Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia.

Katherine S Hall, Eric T Hyde, David R Bassett, Susan A Carlson, Mercedes R Carnethon, Ulf Ekelund, Kelly R Evenson, Deborah A Galuska, William E Kraus, I-Min Lee, Charles E Matthews, John D Omura, Amanda E Paluch, William I Thomas, Janet E Fulton

Journal: The international journal of behavioral nutrition and physical activity 2020;17(1):78

PMID: 32563261

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Plain Language Summary

The health benefits of physical activity for people of all ages, fitness levels, and sociodemographic backgrounds are well-documented. The main aim of this study was to provide an updated description of the association between daily step counts and subsequent cardiovascular disease (CVD) morbidity or mortality, dysglycaemia, and all-cause mortality in adults and the patterns of these associations. This study is a systemic review of 17 studies from 13 different cohorts. Participants’ mean age ranged from 49.7 to 78.9 years with samples comprised of 46.9% female participants on average. Results showed that increasing steps per day is beneficial for health: taking more steps per day was associated with lower risk of all-cause mortality, and lower risk of CVD morbidity or mortality. These associations appear to hold across age, gender, and weight status. Authors conclude that this additional evidence will help guide meaningful volume targets that can be used for health care, education, and behavioural interventions, and potentially inform the development of public health guidelines for steps and health.

Abstract

BACKGROUND

Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes.

METHODS

A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations.

RESULTS

Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics.

CONCLUSIONS

Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.

Address: Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA. [email protected].; Claude D. Pepper Older Americans Independence Center, Duke Aging Center, and the Department of Medicine, Duke University, Durham, NC, USA. [email protected].; Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.; Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN, USA.; Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.; Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway and Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.; Claude D. Pepper Older Americans Independence Center, Duke Aging Center, and the Department of Medicine, Duke University, Durham, NC, USA.; Brigham and Women's Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.; Department of Kinesiology, Institute for Applied Life Sciences, University of Massachusetts, Amherst, MA, USA.; Office of Library Science, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA.

DOI: 10.1186/s12966-020-00978-9