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Association Between Daily Step Count and All-Cause and CV Mortality
Quick Takes
- There is strong evidence that sedentary life may significantly increase the risk of CVD and shorten the lifespan. However, the optimal number of steps—both the cut-off points over which we can see health benefits, and the upper limit (if any)—and their role in health is unclear.
- A 1,000-step increment correlated with a significant reduction of all-cause mortality of 15%, and similarly, a 500-step increment correlated with a reduced risk of CV mortality of 7%. When the steps exceeded ∼5,500 steps/day, the relative risks of all-cause mortality decreased sharply in people in all climate zones (temperate, subtropical, subpolar, and mixed zone) without significant differences between the groups.
- The analysis also revealed that depending on the outcomes, we do not need so many steps to have health benefits starting with even 2,500/4,000 steps/day, which undermines the hitherto definition of a sedentary life. The most impressive incremental value was compared to the mean steps/day of 3,967; Q1 median steps of 5,537 had a 48% reduction in all-cause mortality.
Study Questions:
Inactivity and walking minimal steps/day increase the risk of cardiovascular disease (CVD) and general ill-health. Is there an optimal number of steps/day, and what is their role in health?
Methods:
The authors systematically searched relevant electronic databases from inception until June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226,889 participants (generally healthy or patients at CV risk) with a median follow-up of 7.1 years were included in the meta-analysis.
Results:
The mean age of participants was 64.4 ± 6.7 years, and 48.9% were females. The frequency of alcohol users was higher compared with current smokers (49.9 vs. 20.7%; p = 0.01). Participants were well educated with 55% more than high school. CV events were rare. Of the 226,889 participants followed for mean of 7.1 years, there was 7,574 all-cause and 1,884 CV mortality. Every 1,000-step increment was associated with a 15% decreased risk of all-cause mortality (p < 0.001), while a 500-step increment was associated with a 7% decrease in CV mortality (p < 0.001). Compared with the reference quartile (Q) with median steps/day 3,967, the Q1, median steps 5,537, Q2, median steps 7,370, and Q3, median steps 11,529 were associated with lower risk for all-cause mortality (48%, 55%, and 67%, respectively; p < 0.05, for all). Similarly, compared with the lowest quartile of steps/day used as reference median steps 2,337, higher quartiles of steps/day (Q1 = 3,982, Q2 = 6,661, and Q3 = 10,413) were linearly associated with a reduced risk of CV mortality (16%, 49%, and 77%; p < 0.05, for all). Using a restricted cubic splines model, there was a nonlinear dose–response association between step count and all-cause and CV mortality (Pnonlinearly < 0.001, for both) with a progressively lower risk of mortality with an increased step count.
Conclusions:
This meta-analysis demonstrates a significant inverse association between daily step count and all-cause mortality and CV mortality with more the better over the cut-off point of 3,967 steps/day for all-cause mortality and only 2,337 steps for CV mortality.
Perspective:
This study was conducted on behalf of the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group and the International Lipid Expert Panel (ILEP). Before the outbreak of the COVID-19 pandemic in 2019, the worldwide average daily number of steps was 5,323 (about same as US). Middle-aged and elderly persons may hear that sedentary lifestyle (usually defined as <5,000 steps/day) is significantly associated with an increased risk of mortality from any cause, from CV and oncological diseases, and a greater risk of type 2 diabetes. Most will not start or attain the steps/day needed despite the relative reduction in CV and total mortality associated with steps/day exceeds the value of most primary and secondary prevention strategies. Among the many limitations of the study, the most important is the lack of data regarding CV risk factors within the ‘relatively healthy individuals.’
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Exercise
Keywords: Alcohol Drinking, Exercise, Lipids, Longevity, Primary Prevention, Risk Reduction Behavior, Secondary Prevention, Smokers, Walking
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