How many steps does it take?

For a great many of us there comes the inevitable conversation with a physician, “your running days are over.  Swim, ride a bike, or walk.”  Of the three options, walking is the universal exercise.  It requires no special facilities nor any special equipment; basically a comfortable pair of shoes is all that is required.  If you are fortunate enough to live near a beach, walking barefoot in the sand is a delight unto itself.  Of course, there are also a plethora of high-tech shoes for walking most anywhere.  Additionally, for the sartorially inclined, there are designer options for apparel.  

We walk in our daily lives.  How many steps we take per day on average varies widely as a function of age, sex, education level, body mass (BMI), occupation, and even geography.  One study found adults average just over 5,000 steps per day (the article reports 5,117 … academics like statistical precision).  In today’s more sedentary technology-enhanced society, this number of steps in daily living is highly suspect (unless you are chasing children); only your pedometer knows for sure.  Bassett, D., et al., “Pedometer-Measured Physical Activity and Health Behaviors in U.S. Adults,” Med. & Sci. Sports & Exer. 42(10):1819-1825 (October 2010). https://doi.org/10.1249/MSS.0b013e3181dc2e54 

In assisted living, my mother, before she passed, would take to the hallways with her walker to get her steps in (not likely anywhere near 5,000, but she regularly made the effort).  Adults in Western Australia, Switzerland (~2x), Japan (~1.5 x), China, the United Kingdom, Germany, France and Canada all take more daily steps than people in the United States.  Althoff, T., et al., “Large-scale physical activity data reveal worldwide activity inequality,” Nature 547(7663):336-339 (July 20, 2017).  https://doi.org/10.1038/nature23018

This statistic does not apply to children, older people, or people with special needs.  Young male children take between 12,000 and 16,000 steps per day; young female children 10,000 to 13,000.  Tudor-Locke, C., et al., “How many steps/day are enough? for children and adolescents,” Int. J. Behav. Nutr. Phys. Act. 8:78 (2011).  https://doi.org/10.1186/1479-5868-8-78  Healthy older adults average 2,000 to 9,000 steps per day, and special needs populations 1,200 to 8,800 steps per day.  Tudor-Locke C., et al., “How many steps/day are enough? For older adults and special populations,” Int. J. Behav. Nutr. Phys. Act. 8:80 (July 2011).  https://doi.org/10.1186/1479-5868-8-80

How far do our 5,000 steps take us?  Step length is very dependent upon height; however, 2.5 feet (0.762 meters) is considered an average for men, and 2.2 feet (0.67 meter) for women.  Thus, men on average walk about 12,500 feet (3,810 meters or 2.37 miles) and women 11,000 feet (3,353 meters or 2.08 miles) in daily living.  The average person walks about 3 miles per hour when walking.  Alves, F., et al., “Walkability Index for Elderly Health: A Proposal,” Sustainability 12(18):7360 (2020).  https://doi.org/10.3390/su12187360  I doubt moving around the house or even outside in the garden we walk at 3 miles per hour.  However, using 3 miles per hour as a base, men spend about 45 minutes walking in daily living, and women about 40 minutes; walking the dog counts here.  These estimates do not include jobs that require walking.  Hoeger, W., et al., “One-mile step count at walking and running speeds,” ACSMs Health Fit J. 12(1):14 (January 2008).  https://doi.org/10.1249/01.FIT.0000298459.30006.8d

Decades of scientific research has demonstrated that exercise improves health and extends life.  Regular exercise has been shown to prevent or manage high blood pressure, Type 2 diabetes, stroke, metabolic syndrome, arthritis, and many types of cancer.  Exercise helps control weight.  It also affects mood by reducing anxiety and depression.  In older people it helps reduce the incidence of falls.  Exercise boosts energy, promotes better sleep, and enhances a person’s sex life.  Further, exercise can promote socialization and just be fun.  The Mayo Clinic, “Exercise: 7 benefits of regular physical activity.”  https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389

Falls in older adults are of particular concern because they threaten independence and may cause significant morbidity and mortality.  Vaishya, R. and A. Vaish, “Falls in Older Adults are Serious,” Indian J. Orthop.24;54(1):69-74 (January 2020).  https://doi.org/10.1007/s43465-019-00037-x

Health exercise activity guidelines are typically expressed in terms of frequency, duration, and intensity parameters.  To garner health benefits from exercise, the US Centers for Disease Control and Prevention (CDC) recommends “150 minutes a week of moderate physical activity,” and suggests 30 minutes per day five days a week to meet the recommendation. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

We need to parse this recommendation, starting with “moderate physical activity.”  The Cleveland Clinic defines moderate-intensity activity as exercise that raise your heart rate 50 to 60 percent higher than your resting heart rate.  It suggests “walking two miles in 30 minutes” and “walking stairs for 15 minutes” as example activities to meet the recommendation.  Two miles in 30 minutes is 4 miles per hour, faster than the widely accepted average walking speed of 3 miles per hour.  Cleveland Clinic, “What Does Moderate Exercise Mean, Anyway?” (October 23, 2020).  https://health.clevelandclinic.org/what-does-moderate-exercise-mean-anyway/  The 5,000 steps of daily living do not meet the recommendation; you need to do more.

How many steps are in “150 minutes a week of moderate physical activity?”  We need to walk at 4 miles per hour to get our heart rate up to the target.  So, we need to walk 20 miles a week at this pace to meet the CDC recommendation.  This is 42,240 steps for men and 48,000 steps for women, or 8,448 steps per day each of five days for men and 9,600 steps per day each of five days for women.  Another way of looking at the recommendation is 4 miles each of five days per week.

