Sabine Schootemeijer, Sophie H. Kroesen, Niels A. Stens, Milou Netten, Inge Salzmann, Annemarie Koster, Neeltje A. E. Allard, Bram M. A. van Bakel, Francisco B. Ortega, Emmanuel Stamatakis, Matthew Ahmadi, Janna N. Vrijsen, Dick H. J. Thijssen, Thijs M.H. Eijsvogels, Esmée A. Bakker, STEP COACH collaborators
Abstract Background and Aims Steps are increasingly used to prescribe physical activity, but their impact on quality of life (QoL) remains unclear. We examined the dose-response association between step metrics and QoL, and whether cardiovascular disease (CVD) status moderates this association. Methods Individual-level data of five studies were pooled. Physical activity was measured with thigh-worn accelerometry. We assessed steps/day, daily minutes of fast stepping (≥100 steps/min), peak 1- and 30- min cadence. We investigated the association of step metrics and QoL (questionnaire-based; standardized) with multivariable (non-)linear regression, and the interaction with CVD status. Results We included 9,371 participants (62 [54-68] years; 47% female), comprising 1,977 individuals with and 7,394 without CVD. Significant, curvilinear dose-response associations between step metrics and QoL were found. The optimal step volume was 6,561 steps/day which associated with a 0.35 SD (95%CI: 0.28-0.42) higher QoL compared to the referent 4,000 steps/day. The optimal doses for peak 1-min and peak 30-min cadence were 107 steps/minute (+0.34 SD; 95%CI: 0.28-0.41) and 74 steps/minute (+0.29 SD; 95%CI: 0.24-0.34) respectively, compared to references of 90 and 60 steps/minute. Only fast stepping interacted with CVD status, with a lower optimum in those with versus without CVD (4 minutes/day, +0.20 SD, 95%CI: 0.12-0.28 versus 9 minutes/day, +0.19 SD, 95%CI: 0.12-0.25), compared to the referent 2 minutes/day. Conclusions Step metrics were curvilinearly associated with QoL with optimal benefits at ∼6,500 steps/day. Optimal QoL benefits can be reached at feasible stepping targets, and at slightly fewer daily minutes of fast stepping in CVD versus non-CVD. Structured graphical abstract Key Questions Is there a dose-response association between step metrics and health-related quality of life (QoL)? Does the cardiovascular disease (CVD) health status moderate this association? Key Findings More steps/day and time spent at fast stepping are associated with better QoL following a curvilinear dose-response curve. The optimal step volume is 6,561 steps/day, which was independent of CVD status. Individuals with CVD may gain optimal QoL levels at slightly less time of fast stepping (4 min/day) than those without CVD (9 min/day). Take Home Message More steps and steps at a higher intensity are associated with better QoL. Optimal QoL benefits could be gained at feasible stepping targets (i.e. 4 min/day of fast stepping for CVD, 9 min/day for those without CVD).