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Cited by 660Physical Activity and HealthObesity, Physical Activity, DietCardiovascular and exercise physiology

Association of daily step count and step intensity with mortality among US adults

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Saint-Maurice, Pedro F., Troiano, Richard P., Bassett, David R., Graubard, Barry I., Carlson, Susan A., Shiroma, Eric J., Fulton, Janet E., Matthews, Charles E.·2020·JAMA
DOI 10.1001/jama.2020.1382PMC PMC7093766
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Abstract

Importance: It is unclear whether the number of steps per day and the intensity of stepping are associated with lower mortality. Objective: Describe the dose-response relationship between step count and intensity and mortality. Design, Setting, and Participants: Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). Mortality was ascertained through December 2015. Exposures: Accelerometer-measured number of steps per day and 3 step intensity measures (extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence [steps/min]). Accelerometer data were based on measurements obtained during a 7-day period at baseline. Main Outcomes and Measures: The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios (HRs), mortality rates, and 95% CIs were estimated using cubic splines and quartile classifications adjusting for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema. Results: A total of 4840 participants (mean age, 56.8 years; 2435 [54%] women; 1732 [36%] individuals with obesity) wore accelerometers for a mean of 5.7 days for a mean of 14.4 hours per day. The mean number of steps per day was 9124. There were 1165 deaths over a mean 10.1 years of follow-up, including 406 CVD and 283 cancer deaths. The unadjusted incidence density for all-cause mortality was 76.7 per 1000 person-years (419 deaths) for the 655 individuals who took less than 4000 steps per day; 21.4 per 1000 person-years (488 deaths) for the 1727 individuals who took 4000 to 7999 steps per day; 6.9 per 1000 person-years (176 deaths) for the 1539 individuals who took 8000 to 11 999 steps per day; and 4.8 per 1000 person-years (82 deaths) for the 919 individuals who took at least 12 000 steps per day. Compared with taking 4000 steps per day, taking 8000 steps per day was associated with significantly lower all-cause mortality (HR, 0.49 [95% CI, 0.44-0.55]), as was taking 12 000 steps per day (HR, 0.35 [95% CI, 0.28-0.45]). Unadjusted incidence density for all-cause mortality by peak 30 cadence was 32.9 per 1000 person-years (406 deaths) for the 1080 individuals who took 18.5 to 56.0 steps per minute; 12.6 per 1000 person-years (207 deaths) for the 1153 individuals who took 56.1 to 69.2 steps per minute; 6.8 per 1000 person-years (124 deaths) for the 1074 individuals who took 69.3 to 82.8 steps per minute; and 5.3 per 1000 person-years (108 deaths) for the 1037 individuals who took 82.9 to 149.5 steps per minute. Greater step intensity was not significantly associated with lower mortality after adjustment for total steps per day (eg, highest vs lowest quartile of peak 30 cadence: HR, 0.90 [95% CI, 0.65-1.27]; P value for trend = .34). Conclusions and Relevance: Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.

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  • An increase of only 500 steps/day is associated with 2-9% decreased risk of cardiovascular morbidity and all-cause mortality rates.

    “with an increase of only 500 steps/day associated with 2 -9% decreased risk of cardiovascular morbidity and all-cause mortality rates (105 -107).”

    From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [107]

    The Step Counts and All-cause Mortality and Cardiovascular Disease and Cancer Mortality sections (page numbers unavailable) associate higher daily step counts with lower all-cause and CVD mortality. They compare 8,000 with 4,000 steps/day, however, and do not report a 2–9% reduction per 500 steps/day or assess cardiovascular morbidity. (LLM, conf=0.88)

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  • Prior studies consistently show that taking fewer steps per day is associated with higher risk of all-cause mortality and cardiovascular disease.

    “Prior studies consistently show that taking fewer steps per day1–6 is associated with higher risk of all-cause mortality and cardiovascular disease.”

    From Association of step counts over time with the risk of chronic disease in the All of Us Research Program (2022) · cites this paper as [1]

    The Discussion reports that greater daily step counts were associated with lower all-cause and cardiovascular disease (CVD) mortality in US adults aged 40 or older. The Cardiovascular Disease and Cancer Mortality section likewise reports lower CVD mortality at 8000 versus 4000 steps per day. The paper measures deaths from CVD, not the risk of developing cardiovascular disease, so it does not support that part of the claim as written. (LLM, conf=0.86)

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  • Prior studies have focused on a relatively targeted set of outcomes limited to mortality, diabetes and cardiovascular disease.

    “Second, prior studies have focused on a relatively targeted set of outcomes limited to mortality, diabetes and cardiovascular disease.”

    From Association of step counts over time with the risk of chronic disease in the All of Us Research Program (2022) · cites this paper as [1]

    The Discussion describes prior step-count studies focused on mortality, and the paper examines cardiovascular-disease mortality. But the paper does not identify diabetes as an outcome of those prior studies; its Statistical Analysis lists diabetes as a covariate. It therefore supports the mortality focus, not the full list of outcomes or the claim that prior studies were limited to them. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Physical activity is a key determinant of healthy aging, mitigating physiological decline, reducing the risk of chronic diseases, and preserving functional independence.

    “Physical activity is a key determinant of healthy aging, mitigating physiological decline, reducing the risk of chronic diseases, and preserving functional independence [84,85].”

    From The Power of Environment: A Comprehensive Review of the Exposome's Role in Healthy Aging, Longevity, and Preventive Medicine-Lessons from Blue Zones and Cilento (2025) · cites this paper as [84]

    The Discussion reports that more daily steps were associated with lower all-cause, cardiovascular disease, and cancer mortality among US adults aged 40 or older. It does not establish that physical activity mitigates physiological decline, prevents chronic disease, or preserves functional independence; the Discussion also says the observational study cannot support causal inferences. No page number is available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Prior studies report no information about activity levels between the baseline period and when outcomes are assessed at follow-up, often many years later.

    “Moreover, no information is reported about activity levels between the baseline period and when outcomes are assessed at follow-up, often many years later.”

    From Association of step counts over time with the risk of chronic disease in the All of Us Research Program (2022) · cites this paper as [1]

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2 of the 27 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [21]21. SAS Institute. The MIANALYZE Procedure. In: SAS/STAT 13.1 User's Guide: Volume 62. SAS Institute; 2013:5172-5192.

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Authors
Saint-Maurice, P. F., Troiano, R. P., Bassett, D. R., Graubard, B. I., Carlson, S. A., Shiroma, E. J., Fulton, J. E., & Matthews, C. E.
Affiliations
  • Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
  • National Cancer Institute (US)
  • University of Tennessee at Knoxville (US)
  • Division of Cancer Epidemiology and Genetics (US)
  • Centers for Disease Control and Prevention (US)
  • National Institutes of Health (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2020-03-24
Volume
323
Issue
12
Pages
1151
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2020.1382
PMC
PMC7093766
OpenAlex
W3012745165
Cited by
660
References
27
Citations by year
2026: 58 · 2025: 102 · 2024: 122 · 2023: 104 · 2022: 124 · 2021: 92 · 2020: 57
FWCI
56.70
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
daily step count, physical activity, all-cause mortality, cardiovascular mortality, cancer mortality, dose-response relationship, accelerometer-measured activity, cadence, older adults, obesity, sedentary behavior, physical activity guidelines, mortality risk reduction, NHANES
MeSH terms
Adult, Aged, Cardiovascular Diseases, Female, Gait, Humans, Male, Middle Aged, Neoplasms, Nutrition Surveys, United States, Incidence, Proportional Hazards Models, Walking, Accelerometry

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