Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
Department of Kinesiology and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
Lancet Public Health. 2022 Mar;7(3):e219-e228. doi: 10.1016/S2468-2667(21)00302-9.
Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality.
In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models.
We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]).
Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity.
US Centers for Disease Control and Prevention.
尽管每天走 10000 步被广泛宣传对健康有益，但几乎没有证据支持这一建议。我们旨在确定每天的步数和步频与全因死亡率之间的关联。
在本次荟萃分析中，我们通过之前发表的系统评价和该领域专家的知识，确定了研究成年人（年龄≥18 岁）每天的步数对全因死亡率影响的研究。我们要求参与研究的调查人员按照标准化方案处理他们的参与者水平数据。主要结局指标是从死亡证明和国家登记处收集的全因死亡率。我们分析了每天的步数和步频与全因死亡率的剂量-反应关联。我们使用研究特定的每天步数四分位数进行 Cox 比例风险回归分析，并使用逆方差加权随机效应模型计算危险比（HRs）。
我们确定了 15 项研究，其中 7 项已发表，8 项未发表，研究开始日期为 1999 年至 2018 年。总样本包括 47471 名成年人，其中 3013 人（10.1/1000 人年）死亡（中位随访时间为 7.1 年[IQR 4.3-9.9]；总研究随访时间为 297837 人年）。每天步数的四分位数中位数分别为第 1 四分位数 3553 步，第 2 四分位数 5801 步，第 3 四分位数 7842 步，第 4 四分位数 10001 步。与最低四分位数相比，全因死亡率的调整 HR 为第 2 四分位数 0.60（95%CI 0.51-0.71），第 3 四分位数 0.55（0.49-0.62），第 4 四分位数 0.47（0.39-0.57）。限制性立方样条显示，60 岁及以上成年人每天的步数增加与死亡率呈逐渐降低的风险相关，直到每天 6000-8000 步，60 岁以下成年人每天的步数增加与死亡率呈逐渐降低的风险相关，直到每天 8000-10000 步。在调整每天步数后，与第 1 四分位数相比，较高步频与死亡率之间的关联减弱，但仍有显著意义，峰值为 30 分钟（HR 0.67 [95%CI 0.56-0.83]）和 60 分钟（0.67 [0.50-0.90]），但 40 步/分钟或更快（1.12 [0.96-1.32]）和 100 步/分钟或更快（0.86 [0.58-1.28]）的步行时间（分钟/天）无显著意义。
每天走更多的步与全因死亡率的风险逐渐降低相关，达到了一个因年龄而异的水平。本次荟萃分析的结果可用于为促进身体活动的公共卫生指南提供信息。
美国疾病控制与预防中心。
