Encouraging bouts of walking at higher cadences may represent an important, translatable physical activity goal to reduce MACE risk.In a large study using UK Biobank data, incremental increases in daily step count are associated with a significantly lower risk of major adverse cardiovascular events (MACE) in adults with hypertension, especially when accrued at a higher stepping intensity.
“Our study demonstrated … an inverse dose-response association between daily step count and risk of MACE among adults with hypertension,” the investigators said. “Importantly, daily step counts well below 10,000 steps/day were still associated with lower MACE risk.”
Every 1,000-step increase in daily step count led to an average 17.1 percent reduction in the risk of MACE from the referent 2,344 steps/day to the nadir of the dose-response curve. “Assuming causal relationships, taking 3,000–6,600 steps/day may reduce MACE risk by 5–13 percent, with a progressively lower risk of approximately 17 percent for each 1,000-step increment towards 10,000 steps/day,” they explained.
For each 1,000-step increase in daily step count above the reference point, there was an average 22.3 percent lower risk of future heart failure, 9.3 percent lower risk of future MI, and 24.5 percent lower risk of stroke.
Except for MI (17.9 percent), the risk reductions were similar among participants without hypertension (20.2, 23.2, and 24.6 percent for MACE, heart failure, and stroke, respectively. [Eur J Prev Cardiol 2026;33:2217-2224]
The strong linear association between daily step count and stroke risk may reflect the effects of physical activity (PA) on the underlying disease process in ischaemic stroke, considering the higher prevalence of ischaemic stroke in the study, the researchers noted.
Higher PA volumes directly reduce blood pressure (BP), improve endothelial function and lipid profiles, and may have an antithrombotic effect by improving fibrinolysis and platelet aggregability. [Stroke 2015;46:1735-1739] “In our study, taking 6,500 steps/day was associated with a 15 percent lower risk of stroke, although wide confidence intervals and fewer events limit the certainty of this estimate,” they said.
The median of peak 30-min cadence (76.6 steps/min) was associated with a hazard ratio of 0.70, with lower MACE risk for higher stepping intensities above the reference point of 38.3 steps/min. “Encouraging bouts of walking at higher cadences may represent an important, translatable PA goal to reduce MACE risk in individuals with hypertension,” the researchers pointed out.
Scalable, accessible method
Regular aerobic PA may control BP and eliminate a significant burden of BP-related cardiovascular disease. [Med Sci Sports Exerc 2019;51:1314-1323; Hypertension 2020;75:285-292] However, engagement may be limited by lack of time and resources and limited access to facilities. [PLoS One 2014;9:e84238; BMC Prim Care 2022;23:257]
“Step count-based PA recommendations are easy to understand, communicate, and measure, and may increase PA uptake in individuals with hypertension,” the researchers noted. Wearables and smartphones have enabled constant monitoring of daily step count and cadence in free-living settings, providing a scalable and an accessible method to measure and promote PA. [J Meas Phys Behav 2022;5:3-7]
“Step-based recommendations may provide tangible targets for individuals with hypertension to [encourage them to be] physically active, particularly individuals who are not able or willing to [perform] structured exercises or who mostly engage in incidental PA,” they added.
Any amount is better than none
The study included 36,192 participants (mean age 64 years, 52.2 percent women) with established hypertension from the UK Biobank accelerometry sub-study. They wore a wrist-worn accelerometer 24 hrs daily for 7 consecutive days. A total of 1,935 cases of MACE were reported during a mean follow-up of 7.8 years.
Taken together, the study showed inverse nonlinear associations between higher daily step counts and stepping intensities and overall MACE and all MACE subtypes in individuals with established hypertension. Incremental improvements in daily steps were also tied to a markedly lower risk of MACE.
However, PA was only measured at baseline, and daily step count and peak 30-min cadence may not be representative of habitual stepping behaviours.
“[Nonetheless,] our findings will inform the first step count-based clinical and public health PA recommendations tailored specifically to individuals with hypertension. Enabling them and their healthcare providers to better monitor PA levels may be an important contributor towards sustained improvements in PA in this population,” the researchers said.
“Instead of framing step-based recommendations around a single minimal threshold, our findings reaffirm the message that ‘any amount of PA is better than none, and more is better’ for individuals living with chronic disease,” they added.
Of note, there was a low prevalence of participants at the upper end of the peak 30-min cadence continuum in this study. The investigators recommended further exploration of higher cadence stepping behaviours on MACE risk, specifically the embolic and ischaemic subtypes, to ascertain the role of stepping intensity in individuals with hypertension.