Optimal Healthy Number of Steps per Day

2938 words (12 pages) Essay

26th Sep 2017 Health Reference this

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Julie Wanta 

Introduction

Low level of physical activity throughout the population has created a trend toward negative health consequences. This increase in physical inactivity is leading more of the population to have a lower quality of life, more metabolic risk factors, and increased body weight. One possible reason for this may be people’s trend towards a less active and more sedentary lifestyle. It has been suggested that to reverse this trend people need to start taking 10,000 steps per day. By walking 10,000 steps per day, a person will walk approximately five miles or for about 75 minutes at a moderate intensity which meets the set exercise guidelines for adults. The purpose of this paper is to determine if taking 10,000 steps per day will improve quality of life, decrease cardiometabolic risk factors, and induce weight loss without diet while also assessing the goal of 10,000 steps per day to see if it is attainable. To do so, research that recorded subjects’ step count will be used along with the findings pertaining to quality of life, cardiometabolic risk factors, weight loss, and adherence.

Quality of Life

For those that increase their steps per day count to 10,000, a higher quality of life will be attained compared to those who don’t and compared to their own previous quality of life. One way this is achieved is through increased physical activity. In one study conducted by Hulquist, Albright, and Thompson, it was found that women who were given a goal of 10,000 steps per day were more physically active than those who were told to go for a 30 minute walk each day1. One reason for this is that by achieving 10,000 steps per day, a person will most likely do so throughout their day, decreasing sedentary behavior. On the other hand, women who only do 30 minutes of walking per day are able to be sedentary for the remainder of their day. Therefore, increasing steps per day to 10,000 improves quality of life by decreasing physical inactivity and improving ambulation.

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Another way quality of life is improved is though decreasing depression. In a study conducted by Aoyagi and Shepard, it was found in people under 75 that increased their step count to 10,000 steps per day reported decreased levels of depression post intervention compared to pre-intervention levels2. This seems probable in that increasing step count increases levels of exercise which has been shown to lead to a decrease in depression ratings. One explanation for this is that exercise has an acute effect on hormones and increases levels of endorphins like serotonin in the body, resulting in elevated mood ratings. Also, having a daily step count of 10,000 will turn the acute effect of exercise into having chronic benefits, resulting in constantly elevated levels of serotonin in the brain. This results in decreased depression and increased mood ratings and increases overall quality of life.

Another way increasing steps per day improves quality of life is seen in an improvement of mental health. In a study conducted by Leung, Cheung, and Tse, et al., just increasing the amount of steps taken per day by approximately 2,343 steps on average during a 10-week period, subjects scored higher in the mental health portion of a questionnaire3. In this study subjects did not necessarily reach the 10,000 step goal with the average step count around 8,934 steps per day; however, there were still mental health benefits. These findings are significant because not only was this a relatively short study, but it also found benefits with just increasing step count. It was also found that increasing step count resulted in a decreased level of poor quality of life. This study shows that there are relatively immediate benefits to quality of life by increasing step count and that quality of life will increase even in those who cannot attain 10,000 steps per day every day. In this same study, it was also found that the increase in steps per day resulted in increased lower body strength, increased upper body strength, and an improved 6-minute exercise capability test score. This data is related to an increase in quality of life simply because the increase in strength and capabilities of the person will make ambulation and everyday tasks easier. From these studies, it can be concluded that increasing step count to or around 10,000 steps per day will improve quality of life by increasing physical activity levels, decreasing depressed moods, and improving mental health scores.