Keep in mind that rest days are just as important as exercise days; it’s time for your body to recover and repair.  A rest day is not a couch day, it’s a slower and less intense than exercise day.  It’s a day of living where you can expect to walk 5,000 steps at a normal or leisurely pace.  A rest day allows your body to repair muscle fiber and replenish energy stores, it prevents muscle fatigue and reduces the risk of injury when you do exercise.  A rest day actually improves exercise performance and supports healthy sleep.

All of this math has led us suspiciously close to the commonly and widely recommended 10,000 steps per day.  The goal of 10,000 steps per day was established by the Yamasa company, a pedometer manufacturer, in Tokyo, Japan, around 1965, as an advertising promotion shortly after the Tokyo Olympics.  (Internationally Yamasa is known as Yamax.)  The number was not based on research, it just sounded good.  The Yamasa pedometer was named “manpo-kei,” which roughly translates to “10,000 step meter” in English.  The kanji character for “10,000” roughly resembles a person walking, “万,” ichiman.  It was believed that this amount of physical activity would decrease the risk of coronary heart disease.  Hatano, Y., “Pedometer-assessed physical activity: Measurement and motivations,” Proceedings, 48th annual meeting of the American College of Sports Medicine (May 30–June 3, 2001; Baltimore, MD).

The promotion was extremely successful.  The goal of 10,000 steps per day was adopted by ordinary people concerned about their health, sports clubs, and eventually healthcare providers.  Healthcare researchers found that 10,000 steps per day could indicate that a person was close to meeting the long-established recommended amount of daily physical activity to reduce health risks.  By 1996, quantifying steps had become an accepted and somewhat de facto method of assessing physical activity.  Bassett, D., et al., “Step counting: A review of measurement considerations and health-related applications,” Sports Med. 47(7):1303-131 (2017).   https://doi.org/10.1007/s40279-016-0663-1;  Bravata, D., et al., “Using pedometers to increase physical activity and improve health: a systematic review,” JAMA 298(19):2296-304 (November 21, 2007).  https://doi.org/10.1001/jama.298.19.2296 ; 

Step counting devices have come into use in the last two decades.  Today there are all kinds of pedometers and Smartphone applications that count steps.

But do you really need 10,000 steps per day?  “Some movement is good, and more is better, but the benefits taper at some point.  Your personal peak depends on your age.  People younger than 60 should indeed walk 8,000 to 10,000 steps a day to get the best benefits in terms of life expectancy and cardiovascular health.  People older than 60 show the most benefit between 6,000 and 8,000 steps.”  (Seven thousand to 9,000 steps a day is roughly equivalent to 150 to 300 minutes of brisk walking each week, the target in the 2018 [U.S. Department of Health and Human Services] guidelines.)  …  The total number of steps you take does appear to matter more than the speed at which you take them.”  Denworth, L., “You Don’t Really Need 10,000 Daily Steps to Stay Healthy,” Scientific American (May 1, 2023).  https://www.scientificamerican.com/article/you-dont-really-need-10-000-daily-steps-to-stay-healthy/;  Paluch, A., et al., “Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts,” The Lancet Public Health 7(3):e219 (2022).  https://doi.org/10.1016/S2468-2667(21)00302-9

On the other hand, “[t]he results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity.  Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking.  Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA (moderate-to-vigorous physical activity)”.   Tudor-Locke, C., C. Craig, W. Brown, et al., “How many steps/day are enough? for adults,” Int. J. Behav. Nutr. Phys. Act. 8:79 (July 28, 2011).  https://doi.org/10.1186/1479-5868-8-79

Current research suggests that walking 8,000 brisk steps or more per day may be the sweet spot for receiving the health benefits walking provides.  People who have trouble finding time to walk each day of the week will be encouraged by a new study that demonstrates walking just one to two days is still associated with a significant reduction in all-cause and cardiovascular mortality, and each additional day walked confers greater benefits.  “Briskly walking 8,000 or more steps each day of the week is associated with a significant decrease in all-cause and cardiovascular mortality.  A new study finds, however, that people taking just 8,000 steps one or two days a week are also less likely to die over a 10-year follow-up period.”  Inoue, K., Y. Tsugawa, E. Mayeda, and B. Ritz, “Association of Daily Step Patterns With Mortality in US Adults,” JAMA Netw. Open.6(3):e235174 (March 28, 2023).  https://doi.org/10.1001/jamanetworkopen.2023.5174  See figures below.

The law of diminishing returns applies to walking.  Increasing the number of steps per day is associated with reduced mortality up to about 8,000 steps per day; thereafter, the benefits plateau.  This does not mean you should not walk more than 8,000 steps per day, it is rather a statement of the tradeoff between effort expended and benefit received.  (Look at the black curve in the figures below.)  Paluch, A., et al., “Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts,” The Lancet Public Health 7(3):e219 (2022). https://doi.org/10.1016/S2468-2667(21)00302-9

Full circle, we come back to the original question, how many steps per day matter?  The answer is they all do, the more the better up to a point.  Furthermore, the older you are, the more they matter, relatively speaking.  The sweet spot is about 8,000 brisk steps per day 4 to 5 days per week.  In other words, walking about 4 miles a day has a tremendous impact on health and longevity, especially pronounced as you get older.  This means spending about an hour of your day walking.  The more you increase the pace of your daily living walking, the fewer steps required outside of daily living.  The more days you walk, the better for you, but take rest days. In other words, get off the couch and go walk.  The reality is we all strive to do the best we can do within the constraints of our lives