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. 2023 Oct 10;82(15):1483-1494.
doi: 10.1016/j.jacc.2023.07.029. Epub 2023 Sep 6.

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

Niels A Stens  1 , Esmée A Bakker  2 , Asier Mañas  3 , Laurien M Buffart  4 , Francisco B Ortega  5 , Duck-Chul Lee  6 , Paul D Thompson  7 , Dick H J Thijssen  8 , Thijs M H Eijsvogels  9
Affiliations
Free article

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

Niels A Stens et al. J Am Coll Cardiol. .
Free article

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).

Keywords: exercise; health outcomes; physical activity; population; public health; walking.

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Conflict of interest statement

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 Castilla–La Mancha (MS2021). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.