A large prospective study has examined the relationship between the frequency of meeting specific daily step count thresholds and the risk of all-cause mortality and cardiovascular disease (CVD) among older women. Conducted within the Women’s Health Study cohort, the research included 13,547 women (mean age 71.8 years) who wore accelerometers for seven consecutive days between 2011 and 2015. Participants were followed through 2024.
The study assessed how often individuals achieved daily step thresholds of ≥4000, ≥5000, ≥6000, or ≥7000 steps and whether these patterns were associated with health outcomes. Participants were categorized based on how many days per week they met each threshold (0, 1–2, or ≥3 days). During a median follow-up of 10.9 years, 13% of participants died and 5.8% developed CVD.
Compared to women who did not reach 4000 steps/day on any day of the week, those who met this threshold on 1–2 days had a 26% lower risk of mortality (adjusted hazard ratio [HR] 0.74, 95% CI 0.65 to 0.86), while those reaching it on ≥3 days had a 40% lower risk (HR 0.60, 95% CI 0.53 to 0.68). Similar associations were observed for CVD, with a 27% lower risk associated with meeting the threshold on 1–2 or ≥3 days.
Higher thresholds—5000, 6000, and 7000 steps/day—were also associated with progressively lower mortality risk. For example, achieving ≥7000 steps/day on 1–2 days was linked with a 32% reduction in mortality risk compared to no days (HR 0.68, 95% CI 0.59 to 0.78), while meeting that threshold on ≥3 days showed a similar association (HR 0.68, 95% CI 0.59 to 0.78).
However, when analyses were adjusted for mean daily step volume, the associations between frequency of threshold attainment and outcomes were no longer statistically significant. This suggests that the total number of steps taken per day, regardless of how often a threshold is met during the week, is the main factor associated with reduced mortality and CVD risk.
The findings align with previous work on physical activity patterns, including the so-called "weekend warrior" model, in which activity concentrated on just a few days per week is still associated with health benefits. The study provides evidence that in older populations, step accumulation does not need to occur daily to confer benefit, as long as total volume is sufficient.
Several limitations were noted. Only a single week of step data was collected, and participants were primarily white women of higher socioeconomic status, which may limit generalizability. Additionally, diet and fitness levels were not reassessed at the time of step monitoring. Sensitivity analyses excluding early deaths and participants in poorer health supported the robustness of the primary findings.
In conclusion, this study supports the role of total daily step volume as a predictor of mortality and CVD risk among older women. Achieving modest step counts on even a few days per week was associated with lower risk, though the benefit appears to stem from overall step accumulation rather than frequency of meeting specific thresholds. These results may inform future physical activity guidelines in aging populations.