Res Exerc Epidemiol 2012; 14(2): 107-116.
c 2012 by the Japanese Association of Exercise Epidemiology
Copyright ○【Review Article】

Step by Step: Accumulated Knowledge and Future Directionsof Step-defined Ambulatory Activity
John M. Schuna, Jr., 1) Catrine Tudor-Locke1)
1）Walking Behavior Laboratory, Pennington Biomedical Research Center

ABSTRACT Walking is one of the most common forms of human locomotion. The development of objective
monitoring devices (e.g., pedometers or accelerometers) has afforded public health researchers a unique
opportunity to measure ambulatory behavior, including walking, with minimal bias. Objective monitors have beenused in a number of cross-sectional national- and state-representative studies to assess walking behavior. Data
from these studies, and smaller investigations, have allowed researchers to assess the relationships between total
daily ambulation (steps/day) and various health indicators. The growing body of investigations measuring
ambulatory behavior has also prompted researchers to seek answers to related questions: “how many steps/day are
too few?” and “how many steps/day are enough?” Moreover, recent epidemiological evidence has linked
ambulatory speed (steps/min) to various health outcomes and has peaked researchers’ interests in answering “howfast is enough?” This brief review: 1) summarizes current epidemiological literature examining objectively
monitored ambulatory behavior, 2) answers public health relevant questions concerning insufficient and sufficientamounts of daily walking, 3) considers the relative importance of walking speed in relation to public health, and
4) identifies future research directions related to the assessment of walking behavior.
Key words: walking, public health, physical activity, sedentary lifestyle, epidemiology

steps. Step counts from such devices are often (but notalways) provided in real-time (i.e., using a digital readout) and can be used to characterize ambulation at theindividual or population level. To aid interpretation of
habitual behavior, step counts are typically expressed
as steps/day, which provides practitioners and members of the lay public with an easy to understandmetric representing the total volume of ambulatory
behavior (including walking) in a given day. Guidelines for physical activity from public health authorities have typically prescribed physical activity interms of frequency, duration, and intensity; however,recent step-based physical activity recommendations
have been made by various health groups, professional organizations, and government entities.3-7)
The multiple purposes of this brief article include
assembling the rapidly accumulating knowledge
concerning the epidemiology of objectively monitored
ambulatory activity, summarizing emerging answers
to step-defined indices concerning insufficient andIntroduction
Numerous health benefits are associated with aphysically active lifestyle.1) Although there are amyriad of distinct types of physical activity an
individual may engage in, walking is the mostcommonly reported leisure-time physical activity
among adults.2) Moreover, walking is an integral partof nearly all forms of daily locomotion and is a natural,
simple, accessible, and effective mode of human
movement. Considering the ubiquitous nature ofwalking, its current and future importance tointernational public health should not be overlooked.
Walking can be most precisely measured using
objective monitoring devices (e.g., pedometers or
accelerometers) that quantify movement in terms of
Address for correspondence: Catrine Tudor-Locke;
Walking Behavior Laboratory, Pennington Biomedical
Research Center; 6400 Perkins Road, Baton Rouge, LA,
70808, USA; Tudor-Locke@ pbrc.edu

107Res Exerc Epidemiol 2012; 14(2): 107-116.

sufficient walking doses, pondering the role of walking speed relative to these questions, and identifying
future research needs.

Regardless of the choice of instrumentation (accelerometer or pedometer), it is apparent that daily step
counts within the U.S. are the lowest population-levelvalues collected to date.8,14,15) The only country
reporting trend data based on multi-year surveillancehas been Japan;17) between 1995 and 2007 there has
been a population-level decline in objectively determined physical activity on the order of 529 and 857
steps/day for men and women, respectively, from apeak in 1998-2000. Significantly, the age-adjusted
proportion of people taking < 4,000 steps/day has
increased by 4.8% in men and 8.2% in women.
With few exceptions,10) studies of step-defined
physical activity indicate that men take more steps/day
on average than women.8,9,11-14,16) Steps/day is also
inversely related with age18) and BMI.15,19-25) The
number of daily accumulated steps also reflects day of
the week, with weekend days being typically lower
than weekdays,26) month,27) and season.27,28) For
example, Yasunaga et al.29) and Mitsui et al.30) havereported that steps/day are lower in winter months
compared with summer months. Steps/day appears toalso be impacted by weather changes and perceived
neighborhood walkability.31-33) In particular, having
local and accessible destinations to walk to is
associated with higher steps/day. 34,35) Engagement in

