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

      research-article
      , PhD, , MS, , PhD, , PhD, , PhD, , PhD, , PhD, , PhD, , MD, , ScD, , PhD, , MD, , PhD, , DrPH, , PhD, , PhD, , PhD, , PhD, , PhD, , PhD, , PhD, , PhD, , MS, , PhD, , MD, , PhD, , MSc, , PhD, , PhD, , PhD, , PhD, , BA, , MD, , PhD, , PhD, , MHS, , PhD, , PhD, , PhD, , PhD, , PhD, , PhD, , PhD, , ScD, , PhD
      The Lancet. Public health

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          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          We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018.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.

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          Most cited references48

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          Measuring inconsistency in meta-analyses.

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            Bias in meta-analysis detected by a simple, graphical test

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              World Health Organization 2020 guidelines on physical activity and sedentary behaviour

              Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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                Author and article information

                Contributors
                Journal
                101699003
                46113
                Lancet Public Health
                Lancet Public Health
                The Lancet. Public health
                2468-2667
                11 July 2022
                March 2022
                18 July 2022
                : 7
                : 3
                : e219-e228
                Affiliations
                Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
                Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
                Department Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA
                Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
                Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway
                Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
                Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
                Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
                Department of Primary Care and Population Health, UCL Medical School, London, UK
                Molecular Physiology Institute and Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA
                Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA
                Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA
                Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
                Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
                Department of Population Science, American Cancer Society, Atlanta, GA, USA
                Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
                Department of Population Science, American Cancer Society, Atlanta, GA, USA
                Agaplesion Bethesda Clinic, Research Unit on Ageing, Ulm, Germany
                Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
                Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
                Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
                IB University of Applied Health and Social Sciences, Stuttgart, Germany
                Population Health Research Institute, St George’s, University of London, London, UK
                Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
                Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
                Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
                Department of Pediatrics, Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, TX, USA
                Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
                Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
                Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
                Department of Medicine, Boston University School of Medicine, Boston, MA, USA
                Department of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, USA
                Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden
                Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
                Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden
                Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
                School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
                Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway
                Department of Sport Medicine, Norwegian School of Sport Sciences, Norwegian Institute of Public Health, Oslo, Norway
                Department of Sport Science and Physical Education, University of Agder, Norway
                Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
                Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
                Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
                Murdoch Children’s Research Institute, Melbourne, VIC, Australia
                Murdoch Children’s Research Institute, Melbourne, VIC, Australia
                Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
                Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
                Department of Epidemiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
                Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
                Center on Aging and Health, Johns Hopkins School of Medicine, Baltimore, MD, USA
                Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
                Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
                Faculty of Collaborative Regional Innovation, Ehime University, Matsuyama, Ehime, Japan
                Institute for Pacific Rim Studies, Meio University, Nago, Okinawa, Japan
                Pennington Biomedical Research Center, Baton Rouge, LA, USA
                Pennington Biomedical Research Center, Baton Rouge, LA, USA
                Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
                Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
                Author notes

                Contributors

                AEP, DRB, MRC, UE, KRE, DAG, BJJ, WEK, I-ML, CEM, JDO, AVP, CFP, ER-P, and JEF conceived and designed the study and interpreted the data. AEP, CFP, and SB did the statistical analyses and accessed and verified the underlying study data. AEP and JEF drafted the manuscript. All authors acquired the data. All authors critically revised the manuscript for intellectual content. All authors had full access to the data in the study and had final responsibility for the decision to submit for publication.

                Correspondence to: Dr Amanda E Paluch, Department of Kinesiology, University of Massachusetts, Amherst, Amherst, MA 01003, USA, apaluch@ 123456umass.edu
                Article
                NIHMS1787838
                10.1016/S2468-2667(21)00302-9
                9289978
                35247352
                47a138f5-bd48-42af-a36d-96887aef76b6

                This is an Open Access article under the CC BY-NC-ND 4.0 license.

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