How many steps/day are enough? Preliminary pedometer indices for public health

Pedometers are simple and inexpensive body-worn motion sensors that are readily being used by researchers and practitioners to assess and motivate physical activity behaviours. Pedometer-determined physical activity indices are needed to guide their efforts. Therefore, the purpose of this article is to review the rationale and evidence for general pedometer-based indices for research and practice purposes. Specifically, we evaluate popular recommendations for steps/day and attempt to translate existing physical activity guidelines into steps/day equivalents. Also, we appraise the fragmented evidence currently available from associations derived from cross-sectional studies and a limited number of interventions that have documented improvements (primarily in body composition and/or blood pressure) with increased steps/day. A value of 10 000 steps/day is gaining popularity with the media and in practice and can be traced to Japanese walking clubs and a business slogan 30+ years ago. 10 000 steps/day appears to be a reasonable estimate of daily activity for apparently healthy adults and studies are emerging documenting the health benefits of attaining similar levels. Preliminary evidence suggests that a goal of 10 000 steps/day may not be sustainable for some groups, including older adults and those living with chronic diseases. Another concern about using 10 000 steps/ day as a universal step goal is that it is probably too low for children, an important target population in the war against obesity. Other approaches to pedometer-determined physical activity recommendations that are showing promise of health benefit and individual sustainability have been based on incremental improvements relative to baseline values. Based on currently available evidence, we propose the following preliminary indices be used to classify pedometer-determined physical activity in healthy adults: (i) <5000 steps/ day may be used as a 'sedentary lifestyle index'; (ii) 5000-7499 steps/day is typical of daily activity excluding sports/exercise and might be considered 'low active'; (iii) 7500-9999 likely includes some volitional activities (and/or elevated occupational activity demands) and might be considered 'somewhat active'; and (iv) greater than or equal to10 000 steps/day indicates the point that should be used to classify individuals as 'active'. Individuals who take >12 500 steps/day are likely to be classified as 'highly active'.