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Medically Clear

Medically Clear

Counting Steps

Fit or Fad?

Ballard, Dustin MD

Author Information
doi: 10.1097/01.EEM.0000481859.43313.72

    My brother recently gave me the gift of friendly competition. Sibling rivalry is nothing new with just an 18-month age difference between us. Not that long ago we competed on the basketball court, but these days, due to the ravages of middle-aged arthritis, we're better suited to more pedestrian exploits such as counting steps!

    He introduced me about a month ago to the 20-million-strong Fitbit nation. I've been rocking a Fitbit Zip since then, and have earned buzzy 10,000 steps-in-a-day “badges” and one “Penguin March” award for my first 70 miles. I have tried my bit in my pocket, on my shoe, in my gym bag, and even in the dryer. I have read up on Fitbit and other step counters in the press and scientific literature. I have even committed the Fitbit jingle to memory:

    Fitbit. SmartFit, BallFit, HikeFIT, DaddyFIT, GetFIT, GlowFIT!

    And I have QuestionedIT, ResearchedIT, and AnsweredIT! Here we GoFIT.

    Should You Count?

    Is counting steps a worthwhile endeavor? If you are an uber-active athlete, the type who does yoga in the morning, jogs at midday, and rides a bike in the evening (that sounds fantastic, by the way), then I suspect that counting steps is probably not worth your time. You can measure your activity level in many other ways, and you're not really missing out. In fact, some evidence suggests that it is not just the volume of steps that improves health but the combination of volume and intensity.

    Pillay, et al., compared several metrics of physical health (waist circumference, body fat percentage, and V02max) among study participants with low and high numbers of steps as well as “aerobic” steps (greater than 60 steps/minute for at least a minute). (J Phys ActHealth 2014;11[1]:10.) They found that those in the high-high group (those active at a high volume of steps and aerobic steps) had significantly better metrics of physical health than those in other groups. Counting steps alone may not be of maximal benefit if you are young and active, unless, of course, you think knowing your steps (and perhaps bragging about them) is fun, in which case, go for it.

    On the other hand, if you have fewer athletic outlets or higher intensity exercise isn't practical, then counting steps could have a significant impact on your health, particularly if you tend to gravitate to couches, elevators, and valet parking. You may even find that you really enjoy that little dopamine squirt the buzz-buzz of your phone gives you when you hit your daily step goal.

    How Should You Count?

    Is the Fitbit the best choice? The answer depends on how much you value accuracy. The traditional gold standard is an old-fashioned pedometer, like the Yamax SW-200, which uses a coil spring mechanism to keep count. The downside to these devices is that they lack the technical and social features of step-counters that link to or work on your smartphone. Smartphone step-counting applications use GPS data plus or minus an accelerometer. A recent study in Bio Medical Central Research Notes compared these technologies in accuracy during five different scenarios and found widely divergent values.

    On the other hand, a recent Journal of the American Medical Association study noted that the apps on your smartphone are perhaps even better than the Fitbit, at least in measuring steps and calories. (2015;313[6]:625.) University of Pennsylvania researchers compared 10 of the top-selling smartphone fitness applications and pedometers with wearable devices, tracking 14 healthy adults as they walked on the treadmill, and found that wearable devices had significantly more variation (22%) than smartphones (6%).

    My own informal experiments with two Fitbits (mine and my wife's) supported these findings. A Fitbit in my pocket during a 12-hour ED shift counted 800 fewer steps than one on my shoe. The next day, the Fitbit on my wife's shoe registered 2,000 more steps than the one in her pocket! And I registered 883 steps purely by storing my Fitbit in my gym bag in the back of the car and 6,000 or so by giving it a prolonged spin in the dryer. Bottom line: Buyer bewareFIT if you are a stickler for accuracy.

    You can mitigate discrepancies with a Fitbit by being consistent with how and where you apply your device: Use the same physical location each day, and recognize that your pocket may not be as accurate as your wrist or waist.

    What About a Daily Goal?

    The most widely published goal by far is 10,000 steps a day (the pre-set goal for Fitbit customers). Interestingly, this step target, admittedly a nice round number, does not have its origin in evidence. Apparently, the 10,000-step mantra originated around the time of the 1964 Tokyo Olympics with a pedometer named the Manpo Meter and a popular Japanese “Let's walk 10,000 steps a day” tagline.

    Hitting 10,000 steps with the Fitbit provides a properly configured phone to give you a buzz-buzz of approval, but is there any magic in this number? New evidence suggests that there might be, and in a surprising way.

    Vallance and colleagues examined the association in people 55 or older between steps per day in three categories (less than 7,000, 7,000-10,000, and more than 10,000) and scores on a phone-administered quality of life survey. (J Aging Health 2015; Oct 20 [ePub Ahead of Print].) Participants in the high-step group had significantly better scores on mental, physical, and global health scores independent of obesity markers (such as waist circumference and body mass index) than those in the low-step group. This was a rather skewed sample of wealthy Caucasians, and it is difficult to know if the steps themselves rather than the ability to take steps (e.g., freedom from severe joint pain, time, and wherewithal to walk) contributed to the improvement in quality of life.

    Nonetheless, it would seem that the makers of Fitbit and other step-trackers may be onto something. Research shows that people over 55 who take more steps may be happier and healthier than those who do not. There may be other equally valid means of achieving these benefits, but steps are so easy to count and to take! Want more of them? Don't circle three times to find the closest parking spot, just park and amble; march up the stairs; promenade the dog rather than letting it promenade itself; don't send the tech to grab a warm blanket for Trauma A, grab it yourself! Game on!

    Learn more about this topic by listening to the Medically Clear podcast on iTunes or on Dr. Ballard's website,

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