Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality

Abstract

IMPORTANCERecommendations for the number of steps per day may be easier to enact for some people than the current time-and intensity-based physical activity guidelines, but the evidence to support steps-based goals is limited.OBJECTIVE To describe the associations of step count and intensity with all-cause mortality and cancer and cardiovascular disease (CVD) incidence and mortality. DESIGN, SETTING, AND PARTICIPANTSThis population-based prospective cohort study used data from the UK Biobank for 2013 to 2015 (median follow-up, 7 years) and included adults 40 to 79 years old in England, Scotland, and Wales. Participants were invited by email to partake in an accelerometer study. Registry-based morbidity and mortality were ascertained through October 2021. Data analyses were performed during March 2022.EXPOSURES Baseline wrist accelerometer-measured daily step count and established cadence-based step intensity measures (steps/min): incidental steps, (<40 steps/min), purposeful steps (Ն40 steps/min); and peak-30 cadence (average steps/min for the 30 highest, but not necessarily consecutive, min/d).MAIN OUTCOMES AND MEASURES All-cause mortality and primary and secondary CVD or cancer mortality and incidence diagnosis. For cancer, analyses were restricted to a composite cancer outcome of 13 sites that have a known association with reduced physical activity. Cox restricted cubic spline regression models were used to assess the dose-response associations. The linear mean rate of change (MRC) in the log-relative hazard ratio for each outcome per 2000 daily step increments were also estimated. RESULTSThe study population of 78 500 individuals (mean [SD] age, 61 [8] years; 43 418 [55%] females; 75 874 [97%] White individuals) was followed for a median of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). There were 10 245 incident CVD events and 2813 cancer incident events during the observation period. More daily steps were associated with a lower risk of all-cause (MRC, −0.08; 95% CI, −0.11 to −0.06), CVD (MRC, −0.10; 95% CI, −0.15 to −0.06), and cancer mortality (MRC, 95% CI, −0.11; −0.15 to −0.06) for up to approximately 10 000 steps. Similarly, accruing more daily steps was associated with lower incident disease. Peak-30 cadence was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps. CONCLUSIONS AND RELEVANCEThe findings of this population-based prospective cohort study of 78 500 individuals suggest that up to 10 000 steps per day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.

Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality

“…We excluded participants with missing covariates and insufficient valid wear days. Monitoring days were considered valid if wear time was greater than 16 h. To be included in analysis, participants were required to have at least three valid monitoring days, with at least one of those days being a weekend day 45,46 . We excluded participants who reported that they cannot walk.…”

“…We excluded participants with missing covariates and insufficient valid wear days. Monitoring days were considered valid if wear time was greater than 16 h. To be included in analysis, participants were required to have at least three valid monitoring days, with at least one of those days being a weekend day45,46 . We excluded participants who reported that they cannot walk.To enable examination of VILPA in our study (brief bouts of nonexercise VPA occurring during daily living), we included only participants who reported no leisure time exercise participation and no more than one recreational walk per week.…”

Association of Daily Step Patterns With Mortality in US Adults

“…Physical inactivity is one of the major public health issues worldwide, contributing to an estimated 3.2 million deaths and imposing $54 billion in direct health care costs annually . Several studies have used the number of daily steps as a simple and valid measure of physical activity and have investigated the association of daily steps with health outcomes, including cardiovascular disease and dementia . Recently, a meta-analysis suggested that more daily steps are associated with a steady decline in mortality risk up to approximately 8000 daily steps, at which point mortality risk appeared to plateau .…”

Step-Counting Accuracy of a Commercial Smartwatch in Mild-to-Moderate PD Patients and Effect of Spatiotemporal Gait Parameters, Laterality of Symptoms, Pharmacological State, and Clinical Variables

“…In particular, a daily step count is rather easy to collect, and may represent a useful surrogate measure of physical and ambulatory activity that is associated with relevant clinical outcome parameters [ 3 ]. For example, previous studies associated a reduced number of steps per day with relevant pathological conditions, including cancer and cardiovascular diseases [ 4 ], obesity, major depressive disorder, diabetes and hypertension [ 5 ], and in general mortality [ 6 , 7 ]. As to neurodegenerative disorders, a recent report showed the link between the daily number of steps collected through a wrist-worn accelerometer and the incidence of dementia in a large cohort of patients [ 8 ].…”