Australian researchers have suggested that averaging between 5 000 and 7 000 steps a day can be linked to a significant reduction in risks of all-cause mortality, cardiovascular disease incidence, dementia and falls – and that no extra benefit was shown beyond that range.
Based on a meta-analysis of studies published since 2014, increasing daily step counts above 2 000 was associated with a risk reduction, according to Professor Ding (Melody) Ding, PhD, MPH, of the University of Sydney, and colleagues, who wrote that study after study, higher daily step counts were shown to track with better health outcomes, even well below the oft-touted target of 10 000 steps.
Writing in The Lancet Public Health, they said more steps consistently tracked with reduced cardiovascular disease mortality, cancer incidence, cancer mortality, type 2 diabetes incidence, and depressive symptoms.
“Although 10 000 steps per day, an unofficial target for decades without a clear evidence base, was associated with substantially lower risks for all-cause mortality, cardiovascular disease incidence, cancer mortality, dementia, and depressive symptoms than 7 000 steps per day, the incremental improvement beyond 7 000 was small, and there was no statistical difference between 7 000 and a higher step count for all of the other outcomes,” they wrote.
“Therefore, 7 000 steps per day might be a more realistic and achievable recommendation for some, but 10 000 can still be a viable target for those who are more active,” they suggested.
Medpage Today reports Ding and colleagues acknowledged the step count/health relationship may depend on age, physical function, and other factors that were not controlled for in their study. Their meta-analysis might also have been affected by the small number of studies available for most outcomes: evidence certainty was deemed moderate for all outcomes except for cardiovascular disease mortality (low), cancer incidence (low), physical function (low), and falls (very low).
Nevertheless, they maintained that more walking is still likely to be a good thing.
“Similar to current moderate-intensity to vigorous-intensity physical activity recommendations, the message that every step counts for those who are able should be emphasised as a core public health message, regardless of the specific quantitative target,” the study authors wrote.
When the 2018 US physical activity guidelines and the 2020 WHO guidelines were being created, the evidence on step counts had been deemed insufficient for making recommendations.
Ding's group had performed a systematic review pooling 57 studies on daily steps and health outcomes. From those, they had 31 studies to use for a meta-analysis on outcomes with at least two studies from similar cohorts.
Sample sizes for each outcome ranged from 61 594 for incident type 2 diabetes to 161 176 for all-cause mortality.
Compared with 2 000 steps per day, walking 7 000 steps per day was associated with:
• A significant 47% lower risk of all-cause mortality
• A significant 25% lower risk of incident cardiovascular disease incidence
• A significant 47% lower risk of cardiovascular disease mortality
• A non-significant 6% lower risk of cancer incidence
• A significant 37% lower risk of cancer mortality
• A significant 14% lower risk of type 2 diabetes
• A significant 38% lower risk of dementia
• A significant 22% lower risk of depressive symptoms
• A significant 28% lower risk of falls
Outside research has shown that physical activity can be done daily or saved for just one or two days of the week to show associations with health benefits.
Study details
Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis
Melody Ding, Binh Nguyen, Tracy Nau et al.
Summary
Background
Despite the rapid increase in evidence from the past decade on daily steps and health-related outcomes, existing systematic reviews primarily focused on few outcomes, such as all-cause mortality. This study synthesised the prospective dose-response relationship between daily steps and health outcomes including all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, cognitive outcomes, mental health outcomes, physical function, and falls.
Methods
For this systematic review and meta-analysis, we searched PubMed and EBSCO CINAHL for literature published between Jan 1, 2014, and Feb 14, 2025, supplemented by other search strategies. Eligible prospective studies examined the relationship between device-measured daily steps and health outcomes among adults without restrictions on language or publication type. Pairs of reviewers (BN, KO, ML, and TN) independently did the study selection, data extraction, and risk of bias assessment using the 9-point Newcastle-Ottawa Scale. Hazard ratios (HRs) from individual studies were synthesised using random-effects dose-response meta-analysis where possible. Certainty of evidence was assessed using GRADE. This trial is registered with PROSPERO (CRD42024529706).
Findings
A total of 57 studies from 35 cohorts were included in the systematic review and 31 studies from 24 cohorts were included in meta-analyses. For all-cause mortality, cardiovascular disease incidence, dementia, and falls, an inverse non-linear dose-response association was found, with inflection points at around 5000–7000 steps per day. An inverse linear association was found for cardiovascular disease mortality, cancer incidence, cancer mortality, type 2 diabetes incidence, and depressive symptoms. Based on our meta-analyses, compared with 2000 steps per day, 7000 steps per day was associated with a 47% lower risk of all-cause mortality (HR 0·53 [95% CI 0·46–0·60]; I2=36·3; 14 studies), a 25% lower risk of cardiovascular disease incidence (HR 0·75 [0·67–0·85]; I2=38·3%; six studies), a 47% lower risk of cardiovascular disease mortality (HR 0·53 [0·37–0·77]; I2=78·2%; three studies), a non-significant 6% lower risk of cancer incidence (HR 0·94 [0·87–1·01]; I2=73·7%; two studies), a 37% lower risk of cancer mortality (HR 0·63 [0·55–0·72]; I2=64·5%; three studies), a 14% lower risk of type 2 diabetes (HR 0·86 [0·74–0·99]; I2=48·5%; four studies), a 38% lower risk of dementia (HR 0·62 [0·53–0·73]; I2=0%; two studies), a 22% lower risk of depressive symptoms (HR 0·78 [0·73–0·83]; I2=36·2%; three studies), and a 28% lower risk of falls (HR 0·72 [0·65–0·81]; I2=47·5%; four studies). Studies on physical function (not based on meta-analysis) reported similar inverse associations. The evidence certainty was moderate for all outcomes except for cardiovascular disease mortality (low), cancer incidence (low), physical function (low), and falls (very low).
Interpretation
Although 10 000 steps per day can still be a viable target for those who are more active, 7 000 steps per day is associated with clinically meaningful improvements in health outcomes and might be a more realistic and achievable target for some. The findings of the study should be interpreted in light of limitations, such as the small number of studies available for most outcomes, a lack of age-specific analysis and biases at the individual study level, including residual confounding.
Medpage Today article – 10,000 Daily Step Count Goal Debunked by Huge Study (Open access)
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