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Association of Daily Step Count and Step Intensity With Mortality Among US Adults
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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“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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“First, prior studies assessed physical activity either by self-reported questionnaires or by having participants wear a research-grade device for a brief monitoring period (most often 7 days)1–4.”
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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“The National Health and Nutrition Examination Survey study, which quantified steps over a 7-day monitoring period and assessed mortality over an average of 10.1 years, found a 51% lower mortality at 8,000 steps per day compared with 4,000 steps per day1.”
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]
In the citing paper
“beneficial effects can be observed with minimum step counts ranging from 4,000 to 12,000 steps per day [[62], [63], [64], [65]]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [64]
In the citing paper
“Epidemiological studies examining the relationship between daily step counts and health outcomes have produced varied evidence, indicating that beneficial effects can be observed with minimum step counts ranging from 4,000 to 12,000 steps per day [[62], [63], [64], [65]].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [64]
In the citing paper
“Even an additional 500 steps a day may decrease cardiovascular and all-cause mortality by 2-9%.”
From The Impact of Physical Activity in Patients With Type 2 Diabetes (2025) · cites this paper as [65]
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Citations
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“Despite this observation, recent literature in the healthy population showed that, to reduce all-cause mortality, the step-mortality association was found to be stronger than the intensitymortality association in US adults [37].”
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“Daily step count is representative of general health, with higher daily step count values being significantly associated with lower all-cause mortality (6).”
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“37 This is encouraging for patients who are unable to exercise at higher intensities but can manage walking at lower intensities.”
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“Statistical significance was defined by P values <0.05 after applying the Benjamini–Hochberg procedure for multiple testing correction.”
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“7 While the benefits of exercise and PA in promoting cardiovascular health and cardiorespiratory fitness are well established, 20 21 exercise additionally alters the immune system and anti-viral responses.”
Hamer, M., Blodgett, J. M., & Stamatakis, E. A. (2022) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14173 · Cited by 11
“15 Consistent with other studies, 3,4 taking measures to control for stepping intensity did not materially alter our results.”
Wearable data link urban green space to physical activity
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Daily Physical Activity: Associations With Memory and Affect
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“It has been established that an increase in walking from 4,000 to 8,000 steps/day reduces the risk for all-cause mortality by 51% for adults; this includes reduced risk of cancer and heart disease [1].”
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Mistiri, M. E., Khan, O., Rivera, D. E., & Hekler, E. B. (2023) · Proceedings of the ... American Control Conference/Proceedings of the American Control Conference · doi:10.23919/acc55779.2023.10156652 · Cited by 9
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“Recommendations for daily step counts are less consistent, but range from 6000 to 10,000 per day (Del Pozo Cruz et al., 2022; Hamer et al., 2022; Paluch et al., 2022; Saint-Maurice et al., 2020).”
Treatment adherence and the contemporary approach to treating type 2 diabetes mellitus
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Chao, T., Chiang, S., Lai, C., Huang, C.-Y., Lee, M., Lin, C., Chang, C.-C., & Lin, C. (2024) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2024.04.010 · Cited by 8
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Kato, H. (2025) · Journal of Transport & Health · doi:10.1016/j.jth.2025.102126 · Cited by 10
Yakdan, S. M., Benedict, B. C., Singh, P., Frumkin, M. R., Goodin, B. R., Neuman, B. J., Cheng, A. L., Wang, J., Kelly, M. P., Ray, W. Z., et al. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.105516 · Cited by 12
Koemel, N. A., Ahmadi, M. N., Biswas, R. K., Thøgersen‐Ntoumani, C., Teixeira-Pinto, A. M., Chow, C. K., Harezlak, J., & Stamatakis, E. (2026) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-026-01876-2 · Cited by 16
“Previous physical activity research using the US representative NHANES data has primarily focused on context-agnostic total physical activity in the form of total daily steps [35, 36] or MVPA [13, 37–41] and limited exploration of bouts lasting 10 min in duration [13, 42].”
