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

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.

SUBMITTER: Hall KS

PROVIDER: S-EPMC7305604 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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

Hall Katherine S KS Hyde Eric T ET Bassett David R DR Carlson Susan A SA Carnethon Mercedes R MR Ekelund Ulf U Evenson Kelly R KR Galuska Deborah A DA Kraus William E WE Lee I-Min IM Matthews Charles E CE Omura John D JD Paluch Amanda E AE Thomas William I WI Fulton Janet E JE

The international journal of behavioral nutrition and physical activity 20200620 1

<h4>Background</h4>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.<h4>Methods</h4>A systematic revi ...[more]

PMID: 32563261

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Project description:ImportanceRecommendations for the number of steps per day may be easier to enact for some people than the current time- and intensity-based physical activity guidelines, but the evidence to support steps-based goals is limited.ObjectiveTo describe the associations of step count and intensity with all-cause mortality and cancer and cardiovascular disease (CVD) incidence and mortality.Design, setting, and participantsThis population-based prospective cohort study used data from the UK Biobank for 2013 to 2015 (median follow-up, 7 years) and included adults 40 to 79 years old in England, Scotland, and Wales. Participants were invited by email to partake in an accelerometer study. Registry-based morbidity and mortality were ascertained through October 2021. Data analyses were performed during March 2022.ExposuresBaseline wrist accelerometer-measured daily step count and established cadence-based step intensity measures (steps/min): incidental steps, (<40 steps/min), purposeful steps (≥40 steps/min); and peak-30 cadence (average steps/min for the 30 highest, but not necessarily consecutive, min/d).Main outcomes and measuresAll-cause mortality and primary and secondary CVD or cancer mortality and incidence diagnosis. For cancer, analyses were restricted to a composite cancer outcome of 13 sites that have a known association with reduced physical activity. Cox restricted cubic spline regression models were used to assess the dose-response associations. The linear mean rate of change (MRC) in the log-relative hazard ratio for each outcome per 2000 daily step increments were also estimated.ResultsThe study population of 78 500 individuals (mean [SD] age, 61 [8] years; 43 418 [55%] females; 75 874 [97%] White individuals) was followed for a median of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). There were 10 245 incident CVD events and 2813 cancer incident events during the observation period. More daily steps were associated with a lower risk of all-cause (MRC, -0.08; 95% CI, -0.11 to -0.06), CVD (MRC, -0.10; 95% CI, -0.15 to -0.06), and cancer mortality (MRC, 95% CI, -0.11; -0.15 to -0.06) for up to approximately 10 000 steps. Similarly, accruing more daily steps was associated with lower incident disease. Peak-30 cadence was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps.Conclusions and relevanceThe findings of this population-based prospective cohort study of 78 500 individuals suggest that up to 10 000 steps per day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.

