Friday, March 31, 2023
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
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This activity is intended for primary care physicians, cardiologists, nurses, pharmacists, physician assistants, and other members of the healthcare team who treat and manage patients at risk for cardiovascular events.
The goal of this activity is for learners to be better able to assess how step count can affect the risk for cardiovascular events.
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Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
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CME / ABIM MOC / CE Released: 2/24/2023
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Walking is one of the most popular forms of exercise, but a pooled analysis of more than 50,000 adults suggests that all walking is not created equal. A study by Stamatakis and colleagues found that the pace of walking matters.[1]
All participants in these prospective studies walked regularly for exercise. Compared with walking at a slow pace, adults who walked at a fast pace had a 24% relative reduction in all-cause mortality and a 21% relative reduction in cardiovascular mortality. Increasing pace appeared to have a negative linear relationship with mortality outcomes, and the significant results for fast-paced walking were only evident among adults older than 50 years. Sex and body mass index failed to alter the main study conclusions, and the pace of walking failed to have an effect on cancer mortality.
The current study examines another characteristic of walking--daily steps--on the risk for cardiovascular events.
Taking more steps per day is associated with a progressively lower risk for cardiovascular disease (CVD) among older adults, and the benefits accrue at well below the widely promoted threshold of 10,000 steps per day, new research shows.
Among adults aged 60 years and older, those who took roughly 6000 to 9000 steps per day had a 40% to 50% lower risk for CVD compared with peers logging just 2000 steps per day.
“We hope this study will contribute evidence to future public health and clinical guidance on how many steps we need for health,” Amanda Paluch, PhD, from the University of Massachusetts Amherst, told theheart.org | Medscape Cardiology.
Getting in more steps per day can lower an individual’s risk for heart disease, but it’s not an “all or nothing” situation, Dr Paluch said.
“The heart health benefits begin at lower than 10,000 steps per day. So, for the many adults who may find 10,000 steps a bit out of reach, it is important to promote that even small increases in steps can be beneficial for health,” Dr Paluch said.
The study was published online December 20, 2022, in Circulation.[2]
As part of the Steps for Health Collaborative, Dr Paluch and colleagues examined the dose-response relationship between steps per day and CVD in a meta-analysis of 8 prospective studies involving 20,152 adults (mean age, 63 years; 52% women).
Steps were measured in each study, using 1 of 5 different commercially available step-measuring devices. Adults aged 60 years and older took a median of 4323 steps per day (interquartile range [IQR], 2760-6924), whereas younger adults walked a bit more (median, 6911 daily steps; IQR, 4783-9794).
During follow-up lasting an average of 6.2 years, a total of 1523 CVD events were reported.
In the final adjusted model, for older adults, compared with those in quartile 1 who got the fewest steps per day (median, 1811), the risk for CVD was 20% lower in those in quartile 2, who got a median of 3823 steps per day (hazard ratio [HR], 0.80; 95% CI, 0.69-0.93).
CVD risk was 38% lower in older adults in quartile 3, who got a median of 5520 steps per day (HR, 0.62; 95% CI, 0.52-0.74), and 49% lower in those in quartile 4, who walked the most (a median of 9259 steps per day; HR, 0.51; 95% CI, 0.41-0.63).
Restricting the analysis to individuals without known CVD at baseline showed similar results.
Among 6 studies that excluded adults with a history of CVD at baseline, compared with the lowest quartile, the HR for incident CVD events was 0.74 (95% CI, 0.60-0.91) in the second quartile, 0.60 (95% CI, 0.47-0.77) in the third quartile, and 0.55 (95% CI, 0.40-0.76) in the fourth quartile.
Despite the inverse association of steps with CVD in older adults, there was no association in younger adults. The researchers caution, however, that CVD is a disease of aging, and the follow-up period in these studies may not have been long enough to capture CVD incidence in younger adults.
Stepping rate (pace or cadence) was not associated with CVD risk beyond that of total steps per day. However, only 4 of the 8 studies reported data on stepping rate, so this finding should be viewed as preliminary, Dr Paluch and colleagues say.
Dr Paluch said the take-home message from this study and numerous others is simple.
“Move more and sit less! Being physically active, by getting in your steps, is an important part of keeping your heart healthy,” she told theheart.org | Medscape Cardiology.
For adults who are currently inactive, Dr Paluch suggests finding small ways to get in a few more steps per day. “It does not need to be drastic changes. Consider a brief 5- to 10-minute walking break at lunch, taking the stairs, or playing a game of hide and seek with the grandchildren,” Dr Paluch advised.
“For adults starting at 3000 steps a day, set a goal of 4000, and then 5000. Each improvement can lead to better heart health,” Dr Paluch said. “And for those who are already active, keep it up, as there are benefits with higher volumes of steps per day as well.”
Support for this research was provided by the Intergovernmental Personnel Act Agreement through the Centers for Disease Control and Prevention. The authors have reported no relevant financial relationships.
Circulation. Published online December 20, 2022.
