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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]
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“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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BackgroundInfluentialThe future is not just a 6-minute walk test
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“Physical activity (PA) is a cornerstone of human health, significantly impacting life expectancy and overall well-being (Cecchini et al. 2010; Lee et al. 2012; Das and Horton 2016; Saint-Maurice et al. 2020).”
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Relationships Between Physical Activity Metrics of Intensity and Diabetes
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“However, daily step count has been shown to be a predictor on health effects independent of step intensity (Saint-Maurice et al., 2020).”
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Cadence as a Behavioral Target in Physical Activity Interventions: A Narrative Review
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Physical Activity and Public Health for Adults: Is the Glass Mostly Empty or Half Full?
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Utilizing CGM Ambulatory Glucose Profiles to Optimize Diabetes Management
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What Are the Next Steps for Developing a National Steps Guideline?
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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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