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Revisiting "How Many Steps Are Enough?"



With continued widespread acceptance of pedometers by both researchers and practitioners, evidence-based steps/day indices are needed to facilitate measurement and motivation applications of physical activity (PA) in public health. Therefore, the purpose of this article is to reprise, update, and extend the current understanding of dose-response relationships in terms of pedometer-determined PA. Any pedometer-based PA guideline presumes an accurate and standardized measure of steps; at this time, industry standards establishing quality control of instrumentation is limited to Japan where public health pedometer applications and the 10,000 steps.d slogan are traceable to the 1960s. Adult public health guidelines promote > or =30 min of at least moderate-intensity daily PA, and this translates to 3000-4000 steps if they are: 1) at least moderate intensity (i.e., > or =100 steps.min); 2) accumulated in at least 10-min bouts; and 3) taken over and above some minimal level of PA (i.e., number of daily steps) below which individuals might be classified as sedentary. A zone-based hierarchy is useful for both measurement and motivation purposes in adults: 1) <5000 steps.d (sedentary); 2) 5000-7499 steps.d (low active); 3) 7500-9999 steps.d (somewhat active); 4) > or =10,000-12,499 steps.d (active); and 5) > or =12,500 steps.d (highly active). Evidence to support youth-specific cutoff points is emerging. Criterion-referenced approaches based on selected health outcomes present the potential for advancing evidence-based steps/day standards in both adults and children from a measurement perspective. A tradeoff that needs to be acknowledged and considered is the impact on motivation when evidence-based cutoff points are interpreted by individuals as unattainable goals.
Copyright @ 200 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Revisiting ‘‘How Many Steps Are Enough?’
Walking Behavior Laboratory, Pennington Biomedical Research Center, Baton Rogue, LA;
Physical Education, Arizona
State University, Mesa, AZ;
Kyushu University of Health and Welfare, Kyushu, JAPAN; and
Department of Health and
Human Performance, Middle Tennessee State University, Murfreesboro, TN
TUDOR-LOCKE, C., Y. HATANO, R. P. PANGRAZI, and M. KANG. Revisiting ‘‘How Many Steps Are Enough?’Med. Sci. Sports
Exerc., Vol. 40, No. 7S, pp. S537–S543, 2008. With continued widespread acceptance of pedometers by both researchers and
practitioners, evidence-based steps/day indices are needed to facilitate measurement and motivation applications of physical activity
(PA) in public health. Therefore, the purpose of this article is to reprise, update, and extend the current understanding of dose–response
relationships in terms of pedometer-determined PA. Any pedometer-based PA guideline presumes an accurate and standardized
measure of steps; at this time, industry standards establishing quality control of instrumentation is limited to Japan where public health
pedometer applications and the 10,000 stepsId
slogan are traceable to the 1960s. Adult public health guidelines promote Q30 min of
at least moderate-intensity daily PA, and this translates to 3000–4000 steps if they are: 1) at least moderate intensity (i.e., Q100
); 2) accumulated in at least 10-min bouts; and 3) taken over and above some minimal level of PA (i.e., number of daily
steps) below which individuals might be classified as sedentary. A zone-based hierarchy is useful for both measurement and motivation
purposes in adults: 1) G5000 stepsId
(sedentary); 2) 5000–7499 stepsId
(low active); 3) 7500–9999 stepsId
(somewhat active);
4) Q10,000–12,499 stepsId
(active); and 5) Q12,500 stepsId
(highly active). Evidence to support youth-specific cutoff points
is emerging. Criterion-referenced approaches based on selected health outcomes present the potential for advancing evidence-based
steps/day standards in both adults and children from a measurement perspective. A tradeoff that needs to be acknowledged and
considered is the impact on motivation when evidence-based cutoff points are interpreted by individuals as unattainable goals.
Defining and promoting precise dose–response rela-
tionships in terms of physical activity (PA) and
health are among the most important public health
pursuits in this era of increasing obesity rates. Traditionally,
health-related PA recommendations have focused on multi-
ple elements of frequency, intensity, duration, and mode of
PA; widely accepted adult public health guidelines promote
Q30 min of at least moderate-intensity daily aerobic PA,
such as brisk walking (47). This PA can be accumulated in
brief bouts (i.e., minimally 10 min in duration) during the
course of a day (24,53).
The ability to track daily accumulated PA has recently
improved with the advent of body-worn motion sensor
technology, including accelerometers and pedometers. Of
the two motion sensors, pedometers are generally consid-
ered the more practical (i.e., simple to use, affordable)
alternative for individual- and population-level applications
(14,37). Although pedometers are not able to discriminate
PA intensity on their own, they do provide a simple and
affordable means of tracking daily PA (especially walking)
expressed as a summary output of steps/day. In addition,
their output correlates highly with that of different acceler-
ometers (45). Because the most commonly reported PA is
walking (7,28), researchers and practitioners require steps/
day indices associated with important health-related out-
comes (e.g., obesity, hypertension, etc.) and/or health-related
levels of PA (i.e., translations of public health recommenda-
tions) in terms of walking (36). Therefore, the purpose of this
article is to reprise, update, and extend the current under-
standing of ‘‘how many steps/day are enough?’
THE 10,000 STEPSId
A value of 10,000 stepsId
is often associated with a
healthful level of PA (8,21,34,35) and is commonly
promoted despite any authoritative endorsement; a simple
Google search of the terms ‘‘10,000 steps’’ and ‘‘pedometer’
returns more than 113,000 hits (based on a December 27,
2005 search). This increasingly popular index can be traced
to the 1960s when Japanese walking clubs embraced a
pedometer manufacturer’s (Yamasa Corporation, Tokyo,
Japan) nickname for their product: manpo-kei (literally
translated, ‘‘ten thousand steps meter’’) (15). Subsequently,
Dr. Yoshiro Hatano studied typical steps per day of various
lifestyles and established that 10,000 stepsId
translated to
approximately 300 kcalId
(or 300 METsImin
Address for correspondence: Catrine Tudor-Locke, Walking Behavior
Laboratory, Pennington Biomedical Research Center, 6400 Perkins Rd,
Baton Rogue, LA 70808; E-mail:
Copyright Ó2008 by the American College of Sports Medicine
DOI: 10.1249/MSS.0b013e31817c7133
Copyright @ 200 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
average middle-aged Japanese man (15). Dr. Hatano has
tracked habitually active walkers (i.e., intentional walking for
70 minId
) and found that they achieve ;8500
over incidental, miscellaneous daily activities
amounting to 1000 to 3500 stepsId
, for a total of 9500
to 12,000 stepsId
. Regardless of the target value, the
concept of tracking pedometer-determined PA has been
given credence by the Japanese Ministry of Health and
Public Welfare. Health Nippon 21 by the Japanese Ministry
of Health and Public Welfare (public health objectives
similar to the US Healthy People 2010) set a national goal
to increase 1000 steps over the 1998 baseline values (7200
and 8200 stepsId
for females and males, respectively).