Cardiometabolic Risk Factors

Another benefit of increasing step count to 10,000 steps per day is decreasing cardiometabolic risk factors. In a study conducted by Fujieda, Miura, and Nakagawa, during a six month intervention, subjects increased their step count by 2,500 to reach 10,000 steps per day. After the intervention, it was found that subjects had decreased levels of very low density lipoprotein cholesterol and plasma insulin levels4. Subjects also experienced an increase in high density lipoprotein levels. In a previously mentioned study, Aoyagi and Shepard, in which individuals under 75 increased steps to 10,000 steps per day, it was also found that this decreased aortic arteriosclerosis, improved metabolic health and decreased risk of hypertension and hyperglycemia2. These findings support that 10,000 steps per day reduces cardiometabolic risk factors. Another study the benefit in taking 10,000 steps per day on hyperglycemia can be seen is in the study conducted by Dwyer, Ponsonby, and Ukoumunne, et al.5 In this study, participants’ insulin levels were measured in 2000 and then again in 2005. It was found that those who had a higher step count in 2005 compared to 2000 had greater insulin sensitivity by 1.38 HOMA units. This is beneficial on the impact of cardiometabolic risk because increased insulin sensitivity leads to decreased serum glucose.

Finally, Cocate, Oliveira, and Hermsdorff, et al. studied the relationship between steps per day and cardiometabolic risk factors6. It was found that there was in inverse relationship between the number of steps walked per day and cardiometabolic risk factors, specifically insulin resistance, levels of high density lipoproteins, and levels of triglycerides. It was found that insulin resistance decreased; the level of high density lipoproteins increased; and the level of triglycerides increased.

Decreasing levels of very low density lipoproteins and increasing levels of high density lipoproteins by increasing step count decreases cardiometabolic risk factors and results in decreased levels of atherosclerosis in blood vessels and hypertension2,4,6. Hypertension is a clinical component that contributes to cardiometabolic risk, decreasing hypertension decreases cardiometabolic risk. Decreasing atherosclerosis in the blood vessels results in decreased risk of heart attack. High serum glucose is a cardiometabolic risk factor. By decreasing plasma insulin levels in subjects a decrease in insulin resistance results which in turn decreases serum glucose2,5. The findings from these studies are consistent with decreasing cardiometabolic risk factors. As demonstrated, increasing a person’s step count to 10,000 or near to, will decrease the amount of cardiometabolic risk factors prevalent for that person.

Weight Loss without Diet

Another benefit of taking 10,000 steps per day is seen through weight loss. In a study by Tudor-Locke, Bassett, and Rutherford, et al., they found that for both genders and each age group studied, the group with body mass index less than 25 kg/m2, normal weight, took almost 2,000 more steps per day compared to the group with body mass index equal to or over 25 kg/m2, overweight7. This study shows that there is a correlation between body mass index and steps per day. This correlation is further strengthened in the study by Martinez-Lopez, Grao-Cruces, and Moral-Garcia, et al. which found that obese teenagers were able to decrease their body mass index and body fat by increasing the amount of steps per day to 10,000 for girls and 12,000 for boys8. This study suggests that a higher recommendation than 10,000 steps per day is necessary for weight loss benefits, however, not all studies agree with this. In a previously mentioned study, Fujieda, Miura, and Nakagawa, in which subjects increased their step count by 2,500 steps per day to attain 10,000 steps per day, subjects experienced a decrease in body mass index from 26.3 kg/m2 to 25.7 kg/m2 over a 6 month period4. This study demonstrates that increasing step count has a relatively immediate effect in that within six months subjects were able to see a fairly sizable decrease in body mass index. In another study, previously mentioned, by Dwyer, Ponsonby, and Ukoumunne et al., a direct relationship between steps per day and body mass index was observed. For subjects who increased their step count in 2005 compared to 2000, it was seen that they had a lower waist to hip ratio and decreased their body mass index by .08 kg/m2 per 1,000 steps5. This illustrates a direct inverse, dose-response relationship between steps per day and weight.

Increasing step count decreases more than just body mass index. In Schneider, Bassett, and Thompson’s study, when sedentary people, people who took less than 7,500 steps per day, increased their step count to 10,000 steps per day they decreased their body mass index by 1.6 kg/m2, percent body fat by 3.2%, fat mass by 4.7 kg, waist circumference by 3.1 cm, and hip circumference by 2.9 cm9. These findings are important for understanding how the increase in steps per day promotes weight loss without diet.

