Association of Daily Steps With Cardiovascular Disease

Quick Takes

  • In older adults, taking more daily steps was associated with a progressively decreased risk of CVD.
  • Approximately 6,000–9,000 steps per day were associated with a 40–50% reduced risk of CVD for adults aged ≥60 years compared to those taking 2,000 steps per day.
  • The greatest reduction in risk was observed with the initial increases in daily steps beyond 2,000 steps per day. Monitoring and promoting steps per day is a simple metric to communicate for CVD prevention.

Study Questions:

What is the dose–response relationship between daily steps and cardiovascular disease (CVD) risk?


The Steps for Health Collaborative is a consortium formed to investigate associations of device-measured step volume and rate with prospective health outcomes among adults. Studies were identified through a 2019 systematic review; three of the four studies identified agree to participate in the current analysis. Five additional studies were later identified that met inclusion criteria (i.e., device-measured steps and prospective follow-up for CVD events in adults). Studies quantified step volume as steps per day averaged for the 3–7 days where step data were collected. The primary outcome was adjudicated CVD events, which included fatal and nonfatal coronary heart disease, stroke, and heart failure.


A total of eight prospective studies were included for a combined cohort of 20,152 adults (mean age 63.2 ± 12.4 years, 52% were women, and >70% were non-Hispanic Whites). Mean follow-up was 6.2 years (123,209 person-years), with a total of 1,523 CVD events (12.4 per 1,000 participant-years) reported. The overall median steps per day were 4,323 (interquartile range [IQR], 2,760–6,924) for older adults (≥60 years of age) and 6,911 (IQR, 4,783–9,794) for younger adults. Among seven studies of older adults, there were 1,210 events among 12,741 individuals (19.3 events per 1,000 person-years). There was a significant difference in the association of steps per day and CVD between older (≥60 years) and younger adults.

For older adults, the hazard ratio (HR) for quartile 2 was 0.80 (95% confidence interval [CI], 0.69-0.93), 0.62 for quartile 3 (95% CI, 0.52-0.74), and 0.51 for quartile 4 (95% CI, 0.41-0.63) compared with the lowest quartile. There was a nonlinear association whereby more steps were associated with decreased CVD risk among older adults. Among older adults, taking 6,000–9,000 steps per day was associated with a 40–50% lower risk of CVD. Among four studies of younger adults, there were 313 events among 7,411 individuals (5.1 events per 1,000 person-years). For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46-1.35), 0.90 for quartile 3 (95% CI, 0.64-1.25), and 0.95 for quartile 4 (95% CI, 0.61-1.48) compared with the lowest quartile. However, daily step counts were not associated with CVD risk after adjustment for potential confounders.

Restricting the analysis to individuals without known CVD at baseline showed similar results. In addition, no significant differences were observed between females and males in the quartile comparison or spline models.


The authors concluded that taking more daily steps for older adults was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for patient communication and population health to reduce the risk of CVD.


This analysis supports the benefits of daily walking to lower CVD risk among adults aged ≥60 years. However, a similar association was not observed among younger adults. For older adults, step counts above 6,000 per day were associated with lower CVD risk, suggesting benefits lower than the often suggested 10,000 steps per day.

Clinical Topics: Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Cardiovascular Diseases, Coronary Disease, Exercise, Geriatrics, Heart Failure, Primary Prevention, Public Health, Risk Reduction Behavior, Stroke, Walking

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