Steps per Day and Arterial Stiffness: Systematic Review and Meta-Analysis

Arterial stiffness has emerged as an independent predictor of cardiovascular morbidity and mortality. Furthermore, objectively monitored steps per day is widely perceived to be beneficial for controlling health risk factors, and for preventing morbidity and mortality. The aim of this review was to determine the relationship between steps per day and arterial stiffness, as measured by its reference standard, pulse wave velocity (PWv). We systematically searched for cross-sectional data from studies addressing the association between steps per day and PWv. The DerSimonian and Laird method was used to compute pooled estimates of correlation and their respective 95% CI. Additionally, we used a regression model to estimate the pooled mean PWv by categories of physical activity behavior: sedentary <5000; low active 5000 to 7499; active 7500 to 9999; and highly active 10000+. Twenty published studies were included in the systematic review, but only 10 studies in adults and older adults could be incorporated in the meta-analysis. Steps per day was inversely correlated with arterial stiffness measured by PWv in adults and older adults (r=-0.18; 95% CI: -0.27 to -0.10; P<0.001), with substantial heterogeneity (I-2=77.9%; P<0.001). The regression model showed that the pooled PWv was lower with a corresponding higher level of steps per day, influenced primarily by low PWv values for the highly active lifestyle category (P-trend=0.005). This systematic review and meta-analysis demonstrates a clinically meaningful association between objectively monitored steps per day and PWv, an accepted indicator of arterial stiffness and an early subclinical risk factor for cardiovascular disease. Systematic Review Registration PROSPERO CRD42018088228.