The short answer
In this pooled analysis, people who took more steps a day tended to have lower mortality during follow-up. For adults 60 years and older, risk was progressively lower with more steps up to around 6,000 to 8,000 steps a day, where the fitted curve levelled off. For younger adults, it levelled off at around 8,000 to 10,000 steps a day.
These fitted curves do not establish an optimal step count or show that additional steps have no value. This is a pattern in groups of people followed over time. It does not prove that walking more caused the lower risk.
What this study cannot tell us
It cannot show that taking more steps lowers anyone’s risk. Nobody in these studies was asked to change how much they walked. Step counts were recorded for one week at baseline, and people were then followed. Healthier people tend to walk more, and the authors say that other differences between people, and illness leading to less walking, might still be part of the picture.
It cannot tell you your own risk. The results describe groups of people, not what will happen to an individual.
It cannot say whether walking faster matters beyond the total number of steps. The authors call their findings on walking pace inconclusive.
Who was studied
The analysis combined 15 studies with 47,471 adults in total. The studies came from Europe, Japan, Australia and the United States, plus a multi-country study.
People were followed for a median of 7.1 years, and 3,013 of them died during that time.
All the studies were in high-income countries, the participants were volunteers, and most were White. The authors say this limits how far the results can be applied to everyone.
What was compared
Within each study, people were sorted into four equal-sized groups by their average daily steps, from the least active group to the most active group. Every group was compared with the least active group.
In the least active group, the typical person took about 3,553 steps a day. In the most active group, the typical person took about 10,901.
The authors compared adults 60 years and older with adults under 60 years.
What was measured
Each person wore a step-counting device for one week at the start. They were then followed for death from any cause, taken from death certificates and country records.
The main results were adjusted for age, sex, race and ethnicity, education or income, body mass index, and measures of chronic disease that differed from study to study. Adjusting helps, but it cannot remove every difference between people who walk a lot and people who do not.
The main finding
Compared with the least active group, the next group up had a hazard ratio of 0.60 (95% CI 0.51–0.71). A hazard ratio below the neutral value means a lower rate of death in that group during follow-up. The numbers in brackets are confidence intervals, which show uncertainty around each estimate.
The group above that had a hazard ratio of 0.55 (0.49–0.62), and the most active group had 0.47 (0.39–0.57). All the more active groups had a lower risk of death than the least active group.
For adults 60 years and older, the fitted curve showed lower risk with more steps up to about 6,000 to 8,000 steps a day, then levelled off. For younger adults, it levelled off at about 8,000 to 10,000 steps a day. The age-group difference was statistically clear (p = 0.012).
Older adults in the study walked fewer steps on average. A typical adult 60 years and older took 5,649 steps a day, compared with 7,803 for younger adults.
Limits of the study
Every study in the analysis was observational. The authors say causal conclusions cannot be drawn.
Steps were measured at a single point in time. A person’s walking can change over the years, and the study could not follow those changes.
Step counters disagree. Counts from different devices can differ by 20% or more, so your own device may not match the counts used here. The authors also say devices might undercount steps for frail older adults who walk slowly.
People who become ill may walk less before a diagnosis. The authors say this kind of reverse causality may still affect the pattern they found.
If you are 70 or older
This paper reports adults 60 years and older as its older group. In the main text we could read, it does not split that group further, so we cannot say whether the fitted association differs for the oldest adults.
The authors note that the curve falls most steeply at low step counts, and suggest that adding steps might lower risk most for people who currently walk little. That is their interpretation, and this kind of study cannot prove it. If you have a health condition, your own clinician is the right person to help you plan a change in activity.
How it fits the other evidence
Other large studies in adults in the United States and the United Kingdom also found lower mortality with more daily steps, and a separate pooled analysis of long-term studies found a curved rather than a straight-line pattern, with lower risk at each higher step count it looked at rather than a clear levelling off. They are listed under “The paper” below.
These analyses draw on overlapping groups of studies, so their agreement shows consistency, not independent proof. The authors also say that lower mortality, particularly for older adults, was seen at step counts below the popular 10,000 steps a day target.
What it means for your marker page
The daily steps page on MarkerScore explains the measure and lists its sources. This article is another study read in plain English.