The Japanese have long recognized that any discussion of
‘how many steps/day are enough’ presumes an accurate
and standardized measure of steps. Japanese industry
standards have been set to regulate pedometer quality to
within 3% error of miscounting during normal walking (i.e.,
80 mImin
) (15). Dr. Hatano has stated that this speed of
walking is approximately equivalent to a stepping rate of
120 stepsImin
. Pedometer accuracy is typically reported
to fall off dramatically at speeds of less than 54 mImin
where generated vertical acceleration forces are less likely
to be detected (1,13,20). In Japan, this selective ability to
detect steps taken is considered an attribute that censors
those movements unlikely to contribute to health, while
simultaneously reinforcing participation in more forceful
(i.e., higher intensity) walking. To emphasize, every step
does not count; a greater value is placed on ‘‘healthy’’ steps,
and this is reflected in instrument-sensitivity thresholds.
Unfortunately, pedometer quality is not regulated outside
Japan, and instrument accuracy can vary greatly (44). A
more thorough discussion of these issues is outside the
purview of this article.
Prudence dictates that any accepted steps/day guidelines
be congruent with existing PA recommendations to prevent
being perceived as just another source of confusion and
disagreement. As previously stated, adult public health
guidelines promote Q30 min of at least moderate-intensity
daily PA (46). Evidence continues to accumulate that 30 min
of minimally moderate-intensity PA translates directly to
3000–4000 steps (41,43,50,52). Furthermore, Tudor-Locke
et al. (43) have reported that a minimal stepping rate of 100
represents the floor value (i.e., absolute minimal
value) for moderate-intensity walking in adults. It is
important to emphasize here that, to be considered equivalent
to public health guidelines, these 3000–4000 steps should be
of at least moderate intensity (i.e., be Q100 stepsImin
), be
accumulated in at least 10-min bouts, and be taken over and
above some minimal level of PA (i.e., number of daily steps)
below which individuals might be classified as sedentary. As
previously suggested (36,39), total daily values less than
approximately 5000 stepsId
may be an appropriate index
of sedentary activity that is associated with higher prevalence
of obesity, for example. Adding 3000–4000 steps to this
proposed sedentary activity index approximates 8000–9000
. In contrast, the 2002 Institute of Medicine (IOM)
report (16) indicated that, although some health benefits
could be attained with commonly promoted amounts and
intensities of PA, 30 min is insufficient on its own to prevent
weight gain. The IOM actually recommended double the
time (i.e., 60 min of at least moderate-intensity daily activity)
previously endorsed by the US Surgeon General (47). An
equivalent steps/day index (i.e., 5000 steps from the
proposed sedentary activity index plus twice the 30-min
steps conversion) would therefore range as high as 11,000
13,000 stepsId
In 2004, Tudor-Locke and Bassett (36) reviewed the
published literature and proposed preliminary pedometer-
determined PA cutoff points for healthy adults: 1) less than
5000 stepsId
(sedentary); 2) 5000–7499 stepsId
active); 3) 7500–9999 stepsId
(somewhat active); 4)
Q10,000–12,499 stepsId
(active); and 5) Q12,500 step-
(highly active). Between the two primary anchors of
5000 stepsId
(sedentary) and 10,000 stepsId
they reported smoothing the categories to convenient 2500-
increments. That being said, the category des-
ignated by 7500–10,000 stepsId
(described as somewhat
active) is gaining credibility as evidence continues to
accumulate that health benefits can be realized (and that
accepted public health guidelines are achievable) within this
level (18,33,40). Working independently, Dr. Hatano has
set a very similar steps/day hierarchy with additional
gradations: 1) less than 1499 stepsId
(no moving); 2)
1500–3499 stepsId
(sedentary); 3) 3500–4999 stepsId
(somewhat sedentary); 4) 5000–7999 stepsId
5) 8000–9999 stepsId
(somewhat active); 6) 10,000–
11,999 stepsId
(active); and 7) Q12,000 stepsId
On a population level, specific quantitative indices (i.e.,
benchmarks or cutoff points) are required for screening,
surveillance, intervention, and program evaluation. Such
cutoff points permit us to monitor, compare, and track
population PA behavior trends. On an individual level,
echelons produced from these cutoff points can be used to
guide and evaluate behavior change. We must emphasize,
however, that any steps/day cutoff points must be inter-
preted loosely. The overlap in steps/day between sex and
age groups, the variance that has been repeatedly observed,
and the inevitable potential for misclassification dictate that
precision of these cutoff points and associated increments
should not be overstated. It is possible to lose sight of the
utility of such cutoff points in the push to illuminate the
more obvious shortfalls. We therefore advocate a ‘‘zone’
approach to assessing and promoting pedometer-determined
PA congruent with the categories originally proposed by
Tudor-Locke and Bassett (36). For example, we can both
promote and interpret individual progress through the steps/
day zone hierarchy. From an individual intervention
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perspective, it is important to emphasize that any derived
guidelines should be conveyed to the end-users as assistive
rather than prescriptive; any movement upward (or holding
ground at the highest echelons) should be valued as
A paper by Vincent and Pangrazi (48) was one of the first
studies conducted that examined a large sample of students
aged 6 to 12 yr. Participants (N= 711) wore sealed pe-
dometers for four consecutive days. Pedometer-determined
PA ranged from 10,479 to 11,274 and from 12,300 to
13,989 stepsId
for girls and boys, respectively. Large
individual variability existed among children of the same
sex. Statistical analysis showed no significant differences
between ages, but a significant difference between boys and
girls was found. On the basis of these data, Vincent and
Pangrazi suggested that a reasonable PA standard might be
11,000 stepsId
for girls and 13,000 stepsId
for boys. An
interesting finding in this study was the lack of significance
between age classifications. It has commonly been theo-
rized that youngsters become less active with age, and this
study (followed by others) has shown that there is little
decrease in PA throughout the preadolescent stage of
An oft-quoted standard in recent pedometer studies with
youth is the thresholds set by the President’s Council on
Physical Fitness and Sports (PCPFS). To earn the Presi-
dential Active Lifestyle Award (27), youngsters must
average 13,000 and 11,000 stepsId
for boys and girls,
respectively, over a 6-wk period. Although researchers
often quote these values as aspirational PA goals, in ac-
tuality they are based on a cross-sectional study by Vincent
and Pangrazi (48) that focused on typical PA levels, not
necessarily desirable levels. Although other studies have
shown similar levels of steps/day accumulated by children,
the PCPFS thresholds should not be regarded as criterion-
referenced health standards but rather as award boundaries
that may change if future studies offer more understanding
and insight into healthy PA levels.
