More steps cut chronic disease risk but cannot fully undo long sitting

By Dr. Liji Thomas, MDReviewed by Lauren HardakerApr 10 2026

Tracking over 13 million days of real-world activity, researchers reveal how step counts can counter some harms of prolonged sitting, while warning that too much sedentary time still carries lasting risks for the heart. 

Study: Daily steps offset risks of sedentary behavior in the All of Us research program. Image credit: Jacek Chabraszewski/Shutterstock.com

Over one in three adults spends prolonged periods in sedentary behavior, even though this is associated with a higher risk of chronic disease and premature death. A study in Nature Communications found that higher daily step counts could help offset some of these risks, though not completely for certain heart conditions.

Tracking sedentary time

Sedentary time refers to waking time spent in low-energy behaviors, such as sitting or reclining. Prior research on reducing the impact of such behavior has largely focused on replacing it with moderate-to-vigorous physical activity (MVPA). However, some studies suggest a high correlation between MVPA and daily steps. Thus, they may show similar associations with disease and mortality risk.

The use of commercial wearable sensors and smartphones to track daily step count is a modern innovation that enables such associations to be analyzed more easily.

Prior studies suggest additional daily steps

Based on prior observations, a general recommendation is 7,000 to 9,000 daily steps. Actigraphy-based short-term studies have reported that the lowest cardiovascular risk, regardless of sedentary behavior, was correlated with 9,000 to 10,500 daily steps and reduced risk of incident cardiovascular disease or mortality. Such studies, however, cannot capture natural variations driven by season and individual-specific factors.

The current study used long-term data to assess whether additional daily steps could offset the negative associations of sedentary behavior on cardiovascular and other chronic disease risks.

Fitbit-clinical outcome data

The study included 15,327 adult participants from the All of Us Research Program with Fitbit monitoring data linked to their electronic health records (EHRs). This allowed large-scale assessments of activity data in relation to clinical outcomes.

Most participants were White and female, with a median age of 52 years. Fitbit monitoring covered a median of 3.7 years, while the median daily sedentary time was 11.6 hours, and the median daily step count was 7,416. Sedentary time was higher than suggested by prior studies, but the long period of data acquisition indicates greater reliability.

This suggests that U.S. adults may be more sedentary than previously estimated, although this inference is based on longer-term measurement rather than definitive population estimates. Older, Black, non-college-educated participants were more sedentary and had lower daily step counts.

Increased sedentary time increases risk across systems

The researchers found that increased sedentary time was linked to a 15 % to 66 % higher risk of almost all chronic diseases (the exception being ischemic stroke), mostly in a dose-response manner. The conditions assessed were:

• Obesity
• Diabetes mellitus
• Hypertension
• Coronary artery disease
• Heart failure
• Metabolically-dysfunction-associated steatotic liver disease (MASLD)
• Chronic kidney disease
• Chronic obstructive pulmonary disease (COPD)
• Major depressive disorder
• Sleep apnea
• Atrial fibrillation

These effects might operate through sedentary time's impact on multiple physiological systems, including cardiovascular fitness, muscle and bone mass, immune function, energy balance, and brain blood flow.

More daily steps reduced risk

With additional daily steps, the risk of all 12 chronic conditions assessed here was lower, with higher step counts associated with reduced risk across all conditions. These findings suggest that daily step count and sedentary time may have partly independent effects on health outcomes.

Additional steps required to reduce the risk of sedentary behavior ranged from 1,700 to 5,500 per day, suggesting that sedentary behavior and daily steps affect different conditions differently.

For obesity, 1,700 additional daily steps offset the greater risk due to 14 hours of sedentary behavior compared to 8 hours. The number of additional steps increased with baseline body mass index (BMI). Conversely, 5,500 additional steps were required to offset the increased risk for COPD.

Non-linear patterns for some conditions

At about 8,000 daily steps, the risk of hypertension, heart failure, and MASLD stabilized at a lower level. In contrast, the risk of coronary artery disease decreased until 12,000 daily steps before rising again to eventually exceed baseline risk at 16,000-plus steps. The authors hypothesized that long-term excessive physical activity, such as endurance exercise, may induce adverse cardiovascular remodeling.

These results suggest an upper bound to the cardiovascular benefits of physical activity.

Persistent risk for coronary artery disease and heart failure at high sedentary levels

Additional steps offset the increased risk of coronary artery disease associated with sedentary time up to 14 hours, but not for heart failure. Among individuals with 14 hours of daily sedentary time, the risk of both conditions did not return to baseline levels at any step count between 0 and 20,000 steps.

This suggests that daily steps or physical activity cannot completely compensate for the sedentary behavior impact in some areas, highlighting the importance of reducing sedentary time alongside increasing activity.

Counterintuitive effects

Paradoxical patterns were observed in some conditions. For instance, fewer steps were required to offset the risk of depression with 14 hours of sedentary time compared to 8 hours. This may reflect factors such as psychomotor slowing in more severe depression, though this remains speculative.

Strengths and limitations

The study used over 13 million days of monitored activity data rather than self-reported or accelerometry data. Monthly estimates ensure that individual and seasonal variability are captured for key variables. The risk for multiple conditions was assessed.

However, some limitations exist, such as the potential for systematic bias in sedentary time estimation due to the proprietary algorithm used for the Fitbit device. The cohort was relatively young, White, and female, limiting generalizability.

The number of cases at extreme levels of sedentary time for certain conditions was low, which may limit the stability of some estimates.

Certain chronic conditions were underrepresented. Sedentary behavior was not distinguished as continuous or broken up by active episodes. Reverse causation remains a possibility since this was based on observational data.

Implications

Daily step count is a convenient and practical marker of activity, and could help healthcare providers to advise patients who are monitoring their daily step count and sedentary time. “These findings support personalized, behavior-based recommendations that consider both sedentary behavior and daily steps.”

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