Epidemiology of objectively monitored ambulatory
activity
The body of literature focused on step-defined
physical activity has grown quickly over the last
decade and a clearer understanding of its distribution
and determinants is becoming more apparent. A
number of national- and state-representative surveys
have included objective monitoring of steps/day (byaccelerometer or pedometer) and these are assembled
in Figure 1,8-15) juxtaposed against the highest averagevalues collected to date in an Amish sample. 16) The
representative surveys were conducted in Canada, 9)Japan,11) Norway,10) Switzerland,13) Western Australia,12) and in the United States (U.S.) as part ofColorado on the Move,15) America on the Move,8) andthe National Health and Nutrition Examination Survey(NHANES).14) Since Amish people choose to live
their lives without modern technologies, including
motorized transportation, their pedometer-determineddata16) provide a stark example of what life might
have been like before such contemporary advances.
20000

Men

18000

Women

16000

Steps/day

14000
12000
10000
8000
6000
4000
2000

0

Figure 1

Mean steps/day among men and women by country, geographic region, or population

sub-group.
NHANES = National Health and Nutrition Examination Survey; AOM = America on the Move.

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Res Exerc Epidemiol 2012; 14(2): 107-116.

exercise/sports is associated with increased steps/day
as is active commuting behaviors. 26,36,37) For example,
Wener and Evans reported that train commuters
averaged 30% more steps/day than car commuters andthey were also four times more likely to accumulate
10,000 steps/day.37)

Despite the utility of using a straight-forward
criterion of < 5,000 steps/day as a marker of ambulatory insufficiency, a certain degree of subjectivity
was involved in its development and a range of otherdaily minimums have been proposed. 45) Step accumulations of < 6,000 and < 7,500 steps/day have beenlabeled “inactive” among middle-aged American
women and Australian men and women, respectively.59,60) These same thresholds have been labeled“sedentary” in other studies among postmenopausal
women.61,62) Another definition, “insufficiently active”,
has been defined as < 6,700 steps/day for men and< 5,900 steps/day for women,31) while < 4,000 steps/
day has been referred to as “sedentary” in several
Japanese studies.17,63,64)
Although there is potential usefulness in identifying
a singular minimum steps/day for screening andtracking purposes, this approach is imperfect, as
relatively lower step counts will likely be associatedwith increasingly negative outcomes and relatively
higher step counts will be associated with better
outcomes.45) In this sense, there is an inevitable degreeof subjectivity in identifying any minimum daily step
recommendation in an attempt to answer “how many
steps/day are too few?” However, validation studies
with longitudinal step data and tracking of various
health outcomes may shed light on an appropriate
minimum step threshold. Until that time, and considering the substantial body of published literature
which has already adopted this threshold, the consistent use of the “sedentary lifestyle index” (< 5,000
steps/day) would allow for comparisons between
studies and population groups. 45)

How many steps/day are too few?
Nationally representative assessments within the
U.S. have revealed that many individuals perform
little moderate-to-vigorous physical activity and spend
inordinate amounts of time in sedentary pursuits. 38-40)
These observations are alarming as high levels ofsedentary behavior are associated with increased risks
for a variety of negative health outcomes. 41-44) Suchfindings provide a basis for asking “how many
steps/day are too few?”45) That is, below whatsteps/day threshold are risks for various negative
health outcomes significantly increased?
A minimum threshold of 5,000 steps/day was
initially suggested by Tudor-Locke and colleagues
after observing higher BMI values among adults
accumulating < 5,000 steps/day in comparison to thosetaking > 5,000 steps/day.22) The authors suggested thattaking < 5,000 steps/day may be an indicator of a“sedentary lifestyle index.” Tudor-Locke and Bassettlater used 5,000 steps/day as the floor value of their
proposed graduated step index. 46) Subsequently, the5,000 steps/day threshold has been used by a numberof researchers for population surveillance, 14,17,47-51)
screening,52,53) and intervention.52,54)
In terms of health risks, a number of studies havereported that accumulating < 5,000 steps/day is associated with a higher waist circumference, 19,24) bodyfat percentage,20,22-24) and BMI.15,19,20,22-25,55) Recent
investigations have also indicated that the prevalenceof hypertension, dyslipidemia, and the metabolic
syndrome is higher among individuals taking < 5,000
steps/day in comparison to those accumulating more
steps/day.56,57) Additionally, McKercher and colleagues reported that the prevalence of depression was
50% higher among those individuals taking < 5,000
steps/day in comparison to those taking ≥ 7,500
steps/day among women, and ≥ 12,500 steps/day
among men.58)

How many steps/day are enough?
Numerous government and agency public healthbodies have published guidelines and recommendations which highlight the importance of physicalactivity and its role in chronic disease prevention.3,65-68) These guidelines have emphasized
moderate-to-vigorous physical activity as a primary
behavioral target.68) In recent times, various stepbased recommendations have been put forth. 3-7) Such
recommendations should be thought of as a supplement to existing physical activity guidelines, not a