The decrease in waist circumference resulting from a decrease in abdominal fat is very important because abdominal fat is most associated with health problems5,9. For this reason, it is important to note that increasing steps per day decreases abdominal fat without diet and increases overall health. It is also important to note that fat mass and percent body fat decreased without diet. This is of particular importance because it confirms that increasing step count to 10,000 steps per day results in fat loss, not muscle loss, as seen in some weight loss programs. From the studies presented, increasing the amount of steps per day a person takes will result in weight loss without diet.

Adherence

Although it is very easy for a physician to prescribe a patient 10,000 steps per day, will they actually do it? In a study mentioned above conducted by Schneider, Bassett, and Thompson, et al., although this study resulted in very important findings, only 34% of participants who initiated the program actually adhered to it9. This suggests that although there are numerous health benefits associated with 10,000 steps per day, the goal may not be feasible for everyone to attain. Some possible reasons for this, as found by Schneider, Bassett, and Thompson, et al., is that 10,000 steps per day is an unrealistic goal and they had a lack of time to complete 10,000 steps per day. However, this study reported that only 6% of non-adherers found the goal of 10,000 steps per day to be unrealistically high. On the other hand, 88% of non-adherers reported that they did not complete the goal of 10,000 steps due to lack of time while even 40% of adherers reported that on days they did not complete the goal of 10,000 steps it was due to lack of time. This problem, however, seems to be fairly resolvable. In general it takes a person 75 minutes to walk 10,000 steps, which seems easy enough if broken into small chunks, 15 minutes, throughout the day. It is important to note that 75 minutes may seem like more time than most people spend doing daily walking, and that is because a step goal of 10,000 is designed to increase physical activity and decrease sedentary time. Most likely, if people were to decrease their sedentary time, they would have the time to meet the goal of 10,000 steps per day.

In one study conducted by Clemes, Hamilton, and Lindley, they found that normal weight individuals took 1,000 steps less on Sundays than they normally do and overweight individuals took 2,000 steps less on Sundays than normally do10. This is of significant importance because not only were overweight individuals taking fewer steps per day on regular days, but their decrease in steps per day on Sundays was twice that of the normal weight group. It is evendue to lack of time. discover if the population to have a lower quality of life, more metabolic risk factors, and 111more important on these days to achieve the step goal of 10,000 steps per day, especially in overweight people. By consistently increasing Sunday steps, both groups will see the health benefits explained earlier, while the overweight group will see a larger benefit due to a larger increase in steps per day. Although a goal of 10,000 steps per day appears to be a large and unattainable to some people, for most, it is completely reasonable.

Summary and Conclusion

From the compiled research presented above, it has been shown that there are many health benefits associated with not only 10,000 steps per day, but also by just increasing daily step count. As such, 10,000 steps per day is the correct goal step count. The data presented represents that there is a dose-response relationship between daily step count and the associated health benefits. Increasing step count will improve quality of life through elevated mood ratings and improved ambulation. A higher step count will also decrease cardiometabolic risk factors by decreasing insulin resistance and very low density lipoproteins while increasing high density lipoproteins. Finally, increasing step count will result in weight loss without diet as seen in decreased body mass index, over all weight, and over all fat mass, specifically abdominal fat. While the goal of 10,000 steps per day may seem difficult, it can be easily attained for most adults, barring those with disabilities. Further research is needed to see exactly how strong the dose-response relationship is. I would like to see a study with four groups of people, one control group, another group at 8,000 steps per day, another group at 10,000 steps per day, and a final group at 12,000 steps per day. Possibly even another study with a higher and lower step count per day to see if there is a cap to the health benefits or a minimum to receive the health benefits previously described. These studies would give insight to physicians assigning walking with a step count for health benefits. Although further research is needed to better understand the relationship past 10,000 steps, the evidence that increasing step count to 10,000 steps per day leads to health benefits is undeniable strong and as such, 10,000 steps per day should be the recommended step count to achieve the associated health benefits.

