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Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts - PubMed

Meta-Analysis

. 2022 Mar;7(3):e219-e228.

doi: 10.1016/S2468-2667(21)00302-9.

Shivangi Bajpai  2 , David R Bassett  3 , Mercedes R Carnethon  4 , Ulf Ekelund  5 , Kelly R Evenson  6 , Deborah A Galuska  7 , Barbara J Jefferis  8 , William E Kraus  9 , I-Min Lee  10 , Charles E Matthews  11 , John D Omura  7 , Alpa V Patel  12 , Carl F Pieper  13 , Erika Rees-Punia  12 , Dhayana Dallmeier  14 , Jochen Klenk  15 , Peter H Whincup  16 , Erin E Dooley  17 , Kelley Pettee Gabriel  17 , Priya Palta  18 , Lisa A Pompeii  19 , Ariel Chernofsky  20 , Martin G Larson  20 , Ramachandran S Vasan  21 , Nicole Spartano  22 , Marcel Ballin  23 , Peter Nordström  24 , Anna Nordström  25 , Sigmund A Anderssen  26 , Bjørge H Hansen  27 , Jennifer A Cochrane  28 , Terence Dwyer  29 , Jing Wang  30 , Luigi Ferrucci  31 , Fangyu Liu  32 , Jennifer Schrack  33 , Jacek Urbanek  34 , Pedro F Saint-Maurice  11 , Naofumi Yamamoto  35 , Yutaka Yoshitake  36 , Robert L Newton Jr  37 , Shengping Yang  37 , Eric J Shiroma  38 , Janet E Fulton  7 ; Steps for Health Collaborative

Affiliations

Meta-Analysis

Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts

Amanda E Paluch et al. Lancet Public Health. 2022 Mar.

Abstract

Background: Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.

Methods: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.

Findings: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]).

Interpretation: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.

Funding: US Centers for Disease Control and Prevention.

Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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Conflict of interest statement

Declaration of interests AEP and CFP received funding for this project from US Centers for Disease Control and Prevention (CDC) Intergovernmental Personnel Act Agreement. BJJ receives grant funding through the British Heart Foundation. MRC and RSV have received grant funding through National Heart Lung and Blood Institute, National Institutes of Health (NIH). I-ML, KPG, and PP receive grant funding through NIH. KRE receives grant funding through NIH, Robert Wood Johnson Foundation, US Department of Transportation, and North Carolina Department of Transportation; receives consulting fees from NIH; and is on the Board of Trustees with the American College of Sports Medicine. DD has received grant funding through German Research Foundation, travel expenses for 10th International Meeting on Ageing, honoraria for being an instructor at Boston University School of Public Health, been an unpaid speaker for German Society of Epidemiology, and been an unpaid member of the Alumni Leadership Council of Boston University School of Public Health. JS receives grant funding through National Institutes on Aging, NIH. All other authors declare no competing interests.

Figures

Figure 1:
Figure 1:

Study selection

Figure 2:
Figure 2:. Association between steps per day and all-cause mortality, in all participants, and by age and sex

Model 1 adjusted for age and sex (if applicable). Model 2 was further adjusted for device wear time, race and ethnicity (if applicable), education or income, body-mass index, plus study-specific variables for lifestyle, chronic conditions or risk factors, and general health status. The x-axis of the plot is on the log scale.

Figure 3:
Figure 3:. Dose-response association between steps per day and all-cause mortality, by age group

Thick lines indicate hazard ratio estimates, with shaded areas showing 95% CIs. Reference set at the median of the medians in the lowest quartile group (age ≥60 years = 3000 steps per day and <60 years = 5000 steps per day). Model is adjusted for age, accelerometer wear time, race and ethnicity (if applicable), sex (if applicable), education or income, body-mass index, and study-specific variables for lifestyle, chronic conditions or risk factors, and general health status. pinteraction=0.012 by age group. 14 studies included in spline analysis, excluded Baltimore Longitudinal Study of Aging. The y-axis is on a log scale.

Figure 4:
Figure 4:. Association between stepping rate with all-cause mortality, with and without adjustment for total step volume

Hazard ratios and 95% CIs are adjusted for age, device wear time, race and ethnicity (if applicable), sex (if applicable), education or income, body-mass index, and study-specific variables for lifestyle, chronic conditions or risk factors, and general health status. The model with additional adjustment for step volume uses the residual method for the rate variable. The x-axis is on a log scale.

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