Huang, Y., Lin, Y., Zhai, X., & Cheng, L. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.834150 · Cited by 8
Outcomes After Primary Hip Arthroscopy in Athletes Older Than 40 Years Compared With Nonathletes
Saks, B. R., Monahan, P. F., Hawkins, G. C., Maldonado, D. R., Jimenez, A. E., Sabetian, P. W., Lall, A. C., & Domb, B. G. (2022) · The American Journal of Sports Medicine · doi:10.1177/03635465221096843 · Cited by 8
“Staying active certainly has meaningful health benefits, as indicated by a study of 5000 participants older than 40 years, where decreased all-cause mortality was associated with higher daily step counts.(51) Physical activity 4 or 5 days a week is proven to prevent age-related left ventricular stiffening while also l…”
BackgroundHyde, E. T., Nguyen, S., Tuz‐Zahra, F., Moore, C. C., Greenwood-Hickman, M. A., Walker, R. L., Natarajan, L., Rosenberg, D. E., & Bellettiere, J. (2022) · Journal for the Measurement of Physical Behaviour · doi:10.1123/jmpb.2022-0001 · Cited by 8
Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders
Maldaner, N., Tang, M., Fatemi, P., Leung, C., Desai, A. M., Tomkins‐Lane, C., & Zygourakis, C. C. (2023) · Neurosurgery · doi:10.1227/neu.0000000000002755 · Cited by 8
“4,9,10 These confounders need to be considered when physical activity is used as a diagnostic tool and/ or to assess outcomes.”
BackgroundA Smartphone-Based Shopping Mall Walking Program and Daily Walking Steps
Matsuoka, Y., Yoshida, H., & Hanazato, M. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.53957 · Cited by 6
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“The NHANES dataset can be easily obtained by the public, as participant information is collected and anonymized beforehand, eliminating the requirement for approval from local ethics committees 19 .”
MethodMiller, A. E., Russell, E., Reisman, D. S., Kim, H. E., & Dinh, V. (2022) · PLoS ONE · doi:10.1371/journal.pone.0270105 · Cited by 8
Diseases Prediction from Officially Anonymized Medical and Healthcare Big Data
Kikuchi, H., Ito, S., Ikegami, K., & Shindo, S. (2022) · IEEE International Conference on Big Data (BigData) · doi:10.1109/bigdata55660.2022.10075547 · Cited by 7
“Note first that [12] used a group who walked fewer than 4,000 steps per day as the control group, which differs from our control group (those who walked between 6,000 and 8,000 steps per day).”
BackgroundResultInfluentialKańtoch, E., & Kańtoch, A. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10091997 · Cited by 8
“Furthermore, a higher gait speed could also be associated with a reduced risk of death [34].”
BackgroundGroße, J., Huppertz, C., Röh, A., Oertel, V., Andresen, S., Schade, N., Goerke-Arndt, F., Kastinger, A., Schoofs, N., Thomann, P. A., et al. (2023) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-023-01646-2 · Cited by 9
“Daily step counts lower than 4000 are associated with higher mortality [40].””
Infeld, M. M. (2024) · Heart Rhythm O2 · doi:10.1016/j.hroo.2024.03.009 · Cited by 7
“51,52 Patients with preclinical HFpEF also responded to accelerated pacing in the my PACE and Heart Rate-80 studies, 18,46 suggesting that a greater number of patients in the early stages of HFpEF may bene fi t from higher heart rates when the disease progression is still modi fi able.”
BackgroundBachman, S. L., Gomes, E. L., Aryal, S., Cella, D. F., Clay, I., Lyden, K. A., & Leach, H. J. (2024) · JMIR Cancer · doi:10.2196/53180 · Cited by 8
“…2 measures of cadence: weighted median cadence in stepping bouts of ≥ 1 minute across all valid days, as well as the number of steps in any 30-second recording period (“peak 30 s cadence”) across all valid days, a measure that is thought to reflect an individual’s best natural effort [58-60].”
BackgroundBianchini, E., Rinaldi, D., Carolis, L. D., Galli, S., Alborghetti, M., Hansen, C., Suppa, A., Salvetti, M., Pontieri, F. E., & Vuillerme, N. (2025) · JMIR Formative Research · doi:10.2196/63153 · Cited by 6
“Although this parameter could not provide details regarding subtle gait features, several evidence linked a reduced daily step count to overall mortality risk [6-9], as well as to a range of health conditions, such as dementia [10] and oncological and cardiovascular diseases [11,12].”