Bibliography

  1. Haltquist C, Albright C, Thompson DL. Comparison of walking recommendation in

previously inactive women. Med Sci Sports Exer 2005; 37:4:676-683.

  1. Aoyagi Y, Shephard RJ. Steps per day: the road to senior health? Sports Med 2012;

39:6:423-438.

  1. Leung AY, Cheung MK, Tse MA, et al. Walking in the high-rise city: a health enhancement

and pedometer-determined ambulatory (HEPA) programs in Hong Kong. Clin Interv

Aging 2014;9:1343-52.

  1. Fujieda Y, Miura K, Nakagawa H. Walking 10,000 steps per day is effective to improve

coronary risk factors among Japanese middle-aged men. Fitness Sports Med 2006;

55:37-42.

  1. Dwyer T, Ponsonby A-L, Ukoumunne OC, et al. Association of change in daily step count

over five years with insulin sensitivity and adiposity: population based cohort study.

BMJ 2011; 342:7249.

  1. Cocate PG, Oliviera A, Hermsdorff, et al. Benefits and relationship of steps walked per day

to cardiometabolic risk factor in Brazilian middle-aged men. J Sci Med Sport 2014;

17:3:283-287.

  1. Tudor-Locke, Bassett, Rutherford, et al. BMI-referenced cut points for pedometer

determined steps per day in adults. J Phys Act Health 2008; 5:1:126-139

  1. Martinez-Lopez E, Grao-Cruces A, Moral-Garcia J, et al. Intervention for Spanish

overweight teenagers in physical education lessons. J Sci Med Sport 2012; 11:2:312-321.

  1. Schneider PL, Bassett DR, Thompson DL, et al. Effects of a 10,000 steps per day goal in

overweight adults. Am J Health Promot 2006; 21:2:85-89.

  1. Clemes SA, Hamilton SL, Lindley MR. Four-week pedometer-determined activity in normal

weight, overweight, and obese adults. Prev Med 2008; 46:4:325-30.

Julie Wanta 

Introduction

Low level of physical activity throughout the population has created a trend toward negative health consequences. This increase in physical inactivity is leading more of the population to have a lower quality of life, more metabolic risk factors, and increased body weight. One possible reason for this may be people’s trend towards a less active and more sedentary lifestyle. It has been suggested that to reverse this trend people need to start taking 10,000 steps per day. By walking 10,000 steps per day, a person will walk approximately five miles or for about 75 minutes at a moderate intensity which meets the set exercise guidelines for adults. The purpose of this paper is to determine if taking 10,000 steps per day will improve quality of life, decrease cardiometabolic risk factors, and induce weight loss without diet while also assessing the goal of 10,000 steps per day to see if it is attainable. To do so, research that recorded subjects’ step count will be used along with the findings pertaining to quality of life, cardiometabolic risk factors, weight loss, and adherence.

Quality of Life

For those that increase their steps per day count to 10,000, a higher quality of life will be attained compared to those who don’t and compared to their own previous quality of life. One way this is achieved is through increased physical activity. In one study conducted by Hulquist, Albright, and Thompson, it was found that women who were given a goal of 10,000 steps per day were more physically active than those who were told to go for a 30 minute walk each day1. One reason for this is that by achieving 10,000 steps per day, a person will most likely do so throughout their day, decreasing sedentary behavior. On the other hand, women who only do 30 minutes of walking per day are able to be sedentary for the remainder of their day. Therefore, increasing steps per day to 10,000 improves quality of life by decreasing physical inactivity and improving ambulation.

Another way quality of life is improved is though decreasing depression. In a study conducted by Aoyagi and Shepard, it was found in people under 75 that increased their step count to 10,000 steps per day reported decreased levels of depression post intervention compared to pre-intervention levels2. This seems probable in that increasing step count increases levels of exercise which has been shown to lead to a decrease in depression ratings. One explanation for this is that exercise has an acute effect on hormones and increases levels of endorphins like serotonin in the body, resulting in elevated mood ratings. Also, having a daily step count of 10,000 will turn the acute effect of exercise into having chronic benefits, resulting in constantly elevated levels of serotonin in the brain. This results in decreased depression and increased mood ratings and increases overall quality of life.

