A Summary of the article on “Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis”
Background
The study by Ding D, Nguyen B and Nau T et al (2025) titled “Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis”, offers a comprehensive synthesis of how varying daily step counts influence a wide array of health outcomes in adults. This study published in The Lancet Public Health expands upon previous reviews that primarily focused on all-cause mortality or cardiovascular disease, addressing a broader range of outcomes including cancer, type 2 diabetes, cognitive outcomes, mental health, physical function, and falls.
Methods
The research methodology involved a systematic search of PubMed and EBSCO CINAHL for prospective studies published between January 1, 2014, and February 14, 2025. Eligible studies were required to examine the relationship between device-measured daily steps and health outcomes in adults aged 18 years and older. Hazard ratios from individual studies were synthesised using random-effects dose-response meta-analysis where possible, with 2,000 steps per day serving as the reference point. The systematic review included 57 studies from 35 cohorts, with meta-analyses incorporating data from 31 studies across 24 cohorts.
Results
A significant finding is that even modest daily step counts are associated with health benefits, and risks generally continue to decrease with every 1,000 steps per day increment, up to the highest analysed category of 12,000 steps per day. The study suggests that 7,000 steps per day could be a more realistic and achievable target for some adults, as it is associated with clinically meaningful improvements and sizeable risk reductions across most outcomes. For example, compared with 2,000 steps per day, 7,000 steps per day was linked to a 47% lower risk of all-cause mortality and a 25% lower risk of cardiovascular disease incidence. Even fewer steps, such as 4,000 per day, were associated with a substantial 36% lower risk in all-cause mortality compared to 2,000 steps per day.
For several outcomes, including all-cause mortality, cardiovascular disease incidence, cancer mortality, dementia, and depressive symptoms, higher step counts exceeding 7,000 steps per day were associated with further lower risks. For instance, achieving 10,000 steps per day was linked to a 10% lower risk of all-cause mortality compared with 7,000 steps per day. However, for other outcomes like cardiovascular disease mortality, cancer incidence, type 2 diabetes, and falls, step counts beyond 7,000 steps per day did not demonstrate statistically significant additional risk reductions.
The dose-response relationships varied:
- All-cause mortality, cardiovascular disease incidence, dementia, and falls showed an inverse non-linear association.
- Cardiovascular disease mortality, cancer incidence, cancer mortality, type 2 diabetes incidence, and depressive symptoms exhibited an inverse linear association.
Conclusions
The certainty of evidence was rated as moderate for several outcomes, including all-cause mortality, cardiovascular disease incidence, type 2 diabetes, cancer mortality, dementia, and depressive symptoms, primarily due to meeting dose-response gradient criteria. However, the evidence certainty remained low for cardiovascular disease mortality, cancer incidence, and physical function, and was very low for falls due to inconsistent findings.
The authors acknowledge limitations, such as the small number of studies for certain outcomes, which means some findings should be interpreted as exploratory. Other limitations include the predominantly high-income country data, limiting generalisability, a lack of consistent age-specific analysis across all outcomes, and the possibility of residual confounding. Despite these limitations, the study concludes that daily step volume is consistently associated with lower risks of major health outcomes, supporting the public health message that “every step counts”. Daily steps are presented as a viable supplementary metric for public health recommendations and surveillance.
References
Ding, D., Nguyen, B., Nau, T., Luo, M., Cruz, B. del P., Dempsey, P. C., Munn, Z., Jefferis, B. J., Sherrington, C., Calleja, E. A., Chong, K. H., Davis, R., Francois, M. E., Tiedemann, A., Biddle, S. J. H., Okely, A., Bauman, A., Ekelund, U., Clare, P., & Owen, K. (2025). Daily steps and health outcomes in adults: A systematic review and dose-response meta-analysis. The Lancet Public Health, 0(0). https://doi.org/10.1016/S2468-2667(25)00164-1
This post is based on Open Access research and is for informational purposes only.
