Mortality, CVD Benefits Seen at Relatively Low Daily Step Counts

Just a few thousand steps per day are all that’s needed to lower the risk of cardiovascular disease and all-cause mortality, according to results from a new meta-analysis.

Getting more steps in did result in additional reductions in risk, but the optimal “dose” in terms of event reduction was seen at 7,200 to 8,800 steps per day, with little benefit beyond this number, Niels Stens, MSc (Radboud University Medical Center, Nijmegen, the Netherlands), and colleagues reported online September 6, 2023, in the Journal of the American College of Cardiology.

“This plateau suggests that most benefits were achieved at step counts less than 10,000 steps per day, which aligns with observations from recent other meta-analyses,” they write. “Although step volumes beyond this level were not associated with additional health benefits, there is no reason to discourage individuals from such behavior, as a highly physically active lifestyle may provide other benefits, such as joy, improved quality of life, and better sleep and mental health.”

Borja del Pozo Cruz, PhD (University of Southern Denmark, Odense), who wasn’t involved in the study but has looked into the relationship between step counts and mortality and cardiovascular events, agreed that the meta-analysis confirms prior work, including their own analysis of participants enrolled in the UK Biobank.

Asked if the general public is starting to understand the advantages of any amount of physical activity—and not just hitting the 10,000-step threshold—del Pozo Cruz said he thinks they are. “But in my view, this needs to be stressed further via healthcare providers and public health agencies,” he told TCTMD in an email. “Doing something is better than nothing. And this is key to move that segment of the population that remains inactive.”

Apart from motivational messages in the physician’s office or elsewhere, del Pozo Cruz said improving the overall physical health of the population must start with urban planning and the immediate environment. “Urban designs that are inviting of movement are required,” he said. “People need to move naturally and not rely on gyms or fitness facilities to achieve desired levels of physical activity and health.”

Cadence Matters, Too

This latest analysis to investigate the relationship between step counts and adverse outcomes included 111,309 adults (mean age 62.5 years; 60.8% women) without CVD at baseline participating in 12 studies that used objective step-counting methods, such as accelerometers or pedometers. The mean daily step count was 7,069 steps per day and 4.4% of participants died during a median follow-up period of 77.8 months. Additionally, 1.4% developed CVD during 72.9 months of follow-up.

Stratified by tertiles, those with intermediate daily step counts (median 6,000 steps per day) had a significant 36% lower relative risk of all-cause mortality compared with those in the lowest tertile (median 3,166 steps per day). The most active group—those in the highest tertile (median 10,000 steps per day)—had a significant 50% lower risk of all-cause mortality compared with the least active group. In a similarly stratified analysis, those in the intermediate- and high-step count tertiles had 42% and 58% lower risks of CVD, respectively, compared with the least active adults.

In a continuous dose-response analysis, researchers observed a nonlinear trend between step counts and all-cause deaths and CVD events. The reduction in all-cause mortality was statistically significant in adults who took 2,517 steps per day, while the reduction in CVD events was statistically significant in those who managed 2,735 steps per day. The risk of death and CVD declined further until people hit 8,763 and 7,126 steps per day, respectively. Upping daily steps beyond this point did not lead to significant reductions in either endpoint.   

The study also suggested that faster walking might be beneficial, noting that those with an intermediate or high cadence (median 63 and 88 steps per minute, respectively) had a further 20% lower risk of all-cause mortality than those with a low cadence (median 29 steps per minute).

“These findings underline that both volume (steps per day) and intensity (cadence, or steps per minute) are independently associated with health and that their risk reductions are additive,” write Stens et al.

Doing something is better than nothing. Borja del Pozo Cruz

To TCTMD, del Pozo Cruz said the cadence finding is of interest, noting there’d been some controversy around whether there were further benefits with faster walking. For example, while his group showed that higher cadence appeared to be associated with a further reduction in mortality and CVD, as well as cancer, others found no association with mortality or incident CVD.

In an editorial, Carl Lavie, MD (John Ochsner Heart and Vascular Institute, New Orleans, LA), Charles German, MD, MS (University of Chicago, IL), and Fabian Sanchis-Gomar, MD, PhD (Stanford University School of Medicine, CA), point out that cadence is a marker of cardiorespiratory fitness, which has been shown to be associated with a lower risk of mortality.

“It would make sense that higher step cadence and speed would be associated with greater physical activity and exercise training heart rates and better outcomes,” they write.

Cadence aside, the editorialists say the new study provides a “clear, comforting, and uplifting message” about the benefits of physical activity well below the frequently touted 10,000 steps per day threshold. There’s never been anything magical about this number, they write, pointing out that it was derived from a Japanese maker of pedometers in 1960s and has never had evidence to support it.

“The lower number of steps per day needed to reduce mortality and CVD should provide comfort and encouragement to the public, as well as to clinicians,” write Lavie and colleagues.