Does the Choice of Stepping Intensity Metric Influence Dose-Response Associations with Mortality? Analysis on UK Population Cohort Study of 65,253 Adults

Abstract

Evidence on the potential mortality gain of higher free-living stepping intensity is limited and equivocal, potentially due to the inconsistent usage among various estimation metrics. To estimate the difference in the association with mortality risk across different stepping intensity metrics, this study aimes to compare different metrics in terms of their multivariable-adjusted associations with all-cause (ACM), cardiovascular disease (CVD), and cancer mortality. This cohort study included UK biobank participants wearing wrist-worn accelerometers. We included eight peak cadence metrics, defined as the highest averaged steps/min across eight different time windows (1-, 5-, 10-, 15-, 20-, 25-, 30-, 60-min), and two non-peak-cadence metrics including average daily cadence (steps/accelerometer wearing minutes) and purposeful cadence (averaged steps/min for minutes ≥40 steps). For each metric, we first standardized each individual’s absolute cadence using (individual’s absolute cadence–mean cadence)/standard deviation. We then estimated their dose-response associations using Cox-restricted-cubic-spline models and compared them on overlay plots