Is 10,000 steps per day an evidence-based recommendation? Original paper

Over a mean follow-up period of 10.8 years, this cohort study of black and white men and women found that taking at least 7,000 steps/day was associated with a lower risk of mortality. Taking more than 10,000 steps/day was not associated with further reduction in mortality risk.

This Study Summary was published on October 3, 2021.

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Background

The number of steps that people take each day is a meaningful metric for quantifying total daily activity, but national guidelines for physical activity do not include step counts as a public health target due to limited evidence demonstrating an association between step volume and clinical outcomes.

The study

This prospective cohort study was part of the Coronary Artery Risk Development in Young Adults study. It included 2,110 participants (57.1% women, 42.1% black, aged 38 to 50 years) who wore an accelerometer during 2005–2006. The participants were instructed to wear an accelerometer on the hip during all waking hours for 7 consecutive days, and those with at least 3 days of at least 10 hours per day of wear time were included in this analysis.

Daily step volume was classified as low (<7,000 steps/day), moderate (7,000–9,999 steps/day), and high (≥ 10,000 steps/day), and stepping intensity was classified in terms of peak 30-minute stepping rate and time spent at rates of 100 steps per minute or more. The main outcome was all-cause mortality, and the participants were followed for an average of 10.8 years.

The results

During the follow-up period, 72 participants (3.4%) died. After accounting for confounding factors, compared with participants in the low step volume group, there was a significantly lower risk of mortality for participants in the moderate (hazard ratio: 0.28; 95% CI: 0.15 to 0.54) and high (hazard ratio: 0.45; 95% CI: 0.25 to 0.81) step volume groups. Furthermore, taking more than 10,000 steps/day was not associated with a further reduction in mortality risk. There was no association between step intensity and mortality.

Note

The observational design prevents the ability to establish causation. The lowest step volume group had the highest rates of cardiovascular disease, hypertension, and diabetes. Although the authors attempted to control for these confounding factors, the possibility for residual confounding and reverse causality remains.

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This Study Summary was published on October 3, 2021.