A prospective study of 36,192 patients with established hypertension in the UK Biobank accelerometry sub-study found that each additional 1,000 steps per day was associated with a 17% reduction in the risk of major adverse cardiovascular events.
Patients had a mean age of 64 years, and 48% were male. Over an average follow-up of nearly 8 years, there were 1,935 documented cases of major adverse cardiovascular events, including cardiovascular death, heart failure, myocardial infarction, and stroke.
Researchers observed an inverse association between daily step count and the risk of major adverse cardiovascular events, with benefit seen at step counts well below the commonly cited 10,000-step threshold. Compared with a reference value of 2,344 steps per day, taking more than 3,000 steps per day and achieving higher stepping intensity (median peak 30-minute cadence, 77 steps per minute) were both associated with lower risk of major heart events among patients with hypertension.
Methodology
Hypertension was defined as meeting at least one of the following: a hospital diagnosis of hypertension, systolic blood pressure greater than 140 mmHg and diastolic blood pressure greater than 90 mmHg at baseline, or self-reported use of antihypertensive medication. Participants wore a wrist-worn accelerometer for 7 consecutive days, and step counts were averaged across valid days. The primary endpoint was major adverse cardiovascular events, defined as cardiovascular death, incident heart failure, myocardial infarction, or stroke.
Results
Any number of steps above 2,344 steps per day was associated with lower risk of major adverse cardiovascular events. Each 1,000-step increase in daily step count led to the following average reductions in risk:
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Major adverse cardiovascular events: 17%
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Heart failure: 22%
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Myocardial infarction: 9%
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Stroke: 25%
Higher stepping intensity, as measured by the median peak 30-minute cadence (77 steps per minute), was associated with a 30% lower risk of major adverse cardiovascular events, with lower risk observed at higher stepping intensities above the reference point of 38 steps per minute.
Cardiovascular Event Subtypes
There were 523 cases of heart failure during follow-up, including congestive heart failure, heart failure with preserved ejection fraction, and unspecified heart failure. Each 1,000 steps per day increase in daily step count was associated with a 22% lower risk of heart failure.
Among 525 cases of stroke, 74% were ischemic and 14% were hemorrhagic. There was a linear inverse association between daily step count and stroke risk, with each 1,000-step increase associated with a 25% reduction in stroke risk.
Sex Differences
No significant interaction was found between sex and daily step count for overall major adverse cardiovascular event risk. There was no evidence that the association between daily step count and risk of major adverse cardiovascular events was modified by sex.
Clinical Implications
The researchers noted:
“Instead of framing step-based recommendations around a single minimal threshold, our findings reaffirm the message that ‘any amount of physical activity is better than none, and more is better’ for people living with chronic disease.”
Strengths
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Large sample size
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Highly granular physical activity data collected using wearable devices
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Step count estimation during walking activities using a validated machine learning schema
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Registry-based, prospectively collected data to ascertain cardiovascular events
Limitations
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Physical activity was measured only at baseline; step counts and cadence may not reflect habitual patterns or changes over time
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Five-year time difference between accelerometry data and measurement of covariates
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Potential for reverse causation and unmeasured confounding
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Study population was primarily White, healthier, and more educated than the general UK population, which may limit generalizability
Funding and Disclosures
The study was funded by the Australian National Health and Medical Research Council Investigator Grant. One researcher reported consulting and equity interests in Complement 1, a company with products related to the article content; all other researchers declared no conflicts of interest.