Take a Hike - The Sun is Shining (kinda)
The incremental risk reduction in disease a step at a time
You’ve probably heard of that you should be walking 10,000 steps a day to reach peak health. However, you should know that this number was not based on any science or research, but instead it was a v successful marketing campaign launched in Japan prior to the 1964 Tokyo Olympics. Apparently, the Japanese character for 10,000 (万) looks a bit like a man walking. It caught on, and spread worldwide.
But do we really need to take 10k steps a day for our health?
Undoubtedly, the more steps you take the more you work out, so surely they must not be a negative side to doing 10k or 11k steps - but that does not necessarily translate to added benefit with respect to health and disease risk reduction.
Historically, literature has not agreed on the optimal number of steps, a 2019 JAMA study stated that 4.4k steps per day for older women (mean age: 72 yrs) has significantly lower mortality rates over a 4.3 yr follow-up when compared to women that were more sedentary, doing around 2.7k steps per day. 1 Another JAMA study, using UK Biobank data with 78.5k participants and a mean age of 61 yrs showed that up to about 10k steps per day was associated with declines in mortality risks, decreased cancer, and CVD incidence. They also noted that steps at a higher cadence may be associated with additional risk reduction, where cadence means the number of steps per minute 2 - so if you live in London you already are advantaged due to the London pace. As you can see from the picture below (figure A), the daily steps flatten out around the 10k mark. The remaining three graphs show: 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).
![](https://substackcdn.com/image/fetch/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F5c4fb641-32a3-490b-bedd-a2fd054d8f79_1955x1491.png)
Beside death and disease, dementia incidence has also been looked at - and yet again another JAMA study reported that a higher number of steps was associated with lower risk of all-cause dementia in the UK Biobank cohort. 3 However, they stated that the more steps was indeed better but under the usual 10k steps per day in combination with higher intensity had even better results.
Another aspect looked at, is also the sedentary time of individuals - it’s known that a higher time is associated with increased risk for mortality and morbidity. A BMJ study using the UK Biobank data concluded that there was a 10% lower CVD risk for an equiv number of daily steps for low sedentary time compared to high. They also noted that lowest mortality rates were seen for those with steps of 9k - 10.5k steps per day, regardless of sedentary time. Any amount of daily steps above 2.2k steps was associated with lower mortality and incident CVD risk, for low and high sedentary time groups.4 For reference, high sedentary time was defined as ≥ 10.5 hrs per day and low as < 10.5 hrs per day, so you can automatically identify yourself as high if you’re working a corporate job…
However, there are some things to be noted about these studies. Most used the UK Biobank database with the related accelerometer data that the participants were wearing for 7 days, so one may argue it may not be truly reflective of one’s lifestyle. I think we all see how our step count varies between some weeks. Also, in some cases, see the graph above, increasing past the threshold showed resulted in higher hazard ratios.
A big aspect is also the sedentary lifestyle most of us have being glued behind a screen (or two, or three even…) for the majority of our day. That being said there was a randomised crossover trial published in 2023, showing that even 5 mins of walking every 30 mins improved blood sugar levels and blood pressure, and even a 1 min walking break every 30 mins also provided benefits but with lower impact on blood sugar. 5 High blood pressure is a risk factor for heart attacks and strokes, while elevated blood sugar levels occur in pre-diabetics / diabetics and can damage blood vessels, the heart and the kidneys.
Just a few days ago the NHS App announced that it will monitor patients step counts as part of government plans to get the nation healthier and back to work. 6 Now, will this directly make people healthier - simple answer is no. But it’s known how difficult it is to collect any sort of dietary and lifestyle data retrospectively, as (i) people lie about it as they’re embarrassed and not comfortable and (ii) it is hard to accurately state of the top of your head what the actual value may be. Although this may not be life saving, the communication of the step count and education about the effect may lead to people walking more instead of say taking their car etc. Another aspect, is post-operative care, you’re always advised to walk after having an operation and if it’s one of orthopaedic nature especially in the lower limbs this could also indicate the success of it with people going back to their original state and abilities.
To wrap up, outside of the physical health aspect, walking also helps with reducing stress and anxiety, as well as increasing energy levels. You also get direct vitamin D exposure via the sun, which is highly important for most bodily functions. So, as the weather is getting a tad warmer and the days are longer, put on a podcast or call a friend and go for a nice walk - maybe even during your lunch break or before you start your working day so you feel like you’ve completed at least one thing prior to starting a long day.
As usual, I’ve added some links below. I hope you enjoyed - see you next week! :)
Lee I, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Intern Med. 2019;179(8):1105–1112. doi:10.1001/jamainternmed.2019.0899
del Pozo Cruz B, Ahmadi MN, Lee I, Stamatakis E. Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality. JAMA Intern Med. 2022;182(11):1139–1148. doi:10.1001/jamainternmed.2022.4000
del Pozo Cruz B, Ahmadi M, Naismith SL, Stamatakis E. Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK. JAMA Neurol. 2022;79(10):1059–1063. doi:10.1001/jamaneurol.2022.2672
Ahmadi MN, Rezende LFM, Ferrari G, et al Do the associations of daily steps with mortality and incident cardiovascular disease differ by sedentary time levels? A device-based cohort study British Journal of Sports Medicine 2024;58:261-268. doi:10.1136/bjsports-2023-107221
DURAN, ANDREA T.; FRIEL, CIARAN P.; SERAFINI, MARIA A.; ENSARI, IPEK; CHEUNG, YING KUEN; DIAZ, KEITH M.. Breaking Up Prolonged Sitting to Improve Cardiometabolic Risk: Dose–Response Analysis of a Randomized Crossover Trial. Medicine & Science in Sports & Exercise 55(5):p 847-855, May 2023. | DOI: 10.1249/MSS.0000000000003109