Daily Step Counts Associated With Reduced Mortality and CVD Risk

Significant risk reductions occur at 2517 daily step counts for all-cause mortality and 2735 daily step counts for incident cardiovascular disease (CVD), according to a study in the Journal of the American College of Cardiology.

Researchers conducted a systematic review and meta-analysis to evaluate the dose-response association of objectively measured step count metrics with all-cause mortality and incident CVD in the general population.

A literature search was performed in PubMed and EMBASE from inception to October 2022. Eligible studies quantified daily step count with objective step-counting methods, evaluated the associations between step count and all-cause mortality or incident fatal or nonfatal CVD, had a prospective cohort design, were peer reviewed and published online in English, and included adults aged 18 years or older without CVD at baseline.

The analysis included 12 studies: 11 studies assessed the association between step count and all-cause mortality (n=111,309; 60.8% women; mean age, 62.5±5.3 years), 4 studies assessed step count and incident CVD (n=85,261), and 4 assessed step cadence and all-cause mortality (n=102,191).

Overall, 4854 (4.4%) participants died during a median follow-up of 77.8 months, and 1224 individuals (1.4%) had CVD events during 72.9 months of follow-up.

Continuous dose-response analyses demonstrated nonlinear trends (P for nonlinearity <.001) for associations between step count vs all-cause mortality and incident CVD. Decreases in risk were statistically significant for the associations with all-cause mortality and CVD at 2517 steps/day (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.84-0.999) and 2735 steps/day (aHR, 0.89; 95% CI, 0.79-0.999), respectively.

For all-cause mortality and CVD, the minimal effective step count was 479 steps/day and 735 steps/day greater than the reference category for other cutoff points. Additional step count increases were associated with reduced mortality and CVD risk until 8763 steps/day (aHR, 0.40; 95% CI, 0.38-0.43) and 7126 steps/day (aHR, 0.49; 95% CI, 0.45-0.55), after which additional decreases in mortality and incident CVD risk were not statistically significant (16,000 vs 2,000 steps/day: aHRs, 0.35 [95% CI, 0.30-0.40] and 0.42 [95% CI, 0.33-0.53], respectively).

Cadences considered intermediate (median, 63 steps/min) and high (median, 88 steps/min) were associated with a decreased mortality risk (aHRs, 0.67 [95% CI, 0.56-0.80] and 0.62 [95% CI, 0.40-0.97]) compared with a low cadence (median, 29 steps/min). Further adjustments in step count reduced these associations for intermediate cadence (aHR, 0.78; 95% CI, 0.65-0.93) and high cadence (aHR, 0.79; 95% CI, 0.67-0.94).

Limitations of the study include the evaluation of daily step counts only at baseline and the inability to quantify the effects of reverse causation and other relevant factors that influence daily step count. In addition, only 4 studies assessed the additional effects of step cadence to total step count, and the findings may not apply to chronically diseased, older, and low-income populations.

“As health benefits of daily steps were similar between men and women and step count targets were independent of wear location and device, the integration of uniform daily step targets in future physical activity guidelines may be relevant from a public health perspective, as ‘every step counts,’” wrote the study authors.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.