Hello again, James, your favorite physical therapist here.
I’d like to talk about something almost all healthcare professionals should be talking about – but few rarely do. Daily activity levels. How many steps should an adult take in any given day? Is there a magic number?
A group of researchers published a study in the Journal of American Medical Association that examined all-cause mortality – basically someone who dies of any cause – and how many steps they got in a day. Researchers had subjects wear a device that measured their steps for five days. They then monitored the subjects for a decade to see who died. The results were fascinating.
Individuals who stepped less than 4,000 steps/day were at the highest risk of dying from any cause. If an individual attained 8,000 steps/day, they had a 51% less percent chance of dying of any cause. Those who stepped 12,000 steps/day had a 65% lower risk of death.1 There was a direct correlation between step count on an average day and the risk of death over a decade. The study also examined walking speed. Some experts in this field posit that the speed in which we walk tells us a lot. However, this study did not find any significance if the 8,000 steps were taken slowly or at a full sprint – the thing that matters in this study is that the steps were taken.
I love this study. It’s so simple and so clear. If a person gets moving, they will have better health and a huge decrease in mortality risk. The act of taking steps isn’t so complicated that you must see a specialist or have a costly prescription written – it can be achieved with no oversight or direction.
People ask me all the time, they say: “what’s the best exercise I can do? The one exercise that if I do it, will help me the most?” I think it’s a very loaded question because the human body is meant to move in many planes and varying ways. Some experts in the field come up with little challenges like the “7 minute squat challenge” or some novel challenge that comes in vogue. I like those challenges and they can be fun. However, whenever an individual does the same activity repetitively, they are prone to overuse injuries – think runners, swimmers or really any repetitive sport that that is all they do. The exercises people do should have some variability. The basic recommendation in the general population is to just get moving.
The researchers in the step study did not examine other treatment variables – just steps and the velocity of the steps. They didn’t assess how often the subjects went to the gym or did strength training. They didn’t assess how many cups of broccoli or if the subjects had a salad for lunch – just how many steps they took in a five-day period and did they die over the next decade? There are a lot of holes in this study, sure; and I’m sure some of the peers I respect will challenge me for blogging about it – which is good.
So, if I had to recommend a general 2023 goal for anyone, would it be too much to try to get 8,000 steps/day? The average step length is 30 inches. 8,000 Steps X 30 inches = 240,000 inches or 20,000 feet or 3.8 miles. Which may or may not sound like a lot depending on where you are in life. I would submit that if you can, you should, or someday you won’t be able to. I’ve always chuckled when I go to some massive super store and people are circling the parking lot trying to find the closest parking spot, so they don’t have to walk very far. I like to park in the farthest parking space – which is usually the first one I come to – and walk in.
I think there is something cultural about inactivity. I was in the Denver airport a couple weeks back heading home from Drill. I walked to an escalator and stepped onto it. Everybody in front of me stopped walking. Once they hit the escalator they stood still. If you’ve ever been to Japan, people that need a rest stand on the right side of the escalator and allow anyone that wants to get past them to walk on the left. Culturally, in the US, we are different. Everyone stops on the escalator because I guess it’s socially accepted that everyone wants a rest? I speculate as to why, but if you want to walk up the escalator in the Denver Airport, you are a super minority.
Another paradox to me is that the step study has largely been a big nothing burger. Let’s take a look at Baby Aspirin and the prevention of heart attacks or other cardiovascular related illnesses. I dug up a little article on Aspirin and reduction of cardiovascular adverse events.2 It seems that Aspirin can reduce the risk of a heart attack in those who have never had a heart attack previously by 20%. That’s amazing. It’s been heralded as a miracle drug based off this type of research data. You might have even seen TV commercials that are geared at making you think you have to have it. A 20% decrease in risk over a couple years with taking daily aspirin really pales in comparison to a 65% risk reduction with >8,000 steps. The science is clearly in favor of movement. What really blows my mind is that aspirin isn’t unique. Pretty much most drugs on the market cannot measure up to lifelong exercise.
I’m not writing this as a diatribe against pharmaceuticals. They have come a long ways and if I ever have a stroke I’m going to be asking for that “clot buster”. I also wouldn’t advocate for a diabetic to discard the insulin and just grab a few more steps. But I do believe that the efficacy of exercise is vastly underrated. I remember early in physical therapy school, we had a crusty old professor say: “everybody wants to use some intervention that is the newest gimmick. We buy into these all the time. Do you know what works really well? Exercise!” I’ve thought a lot about those words over the years. Since I’m a good little physical therapist, I stay in my lane. People might ask me what I think about a drug or something pharmaceutical. I tell them to chat that over with their doctor and let’s focus on what I specialize in – human movement.
You might be saying to yourself: “wait, I can overdose on exercise and that’s not healthy!” Sure. There is a condition out there called Rhabdomyolysis. It’s a condition where muscle fibers are broken down and toxins released into the bloodstream. It’s definitely serious. Most people don’t overdose on exercise. It’s super rare. I work in the exercise field and have worked with people of all ages and types in a spectrum of settings. I know one friend of mine that was hospitalized with Rhabdomyolysis. He was in Navy SEAL school and wasn’t going to quit under any circumstances. Unfortunately, his body started to shut down before his mind did and he went on to develop rhabdomyolysis. Most people will cease activity far before they develop this condition because their body will tell sendoff signals of fatigue long before the condition sets in.
Turning to bed rest. Some people think they can rest their way to health. A study was conducted in the 1960’s where they took five healthy men in their 20’s and had them do nothing but lay in bed for three weeks – infamously named the Dallas Bed Rest Study. They weren’t allowed to weight-bear at all. Just snoozing and enjoying 3 weeks in the rack. The study was designed to examine the effects of long-term space flight. After the three weeks, they assessed the men’s cardiovascular function. The researchers found a massive decline in cardiac function. They found that the once young men had the cardiovascular function of someone at least twice their age. After the three weeks of bed rest, the researchers put the group through 8 weeks of very strenuous reconditioning. Luckily, the effects of three weeks in the sack were stymied by 8 weeks of vigorous training. Paradoxically, in 1996, the researchers of the original study re-examined the same participants. They found that their VO2 max after the three weeks in bed in the 1960’s was significantly less than after 30 years of aging naturally. In short, the researchers concluded: “Bed rest was found to be extremely harmful and endurance training beneficial across the age spectrum.”
One of my most favorite quotes from the bible comes out of the apostle Matthew’s writing, and he says: “narrow is the road that leads to righteousness, and few will take it; wide is the road that leads to destruction and most will take it.”
I will end with this. I believe the human body is somewhat like a bicycle. A bicycle is meant to be upright and in motion. When it is not in motion it will tip over and begin to rust.
1. Park in the back of the parking lot.
2. Always take the stairs over the elevator.
/s/
James Whitcher
Physical Therapist
Reference(s):
1. Exercise and Mortality: https://jamanetwork.com/journals/jama/fullarticle/2763292
2. Aspirin: https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.111.046243
3. Dallas Bed Rest: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.041046
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