Project description:Importance:It is unclear whether the number of steps per day and the intensity of stepping are associated with lower mortality. Objective:Describe the dose-response relationship between step count and intensity and mortality. Design, Setting, and Participants:Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). Mortality was ascertained through December 2015. Exposures:Accelerometer-measured number of steps per day and 3 step intensity measures (extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence [steps/min]). Accelerometer data were based on measurements obtained during a 7-day period at baseline. Main Outcomes and Measures:The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios (HRs), mortality rates, and 95% CIs were estimated using cubic splines and quartile classifications adjusting for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema. Results:A total of 4840 participants (mean age, 56.8 years; 2435 [54%] women; 1732 [36%] individuals with obesity) wore accelerometers for a mean of 5.7 days for a mean of 14.4 hours per day. The mean number of steps per day was 9124. There were 1165 deaths over a mean 10.1 years of follow-up, including 406 CVD and 283 cancer deaths. The unadjusted incidence density for all-cause mortality was 76.7 per 1000 person-years (419 deaths) for the 655 individuals who took less than 4000 steps per day; 21.4 per 1000 person-years (488 deaths) for the 1727 individuals who took 4000 to 7999 steps per day; 6.9 per 1000 person-years (176 deaths) for the 1539 individuals who took 8000 to 11 999 steps per day; and 4.8 per 1000 person-years (82 deaths) for the 919 individuals who took at least 12 000 steps per day. Compared with taking 4000 steps per day, taking 8000 steps per day was associated with significantly lower all-cause mortality (HR, 0.49 [95% CI, 0.44-0.55]), as was taking 12 000 steps per day (HR, 0.35 [95% CI, 0.28-0.45]). Unadjusted incidence density for all-cause mortality by peak 30 cadence was 32.9 per 1000 person-years (406 deaths) for the 1080 individuals who took 18.5 to 56.0 steps per minute; 12.6 per 1000 person-years (207 deaths) for the 1153 individuals who took 56.1 to 69.2 steps per minute; 6.8 per 1000 person-years (124 deaths) for the 1074 individuals who took 69.3 to 82.8 steps per minute; and 5.3 per 1000 person-years (108 deaths) for the 1037 individuals who took 82.9 to 149.5 steps per minute. Greater step intensity was not significantly associated with lower mortality after adjustment for total steps per day (eg, highest vs lowest quartile of peak 30 cadence: HR, 0.90 [95% CI, 0.65-1.27]; P value for trend = .34). Conclusions and Relevance:Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.

Project description:ImportancePrevious studies have shown that individuals who regularly walk, particularly 8000 daily steps or more, experience lower mortality. However, little is known about the health benefits of walking intensively only a few days a week.ObjectiveTo evaluate the dose-response association between the number of days an individual takes 8000 steps or more and mortality among US adults.Design, setting, and participantsThis cohort study evaluated a representative sample of participants aged 20 years or older in the National Health and Nutrition Examination Surveys 2005-2006 who wore an accelerometer for 1 week and their mortality data through December 31, 2019. Data were analyzed from April 1, 2022, to January 31, 2023.ExposuresParticipants were grouped by the number of days per week they took 8000 steps or more (0 days, 1-2 days, and 3-7 days).Main outcomes and measuresMultivariable ordinary least squares regression models were used to estimate adjusted risk differences (aRDs) for all-cause and cardiovascular mortality during the 10-year follow-up, adjusting for potential confounders (eg, age, sex, race and ethnicity, insurance status, marital status, smoking, comorbidities, and average daily step counts).ResultsAmong 3101 participants (mean [SD] age, 50.5 [18.4] years; 1583 [51.0%] women and 1518 [49.0%] men; 666 [21.5%] Black, 734 [23.7%] Hispanic, 1579 [50.9%] White, and 122 [3.9%] other race and ethnicity), 632 (20.4%) did not take 8000 steps or more any day of the week, 532 (17.2%) took 8000 steps or more 1 to 2 days per week, and 1937 (62.5%) took 8000 steps or more 3 to 7 days per week. Over the 10-year follow-up, all-cause and cardiovascular deaths occurred in 439 (14.2%) and 148 (5.3%) participants, respectively. Compared with participants who walked 8000 steps or more 0 days per week, all-cause mortality risk was lower among those who took 8000 steps or more 1 to 2 days per week (aRD, -14.9%; 95% CI -18.8% to -10.9%) and 3 to 7 days per week (aRD, -16.5%; 95% CI, -20.4% to -12.5%). The dose-response association for both all-cause and cardiovascular mortality risk was curvilinear; the protective association plateaued at 3 days per week. Different thresholds for the number of daily steps between 6000 and 10 000 yielded similar results.Conclusions and relevanceIn this cohort study of US adults, the number of days per week taking 8000 steps or more was associated with a lower risk of all-cause and cardiovascular mortality in a curvilinear fashion. These findings suggest that individuals may receive substantial health benefits by walking just a couple days a week.

