Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

doi:10.1016/S2468-2667(21)00302-9

Meta-Analysis

. 2022 Mar;7(3):e219-e228.

doi: 10.1016/S2468-2667(21)00302-9.

Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

Amanda E Paluch¹, Shivangi Bajpai², David R Bassett³, Mercedes R Carnethon⁴, Ulf Ekelund⁵, Kelly R Evenson⁶, Deborah A Galuska⁷, Barbara J Jefferis⁸, William E Kraus⁹, I-Min Lee¹⁰, Charles E Matthews¹¹, John D Omura⁷, Alpa V Patel¹², Carl F Pieper¹³, Erika Rees-Punia¹², Dhayana Dallmeier¹⁴, Jochen Klenk¹⁵, Peter H Whincup¹⁶, Erin E Dooley¹⁷, Kelley Pettee Gabriel¹⁷, Priya Palta¹⁸, Lisa A Pompeii¹⁹, Ariel Chernofsky²⁰, Martin G Larson²⁰, Ramachandran S Vasan²¹, Nicole Spartano²², Marcel Ballin²³, Peter Nordström²⁴, Anna Nordström²⁵, Sigmund A Anderssen²⁶, Bjørge H Hansen²⁷, Jennifer A Cochrane²⁸, Terence Dwyer²⁹, Jing Wang³⁰, Luigi Ferrucci³¹, Fangyu Liu³², Jennifer Schrack³³, Jacek Urbanek³⁴, Pedro F Saint-Maurice¹¹, Naofumi Yamamoto³⁵, Yutaka Yoshitake³⁶, Robert L Newton Jr³⁷, Shengping Yang³⁷, Eric J Shiroma³⁸, Janet E Fulton⁷; Steps for Health Collaborative

Affiliations

¹ Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA. Electronic address: apaluch@umass.edu.
² Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
³ Department Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
⁴ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway; Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
⁶ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
⁷ Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁸ Department of Primary Care and Population Health, UCL Medical School, London, UK.
⁹ Duke Molecular Physiology Institute and Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA.
¹⁰ Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
¹¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
¹² Department of Population Science, American Cancer Society, Atlanta, GA, USA.
¹³ Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
¹⁴ Agaplesion Bethesda Clinic, Research Unit on Ageing, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
¹⁵ Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany; IB University of Applied Health and Social Sciences, Stuttgart, Germany.
¹⁶ Population Health Research Institute, St George's, University of London, London, UK.
¹⁷ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁸ Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
¹⁹ Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, TX, USA.
²⁰ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
²¹ Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
²² Department of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, USA.
²³ Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
²⁴ Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.
²⁵ Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden; School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
²⁶ Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway.
²⁷ Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway; Department of Sport Science and Physical Education, University of Agder, Norway.
²⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
²⁹ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
³⁰ Murdoch Children's Research Institute, Melbourne, VIC, Australia.
³¹ Intramural Research Program, National Institute on Aging, Baltimore, MD, USA.
³² Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³³ Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³⁴ Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³⁵ Faculty of Collaborative Regional Innovation, Ehime University, Matsuyama, Ehime, Japan.
³⁶ Institute for Pacific Rim Studies, Meio University, Nago, Okinawa, Japan.
³⁷ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
³⁸ Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA.

PMID: 35247352
PMCID: PMC9289978
DOI: 10.1016/S2468-2667(21)00302-9

Meta-Analysis

Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

Amanda E Paluch et al. Lancet Public Health. 2022 Mar.

. 2022 Mar;7(3):e219-e228.

doi: 10.1016/S2468-2667(21)00302-9.

Authors

Affiliations

¹ Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA. Electronic address: apaluch@umass.edu.
² Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
³ Department Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
⁴ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway; Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.
⁶ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
⁷ Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁸ Department of Primary Care and Population Health, UCL Medical School, London, UK.
⁹ Duke Molecular Physiology Institute and Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA.
¹⁰ Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
¹¹ Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
¹² Department of Population Science, American Cancer Society, Atlanta, GA, USA.
¹³ Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
¹⁴ Agaplesion Bethesda Clinic, Research Unit on Ageing, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
¹⁵ Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany; IB University of Applied Health and Social Sciences, Stuttgart, Germany.
¹⁶ Population Health Research Institute, St George's, University of London, London, UK.
¹⁷ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁸ Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
¹⁹ Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, TX, USA.
²⁰ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
²¹ Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
²² Department of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, USA.
²³ Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
²⁴ Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.
²⁵ Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden; School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
²⁶ Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway.
²⁷ Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway; Department of Sport Science and Physical Education, University of Agder, Norway.
²⁸ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
²⁹ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
³⁰ Murdoch Children's Research Institute, Melbourne, VIC, Australia.
³¹ Intramural Research Program, National Institute on Aging, Baltimore, MD, USA.
³² Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³³ Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³⁴ Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
³⁵ Faculty of Collaborative Regional Innovation, Ehime University, Matsuyama, Ehime, Japan.
³⁶ Institute for Pacific Rim Studies, Meio University, Nago, Okinawa, Japan.
³⁷ Pennington Biomedical Research Center, Baton Rouge, LA, USA.
³⁸ Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA.

PMID: 35247352
PMCID: PMC9289978
DOI: 10.1016/S2468-2667(21)00302-9

Abstract

Background: Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.

Methods: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.

Findings: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]).

Interpretation: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.

Funding: US Centers for Disease Control and Prevention.

