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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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A knitted smart sneaker system based on piezoresistive strain sensing for stride counting
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Culverhouse, J., Hillsdon, M. M., Koster, A., Bosma, H., de Galan, B. E., Savelberg, H. H. C. M., & Pulsford, R. M. (2024) · European Review of Aging and Physical Activity · doi:10.1186/s11556-024-00343-w · Cited by 4
“Step-rate has been shown to be associated with a range of health outcomes [63, 64], including the 400-m walk test in older adults; [65] though, conversely, step-rate has not always been shown to be associated with mortality when adjusted for volume [66, 67].”
BackgroundMethodFanaroff, A. C., Orr, J. A., Anucha, C., Kim, E., Rareshide, C. A. L., Echevarria, M., Rodarte, S., Kassabian, M., Balasian, E., Ky, B., et al. (2024) · American Heart Journal · doi:10.1016/j.ahj.2024.10.021 · Cited by 5
Physical Activity, Steps, and Cardiovascular Disease: A Literature Review
Saldana, G., Liu, L. L., & German, C. A. (2025) · Heart and Mind · doi:10.4103/hm.hm-d-24-00094 · Cited by 4
Scheffey, K., Aronson, J., Goncalves, Y., Greysen, R., Iwu, A., Kwong, P. L., Nezir, F., Small, D. S., & Glanz, K. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.107909 · Cited by 4
Russell, L. B., Volpp, K. G. M., Patel, M. S., Chokshi, N. P., Coratti, S., Farraday, D., Norton, L. A., Rareshide, C. A. L., Zhu, J., Klaiman, T. A., et al. (2025) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.124.011839 · Cited by 4
Obesity 2021: Current Clinical Management of a Chronic, Serious Disease
Kushner (2021) · The Journal of Family Practice · doi:10.12788/jfp.0221 · Cited by 6
“Recent evidence shows that compared with a person who takes 2,000 steps per day, a person who regularly takes 10,000 steps per day has one-third the cardiovascular mortality rate and one-half the cancer mortality rate.(36) Resistance training is recommended at least 2 days per week to promote loss of fat mass and redu…”
BackgroundThe effects of a group‐deposit prize draw on the step counts of sedentary and low active adults
McCurdy, A. J., & Normand, M. P. (2022) · Behavioral Interventions · doi:10.1002/bin.1869 · Cited by 4
Mistiri, M. E., Rivera, D. E., Klasnja, P., Park, J.-H., & Hekler, E. B. (2022) · Proceedings of the ... American Control Conference/Proceedings of the American Control Conference · doi:10.23919/acc53348.2022.9867493 · Cited by 4
“On the other hand, maintaining healthy levels of PA can work as a preventive measure against all of these illnesses, or at least delay their onset [1], [2]; an increase from 4,000 to 8,000 steps/day reduces the risk for all-cause mortality by 51% for adults.”
BackgroundSuzuki, T., Rewley, J., Sugibuchi, K., Suzuki, Y., Suzumura, S., Tsurugi, N., Okamura, D., Node, K., & Mizuno, A. (2024) · International Heart Journal · doi:10.1536/ihj.23-415 · Cited by 4
Covid 19 Pandemi Sürecinin Gençlerin Fiziksel Aktivite Sürelerine Olan Etkisinin Araştırılması
Koca, R., & Fazlıoğulları, Z. (2021) · Genel Tıp Dergisi · doi:10.15321/geneltipder.2021.304 · Cited by 4
Screening for Autoantibodies in Type 1 Diabetes: A Call to Action
Петерс (2021) · The Journal of Family Practice · doi:10.12788/jfp.0223 · Cited by 7
Making the Case for “COVID-19 Prophylaxis” With Lifestyle Medicine
Frates, E. P., & Rifai, T. (2020) · American Journal of Health Promotion · doi:10.1177/0890117120930536c · Cited by 4
“The ideal step count will approximately double the typical US average (eg, approximately 8000 steps vs the average of approximately 4000 steps), which has been recently associated with substantially reduced non–COVID-19-associated deaths.(12) Regarding quitting smoking, benefits include decrease in blood pressure with…”
BackgroundThe role of occupational physical activity on longevity – Authors' reply
Dalene, K. E., Tarp, J., & Ekelund, U. (2021) · The Lancet Public Health · doi:10.1016/s2468-2667(21)00155-9 · Cited by 4
Gao, S., Zhou, X., Koffman, L. J., Wanigatunga, A. A., Schrack, J. A., Crainiceanu, C. M., & Muschelli, J. (2025) · The Journals of Gerontology Series A · doi:10.1093/gerona/glaf034 · Cited by 5
Continuous In-Home Gait Analysis Using FMCW Radar in Naturalistic Environments
Abedi, H., Hall, J., Bae, J. B., Morita, P., Wong, A., Boger, J., & Shaker, G. (2025) · IEEE Transactions on Radar Systems · doi:10.1109/trs.2025.3580623 · Cited by 3
“However, in [51], researchers investigated the relationship between daily step counts and the risk of death over a follow-up period.”
