Association between device-measured stepping behaviors and cardiometabolic health markers in middle-aged women: The Australian Longitudinal Study on Women's Health

Abstract

The associations between different types and contexts of stepping behaviors and cardiometabolic (CM) health markers are unclear. This study aimed to examine the associations of daily total, walking, stair, incidental and purposeful steps with cardiometabolic risk. A total of 943 women (mean age ± SD = 44.1 ± 1.6 years) from the Australian Longitudinal Study on Women's Health (ALSWH) were included in this cross-sectional study. Daily total, walking, stair, incidental, and purposeful steps were measured using thigh-worn accelerometry. Outcomes comprised of CM markers of adiposity, blood pressure, resting heart rate, lipids, glycaemia, and the composite CM score. We used generalized linear modeling and multiple linear regression to assess the associations. We observed that all stepping behaviors were beneficial to CM health, for example, compared to the lowest quartile (Q1), the change of the composite CM score across low to high quartile of purposeful steps was -0.12 (Q2, 95% CI: -0.41, 0.17), -0.16 (Q3, -0.46, 0.14), and -0.36 (Q4, -0.66, -0.05). Stair steps showed linear associations with blood pressure and adiposity biomarkers, for example, the change of quartile of waist circumference was -1.45 cm (Q2, -4.35, 1.44), -3.56 cm (Q3, -6.52, -0.60), and -7.08 cm (Q4, -10.31, -3.86). Peak 30-min walking intensity showed independent association with adiposity biomarkers (p linear < 0.001 and p = 0.002 for waist circumference and BMI, respectively). Our study showed that all stepping forms were beneficial to CM health. Higher stair steps and peak 30-min walking cadence were associated with a steep decline of adiposity biomarkers. Purposeful steps showed more consistent associations with CM biomarkers than incidental steps.

Keywords: accelerometry; epidemiology; intensity; physical activity; stair; walking.

FIGURE 1

Participants flowchart.

FIGURE 2

Associations of Daily Total Steps with Cardiometabolic Markers of Adiposity, Blood Pressure and Resting Heart Rate. Note: The multivariable‐adjusted means and the corresponding 95% CIs of the relative change of each quartile of daily total steps compared to quartile 1 were presented for each biomarker in this figure (1 is bottom quartile, 2 is 2nd quartile, 3 is 3rd quartile, 4 is top quartile). P‐values for linear trend between the mean daily total steps and each CM biomarker were: (A) BMI, n = 670, p = 0.001; (B) Waist circumference, n = 678, p < 0.001; (C) Waist‐hip ratio, n = 678, p = 0.005; (D) Systolic blood pressure, n = 353, p = 0.026; (E) Diastolic blood pressure, n = 353, p < 0.001; (F) Resting heart rate, n = 359, p = 0.031. Models were adjusted for age, occupation, education, diet, smoking, alcohol consumption, self‐rated health, sleep time per day, and sitting time per day.

FIGURE 3

Associations of Daily Walking Steps with Cardiometabolic Markers of Adiposity, Blood Pressure and Resting Heart rate. Note: Multivariable‐adjusted means and the corresponding 95% CIs of the relative change of each quartile of daily walking steps compared to quartile 1 were presented for each biomarker in this figure (1 is bottom quartile, 2 is 2nd quartile, 3 is 3rd quartile, 4 is top quartile). P‐values for linear trend between the mean walking steps per day and each biomarker were: (A) BMI, n = 670, p = 0.561; (B) Waist circumference, n = 678, p = 0.107; (C) Waist‐hip ratio, n = 678, p = 0.134; (D) Systolic blood pressure, n = 353, p = 0.256; (E) Diastolic blood pressure, n = 353, p = 0.013; (F) Resting heart rate, n = 359, p = 0.400. Models were adjusted for age, occupation, education, diet, smoking, alcohol consumption, self‐rated health, sleep time per day, sitting time per day, and non‐walking steps per day.

FIGURE 4

Associations of Daily Stair Steps with Cardiometabolic Markers of Adiposity, Blood Pressure and Resting Heart rate. Note: Multivariable‐adjusted means and the corresponding 95% CIs of the relative change of each quartile of daily stair steps compared to quartile 1 were presented for each biomarker in this figure (1 is bottom quartile, 2 is 2nd quartile, 3 is 3rd quartile, 4 is top quartile). P‐values for linear trend between the mean stair steps per day and each biomarker were: (A) BMI, n = 670, p < 0.001; (B) Waist circumference, n = 678, p < 0.001; (C) Waist‐hip ratio, n = 678, p = 0.687; (D) Systolic blood pressure, n = 353, p < 0.001; (E) Diastolic blood pressure, n = 353, p < 0.001; (F) Resting heart rate, n = 359, p = 0.127. All Models were adjusted for age, occupation, education, diet, smoking, alcohol consumption, self‐rated health, sleep time per day, sitting time per day, and non‐stair steps per day.

FIGURE 5

Associations of Daily Incidental Steps with Cardiometabolic Markers of Adiposity, Blood Pressure and Resting Heart rate. Note: Multivariable‐adjusted means and the corresponding 95% CIs of the relative change of each quartile of daily incidental steps compared to quartile 1 were presented for each biomarker in this figure (1 is bottom quartile, 2 is 2nd quartile, 3 is 3rd quartile, 4 is top quartile). P‐values for linear trend between mean incidental steps per day and each biomarker were: (A) BMI, n = 670, p = 0.088; (B) Waist circumference, n = 678, p = 0.421; (C) Waist‐hip ratio, n = 678, p = 0.545; (D) Systolic blood pressure, n = 353, p = 0.492; (E) Diastolic blood pressure, n = 353, p = 0.040; (F) Resting heart rate, n = 365, p = 0.424. All Models were adjusted for age, occupation, education, diet, smoking, alcohol consumption, self‐rated health, sleep time per day, sitting time per day, non‐incidental steps (purposeful steps) per day.

FIGURE 6

Associations of Daily Purposeful Steps with Cardiometabolic Markers of Adiposity, Blood Pressure and Resting Heart Rate. Note: Multivariable‐adjusted means and the corresponding 95% CIs of the relative change of each quartile of daily purposeful steps compared to quartile 1 were presented for each biomarker in this figure (1 is bottom quartile, 2 is 2nd quartile, 3 is 3rd quartile, 4 is top quartile). P‐values for linear trend between mean purposeful steps per day and each biomarker were: (A) BMI, n = 670, p = 0.026; (B) Waist circumference, n = 678, p < 0.001; (C) Waist‐hip ratio, n = 678, p = 0.004; (D) Systolic blood pressure, n = 353, p = 0.035; (E) Diastolic blood pressure, n = 353, p = 0.002; (F) Resting heart rate, n = 359, p = 0.007. All Models were adjusted for age, occupation, education, diet, smoking, alcohol consumption, self‐rated health, sleep time per day, sitting time per day, non‐purposeful steps (incidental steps) per day.