Welcome back to SpineIQ’s Back Blog! This week we will be continuing with the last two weeks Back Blog topics of physical activity and daily step count with an article by Saint-Maurice et al. titled “Association of daily step count and step. Intensity with mortality among US adults.”1 As conservative spine clinicians, patients usually come and see us to address the pain and disability however, it is important for us to be able to discuss other benefits to our interventions besides pain and disability reduction. In our previous blogs, we have written about the positive effects of walking on spinal pain2 and fibromyalgia3 but what is the effect of walking on mortality? Does the intensity of the walking matter? This paper attempted to answer that question. The results may help conservative spine clinicians inform patients about the myriad of benefits of our interventions and help the patients get out of pain AND decrease their mortality risk.


While higher step counts has been shown to reduce mortality, the trials usually involve significantly older adults4 which may limit the generalizability of the results to people who are not significantly older. Also, studies typically evaluate step count but rarely step intensity (cadence; steps/minute) effect on mortality. Therefore, this study evaluated the effect of total daily step count and step intensity effect on mortality in adults 40 years or older.


This study used data from the National Health and Nutrition Examination Survey (NHANES). The inclusion criteria was adults (>40 years old) that wore an accelerometer during the 7 day study period. The step count and intensity were measured with accelerometers, which has been validated as an accurate and reliable measurement tool. Using accelerometer data collected over 7 days with at least 10 hours of wearing the accelerometer for 5 days is a validated measurement method to collect the amount of physical activity (e.g., step count and step intensity) of the participant. Step intensity was measured as the number of steps per one minute. Mortality was the primary outcome and was collected using the National Death Index that allows the researchers to measure mortality in the participants of this study. Additionally, whether the death was due to cardiovascular disease or cancer was measured as secondary outcomes.


The study included data based on 4840 participants. On average 9124 steps per day were taken by the participants. The results suggest that higher step count results in lower mortality. Participants taking 2000 steps per day were associated with 51% increased mortality compared to those who took 4000 steps per day. Additionally, taking 8000 and 12,000 steps per day was associated with 51% and 65% decreased mortality, respectively compared to those taking 4000 steps per day. Cardiovascular disease mortality and cancer mortality were also associated with total daily step count. For example, taking 8000 steps per day compared to 4000 steps per day was associated with 51% lower cardiovascular and 33% lower cancer mortality. These results were consistent when stratifying among sex, age, and race. Interestingly, higher step intensity was not associated with significantly lower overall mortality, cancer mortality, or cardiovascular mortality when the authors considered total daily step count.


It is imperative that as conservative spine clinicians that we help our patients achieve the best possible quality and quantity of life. Using the results of this study, we can inform them that walking may be effective in helping with their back pain and decrease their likelihood of mortality. In a previous blog, we discussed some advice on how to program walking as an intervention for patients seeking care for back pain. This same intervention may also help them outside of their back pain. Conservative spine clinicians can also inform patients that the intensity which they walk may not be an important factor and walking more even at a slower pace is just as beneficial as walking faster. While there is continued benefit the more total daily steps that a person takes, these results suggest that just doing more than previously done may be beneficial.



  1. Saint-Maurice PF, Troiano RP, Bassett DR Jr, et al. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. 2020;323(12):1151-1160. doi:10.1001/jama.2020.1382
  2. Vanti C, Andreatta S, Borghi S, Guccione AA, Pillastrini P, Bertozzi L. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disabil Rehabil. 2019;41(6):622-632. doi:10.1080/09638288.2017.1410730
  3. Kaleth AS, Slaven JE, Ang DC. Does increasing steps per day predict improvement in physical function and pain interference in adults with fibromyalgia? Arthritis Care Res. 2014;66(12):1887-1894. doi:10.1002/acr.22398
  4. Jefferis BJ, Parsons TJ, Sartini C, et al. Objectively measured physical activity, sedentary behaviour and all-cause mortality in older men: does volume of activity matter more than pattern of accumulation? Br J Sports Med. 2019;53(16):1013-1020. doi:10.1136/bjsports-2017-098733