US Guidelines established by the National Association for
Sport and Physical Education in 1993 (25) recommended
that elementary school children should be physically active
for at least 30–60 min daily. The UK Health Education
Authority has recommended that all young people accumu-
late at least 1 h daily of PA that is of at least moderate
intensity (4,6). The IOM 2002 report (16) included both
adults and children in its recommendation for at least 1 h
daily of PA (16) if body fat maintenance is the desired
outcome. The most recent revision of the National Associ-
ation for Sport and Physical Education recommendations
actually pushes for even more PA in youth. That is, youth
should accumulate at least 60 min and up to several hours
of moderate-to-vigorous PA (MVPA) daily (26). Although
Scruggs et al. (32) have reported that 6- to 7-yr-old
schoolchildren take approximately 1800 steps in a 30-min
physical education class specifically taught to meet a
minimal standard of achieving MVPA, a more direct
conversion of pedometer-determined PA to time-based
equivalents of MVPA in children has only recently been
published. Specifically, Jago et al. (17) recorded 117
pedometer stepsImin
taken by 78 11- to 15-yr-old Boy
Scouts in timed walking bouts at a pace equivalent to 3
METs (i.e., metabolic equivalents indicative of minimally
moderate-intensity PA) or 3510 steps in a 30-min period.
Because 3 METs is a floor value of moderate-intensity PA
and health recommendations value even higher levels of
intensity, the authors were justified in adjusting and
simplifying the message to recommend 4000 steps in
30 min or at least 8000 stepsId
to meet widely accepted
time-based recommendations (i.e., at least 60 min). The
overall 3000–5000 stepsId
difference between this direct
conversion of minimal time in MVPA and the norm-based
daily values reported by Vincent and Pangrazi (48) likely
also captures residual steps/day derived from incidental,
miscellaneous activities of daily life. In addition, the
estimate of Jago et al. (17) captures only that PA directly
related to general health enhancement and is not focused on
questions of energy balance as reflected by a healthy body
A study by Tudor-Locke et al. (42) examined body mass
index (BMI)-referenced standards for pedometer steps/day
in preadolescent youth. This study was a secondary analysis
of pedometer data and BMI based on 1954 youth from the
United States, Australia, and Sweden. The contrasting
group method (described below) was used to identify
optimal age- and sex-specific standards for steps/day related
to international BMI cutoff points (12) for normal-weight
and overweight/obese children. In this study, the optimal
cutoff point that separated normal-weight and overweight/
obese students was 12,000 stepsId
for girls and 15,000
for boys. In other words, students averaging fewer
daily steps than this cutoff point were more likely to be
labeled as overweight/obese. Mean differences between
normal-weight and overweight/obese boys and girls were as
large as 5000 stepsId
. Although this study is an example
of a criterion-referenced approach to setting pedometer-
determined PA, it is important to emphasize that this is still
based on cross-sectional data and, as such, is of limited use
in inferring causality.
It is important to emphasize here that, if these apparently
higher steps per day cutoff points are to be touted as PA
recommendations, they should come with the caveat that, at
least according to the recent work of Jago et al. (17),
minimally 8000 of these steps (representing 67% of daily
steps for girls, although no girl-specific step conversion is
yet available, and 53% for boys) should be performed at no
less than moderate to vigorous intensity. Rowlands and
Eston (30) recently reported that, in a small sample (N= 34)
of children, all those who met the Tudor-Locke et al. (42)
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BMI-referenced cutoff points also accumulated at least
60 min of moderate-intensity PA (as evaluated by Tritrac
accelerometer). However, some children were able to meet
the time-based recommendation without accumulating this
volume of steps/day. That is, these children could still meet
the steps/day associated with health-enhancing recommen-
dations, although still falling short of the BMI-referenced
cutoff points.
The BMI-referenced cutoff points are substantially higher
than PCPFS award threshold step counts. Part of this
elevated standard might be related to a difference in the
students who participated in the study. All the students used
in the Vincent and Pangrazi study (48) were from the
United States, whereas participants in secondary analysis by
Tudor-Locke et al. (42) were from the United States,
Sweden, and Australia. The original analysis of these data
was reported by Vincent et al. (49), and it showed that the
Australian and Swedish children accumulated significantly
higher step counts than children from the United States.
Thus, possibly these cutoff points might be closer to the
PCPFS level if they were limited to American youth.
How do children in other parts of the world compare to
the PCPFS award thresholds? Vincent et al. (49) reported
results on children, aged 6 to 12 yr, living in Australia and
Sweden. Results showed that for boys the mean values
ranged from 15,673 to 18,346 stepsId
for Sweden, 13,864
to 15,023 stepsId
for Australia, and 12,554 to 13,872
for the United States. Girls averaged between
12,041 and 14,825 stepsId
for Sweden, between 11,221
and 12,322 stepsId
for Australia, and between 10,661 and
11,383 stepsId
for the United States. Furthermore, the
authors reported that the Australian values did not include a
30-min bout of swimming that these participants did most
days during the duration of the study. This study also
showed that the PA curve (i.e., a visual representation of the
natural history of PA behaviors) remained relatively flat
throughout the preadolescent years, and the rate of increase
in BMI with age was much greater in American children
than in the Swedish and Australian youth.
