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

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 re-ductions 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 prescrip-tions 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) (J Am Coll Cardiol 2023;82:1483- 1494) (c) 2023 by the American College of Cardiology Foundation.

Automated summary

According to the meta-analysis, daily step counts of approximately 2,600 and 2,800 already yield significant benefits in terms of reducing mortality and cardiovascular disease. Further increasing the step count up to approximately 8,800 and 7,200 steps per day leads to progressive risk reductions. There are additional mortality benefits from moderate to high step cadences.