We certainly have a tendency to be meticulous when it comes to health behaviors like diet, exercise, and sleep. While we can make a strong case that there’s added benefit to doing things in specific ways, the reality is that you can get the bulk of the health benefits with very simple strategies. A great example of this is step counting, which can be done with virtually no added cost or effort. The impacts are enormous, as you can see from this study published in JAMA in 2020 (Figure 1).

Figure 1: The risk of mortality sharply declines as steps per day increase (Saint-Maurice et al., 2020).
Even with a moderate change, such as walking 4000 steps/day as compared to 8000 steps/day, you’re looking at a 200% or greater (much greater if male) increased risk of mortality. Of course, this study demonstrates association and isn’t able to say definitively that higher step counts cause lower risk of death. It is certainly true that there are people with health issues which lead to them walking less. There’s also the “healthy user bias” which reminds us that people who are walking more are likely prioritizing their health in other ways as well. Nevertheless, with data this clear and with everything we know about the positive impacts of exercise, we can be pretty confident that walking 8000 steps/day or more is going to have significant health benefits.
Now, reaching 8000 steps/day requires a conscious effort in most parts of the U.S. where driving is the norm and walking is not typically built-in to one’s day. We tend to drive to work and to the grocery store, whereas in other locations these trips are made on foot. I try to force walking into my day however I can, whether it’s going up and down the stairs between patients or circling the block at least once or twice after dinner. Striving for a high step count may not work for everyone, but it has far less barriers to entry than just about any other exercise approach. It can be done anytime, anywhere, for essentially zero cost. Even better, for those who can’t find time for an hour workout each day, step counts can be split up into as many sessions as you’d like. Even 2 minutes of walking contributes to your daily count.
Beyond step counting, the message here is that simplicity and sustainability are essential. This goes for diet, exercise, and virtually every aspect of life. As much as we talk about structured Zone 2 exercise, someone who doesn’t enjoy this or can’t make it work in their schedule isn’t going to benefit from it. If simply walking 8000 steps/day is something they can keep up with long-term, we’d much rather have them do this and stick with it versus forcing themselves to try and fail other regimens. It’s been said many times before but it’s so important to seriously let it sink in: health is built not through miracle drugs or short-term heroic efforts, but rather by the habits that you perform every day of your life. Find something, no matter how small, that you can do each and every day with few exceptions, and trust that the benefits will eventually appear.
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