A study of 871 Swedish children, aged 7 to 14 yr, by
Raustorp et al. (29) showed steps/day values that ranged
from 14,911 to 16,752 for boys and 12,238 to 14,825 for
girls. A large majority of the youth (83% of boys and 82%
of girls) would have been able to reach the PCPFS award
threshold of 11,000 and 13,000 stepsId
on the basis of
their accumulated values. An interesting aspect of this study
showed that there were no significant correlations between
PA level and BMI.
A study of Belgian boys and girls (5) focused on
pedometer data for 92 children aged 6 to 12 yr. Boys in
this study averaged 16,628 stepsId
and girls accumulated
13,002 stepsId
. In contrast to the previous studies
described, these data were gathered during the summer
months as opposed to the school year. In addition, data
were collected during the entire week, and there were no
reported differences between weekdays and weekend days.
Participants in this study were asked to fill out a PA diary
with the aid of one parent to determine the number of
minutes of MVPA they had accumulated each day. On the
basis of regression equations, 60 min of MVPA was
equivalent to 15,340 stepsId
in boys and 13,130 stepsId
in girls. A moderate correlation (r= 0.39, PG0.001) was
found between pedometer-determined PA and reported
minutes of MVPA. However, the authors suggested that
using steps/day to predict MVPA should be used with
caution because of a number of weak statistical indices. A
study of schoolchildren in Cyprus (23) was undertaken to
see if there was a difference in PA levels living in rural or
urban settings. The study sample included 256 Greek
Cypriot children, aged 11 and 12 yr, from two schools
representing urban areas and three schools representing
rural areas. PA levels were assessed for 4 weekdays in the
summer and 4 weekdays in the winter. Results showed that
urban schoolchildren (13,583 stepsId
) were significantly
more active than their rural counterparts (12,436 stepsId
during the winter season. However, rural schoolchildren
were significantly more active (16,450 vs 14,531 stepsId
in the summer months. Results of this study showed that
there is a need to consider seasonal and geographical
location differences that impact PA levels of youth.
Steps/day guidelines have been typically established on
the basis of the norm-referenced approach, which compares
an individual’s performance to that of others. For example,
Tudor-Locke and Myers (38) reported that healthy adults
can be expected to average between 7000 and 13,000
on the basis of a simple expression of ranges of
published values at the time. As stated in the previous
sections, the PCPFS award thresholds are based on the
Vincent and Pangrazi (48) reported normative values for
children. This approach to setting cutoff points is necessa-
rily based on the average score of each targeted group.
Therefore, the guidelines may vary among different groups
of individuals, as can be seen from the discussion in the
previous section, comparing varying normative values
between geographies, climates, and seasons, to name but a
few factors. In the norm-referenced approach, an individual’s
health status is not considered in determining the guideline.
A criterion-referenced approach to setting cutoff points
considers a specific health outcome or a health risk factor as
the decisive factor. The criterion-referenced approach has
been successfully applied by several national fitness testing
programs (e.g., FITNESSGRAM). These tests have set
guidelines on the basis of the minimum level of perfor-
mance related to good health (51).
A key element of the criterion-referenced approach in
establishing pedometer-based guidelines is its link to spe-
cific health risk factors (e.g., obesity, cardiovascular disease,
diabetes). The derived cutoff point is a score on a scale
corresponding to the accepted health-related threshold of
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the selected health risk factor (19). As such, the cutoff
point represents an absolute protective level related to the
specific health outcome. Several methods using the criterion-
referenced approach have been introduced in the mea-
surement literature for setting standards (9,10,22). The
borderline group method and the contrasting group method are
both widely used. To establish a cutoff point using the
borderline group method (22), researchers (or practitioners)
identify ‘‘borderline’’ individuals from the sample, whose
health level approaches the intended guideline. The median
score (or other measure of central tendency) for the distribu-
tion of the borderline individuals’ performance reflects the
cutoff point. Applying this approach, researchers might
establish a steps/day cutoff point related to osteoporosis
defined by bone mineral density. Specifically, a criterion
measure of bone mineral density (i.e.,using a DEXA machine)
could be used to identify a borderline group considered
osteopenic, and the median steps/day of this group becomes
the associated pedometer-determined PA cutoff point.
To establish a cutoff point using the contrasting group
method (2,3), researchers determine two different levels of
groups from the sample (e.g., nonhealthy and healthy). The
cutoff point is then identified from the threshold between
the two groups’ distributions, that is, the point which
discriminates between the two contrasting group. For
example, to determine a steps/day cutoff point related to
osteoporosis, researchers would classify individuals into
one of two groups on the basis of their bone mineral density
level: the osteoporosis group (i.e., nonhealthy) and the
normal group (i.e., healthy). The cutoff point is the steps/
day threshold that best defines the likelihood of classifica-
tion as nonhealthy versus healthy. As discussed above,
Tudor-Locke et al. (42) provide an example of setting
pedometer-based steps/day guidelines related to healthy
body composition in children using the criterion-referenced
approach. A series of cutoff points can also be set using a
modification to the contrasting group method. Instead of
classifying individuals into two groups from the sample,
multiple groups are formed depending on the desired
number of cutoff points.
To set a defensible cutoff point, a relatively large sample
size is required for the contrasting group method (11).
Specifically, the shapes of the two distributions must be
large enough to identify the threshold on the scale
representing the boundary between two groups. This may
not be the case for the borderline-group method, in which a
median can be estimated fairly well with a relatively small
sample. The more important issue is whether the sample of
individuals is representative. If not, the resulting steps/day
cutoff point may not be externally valid (i.e., not suitable
for generalizing the guideline to the population).
