# Step-Determined Physical Activity among Individuals with Chronic Conditions: The 2007-2019 National Health and Nutrition Survey of Japan

## TL;DR

People with chronic conditions in Japan take fewer steps daily than healthy individuals, even when they exercise, suggesting lifestyle changes beyond exercise are needed.

## Contribution

This study quantifies step-based physical activity levels in individuals with chronic conditions using a national survey and highlights gaps in meeting activity guidelines.

## Key findings

- Individuals with multiple chronic conditions took 480 fewer steps/day than healthy individuals.
- Over half of those with chronic conditions who exercised still failed to meet physical activity guidelines.
- Diabetes patients had the lowest proportion of exercisers meeting physical activity targets.

## Abstract

Clinical guidelines recommend exercise therapy to modify an unhealthy lifestyle among individuals with chronic conditions (CCs), including hypertension, diabetes, and dyslipidemia. However, it remains unclear whether individuals with CCs engage in higher physical activity levels than do healthy individuals or whether implementing exercise therapy causes achieving sufficient daily physical activity levels for this population. We investigated steps/day as a measure of total physical activity levels in this group.

Participants aged ≥20 years were identified from the Japanese National Health and Nutrition Examination Survey (2007-2019). Age-adjusted steps/day by health status were estimated using the analysis of covariance. The proportions of those meeting the physical activity recommendations (≥8,000 steps/day) among individuals with CCs who practiced exercise therapy were confirmed by density plots.

The data of 59,703 participants were analyzed. Age-adjusted steps/day in the multiple CC group (i.e., combinations of hypertension, diabetes, and dyslipidemia) were 480 steps/day fewer than those in the healthy group and 341 steps/day fewer than those in the single CC group. Furthermore, among the participants who engaged in exercise, the proportions of those not meeting physical activity guidelines were 51.2%, 56.7%, and 60.7% in the healthy, single CC, and multiple CC groups, respectively. Participants with diabetes (46.6%) showed the lowest proportion of those not meeting the physical activity guidelines among exercisers.

Despite physical activity recommendations by clinical guidelines, steps/day in individuals with CCs were very low. More than half of individuals with CCs did not meet the physical activity guideline targets, even for those who reported engaging in exercise. This suggests that focusing only on exercise is not an appropriate strategy to increase total daily physical activity. Healthcare providers need to effectively promote physical activity in clinical settings, especially advocating for increasing not only exercise but also daily lifestyle physical activities.