysis of 15 international cohortsLancet Public Health(2022)
• M. Sheng et al.The relationships between step count and all-cause mortality and cardiovascular events: a dose-response meta-analysisJ Sport Health Sci(2021)
• A. Isath et al.Meta-analysis of per-day step count and all-cause mortalityAm J Cardiol(2022)
• R. DerSimonian et al.Meta-analysis in clinical trialsControl Clin Trials(1986)
• T. Yates et al.Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysisLancet(2014)
• A. Mañas et al.Association of accelerometer-derived step volume and intensity with hospitalizations and mortality in older adults: a prospective cohort studyJ Sport Health Sci(2022)
• S. Oftedal et al.Daily steps and diet, but not sleep, are related to mortality in older AustraliansJ Sci Med Sport(2020)
• B.J. Jefferis et al.Does total volume of physical activity matter more than pattern for onset of CVD? A prospective cohort study of older British menInt J Cardiol(2019)
• S.R. Chekroud et al.Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional studyLancet Psychiatry(2018)
• J.A. Laukkanen et al.Objectively assessed cardiorespiratory fitness and all-cause mortality risk: an updated meta-analysis of 37 cohort studies involving 2,258,029 participantsMayo Clin Proc(2022)
• P. Kokkinos et al.Cardiorespiratory fitness and mortality risk across the spectra of age, race, and sexJ Am Coll Cardiol(2022)
• M.A. Case et al.Accuracy of smartphone applications and wearable devices for tracking physical activity dataJAMA(2015)
• R.E. Hasson et al.Validity of the Omron HJ-112 pedometer during treadmill walkingMed Sci Sports Exerc(2009)
• D.W. Esliger et al.Validity of the Actical accelerometer step-count functionMed Sci Sports Exerc(2007)
• G. Samitz et al.Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studiesInt J Epidemiol(2011)
• Y. Liu et al.Dose-response association between the daily step count and all-cause mortality: a systematic review and meta-analysisJ Sports Sci(2022)
• A. Jayedi et al.Daily step count and all-cause mortality: a dose-response meta-analysis of prospective cohort studiesSports Med(2022)
• World Health OrganizationWHO guidelines on physical activity and sedentary behaviour(2020)
• A.E. Paluch et al.Prospective association of daily steps with cardiovascular disease: a harmonized meta-analysisCirculation(2023)
• C. Tudor-Locke et al.How many steps/day are enough? For adultsInt J Behav Nutr Phys Act(2011)
• I.M. Lee et al.Association of step volume and intensity with all-cause mortality in older womenJAMA Intern Med(2019)
• A.E. Paluch et al.Steps per day and all-cause mortality in middle-aged adults in the Coronary Artery Risk Development in Young Adults StudyJAMA Netw Open(2021)
• P.F. Saint-Maurice et al.Association of daily step count and step intensity with mortality among US adultsJAMA(2020)
• D.F. Stroup et al.for the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) Group. Meta-analysis of observational studies in epidemiology: a proposal for reportingJAMA(2000)

There are more references available in the full text version of this article.