Regardless of the approach, however, application of
cutoff points derived from the process of standard setting
is not always favorable; misclassification of error always
exists and may be magnified by many factors ranging from
the choice of health outcome measure used to the
participants’ motivation under testing conditions. There
are two possible types of misclassification errors: false-
positive and false-negative (31). False-positive error occurs
when nonhealthy individuals are classified as healthy
individuals. False-negative error reflects healthy individuals
who are classified as nonhealthy individuals. In terms of
pedometer-determined PA associated with a specific health
outcome, a false-positive error may be a more serious
measurement offense than a false-negative error. It may
therefore be prudent to adjust a criterion-referenced cutoff
point to a more conservative value, thereby reducing the
ratio of false-positive to false-negative errors. This strategy
would produce a more stringent steps/day cutoff point.
Although this works well from a measurement perspective,
unfortunately, the tradeoff from an individual intervention
approach may be the perception of an unattainable goal. It
is plausible that such perception, if universal, can under-
mine the well-intentioned act of setting such as public
health PA guidelines.
There has been increasing interest to linking health-
related outcomes to pedometer-determined PA to establish
steps/day guidelines. Although there is a growing number
of articles presenting habitual steps/day accumulated by
adults and children, little research has provided evidence on
the dose–response relationship between steps/day and
specific health outcomes. The criterion-referenced approach
to setting the steps/day guideline is favorable compared with
the more common norm-referenced approach and may
represent an absolute protective level of specific health
outcomes. A limitation, of course, is that criterion-referenced
approaches are based on cross-sectional data that must be
verified by other study designs. Further investigation is
warranted to provide evidence on the number of steps/day
relative to common health outcomes, such as coronary heart
disease, cancer, and diabetes.
Widespread acceptance of pedometers for PA measure-
ment and motivation requires evidence-based steps/day
indices associated with important health-related outcomes
and/or health-related levels of PA if their simple output is to
be interpreted and compared between populations and
studies. Setting any single cutoff point that meets the
epidemiologist’s need to classify and track populations yet
also instills a sense of achievement in those struggling to
increase their PA is a complex proposition. Although there
is much room for additional research to distill dose–response
questions, both from the validity and health messaging
perspectives, herein we proposed a zone-based hierarchy
that may be used to meet both needs, acknowledging that
the precision of pedometer-determined steps/day should not
be overstated. Bearing these issues in mind, Table 1 presents
the adult zones originally proposed by Tudor-Locke and
Bassett (36) and preliminary schematics of youth zones on
the basis of emerging criterion-based evidence reviewed in
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the previous sections. We chose not to use the same qual-
itative descriptors for the children as used with the adults
in a conscious attempt to recognize that children are not
merely ‘‘small adults’’ and declare the greater value we
place on motivating children’s PA and avoiding untoward
labeling. We anticipate refinement as our science advances.
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TABLE 1. Schematic presentation of potential steps/day zone groupings and associated descriptive categories.
Healthy Adults
Girls (6–12 yr)
Boys (6–12 yr)
Steps/day Zone Descriptive Category Steps/day Zone Descriptive Category Steps/day Zone Descriptive Category
Q17,500 Platinum
Q14,500 Platinum 15,000–17,499 Gold
Q12,500 Highly active 12,000–14,499 Gold 12,500–14,999 Silver
10,000–12,499 Active 9500–11,999 Silver 10,000–12,499 Bronze
7500–9999 Somewhat active 7000–9499 Bronze G10,000 Copper
5000–7499 Low active G7000 Copper
G5000 Sedentary
Based on the compiled evidence presented in Tudor-Locke and Bassett (36).
Based on a criterion presented by Tudor-Locke et al. (42).
http://www.acsm-msse.orgS542 Official Journal of the American College of Sports Medicine
Copyright @ 200 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
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HOW MANY STEPS ARE ENOUGH? Medicine & Science in Sports & Exercise
... To directly assess the level of habitual physical activity, individuals were instructed to use a digital pedometer (Digiwalker SW-200, Yamax Corporation, Tokyo, Japan) as appropriate during the entire day of wakefulness in a typical week [eight consecutive days] [11]. The daily average of steps was obtained from the number of steps in the last 7 days; and 10.000 steps/day was the cutoff point to classify participants as physically active [12]. For subsequent analyses, individuals having low physical activity were grouped into inactive; and those moderately active into active and very active. ...
... Hypercholesterolemia was present in 68.25%, high serum LDL-c concentration in 55.96%, hypertriglyceridemia in 30.15%, overweight or obese in 60.93%, and metabolic syndrome in 31.74%. [12]. ...
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This study investigated the association of self-reported daily time in sedentary behavior with cardiometabolic risk factors in middle-aged adults living in a Brazilian eastern Amazon city. Middle-aged public civil servant living in Palma’s city participated in this cross-sectional study. Daily sedentary behavior and physical activity were measured, and anthropometric parameters and blood biochemical biomarkers were obtained. The results showed that total daily time in sedentary behavior measured using International Physical Activity Questionnaire associated positively with waist to height ratio [β = 0.008 (95% CI = 0.001; 0.016), p = 0.023] and body adiposity index [β = 0.570 (95% CI = 0.110; 1.020), p = 0.016]; and the time spent in passive transport measured using Longitudinal Aging Study Amsterdam - Sedentary Behavior Questionnaire was positively associated with neck [β = 4.420 (95% CI = 1.360; 7.480), p = 0.005) and waist circumference [β = 7.990 (95% CI = 3.490; 12.500), p = 0.005], waist to hip ratio [β = 0.060 (95% CI = 0.030; 0.100), p = 0.001), conicity index [0.050 (95% CI = 0.010; 0.080), p = 0.002], and the concentrations of triglycerides [β =38.500 (95% CI = 6.640; 70.390), p = 0.019] and insulin [β = 2.490 (95% CI = 1.030; 3.950), p = 0.001]. In conclusion, self-reported sedentary behavior is associated with anthropometric and biochemical risk factors for cardiometabolic diseases in the studied individuals.
... Sex-based differences may, therefore, also be present for caddies' step counts. The step count accrued whilst caddying exceeds commonly reported daily targets of 10,000 steps (Kobriger et al., 2006), and classifies individuals as highly active (Tudor-Locke et al., 2008). Collectively, the step count and PA intensity data reported in this study provide important information regarding the work demands of caddying, demonstrating that it is a highly active profession. ...