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Res Exerc Epidemiol 2012; 14(2): 107-116.

replacement or a source of additional confusion. 69)
Still, it would be useful to identify, in terms ofhabitual activity levels, “how many steps/day areenough?” while also reflecting existing public healthrecommendations for frequency, duration, and intensity.
A previous review attempted to answer “how many
steps/day are enough?” by computing a steps/day
value based upon current physical activity guidelines.70) The review referenced previous laboratory
studies which identified a cadence of 100 steps/
min as a proxy for moderate-to-vigorous physicalactivity.71-75) Using this information, and further
assuming that physical activity guidelines typically
call for 30 to 60 minutes of moderate-to-vigorous
intensity activity per day, 67,76,77) a range of 7,10011,000 steps/day was identified as the daily volume ofsteps needed to be sufficiently active. 70) This range ofvalues accounts for a basal minimum of 5,000
steps/day. In order to truly meet physical activity
guidelines, a portion of the abovementioned range(3,000 steps/day or 15,000 steps/week) should becompleted in bouts of at least 10 minutes and at an
intensity of at least 100 steps/min. 70)
Results from a series of studies that reported
steps/day translations for time spent in moderateto-vigorous physical activity and energy expenditurepresent another option for addressing the “how many
steps/days are enough?” question. 50,78-82) Findings
from these studies were summarized by Tudor-Lockeand colleagues who reported that a threshold of 7,0008,000 steps/day is indicative of an individual meeting
minimal physical activity or energy expenditure
guidelines.70) Interestingly, the minimum steps/day
value computed using the previously describedassumption-based methods (i.e., 7,100 steps/day) falls
within the 7,000 to 8,000 steps/day range. The
American College of Sports Medicine (ACSM)
included achieving ≥ 7,000 steps/day in its list ofevidence-based recommendations collated as part ofits 2011 Position Stand providing guidance forprescribing exercise.7)
The “how many steps/day are enough?” question
can also be evaluated from a health risk perspective.
Krumm and colleagues reported that post-menopausal
women who took 5,000-7,500 steps/day had sig-

nificantly lower BMI values than those accumulating< 5,000 steps/day. Moreover, women who took 7,5009,999 steps/day had significantly lower BMI values
than those accumulating 5,000-7,500 steps/day. Despite this evidence, the general lack of information
relating steps/day to health outcomes makes it difficult
to answer “how many steps/day are enough?”
How fast is enough?
A measure of steps/day is an indicator of total
volume of ambulatory activity, regardless of the
speed at which it is accumulated. A meta-analysis ofprospective cohort studies indicated that self-reported
walking pace (or speed) was a stronger independent
predictor of all-cause mortality than self-reported
walking volume (48 vs. 26% reductions in risk,
respectively).83) Recently, some researchers havebegun to capture and interpret cadence (step/min) inan effort to provide more information about freeliving walking speed beyond simply using a measureof steps/day.84-88) Walking speed is determined chiefly
by cadence and stride length; cadence is the primarystrategy employed to increase walking speed, giving
over to stride lengthening as an individual transitions
from walking to jogging to running.89)
A number of controlled studies71-75) have demonstrated that cadence is strongly related to intensity (r =0.93)89) and have consistently concluded that, despite
inevitable inter-individual variability, a cadence of
100 steps/min is a reasonable heuristic value indicative of moderate intensity (defined as 3 METs;
metabolic equivalents; 1 MET = 3.6 ml of oxygen
consumed per kg body weight per minute). Based oneight different covert observation studies90-97) of adults
walking in parks, shopping centers, and city streetsaround the world, the mean weighted observed
cadence is 115.2 steps/min, 89) clearly showing that
cadences of > 100 steps/min are easily attainable innatural settings. However, analyses of accelerometerdata collected as part of the U.S. NHANES indicatesthat time accumulated over 100 steps/min is a seemingly rare phenomenon in daily life for the average
U.S. citizen.88) In fact, these data show that U.S.
adults average < 7 min/day at such a cadence but they
do spend > 383 min/day at a cadence of 1-19 steps/

110Res Exerc Epidemiol 2012; 14(2): 107-116.

