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Optimal Daily Step Counts to Reduce CV Risk
Quick Takes
- A minimum of 2,517 steps/day was associated with 8% reduction in all-cause mortality and 2,735 steps/day for 11% reduction in CVD risk.
- The optimal volume of 8,763 steps/day resulted in 60% risk reduction in all-cause mortality and 7,126 steps/day for 51% risk reduction of incident CVD.
- The volume (steps/day) and intensity (cadence, steps/min) were independently associated with all-cause and CVD risk reductions; however, volumes >10,000 steps/day had a plateau effect with no significant additional risk benefit.
Study Questions:
What are the optimal daily step counts needed to significantly reduce cardiovascular (CV) risk?
Methods:
This systematic review and meta-analysis of 12 studies (N = 111,309) analyzed the relationship of the volume of daily step counts to all-cause mortality and incident CVD in the general population (60.8% women, 62.5 ± 5.3 years old, body mass index 27.0 ± 1.3 kg/m2). Additionally, the association of 1) sex, 2) intensity (cadence or steps/min), and 3) location of measuring device worn were examined.
Results:
There were no significant differences between men and women. Compared to the low step count group reaching 2,022 (1,468-2,885) steps/day, the study found that a minimum of 2,517 steps/day (adjusted hazard ratio [aHR], 0.92; 95% confidence interval [CI], 0.84-0.999) was associated with an 8% reduction in all-cause mortality and 2,735 steps/day (aHR, 0.89; 95% CI, 0.79-0.999) for an 11% reduction in CVD risk. The optimal volume of 8,763 steps/day (aHR, 0.40; 95% CI, 0.38-0.43) resulted in a 60% risk reduction in all-cause mortality and 7,126 steps/day (aHR, 0.49; 95% CI, 0.45-0.55) for a 51% risk reduction of incident CVD. In addition, the intermediate and high step count groups were associated with a lower risk of CVD (aHR, 0.58; 95% CI, 0.46-0.73 and aHR, 0.42; 95% CI, 0.33-0.53, respectively) compared to the low step count category steps/day.
When step intensity was increased from low (25-59 average steps/min) to intermediate (average 63-76 steps/min), and from low to high (88-97 average steps/min), all-cause mortality improved (33% and 38% risk reduction, respectively), even after adjustment for daily step count (22% and 21% risk reduction, respectively). Although step volumes performed at a higher step cadence provided improved risk compared to volumes at low cadence, the risk reduction plateaued at volumes beyond 10,000 steps/day.
Risk reduction was found to be higher when hip-worn accelerometers were used compared to pedometers or wrist-worn accelerometers likely due to their proximity of locomotion being measured; however, the minimal and optimal steps/day for benefit were not significant for the device type or location.
Conclusions:
A minimum of 2,517 steps/day was associated with significant reduction in all-cause mortality and 8,763 steps/day for optimal benefit (8% and 60%, respectively). For CVD risk reduction, 2,735 steps/day was observed for significant reduction and 7,126 steps/day for optimal benefit (11%, 51%, respectively).
Perspective:
Clinicians can use findings of this study to prescribe optimal physical activity for patients using step count devices. The volume of steps/day and intensity of cadence were independently associated with risk reductions, although higher step counts beyond 10,000 were not associated with significant additional health benefits. While the World Health Organization and other national physical activity guidelines outline different parameters (e.g.,150 minutes of moderate activity/week), and various patient populations may have confounding needs based on age, sex, socioeconomic, and diagnoses, the findings from this study can encourage patients to reach tangible targets by using readily available self-care tools to achieve optimal health benefits.
Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Exercise
Keywords: Exercise, Patient Care Team, Risk Reduction Behavior, Secondary Prevention, Walking
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