Getting most of their daily steps in one long walk rather than several shorter walks was associated with a lower risk of cardiovascular disease and all-cause mortality among adults who did not reach recommended activity levels, according to a prospective cohort study published Oct. 28 in Annals of Internal Medicine.

Borja Del Pozo Cruz, PhD, et al., analyzed data from 33,560 participants (mean age, 62 years; 59% women) in the UK Biobank who walked an average of ≤8,000 steps per day (defined as suboptimally active) and had no baseline cardiovascular disease or cancer. Participants wore accelerometers on their wrist for up to seven consecutive days to record their step counts and how their steps were distributed throughout the day.

Results showed that the median step count per day was 5,165. Participants accumulated most daily steps in bouts lasting <5 minutes in 43%, 5 to <10 minutes in 34%, 10 to <15 minutes in 55%, and ≥15 minutes in 8%.

Findings revealed that 735 deaths and 3,119 cardiovascular disease events occurred during an average 7.9-year follow-up. At 9.5 years, cumulative all-cause mortality decreased and was 4.36%, 1.83%, 0.84%, and 0.80% for bouts <5 minutes, 5 to <10 minutes,10 to <15 minutes and ≥15 minutes, respectively. At 9.5 years, cumulative cardiovascular disease incidence also decreased and was 13.03%, 11.09%, 7.71% and 4.39% for bouts <5 minutes, 5 to <10 minutes, 10 to <15 minutes and ≥15 minutes, respectively. Notably, the differences were larger among participants who were more sedentary (<5,000 steps/day).

In an accompanying editorial comment, Fabian Sanchis-Gomar, MD, PhD, et al., write that the researchers provide compelling "evidence that even small increases in physical activity – preferably through longer walking episodes – are associated with health benefits," highlighting "the necessity of including step patterns in future physical activity recommendations beyond the step counts currently included in the International Lipid Expert Panel algorithm for 'stepping up our game' to improve cardiovascular health and longevity."