min and > 289 min/day at zero cadence (indicative of
non-movement).
Faced with the rarity of moderate intensity freeliving ambulation, but needing to rank individuals forsurveillance and empirical inquiry nonetheless, someresearchers have begun to report peak cadence indicators, specifically peak 30-minute cadence, definedas the mean steps/min for the highest (not necessarily
consecutive) minutes in a day using the output fromtime-stamped accelerometers. 86,87,98) Peak 30-minutecadence has been described as an indicator of “bestnatural effort.”87) U.S. men average a peak 30-minutecadence of 73.7 steps/min, and despite their generally
shorter stature (and therefore relatively higher cadence
measured during short distance gait tests 99)), U.S.
women have a lower average peak 30-minute cadenceof 69.6 steps/min.87) Peak 30-minute cadence is also
related to age, BMI, and steps/day. 87,98)

Factors which appear to influence steps/day include
climatic forces and perceived neighborhood walkability, however, additional research is required to
explore, manipulate, and evaluate other factors that
may shape this critical health behavior. Using cadence
to capture and study ambulatory intensity in freeliving is a novel frontier and more investigations areneeded to elucidate the relationships between habitual
best cadence measures (e.g., peak 30-minute cadence)and various negative health outcomes. In addition, it
has yet to be determined whether or not cadence
provides any more useful information compared toonly using a simple volume indicator of steps/day.
Given the obvious worldwide interest in step-defined
physical activity research, it would be beneficial tofoment international collaborations in an effort tosupport and implement this next phase of research.
References
1） Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Report, 2008.
U.S. Department of Health and Human Services,
Washington, DC, 2008.
2） Ham SA, Kruger J, Tudor-Locke C. Participation
by US adults in sports, exercise, and recreational
physical activities. J Phys Act Health. 2009; 6(1):6-14.
3） Ishikawa-Takata K, Tabata I. Exercise and physical activity reference for health promotion 2006
(EPAR2006). J Epidemiol. 2007; 17(5): 177.
4） National Obesity Forum. Useful tools and agencies: Pedometers National Obesity Forum, 2006.
http://www.nationalobesityforum.org.uk/healthcare-professionals-mainmenu-155/treatmentmainmenu-169/192-useful-tools-and-agencies.
html: Accessed 08/06/2012
5） Queensland Health. 10,000 Steps. Queensland
Health, 2012.
http://www.10000steps.org.au: Accessed 08/08/
20126） The President’s Council on Fitness, Sports &Nutrition. The President’s Challenge: Presidential Active Lifestyle Award (PALA+). The
President’s Council on Fitness, Sports & Nutrition, 2012.
https://www.presidentschallenge.org/challenge/

Conclusions/Future research needs
Walking is integral to daily mobility and is also apart of a healthy lifestyle. Although a number ofnational- and state-representative assessments ofstep-defined physical activity have been published,
continued collection of data representing other regions
will further inform distribution characteristics of thisobjectively determined indicator of mobility andhealth. In addition, continued secondary analysis ofexisting health-related data sets will illuminate important relationships between steps/day and various
health indicators. Widespread adoption of systematic
on-going surveillance of step-defined physical activity
outside of Japan would provide more precise international tracking data.
The available cross-sectional literature suggests thatambulatory volume (steps/day) is inversely associatedwith waist circumference, body fat percentage, and
BMI; however, more longitudinal and intervention
studies are needed if dose-response issues (e.g., “howmany steps/day are too few?” or “how many steps/day
are enough?”) are to be clarified. Such studies may
elucidate the relationships between walking andvarious negative health outcomes (e.g., obesity, heartdisease, diabetes, etc.), while evaluating the best
approaches to favorably modify walking behavior.

111

Res Exerc Epidemiol 2012; 14(2): 107-116.

active/index.shtml: Accessed 08/08/2012
7） Garber CE, Blissmer B, Deschenes MR, et al.
Quantity and quality of exercise for developing
and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently
healthy adults: Guidance for prescribing exercise.
Med Sci Sports Exerc. 2011; 43(7): 1334-59.
8） Bassett DR, Jr, Wyatt HR, Thompson H, Peters
JC, Hill JO. Pedometer-measured physical activity and health behaviors in United States adults.
Med Sci Sports Exerc. 2010; 42(10): 1819-25.
9） Colley RC, Garriguet D, Janssen K, Craig CL,
Clarke J, Tremblay MS. Physical activity ofCanadian adults: Accelerometer results from the2007 to 2009 Canadian Health Measures Survey.
Health Rep. 2011; 22(1): 1-8.
10） Hansen BH, Kolle E, Dyrstad SM, Holme I,
Anderssen SA. Accelerometer-determined physical activity in adults and older people. Med Sci
Sports Exerc. 2012; 44(2): 266-72.
11） Inoue S, Ohya Y, Odagiri Y, et al. Sociodemographic determinants of pedometer-determined
physical activity among Japanese adults. Am J
Prev Med. 2011; 40(5): 566-71.
12） McCormack G, Giles-Corti B, Milligan R.
Demographic and individual correlates of achieving 10,000 steps/day: Use of pedometers in a
population-based study. Health Promot J Austr.
2006; 17(1): 43-7.
13） Sequeira MM, Rickenbach M, Wietlisbach V,
Tullen B, Schutz Y. Physical activity assessment
using a pedometer and its comparison with aquestionnaire in a large population survey. Am J
Epidemiol. 1995; 142(9): 989-99.
14） Tudor-Locke C, Johnson WD, Katzmarzyk PT.
Accelerometer-determined steps per day in US
adults. Med Sci Sports Exerc. 2009; 41(7): 138491.
15） Wyatt HR, Peters JC, Reed GW, Barry M, Hill
JO. A Colorado statewide survey of walking and
its relation to excessive weight. Med Sci Sports
Exerc. 2005; 37(5): 724-30.
16） Bassett DR, Jr, Schneider PL, Huntington GE.
Physical activity in an Old Order Amish community. Med Sci Sports Exerc. 2004; 36(1):79-85.

