Even a short walk helps to reduce the risk of mortality

reference

lee im, Shiroma ej, Kamada M, Bassett Dr, Matthews CE, BUSING JE. Association of step volume and intensity with total mortality in older women. Jama internal med . 2019; 179 (8): 1105-1112.

draft

A prospective cohort study that tests the connection between physical activity, measured in steps per day, and the overall mortality

participant

The study cocoton locations comprised 18,289 women in the Women’s Health Study, who in 2011 and 2015 bore a accelerator on seven days in the wake state (n = 16,741). Their average age was 72 years.

target parameter

deaths were found either by family members or public records.

important knowledge

504 women died during an average follow -up period of 4.3 years. Conversely, the risk of death was connected to the number of steps a day. The risk of death decreased significantly with increasing number of daily steps. After the number of steps and intensity of the effort, interpreted from the frequency of the steps, the women were divided into 4 quarters. Those in the first quartile took an average of 2,718 steps a day; In the second quartile 4,363 steps a day; In the third 5,905 steps a day; and in the fourth quartile 8,442 steps a day.

If you set the relative risk of death for women in the lowest quartile of steps a day to 1.00, the risk for each quartile drops significantly. The risk dropped to 0.51 for people in the second quartile, 0.44 in the third and 0.33 in the fourth ( p <0.01; adapted to age and wearing time). Another adaptation for potential confoundation weakens the associations only slightly to 1.00, 0.59, 0.54 or 0.42 ( p <0.01).

The mortality rates continued to fall up to about 7,500 steps a day with increasing steps, at what point the benefit leveled off.

The absolute installment reduction for women in the fourth quartile compared to women in the first quartile was 9.3 deaths per 1,000 people. The Hazard Ratio (HR) fell by 15 %for another 1,000 steps a day. An additional adaptation for the body mass index (BMI), high blood pressure, high cholesterol and diabetes postponed the quartile heart frequencies to become more similar that were only adapted for age and the time of wearing (1.00, 0.54, 0.47, 0.34; p <0.01). When adapting to the step intensity in addition to disruptive factors, the associations were weakened, but all remained significant (HRS per quartile: 1.00, 0.68, 0.58; p <0.01).

The greatest impact was the reduction in the mortality rate by 41 % between women in the first and second quartile - that is, women who only took 2,700 steps a day compared to 4,400 steps a day. With increasing steps, the mortality rates continued to go up to around 7,500 steps a day at what point the benefit settled. The step intensity (basically how quickly you went) had relatively little influence on the mortality rates. The number of steps was more important than the intensity.

clinical implications

Many of our patients are obsessed with stepping. It is more than fashionable. Fitbit sold 14 million devices between 2010 and 2018. ^{1 Most people who have a Fitbit or another pedometer are certain that their goal is to take 10,000 steps a day, although this number is not based on evidence.}

Rather, the 10,000-step goal was apparently from Yamasa, a Japanese company that designed a pedometer named Manpo-Kei in 1965, a name that can be translated as "10,000-step meters". That was more of a marketing idea than a medical finding.

The stepping is nothing new. People have used it as a method for distance measurement since antiquity. The word mile is of Latin origin, from milia passum or thousands of steps. 3 If you could count, you could create exact cards and know where you are. The idea of ​​counting steps with mechanical aids goes back to Da Vinci. Thomas Jefferson had a tailor -made pedometer for himself when he lived in Paris, and found that in cold weather he took fewer steps to take a mile than with warm.

There is hardly any evidence of how many steps people actually have to take to improve their health. A meta -analysis by Oja et al. From 2018, in which walking intervention studies were examined, reported improvements in cardiovascular risk factors with increasing steps. In the meta -analysis of observation studies by Kelly et al. From 2014 it was reported that walking and cycling was in reverse relationship with the mortality rates, but their conclusions were recorded in metabolic equivalents of tasks (met) hours per week. ^{7 stamakis et al. In 2017 that faster walking is also conjured up with the mortality rate.}

There are a number of specific mortality studies that are worth mentioning. In 2015, Dwyer et al. About the number of steps and the overall mortality at a cohort of Tasmaniert and found a linear relationship between increasing daily steps and a reduced risk of mortality (n = 2,576). Compared to those who were described as sedentary, those who took 10,000 steps a day had a 46 % lower risk of mortality in the decade of follow -up. Those who increased their daily steps in the course of the study also experienced a significant reduction in the risk of mortality. An increase of 1,000 steps a day was associated with a risk reduction of 6 %. On older men (n = 1,655) from 2018, every step of 1,000 steps a day was connected by 14 % with a reduction in the risk of mortality.

Other step-counting studies have a lower risk of dysglycaemia, a decrease in obesity and improved insulin sensitivity with increasing steps. ^{11 In the opinion of the patients, however, this type of improvements generally outweigh changes in the risk of mortality.}

This current study by Lee et al. Was much more extensive than previous research attempts, and pedometer technology became more and more sophisticated over time. Based on these results, the evidence indicates that the health benefits level off at around 7,500 steps a day, at least in terms of mortality. This can be a problem, since the 10,000-step goal is now so firmly anchored in public conviction that it can only cause your patients to question your specialist knowledge.

Maybe it is best to keep the patients think that their goal is 10,000 steps, and if they admit that they have only reached 7,500 steps, they explain the evidence. The real profit is to get the room stools, the lowest quartile (<2,700 steps a day), to move more. While we should encourage all of our patients to go, we should make our greatest effort where it makes the biggest difference.