Daily steps offset risks of sedentary behavior in the All of Us research program

Sedentary behavior is associated with increased mortality and chronic diseases, yet it remains unclear whether higher daily step counts can mitigate these risks. In this study, we analyzed longitudinal sedentary and step data from Fitbit devices in the All of Us Research Program to examine incident diagnoses of chronic conditions. We show that greater sedentary time was associated with higher risk of obesity, diabetes mellitus, hypertension, coronary artery disease, heart failure, chronic kidney disease, metabolic dysfunction-associated steatotic liver disease, chronic obstructive pulmonary disease, major depressive disorder, sleep apnea, and atrial fibrillation. Increasing daily steps offset the excess risk of high sedentary time (14 vs. 8 hours/day) for several conditions, with the additional steps required ranging from 1700 to 5500 per day. However, no step count fully offset sedentary risks for coronary artery disease or heart failure. These findings support personalized, behavior-based recommendations that consider both sedentary behavior and daily steps.