Accelerometer-derived Step Metrics and Quality of Life in Individuals with and without Cardiovascular Diseases
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Background and Aims
Steps are increasingly used to prescribe physical activity, but their impact on quality of life (QoL) remains unclear. We examined the dose-response association between step metrics and QoL, and whether cardiovascular disease (CVD) status moderates this association.
Methods
Individual-level data of five studies were pooled. Physical activity was measured with thigh-worn accelerometry. We assessed steps/day, daily minutes of fast stepping (≥100 steps/min), peak 1- and 30- min cadence. We investigated the association of step metrics and QoL (questionnaire-based; standardized) with multivariable (non-)linear regression, and the interaction with CVD status.
Results
We included 9,371 participants (62 [54-68] years; 47% female), comprising 1,977 individuals with and 7,394 without CVD. Significant, curvilinear dose-response associations between step metrics and QoL were found. The optimal step volume was 6,561 steps/day which associated with a 0.35 SD (95%CI: 0.28-0.42) higher QoL compared to the referent 4,000 steps/day. The optimal doses for peak 1-min and peak 30-min cadence were 107 steps/minute (+0.34 SD; 95%CI: 0.28-0.41) and 74 steps/minute (+0.29 SD; 95%CI: 0.24-0.34) respectively, compared to references of 90 and 60 steps/minute. Only fast stepping interacted with CVD status, with a lower optimum in those with versus without CVD (4 minutes/day, +0.20 SD, 95%CI: 0.12-0.28 versus 9 minutes/day, +0.19 SD, 95%CI: 0.12-0.25), compared to the referent 2 minutes/day.
Conclusions
Step metrics were curvilinearly associated with QoL with optimal benefits at ∼6,500 steps/day. Optimal QoL benefits can be reached at feasible stepping targets, and at slightly fewer daily minutes of fast stepping in CVD versus non-CVD.
Structured graphical abstract
Key Questions
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Is there a dose-response association between step metrics and health-related quality of life (QoL)?
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Does the cardiovascular disease (CVD) health status moderate this association?
Key Findings
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More steps/day and time spent at fast stepping are associated with better QoL following a curvilinear dose-response curve.
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The optimal step volume is 6,561 steps/day, which was independent of CVD status.
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Individuals with CVD may gain optimal QoL levels at slightly less time of fast stepping (4 min/day) than those without CVD (9 min/day).
Take Home Message
More steps and steps at a higher intensity are associated with better QoL. Optimal QoL benefits could be gained at feasible stepping targets (i.e. 4 min/day of fast stepping for CVD, 9 min/day for those without CVD).
