Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis

BACKGROUND: Despite the rapid increase in evidence from the past decade on daily steps and health-related outcomes, existing systematic reviews primarily focused on few outcomes, such as all-cause mortality. This study synthesised the prospective dose-response relationship between daily steps and health outcomes including all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, cognitive outcomes, mental health outcomes, physical function, and falls. METHODS: For this systematic review and meta-analysis, we searched PubMed and EBSCO CINAHL for literature published between Jan 1, 2014, and Feb 14, 2025, supplemented by other search strategies. Eligible prospective studies examined the relationship between device-measured daily steps and health outcomes among adults without restrictions on language or publication type. Pairs of reviewers (BN, KO, ML, and TN) independently did the study selection, data extraction, and risk of bias assessment using the 9-point Newcastle-Ottawa Scale. Hazard ratios (HRs) from individual studies were synthesised using random-effects dose-response meta-analysis where possible. Certainty of evidence was assessed using GRADE. This trial is registered with PROSPERO (CRD42024529706). FINDINGS: =47·5%; four studies). Studies on physical function (not based on meta-analysis) reported similar inverse associations. The evidence certainty was moderate for all outcomes except for cardiovascular disease mortality (low), cancer incidence (low), physical function (low), and falls (very low). INTERPRETATION: Although 10 000 steps per day can still be a viable target for those who are more active, 7000 steps per day is associated with clinically meaningful improvements in health outcomes and might be a more realistic and achievable target for some. The findings of the study should be interpreted in light of limitations, such as the small number of studies available for most outcomes, a lack of age-specific analysis and biases at the individual study level, including residual confounding. FUNDING: National Health and Medical Research Council, New South Wales Health, and Ian Potter Foundation.