Is this an arbitrary target to hit, or are there health benefits? Rod Tucker examines the evidence
We all know that exercise is a good way of keeping healthy. The NHS recommends that adults aged 19 to 64 years of age need 150 minutes of moderate intensity aerobic exercise per week and strength training on at least two days a week.
Unfortunately, far too many of us are physically inactive. A report by Public Health England in 2018 noted that one in two women and nearly a third of all men are damaging their health through a lack of physical activity – which is estimated to cost £7.4bn a year. While many people don’t have either the time or inclination to visit the gym, even taking simple measures such as walking can reduce the risk of cardiovascular disease and overall mortality by roughly 11%.
But how can we get adults to become more physically active? One approach of instigating behavioural change is through the principle of self-monitoring. This has become increasingly fashionable as a result of wearable technologies or wearables. In fact, worldwide sales of such devices in 2018 was 172.2 million.
These portable devices measure parameters such as calories burnt and the steps taken each day. Most devices set a goal of 10,000 steps per day, which can be achieved through daily activities, exercise or something as simple as walking. This figure appears to have originated from the translation of the name of a Japanese pedometer developed in the 1960s. The device was known as a Manpo-kei, which literally means ‘10,000 steps meter’. Although this seems an arbitrary figure, there is evidence to show that doing up to 10,000 steps/ per day can reduce hypertension and glucose tolerance in those with type 2 diabetes.
There is actually a sound theoretical basis for the principle of self-monitoring. The goal is to increase awareness of target behaviours and self-monitoring successfully used in areas such as smoking cessation and reducing alcohol consumption. Self-monitoring is the skill most strongly linked to the success of an intervention when combined with another self-regulatory technique from control theory.
For example, in control theory, an individual receives feedback on current performance (in this case the number of steps already taken) and the discrepancy from the target (ie 10,000 steps). Knowledge of this difference then encourages a behaviour change, i.e. more walking, in an attempt to reach the 10,000 step goal.
But a recent study in the Journal of the American Medical Association (JAMA) has challenged the belief that we need to achieve 10,000 steps per day to accrue the greatest benefit from walking. The study included over 16,5000 women with an average age of 72 who were followed for just over four years and wore devices to measure their daily step count. After four years there were 504 deaths.
It turned out that doing at least 4,400 steps per day was associated with a 41% reduction in overall mortality. While this benefit increased to 65% when women achieved 75,00 steps per day, there was no additional mortality advantage from doing more steps.
Unfortunately, the results from the JAMA study are not consistent with other research. For instance, a recent Japanese study found that people walking over 7972 steps per day had the lowest mortality and an Australian study found that increasing steps to 10,000 per day was associated with the lowest risk of mortality.
So, what should pharmacists advise patients who are actively tracking steps with their new wearable? Firstly, we should encourage people to get off the couch and become more active. Secondly, despite the findings in the JAMA study, other evidence points to greater benefits from a higher number of daily steps.
Although we don’t really need a fancy gizmo to tell us that we’ve had a long walk, if people do want to use one, then a recommendation of 10,000 steps per day seems reasonable. It is easy to remember and more importantly, a suitable target for increasing physical activity.
Rod Tucker is a community pharmacist