Another way increasing steps per day improves quality of life is seen in an improvement of mental health. In a study conducted by Leung, Cheung, and Tse, et al., just increasing the amount of steps taken per day by approximately 2,343 steps on average during a 10-week period, subjects scored higher in the mental health portion of a questionnaire3. In this study subjects did not necessarily reach the 10,000 step goal with the average step count around 8,934 steps per day; however, there were still mental health benefits. These findings are significant because not only was this a relatively short study, but it also found benefits with just increasing step count. It was also found that increasing step count resulted in a decreased level of poor quality of life. This study shows that there are relatively immediate benefits to quality of life by increasing step count and that quality of life will increase even in those who cannot attain 10,000 steps per day every day. In this same study, it was also found that the increase in steps per day resulted in increased lower body strength, increased upper body strength, and an improved 6-minute exercise capability test score. This data is related to an increase in quality of life simply because the increase in strength and capabilities of the person will make ambulation and everyday tasks easier. From these studies, it can be concluded that increasing step count to or around 10,000 steps per day will improve quality of life by increasing physical activity levels, decreasing depressed moods, and improving mental health scores.

Cardiometabolic Risk Factors

Another benefit of increasing step count to 10,000 steps per day is decreasing cardiometabolic risk factors. In a study conducted by Fujieda, Miura, and Nakagawa, during a six month intervention, subjects increased their step count by 2,500 to reach 10,000 steps per day. After the intervention, it was found that subjects had decreased levels of very low density lipoprotein cholesterol and plasma insulin levels4. Subjects also experienced an increase in high density lipoprotein levels. In a previously mentioned study, Aoyagi and Shepard, in which individuals under 75 increased steps to 10,000 steps per day, it was also found that this decreased aortic arteriosclerosis, improved metabolic health and decreased risk of hypertension and hyperglycemia2. These findings support that 10,000 steps per day reduces cardiometabolic risk factors. Another study the benefit in taking 10,000 steps per day on hyperglycemia can be seen is in the study conducted by Dwyer, Ponsonby, and Ukoumunne, et al.5 In this study, participants’ insulin levels were measured in 2000 and then again in 2005. It was found that those who had a higher step count in 2005 compared to 2000 had greater insulin sensitivity by 1.38 HOMA units. This is beneficial on the impact of cardiometabolic risk because increased insulin sensitivity leads to decreased serum glucose.

Finally, Cocate, Oliveira, and Hermsdorff, et al. studied the relationship between steps per day and cardiometabolic risk factors6. It was found that there was in inverse relationship between the number of steps walked per day and cardiometabolic risk factors, specifically insulin resistance, levels of high density lipoproteins, and levels of triglycerides. It was found that insulin resistance decreased; the level of high density lipoproteins increased; and the level of triglycerides increased.

Decreasing levels of very low density lipoproteins and increasing levels of high density lipoproteins by increasing step count decreases cardiometabolic risk factors and results in decreased levels of atherosclerosis in blood vessels and hypertension2,4,6. Hypertension is a clinical component that contributes to cardiometabolic risk, decreasing hypertension decreases cardiometabolic risk. Decreasing atherosclerosis in the blood vessels results in decreased risk of heart attack. High serum glucose is a cardiometabolic risk factor. By decreasing plasma insulin levels in subjects a decrease in insulin resistance results which in turn decreases serum glucose2,5. The findings from these studies are consistent with decreasing cardiometabolic risk factors. As demonstrated, increasing a person’s step count to 10,000 or near to, will decrease the amount of cardiometabolic risk factors prevalent for that person.