... Participants' daily physical activity was measured by their selfreported step count throughout the day. Following Tudor-Locke and Bassett's 69 and Tudor-Locke et al.'s 70,71 proposed step indices for daily physical activity in healthy adults (including working adults), this item is rated on a five-point scale accordingly (1 = '<30 minutes (<5000 steps/day), Sedentary', 2= '30 minutes-1 hour (5000-7499 steps/day), Low Active', 3 = '>1-1.5 hours (7500-9999 steps/day), Somewhat Active', 4 = '>1.5-2 ...
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Evidence-based mobile health (mHealth) applications on smartphones are a cost-effective way for employees to take proactive steps to improve well-being and performance. However, little is known about what sustains engagement on these applications and whether they could dynamically improve occupational outcomes such as resilience and mood. Using real-world data, this intensive longitudinal study examines (a) which employees would continually engage with a cognitive behavioural therapy-informed mHealth application (‘Intellect’); and (b) if daily engagement of ‘Intellect’ would relate to better occupational outcomes on the following day. A total of 515 working adults in Singapore and Hong Kong ( M age = 32.4, SD age = 8.17) completed daily in-app items on mood and resilience components (i.e. sleep hours, sleep quality, physical activity, and stress levels). Our results revealed that employees with lower baseline resilience (β = −0.048, odds ratio (OR) = 0.953, p < 0.01), specifically poorer sleep quality (β = −0.212, OR = 0.809, p = 0.001) and/or higher stress levels (β = −0.255, OR = 0.775, p = 0.05), were more likely to resume engagement on the application. Among the 150 active users (i.e. ≥3 consecutive days of engagement) ( M age = 32.2, SD age = 8.17), daily engagement predicted higher resilience (β = 0.122; 95% confidence interval (CI) 0.039–0.206), specifically lower stress levels (β = 0.018; 95% CI 0.004–0.032), higher physical activity (β = 0.079; 95% CI 0.032–0.126), and mood levels (β = 0.020; 95% CI 0.012–0.029) on the following day even after controlling for same-day outcomes. Our preliminary findings suggest that engaging with a mHealth application was associated with higher dynamic resilience and emotional well-being in employees.
... 24 Previous studies have proposed the following classifications for daily steps: <5000 steps/day = sedentary, 5000-7499 steps / day = low active, 7500-9999 steps / day = somewhat active, 10,000-12,499 steps/day = active, and ≥12,500 steps = highly active. 25 An inverse correlation was found between the risk of metabolic syndrome and an increased step count. 26 Newton et al showed a correlation between an increase in the number of daily steps and a decrease in the prevalence of metabolic syndrome. ...
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Purpose: Research on whether wearable device interventions can effectively prevent metabolic syndrome remains insufficient. This study aimed to evaluate the effect of feedback on clinical indicators in patients with metabolic syndrome on activities measured using wearable devices, such as smartphone apps. Methods: Patients with metabolic syndrome were recruited and prescribed to live for 12 weeks using a wrist-wearable device (B.BAND, B Life Inc., Korea). A block randomization method was used to distribute participants between the intervention (n=35) and control groups (n=32). In the intervention group, an experienced study coordinator provided feedback on physical activity to individuals through telephonic counseling every other week. Results: The mean number of steps in the control group was 8892.86 (4473.53), and those in the intervention group was 10,129.31 (4224.11). After 12 weeks, metabolic syndrome was resolved. Notably, there were statistically significant differences in the metabolic composition among the participants who completed the intervention. The mean number of metabolic disorder components per person remained at 3 in the control group, and decreased from 4 to 3 in the intervention group. Additionally, waist circumference, systolic and diastolic blood pressure, and triglyceride levels were significantly reduced, while HDL-cholesterol levels were significantly increased in the intervention group. Conclusion: Overall, 12 weeks of telephonic counseling intervention using wearable device-based physical activity confirmation improved the damaged metabolic components of patients with metabolic syndrome. Telephonic intervention can help increase physical activity and reduce waist circumference, which is a typical clinical indicator of metabolic syndrome.
... Physical activity among LLP users is characterized by limited volume [56][57][58][59], duration [56,58], and intensity [57,60]. For example, LLP users take between 1540 and 4000 steps per day [57][58][59][60][61][62][63][64], well below physical activity guidelines for the general population (i.e., 10,000 steps per day) [65,66] or adults with a disability or chronic illness (i.e., 5500 to 6500 steps per day) [67]. While lower body muscle strength would be expected to decrease with reduced physical activity and the accompanying disuse of lower limb muscles [9], residual limb hip muscles may be less susceptible to the adverse effects of inactivity than intact limb hip muscles. ...
Full-text available
Abstract Background Hip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.e., which muscle group(s) to target), and expedite the search for modifiable factors associated with deficits in hip muscle function among LLP users. The purpose of this study was to test whether hip strength, estimated by maximum voluntary isometric peak torque, differed between the residual and intact limbs of LLP users, and age- and gender-matched controls. Methods Twenty-eight LLP users (14 transtibial, 14 transfemoral, 7 dysvascular, 13.5 years since amputation), and 28 age- and gender-matched controls participated in a cross-sectional study. Maximum voluntary isometric hip extension, flexion, abduction, and adduction torque were measured with a motorized dynamometer. Participants completed 15 five-second trials with 10-s rest between trials. Peak isometric hip torque was normalized to body mass × thigh length. A 2-way mixed-ANOVA with a between-subject factor of leg (intact, residual, control) and a within-subject factor of muscle group (extensors, flexors, abductors, adductors) tested for differences in strength among combinations of leg and muscle group (α = 0.05). Multiple comparisons were adjusted using Tukey’s Honest-Difference. Results A significant 2-way interaction between leg and muscle group indicated normalized peak torque differed among combinations of muscle group and leg (p
... Previous studies with accelerometer-based walking activity monitoring have shown that people with LLA typically have step counts that can be as low as 1721 to 4785 daily steps on average (1721 ± 1524 [7]; 4217 ± 3027 [24]; 4785 ± 1868 [8]), which our current cohort aligns with prior to osseointegration (4050 ± 1958). The value of 5000 steps has been suggested as an important clinical threshold to distinguish sedentary from non-sedentary lifestyle, which our cohort surpassed 12 months following prosthesis osseointegration (5313 ± 1743) [12,25]. Furthermore, progressively lower daily step counts below 6000 steps/day are linked to higher mortality risk for adults over the age of 60 [26]. ...
