Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality

Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality

 

Key Points

 

Questions  What are the associations of daily step counts with cancer and cardiovascular disease incidence and mortality and all-cause mortality; and does the intensity of steps have additional benefits?

Findings  This population-based prospective cohort study using UK Biobank data for 78 500 individuals (mean age, 61 years) found that more steps per day (up to about 10 000 steps) was associated with declines in mortality risks and decreased cancer and CVD incidence. Peak-30 cadence (stepping intensity) showed consistent associations with improved morbidity and mortality rates.

Meaning  These findings indicate that accumulating more steps per day (up to about 10 000) may be associated with a lower risk of all-cause, cancer, and CVD mortality and incidence of cancer and CVD; higher step intensity may provide additional benefits.

 

Abstract

 

Importance  Recommendations for the number of steps per day may be easier to enact for some people than the current time- and intensity-based physical activity guidelines, but the evidence to support steps-based goals is limited.

Objective  To describe the associations of step count and intensity with all-cause mortality and cancer and cardiovascular disease (CVD) incidence and mortality.

Design, Setting, and Participants  This population-based prospective cohort study used data from the UK Biobank for 2013 to 2015 (median follow-up, 7 years) and included adults 40 to 79 years old in England, Scotland, and Wales. Participants were invited by email to partake in an accelerometer study. Registry-based morbidity and mortality were ascertained through October 2021. Data analyses were performed during March 2022.

Exposures  Baseline wrist accelerometer-measured daily step count and established cadence-based step intensity measures (steps/min): incidental steps, (<40 steps/min), purposeful steps (≥40 steps/min); and peak-30 cadence (average steps/min for the 30 highest, but not necessarily consecutive, min/d).

Main Outcomes and Measures  All-cause mortality and primary and secondary CVD or cancer mortality and incidence diagnosis. For cancer, analyses were restricted to a composite cancer outcome of 13 sites that have a known association with reduced physical activity. Cox restricted cubic spline regression models were used to assess the dose-response associations. The linear mean rate of change (MRC) in the log-relative hazard ratio for each outcome per 2000 daily step increments were also estimated.

Results  The study population of 78 500 individuals (mean [SD] age, 61 [8] years; 43 418 [55%] females; 75 874 [97%] White individuals) was followed for a median of 7 years during which 1325 participants died of cancer and 664 of CVD (total deaths 2179). There were 10 245 incident CVD events and 2813 cancer incident events during the observation period. More daily steps were associated with a lower risk of all-cause (MRC, −0.08; 95% CI, −0.11 to −0.06), CVD (MRC, −0.10; 95% CI, −0.15 to −0.06), and cancer mortality (MRC, 95% CI, −0.11; −0.15 to −0.06) for up to approximately 10 000 steps. Similarly, accruing more daily steps was associated with lower incident disease. Peak-30 cadence was consistently associated with lower risks across all outcomes, beyond the benefit of total daily steps.

Conclusions and Relevance  The findings of this population-based prospective cohort study of 78 500 individuals suggest that up to 10 000 steps per day may be associated with a lower risk of mortality and cancer and CVD incidence. Steps performed at a higher cadence may be associated with additional risk reduction, particularly for incident disease.

Article Information

Accepted for Publication: July 20, 2022.

Published Online: September 12, 2022. doi:10.1001/jamainternmed.2022.4000

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 del Pozo Cruz B et al. JAMA Internal Medicine.

Corresponding Author: Borja del Pozo Cruz, PhD, Department of Sport Sciences and Clinical Biomechanics, Center for Active and Healthy Ageing, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark (bdelpozocruz@health.sdu.dk).

Author Contributions: Drs del Pozo Cruz and Stamatakis had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs del Pozo Cruz and Ahmadi contributed equally as co-first authors.

Concept and design: del Pozo Cruz, Ahmadi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: del Pozo Cruz, Ahmadi.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: del Pozo Cruz, Ahmadi.

Obtained funding: Stamatakis.

Administrative, technical, or material support: del Pozo Cruz, Ahmadi, Stamatakis.

Supervision: del Pozo Cruz, Stamatakis.

Conflict of Interest Disclosures: None were reported.

Funding/Support: This work was supported by the University of Southern Denmark (Dr del Pozo Cruz) and by the National Health and Medical Research Council (Dr Stamatakis; investigator grant No. APP1194510).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Date: September 12, 2022

 

Borja del Pozo Cruz, PhD¹; Matthew N. Ahmadi, PhD²; I-Min Lee, MBBS, ScD^3,4; et al

 

JAMA Intern Med. Published online September 12, 2022. doi:10.1001/jamainternmed.2022.4000

 

Link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2796058

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