The paper
Paluch et al. (Steps for Health Collaborative) (2022). Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. The Lancet Public Health. Read the paper PMID 35247352
Other papers mentioned
- Banach et al. (2023). The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. European Journal of Preventive Cardiology. Read the paper
- Saint-Maurice et al. (2020). Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. Read the paper
- Del Pozo Cruz et al. (2022). Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality. JAMA Internal Medicine. Read the paper
Where every number comes from
Each number above links here. The words in quotation marks are copied from the paper (PMC9289978 (open-access full text from NCBI PMC)).
15 (studies)
The meta-analysis pooled 15 studies that followed people over time, seven published and eight unpublished.
Found in: Abstract (p. e219)
“We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018.”
47,471 (people)
The pooled sample was 47,471 adults.
Found in: Abstract (p. e219)
“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”
3,013 (deaths)
There were 3,013 deaths from any cause across the studies.
Found in: Abstract (p. e219)
“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”
7.1 years (years)
Median follow-up was 7.1 years.
Found in: Abstract (p. e219)
“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)”
60 years and older (years)
The study split adults into younger (under 60) and older (60 and above) groups.
Found in: Methods; Figure 3 (article e219-e228)
“Age was grouped into younger (<60 years) and older (≥60 years) groups”
under 60 years (years)
The study grouped adults younger than 60 years as the younger group.
Found in: Methods; Figure 3 (article e219-e228)
“Age was grouped into younger (<60 years) and older (≥60 years) groups”
3,553 (steps/day)
In the lowest quarter of walkers, the median was 3,553 steps a day.
Found in: Abstract (p. e219)
“Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4.”
10,901 (steps/day)
In the highest quarter of walkers, the median was 10,901 steps a day.
Found in: Abstract (p. e219)
“Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4.”
0.60 (95% CI 0.51–0.71) (hazard ratio)
Second-lowest quarter vs lowest quarter, all-cause mortality, adjusted hazard ratio.
Found in: Abstract (p. e219); Figure 2 (article e219-e228)
“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.”
0.55 (0.49–0.62) (hazard ratio)
Second-highest quarter vs lowest quarter, all-cause mortality, adjusted hazard ratio.
Found in: Abstract (p. e219); Figure 2 (article e219-e228)
“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.”
0.47 (0.39–0.57) (hazard ratio)
Highest quarter vs lowest quarter, all-cause mortality, adjusted hazard ratio.
Found in: Abstract (p. e219); Figure 2 (article e219-e228)
“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.”
6,000 to 8,000 steps a day (steps/day)
Among adults 60 and older, the fitted curve associated more steps with lower mortality until about 6,000 to 8,000 steps a day. The curve analysis left out one of the 15 studies, because its step data were processed with a setting that inflates daily step counts (Methods).
Found in: Abstract (p. e219); Figure 3 (article e219-e228)
“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”
8,000 to 10,000 steps a day (steps/day)
Among adults under 60, the fitted curve associated more steps with lower mortality until about 8,000 to 10,000 steps a day. The curve analysis left out one of the 15 studies, because its step data were processed with a setting that inflates daily step counts (Methods).
Found in: Abstract (p. e219); Figure 3 (article e219-e228)
“and among adults younger than 60 years until 8000–10 000 steps per day”
5,649 (steps/day)
Adults 60 and older had a median of 5,649 steps a day.
Found in: Results; age-stratified step-count comparison (article e219-e228)
“Adults younger than 60 years had significantly higher median steps per day (7803 [IQR 5377–10 352]) than did adults aged 60 years and older (5649 [IQR 3686–8092]; p=0.033).”
7,803 (steps/day)
Adults under 60 had a median of 7,803 steps a day.
Found in: Results; age-stratified step-count comparison (article e219-e228)
“Adults younger than 60 years had significantly higher median steps per day (7803 [IQR 5377–10 352]) than did adults aged 60 years and older (5649 [IQR 3686–8092]; p=0.033).”
10,000 steps a day (steps/day)
The authors say mortality associations are seen below the popular 10,000 steps a day reference.
