Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia

Abstract

Background Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes. Methods A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations. Results Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4–10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6–36%) and CVD (5–21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics. Conclusions Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.

Daily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort study

“…Today, a lay belief is that one needs to take 10,000 steps every day in order to stay healthy, despite that the scientific evidence to support this statement is weak. On the contrary, a compelling body of evidence shows that compared to being inactive, performing any amount of PA is associated with health benefits, as shown in metaanalyses for the outcome of diabetes, cardiovascular mortality and all-cause mortality [27][28][29]. Interestingly, although self-reported walking has previously been associated with lower risk of diabetes [18], a recent metaanalysis was unable to definitely characterize the association between daily step count and dysglycemia, partly due to the limited number of studies on this topic [29].…”

“…On the contrary, a compelling body of evidence shows that compared to being inactive, performing any amount of PA is associated with health benefits, as shown in metaanalyses for the outcome of diabetes, cardiovascular mortality and all-cause mortality [27][28][29]. Interestingly, although self-reported walking has previously been associated with lower risk of diabetes [18], a recent metaanalysis was unable to definitely characterize the association between daily step count and dysglycemia, partly due to the limited number of studies on this topic [29]. This conclusion confirmed what was highlighted in the 2018 report by the US Physical Activity Guidelines Advisory Committee, which urged researchers to investigate the link between step volume and health outcomes [22].…”

Recommendations for determining the validity of consumer wearable and smartphone step count: expert statement and checklist of the INTERLIVE network

“…The 2018 PA Guidelines Advisory Committee Report highlighted that step counting is an accessible means to monitor and set PA goals, and that recent evidence supports an inverse doseresponse relationship between daily step count and all-cause mortality, cardiovascular events and type 2 diabetes. [5][6][7][8][9] Furthermore, 'active' interventions using wearable activity trackers as a measurement tool can result in significant increases in PA participation, highlighting their potential utility in personalised medicine, increasing adherence to PA and to embed sustained healthy lifestyle habits. 4 10 Furthermore, the 'passive' and unobtrusive measurement of step count across the globe opens a new era of opportunities in the field of digital phenotyping.…”

Daily Step Counts from the First Thailand National Steps Challenge in 2020: A Cross-Sectional Study

“…Thailand's national steps challenge policy has been initiated in 2019 by the National Steering Committee on physical activity [16] based on the concept of walking as a central component of physical activity promotion efforts [15,[17][18][19][20][21][22][23]. The Thailand National Steps Challenge Season 1 was the countrywide program, implemented from 1 February to 31 March 2020.…”