17） Inoue S, Ohya Y, Tudor-Locke C, Tanaka S,
Yoshiike N, Shimomitsu T. Time trends for stepdetermined physical activity among Japanese
adults. Med Sci Sports Exerc. 2011; 43(10):1913-9.
18） Tudor-Locke C, Hart TL, Washington TL.
Expected values for pedometer-determined physical activity in older populations. Int J Behav
Nutr Phys Act. 2009; 6: 59.
19） Dwyer T, Hosmer D, Hosmer T, et al. The
inverse relationship between number of steps per
day and obesity in a population-based sample:
the AusDiab study. Int J Obes (Lond). 2007;
31(5): 797-804.
20） Krumm EM, Dessieux OL, Andrews P,
Thompson DL. The relationship between daily
steps and body composition in postmenopausal
women. J Womens Health. 2006; 15(2): 202-10.
21） Tudor-Locke C, Bassett DR, Jr, Rutherford WJ,
et al. BMI-referenced cut points for pedometerdetermined steps per day in adults. J Phys Act
Health. 2008; 5(Suppl 1): 126-39.
22） Tudor-Locke C, Ainsworth BE, Whitt MC,
Thompson RW, Addy CL, Jones DA. The relationship between pedometer-determined ambulatory activity and body composition variables. Int
J Obes Relat Metab Disord. 2001; 25(11):1571-8.
23） Mitsui T, Shimaoka K, Tsuzuku S, Kajioka T,
Sakakibara H. Pedometer-determined physicalactivity and indicators of health in Japanese
adults. J Physiol Anthropol. 2008; 27(4): 179-84.
24） Hornbuckle LM, Bassett DR, Jr, Thompson DL.
Pedometer-determined walking and body composition variables in African-American women.
Med Sci Sports Exerc. 2005; 37(6): 1069-74.
25） Cook I, Alberts M, Lambert EV. Relationshipbetween adiposity and pedometer-assessed ambulatory activity in adult, rural African women.
Int J Obes (Lond). 2008; 32(8): 1327-30.
26） Tudor-Locke C, Jones R, Myers AM, Paterson
DH, Ecclestone NA. Contribution of structured
exercise class participation and informal walking
for exercise to daily physical activity in community-dwelling older adults. Res Q Exerc Sport.
2002; 73(3): 350-6.

112

Res Exerc Epidemiol 2012; 14(2): 107-116.

27） Kang M, Basset DR, Barreira TV, Tudor-Locke C,
Ainsworth BE. Measurement effects of seasonaland monthly variability on pedometer-determined data. J Phys Act Health. 2012; 9(3): 33643.
28） Dasgupta K, Chan C, Da Costa D, et al. Walking
behaviour and glycemic control in type 2
diabetes: Seasonal and gender differences - study
design and methods. Cardiovasc Diabetol. 2007;
6: 1.
29） Yasunaga A, Togo F, Watanabe E, Park H,
Shephard RJ, Aoyagi Y. Sex, age, season, andhabitual physical activity of older Japanese: The
Nakanojo study. J Aging Phys Act. 2008; 16(1):3-13.
30） Mitsui T, Barajima T, Kanachi M, Shimaoka K.
Daily walking activity among male office
workers in a rural town in northern Japan. J
Physiol Anthropol. 2010; 29(1): 43-6.
31） Oka K, Shibata A. Determinants of meeting the
public health recommendations for physicalactivity among community-dwelling elderly
Japanese. Curr Aging Sci. 2012; 5(1): 58-65.
32） Chan CB, Ryan DA, Tudor-Locke C. Relationship between objective measures of physicalactivity and weather: A longitudinal study. Int J
Behav Nutr Phys Act. 2006; 3: 21.
33） Van Dyck D, Deforche B, Cardon G, De
Bourdeaudhuij I. Neighborhood walkability andits particular importance for adults with apreference for passive transport. Health Place.
2009; 15(2): 496-504.
34） Kondo K, Lee JS, Kawakubo K, et al. Association between daily physical activity andneighborhood environments. Environ HealthPrev Med. 2009; 14(3): 196-206.
35） King WC, Belle SH, Brach JS, Simkin-Silverman
LR, Soska T, Kriska AM. Objective measures ofneighborhood environment and physical activity
in older women. Am J Prev Med. 2005; 28(5):461-9.
36） Tudor-Locke C, Basset DR, Swartz AM, et al. A
preliminary study of one year of pedometer
self-monitoring. Ann Behav Med. 2004; 28(3):158-62.
37） Wener RE, Evans GW. A morning stroll: Levels