Visovatti, M. A., Jung, M. S., Mason, H., DeRubeis, M. B., Worden, F. P., & Barton, D. L. (2023) · PubMed · doi:10.1097/ncc.0000000000001037 · Cited by 3
“Low daily step count (<4000 daily steps) has been associated with significantly higher all-cause mortality among US adults.(42) In individuals with cancer, low step counts have been associated with shorter survival as well as a higher risk for unplanned hospital admissions in patients undergoing treatment.”
BackgroundKompf, J. M., & Rhodes, R. E. (2023) · Measurement in Physical Education and Exercise Science · doi:10.1080/1091367x.2023.2258869 · Cited by 3
“…Fransen et al., 2015), cancer (Renzende, Sa, Markozannes et al., 2018), diabetes (Lao, Deng, Liu et al., 2019), myocardial infarction (Yusuf et al., 2004), depression (Schuch, Vancampfort & Firth et al., 2018), and all-cause mortality (Saint-Maurice et al., 2020; Wen, Wai, Tsai et al., 2011).”
BackgroundLiu, H., Zhang, Y.-J., & Zhang, W. (2024) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2024.1418455 · Cited by 3
Estimating lead-attributable mortality burden by socioeconomic status in the USA
Tao, C., Li, Z., Fan, Y., Huang, Y., Wan, T., Shu, M., Han, S., Qian, H., Yan, W., Xu, Q., et al. (2024) · International Journal of Epidemiology · doi:10.1093/ije/dyae089 · Cited by 3
Urban facility location models focusing on the health benefits of walking
Kurita, O. (2024) · Journal of the City Planning Institute of Japan · doi:10.11361/journalcpij.59.1155 · Cited by 3
Rahman, S. A., Poort, H., Schrag, D., Tung, S. C., Zhou, E. S., Wiley, A., Finkelstein, L. B., Elguenaoui, E., Nolan, M., Mayer, E. L., et al. (2024) · The Oncologist · doi:10.1093/oncolo/oyae316 · Cited by 4
“23 Baseline levels of each treatment factor predicting treatment-emergent fatigue were tested using generalized estimating equations with a binomial distribution after adjusting for palbociclib cycle number, age (dichotomized on median age), concurrent endocrine therapy (letrozole vs fulvestrant),…”
Nolasco, T. R., Figueiredo, R. I. D. N., Zanella, P. B., Porcher, F., Gass, R., Hauck, M., & Knorst, M. M. (2025) · Journal of Cardiopulmonary Rehabilitation and Prevention · doi:10.1097/hcr.0000000000000940 · Cited by 3
Mistiri, M. E., Rivera, D. E., Klasnja, P., Park, J.-H., & Hekler, E. B. (2025) · International Journal of Control · doi:10.1080/00207179.2025.2491109 · Cited by 3
“According to a study by Saint-Maurice et al. (2020), an increase in daily steps from 4000 to 8000 steps/day can reduce the risk of all-cause mortality by 51% in adults, including a reduced risk of cancer and heart disease.”
Zheng, P., & Motl, R. W. (2025) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2025.05.005 · Cited by 3
Improved functional assessment in cancer patients using home-based digital technologies
Karahanoğlu, F. I., Jensen, C. E., Cai, X., Santamaria, M., Psaltos, D., Messere, A., Demanuele, C., Stone, J., Tarachandani, A., Adamowicz, L., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-02401-4 · Cited by 3
Ge, Y., Chao, T., Sun, J., Huan, N., Liu, W., Chen, Y., & Wang, C. (2023) · International Journal of Environmental Health Research · doi:10.1080/09603123.2022.2160866 · Cited by 3
“The study published in JAMA in 2020 (Saint-maurice et al. 2020) on the relationship between daily step count and step intensity with mortality was also used the data of PA from NHANES, which validates the validity and accuracy of PA measurements in the NHANES database.”
