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

Niels A Stens; Esmée A Bakker; Asier Mañas; Laurien M Buffart; Francisco B Ortega; Duck-Chul Lee; Paul D Thompson; Dick H J Thijssen; Thijs M H Eijsvogels

doi:10.1016/j.jacc.2023.07.029

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

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

Authors

Niels A Stens¹, Esmée A Bakker², Asier Mañas³, Laurien M Buffart⁴, Francisco B Ortega⁵, Duck-Chul Lee⁶, Paul D Thompson⁷, Dick H J Thijssen⁸, Thijs M H Eijsvogels⁹

Affiliations

¹ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
² Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute, University of Granada, Granada, Spain.
³ GENUD Toledo Research Group, Faculty of Sports Sciences, Universidad de Castilla-La Mancha, Toledo, Spain; CIBER de Fragilidad y Envejecimiento Saludable, CIBERFES, Instituto de Salud Carlos III, Madrid, Spain; Center UCM-ISCIII for Human Evolution and Behavior, Madrid, Spain; Didactics of Languages, Arts and Physical Education Department, Faculty of Education, Complutense University of Madrid, Madrid, Spain.
⁴ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands.
⁵ Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute, University of Granada, Granada, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Granada, Spain; Faculty of Sport and Health Sciences University of Jyväskylä, Jyväskylä, Finland.
⁶ Department of Kinesiology, Iowa State University, Ames, Iowa, USA.
⁷ Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA.
⁸ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
⁹ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: thijs.eijsvogels@radboudumc.nl.

PMID: 37676198
DOI: 10.1016/j.jacc.2023.07.029

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.