Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study

Abstract

IMPORTANCESteps per day is a meaningful metric for physical activity promotion in clinical and population settings. To guide promotion strategies of step goals, it is important to understand the association of steps with clinical end points, including mortality. OBJECTIVETo estimate the association of steps per day with premature (age 41-65 years) all-cause mortality among Black and White men and women. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was part of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants were aged 38 to 50 years and wore an accelerometer from 2005 to 2006. Participants were followed for a mean (SD) of 10.8 (0.9) years. Data were analyzed in 2020 and 2021. EXPOSURE Daily steps volume, classified as low (<7000 steps/d), moderate (7000-9999 steps/d), and high (Ն10 000 steps/d) and stepping intensity, classified as peak 30-minute stepping rate and time spent at 100 steps/min or more. MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS A total of 2110 participants from the CARDIA study were included, with a mean (SD) age of 45.2 (3.6) years, 1205 (57.1%) women, 888 (42.1%) Black participants, and a median (interquartile range [IQR]) of 9146 (7307-11 162) steps/d. During 22 845 person years of follow-up, 72 participants (3.4%) died. Using multivariable adjusted Cox proportional hazards models, compared with participants in the low step group, there was significantly lower risk of mortality in the moderate (hazard ratio [HR], 0.28 [95% CI, 0.15-0.54]; risk difference [RD], 53 [95% CI, 27-78] events per 1000 people) and high (HR, 0.45 [95% CI, 0.25-0.81]; RD, 41 [95% CI, 15-68] events per 1000 people) step groups. Compared with the low step group, moderate/high step rate was associated with reduced risk of mortality in Black participants (HR, 0.30 [95% CI, 0.14-0.63]) and in White participants (HR, 0.37 [95% CI, 0.17-0.81]). Similarly, compared with the low step group, moderate/ high step rate was associated with reduce risk of mortality in women (HR, 0.28 [95% CI, 0.12-0.63]) and men (HR, 0.42 [95% CI, 0.20-0.88]). There was no significant association between peak 30-minute intensity (lowest vs highest tertile: HR, 0.98 [95% CI, 0.54-1.77]) or time at 100 steps/min or more (lowest vs highest tertile: HR, 1.38 [95% CI, 0.73-2.61]) with risk of mortality.CONCLUSIONS AND RELEVANCE This cohort study found that among Black and White men and women in middle adulthood, participants who took approximately 7000 steps/d or more experienced lower mortality rates compared with participants taking fewer than 7000 steps/d.There was no association of step intensity with mortality.

Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

“…6 Several observational studies have shown stepping rate, a marker of intensity, is inversely associated with mortality; however, when adjusted for volume of steps per day, step rate was no longer associated with mortality. 5,6,8 A metaanalysis observed a linear asso ciation between step volume and mortality from seven studies, observing large heterogeneity among studies and did not report associations by age, sex, or stepping rate. 9 Here, we aimed to complete a metaanalysis on steps per day and mortality, addressing the limitations of previous studies.…”

Walking Engagement in Mexican Americans Who Participated in a Community-Wide Step Challenge in El Paso, TX

“…Step counts were also used as time point outcomes in the regression analysis. Baseline step counts were also categorized at (1) less than 7000, (2) 7000 to 9999, and (3) 10,000 or greater and used in descriptive and regression analysis to assess change by thresholds for health benefit [ 44 , 52 ].…”

Association between Active Transportation and Public Transport with an Objectively Measured Meeting of Moderate-to-Vigorous Physical Activity and Daily Steps Guidelines in Adults by Sex from Eight Latin American Countries

“…Daily step counts measured over 7 days using the ActiGraph GT3X+ was previously shown to correlate (r = 0.86 for men; r = 0.89 for women) well to physical activity energy expenditure as measured by doubly labeled water [ 30 ]. We defined those who walked ≥ 7000 steps as meeting the recommendations regarding walking for health, given the impact that it has on all-cause mortality in middle-aged adults [ 4 ].…”

“…For descriptive and categorical analyses, the variables were analysed separately and stratified into the following two categories: (1) active transportation: self-reported time who spent < 10 min or ≥10 min of walking and/or cycling for transportation; (2) active transportation plus public transport: who spent < 10 min of active transportation without use of active transport or ≥10 min of active transportation plus use of public transport; (3) meeting MVPA guidelines: < 150 min/week or ≥150 min/week [ 2 ]; (4) meeting steps per day: <7000 or ≥7000 [ 4 ].…”

“…In addition to the moderate-to-vigorous physical activity (MVPA) recommendations, an important factor to consider is the number of steps per day. In fact, walking a total of 7000 steps per day is associated with a lower risk of all-cause mortality [ 4 ]. Another variable which impacted the development of physical activity levels is private transport, which contributed to physical inactivity and the reduction in the number of steps per day taken by the population.…”