Project description:BackgroundPhysical inactivity is an essential factor in the prognosis of patients with chronic kidney disease (CKD). Daily step count is a straightforward measure to assess physical activity levels. Understanding the step counts among different CKD stages is essential to change sedentary behavior.ObjectivesThis systematic review and meta-analysis aimed to investigate the daily step counts in patients with CKD at a different stage.DesignA systematic review and meta-analysis.Data sourcesThe literature search was performed in PubMed, Embase, and Web of Science from inception to November 3rd, 2021.Review methodsObservational studies (cross-sectional, case-control, or cohort studies) reported specific values of step counts in CKD patients by the wearable device were included. A random-effects model was used to pool the data. Subgroup analysis explored differences in outcomes by stage of CKD. Heterogeneity between studies was assessed using the χ2 test of Cochrane's Q statistic. A contour-enhanced funnel plot was conducted to investigate publication bias. Univariate and multivariate meta-regression was conducted to examine possible sources of heterogeneity.ResultsTwenty-eight articles were identified and used for quantitative analysis. The result showed that the daily step count in patients with CKD was 4642.47 (95% CI: 4274.18-5010.76), and significantly lower than the healthy population. Subgroup analysis revealed that the step counts decreased before dialysis, dropped to a freezing point at the hemodialysis phase, and increased after kidney transplantation. Meta-regression analysis showed that daily step counts were relatively higher in the Americas or younger than 60 or kidney transplant recipients.ConclusionThe status of daily step counts in patients with CKD decreases with CKD severity and increases after kidney transplantation. Although studies have begun to focus on strategies to improve step counts in patients with CKD, future studies should focus more on step counts in pre-dialysis patients and changing their physically inactive lifestyle early to alleviate deteriorating renal function.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291551, identifier: CRD42021291551.

Project description:ObjectivesAlthough previous studies have reported lower mortality and morbidity in people with higher daily step counts, the association between frailty and objectively measured step counts has not been evaluated well. We investigated the association between step counts and prevalence of frailty in community-dwelling older adults.DesignA cross-sectional study.SettingThe Kyoto-Kameoka study in Japan.ParticipantsWe used data of 3,616 Japanese older adults, aged 65 years or older, with valid daily step count data, obtained by an accelerometer-based pedometer.MeasurementsThe step count during 4 or more days was objectively obtained by a validated triaxial accelerometer. Participants were classified by quartiles (Qs) based on their step counts. Frailty was defined using the Fried phenotype (FP) model and the Kihon Checklist (KCL). We evaluated the association between prevalence of frailty and step counts using multivariate logistic regression and the restricted cubic spline model.ResultsMean step counts across low-to-high Qs of distribution were 1,759, 2,988, 4,377, and 7,200 steps/day, respectively. The prevalence of frailty, as defined by the FP model and KCL, was 11.3% and 26.8%, respectively. After adjusting for confounders, there was a negative association between the odds ratio (OR) and prevalence of frailty, as defined by the FP model among people with higher step counts (Q1: reference; Q2: OR = 0.73; 95% confidence interval (CI) = 0.56-0.96; Q3: OR = 0.56; 95% CI = 0.42-0.76; and Q4: OR = 0.41; 95% CI = 0.30-0.57; P for trend <.001). The mean step count of the population was 4,081. The OR of frailty for a 1,000-steps/day increment was 0.74 (95% CI = 0.58-0.91) and 0.85 (95% CI = 0.72-0.97) below 4,000 steps and above 4,000 steps, respectively. In the spline model, this relationship was similar between the FP model and KCL.ConclusionThese findings suggest that slightly increasing the current step count, as by 1,000 steps/day (about 10 minutes of activity), may potentially prevent frailty. J Am Geriatr Soc 68:2310-2318, 2020.