Weight Loss without Diet

Another benefit of taking 10,000 steps per day is seen through weight loss. In a study by Tudor-Locke, Bassett, and Rutherford, et al., they found that for both genders and each age group studied, the group with body mass index less than 25 kg/m2, normal weight, took almost 2,000 more steps per day compared to the group with body mass index equal to or over 25 kg/m2, overweight7. This study shows that there is a correlation between body mass index and steps per day. This correlation is further strengthened in the study by Martinez-Lopez, Grao-Cruces, and Moral-Garcia, et al. which found that obese teenagers were able to decrease their body mass index and body fat by increasing the amount of steps per day to 10,000 for girls and 12,000 for boys8. This study suggests that a higher recommendation than 10,000 steps per day is necessary for weight loss benefits, however, not all studies agree with this. In a previously mentioned study, Fujieda, Miura, and Nakagawa, in which subjects increased their step count by 2,500 steps per day to attain 10,000 steps per day, subjects experienced a decrease in body mass index from 26.3 kg/m2 to 25.7 kg/m2 over a 6 month period4. This study demonstrates that increasing step count has a relatively immediate effect in that within six months subjects were able to see a fairly sizable decrease in body mass index. In another study, previously mentioned, by Dwyer, Ponsonby, and Ukoumunne et al., a direct relationship between steps per day and body mass index was observed. For subjects who increased their step count in 2005 compared to 2000, it was seen that they had a lower waist to hip ratio and decreased their body mass index by .08 kg/m2 per 1,000 steps5. This illustrates a direct inverse, dose-response relationship between steps per day and weight.

Increasing step count decreases more than just body mass index. In Schneider, Bassett, and Thompson’s study, when sedentary people, people who took less than 7,500 steps per day, increased their step count to 10,000 steps per day they decreased their body mass index by 1.6 kg/m2, percent body fat by 3.2%, fat mass by 4.7 kg, waist circumference by 3.1 cm, and hip circumference by 2.9 cm9. These findings are important for understanding how the increase in steps per day promotes weight loss without diet.

The decrease in waist circumference resulting from a decrease in abdominal fat is very important because abdominal fat is most associated with health problems5,9. For this reason, it is important to note that increasing steps per day decreases abdominal fat without diet and increases overall health. It is also important to note that fat mass and percent body fat decreased without diet. This is of particular importance because it confirms that increasing step count to 10,000 steps per day results in fat loss, not muscle loss, as seen in some weight loss programs. From the studies presented, increasing the amount of steps per day a person takes will result in weight loss without diet.

Adherence

Although it is very easy for a physician to prescribe a patient 10,000 steps per day, will they actually do it? In a study mentioned above conducted by Schneider, Bassett, and Thompson, et al., although this study resulted in very important findings, only 34% of participants who initiated the program actually adhered to it9. This suggests that although there are numerous health benefits associated with 10,000 steps per day, the goal may not be feasible for everyone to attain. Some possible reasons for this, as found by Schneider, Bassett, and Thompson, et al., is that 10,000 steps per day is an unrealistic goal and they had a lack of time to complete 10,000 steps per day. However, this study reported that only 6% of non-adherers found the goal of 10,000 steps per day to be unrealistically high. On the other hand, 88% of non-adherers reported that they did not complete the goal of 10,000 steps due to lack of time while even 40% of adherers reported that on days they did not complete the goal of 10,000 steps it was due to lack of time. This problem, however, seems to be fairly resolvable. In general it takes a person 75 minutes to walk 10,000 steps, which seems easy enough if broken into small chunks, 15 minutes, throughout the day. It is important to note that 75 minutes may seem like more time than most people spend doing daily walking, and that is because a step goal of 10,000 is designed to increase physical activity and decrease sedentary time. Most likely, if people were to decrease their sedentary time, they would have the time to meet the goal of 10,000 steps per day.

