Higher Step Counts Equal Better CV Health: UK Biobank

Simply walking on a regular basis, up to a threshold of 10,000 daily steps, is associated with reductions in all-cause and CVD-related death, as well as fewer cardiovascular events, UK Biobank data suggest.

People who reach a faster pace or greater intensity stand to gain the most benefit, Borja del Pozo Cruz, PhD (University of Southern Denmark, Odense), and colleagues note in their paper, published online this week in JAMA Internal Medicine. The researchers also found reductions in cancer diagnoses and mortality, while in another new paper they report similar findings for dementia.

“We know that physical activity is good for health,” del Pozo Cruz told TCTMD. “Yet the majority of the population, particularly people with chronic conditions or older adults, are inactive—that’s a fact. So we thought that by exploring steps—walking—which is something that everyone understands, it would be easier to translate the message into meaningful, tangible recommendations” as opposed to the current physical activity recommendations based on time.

For example, he suggested, “if I think about my mom or dad and I tell them, ‘You’ve got to engage in 30 minutes per day of moderate-to-vigorous physical activity,’ [they’d say] ‘What is that?’ But if I tell them, ‘Hit the road and walk for 10,000 steps’ or whatever, they understand. And they say, ‘Yeah, I can do it.’”

Scott Lear, PhD (Simon Fraser University and St. Paul’s Hospital, Vancouver, Canada), commenting on the findings for TCTMD, said a strength of the study is that the researchers “used accelerometers to measure physical activity, as opposed to self-report,” which enabled them to get a more-accurate assessment of both step count and cadence.

From the first step through the 10,000th, the benefits appear to be linear, he added. Beyond this cut point, additional steps did little to further reduce risk.

“I was actually surprised,” said Lear, “that the ideal point of steps is close to this 10,000-step recommendation, because [that metric] is arbitrary and has its origins back in the 60s, when Tokyo had the Summer Olympics. It was a marketing thing. It wasn’t based on any science,” but rather a way to promote activity ahead of the 1964 games.

Every step counts. Borja del Pozo Cruz

For del Pozo Cruz, the symmetry between their findings and the anecdotal but widely held 10,000-step goal also came as a pleasant surprise. Yet the health gains start before that threshold, he stressed.

“Every step counts,” he said. “From the very first step, you start decreasing the risk of cardiovascular disease. That’s very important, because that takes away the lack of motivation to [reach] 10,000 steps,” which can be an “intimidating” goal for people just starting out.

He said he wants their study to have a real-world impact. “Hopefully, this information is actually used by people to motivate themselves to walk more, but also by healthcare professionals to give patients tangible, meaningful, and practical recommendations, so that we can spread the message and get people out and walking,” said del Pozo Cruz.

Faster Is Better

For their study, del Pozo Cruz and colleagues emailed 236,442 UK Biobank participants ages 40 to 79 years between February 2013 and December 2015, inviting them to receive a free accelerometer (Axivity AX3) and wear it for 7 days. In all, 103,684 accepted the offer.

The final study population consisted of 78,500 people (mean age 61 years; 55% female, 97% white) in England, Scotland, and Wales. Outcomes were tracked through the end of October 2021, with a median follow-up of 7 years. During this time, 1,325 died of cancer and 664 of CVD. A total of 10,245 incident CVD events and 2,813 incident cancer events were captured by the registry.

Higher step counts per day were linked to significantly lower risks of all-cause and CVD-related mortality, with the biggest benefits seen up until the 10,000-step mark. At this threshold, the adjusted hazard ratios were around 0.60 and 0.80, respectively, for the two endpoints. Similar patterns were seen for cancer-related death, CVD events (fatal and nonfatal coronary heart disease, stroke, and heart failure), and cancer.

To capture the slope of the curve, the researchers calculated how sharply outcomes improved in conjunction with more steps. With each 2,000-step increment up to 10,000 steps, the mean rate of change (MRC) was -0.08 for all-cause mortality and -0.10 for CVD mortality. Slopes were steeper, with greater MRC values, when study participants walked at “purposeful” speeds of ≥ 40 steps per minute or had greater peak-30 cadence, a metric that captures intensity (average steps per minute for the 30 highest, but not necessarily consecutive, minutes each day).

The UK Biobank data set consists of “mainly white, wealthy people,” del Pozo Cruz acknowledged, and is not representative of a more-diverse population. Thus, the study “needs to be replicated in other populations,” he said, adding that future research should also compare individuals given the goal of pursuing 10,000 steps versus controls who continue with usual activity levels.

Lear noted, too, that there can be a “healthy volunteer bias” in studies such as this, but observed that the findings are consistent with an entire body of literature supporting physical activity. What’s unique about this one, he said, is how simply it measures ideal activity: “Throughout the day, aim for 10,000 steps and try to get about half an hour of those steps at a cadence of . . . 80 to 120 steps per minute.”

Any amount of walking is better than none and can be incorporated into daily chores, ordinary activities, and the like, he added. But if walking is someone’s main form of exercise, at least some of it should be brisk. These recommendations apply not just to patients but also to healthcare providers, stressed Lear. “This is what everyone should be doing.”

Going forward, it will be interesting to learn more about people at the highest end of the step-count spectrum, who may be walking not as a means of leisure-time exercise but through their jobs, Lear said. In 2017, data from the Prospective Urban Rural Epidemiology (PURE) study, which he led, suggested that higher levels of activity are protective against cardiovascular disease and death, regardless of whether that activity is recreational, at the workplace, or otherwise.