CVD Benefits of Activity Seen Below Widely Quoted Step Goal in Older Adults

Being physically active, even when not achieving the frequently promoted target of 10,000 steps per day, is associated with a significantly lower risk of cardiovascular disease in older adults, according to a meta-analysis.

Among those 60 years and older, taking between 6,000 and 9,000 steps per day was associated with a 40% to 50% lower risk of cardiovascular disease when compared with taking approximately 2,000 steps each day, report investigators. Amanda Paluch, PhD (University of Massachusetts Amherst), who led the study, said one of the most important public health messages is that people shouldn’t be daunted by the widely quoted goal of 10,000 steps per day, which in some people can amount to roughly 5 miles or 8 km.

“If you’re at 10,000 steps per day, that’s great,” she told TCTMD. “There’s no increased risk of hitting those high numbers. But for those other people—and it’s a large proportion of the population that might find that difficult to achieve—there’s definitely benefit from incremental increases in steps per day to improve heart health.”

At the moment, there is no clear consensus around the optimal number of steps per day to reduce the risk of death and disease. In recent years, some have challenged whether it’s necessary to knock off 10,000 steps in a day to improve health and reduce the risk of premature death. In fact, Paluch noted, that metric is not rooted in science but is instead the result of a marketing campaign developed by a Japanese pedometer manufacturer.

“It’s thought that the 10,000 steps per day goal started about half a century ago,” said Paluch. “It’s pretty much stuck as a very common goal that we see in the mainstream for the general population. There really has not been any scientific evidence to back up this 10,000 steps per day number.”

Benefits Vary by Age

With the lack of data, the Steps for Health Collaborative has been trying to dig into the numbers to investigate the associations between device-measured step volume and rate with prospective health outcomes, including cardiovascular disease. The research, which was published last week in Circulation, involved eight prospective studies with a total of 20,152 adults who tracked their daily step counts and who were followed for a mean of 6.2 years. These studies included three previously published studies as well as unpublished data from ARIC, CARDIA, the Framingham Heart Study, the Healthy Ageing Initiative, and the Jackson Heart Study. Overall, the daily median steps per day was 4,323 for adults ages 60 years and older and 6,911 for younger adults.

To examine the association between step counts and cardiovascular disease (stroke, coronary heart disease, or heart failure), study participants were stratified by age into quartiles based on the amount of activity. In adults 60 years and older, those in quartile 2 (median steps 3,823) had a 20% lower risk of cardiovascular disease compared with those in quartile 1 (median steps 1,811). Those in quartiles 3 and 4 (median steps 5,520 and 9,259, respectively) had a 38% and 49% lower risk of disease when compared with those who had the lowest step count. There was no association between daily step count and cardiovascular disease in participants younger than 60 years. 

“We wanted to look at the data by age group, both for younger and older adults,” said Paluch. Earlier this year, the Steps for Health Collaborative published a study in the Lancet showing that taking more steps per day was associated with a lower risk of all-cause mortality, but the number of steps needed varied by age. In younger adults, 8,000 to 10,000 steps per day was associated with a lower risk of mortality, but in adults 60 years and older, the benefit was seen at 6,000 to 8,000 steps per day.

The lack of association between daily step counts and cardiovascular disease in younger adults is likely because the follow-up period is too short. Cardiovascular disease, said Paluch, is a disease of aging and likely hasn’t yet progressed enough to become evident in those with lower step counts. Given this, one of the group’s next tasks is to examine any association between daily step counts and cardiovascular risk factors that present in young to middle-aged adults.

In the older adults, the relationship between step count and events appeared to be nonlinear, said Paluch, meaning that the largest benefit in terms of cardiovascular disease prevention would be seen in people moving from little activity to doing a bit more.

“They would get the biggest bang for the buck,” said Paluch. “Going from, say, 2,000 to 3,000 steps or from 3,000 to 4,000 steps. We saw a slight bend [in the curve] around 6,000 steps per day where cardiovascular disease [risk] continued to decline—say, going from 6,000 to 7,000 or from 7,000 to 8,000—but it just wasn’t as substantial. It was slightly different from what we saw with mortality where there was a very clear leveling off. With cardiovascular disease, there does continue to be a gradual decline with a higher number of steps.”