Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis.

Stuart J H Biddle, Philip Clare, Kar Hau Chong, Elizabeth A Calleja, Mengyun Luo, Tracy Nau, Ulf Ekelund, Anne Tiedemann, Adrian Bauman, Ding Ding, Binh Nguyen, Barbara J Jefferis, Paddy C Dempsey, Monique E Francois, Borja Del Pozo Cruz, Katherine Owen, Cathie Sherrington, Rochelle Davis, Anthony Okely, Zachary Munn

Journal: The Lancet. Public health 2025;10(8):e668-e681

PMID: 40713949

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

Despite the rapid increase in evidence from the past decade on daily steps and health-related outcomes, existing systematic reviews primarily focused on few outcomes, such as all-cause mortality. This study synthesised the prospective dose-response relationship between daily steps and health outcomes including all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, cognitive outcomes, mental health outcomes, physical function, and falls.

METHODS

For this systematic review and meta-analysis, we searched PubMed and EBSCO CINAHL for literature published between Jan 1, 2014, and Feb 14, 2025, supplemented by other search strategies. Eligible prospective studies examined the relationship between device-measured daily steps and health outcomes among adults without restrictions on language or publication type. Pairs of reviewers (BN, KO, ML, and TN) independently did the study selection, data extraction, and risk of bias assessment using the 9-point Newcastle-Ottawa Scale. Hazard ratios (HRs) from individual studies were synthesised using random-effects dose-response meta-analysis where possible. Certainty of evidence was assessed using GRADE. This trial is registered with PROSPERO (CRD42024529706).

FINDINGS

57 studies from 35 cohorts were included in the systematic review and 31 studies from 24 cohorts were included in meta-analyses. For all-cause mortality, cardiovascular disease incidence, dementia, and falls, an inverse non-linear dose-response association was found, with inflection points at around 5000-7000 steps per day. An inverse linear association was found for cardiovascular disease mortality, cancer incidence, cancer mortality, type 2 diabetes incidence, and depressive symptoms. Based on our meta-analyses, compared with 2000 steps per day, 7000 steps per day was associated with a 47% lower risk of all-cause mortality (HR 0·53 [95% CI 0·46-0·60]; I=36·3; 14 studies), a 25% lower risk of cardiovascular disease incidence (HR 0·75 [0·67-0·85]; I=38·3%; six studies), a 47% lower risk of cardiovascular disease mortality (HR 0·53 [0·37-0·77]; I=78·2%; three studies), a non-significant 6% lower risk of cancer incidence (HR 0·94 [0·87-1·01]; I=73·7%; two studies), a 37% lower risk of cancer mortality (HR 0·63 [0·55-0·72]; I=64·5%; three studies), a 14% lower risk of type 2 diabetes (HR 0·86 [0·74-0·99]; I=48·5%; four studies), a 38% lower risk of dementia (HR 0·62 [0·53-0·73]; I=0%; two studies), a 22% lower risk of depressive symptoms (HR 0·78 [0·73-0·83]; I=36·2%; three studies), and a 28% lower risk of falls (HR 0·72 [0·65-0·81]; I=47·5%; four studies). Studies on physical function (not based on meta-analysis) reported similar inverse associations. The evidence certainty was moderate for all outcomes except for cardiovascular disease mortality (low), cancer incidence (low), physical function (low), and falls (very low).

INTERPRETATION

Although 10 000 steps per day can still be a viable target for those who are more active, 7000 steps per day is associated with clinically meaningful improvements in health outcomes and might be a more realistic and achievable target for some. The findings of the study should be interpreted in light of limitations, such as the small number of studies available for most outcomes, a lack of age-specific analysis and biases at the individual study level, including residual confounding.

FUNDING

National Health and Medical Research Council, New South Wales Health, and Ian Potter Foundation.

Address: Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia. Electronic address: [email protected].; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.; Department of Sport Sciences, Faculty of Medicine, Health, and Sports, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.; Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia; Baker Heart & Diabetes Institute, Melbourne, VIC, Australia; Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK; MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.; Health Evidence Synthesis, Recommendations and Impact (HESRI), School of Public Health, University of Adelaide, Adelaide, SA, Australia.; UCL Department of Primary Care and Population Health, University College London, London, UK.; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.; National Heart Foundation of Australia, Melbourne, VIC, Australia.; School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, The University of Wollongong, Wollongong, NSW, Australia.; School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, The University of Wollongong, Wollongong, NSW, Australia.; Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia.; Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Department of Chronic Diseases, Norwegian Public Health Institute, Oslo, Norway.; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.

DOI: 10.1016/S2468-2667(25)00164-1