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 all-cause 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.