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Conflict of interest statement

Declaration of interests AEP and CFP received funding for this project from US Centers for Disease Control and Prevention (CDC) Intergovernmental Personnel Act Agreement. BJJ receives grant funding through the British Heart Foundation. MRC and RSV have received grant funding through National Heart Lung and Blood Institute, National Institutes of Health (NIH). I-ML, KPG, and PP receive grant funding through NIH. KRE receives grant funding through NIH, Robert Wood Johnson Foundation, US Department of Transportation, and North Carolina Department of Transportation; receives consulting fees from NIH; and is on the Board of Trustees with the American College of Sports Medicine. DD has received grant funding through German Research Foundation, travel expenses for 10th International Meeting on Ageing, honoraria for being an instructor at Boston University School of Public Health, been an unpaid speaker for German Society of Epidemiology, and been an unpaid member of the Alumni Leadership Council of Boston University School of Public Health. JS receives grant funding through National Institutes on Aging, NIH. All other authors declare no competing interests.

Figures

**Figure 2:. Association between steps per day and all-cause mortality, in all participants, and by age and sex**
Model 1 adjusted for age and sex (if applicable). Model 2 was further adjusted for device wear time, race and ethnicity (if applicable), education or income, body-mass index, plus study-specific variables for lifestyle, chronic conditions or risk factors, and general health status. The x-axis of the plot is on the log scale.

**Figure 3:. Dose-response association between steps per day and all-cause mortality, by age group**
Thick lines indicate hazard ratio estimates, with shaded areas showing 95% CIs. Reference set at the median of the medians in the lowest quartile group (age ≥60 years = 3000 steps per day and <60 years = 5000 steps per day). Model is adjusted for age, accelerometer wear time, race and ethnicity (if applicable), sex (if applicable), education or income, body-mass index, and study-specific variables for lifestyle, chronic conditions or risk factors, and general health status. p_interaction=0.012 by age group. 14 studies included in spline analysis, excluded Baltimore Longitudinal Study of Aging. The y-axis is on a log scale.

**Figure 4:. Association between stepping rate with all-cause mortality, with and without adjustment for total step volume**
Hazard ratios and 95% CIs are adjusted for age, device wear time, race and ethnicity (if applicable), sex (if applicable), education or income, body-mass index, and study-specific variables for lifestyle, chronic conditions or risk factors, and general health status. The model with additional adjustment for step volume uses the residual method for the rate variable. The x-axis is on a log scale.

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Comment in

Living a long life is a multi-step process.
Montoye AHK, Conger SA. Montoye AHK, et al. Lancet Public Health. 2022 Mar;7(3):e200-e201. doi: 10.1016/S2468-2667(22)00012-3. Lancet Public Health. 2022. PMID: 35247349 No abstract available.
10.000 Schritte am Tag - bei Älteren reichen auch 6.000.
Müssig K. Müssig K. MMW Fortschr Med. 2022 Oct;164(17):27-28. doi: 10.1007/s15006-022-1843-6. MMW Fortschr Med. 2022. PMID: 36198950 Review. German. No abstract available.

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References

1. 2018 Physical Activity Guidelines Advisory Committee. 2018. Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services, 2018.
1. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020. guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54: 1451–62. - PMC - PubMed
1. Fortune Business Insights. The global fitness tracker market is projected to grow from $36.34 billion in 2020 to $114.36 billion in 2028 at a CAGR of 15.4% in forecast period 2021–2028. May, 2021. https://www.fortunebusinessinsights.com/fitness-tracker-market-103358 (accessed July 8, 2021).
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[1] 2018 Physical Activity Guidelines Advisory Committee. 2018. Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services, 2018.

[2] 2018 Physical Activity Guidelines Advisory Committee. 2018. Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: US Department of Health and Human Services, 2018.

[3] Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020. guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54: 1451–62. - PMC - PubMed

[4] Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020. guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54: 1451–62. - PMC - PubMed

[5] Fortune Business Insights. The global fitness tracker market is projected to grow from $36.34 billion in 2020 to $114.36 billion in 2028 at a CAGR of 15.4% in forecast period 2021–2028. May, 2021. https://www.fortunebusinessinsights.com/fitness-tracker-market-103358 (accessed July 8, 2021).

[6] Fortune Business Insights. The global fitness tracker market is projected to grow from $36.34 billion in 2020 to $114.36 billion in 2028 at a CAGR of 15.4% in forecast period 2021–2028. May, 2021. https://www.fortunebusinessinsights.com/fitness-tracker-market-103358 (accessed July 8, 2021).

[7] Pew Research Center Mobile fact sheet. April 7, 2021. https://www.pewresearch.org/internet/fact-sheet/mobile/(accessed July 8, 2021).

[8] Pew Research Center Mobile fact sheet. April 7, 2021. https://www.pewresearch.org/internet/fact-sheet/mobile/(accessed July 8, 2021).

[9] Lee IM, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of step volume and intensity with all-cause mortality in older women. JAMA Intern Med 2019; 179: 1105–12. - PMC - PubMed

[10] Lee IM, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of step volume and intensity with all-cause mortality in older women. JAMA Intern Med 2019; 179: 1105–12. - PMC - PubMed

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Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

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Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

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