Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts.

Sigmund A Anderssen, Carl F Pieper, Erika Rees-Punia, Dhayana Dallmeier, Jochen Klenk, Erin E Dooley, Kelley Pettee Gabriel, Priya Palta, Lisa A Pompeii, Ramachandran S Vasan, Marcel Ballin, Anna Nordström, Charles E Matthews, Bjørge H Hansen, Jennifer A Cochrane, Terence Dwyer, Jing Wang, Fangyu Liu, Jennifer Schrack, Jacek Urbanek, Pedro F Saint-Maurice, Yutaka Yoshitake, Eric J Shiroma, Ariel Chernofsky, Mercedes R Carnethon, Alpa V Patel, Shengping Yang, Peter Nordström, Deborah A Galuska, John D Omura, Janet E Fulton, Naofumi Yamamoto, Peter H Whincup, Luigi Ferrucci, Robert L Newton, Martin G Larson, Nicole Spartano, Amanda E Paluch, Shivangi Bajpai, David R Bassett, Ulf Ekelund, Kelly R Evenson, Barbara J Jefferis, William E Kraus, I-Min Lee

Journal: The Lancet. Public health 2022;7(3):e219-e228

PMID: 35247352

Abstract

BACKGROUND

Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.

METHODS

In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.

FINDINGS

We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]).

INTERPRETATION

Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.

FUNDING

US Centers for Disease Control and Prevention.

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Address: Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA. Electronic address: [email protected].; Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA.; Department Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway; 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.; 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 Primary Care and Population Health, UCL Medical School, London, UK.; Duke Molecular Physiology Institute and Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA.; Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.; Department of Population Science, American Cancer Society, Atlanta, GA, USA.; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.; Agaplesion Bethesda Clinic, Research Unit on Ageing, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany; IB University of Applied Health and Social Sciences, Stuttgart, Germany.; Population Health Research Institute, St George's, University of London, London, UK.; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.; Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.; Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, TX, USA.; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Medicine, Boston University School of Medicine, Boston, MA, USA.; Department of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, USA.; Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.; Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.; Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden; School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.; Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway.; Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway; Department of Sport Science and Physical Education, University of Agder, Norway.; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia.; Murdoch Children's Research Institute, Melbourne, VIC, Australia.; Intramural Research Program, National Institute on Aging, Baltimore, MD, USA.; Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.; Faculty of Collaborative Regional Innovation, Ehime University, Matsuyama, Ehime, Japan.; Institute for Pacific Rim Studies, Meio University, Nago, Okinawa, Japan.; Pennington Biomedical Research Center, Baton Rouge, LA, USA.; Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA.
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