In one study conducted by Clemes, Hamilton, and Lindley, they found that normal weight individuals took 1,000 steps less on Sundays than they normally do and overweight individuals took 2,000 steps less on Sundays than normally do10. This is of significant importance because not only were overweight individuals taking fewer steps per day on regular days, but their decrease in steps per day on Sundays was twice that of the normal weight group. It is evendue to lack of time. discover if the population to have a lower quality of life, more metabolic risk factors, and 111more important on these days to achieve the step goal of 10,000 steps per day, especially in overweight people. By consistently increasing Sunday steps, both groups will see the health benefits explained earlier, while the overweight group will see a larger benefit due to a larger increase in steps per day. Although a goal of 10,000 steps per day appears to be a large and unattainable to some people, for most, it is completely reasonable.

Summary and Conclusion

From the compiled research presented above, it has been shown that there are many health benefits associated with not only 10,000 steps per day, but also by just increasing daily step count. As such, 10,000 steps per day is the correct goal step count. The data presented represents that there is a dose-response relationship between daily step count and the associated health benefits. Increasing step count will improve quality of life through elevated mood ratings and improved ambulation. A higher step count will also decrease cardiometabolic risk factors by decreasing insulin resistance and very low density lipoproteins while increasing high density lipoproteins. Finally, increasing step count will result in weight loss without diet as seen in decreased body mass index, over all weight, and over all fat mass, specifically abdominal fat. While the goal of 10,000 steps per day may seem difficult, it can be easily attained for most adults, barring those with disabilities. Further research is needed to see exactly how strong the dose-response relationship is. I would like to see a study with four groups of people, one control group, another group at 8,000 steps per day, another group at 10,000 steps per day, and a final group at 12,000 steps per day. Possibly even another study with a higher and lower step count per day to see if there is a cap to the health benefits or a minimum to receive the health benefits previously described. These studies would give insight to physicians assigning walking with a step count for health benefits. Although further research is needed to better understand the relationship past 10,000 steps, the evidence that increasing step count to 10,000 steps per day leads to health benefits is undeniable strong and as such, 10,000 steps per day should be the recommended step count to achieve the associated health benefits.

Bibliography

  1. Haltquist C, Albright C, Thompson DL. Comparison of walking recommendation in

previously inactive women. Med Sci Sports Exer 2005; 37:4:676-683.

  1. Aoyagi Y, Shephard RJ. Steps per day: the road to senior health? Sports Med 2012;

39:6:423-438.

  1. Leung AY, Cheung MK, Tse MA, et al. Walking in the high-rise city: a health enhancement

and pedometer-determined ambulatory (HEPA) programs in Hong Kong. Clin Interv

Aging 2014;9:1343-52.

  1. Fujieda Y, Miura K, Nakagawa H. Walking 10,000 steps per day is effective to improve

coronary risk factors among Japanese middle-aged men. Fitness Sports Med 2006;

55:37-42.

  1. Dwyer T, Ponsonby A-L, Ukoumunne OC, et al. Association of change in daily step count

over five years with insulin sensitivity and adiposity: population based cohort study.

BMJ 2011; 342:7249.

  1. Cocate PG, Oliviera A, Hermsdorff, et al. Benefits and relationship of steps walked per day

to cardiometabolic risk factor in Brazilian middle-aged men. J Sci Med Sport 2014;

17:3:283-287.

  1. Tudor-Locke, Bassett, Rutherford, et al. BMI-referenced cut points for pedometer

determined steps per day in adults. J Phys Act Health 2008; 5:1:126-139

  1. Martinez-Lopez E, Grao-Cruces A, Moral-Garcia J, et al. Intervention for Spanish

overweight teenagers in physical education lessons. J Sci Med Sport 2012; 11:2:312-321.

  1. Schneider PL, Bassett DR, Thompson DL, et al. Effects of a 10,000 steps per day goal in

overweight adults. Am J Health Promot 2006; 21:2:85-89.

  1. Clemes SA, Hamilton SL, Lindley MR. Four-week pedometer-determined activity in normal

weight, overweight, and obese adults. Prev Med 2008; 46:4:325-30.

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