Project description:PurposeA systematic primary literature review was conducted to evaluate the relationship of physical activity-as measured by daily step counts-with all-cause mortality, cardiovascular disease mortality, incident cardiovascular disease, and type 2 diabetes mellitus; to evaluate the shape of dose-response relationships; and to interpret findings in the context of development of the Physical Activity Guidelines for Americans, Second Edition.MethodsA primary literature search encompassing 2011 to March 2018 for existing literature reporting on these relationships was conducted.ResultsEleven pertinent articles were identified. Seven longitudinal studies examined the relationship between daily step counts and mortality, disease incidence, or risk. Two studies examined objectively measured steps per day and all-cause mortality; one was restricted to a relatively small elderly population. One study examined cardiovascular events, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. The other four longitudinal studies addressed incident type 2 diabetes. All longitudinal studies reported an inverse relationship between steps per day and outcome risk. In one study, 531 cardiovascular events occurred during more than 45,000 person-years of follow-up. Before intervention, each increment of 2000 steps per day up to 10,000 steps was associated with a 10% lower cardiovascular event rate. Also, for every increase of 2000 steps per day over baseline, there was an 8% yearly reduction in cardiovascular event rate in individuals with impaired glucose tolerance.ConclusionsDaily step count is a readily accessible means by which to monitor and set physical activity goals. Recent evidence supports previously limited evidence of an inverse dose-response relationship of daily steps with important health outcomes, including all-cause mortality, cardiovascular events, and type 2 diabetes. However, more independent studies will be required before these observations can be translated into public health guidelines.

Project description:BackgroundTaking fewer than the widely promoted "10 000 steps per day" has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose-response relationship between steps per day and CVD can help inform clinical and public health guidelines.MethodsEight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance-weighted random effects models.ResultsThe mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, <60 years of age). For older adults, the HR for quartile 2 was 0.80 (95% CI, 0.69 to 0.93), 0.62 for quartile 3 (95% CI, 0.52 to 0.74), and 0.51 for quartile 4 (95% CI, 0.41 to 0.63) compared with the lowest quartile. For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46 to 1.35), 0.90 for quartile 3 (95% CI, 0.64 to 1.25), and 0.95 for quartile 4 (95% CI, 0.61 to 1.48) compared with the lowest quartile. Restricted cubic splines demonstrated a nonlinear association whereby more steps were associated with decreased risk of CVD among older adults.ConclusionsFor older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician-patient communication and population health to reduce the risk of CVD.

Project description:BackgroundThe associations between dysglycemia and mortality in septic patients with and without diabetes are yet to be confirmed. Our aim was to analyze the association of diabetes and sepsis mortality, and to examine how dysglycemia (hyperglycemia, hypoglycemia and glucose variability) affects in-hospital mortality of patients with suspected sepsis in emergency department (ED) and intensive care units.MethodsClinically suspected septic patients admitted to ED were included, and stratified into subgroups according to in-hospital mortality and the presence of diabetes. We analyzed patients' demographics, comorbidities, clinical and laboratory parameters, admission glucose levels and severity of sepsis. Odds ratio of mortality was assessed after adjusting for possible confounders. The correlations of admission glucose and CoV (blood glucose coefficients of variation) and mortality in diabetes and non-diabetes were also tested.ResultsDiabetes was present in 58.3% of the patients. Diabetic patients were older, more likely to have end-stage renal disease and undergoing hemodialysis, but had fewer malignancies, less sepsis severity (lower Mortality in Emergency Department Sepsis Score), less steroid usage in emergency department, and lower in-hospital mortality rate (aOR:0.83, 95% CI 0.65-0.99, p = 0.044). Hyperglycemia at admission (glucose≥200 mg/dL) was associated with higher risks of in-hospital mortality among the non-diabetes patients (OR:1.83 vs. diabetes, 95% CI 1.20-2.80, p = 0.005) with the same elevated glucose levels at admission. In addition, CoV>30% resulted in higher risk of death as well (aOR:1.88 vs. CoV between 10 and 30, 95%CI 1.24-2.86 p = 0.003).ConclusionsThis study indicates that while diabetes mellitus seems to be a protective factor in sepsis patients, hyper- or hypoglycemia status on admission, and increased blood glucose variation during hospital stays, were independently associated with increased odds ratio of mortality.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

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