Even a Modest Increase in Step Count Reduces Risk of Disease and Death

A meta-analysis of 226,889 people from 17 different research projects around the world suggests that the more you walk, the lower your risk of death and cardiovascular disease (CVD). The research is published in the European Journal of Preventive Cardiology.

What is the optimum number of steps per day?

A sedentary lifestyle – one lacking much physical activity – can contribute to our risk of developing diseases and living a shorter life. According to the World Health Organization (WHO), people who are insufficiently active carry a 20–30% increased risk of death compared to their active peers. On a global level, one in four adults fail to meet the suggested recommended levels of activity. For individuals that want to increase their physical activity, walking is often recommended as it is generally considered an accessible form of exercise.

But how many steps should you aim to walk each day? Current guidelines suggest 10,000 is optimal, but the new study – led by renowned cardiologist Professor Maciej Banach, proposes that even ~4,000 steps per day can reduce your risk of dying. “Our analysis indicates that as little as 4,000 steps a day are needed to significantly reduce deaths from any cause, and even fewer to reduce deaths from CVD,” Banach says.

"Until now, it has not been clear what is the optimal number of steps, both in terms of the cut-off points over which we can start to see health benefits, and the upper limit, if any, and the role this plays in people’s health,” says Dr. Ibadete Bytyçi from the University Clinical Centre of Kosovo, Pristina, Kosovo, senior author of the paper. In this large meta-analysis, the research team wanted to assess the relationship between step count and all-cause mortality and CVD mortality.

Banach and colleagues searched electronic databases to source data from studies that reported on daily step counts in the general population. A total of 17 studies recruiting 22,689 participants with an average follow-up period of 7 years were included. The studies were conducted in different regions of the world, such as Australia, Japan, the United Kingdom and the United States. Participants were 64 years old on average, with 49% identifying as female.

More walking – even if it’s a small amount – benefits health

A 1000-step increment was associated with a 15% decline in risk of all-cause mortality and boosting step count by just 500 steps was associated with a 7% reduction in risk of dying from CVD. The health benefits continued to increase in individuals that walked up to 20,000 steps per day but, as the researchers did not have access to data beyond 20,000 steps, they cannot confirm what the “upper limit” would be.

Banach and colleagues’ work also assessed whether the benefits of walking differed across participants of different ages, sex or location. In participants aged 60 years or older, there was a 42% decrease in risk of death for individuals that walked between 6,000–10,000 steps per day. In contrast, participants that were younger than 60, who walked between 7,000–13,000 steps per day, had a 49% decrease in risk of death.

“Our study confirms that the more you walk, the better,” says Banach. “We found that this applied to both men and women, irrespective of age, and irrespective of whether you live in a temperate, sub-tropical or sub-polar region of the world, or a region with a mixture of climates.”

Exercise the “hero” of health

Banach emphasizes that in a society that places so much focus on treating diseases, we need to consider the effect of lifestyle changes including diet and exercise, the latter of which he calls the “hero” of the study’s analysis: “We still need good studies to investigate whether these benefits may exist for intensive types of exertion, such as marathon running and iron man challenges, and in different populations of different ages, and with different associated health problems. However, it seems that, as with pharmacological treatments, we should always think about personalising lifestyle changes,” he says.

The research team note that while this is the largest meta-analysis of its kind, the study does have some limitations. It is observational in nature, meaning it cannot prove causation. While an increased step count is associated with a reduced risk of death and CVD risk, we cannot say with certainty that walking is the cause of this. Furthermore, the study utilized data from healthy populations, so the data is not necessarily applicable to individuals battling health conditions.

That being said, the researchers are confident that their data may be used to promote public awareness of the importance of physical activity, “particularly in the easily implementable activity of walking.”

Reference: Banach M, Lewek J and Surma S, et al. The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. EJPC. 2023. doi: 10.1093/eurjpc/zwad229

This article is a rework of a press release issued by the European Society of Cardiology. Material has been edited for length and content.