Daily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort study
Open accessAbstract
Background: Older adults with diabetes take fewer steps per day than those without diabetes. The purpose of the present study was to investigate the association of daily step count with incident diabetes in community-dwelling 70-year-olds. Methods: This prospective cohort study included N = 3055 community-dwelling 70-year-olds (52% women) who participated in a health examination in Umeå, Sweden during 2012–2017, and who were free from diabetes at baseline. Daily step count was measured for 1 week using Actigraph GT3X+ accelerometers. Cases of diabetes were collected from the Swedish National Patient Register. The dose-response association was evaluated graphically using a flexible parametric model, and hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regressions. Results: During a mean follow-up of 2.6 years, diabetes was diagnosed in 81 participants. There was an inverse nonlinear dose-response association between daily step count and incident diabetes, with a steep decline in risk of diabetes from a higher daily step count until around 6000 steps/day. From there, the risk decreased at a slower rate until it leveled off at around 8000 steps/day. A threshold of 4500 steps/day was found to best distinguish participants with the lowest risk of diabetes, where those taking ≥ 4500 steps/day, had 59% lower risk of diabetes, compared to those taking fewer steps (HR, 0.41, 95% CI, 0.25–0.66). Adjusting for visceral adipose tissue (VAT) attenuated the association (HR, 0.64, 95% CI, 0.38–1.06), which was marginally altered after further adjusting for sedentary time, education and other cardiometabolic risk factors and diseases (HR, 0.58, 95% CI, 0.32–1.05). Conclusions: A higher daily step count is associated with lower risk of incident diabetes in community-dwelling 70-year-olds. The greatest benefits occur at the lower end of the activity range, and much earlier than 10,000 steps/day. With the limitation of being an observational study, these findings suggest that promoting even a modest increase in daily step count may help to reduce the risk of diabetes in older adults. Because VAT appears to partly mediate the association, lifestyle interventions targeting diabetes should apart from promoting physical activity also aim to prevent and reduce central obesity.
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A prospective cohort study in 3,055 community-dwelling adults aged over 70 years found a similar nonlinear relation between daily steps and risk of developing diabetes, where the risk leveled off at 8,000 steps per day.
“A prospective cohort study conducted in 3,055 community-dwelling adults aged over 70 years found a similar nonlinear relation between daily steps and risk of developing diabetes, where the risk leveled off at 8,000 steps per day12.”
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 [12]
The Methods report 3,055 community-dwelling participants, and the Results describe a nonlinear association between daily steps and incident diabetes that leveled off around 8,000 steps per day. The age description is imprecise: the Methods specify eligibility at exactly age 70, rather than a cohort of adults generally aged over 70. (LLM, conf=0.87)
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References 51 · Cited by 47
- Authors
- Ballin, M., Nordström, P., Niklasson, J., Alamäki, A., Condell, J., Tedesco, S., & Nordström, A.
- Affiliations
- Umeå University (SE)
- Karelia University of Applied Sciences (FI)
- Ulster University, Derry-Londonderry Campus (GB)
- University College Cork (IE)
- UiT The Arctic University of Norway (NO)
- Corresponding author
- Ballin, Marcel
- ORCID
- Venue
- BMC Public Health
- Published
- 2020-11-30
- Volume
- 20
- Issue
- 1
- Pages
- 1830-1830
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC7706282
- OpenAlex
- W3107195343
- Cited by
- 47
- References
- 51
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 8 · 2023: 9 · 2022: 14 · 2021: 9
- FWCI
- 4.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Cork Open Research Archive (University College Cork, Ireland) (acceptedVersion, cc-by)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by)
- DiVA at Umeå University (Umeå University) (submittedVersion, other-oa)
- Cork Open Research Archive (University College Cork, Ireland) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Ulster University Research Portal (Ulster University) (submittedVersion, cc-by)
- Funders
- Vetenskapsrådet (2016-02589)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- daily step count, physical activity, new-onset diabetes, older adults, community-dwelling older adults, accelerometer-measured steps, visceral adipose tissue, dose-response relationship, sedentary time, diabetes prevention, lifestyle intervention, cardiometabolic risk factors, Swedish National Patient Register, flexible parametric models, Cox proportional hazards model
- MeSH terms
- Aged, Diabetes Mellitus, Female, Humans, Male, Prospective Studies, Sweden, Incidence, Walking, Independent Living
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