The relationships between step count and all-cause mortality and cardiovascular events:A dose-response meta-analysis

Background:A goal of 10,000 steps per day is widely advocated,but there is little evidence to support that goal.Our purpose was to examine the dose-response relationships between step count and all-cause mortality and cardiovascular disease risk.Methods:Cochrane Central Register of Controlled Trials,EMBASE,OVID,PubMed,Scopus,and Web of Science databases were systematically searched for studies published before July 9,2021,that evaluated the association between daily steps and at least 1 outcome.Results:Sixteen publications(12 related to all-cause mortality,5 related to cardiovascular disease;and 1 article contained 2 outcomes:both allcause death and cardiovascular events) were eligible for inclusion in the meta-analysis.There was evidence of a nonlinear dose-response relationship between step count and risk of all-cause mortality or cardiovascular disease(p-0.002 and p=0.014 for nonlinearity,respectively).When we restricted the analyses to accelerometer-based studies,the third quartile had a 40.36% lower risk of all-cause mortality and a 35.05%lower risk of cardiovascular event than the first quartile(all-cause mortality:Q1=4183 steps/day,Q3=8959 steps/day;cardiovascular event:Q1=3500 steps/day,Q3=9500 steps/day;respectively).Conclusion:Our meta-analysis suggests inverse associations between higher step count and risk of premature death and cardiovascular events in middle-aged and older adults,with nonlinear dose-response patterns.