Reconsidering Causal Interpretation of Stair-Climbing Epidemiology and Necessary Precautions for Cardiovascular...

Background: Stair climbing is increasingly associated with reduced cardiovascular risk, including a lower incidence of atrial fibrillation and mortality. Objectives: In this opinion paper, we aim to critically evaluate whether these associations reflect a true protective effect or, rather, underlying differences in baseline health status. Methods: After performing a narrative synthesis of recent observational studies and meta-analyses, we prepared this thought-provoking "Opinion paper" considering current clinical guidelines on cardiovascular risk and exertional stress. Results: Habitual stair climbing is consistently associated with reduced risks of atrial fibrillation, cardiovascular mortality, and all-cause mortality, with apparent dose-response relationships. However, these findings may be influenced by reverse causation, as individuals with greater functional capacity are more likely to engage in stair climbing. Conclusions: additional research is required to elucidate the underlying mechanisms and define optimal conditions under which stair climbing may act as a causal protective factor, before its widespread promotion in public health campaigns.