The Effect of Step Accumulation Patterns on Cardiovascular Events and All-Cause Mortality

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Summary of Annals of Internal Medicine, https://doi.org/10.7326/ANNALS-25-0154  
Dr. Borja del Pozo Cruz et al.

Points

This prospective cohort study of 33,560 suboptimally active UK adults examined how step accumulation patterns affect long-term health outcomes over 7.9 years of follow-up.
The analysis found a strong inverse association between step bout length and the risk of both all-cause mortality and cardiovascular disease (CVD) incidence.
Cumulative all-cause mortality at 9.5 years decreased from 4.36% for bouts shorter than 5 minutes down to only 0.80% for bouts 15 minutes or longer.
Cumulative CVD incidence at 9.5 years showed a similar pattern, dropping from 13.03% for the shortest bouts to just 4.39% for the longest step accumulation bouts.
The findings suggest that existing physical activity recommendations for low-active populations should be modified to explicitly prioritize sustained longer bouts of stepping activity for maximum health benefit.

Summary

This prospective cohort study, leveraging UK Biobank data, examined the association between step accumulation patterns—categorized by short versus sustained longer bouts—and the risk of all-cause mortality and cardiovascular disease (CVD) incidence in 33,560 suboptimally active individuals. The participants, who had a mean age of 62.0 years (SD, 7.7) and engaged in 8,000 or fewer daily steps, were followed for an average of 7.9 years (266,283 person-years). Participants were grouped by the bout duration in which they accumulated most steps: shorter than 5 minutes, 5 to shorter than 10 minutes, 10 to shorter than 15 minutes, or 15 minutes or longer.

Over the follow-up period, 735 deaths and 3,119 CVD events were recorded. Both all-cause mortality and CVD incidence exhibited a clear inverse relationship with increasing step bout length. Cumulative all-cause mortality at 9.5 years saw a substantial decrease, dropping from 4.36% (95% CI, 3.52% to 5.19%) for bouts less than 5 minutes to only 0.80% (95% CI, 0.00% to 1.89%) for bouts 15 minutes or longer. A similarly steep reduction was observed for the 5 to shorter than 10-minute group (1.83%; 95% CI, 1.29% to 2.36%) and the 10 to shorter than 15-minute group (0.84%; 95% CI, 0.13% to 1.53%).

Cumulative CVD incidence at 9.5 years followed an analogous protective pattern. The incidence decreased from a high of 13.03% (95% CI, 11.92% to 14.14%) for bouts less than 5 minutes to 4.39% (95% CI, 1.89% to 6.83%) for bouts 15 minutes or longer. These data, which indicate that step accumulation in longer bouts provides superior protection against both mortality and CVD even in individuals with suboptimal overall daily steps, support modifying physical activity recommendations to emphasize bout duration alongside total step count.

Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01547

References

Del Pozo Cruz, B., Ahmadi, M., Sabag, A., Saint Maurice, P. F., Lee, I.-M., & Stamatakis, E. (2025). Step accumulation patterns and risk for cardiovascular events and mortality among suboptimally active adults. Annals of Internal Medicine, ANNALS-25-01547. https://doi.org/10.7326/ANNALS-25-0154