Walk for a healthy heart


Dr. Madhur Verma, Assistant Professor, Dept. of Community & Family Medicine, AIIMS, Bathinda, Punjab; Dr Sanjay Kalra, DM (AIIMS); President-elect, SAFES, Bharti Hospital, Karnal, India    05 January 2023

Walking 10k steps daily may seem an intimidating goal for many. Don’t be disheartened, if you are not able to achieve this. A recent study published in the journal Circulation says that the beneficial effects of walking on heart health progressively increased even with small increases in the number of steps per day in older adults. Daily step count ranging between 6000 and 9000 lowered the risk of cardiac events by up to 50% among older adults compared to those who walked just 2000 steps in a day.1


A meta-analysis of 8 studies involving 20,152 adults was conducted to examine the association of daily step counts and cardiovascular events - fatal and nonfatal coronary heart disease, stroke, heart failure - by age group (younger and older adults) and the amount of physical activity. The mean age of participants was 63.2 years; 52% were women. Based on the physical activity, the participants were categorised into four quartiles, quartile 1 being the least and quartile 4 being the group with the maximum activity. The hazard ratios (HR) were generated using restricted cubic spline models.


The older adults walked less with a median number of 4323 steps per day, whereas the younger adults walked more with 6911 steps per day. During a mean follow-up period of 6.2 years, 1523 cardiovascular events (12.4 per 1000 person-years) occurred. The association of daily steps and the first cardiovascular event, which was the primary outcome of the study, differed considerably between the older (≥60 years of age) and younger adults (<60 years of age).


The risk of a cardiac event was the least among older adults in quartile 4 (median steps 9259) with hazard ratio (HR) of 0.51. For those in quartile 3 (median steps 5520, the HR was 0.62; for quartile 2 (median steps 3823), the HR was 0.80 compared with those in quartile 1 with the lowest step count (median steps 1811). In the spline model, a significant curvilinear association was noted for older adults demonstrating the link between more steps and decreased risk of CVD in this age group. Among the younger participants, the HR for risk of CVD  among quartile 2 was 0.79, 0.90 for quartile 3 and 0.95 for quartile 4 compared with the lowest quartile. These results were nonsignificant vs the lowest quartile. In the spline model, no significant association was noted between steps per day and CVD events for them.


No association was noted between the pace of steps and cardiovascular risk.


The key takeaway from this meta-analysis is the inverse relationship between the number of daily steps and risk of cardiovascular disease among older adults. The risk progressively declined as the daily step count increased. Walking 6000 to 9000 steps per day reduced CVD risk by as much as 50% compared to those who walked 2000 steps per day. However, no such association was observed for younger adults. This can be attributed to the shorter follow-up duration, which was insufficient to measure the incidence of heart disease in the younger adults. This, note the authors, is a limitation of their study.


These findings have significant clinical implications for older adults in particular. One, that it is important to be physically active and two, that gradually increasing the number of steps in a day reduces their risk of acute cardiac events. Physical activity also helps preserve their cognitive skills.


There is no age bar for exercise. Walking is the simplest and most inexpensive form of exercise. Physicians should set attainable goals for all their patients, not just the older adults, who walk less than 10,000 steps in a day and encourage them to be more active for optimum cardiovascular health.




  1. Paluch AE, et al; Steps for Health Collaborative. Prospective association of daily steps with cardiovascular disease: a harmonized meta-analysis. Circulation. 2022 Dec 20. doi: 10.1161/CIRCULATIONAHA.122.061288.

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