Population Care

Why your patients should lace up their walking shoes

Older women don’t need to get in 10,000 steps a day to lower their mortality rates. Just 4,400 steps daily—even at a low intensity—is linked to significantly lower mortality rates when compared to rates for those who take 2,700 steps a day, a new study finds.

“We try to shy away from the word exercise with patients because it sounds like they have to go to the gym, or do something high-intensity. But this study shows that just moving more, something that doesn’t need to be complex or high intensity, has a benefit for older women,” said Kate Kirley, MD, a family physician and director of chronic disease prevention at the AMA. “That is less intimidating to people and more attainable.”

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The study, published in JAMA Internal Medicine, included women ages 62 to 101 years old, with an average age of 72, and looked at the larger picture of mortality rates. Previous studies have shown that walking also reduces patients’ risk for developing diabetes and high blood pressure, two areas of intense focus in the AMA’s efforts to help physicians prevent and manage those chronic diseases.

Target: BP™, a joint national initiative by the AMA and the American Heart Association, gives physician practices access to clinical tools and support to improve patients’ blood pressure control rates. The program offers annual, recurring recognition for all participating sites and for sites that have blood pressure control rates at 70% or higher for their adult patients. Last year, nearly 800 organizations were recognized for blood pressure control efforts.

Meanwhile, the AMA Prevent Diabetes website offers physicians a comprehensive assessment and guided process to help organizations implement a diabetes prevention strategy, including a diabetes prevention toolkit to aid different members of the practice and access to an evidence-based diabetes prevention lifestyle change program.

How brisk must steps be?

Patients didn’t need to step quickly or intensely to lower their mortality rates, according to the study, “Association of Step Volume and Intensity With All-Cause Mortality in Older Women,” which was supported by grants from the National Institutes of Health.

In fact, “there was little fast stepping among these older women (only 0.2% of the time was spent at a stepping rate equivalent to walking at approximately 2.5 mph or faster),” the study’s authors wrote.

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More than 16,000 women took part in the research by wearing a device to measure their steps over seven days. At a follow-up slightly more than four years later, the data showed that women’s mortality rates progressively decreased with more steps per day, with the benefits leveling off at about 7,500 steps daily.

The “number of steps, rather than stepping intensity, was the step metric consistently related to lower mortality rates,” the study concludes. “These findings may serve as encouragement to the many sedentary individuals for whom 10,000 steps a day pose an unattainable goal.”

Why have 10,000 steps been goal?

Ten thousand steps a day was most often the default goal on the more than 125 million wearable technologies tracking a person’s physical activity that were shipped worldwide in 2017, study authors begin their report. They note that trackers on smart phones also use this number, as do the lay press when talking about how much people should be moving every day.

But, the authors say, where this goal came from is unclear.

“It likely derives from the trade name of a pedometer sold in 1965 by Yamasa Clock and Instrument Company in Japan called Manpo-kei, which translates to ‘10,000 steps meter’ in Japanese,” they wrote, telling readers that is why it is important to study the real impact that step numbers and intensity have on health.

Dr. Kirley agrees and said it is encouraging to see results that show older women can take fewer than 10,000 steps a day at a low intensity and still see a positive impact on their health.

“You can tell patients that 7,500 steps is excellent, but that even taking more than 4,000 steps has a benefit,” she said. “It is doable and patients can do it at their own pace. It is about getting the steps in, not how fast you take them.”