113of physical activity in car and mass transit
commuting. Environ Behav. 2007; 39(1): 62-74.
38） Matthews CE, Chen KY, Freedson PS, et al.
Amount of time spent in sedentary behaviors in
the United States, 2003-2004. Am J Epidemiol.
2008; 167(7): 875-81.
39） Troiano RP, Berrigan D, Dodd KW, Mâsse LC,
Tilert T, McDowell M. Physical activity in the
United States measured by accelerometer. Med
Sci Sports Exerc. 2008; 40(1): 181-8.
40） Tucker JM, Welk GJ, Beyler NK. Physicalactivity in U.S. adults: Compliance with the
Physical Activity Guidelines for Americans. Am
J Prev Med. 2011; 40(4): 454-61.
41） Katzmarzyk PT, Church TS, Craig CL, Bouchard
C. Sitting time and mortality from all causes,
cardiovascular disease, and cancer. Med Sci
Sports Exerc. 2009; 41(5): 998-1005.
42） Hu FB, Li TY, Colditz GA, Willett WC, Manson
JE. Television watching and other sedentary
behaviors in relation to risk of obesity and type 2
diabets mellitus in women. JAMA. 2003; 289(14): 1785-91.
43） Ford ES, Kohl HW, III, Mokdad AH, Ajani UA.
Sedentary behavior, physical activity, and themetabolic syndrome among U.S. adults. Obes
Res. 2005; 13(3): 608-14.
44） Morris JN, Heady JA, Raffle PA, Roberts CG,
Parks JW. Coronary heart-disease and physicalactivity of work. Lancet. 1953; 265(6796): 111120.
45） Tudor-Locke C, Craig CL, Thyfault JP, Spence
JC. A step-defined sedentary lifestyle index:< 5,000 steps/day. Appl Physiol Nutr Metab. In
press.
46） Tudor-Locke C, Bassett DR, Jr. How many
steps/day are enough? Preliminary pedometer
indices for public health. Sports Med. 2004; 34(1): 1-8.
47） Sisson SB, Camhi SM, Church TS, Tudor-Locke
C, Johnson WD, Katzmarzyk PT. Accelerometerdetermined steps/day and metabolic syndrome.
Am J Prev Med. 2010; 38(6): 575-82.
48） Sisson SB, Camhi SM, Tudor-Locke C, Johnson
WD, Katzmarzyk PT. Characteristics of stepdefined physical activity categories in U.S. adults.

Res Exerc Epidemiol 2012; 14(2): 107-116.

Am J Health Promot. 2012; 26(3): 152-9.
49） Tudor-Locke C, Brashear MM, Johnson WD,
Katzmarzyk PT. Accelerometer profiles of physical activity and inactivity in normal weight,
overweight, and obese U.S. men and women. Int
J Behav Nutr Phys Act. 2010; 7: 60.
50） Tudor-Locke C, Johnson WD, Katzmarzyk PT.
Relationship between accelerometer-determined
steps/day and other accelerometer outputs in U.S.
adults. J Phys Act Health. 2011; 8(3): 410-9.
51） Tudor-Locke C, Leonardi C, Johnson WD,
Katzmarzyk PT, Church TS. Accelerometer steps/day translation of moderate-to-vigorous activity.
Prev Med. 2011; 53(1-2): 31-3.
52） Bell GJ, Harber V, Murray T, Courneya KS,
Rodgers W. A comparison of fitness training to apedometer-based walking program matced for
total energy cost. J Phys Act Health. 2010; 7(2):203-13.
53） Musto A, Jacoba K, Nash M, DelRossi G, Perry
A. The effects of an incremental approach to
10,000 steps/day on metabolic syndrome components in sedentary overweight women. J Phys Act
Health. 2010; 7(6): 737-45.
54） Villanova N, Pasgui F, Burzacchini S, et al. A
physical activity program to reinforce weight
maintenance following a behavior program in
overweight/obese subjects. Int J Obes (Lond).
2006; 30(4): 697-703.
55） Inoue S, Ohya Y, Tudor-Locke C, Yoshiike N,
Shimomitsu T. Step-defined physical activity andcardiovascular risk among middle-aged Japanese:
The National Health and Nutrition Survey ofJapan 2006. J Phys Act Health. In press.
56） Schmidt MD, Cleland VJ, Shaw K, Dwyer T,
Venn AJ. Cardiometabolic risk in younger andolder adults across an index of ambulatory
activity. Am J Prev Med. 2009; 37(4): 278-84.
57） Sisson SB, Camhi SM, Church TS, Tudor-Locke
C, Johnson WD, Katzmarzyk PT. Accelerometer-determined steps/day and metabolic syndrome. Am J Prev Med. 2010; 38(6): 575-82.
58） McKercher CM, Schmidt MD, Sanderson KA,
Patton GC, Dwyer T, Venn AJ. Physical activity
and depression in young adults. Am J Prev Med.
2009; 36(2): 161-4.

