Step Counts and Health Outcomes CENTRAL I LL USTRATI O N Dose-Response Associations of Daily Step Count With Clinical Outcomes Stens NA, et al. J Am Coll Cardiol. 2023;82(15):14831494. Dose-response curves for the association between daily step count vs all-cause mortality (left) and incidence of cardiovascular diseases (CVD) (middle). Adjusted HRs (aHRs) from published dose-response curves were extracted and pooled using restricted cubic spline models. Compared with the reference level of 2,000 steps/d, the minimal dose to signicantly reduce the risk for adverse outcomes was 2,517 steps/d for all-cause mortality and 2,735 steps/d for incident CVD. The optimal dose, dened as the maximal risk reduction at the least effort, was established at 8,763 steps/d for all-cause mortality and 7,126 steps/d for incident CVD. Shaded areas indicate the corresponding 95% CI. metrics with all-cause mortality and incident CVD in

Minimal doses of 2,517 and worn accelerometers. There were no important dif2,735 steps/d were associated with an 8% reduction in ferences in risk reductions with step count between all-cause mortality and an 11% reduction in CVD risk, men and women. Findings from this meta-analysis respectively, compared with individuals accumumay optimize physical activity prescription in daily lating 2,000 steps/d. The optimal doses were found at practice given the easy-to-understand concept of step 8,763 steps/d for all-cause mortality (ie, 60% risk count from a public health perspective.

Increasing from low to intermediate and high cadences was also associated with a decreased all-cause mortality risk (33% and 38% risk MINIMAL DOSE. We found that the minimal stepcount dose needed to elicit signicant health benets was about 2,600 steps/d for all-cause mortality and about 2,800 steps/d for incident CVD in comreductions, respectively), even after adjustment for daily step count (22% and 21% risk reductions, respectively). Risk reductions were greater for hipparison with individuals who accumulated 2,000 steps/d. These ndings highlight changes from physical inactivity to a lifestyle with that behavior 1489 1490 Stens et al J A C C V O L . 8 2 , N O . 1 5 , 2 0 2 3

Step Counts and Health Outcomes O C T O B E R 1 0 , 2 0 2 3 : 1 4 8 3 1 4 9 4 F I G U R E 4 Associations Between Different Step Count Volumes and Clinical Outcomes y a D / s p e t S 0 0 0 , 2 y a D / s p e t S 0 0 0 , 3 y a D / s p e t S 0 0 0 4 , y a D / s p e t S 0 0 0 , 5 y a D / s p e t S 0 0 0 6 , y a D / s p e t S 0 0 0 , 7 y a D / s p e t S 0 0 0 8 , y a D / s p e t S 0 0 0 9 , y a D / s p e t S 0 0 0 0 1 , y a D / s p e t S 0 0 0 , 1 1 y a D / s p e t S 0 0 0 , 2 1 y a D / s p e t S 0 0 0 , 3 1 y a D / s p e t S 0 0 0 4 1 , y a D / s p e t S 0 0 0 , 5 1 y a D / s p e t S 0 0 0 6 1 , All-Cause Mortality Magnitude of Risk Estimates (aHR) No Significant Change 2,000 Steps/Day REF 0.85 0.72 0.61 0.53 0.47 0.43 0.39 0.37 0.36 0.36 0.35 0.35 0.35 0.35 0.99-0.80* 3,000 Steps/Day 1.18 REF 0.85 0.73 0.63 0.56 0.50 0.47 0.44 0.43 0.42 0.42 0.42 0.42 0.42 0.79-0.60* 4,000 Steps/Day 1.39 1.18