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. 2025 Jan 11;25(1):129.
doi: 10.1186/s12889-024-21216-y.

Associations of daily step count with all-cause mortality and cardiovascular mortality in hypertensive US adults: a cohort study from NHANES 2005-2006

Tuo Guo  1   2   3 , Yang Zhou  4   5 , Guifang Yang  1   2 , Aifang Zhong  1   2 , Xiaogao Pan  1   2 , Yuting Pu  1   2 , Michael Simons  3 , Lijuan Sheng  6 , Xiangping Chai  7   8
Affiliations

Associations of daily step count with all-cause mortality and cardiovascular mortality in hypertensive US adults: a cohort study from NHANES 2005-2006

Tuo Guo et al. BMC Public Health. .

Abstract

Background: The health benefits of physical activity, including walking, are well-established, but the relationship between daily step count and mortality in hypertensive populations remains underexplored. This study investigates the association between daily step count and both all-cause and cardiovascular mortality in hypertensive American adults.

Methods: We used data from the National Health and Nutrition Examination Survey 2005-2006, including 1,629 hypertensive participants with accelerometer-measured step counts. Cox proportional hazards models and restricted cubic spline regression were employed to assess the associations between daily step count and mortality outcomes. Analyses were adjusted for demographics, lifestyle factors, and comorbidities.

Results: Over an average follow-up of 12.57 years, 370 deaths occurred, of which 177 were due to cardiovascular causes. We observed non-linear associations between daily step count and mortality. Mortality risks were significantly reduced with step counts to 8,250 steps/day for all-cause mortality and 9,700 steps/day for cardiovascular mortality. Beyond these thresholds, the benefits plateaued.

Conclusion: Increasing daily step count is associated with reduced all-cause and cardiovascular mortality in hypertensive individuals, with optimal benefits observed below 8,250 and 9,700 daily steps, respectively. Moderate levels of physical activity provide substantial health benefits, highlighting the importance of setting realistic and attainable activity goals for hypertensive populations.

Keywords: Daily step count; Hypertension; Mortality; NHANES.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The ethics review board of the National Center for Health Statistics approved all NHANES protocols, and written informed consents were obtained from all participants or their proxies. All the experiment protocol for involving humans was in accordance to guidelines of national/international/institutional or Declaration of Helsinki in the manuscript. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study participants
Fig. 2
Fig. 2
Kaplan-Meier survival curve for all-cause (a) and cardiovascular (b) mortality by daily step count quartiles
Fig. 3
Fig. 3
Association of daily step count with the all-cause (a) and cardiovascular (b) mortality performed by restricted cubic spline analysis. Results were adjusted for age, sex, race, marital status, educational level, smoking status, drinking status, and history of DM, CHD, CHF and stroke. Red lines represent the HR (hazard ratio), and red transparent areas represent the 95% confidence intervals
Fig. 4
Fig. 4
Association of daily step count (per 1000 steps/day) with all-cause mortality (a) and cardiovascular mortality (b) in various subgroups. Results are expressed as multivariable-adjusted HRs after controlling covariates that include age, sex, race, marital status, educational level, smoking status, drinking status, and history of DM, CHD, CHF and stroke, except for the variable used in each specific subgroup analysis, which was not adjusted for in its own analysis. The results are weighted based on the survey. Abbreviation: N, number; HR, hazard ratio; CI, confidence; DM, diabetes mellitus; CHD, coronary heart disease; CHF, congestive heart failure
See this image and copyright information in PMC

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