59） Thompson DL, Rakow J, Perdue SM. Relationship between accumulated walking and bodycomposition in middle-aged women. Med Sci
Sports Exerc. 2004; 36(5): 911-4.
60） Tudor-Locke C, Giles-Corti B, Knuiman M,
McCormack G. Tracking of pedometer-determined physical activity in adults who relocate:
results from RESIDE. Int J Behav Nutr Phys Act.
2008; 5: 39.
61） Lara S, Casanova G, Spritzer PM. Influence ofhabitual physical activity on body composition,
fat distribution and metabolic variables in early
postmenopausal women receiving hormonal
therapy. Eur J Obstet Gynecol Reprod Biol.
2010; 150(1): 52-6.
62） Barbat-Artigas S, Plouffe S, Dupontgand S,
Aubertin-Leheudre M. Is functional capacity
related to the daily amount of steps in postmenopausal women? Menopause. 2012; 19(5): 541-8.
63） Ishikawa-Takata K, Tanaka H, Nanbu K, Ohta T.
Beneficial effect of physical activity on bloodpressure and blood glucose among Japanese maleworkers. Diabetes Res Clin Pract. 2010; 87(3):394-400.
64） Park H, Togo F, Watanabe E, et al. Relationshipof bone health to yearlong physical activity inolder Japanese adults: Cross-sectional data fromthe Nakanojo Study. Osteoporosis Int. 2007;
18(3): 285-93.
65） Commonwealth Department of Health and Aged
Care. National physical activity guidelines forAustralians. Commonwealth Department of
Health and Aged Care, Canberra, AUS, 1999.
66） Department of Health. Strategy statement on
physical activity. Department of Health, London,
UK, 1996.
67） US Department of Health and Human Services.
Physical activity and health: A report of theSurgeon General. Centers for Disease Control
and Prevention, Atlanta, US, 1996.
68） US Department of Health and Human Services.
2008 Physical activity guidelines for Americans.
US Department of Health and Human Services,
Washington, DC, 2008.
69） Tudor-Locke C. Steps to better cardiovascular
health: How many steps does it take to achieve

114

Res Exerc Epidemiol 2012; 14(2): 107-116.

