Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective observational cohort studies
PubMed 40713949 · doi:10.1016/S2468-2667(25)00164-1
What was done
A systematic review and random-effects dose-response meta-analysis of prospective studies published between January 1, 2014, and February 14, 2025 (searched via PubMed and EBSCO CINAHL) evaluating device-measured daily steps and health outcomes in adults. Outcomes assessed included all-cause mortality, cardiovascular disease (CVD), cancer, type 2 diabetes, cognitive outcomes, mental health, physical function, and falls. Risk of bias was evaluated with the 9-point Newcastle-Ottawa Scale, and evidence certainty was graded using GRADE.
What was found
57 studies from 35 cohorts were included in the systematic review and 31 studies from 24 cohorts in the meta-analyses. Non-linear inverse dose-response curves with inflection points around 5,000–7,000 steps/day were identified for all-cause mortality, CVD incidence, dementia, and falls. Linear inverse associations were observed for CVD mortality, cancer incidence, cancer mortality, type 2 diabetes incidence, and depressive symptoms. Comparing 7,000 versus 2,000 steps/day: - All-cause mortality: HR 0.53 (95% CI 0.46–0.60; I² = 36.3%; 14 studies; moderate certainty) - CVD incidence: HR 0.75 (95% CI 0.67–0.85; I² = 38.3%; 6 studies; moderate certainty) - CVD mortality: HR 0.53 (95% CI 0.37–0.77; I² = 78.2%; 3 studies; low certainty) - Cancer incidence: HR 0.94 (95% CI 0.87–1.01; I² = 73.7%; 2 studies; low certainty) - Cancer mortality: HR 0.63 (95% CI 0.55–0.72; I² = 64.5%; 3 studies; moderate certainty) - Type 2 diabetes: HR 0.86 (95% CI 0.74–0.99; I² = 48.5%; 4 studies; moderate certainty) - Dementia: HR 0.62 (95% CI 0.53–0.73; I² = 0%; 2 studies; moderate certainty) - Depressive symptoms: HR 0.78 (95% CI 0.73–0.83; I² = 36.2%; 3 studies; moderate certainty) - Falls: HR 0.72 (95% CI 0.65–0.81; I² = 47.5%; 4 studies; very low certainty) - Physical function: Inverse associations reported narratively without meta-analysis (low certainty)
Why it matters
This review demonstrates that substantial health and longevity benefits accrue at ~7,000 steps per day across diverse clinical endpoints, providing an evidence-based and achievable alternative to the conventional 10,000 steps target.
Limits
All included data derive from observational cohorts, leaving potential for residual confounding and reverse causality. Many non-mortality outcomes relied on very few studies (2 to 4 studies each), substantial statistical heterogeneity was present for several endpoints (e.g., CVD mortality I² = 78.2%, cancer incidence I² = 73.7%), age-stratified analyses were not conducted, and physical function could not be quantitatively meta-analyzed.