Association of Step Volume and Intensity With All-Cause Mortality in Older Women
Open accessAbstract
IMPORTANCE: A goal of 10 000 steps/d is commonly believed by the public to be necessary for health, but this number has limited scientific basis. Additionally, it is unknown whether greater stepping intensity is associated with health benefits, independent of steps taken per day. OBJECTIVE: To examine associations of number of steps per day and stepping intensity with all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included 18 289 US women from the Women's Health Study who agreed to participate by wearing an accelerometer during waking hours for 7 days between 2011 and 2015. A total of 17 708 women wore and returned their devices; data were downloaded successfully from 17 466 devices. Of these women, 16 741 were compliant wearers (≥10 h/d of wear on ≥4 days) and included in the analyses, which took place between 2018 and 2019. EXPOSURES: Steps per day and several measures of stepping intensity (ie, peak 1-minute cadence; peak 30-minute cadence; maximum 5-minute cadence; time spent at a stepping rate of ≥40 steps/min, reflecting purposeful steps). MAIN OUTCOMES AND MEASURES: All-cause mortality. RESULTS: Of the 16 741 women who met inclusion criteria, the mean (SD) age was 72.0 (5.7) years. Mean step count was 5499 per day, with 51.4%, 45.5%, and 3.1% of time spent at 0, 1 to 39 (incidental steps), and 40 steps/min or greater (purposeful steps), respectively. During a mean follow-up of 4.3 years, 504 women died. Median steps per day across low-to-high quartiles of distribution were 2718, 4363, 5905, and 8442, respectively. The corresponding quartile hazard ratios (HRs) associated with mortality and adjusted for potential confounders were 1.00 (reference), 0.59 (95% CI, 0.47-0.75), 0.54 (95% CI, 0.41-0.72), and 0.42 (95% CI, 0.30-0.60), respectively (P < .01). In spline analysis, HRs were observed to decline progressively with higher mean steps per day until approximately 7500 steps/d, after which they leveled. For measures of stepping intensity, higher intensities were associated with significantly lower mortality rates; however, after adjusting for steps per day, all associations were attenuated, and most were no longer significant (highest vs lowest quartile for peak 1-minute cadence, HR = 0.87 [95% CI, 0.68-1.11]; peak 30-minute cadence, HR = 0.86 [95% CI, 0.65-1.13]; maximum 5-minute cadence, HR = 0.80 [95% CI, 0.62-1.05]; and time spent at a stepping rate of ≥40 steps/min, HR = 1.27 [95% CI, 0.96-1.68]; P > .05). CONCLUSIONS AND RELEVANCE: Among older women, as few as approximately 4400 steps/d was significantly related to lower mortality rates compared with approximately 2700 steps/d. With more steps per day, mortality rates progressively decreased before leveling at approximately 7500 steps/d. Stepping intensity was not clearly related to lower mortality rates after accounting for total steps per day.
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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 [2]
The Discussion and the passage following the dose-response figure (page not provided) describe prior step-count studies of mortality, diabetes, and cardiovascular events. But the latter also reports analyses of metabolic syndrome risk score and glucose, so the claim that outcomes were limited to the three named categories is too narrow. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrior 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 [2]
The Limitations section says this study used a single assessment of steps, supporting the concern that activity was not routinely measured throughout follow-up. But it also reports repeated assessments in a subgroup over 2–3 years, and the discussion describes another study measuring steps at baseline and 12 months. The blanket claim that prior studies report no intervening activity information is therefore too broad. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPrior 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 [2]
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.
“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 [2]
Beneficial effects can be observed with minimum step counts ranging from 4,000 to 12,000 steps per day.
“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 [63]
Beneficial effects of daily step counts can be observed with minimum step counts ranging from 4,000 to 12,000 steps per day.
“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 [63]
Objectively measured physical activity levels, categorized into sedentary behaviour, light PA and MVPA, can be used to assess the risk of cardiovascular and all-cause death.
“Objectively measured PA levels, categorized into sedentary behaviour, light PA and MVPA, can be used to assess the risk of cardiovascular and all-cause death”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [39]
In women with mean age 72, as few as 4,400 steps per day were associated with a 41% reduction in mortality compared with 2,700 steps per day, but benefits levelled at 7,500 steps per day.
“Another study of women with a mean (s.d.) age of 72 (5.7) years showed that as few as 4,400 steps per day were significantly associated with a 41% reduction in mortality compared with 2,700 steps per day, but the benefits levelled at 7,500 steps per day39.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [39]
Stepping intensity was not associated with mortality after adjusting for steps per day.
“Of note, stepping intensity was not associated with mortality after adjusting for steps per day.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [39]
We used the residual method in which total MVPA was regressed on the bout exposure volume; the resulting residuals were independent variables in the analyses consistent with previous research assessing activity volume over a fixed time interval.
“We therefore used the residual method in which total MVPA was regressed on the bout exposure volume.The resulting residuals were independent variables in the analyses consistent with previous research assessing activity volume over a fixed time interval.20,21”
Among older women, as few as ~4,400 steps/day were significantly related to lower mortality rates compared with ~2,700 steps/day.
“Moreover, among older women, as few as $4,400 steps Á day À1 were significantly related to lower mortality rates compared with $2,700 steps Á day À1 (35)”
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- Authors
- Lee, I.-M., Shiroma, E. J., Kamada, M., Bassett, D. R., Matthews, C. E., & Buring, J. E.
- Affiliations
- Brigham and Women's Hospital (US)
- National Institute on Aging (US)
- The University of Tokyo (JP)
- University of Tennessee at Knoxville (US)
- National Cancer Institute (US)
- Corresponding author
- Lee, I-Min
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2019-08-01
- Volume
- 179
- Issue
- 8
- Pages
- 1105
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6547157
- OpenAlex
- W2947883860
- Cited by
- 604
- References
- 40
- Citations by year
- 2026: 47 · 2025: 63 · 2024: 90 · 2023: 79 · 2022: 94 · 2021: 104 · 2020: 106 · 2019: 21
- FWCI
- 55.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Japan Society for the Promotion of Science (19H03996)
- National Cancer Institute (U01CA182913)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
- Keywords
- step count, cadence, all-cause mortality, older women, accelerometer-measured activity, 10,000 steps goal, Women's Health Study, physical activity guidelines, mortality risk reduction, sex differences in physical activity
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