Patient-Oriented Evidence That Matters

Increased Daily Steps Associated with Reduced All-Cause Mortality


Am Fam Physician. 2020 Oct 15;102(8):online.

Clinical Question

Is daily step count and the intensity of steps associated with the risk of premature mortality?

Bottom Line

This study found that a greater number of daily steps was significantly associated with lower all-cause mortality. Step intensity was not significantly associated with mortality after controlling for total daily steps. (Level of Evidence = 1b)


The investigators reviewed data obtained from the National Health and Nutrition Examination Survey focusing on participants who were asked to wear a hip accelerometer during waking hours for a seven-day period from 2003 to 2006. Individuals with at least one day of valid wear (at least 10 hours) were included. Additional data collection included demographic information (e.g., age, sex, education), smoking status, alcohol intake, and diagnoses of chronic medical conditions (e.g., diabetes mellitus, heart disease, stroke, cancer, chronic bronchitis). In addition to counting steps, step intensity was estimated based on extended bouts of stepping and peak one-minute and 30-minute cadences. Assessments of mortality occurred via the U.S. National Death Index.

Participants (N = 4,840) took a mean of 9,124 steps per day. The incidence of all-cause mortality was 76.7 per 1,000 person-years for individuals who took fewer than 4,000 steps per day; 21.4 per 1,000 person-years for individuals who took 4,000 to 7,999 steps per day; 6.9 per 1,000 person-years for individuals who took 8,000 to 11,999 steps per day; and 4.8 per 1,000 person-years for individuals who took at least 12,000 steps per day. After controlling for total steps per day, greater step intensity was not significantly associated with lower mortality.

Study design: Cohort (prospective)

Funding source: Foundation

Setting: Population-based

Reference: Saint-Maurice PF, Troiano RP, Bassett DR Jr, et al. Association of daily step count and step intensity with mortality among US adults. JAMA. 2020;323(12):1151–1160.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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