Researchers tracked more than 13 million days of real-world activity to reveal how step counts can counteract the harms of sitting for too long, while warning that too much sitting still poses lasting risks to the heart.
Study: All of Us research program shows daily step count offsets the risk of sedentary behavior. Image credit: Jacek Chabraszewski/Shutterstock.com
More than one in three adults spends long periods of time sedentary, which is associated with a higher risk of chronic disease and early death. research in nature communications We found that while not foolproof against certain heart conditions, increasing the number of steps you take each day may offset some of these risks.
Track sedentary time
Sedentary time refers to waking hours spent in low-energy activities, such as sitting or lying down. Previous research on reducing the effects of such behavior has primarily focused on replacing it with moderate-to-vigorous physical activity (MVPA). However, some studies suggest a high correlation between MVPA and daily step count. Therefore, they may show similar associations with disease and mortality risk.
Tracking daily steps using commercially available wearable sensors and smartphones is the latest innovation that makes it easier to analyze such associations.
Previous research suggests an additional number of daily steps
Based on previous observations, the general recommendation is 7,000 to 9,000 steps per day. Short-term actigraphy-based studies have reported that regardless of sedentary behavior, the lowest cardiovascular risk is between 9,000 and 10,500 steps per day, which is associated with a lower risk of developing cardiovascular disease or death. However, such studies cannot capture natural variations caused by seasonal and individual-specific factors.
The current study used longitudinal data to assess whether increasing the number of daily steps could offset the negative association of sedentary behavior with the risk of cardiovascular disease and other chronic diseases.
Fitbit clinical outcome data
The study included 15,327 adult participants from the All of Us Research Program, whose Fitbit monitoring data was linked to electronic health records (EHRs). This enabled large-scale evaluation of activity data related to clinical outcomes.
Most participants were white women, with a median age of 52 years. The median period of Fitbit monitoring was 3.7 years, the median daily sedentary time was 11.6 hours, and the median daily step count was 7,416. Although sedentary time was longer than previous studies suggested, the longer data acquisition period suggests greater reliability.
This suggests that U.S. adults may be more sedentary than previous estimates, but this inference is based on long-term measurements rather than final population estimates. Older black participants without a college education were more sedentary and took fewer steps per day.
Increased sedentary time increases system-wide risk
The researchers found that increased sedentary time was primarily associated with a 15% to 66% increased risk of almost all chronic diseases (except ischemic stroke) in a dose-response manner. The conditions evaluated were:
- obesity
- diabetes
- high blood pressure
- coronary artery disease
- heart failure
- Fatty liver disease associated with metabolic dysfunction (MASLD)
- chronic kidney disease
- Chronic obstructive pulmonary disease (COPD)
- major depressive disorder
- sleep apnea syndrome
- atrial fibrillation
These effects may operate through the effects of sedentary time on multiple physiological systems, including cardiovascular fitness, muscle and bone mass, immune function, energy balance, and cerebral blood flow.
Increasing the number of steps you take each day reduces your risk
Increasing the number of steps taken each day decreased the risk of all 12 chronic diseases evaluated here, and increasing the number of steps decreased the risk of all diseases. These findings suggest that daily step count and sedentary time may have partially independent effects on health outcomes.
The number of additional steps needed to reduce the risk of sedentary behavior is between 1,700 and 5,500 per day, suggesting that sedentary behavior and daily step count have different effects on different conditions.
For obese people, an additional 1,700 steps each day offsets the greater risk of 14 hours of sedentary behavior compared to 8 hours of sedentary behavior. Additional steps increased with baseline body mass index (BMI). Conversely, an additional 5,500 steps were required to offset the increased risk of COPD.
Nonlinear patterns in some conditions
At about 8,000 steps per day, the risk of high blood pressure, heart failure, and MASLD stabilized at a low level. In contrast, the risk of coronary artery disease decreased to 12,000 steps per day, then rose again, and finally exceeded the baseline risk after 16,000 steps per day. The authors hypothesized that prolonged excessive physical activity, such as endurance exercise, may induce deleterious cardiovascular remodeling.
These results suggest an upper limit to the cardiovascular benefits of physical activity.
Sedentary lifestyle increases risk of coronary artery disease and heart failure
The additional steps offset the increased risk of coronary artery disease associated with up to 14 hours of sitting, but not the risk of heart failure. In people who were sedentary for 14 hours a day, the risk of both symptoms did not return to baseline levels at any step count between 0 and 20,000 steps.
This suggests that daily steps and physical activity cannot fully compensate for the effects of sedentary behavior in some areas, highlighting the importance of increasing activity while simultaneously decreasing sedentary time.
Counterintuitive effect
Paradoxical patterns were observed in several conditions. For example, 14 hours of sedentary time compared to 8 hours requires fewer steps to offset the risk of depression. This may reflect factors such as psychomotor decline in more severe depression, but this remains speculative.
strengths and limitations
The study used more than 13 million days of monitored activity data, rather than self-report or accelerometer data. Monthly estimates ensure that individual and seasonal variations in key variables are captured. Risk for multiple conditions was assessed.
However, some limitations exist, including the possibility that the proprietary algorithms used in Fitbit devices can introduce systematic biases in estimates of sedentary time. This cohort was relatively young, white, and female, limiting generalizability.
The number of cases of extreme levels of sedentary behavior was small under certain conditions, which may limit the stability of some estimates.
Certain chronic diseases were underrepresented. Sedentary behavior was not differentiated whether it was continuous or interrupted by active episodes. Since this is based on observational data, there is still the possibility of reverse causation.
what it means
Daily step count is a useful and practical marker of activity and can help healthcare providers advise patients to monitor daily step count and sedentary time. “These findings support personalized behavioral recommendations that take into account both sedentary behavior and daily step count.”
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Reference magazines:
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Zheng, N.S., Huang, S., Annis, J., et al. (2026). In the All of Us research program, daily step counts offset the risks of sedentary behavior. Nature Communications. Toi: https://doi.org/10.1038/s41467-026-71652-0. https://www.nature.com/articles/s41467-026-71652-0