Purpose: People with lower-limb loss participate in less physical activity than able-bodied individuals, which increases the mortality risk and incidence of metabolic syndromes. This study evaluated the effect of lower-limb prosthesis osseointegration on physical activity, including daily steps and stepping cadence. Methods: Free-living walking activity was assessed from 14 patients scheduled to undergo prosthesis osseointegration at two time points (within 2 weeks prior to osseointegration surgery and 12-months following). Daily step count, stepping time, number of walking bouts, average step cadence per bout, maximum step cadence per bout, and time spent in bands of step cadence were compared before and after osseointegration. Results: Twelve months after prosthesis osseointegration, participants increased daily steps, daily stepping time, average step cadence, and maximum cadence per walking bout compared to pre-osseointegration. Conclusions: Participants engaged in more daily steps, higher stepping cadence, and longer bouts at higher cadence one year following osseointegration compared to when using a socket prosthesis. As a novel intervention that is becoming more common, it is important to understand walking activity outcomes as these are critical for long-term health. • Implications for Rehabilitation • People with lower-limb loss participate in less physical activity than able-bodied individuals, which increases the mortality risk and incidence of metabolic syndromes. • Daily step count, walking bouts, and step cadence during free-living walking activity are promising measures to capture physical functional performance in patients with lower-limb amputation. • This study shows that patients with osseointegrated prostheses increase their stepping activity, including daily steps, number of bouts, and stepping cadence compared to when using a socket prosthesis, which has positive implications on overall patient health. • As a novel intervention that is becoming more common, it is important for clinicians, patients, and researchers to understand expectations for walking activity outcomes as a critical factor in long-term patient health after prosthesis osseointegration.
... On the other hand, the progression of time and intensity of NEPA, such as active transportation (e.g., walking), will not only identify health risk but also encourage physical activity in subjects with low adherence to physical conditioning programs [54]. For example, increasing physical activity at the expense of NEPA has clinically relevant effects for healthy (e.g., untrained) individuals and NCDs, even, in some settings, without reaching the minimum recommended physical activity [55]. ...
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Non-exercise physical activity (NEPA), also called unstructured or informal physical activity, refers to those daily activities that require movement of the human body without planning or strict control of the physical effort made. Due to new technologies and motorized transportation devices, the general population has significantly decreased its NEPA. This increase in sedentary lifestyles, physical inactivity, and excessive energy intake is considered a risk factor for obesity, non-communicable diseases (NCDs), and all-cause mortality. Searching in PubMed/MEDLINE and Web of Science databases, a narrative review of NEPA was carried out to address its conceptualization, promotion strategies for the general population, and monitoring through wearable devices. It is strongly recommended that governmental entities, health practitioners, and the construction industry adhere to "The Global Action Plan on Physical Activity 2018-2030: More Active People for a Healthier World" and implement different salutogenic urban strategies. These strategies aim to generate environments that motivate increases in NEPA, such as cycling and walking transportation (between 5000-12,500 steps per day), and the progression to physical exercise. There is a wide variety of electronic devices for personal use, such as accelerometers, smartphone apps, or "smart clothes", that allow for the monitoring of NEPA, some with a wide range of analysis variables contributing to the estimation of total daily energy expenditure and the promotion of healthy habits. In general, the further promotion and monitoring of NEPA is required as part of a strategy to promote healthy habits sustainable over time for the prevention and control of obesity and NCDs.
... La profesora Tudor-Loke. es una de las investigadoras más reconocidas en este plano y fue de las primeras investigadoras en ofrecer una panorámica global sobre cuántos pasos son necesarios para mejorar y mantener parámetros saludables en población general (Tudor-Locke and Bassett, 2004; Tudor-Locke, Hatano and Pangrazi, 2008;Tudor-Locke, Craig, Aoyagi, et al., 2011;Tudor-Locke, Craig, Brown, et al., 2011). De hecho, en una de sus investigaciones de esta última década ofrece una visión científica en la que traduce el número de pasos y la cadencia de estos a la intensidad, frecuencia y duración de actividad física, de forma que se traduce una cifra de pasos mínimos para la población (figura 3). ...
Supervised physical activity can increase functional capacity in persons with HIV (PWH); however, aerobic interventions have shown little improvement in overall physical activity in PWH. In response, we sought to assess the effect of wearing a fitness tracker (FitBit) paired with walk step reminders delivered through an mHealth application to improve physical activity and decreasing body mass index among PWH in New York City. There was no significant difference in the frequency of walk steps between participants in the control group and intervention group from baseline to 6-month follow-up. These findings show that walk step reminders alone were inadequate for sustained improvement of physical activity. This study highlights the need to develop and test the comparative efficacy of physical activity interventions that are tailored to the unique needs and capabilities of PWH. Future interventions should incorporate fitness tracking with tailored interventions focused on the promotion of physical activity. Clinical Trials.Gov Registration number: NCT03205982.
