Optimal Number of Steps per Day to Prevent All-Cause Mortality in People With Prediabetes and Diabetes

Abstract

OBJECTIVE We aimed to examine the dose-response associations between the number of steps per day and all-cause mortality among adults with prediabetes and diabetes. RESEARCH DESIGN AND METHODS This prospective study used data from 1,194 U.S. adults with prediabetes and 493 with diabetes for whom accelerometer-derived steps per day could be retrieved. Mortality was ascertained through the National Death Index (February 25, 2019). Splines were used to assess the dose-response associations between steps per day and all-cause mortality. RESULTS Over ∼9 years of follow-up, 200 adults with prediabetes and 138 with diabetes died. Nonlinear associations akin to an L shape were observed. We estimated an optimal dose of ∼10,000 steps per day to reduce the risk of all-cause mortality for both individuals with prediabetes and those with diabetes. CONCLUSIONS Accumulating more steps per day up to ∼10,000 steps per day may lower the risk of all-cause mortality of adults with prediabetes and diabetes.

Leisure-time physical activity and all-cause mortality and cardiovascular disease in adults with type 2 diabetes: Cross-country comparison of cohort studies

“…Large observational studies with device-measured total PA will provide more robust quantifications of the dose–response relationship and the minimal amount of PA needed to prevent major health outcomes in adults with type 2 diabetes. 40 (c) There was no association between leisure-time PA and mortality in the subsample of UK Biobank participants with repeated dietary recalls ( n = 5857), which may indicate residual confounding from diet quality or quantity. However, this subsample may also represent a highly selected and motivated group, which can lead to bias in observational studies of aetiology.…”

Diabetes update: What's new, what's interesting

“…In a study of 1194 US adults with prediabetes and 493 with diabetes wearing an accelerometer for at least 1 day (mean 5.5) during the 2005–2006 National Health and Nutrition Examination Survey (NHANES), 200 and 138 had died over approximately 9 years of follow‐up, respectively. The mean number of steps per day was 8950 and 7151 and the 10th percentile of steps per day was 3779 and 2532 for the prediabetes and diabetes groups, respectively; the 10th percentile was associated with 4‐fold greater mortality risk than that of individuals walking >10 000 steps per day 1 . The dilemma of interpretation of this observation is the question of whether a confounding bias exists, so that walking fewer steps per day applies to those individuals with other characteristics leading to greater mortality 2 .…”

“…The mean number of steps per day was 8950 and 7151 and the 10th percentile of steps per day was 3779 and 2532 for the prediabetes and diabetes groups, respectively; the 10th percentile was associated with 4‐fold greater mortality risk than that of individuals walking >10 000 steps per day. 1 The dilemma of interpretation of this observation is the question of whether a confounding bias exists, so that walking fewer steps per day applies to those individuals with other characteristics leading to greater mortality. 2 The long follow‐up lessens but does not eliminate this concern, and it would be of interest to use techniques such as probabilistic bias analysis, 3 or simply comparing characteristics of persons in the 10th percentile of steps per day with those in the overall group, to further address this issue.…”

“…The mean number of steps per day was 8950 and 7151 and the 10th percentile of steps per day was 3779 and 2532 for the prediabetes and diabetes groups, respectively; the 10th percentile was associated with 4-fold greater mortality risk than that of individuals walking >10 000 steps per day. 1 The dilemma of interpretation of this observation is the question of whether a confounding bias exists, so that walking fewer steps per day applies to those individuals with other characteristics leading to greater mortality. 2 The long follow-up lessens but does not eliminate this concern, and it would be of interest to use techniques such as probabilistic bias analysis, 3 or simply comparing characteristics of persons in the 10th percentile of steps per day with those in the overall group, to further address this issue.Another study using the NHANES data set compared measured and predicted HbA1c (based on fasting and 2-h post oral glucose) in 10 361 adults and 2201 youth to determine clinically significant mismatches; 15% of individuals age ≥65 and 7% of those aged 18-64 had measured HbA1c at least 0.5% over the predicted level, with this particularly an issue for non-Hispanic Black persons, for whom 20% of those aged ≥18 had such a discrepancy, 4 confirming earlier studies 5 and reminding us that HbA1c is only an indirect measure of glycemia.A study using NHANES data obtained from 55 081 US adults from 1999 to 2018 showed an increase in the proportion aged ≥65 from 15.85% to 20.4%, along with increases in obesity and diabetes; the prevalence of metabolic syndrome increased significantly from 36.2% to 47.3% (Figure 1).…”

Walking 200 min per day keeps the bariatric surgeon away

“…In terms of weight loss, standard exercise regimens often lead to mild benefits, and a yo-yo effect whereby the weight is quickly regained once the intervention is stopped [ 10 ]. Nonetheless, diabetic and prediabetic patients benefit from mild physical activity, with a measurable decrease in cardiovascular mortality for every 2,000 steps of additional walking per day, prompting the American Diabetes Association to recommend an optimum of 10,000 steps per day in their guidelines [ 1 , 11 ]. Hence, there is a need to find a regimen of mild physical activity that can cause weight loss, and to understand the metabolic consequences of walking.…”