The optimal daily step count for each client should be personalized to their current activity levels and needs.
How many steps should a person take each day to promote and maintain health? Recently, we published an article entitled “Using Step Counts to Prescribe Physical Activity: What Is the Optimal Dose?” in ACSM’s Current Sports Medicine Reports that aimed to do just that. We reviewed the literature and hoped to arrive at some basic guidelines for prescribing activity using daily step counts.
Physical Activity Guidelines for Americans
Prior to the last several years, the main guidelines for activity focused mostly on the CDC/ACSM initial guidelines from 1995, which have been updated and widely promoted as the Physical Activity Guidelines for Americans. These state that all adults should get a minimum of either 30 minutes of moderate-intensity physical activity five days per week, 25 minutes of vigorous-intensity activity three days per week, or some combination of the two. While these guidelines have been useful, only about half of Americans achieve this recommended amount of physical activity.
Access resources for meeting the physical activity guidelines here.
With the increasing ability to track steps using smartphones and consumer-based physical activity monitors, researchers have begun to publish more data on the effect of daily step counts on a variety of health conditions including all-cause mortality, cardiovascular disease, cancer, diabetes, weight loss and musculoskeletal disorders. These data are especially useful because they show us that even accumulating light intensity physical activity (LIPA) for several thousand steps per day can impart positive health benefits.
Is achieving 10,000 steps per day necessary?
Our review article attempts to bring together data showing that significant health benefits can occur at activity levels below 10,000 daily steps, especially if individuals increase their baseline activity by at least 1,000 steps per day. Several studies demonstrate that near-maximal or maximal health benefits can be achieved by engaging in predominantly LIPA totaling approximately 6,000 to 8,000 steps per day. However, there also appears to be continued benefit above that level of activity, although some studies report diminishing returns and others show a more linear relationship with higher activity levels. Many studies indicate that each additional 1,000 daily steps impart additional health benefits. This is relevant for active individuals who may already be achieving 10,000 steps per day or more and is consistent with a common theme that “more is better,” with benefits existing at daily step count levels above 10,000 per day. At the lower end of the activity level spectrum, reaching a minimum of about 4,000 steps per day may be beneficial for many groups if they are at or below this level of activity at baseline. This number may be more appropriate for older individuals, given that few studies in our review looked at adults under the age of 50. Also, we did not review comparisons of health benefits of those achieving high levels of moderate or vigorous activity with those who achieve activity primarily through LIPA.
In our clinic settings we see very active patients but also see some who get only several hundred steps per day, and because of general health or specific musculoskeletal conditions, would not be able to accomplish the more intense current recommendations for physical activity. Determining an optimum daily step count requires an individualized approach, considering both physical and psychological factors. Our review article shows that pursuing a goal of even 4,000 steps per day through light intensity physical activity for those who are not currently achieving this will impart some health benefit.
Ultimately, pursuing or maintaining an activity level that meets or surpasses the moderate and/or vigorous physical activity recommendations will likely keep someone healthier than someone who achieves a lower level of activity. But for some a lower level of activity will still be better than being less active. In order to promote this in the clinic, we commonly discuss daily step counts and often utilize the Exercise is Medicine prescription form. This allows us to discuss not only steps counts, but also the recommendations for aerobic and resistance exercise, both of which are on the form. We also often utilize widely available free smartphone apps or inexpensive activity trackers or pedometers to monitor daily step counts and encourage longitudinal progress toward increased activity levels.
Given how daily steps achieved through LIPA have been shown to improve one’s general health and reduce risk of death and certain common chronic health conditions, it would not be surprising if step counts become part of the general recommendations for physical activity and health in the future.
More ACSM resources on step count:
"Daily Steps and Health: Walking Your Way to Better Health" | Blog
"Daily Step Counts for Measuring Physical Activity Exposure and Its Relation to Health" | Medicine & Science in Sports & Exercise®
Starting a Walking Program | Handout
Joseph Ihm, M.D., FACSM, is an attending physician at Shirley Ryan AbilityLab and an associate professor in the department of physical medicine and rehabilitation in Northwestern University Feinberg School of Medicine. He has a B.S. in exercise physiology and is on the Exercise is Medicine Clinical Practice Committee.
Benjamin Washburn, M.D., is an Assistant Professor of Clinical PM&R and Clinical Orthopaedic Surgery at the University of Missouri.