Trunk muscles may be an overlooked region of deficits following lower-limb amputation. This study sought to determine the extent that trunk muscle deficits are associated with physical function following amputation. Sedentary adults with a unilateral transtibial- (n=25) or transfemoral-level (n=14) amputation were recruited for this cross-sectional research study. Participants underwent a clinical examination that included ultrasound imaging of the lumbar multifidi muscles, the modified Biering-Sorensen Endurance Test (mBSET), and performance-based measures, i.e., the Timed Up and Go (TUG), Berg Balance Scale (BBS), and 10-meter Walk Test (10mWT). Associations between trunk muscle metrics and performance were explored with regression modeling, while considering covariates known to impact performance post-amputation (p≤.100). Average ultrasound-obtained, lumbar multifidi activity was 14% and 16% for transfemoral- and transtibial-level amputations, respectively, while extensor endurance was 37.34 seconds and 12.61 seconds, respectively. For TUG, non-amputated-side multifidi activity and an interaction term (level x non-amputated-side multifidi activity) explained 9.4% and 6.2% of the total variance, respectively. For 10mWT, beyond covariates, non-amputated-side multifidi activity and the interaction term explained 6.1% and 5.8% of the total variance, respectively. For TUG, extensor endurance and an interaction term (level x mBSET) explained 11.9% and 8.3% of the total variance beyond covariates; for BBS and 10mWT, extensor endurance explained 11.2% and 17.2% of the total variance, respectively. Findings highlight deficits in lumbar multifidi activity and extensor muscle endurance among sedentary adults with a lower-limb amputation; reduced muscle activity and endurance may be important factors to target during rehabilitation to enhance mobility-related outcomes. This article is protected by copyright. All rights reserved.
In this study pedometer counts were recorded for 6 consecutive days for 92 children (mean age = 9.6 years; range 6.5-12.7) and were compared with the number of minutes per day in which the participants engaged in moderate-to-vigorous physical activity (MVPA). Diaries filled out with the assistance of one of the children's parents were used to determine minutes of MVPA. The average daily step count was significantly higher in boys than in girls, although the average daily MVPA engagement in minutes did not vary significantly between genders. Based on the regression equations, 60 min of MVPA was equivalent to 15,340 step counts in boys, 11,317 step counts in girls, and 13,130 step counts when results for both genders were combined. A moderate correlation (r =.39, p <.001) was found between pedometer step counts and reported minutes of MVPA. According to the present study findings, however, predictions and promotion of daily MVPA engagement in children based on pedometer counts per day should be made with caution.
An empirical methodology is proposed for determining optimal cutting scores for short-fixed-length criterion-referenced tests. Classification of outcome probabilities and validity coefficient approaches are developed using validation samples of instructed and uninstructed students. The optimal cutting score is selected according to the estimated probabilities of correct and incorrect mastery-nonmastery decisions. These probabilities, along with the gains and losses associated with the decisions, are then incorporated into an index of utility for identifying the cutting score which maximizes test usefulness in specific individual and group decision situations. The practical value of using the test compared to an alternative is also examined in terms of incremental validity.
Research has suggested a trend of decreasing activity with age necessitating a renewed emphasis on promoting physical activity for children. The purpose of this study was to assess current physical activity levels of children and to establish initial standards for comparison in determining appropriate activity levels of children based on pedometer counts. Children, 6-12 years old (N = 711), wore sealed pedometers for 4 consecutive days. Mean step counts ranged from 10,479-11,274 and 12300-13989 for girls and boys respectively. Factorial ANOVA found a significant difference between sex (F = 90.16, p < .01) but not among age (F = 0.78, p = .587). Great individual variability existed among children of the same sex. Further analysis found significant differences among children of the same sex above the 80th percentile and below the 20th percentile. A reasonable activity standard might be approximately 11,000 and 13,000 steps per day for girls and boys respectively, although further discussion of this is warranted. The descriptive nature of this study provides insights into the activity patterns of children and the mean step counts for boys and girls at each age can serve as a preliminary guide for determining meaningful activity levels for children based on pedometer counts.
Pedometers are simple and inexpensive body-worn motion sensors that are readily being used by researchers and practitioners to assess and motivate physical activity behaviours. Pedometer-determined physical activity indices are needed to guide their efforts. Therefore, the purpose of this article is to review the rationale and evidence for general pedometer-based indices for research and practice purposes. Specifically, we evaluate popular recommendations for steps/day and attempt to translate existing physical activity guidelines into steps/day equivalents. Also, we appraise the fragmented evidence currently available from associations derived from cross-sectional studies and a limited number of interventions that have documented improvements (primarily in body composition and/or blood pressure) with increased steps/day. A value of 10 000 steps/day is gaining popularity with the media and in practice and can be traced to Japanese walking clubs and a business slogan 30+ years ago. 10 000 steps/day appears to be a reasonable estimate of daily activity for apparently healthy adults and studies are emerging documenting the health benefits of attaining similar levels. Preliminary evidence suggests that a goal of 10 000 steps/day may not be sustainable for some groups, including older adults and those living with chronic diseases. Another concern about using 10 000 steps/day as a universal step goal is that it is probably too low for children, an important target population in the war against obesity. Other approaches to pedometer-determined physical activity recommendations that are showing promise of health benefit and individual sustainability have been based on incremental improvements relative to baseline values. Based on currently available evidence, we propose the following preliminary indices be used to classify pedometer-determined physical activity in healthy adults: (i) 12 500 steps/day are likely to be classified as ‘highly active’.
ed. by Gregory J. Cizek., The following values have no corresponding Zotero field: Label: B821 Research Notes: Pant ID - 86
This review identifies 38 methods for either setting standards or adjusting them based on an analysis of classification error rates. A trilevel classification scheme is used to categorize the methods, and 10 criteria of technical adequacy and practicability are proposed to evaluate them. The salient characteristics of 23 continuum standard-setting methods are described and evaluated in the form of a “consumer’s guide.” Specific recommendations are offered for classroom teachers, educational certification test specialists, licensing and certification boards, and test publishers and independent test contractors.
Most standard setting methods can be classified as either test-centered or examinee-centered. Test-centered methods (e.g., the Angoff method, 1971) appear to work well with objective tests but seem less useful with extended-response tests. Examinee-centered methods (e.g., the borderline-groups method and the contrasting-groups method), on the other hand, appear to be particularly appropriate for extended-response tests. In this article, we describe a generalized examinee-centered method for setting multiple cutscores on a test involving both objective and extended-response items. Judges evaluate a representative sample of examinee performances using a rating scale that is defined in terms of performance standards (e.g., proficient, advanced levels). These ratings are linked to examinee's test scores to generate a functional relation between scores and ratings, which is then used to assign a cutscore to each performance level. This approach is potentially more efficient than traditional examinee-centered methods because all ratings are used to define each cutscore. An example involving the setting of multiple cutscores for a state testing program is presented and used to suggest some ways to evaluate the sampling error in the resulting cutscore.