Found in: Discussion (article e219-e228)
“Our findings suggest mortality benefits, particularly for older adults, can be seen at levels less than the popular reference of 10 000 steps per day.”
20% (percent)
Step counts from different devices can differ by 20% or more.
Found in: Discussion (article e219-e228)
“Step counts obtained from research and consumer devices are highly correlated but can vary by 20% or more;”
four equal-sized groups (groups)
Each study split people into quartiles (four equal-sized groups) of average daily steps, with the lowest quartile as the reference.
Found in: Methods; Individual study-level analyses (article e219-e228)
“Investigators of participating studies were asked to categorise step volume into quartiles across the study population and examine associations with all-cause mortality (referenced against the lowest quartile)”
one week (weeks)
Participants wore a step-counting device for one week at baseline, then were followed for death from any cause.
Found in: Methods; Individual study-level data processing (article e219-e228)
“In each study, participants wore a step counting device for 1 week, considered baseline in this study, and then were followed up for death from any cause.”
0.012 (p value)
The difference in the curve between the under-60 and 60-and-older groups had p = 0.012.
Found in: Results; Figure 3 (article e219-e228)
“There was a significant interaction (p=0.012) by age group in the spline model”
Europe, Japan, Australia, the United States and one multi-country study (no unit)
The studies came from Europe, Japan, Australia and the USA, and one used data from 40 countries.
Found in: Results; Table 1 (article e219-e228)
“including four studies in Europe, one in Japan, one in Australia, eight in the USA, and one that included data from 40 countries”
All-cause mortality from death certificates and country registries (no unit)
The primary outcome was death from any cause, taken from death certificates and country registries.
Found in: Methods; Individual study-level data processing (article e219-e228)
“Our primary outcome was all-cause mortality collected from death certificates and country registries.”
Adjusted for age, sex, race and ethnicity, education or income, body-mass index and chronic disease measures (no unit)
The main model (model 2) adjusted for these factors.
Found in: Methods; Individual study-level analyses; Figure 2 (article e219-e228)
“Model 2 also adjusted for age, sex, race and ethnicity, education or income, body-mass index, and study-specific covariates for chronic disease”
Steps measured at a single timepoint (no unit)
The authors list a single-timepoint step measurement as a limitation.
Found in: Discussion; Limitations (article e219-e228)
“Steps were measured at a single timepoint.”
Devices might underestimate steps among frail older adults (no unit)
The authors say devices may miss steps at very slow walking speeds and might underestimate steps especially among frail older adults.
Found in: Discussion; device accuracy (article e219-e228)
“Therefore, devices might underestimate steps particularly among frail older adults.”
Steep early slope; authors suggest more steps may matter most at low step counts (no unit)
The authors read the steep early slope as suggesting that increasing steps might lower mortality risk most for people with lower step volumes. This is their interpretation of observational data.
Found in: Discussion; Figure 3 (article e219-e228)
“The steep early slope of the dose–response curve suggests increasing steps might be beneficial in terms of reducing risk of mortality, particularly among individuals who have lower step volumes.”
Observational data; causal inferences cannot be made (no unit)
The authors state the data are observational, so cause and effect cannot be concluded.
Found in: Discussion (article e219-e228)
“The data are derived from observational studies; therefore, causal inferences cannot be made.”
Residual confounding and reverse causality might remain (no unit)
The authors say residual confounding and reverse causality might still be present.
Found in: Discussion (article e219-e228)
“Although we attempted to control for sociodemographic, lifestyle, and health status factors in our analyses, residual confounding and reverse causality might still be present.”
High-income countries, volunteers, mostly White participants (no unit)
The authors say all studies were in high-income countries with volunteers who were mainly White.
Found in: Discussion (article e219-e228)
“All included studies were in high-income countries and participants were volunteers primarily among White populations, restricting generalisability of the findings.”
Inconclusive on walking pace beyond total steps (no unit)
The authors say their findings were inconclusive on whether walking pace adds to the link with lower mortality beyond total steps.
Found in: Discussion; Figure 4 (article e219-e228)
“Taken together, our findings were inconclusive when determining if step intensity has additional mortality benefits beyond that associated with total steps.”
Corrections
None recorded since publication.
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