Daily Steps as a Public Health Metric for Physical Activity Monitoring and Promotion
Paluch, A. E., Matthews, C. E., Doherty, A., Ekelund, U., Evenson, K. R., Galuska, D. A., Jefferis, B. J. M. H., Kong, L., Kraus, W. E., Lee, I.-M. M., et al. (2025) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000375 · Cited by 7
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“Possible mechanisms underlying the BP-lowering short-term effects of PA involve a reduction in sympathetic activity, lower insulin resistance due to the release of vasodilatory substances, and a decrease in plasma renin levels [30].”
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“Importantly, even smaller than recommended amounts of PA confer health benefits compared to inactivity [17].”
BackgroundWalking past barriers to physical activity
Abe, T., Mitsukawa, N., & Loenneke, J. P. (2020) · Journal of Trainology · doi:10.17338/trainology.9.1_9 · Cited by 7
Effort-Based Decision-Making for Exercise in People with Parkinson’s Disease
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Physical activity and exercise in the context of SARS-Cov-2: A perspective from geroscience field
Barreto, P. D. S., Vellas, B. J., & Rolland, Y. (2021) · Ageing Research Reviews · doi:10.1016/j.arr.2021.101258 · Cited by 8
Associations Between Muscular Strength and Gastroesophageal Reflux Disease in Older Adults
Song, B. K., Brellenthin, A. G., Saavedra, J. M., & Lee, D.-C. (2021) · Journal of Physical Activity and Health · doi:10.1123/jpah.2021-0013 · Cited by 7
Primary Prevention of CVD with Aspirin: Benefits vs Risks
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StepUp Forecast: Predicting Future to Promote Walking
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“People who take 8,000 steps per day are associated with signifcantly lower all-cause mortality than those who take 4,000 steps per day [27], so promoting walking is now very important.”
BackgroundObjectively-measured out-of-home behavior and physical activity in rural older adults
Uemura, K., Iwamoto, T., Hiromatsu, M., Watanabe, A., & Okamoto, H. (2022) · Geriatric Nursing · doi:10.1016/j.gerinurse.2022.06.010 · Cited by 7
Associations between cardiorespiratory fitness and diverticulitis in older adults
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“For example, the average detected daily step count of 2633 was lower than expected, compared to a study of Saint-Maurice et al. (2020), where the average daily step count was 9124.”
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“For example, Saint-Maurice et al [35] analyzed data collected from 4840 adults (mean age 56.8 years; n=2435, 54% women) and found that taking 8000 steps per day was associated with significantly lower all-cause mortality compared with taking 4000 steps per day.”
InfluentialShin, S., Kowahl, N., Hansen, T., Ling, A. Y., Barman, P., Cauwenberghs, N., Rainaldi, E., Short, S., Dunn, J., Shandhi, M. M. H., et al. (2024) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2024.02.028 · Cited by 6
A Hunter-Gatherer Exercise Prescription to Optimize Health and Well-Being in the Modern World
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Number of steps and systolic blood pressure: Do work and leisure matter?
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Qin, X., Song, Y., Zhang, G., Guo, F., & Zhu, W. (2021) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2021.103136 · Cited by 7
Cardiovascular risk assessment: baseline snapshots or accumulated burden?
Schonmann, Y. (2020) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaa092 · Cited by 7
L. P. de Oliveira, V., de Freitas, M. M., P. de Paula, T., Gubert, M. L., Miller, M. E. P., Schuchmann, R. A., Souza, K. L. A., & Viana, L. V. (2024) · Nutrition and Health · doi:10.1177/02601060221124201 · Cited by 8
“A recent observational study with > 40-year-old American participants without comorbidities concluded that reduced all-cause mortality is related to a higher number of steps and not to intensity (Saint-Maurice et al., 2020).”
BackgroundTakino, K., Hara, Y., Sakui, D., Kawamura, I., Kikuchi, J., Komoda, T., & Koeda, T. (2024) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2024.2319780 · Cited by 6
“In addition, individuals who took 2,000 steps per day demonstrated a higher rate of all-cause mortality than those who took 4,000 steps per day (Saint-Maurice et al., 2020).”
Metadata
- 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
- 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
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Physiology (medical) › 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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