good health and how confident are we in thisnumber? Curr Cardiovasc Risk Rep. 2010; 4(4):271-6.
70） Tudor-Locke C, Craig CL, Brown WJ, et al. How
many steps/day are enough? For adults. Int J
Behav Nutr Phys Act. 2011; 8: 79.
71） Abel M, Hannon J, Mullineaux D, Beighle A.
Determination of step rate thresholds corresponding to physical activity classifications in adults. J
Phys Act Health. 2011; 8(1): 45-51.
72） Beets MW, Agiovlasitis S, Fahs CA, Ranadive
SM, Fernhall B. Adjusting step count recommendations for anthropometric variations in leg
length. J Sci Med Sport. 2010; 13(5): 509-12.
73） Marshall SJ, Levy SS, Tudor-Locke CE, et al.
Translating physical activity recommendations
into a pedometer-based step goal: 3000 steps in
30 minutes. Am J Prev Med. 2009; 36(5): 410-5.
74） Rowe DA, Welk GJ, Heil DP, et al. Stride rate
recommendations for moderate intensity walking.
Med Sci Sports Exerc. 2011; 43(2): 312-8.
75） Tudor-Locke C, Sisson SB, Collova T, Lee SM,
Swan PD. Pedometer-determined step countguidelines for classifying walking intensity in ayoung ostensibly healthy population. Can J Appl
Physiol. 2005; 30(6): 666-76.
76） Public Health Agency of Canada and the Canadian Society for Exercise Physiology. Canada’s
physical activity guide to healthy active living.
Public Health Agency of Canada, Ottawa, ON,
1998.
77） Institute of Medicine. Dietary reference intakesfor energy, carbohydrates, fiber, fat, protein andamino acids (macronutrients). National Academyof Sciences, Washington, DC, 2002.
78） Tudor-Locke C, Ainsworth BE, Thompson RW,
Matthews CE. Comparison of pedometer andaccelerometer measures of free-living physicalactivity. Med Sci Sports Exerc. 2002; 32(12):2045-51.
79） Miller R, Brown W. Meeting physical activity
guidelines and average daily steps in a working
population. J Phys Act Health. 2004; 1(3): 218-26.
80） Behrens TK, Hawkins SB, Dinger MK. Relationship between objectively measured steps andtime spent in physical activity among free-living
college students. Meas Phys Educ Exerc Sci.
2005; 9(2): 67-77.
81） Jordan AN, Jurca GM, Locke CT, Church TS,
Blair SN. Pedometer indices for weekly physicalactivity recommendations in postmenopausal
women. Med Sci Sports Exerc. 2005; 37(9):1627-32.
82） Macfarlane DJ, Chan D, Chan KL, Ho EY, Lee
CC. Using three objective criteria to examine
pedometer guidelines for free-living individuals.
Eur J Appl Physiol. 2008; 104(3): 435-44.
83） Hamer M, Chida Y. Walking and primary prevention: A meta-analysis of prospective cohort
studies. Br J Sports Med. 2008; 42(4): 238-43.
84） Ayabe M, Aoki J, Kumahara H, Tanaka H.
Assessment of minute-by-minute stepping rate ofphysical activity under free-living conditions infemale adults. Gait Posture. 2011; 34(2): 292-4.
85） Ayabe M, Aoki J, Kumahara H, et al. Minuteby-minute stepping rate of daily physical activity
in normal and overweight/obese adults. Obes Res
Clin Pract. 2011; 5(2): e151-6.
86） Gardner AW, Montgomery PS, Scott KJ, Afaq A,
Blevins SM. Patterns of ambulatory activity insubjects with and without intermittent claudication. J Vasc Surg. 2007; 46(6): 1208-14.
87） Tudor-Locke C, Brashear MM, Katzmarzyk PT,
Johnson WD. Peak stepping cadence in freeliving adults: 2005-2006 NHANES. J Phys Act
Health. In press.
88） Tudor-Locke C, Camhi SM, Leonardi C, et al.
Patterns of adult stepping cadence in the 20052006 NHANES. Prev Med. 2011; 53(3): 178-81.
89） Tudor-Locke C, Rowe DA. Using cadence tostudy free-living ambulatory behavior. Sports
Med. 2012; 42(5): 381-98.
90） Drillis R. Objective recording and biomechanics
of pathological gait. Ann N Y Acad Sci. 1958;
74(1): 86-109.
91） Molen NH, Rozendal RH. Some factors ofhuman gait. Proc K Ned Akad Wet C. 1966;
69(4): 522-7.
92） Finley FR, Cody KA. Locomotive characteristics
of urban pedestrians. Arch Phys Med Rehabil.
1970; 51(7): 423-6.

115

Res Exerc Epidemiol 2012; 14(2): 107-116.

Ergol (Tokyo). 1991; 20(1): 85-8.
97） Hangland A, Cimbalo RS. Human ethology: Ageand sex differences in mall walking. Percept Mot
Skills. 1997; 85(3 Pt 1): 845-6.
98） Barreira TV, Katzmarzyk PT, Johnson WD,
Tudor-Locke C. Cadence patterns and peakcadence in U.S. children and adolescents:
NHANES, 2005-2006. Med Sci Sports Exerc. In
press.
99） Hollman JH, McDade EM, Petersen RC. Normative spatiotemporal gait parameters in older
adults. Gait Posture. 2011; 34(1): 111-8.

93） Molen NH, Rozendal RH, Boon W. Fundamental
characteristics of human gait in relation to sex
and location. Proc K Ned Akad Wet C. 1972;
45(3): 215-23.
94） Eke-Okoro ST, Sandlund B. The effects of load,
shoes, sex, and direction on the gait characteristics of street pedestrians. J Hum Movement
Stud. 1984; 10: 107-14.
95） Sato H, Ishizu K. Gait patterns of Japanesepedestrians. J Hum Ergol (Tokyo). 1990; 19(1):13-22.
96） Sato H, Sako H, Mukae H, Sato A, Takahashi T.
Gait patterns of young Japanese women. J Hum

116