How many steps a day do I really need?

And where DID 10,000 a day come from?

As I sat writing The Menopause Manifesto I became more aware of how little I was moving. First of all, this was during the first wave of the pandemic, before we knew there would be waves (insert a very sad face emoji), and everyone was terrified to go out. Or at least I was. I had curtailed many activities due to the fear of catching COVID and the time that I wasn’t writing seemed occupied by monitoring the news. Sure, I went for a run or a hike on the weekends, but during the week I would be surprised if I moved more than 1,500 steps a day. I worked from home for at least 4 weeks and all the little trips to the store to pick up that “one thing” vanished. What ever was in the pantry had to last until the next time I felt like braving the grocery store.

Basically, I felt as if I were turning into veal. 

At the same time I was reading article upon article about the health benefits of exercise for the book, and not just aerobic exercise, but simply moving more. Not just for osteoporosis prevention, but for heart disease, mental health, maintaining muscle mass and so on. 

It took me quite a while to get out of the minimal moving mindset, procrastination is a bitch, ya know? But eventually I began working with a trainer (the wonderful Kim Schlag), and movement was part of the plan. She set me a goal of 5,500 steps a day, which I thought would be a cinch, but of course it’s not. So many things in America feel designed to keep us from moving. I park at a garage across the street from work (about 1 block from my car to my office), climb 6 flights of stairs, and I am in and out of exam rooms all day, but of course I am sitting when listening to my patients and when calling them on the phone. That doesn’t get me past 4,250 steps on a busy day. The only way I can crack 5,500 steps is if I add in a walk at lunch or after work, and so it takes a lot of planning.

But lately I’ve been wondering how many steps are ideal health-wise and should I be aiming for more? We’ve all heard “10,000 steps”, but is that based in science? I’m always skeptical about quasi-medical truisms like this. After all, drinking ahead of your thirst is a Gatorade marketing slogan that found its way into our everyday lexicon and is now taken by many as gospel! Find out about more about that here.

It’s a shocker, I know, but 10,000 steps a day didn’t come from science. While no one is exactly sure where it comes from, most people in the movement-space think it is from the name of a pedometer that was sold in Japan in 1965, which was called Manpo-kei, which translates to “10 000 steps meter” in English.

Never underestimate the power of marketing. 

So what does science tell us?

I had the good fortune to get some great information from an interview with Dr. Herman Pontzer, an expert in metabolism, for the upcoming season of my podcast, Body Stuff. He’s spent a lot of time studying the Hadza, a hunter gatherer community in Tanzania (if you have read The Menopause Manifesto, data from the Hadza also helped inform the grandmother hypothesis, and you can listen to this episode of Body Stuff on menopause to hear me interview one of the experts behind that hypothesis, Dr. Kristen Hawkes). Dr. Pontzer told me that Hadza women average about 13,000 steps a day. And interestingly, women in an Old Order Amish community in Canada, where no motorized vehicles are used, walk about 14,000 steps a day. 

If you think back to ancestral humans, before farming, we were all hunter gatherers, and so getting food took effort. If hunting and gathering were too taxing physically, well, we’d have evolved differently. Being able to move a lot also means being capable of moving to places with better food when needed. If this kind of movement also keeps us healthy, it’s an evolutionary win.

But are 13,000-14,000 steps a day for women really what we need? I was hoping not as it seemed like that would be a challenge. The only time I consistently get that amount of steps a day in is when I am visiting a big city, like New York, London or Paris, and I’m not working full time while I’m there! I’m hustling to see the city.

The Women’s Health Study followed a cohort of women who wore pedometers and then compared outcomes of several health metrics with the number of steps taken. Data from this study was published in 2019, and what it shows is among women ages 45 and older that those women who took 4400 steps/day had significantly lower mortality than those with 2700 steps/day. In fact, the more steps the women took, the lower the mortality rate until they reached 7500 steps/day where the benefits leveled off. Interestingly, the speed of the steps didn’t matter, just the number of steps. 

From: Lee I-M et al. JAMA Intern Med. 2019 Aug; 179(8): 1105–1112.

I love this graph from that study. You can see the benefit level off at 7,500 steps and hold steady right up to the Hadza range of 13,000 steps a day. 

A more recent meta-analysis was published this year, looking at 15 studies, with very similar results. Among adults younger than 60 the more steps taken, the lower the mortality rate until you reach 8000-10000 steps per day. For those aged 60 and older the health benefit plateaued around 6000–8000 steps per day.

American women average a little less than 5,000 steps a day, so many people are starting from a good place, but that data is also pre-COVID and I wonder how many people were like me and curtailed activities a lot to limit their risk of exposure, and then never returned back to baseline?

So now I’ve got a new goal in mind. I’m aiming for 7,500 steps a day!  I am also reminding myself that even if I don’t hit that number, I need to think of exercise more like finding a bill on the street. Here’s what I mean. Some of us, and my hand is definitely raised here, are binary about exercise. We either hit our goal and we are amazing people or we don’t and we are bad. But imagine if you used that binary thinking with money. If you found $5 on the street, would you say to yourself, “No thanks, I was aiming for $50” and just leave it on the ground? Um, no. You would be thrilled that you found $5! That is how I now think of exercise. Because even some exercise is always good for me… just like found money. 

References

1. Jordan AN, Jurca GM, Locke CT, Church TS, Blair SN. Pedometer indices for weekly physical activity recommendations in postmenopausal women. Medicine and Science in Sports and Exercise. 2005 Sep;37(9):1627-1632.

2. Bassett DR, Schneider PL, Huntington GE. Physical Activity in an Older Amish Community. Med Sci Sports Exerc. 2004 Jan;36(1):79-85. 

3. Bassett DR JR, Wyatt H, Thompson H, et al. Pedometer-Measured Physical Activity and Health Behaviors in U.S. Adults, Medicine & Science in Sports & Exercise: October 2010 - Volume 42 - Issue 10 - p 1819-1825.

4. Paluch AE, Bajpai S, Bassett DR, et al. Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet Public Health 2022;Volume 7:3.

5. Lee I-M, Shiroma EJ, Kamada M, et al. Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Intern Med. 2019 Aug; 179(8): 1105–1112.