Association of Daily Step Count and Step Intensity With Mortality Among US Adults | Cardiology | JAMA | JAMA Network
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Original Investigation
March 24/31, 2020

Association of Daily Step Count and Step Intensity With Mortality Among US Adults

Author Affiliations
  • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
  • 2Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
  • 3Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville
  • 4Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 5Epidemiology and Population Science Laboratory, National Institute on Aging, Bethesda, Maryland
JAMA. 2020;323(12):1151-1160. doi:10.1001/jama.2020.1382
Key Points

Question  What are the associations between daily step counts and step intensity with mortality among US adults?

Findings  In this observational study that included 4840 participants, a greater number of steps per day was significantly associated with lower all-cause mortality (adjusted hazard ratio for 8000 steps/d vs 4000 steps/d, 0.49). There was no significant association between step intensity and all-cause mortality after adjusting for the total number of steps per day.

Meaning  Greater numbers of steps per day were associated with lower risk of all-cause mortality.


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.