Adults who accumulated most of their daily steps in bouts lasting at least 10 minutes had up to an approximately 80% lower risk of death and a 70% lower risk of cardiovascular disease compared with those whose steps were taken in shorter bursts, according to a recent study. Researchers conducted a prospective cohort study, published in Annals of Internal Medicine, examining how step accumulation patterns affect cardiovascular and mortality risk in suboptimally active adults.
Using accelerometer data from 33,560 participants in the UK Biobank, the researchers evaluated whether accumulating daily steps in short bursts or longer, sustained bouts influenced health outcomes among adults averaging 8,000 steps per day or fewer. All participants were free of cardiovascular disease (CVD) and cancer at baseline and had valid accelerometer recordings for at least 3 days between 2013 and 2015.
“We found that among suboptimally active participants (those with an average daily step count <8000), those who accumulated most of their steps in longer bouts had lower risks for all-cause mortality and CVD than those whose steps were mostly taken in shorter bouts,” noted the lead author Borja del Pozo Cruz, PhD, of the Department of Sport Sciences, Faculty of Medicine, Health, and Sports, Villaviciosa de Odón, Madrid, Spain, and colleagues.
Participants were divided into four groups based on the duration of the bouts in which they accumulated most of their steps: less than 5 minutes, 5 to less than 10 minutes, 10 to less than 15 minutes, and 15 minutes or more. Over an average follow-up of 7.9 years (266,283 person-years), the study recorded 735 deaths and 3,119 CVD events. Inverse probability weighting was applied to balance covariates including age, sex, body mass index, smoking history, alcohol consumption, sleep duration, and comorbidities.
The 9.5-year cumulative all-cause mortality declined as duration increased: 4.36% for bouts less than 5 minutes, 1.83% for 5 to less than 10 minutes, 0.84% for 10 to less than 15 minutes, and 0.80% for 15-minute or more bouts. Similarly, the cumulative CVD incidence was 13.03%, 11.09%, 7.71%, and 4.39%, respectively. Compared with participants with bouts less than 5 minutes, those with bouts 15 minutes or more had a relative risk of death of 0.17 and a relative risk of CVD of 0.32.
The associations were strongest among sedentary adults (<5,000 steps per day). In this subgroup, all-cause mortality dropped from 5.13% to 0.86%, and CVD incidence declined from 15.39% to 6.89% across increasing bout durations. Results remained consistent in sensitivity analyses excluding frail participants, those with poor self-rated health, or early follow-up events.
In an accompanying editorial, Fabian Sanchis-Gomar, MD, PhD, Carl J. Lavie, MD, and Maciej Banach, MD, PhD, highlighted that sustained walking sessions of 10 to 15 minutes may better stimulate cardiometabolic mechanisms such as improved heart rate variability, endothelial function, and insulin sensitivity. The researchers noted that encouraging longer walking bouts, particularly among sedentary adults, may help reduce cardiovascular risk and that future physical activity guidelines could consider both the total amount of walking and the way steps are accumulated. “In addition to encouraging patients (especially those who are least active) to increase total steps, it may also be important to recommend walking sessions of 10 to 15 minutes, or at least taking most daily steps in a row,” noted Fabian Sanchis-Gomar, MD, PhD, of the Department of Medicine, Division of Cardiovascular Diseases, Stanford University School of Medicine, Stanford, California, and colleagues.
Full disclosures can be found in the published study and editorial.
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