By Seema Gupta, MD, MSPH
Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
SYNOPSIS: In a meta-analysis, researchers found walking 6,000 to 9,000 steps daily lowered the risk of cardiovascular disease by 40% to 50% vs. walking 2,000 steps daily.
SOURCE: Paluch AE, Bajpai S, Ballin M, et al; Steps for Health Collaborative. Prospective association of daily steps with cardiovascular disease: A harmonized meta-analysis. Circulation 2023;147:122-131.
Cardiovascular disease (CVD) remains the leading cause of death for men and women, as well as individuals of most racial and ethnic groups, across the United States, costing the nation approximately $219 billion annually.1 Physical activity has been associated with a lower risk of developing CVD, and its role in primary prevention is well established.2 While current guidelines for the primary prevention of CVD recommend at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity or an equivalent combination of aerobic activity per week, few Americans have historically followed such guidelines.3
Monitoring steps taken daily can be an effective tactic to increase physical activity. A goal of 10,000 steps per day has been widely promoted, but the evidence for this goal has been limited in the scientific literature. In fact, some evidence from longitudinal data has indicated that for adults, an additional 1,000 steps per day from baseline can help lower the risk of CVD morbidity and mortality.4 Thus, the health benefits may be present below 10,000 steps per day, but the shape of that dose-response relationship is unclear.
Paluch et al examined whether a dose-response relationship exists between steps per day and a lower risk of developing CVD among older adults. The researchers conducted a meta-analysis of eight prospective studies, using health data from 20,152 individuals across the United States and 42 other countries. The mean age of study participants was 63.2 years, plus or minus 12.4 years; 52% were women. The mean follow-up was 6.2 years.
The authors saw a significant difference in the association of steps per day and CVD between subjects who were ≥ age 60 years (older) and subjects who were < age 60 years (younger). For older adults, the investigators found walking 6,000 to 9,000 steps daily was associated with a 40% to 50% lower risk of developing CVD vs. walking 2,000 steps daily. Each additional 1,000 steps taken daily, especially for people who currently walk less than 3,000 steps daily, marked a significant reduction in CVD risk. The study did not reveal similar benefits in younger adults. Interestingly, the stepping rate or the pace was not associated with CVD risk benefit beyond that of total steps per day.
COMMENTARY
We often recommend physical activity like walking to our patients. Walking is a form of low-impact, moderate-intensity exercise that produces a range of health benefits and carries few risks. However, there is a lack of scientific consensus on how much walking is needed to produce health benefits. For instance, the 10,000-steps-a-day recommendation (walking about five miles) has nothing to do with science; in fact, this was a product marketing campaign for a pedometer that popped up in Japan around the 1964 Summer Olympics.5 Yet, this is a milestone that has become widely accepted. However, evidence is mounting that suggests patients do not have to walk 10,000 steps daily, that even a few thousand steps daily can be beneficial.6 Simply put, the relative benefit of engaging in more physical activity, even if it is only more daily walking, likely is better than living a sedentary lifestyle.
The findings by Paluch et al carry significant implications for clinical care and public health guidelines. As the use of technology, such as step-monitoring fitness trackers and smartphones, expands, it is important for clinicians to provide guidance that is practical and evidence-based. The evidence suggests patients who are the least active have the most to gain from setting a walking regimen. For most Americans who walk 3,000 or 4,000 steps a day, which equates to about 1.5 miles to two miles, going a little farther (perhaps even an additional 1,000 steps) can mean a lot for their heart health. Among older adults who walk 7,000 steps a day, adding another 1,000 steps also can produce meaningful benefits. The authors did not report a similar benefit for patients younger than age 60 years, but that could be because the risk for developing CVD increases significantly as patients age past 65 years.7 Nevertheless, this study reinforces the idea that for patients older than age 60 years, we should be recommending more daily walking — and it does not have to be 10,000 steps.
REFERENCES
1. Centers for Disease Control and Prevention. Office of the Associate Director for Policy and Strategy. Health topics – Heart disease and heart attack. Page last reviewed Aug. 17, 2021.
2. Winzer EB, Woitek F, Linke A. Physical activity in the prevention and treatment of coronary artery disease. J Am Heart Assoc 2018;7:e007725.
3. Hyde ET, Whitfield GP, Omura JD, et al. Trends in meeting the physical activity guidelines: Muscle-strengthening alone and combined with aerobic activity, United States, 1998-2018. J Phys Act Health 2021;18:S37-S44.
4. Hall KS, Hyde ET, Bassett DR, et al. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act 2020;17:78.
5. Bassett DR Jr, Toth LP, LaMunion SR, Crouter SE. Step counting: A review of measurement considerations and health-related applications. Sports Med 2017;47:1303-1315.
6. Lee IM, Shiroma EJ, Kamada M, et al. Association of step volume and intensity with all-cause mortality in older women. JAMA Intern Med 2019;179:1105-1112.
7. National Institute on Aging. Heart health and aging. Content reviewed June 1, 2018.
In a meta-analysis, researchers found walking 6,000 to 9,000 steps daily lowered the risk of cardiovascular disease by 40% to 50% vs. walking 2,000 steps daily.
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