MethodEffects of ankle-foot orthoses on step activities in the community: a systematic review
Jor, A., Lau, N. W. K., Daryabor, A., & Kobayashi, T. (2023) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2169774 · Cited by 3
“A recent study investigated the relationships between step counts and health issues and found that taking more steps each day led to significantly lower incident rates [13].”
BackgroundShapira‐Daniels, A., Kornej, J., Spartano, N. L., Wang, X., Zhang, Y., Pathiravasan, C. H., Liu, C., Trinquart, L., Borrelli, B., McManus, D. D., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/43123 · Cited by 3
“The overall benefits of increased physical activity have been well documented, including reductions in all-cause mortality, CVD-related mortality, and overall CVD risk [12-15, 27 , 28].”
Data-driven physical actigraphy patterns relate to cognitive and vascular health in older adults
Paolillo, E. W., Lee, S. Y., VandeBunte, A. M., Saloner, R., Gaynor, L. S., Djukic, N. A., Tsuei, T., Cobigo, Y., Kramer, J. H., & Casaletto, K. B. (2023) · Experimental Gerontology · doi:10.1016/j.exger.2023.112231 · Cited by 3
Christensen, M. R., Nabe‐Nielsen, K., Holtermann, A., & Gupta, N. (2023) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-023-01468-4 · Cited by 3
Chen, S., Yang, C., Hyun, J., & Ku, P. (2023) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2023.102561 · Cited by 4
Langer, S. L., Joseph, R. P., Mistretta, E. G., Tao, C., Porter, L. S., Campos, A. S., & Khera, N. (2024) · Transplantation and Cellular Therapy · doi:10.1016/j.jtct.2024.01.066 · Cited by 3
Timmins, I. R., Zaccardi, F., Yates, T. E., & Dudbridge, F. (2024) · Scientific Reports · doi:10.1038/s41598-024-60398-8 · Cited by 3
Burd, J., & Zofkie, A. C. (2024) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2024.101566 · Cited by 3
Carlin, T., & Vuillerme, N. (2021) · JMIR Research Protocols · doi:10.2196/21262 · Cited by 3
“At this point, it is important to recall that valid and reliable step count and distance estimates are vital output metrics and constitute crucial selection criteria for use in clinical practice [28].”
Comparison of habitual stepping cadence analysis methods: Relationship with step counts
O'Brien, M. W., Johns, J. A., Frayne, R. J., & Kimmerly, D. S. (2021) · Gait & Posture · doi:10.1016/j.gaitpost.2021.12.006 · Cited by 3
Does the COVID-19 Outbreak, Global Trends, Physical Inactivity and Sedentary Behavior Effects?
Pündük, Z. (2020) · Turkiye Klinikleri Journal of Sports Sciences · doi:10.5336/sportsci.2020-76411 · Cited by 3
Anticipating the ageing trajectories of superheroes in the Marvel cinematic universe
Fox, S. T., Reid, N., Tornvall, I., Weerasekera, S., Gordon, E. H., & Hubbard, R. E. (2021) · BMJ · doi:10.1136/bmj-2021-068001 · Cited by 3
Knowing Well, Being Well: well-being born of understanding
Katz, D. L., Rollston, R. L., Galea, S., Frates, E. P., Rifai, T., & McNaughton, C. D. (2020) · American Journal of Health Promotion · doi:10.1177/0890117120930536 · Cited by 3
Moving beyond Sedentarism in CKD
Kim, T. Y., & Roshanravan, B. (2021) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.03460321 · Cited by 3
Mazéas, A., Forestier, C., Harel, G., Duclos, M., & Chalabaëv, A. (2022) · medRxiv · doi:10.1101/2022.11.18.22282458 · Cited by 3
Koemel, N. A., Ahmadi, M. N., Biswas, R. K., Thøgersen‐Ntoumani, C., Teixeira-Pinto, A. M., Chow, C. K., Harezlak, J., & Stamatakis, E. A. (2025) · medRxiv · doi:10.1101/2025.08.05.25333017 · Cited by 3
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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