Walking as little as 2500 to 3000 steps per day yields significant health benefits in terms of reduced mortality and incident heart disease, according to a new research published in the Journal of American College of Cardiology.¹ Walking faster adds to the beneficial outcomes.^1,2

This study was a meta-analysis of published evidence (up to October 2022) with the objective to investigate the relationship between daily step counts and adverse outcomes. Twelve studies involving 111,309 adults, aged 62.5 years (mean) and comprising 60.8% women were selected for analysis. None of the participants had a history of known heart disease. All-cause mortality and incident heart disease were the primary endpoints of the study. There were 4.4% deaths during a median follow-up period of 77.8 months and 1.4% incident heart disease during 72.9 months of follow-up.

Analysis of data revealed a marked decrease in risk for death due to any cause with a daily step count of 2517 compared to 2000 steps per day with adjusted hazard ratio (aHR) of 0.92. The risk of new onset of heart disease was also reduced in participants who took a daily step count of 2735 compared to 2000 steps per day with aHR of 0.89.

The risk of all-cause mortality was reduced by 36% among participants who took 6000 (median) steps per day (vs median of 3166 steps per day). The highest risk reduction (50%) was observed for those who took 10,000 (median) steps per day compared to the participants who were least active (median of 3166 steps per day). Compared with the least active participants, the risk of CVD was lower by 42% among the participants with 6000 (median) steps per day and by 58% among those with 10,000 (median) steps per day.²

The risk of all-cause mortality and incident heart disease declined further in a nonlinear manner as step count increased to 8763 steps per day for all-cause mortality (aHR: 0.40) and 7126 steps per day for incident heart disease (aHR: 0.49). However, an increase in daily step count further than these had no significant impact on the two study endpoints.

A notable finding of the study was a decline in the risk for all-cause mortality as the step count per minute (cadence) increased from low to intermediate or high. Gender had no impact on the dose-response. The risk of all-cause mortality reduced by further 20% with median step per minute count of 63 and 88 compared to 29 steps per minute. The researchers also examined the impact of devices used to measure step count. They found that risk reduction was significant for hip-worn accelerometers compared with pedometers and wrist-worn accelerometers.

This study has demonstrated a dose-response association of steps per day with clinical outcomes. It has identified the minimum step count and the optimum step count to reduce the adverse health outcomes.

The American Heart Association (AHA) as well as the CDC recommend a daily step count of 10,000 steps per day for a healthy heart and overall health. This study illustrates that this number is not sacrosanct as the benefits were significant even at a step count of ≥2500, which is less than 10,000 steps per day. Failure to achieve the 10,000-step mark may be disheartening for many. For some, for instance, persons with osteoarthritis, reaching this goal may be a daunting task. The take home message from this study is that it is important to be physically active; even some amount of physical activity is better than none. Hence, all patients must be encouraged to be more active for optimum cardiovascular health. Walking, and brisk walking at that, is the simplest, most inexpensive and an effective form of exercise.

“Although step volumes beyond this level were not associated with additional health benefits, there is no reason to discourage individuals from such behavior, as a highly physically active lifestyle may provide other benefits, such as joy, improved quality of life, and better sleep and mental health,” write the authors.²

References

1. Stens NA, et al. Relationship of daily step counts to all-cause mortality and cardiovascular events. J Am Coll Cardiol. 2023 Oct 10;82(15):1483-1494. doi: 10.1016/j.jacc.2023.07.029.
2. TCTMD News. Available at: https://www.tctmd.com/news/mortality-cvd-benefits-seen-relatively-low-daily-step-counts, dated Sept. 8, 2023. Accessed on Oct. 6, 2023.