Association of step counts over time with the risk of chronic disease in the All of Us Research Program

Abstract

The association between physical activity and human disease has not been examined using commercial devices linked to electronic health records. Using the electronic health records data from the All of Us Research Program, we show that step count volumes as captured by participants’ own Fitbit devices were associated with risk of chronic disease across the entire human phenome. Of the 6,042 participants included in the study, 73% were female, 84% were white and 71% had a college degree, and participants had a median age of 56.7 (interquartile range 41.5–67.6) years and body mass index of 28.1 (24.3–32.9) kg m–2. Participants walked a median of 7,731.3 (5,866.8–9,826.8) steps per day over the median activity monitoring period of 4.0 (2.2–5.6) years with a total of 5.9 million person-days of monitoring. The relationship between steps per day and incident disease was inverse and linear for obesity (n = 368), sleep apnea (n = 348), gastroesophageal reflux disease (n = 432) and major depressive disorder (n = 467), with values above 8,200 daily steps associated with protection from incident disease. The relationships with incident diabetes (n = 156) and hypertension (n = 482) were nonlinear with no further risk reduction above 8,000–9,000 steps. Although validation in a more diverse sample is needed, these findings provide a real-world evidence-base for clinical guidance regarding activity levels that are necessary to reduce disease risk.

Daily Step Counts Before and After the COVID-19 Pandemic Among All of Us Research Participants

“…Any meaningful difference is likely dependent on baseline activity, age, and other patient-level factors. Our prior work in the AOU cohort suggests that modestly lower step counts over a long period could have a substantial contribution to long-term disease risk …”

Wearable Devices in Cardiovascular Medicine

“…Since patients can observe these clinical measurements in real time, it also fosters shared decision-making and improves patients’ engagement in their care. A recent study 55 leveraged the longitudinal Fitbit and EHR data from the “All of Us” research program to examine the association between daily steps and incident disease that can occur across the entire human phenome. This study illustrates the potential clinical value of linking wearables data to the EHR since it may provide valuable and actionable information to health care professionals and help advance personalized care.…”

Reducing chronic disease may just be a walk in the park

“…The researchers included 6,042 subjects from the AoURP database, with each participant having a median of 4 years of Fitbit data. 1 Looking at nearly two thousand diagnostic codes, the authors found which diagnostic codes had the largest significant association with daily step count. These diagnoses include sleep apnea, obesity, type two diabetes, hypertension, gastroesophageal reflux disease (GERD), and major depressive disorder.…”

“…demonstrate the power of this technology to estimate the risk of disease based on daily step counts. 1 …”