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Cited by 361Physical Activity and HealthCardiovascular and exercise physiologyDiabetes, Cardiovascular Risks, and Lipoproteins

Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia

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Hall, Katherine S., Hyde, Eric T., Bassett, David R., Carlson, Susan A., Carnethon, Mercedes R., Ekelund, Ulf, Evenson, Kelly R., Galuska, Deborah A. +7 more·2020·International Journal of Behavioral Nutrition and Physical Activity
DOI 10.1186/s12966-020-00978-9PMC PMC7305604
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Abstract

Background: Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes. Methods: A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations. Results: Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4–10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6–36%) and CVD (5–21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics. Conclusions: Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.

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  • A systematic review by Hall et al. found that taking more steps per day was related to lower risk of all-cause mortality, cardiovascular events and incident diabetes.

    “A systematic review by Hall et al.10 found that taking more steps per day was related to lower risk of all-cause mortality, cardiovascular events and incident diabetes.”

    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 [10]

    The Discussion (page not provided) reports that more daily steps were associated with lower all-cause mortality and CVD morbidity or mortality. It says the evidence for incident diabetes was limited and the review could not definitively characterize that association, although some large cohorts suggested a benefit. (LLM, conf=0.90)

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  • Our findings are consistent with previous literature describing associations between step counts and adverse events.

    “Our findings are consistent with previous literature describing associations between step counts and adverse events10,11.”

    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 [10]

  • An increase of 1000 steps/day can help reduce all-cause mortality risk between 6% and 36%, although an increase of approximately 600 steps may not have a similar effect.

    “It is also worth noting that an increase of 1000 steps/day can help reduce all-cause mortality risk between 6% and 36%, although an increase of approximately 600 steps may not have a similar effect [32].”

    From Feasibility, Usability, and Effectiveness of a Machine Learning–Based Physical Activity Chatbot: Quasi-Experimental Study (2021) · cites this paper as [32]

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Research works printed but not linked: 1

  1. [1]U.S. Department of Health and Human Services Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities 2015 Washington, DC U.S. Department of Health and Human Services, Office of the Surgeon General 30860691

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Authors
Hall, K. S., Hyde, E. T., Bassett, D. R., Carlson, S. A., Carnethon, M. R., Ekelund, U., Evenson, K. R., Galuska, D. A., Kraus, W. E., Lee, I.-M., Matthews, C. E., Omura, J. D., Paluch, A. E., Thomas, W. I., & Fulton, J. E.
Affiliations
  • Duke University (US)
  • Centers for Disease Control and Prevention (US)
  • University of Tennessee at Knoxville (US)
  • Northwestern University (US)
  • Norwegian Institute of Public Health (NO)
  • University of North Carolina at Chapel Hill (US)
  • Brigham and Women's Hospital (US)
  • Division of Cancer Epidemiology and Genetics (US)
  • University of Massachusetts Amherst (US)
Corresponding author
Hall, Katherine S.
ORCID
Venue
International Journal of Behavioral Nutrition and Physical Activity
Publisher
Springer Science and Business Media LLC
Published
2020-06-20
Volume
17
Issue
1
Pages
78-78
ISSN
1479-5868 (ISSN-L)
DOI
10.1186/s12966-020-00978-9
PMC
PMC7305604
OpenAlex
W3036483363
Cited by
361
References
45
Citations by year
2026: 37 · 2025: 41 · 2024: 60 · 2023: 65 · 2022: 87 · 2021: 60 · 2020: 10 · 2019: 1
FWCI
7.06
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders
  • National Cancer Institute (CA182913, 1R01CA227122)
  • National Institute on Aging (P30AG028716)
  • U.S. Department of Veterans Affairs (2RX001316)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
daily step count, physical activity, all-cause mortality, cardiovascular disease, dysglycemia, diabetes incidence, insulin sensitivity, fasting blood glucose, HbA1c, pedometers, accelerometer, dose-response relationship, physical activity thresholds, walking, physical activity guidelines, adults, public health policy, health disparities
MeSH terms
Fitness Trackers, Adult, Blood Glucose, Cardiovascular Diseases, Humans, Prospective Studies, Walking, Glucose Metabolism Disorders

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