Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA.
Claude D. Pepper Older Americans Independence Center, Duke Aging Center, and the Department of Medicine, Duke University, Durham, NC, USA.
Int J Behav Nutr Phys Act. 2020 Jun 20;17(1):78. doi: 10.1186/s12966-020-00978-9.
Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes.
A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations.
Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics.
Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.
日常步数是一种直观的指标，已证明在激励成年人进行身体活动方面取得了成功，并且可能对未来的公共卫生身体活动建议具有潜力。本综述旨在阐明日常步数与全因死亡率、心血管疾病（CVD）发病率和死亡率以及血糖异常之间关联的模式，以及获得健康结果所需的日常步数。
进行了系统综述，以确定通过计步器或加速度计评估日常步数的前瞻性研究，并评估其与全因死亡率、CVD 发病率或死亡率以及血糖异常（血糖异常或糖尿病发病率、胰岛素敏感性、空腹血糖、HbA1c）之间的关联。检索范围包括 Medline、Embase、CINAHL 和 Cochrane 图书馆数据库，从建库至 2019 年 8 月 1 日。纳入标准包括具有健康结果评估的纵向设计，基线和后续时间点；将每天的步数定义为暴露因素；报告全因死亡率、CVD 发病率或死亡率和/或血糖异常结果；成人年龄≥18 岁；以及非患者人群。
确定了 17 项涉及超过 30000 名成年人的前瞻性研究。五项研究报告了全因死亡率（随访时间为 4-10 年），四项研究报告了心血管风险或事件（6 个月至 6 年），八项研究报告了血糖异常结果（3 个月至 5 年）。在纳入研究的亚组中，估计基线时每天增加 1000 步，可降低后续全因死亡率（6%-36%）和 CVD 风险（5%-21%）。在测试交互作用的研究中，没有证据表明年龄、性别、健康状况或行为（如饮酒、吸烟状况、饮食）存在显著的交互作用。研究血糖异常结果的研究报告了不一致的发现，部分原因是与血糖相关生物标志物结果、分析方法和样本特征有关的研究之间存在异质性。
来自纵向数据的证据一致表明，成年人每天多走 1000 步可以帮助降低全因死亡率和 CVD 发病率和死亡率的风险，并且在每天 10000 步以下就存在健康益处。然而，剂量反应关系的形状尚不清楚。目前尚无数据确定获得整体健康益处所需的日常步数的特定最低阈值。
