Daily steps reduce all-cause mortality

Findings from the Coronary Artery Risk Development in Young Adults (CARDIA), suggest there is a dose-response relationship between the number of daily steps people take and mortality. And the benefits of steps appear to help racially diverse populations equally, according to Dr. Amanda Paluch. She was lead author of a study investigating the effects of steps on younger adults. Results were published in JAMA Open Network with additional details in the Lancet. Findings showed the more steps the better with 7,000 steps a day being a good minimum, regardless of intensity. Any additional mortality benefits appeared to plateau at 10,000 steps. “Physical activity, such as walking, works on multiple mechanisms, affecting nearly every cell in body, to benefit our health. Benefits range from stronger bones and muscles, weight management, better mental health, and lower risk of diabetes, some cancers, and heart disease,” Dr. Paluch told the Medical Post. Read: Sudden cardiac death and intercourse Earlier studies demonstrated the benefits of daily steps in older adults but there was a need for more data on the effects on younger adults and racially diverse populations, she said. Race was considered because mortality rates are higher for Black adults than white adults, and there was a question of whether there were differences in the association of steps with mortality. The analyses included 2,110 participants with a mean age of 45.2 years, 57.1% were women. and 42.1% were Black. CARDIA was launched in 1985 and at the year 20 mark in 2005, participants wore an accelerometer that measured steps as part of a fitness study. Participants were divided into three groups: low daily steps (fewer than 7,000), moderate (7,000 to 10,000), and high (10,000 steps or more). At follow-up, 72 participants (3.4%) had died. When compared to participants in the low step group, there was significantly lower risk of mortality in the moderate and high step groups. Findings were similar between Black and white participants. There was no association of step intensity with mortality. Canadian doc suggests written prescriptions for steps But how can doctors encourage patients to walk a minimum number of steps each day? Ask Dr. Kaberi Dasgupta who helped develop the Step Monitoring to Improve Arterial Health (SMARTER) step-count prescription program. She is a professor of medicine at McGill University. “We designed a ‘prescription for steps’ for physicians to use with their type 2 diabetes patients and patients with hypertension,” she said. It was tested in a year-long study comparing patients using the step-count prescription approach to a control group given standard advice to walk each day. Findings were published in Diabetes, Obesity and Metabolism. Patients were given a target number of steps to achieve in the form of a prescription for steps signed by their doctor. They saw their doctor three or four times over a year during which time their steps were reviewed. If patients had increased their steps, higher targets were set. Patients tracked and wrote down their steps daily for one year. In the end, it was found those with a step-count prescription did an average of 1,200 steps per day more than the control arm—a lofty 20% increase. “Our patients had a low average activity level of 4,000 to 5,000 steps per day. We tried to encourage everyone to increase their steps by 3,000 per day over one year, with faster increases in more active people and slower increases in less active people. It takes about 10 minutes to complete 1,000 steps. The nice thing is that every step counts, whether you are walking down the hall or actually going out for a walk,” he said. Often, doctors just tell their patients to be more active which is too vague. “They didn’t get to the 3,000 steps per day increase, but they still had an important increase in their steps. They also had a 0.38% lower hemoglobin A1C than the control arm, comparable to a single glucose lowering medication,” Dr. Dasgupta said. The program turned out to be so effective that in 2018, Diabetes Canada added the SMARTER step-count prescription to its clinical practice guidelines. There are numerous devices and apps on the market that can help patients count steps and keep track of them. Dr. Dasgupta offered these tips to help patients increase their daily steps. Encourage patients to check their steps and to use some sort of step counter. Review their steps during clinic visits. If their steps are under 7,000 steps per day, encourage them upwards by as little as 250 to 500 steps per day, or larger increments of 1,000 to 2,000 daily steps for those are more motivated. Brainstorm ways to increase steps: walking around home, getting up when watching videos, walking to public transit or to destinations, parking the car further away. Help patients verify their step counter is working. Some counters require a particular position to capture steps. For people who already do 7,000 steps daily, consider adding more intensive forms of exercise such as stationary cycling, running or dancing. Add in some resistance training with small weights, bands, or at a gym. Online exercise videos can help. Dr. Dasgupta and her team reported on the cost of a step-count prescription compared to usual care, using data pertaining to the 174 patients from the earlier SMARTER study cohort. The researchers calculated nursing costs corresponding to patient support time over one year, pedometer costs for half of the patients (those without a smartphone), and estimated the number of cardiovascular disease (CVD) hospitalizations, the reduction expected with a mean 1,000 steps per day increase, and associated savings. The intervention cost an average of $51.28 per patient. Daily steps would lead to an estimated 8,875 CVD events prevented and a savings of $208 million. “This savings would result in about $40-million in net savings with 50% device ownership, cost neutrality with 25% device ownership, and about $42-million in net costs if all patients required the healthcare system to provide a device,” the study said.

Daily steps reduce all-cause mortality

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