Physicians' Academy for Cardiovascular Education

Minimal and optimal daily step counts for healthy individuals to reduce mortality and CVD risks

Relationship of Daily Step Counts to All-Cause Mortality and Cardiovascular Events

Literature - Stens NA, Bakker EA, Mañas A, et al. - J Am Coll Cardiol. 2023 Aug 26;S0735-1097(23)06400-8. doi: 10.1016/j.jacc.2023.07.029

Introduction and methods


Studies have shown that walking an additional 1000 steps per day is associated with a reduced risk of all-cause mortality of 12%–15% [1,2] and lower odds of frailty [3]. However, the minimal and optimal daily step counts for health improvements have not been fully established.

Aim of the study

The authors examined the dose-response association of objectively measured step count metrics with all-cause mortality and incident CVD in the general population, as well as the moderating effects of sex, device type and wear location, and step cadence on the step count assessment.


In this systematic review and meta-analysis, a systematic literature search was performed in PubMed and EMBASE from inception to October 2022 to identify eligible prospective cohort studies. In total, 12 studies were included (n=111,309). The risk of bias was low for all studies, except for one that had an intermediate risk for bias. Publication bias was considered to be minimal.


The primary endpoints were all-cause mortality and incident fatal or nonfatal CVD, which included ischemic or coronary heart disease, stroke, and/or HF.

Main results

Categorical dose-response association between daily step count and clinical outcomes

Continuous dose-response association between daily step count and clinical outcomes

Moderating effects on step count assessment


In this systematic review and meta-analysis of prospective cohort studies among the general population, walking a minimum of ~2600 steps per day lowered the risk of all-cause mortality by 8% compared with a daily step count of 2000, while a daily minimum of ~2800 steps reduced incident CVD risk by 11%. The optimal daily step count for risk reduction was ~8800 for mortality (leading to 60% risk reduction) and ~7200 for CVD (leading to 51% risk reduction). Intermediate and high step cadences were also associated with a decreased mortality risk compared with a low step cadence, irrespective of total step count.

The authors believe that setting physical activity goals based on step count could be a promising public health tool and contend that “[ph]ysicians may stimulate individuals, even those who are moderately active, to increase their physical activity with at least 1,000 steps/day.”


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Find this article online at J Am Coll Cardiol.

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