Steps, moderate-to-vigorous physical activity, and cardiometabolic profiles

The relative benefits of meeting the current moderate-to-vigorous intensity physical activity (MVPA) and active step count recommendations are unknown. Using robust linear regressions, we compared cardiometabolic marker differences (blood pressure, lipid levels, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), hemoglobin A1C, C-reactive protein (CRP), and body mass index (BMI)) across MVPA (150min/week) and step (10,000 steps/day) thresholds and between step categories (low active: 5000 to 7499, somewhat active: 7500 to 9999, and active: ≥10,000 steps/day vs. inactive: <5000 steps/day) in approximately 6000 Canadian adults (41.5years, SD 14.9). Differences across MVPA and step thresholds were similar but additional benefits were observed for BMI and A1C for the MVPA target (i.e., above vs. below 150min/week MVPA: -1.02kg/m² (95% Confidence Interval [CI] -1.25 to -0.80) and -0.04% (95% CI -0.06 to -0.02); above vs. below ≥10,000 steps/day: -0.40kg/m² (95% CI -0.63 to -0.16) and 0.01% (95% CI -0.01 to 0.03)). In terms of steps categories, the greatest incremental improvement was achieved at the somewhat active threshold (e.g., somewhat active vs. inactive: -0.90kg/m², 95% CI -1.28 to -0.53; low active vs. inactive: -0.36kg/m², 95% CI -0.73 to 0.02). Additional benefits beyond the 10,000 step/day threshold were limited (e.g., -0.93kg/m², 95% CI -1.30 to -0.57). Given that most benefits to markers of cardiometabolic health were at the ≥7500 step/day threshold and that there was some additional benefit across the 150min/week MVPA threshold compared to a 10,000 steps/day threshold, we suggest aiming for ≥7500 steps/day and then advancing to a 150min/MVPA goal.