Just a Few Thousand Daily Steps Can Rein in Mortality Risk: Meta-analysis

Even at levels that might be thought of as “sedentary,” getting in some extra daily steps appears to reduce the risk of all-cause and cardiovascular death, a new meta-analysis confirms. All-cause mortality begins to drop at 4,000 steps and CV mortality at around 2,300.

As reported by TCTMD, there’s growing evidence that being physically active holds benefits well before the frequently promoted target of 10,000 steps per day and even below the 5,000-step threshold typically used to define a sedentary lifestyle.

Maciej Banach, MD, PhD (Medical University of Lodz, Poland, and Johns Hopkins University School of Medicine, Baltimore, MD), lead author of the meta-analysis, pointed out that it provides real-world evidence in a large dataset of nearly a quarter million people.

“It was critically important,” he told TCTMD, “for us to investigate and maybe overcome some inconsistencies [that had] been seen in previous studies,” clarifying things like the optimal step count, the minimal amount needed to make a dent in mortality, and if there are any upper limits on what’s beneficial or differences by sex.

As a preventive cardiologist, Banach has seen firsthand how it can sometimes be hard to convince patients to exercise more regularly when the target is getting at least 6,000 or 7,000 daily steps, or even better, 10,000. “For many of them it was simply discouraging because they were not able to do it. They spent a lot of time and work, and so on,” he said. Also, some patients simply didn’t have the level of physical fitness at the outset to reach these goals.

What their calculations showed, however, is that good things can come from just a few thousand steps.

“We can say to our patients now, ‘Do not worry about your baseline: the number of steps you are doing at the very beginning. It might be even 4,000. But try your best to improve yourself, try to increase these numbers, because every increase by 500 [or] 1,000 might be additionally associated with [further mortality reductions] of 7% to 15%,’” Banach advised.

It’s still correct to say “the more, the better” for activity, as the largest mortality reductions were seen beyond the 6,000 to 7,000 mark, he added.

Do not wait until you are 50 or 60 years of age or until you have established coronary artery disease. Maciej Banach

Borja del Pozo Cruz, PhD (University of Cádiz, Spain, and University of Southern Denmark, Odense), commenting for TCTMD, said the meta-analysis reinforces prior reports and is notable for its size. “However, the take-home message is not new: some steps better than none, and the more, the better,” he noted in an email.

“You do not need large amounts of steps to become healthier, and every step counts! So that can motivate the most inactive segment of the population,” said del Pozo Cruz. In planning their day, people can apply this message to add a little extra activity, he continued. “For example, taking the stairs instead of using the lift, dropping from the bus a stop prior to their destination, doing household chores, standing up more, or meeting friends for a walk instead of sitting with them are just a few examples that may help in increasing the level of activity incidentally.”

Gains With 500 or 1,000 Extra Steps

For the meta-analysis, published in the European Journal of Preventive Cardiology, Banach et al identified 17 cohort studies with a total of 226,889 people (mean age 64 years; 49% female) who were generally healthy or at risk for developing CVD. Median follow-up lasted 7.1 years.

Each 1,000-step increase was linked to lower risk of all-cause mortality (HR 0.85; 95% CI 0.81-0.92). For CV mortality, each 500-step increase was associated with lower risk (HR 0.93; 95% CI 0.91-0.95).

Starting at 3,967 steps per day, people saw reductions in all-cause mortality. At a minimum of around 2,337 steps per day, there were decreases in CV mortality. Nonlinear dose-response relationships were seen, wherein the risks of all-cause and CV mortality progressively declined as the number of steps grew.

Results were similar for both men and women, and across different climates (temperate, subtropical, subpolar, and mixed zones). However, individuals ages 60 years and older had a smaller reduction in the risk of death (42% decrease with 6,000-10,000 steps per day) than did younger patients (49% reduction with 7,000-13,000 steps per day).

You do not need large amounts of steps to become healthier, and every step counts! Borja del Pozo Cruz

Importantly, though, “there are many questions that are still unanswered,” Banach noted. Using the available data, they were able to analyze what happens up to 20,000 steps only, so it’s unclear whether there are similar health benefits for people with higher numbers. It’s also unknown if a faster walking pace would offer greater benefits and how the associations they saw here would extend to patients already diagnosed with cardiovascular disease.

For patients, the most important thing is to get moving, even if it starts at lower levels of activity, stressed Banach. “Do not wait until you are 50 or 60 years of age or until you have established coronary artery disease. Let’s start really early, because it is so important for the lifestyle benefits and so important for the longevity.”