Association of Step Volume and Intensity With All-Cause Mortality in Older Women

Abstract

IMPORTANCE A goal of 10 000 steps/d is commonly believed by the public to be necessary for health, but this number has limited scientific basis. Additionally, it is unknown whether greater stepping intensity is associated with health benefits, independent of steps taken per day. OBJECTIVE To examine associations of number of steps per day and stepping intensity with all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 18 289 US women from the Women's Health Study who agreed to participate by wearing an accelerometer during waking hours for 7 days between 2011 and 2015. A total of 17 708 women wore and returned their devices; data were downloaded successfully from 17 466 devices. Of these women, 16 741 were compliant wearers (Ն10 h/d of wear on Ն4 days) and included in the analyses, which took place between 2018 and 2019. EXPOSURES Steps per day and several measures of stepping intensity (ie, peak 1-minute cadence; peak 30-minute cadence; maximum 5-minute cadence; time spent at a stepping rate of Ն40 steps/min, reflecting purposeful steps). MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS Of the 16 741 women who met inclusion criteria, the mean (SD) age was 72.0 (5.7) years. Mean step count was 5499 per day, with 51.4%, 45.5%, and 3.1% of time spent at 0, 1 to 39 (incidental steps), and 40 steps/min or greater (purposeful steps), respectively. During a mean follow-up of 4.3 years, 504 women died. Median steps per day across low-to-high quartiles of distribution were 2718, 4363, 5905, and 8442, respectively. The corresponding quartile hazard ratios (HRs) associated with mortality and adjusted for potential confounders were 1.00 (reference), 0.59 (95% CI, 0.47-0.75), 0.54 (95% CI, 0.41-0.72), and 0.42 (95% CI, 0.30-0.60), respectively (P < .01). In spline analysis, HRs were observed to decline progressively with higher mean steps per day until approximately 7500 steps/d, after which they leveled. For measures of stepping intensity, higher intensities were associated with significantly lower mortality rates; however, after adjusting for steps per day, all associations were attenuated, and most were no longer significant (highest vs lowest quartile for peak 1-minute cadence, HR = 0.87 [95% CI, 0.68-1.11]; peak 30-minute cadence, HR = 0.86 [95% CI, 0.65-1.13]; maximum 5-minute cadence, HR = 0.80 [95% CI, 0.62-1.05]; and time spent at a stepping rate of Ն40 steps/min, HR = 1.27 [95% CI, 0.96-1.68]; P > .05). CONCLUSIONS AND RELEVANCE Among older women, as few as approximately 4400 steps/d was significantly related to lower mortality rates compared with approximately 2700 steps/d. With more steps per day, mortality rates progressively decreased before leveling at approximately 7500 steps/d. Stepping intensity was not clearly related to lower mortality rates after accounting for total steps per day.

Exercising in times of COVID-19: what do experts recommend doing within four walls?

“…However, there are still doubts on the most suitable characteristics of the exercise to be taken, such as type, frequency, duration, volume, and intensity.For a long time, 10 000 steps/d have been established as the minimum amount necessary for a person to be considered "physically active", with a slightly lower number for elderly and chronically ill patients (7000-10 000) and higher digits for children and adolescents (> 11 000-13 000, approximately) 8. Recently, this threshold has been questioned and a lower mortality rate has been found in older women who walked 4400 steps/d, obtaining the maximum benefits at 7500 steps/d 9. Moreover, the role of intensity seems to be decisive in achieving these recommendations, and the number of steps can be reduced if cadence is increased at certain times of the day (≥ 100 steps/min) or if the activity is vigorous.…”

Ejercitarse en tiempos de la COVID-19: ¿qué recomiendan hacer los expertos entre cuatro paredes?

“…Durante mucho tiempo, se ha considerado que 10.000 pasos al día son la cantidad mínima necesaria para considerar a una persona «físicamente activa», con una cifra ligeramente inferior para las personas mayores y los enfermos crónicos (7.000-10.000) y cifras más altas para los niños y adolescentes (> 11.000-13.000, aproximadamente) 8 . Hace poco se ha cuestionado este umbral y se ha observado una mortalidad inferior en mujeres mayores que realizaban 4.400 pasos al día, y los beneficios máximos se han obtenido con 7.500 pasos diarios 9 . Además, el papel que desempeña la intensidad es, al parecer, decisivo para conseguir estas recomendaciones y el número de pasos puede reducirse si la cadencia aumenta en determinados momentos del día (≥ 100 pasos/min) o si la actividad es enérgica.…”

Impact of Hemodialysis and Post-Dialysis Period on Granular Activity Levels

“…[45] General and elderly populations have been shown to exhibit an inverse relationship between steps taken and outcomes. [46][47][48][49][50] Achievement of increases of 1000 more steps per day associates with about a 5% lower cardiovascular event rate and a 15% lower all-cause mortality rate. [46,47] A 7-year observational study in HD patients found taking ≥5000 steps a day associates with an 18.5 percentage point improvement in the cumulative survival rate compared to having <5000 steps daily.…”

“…[46][47][48][49][50] Achievement of increases of 1000 more steps per day associates with about a 5% lower cardiovascular event rate and a 15% lower all-cause mortality rate. [46,47] A 7-year observational study in HD patients found taking ≥5000 steps a day associates with an 18.5 percentage point improvement in the cumulative survival rate compared to having <5000 steps daily. [24] In addition, this study found patients who had a 30% decrease in daily steps had a 3-fold higher adjusted risk of death compared to patients with a 30% increase.…”