# Association Between Daily Steps Measured by Accelerometry and Diabetes in ELSA-Brasil Participants

## TL;DR

This study shows that taking at least 6,880 steps per day can help reduce the risk of diabetes, offering a simple and low-cost way to promote healthier lifestyles.

## Contribution

The study identifies a specific step count threshold (6,880 steps/day) associated with a protective effect against diabetes.

## Key findings

- A daily step count of 6,880 is associated with a lower prevalence of diabetes.
- The study supports low-cost, accessible interventions to prevent diabetes in urban working populations.
- Findings align with WHO recommendations for increasing daily physical activity.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This study addresses a relevant public health issue by demonstrating that daily physical activity, measured in steps per day, is associated with a lower prevalence of diabetes in adults. A cutoff point of 6880 steps/day with a protective effect was identified, offering a simple metric for the population. With approximately 12,636 federal employees, the study presents good statistical robustness and external validity for urban work contexts. The findings align with WHO recommendations to increase daily movement to prevent chronic diseases and highlight the use of low-cost technologies such as pedometers and smartphones.These findings are relevant because they indicate that a feasible number of daily steps already exerts a protective effect against diabetes, making the recommendation more accessible to the population. The cutoff point of 6880 steps/day allows scientific evidence to be transformed into simple and objective messages. In a scenario of high prevalence of sedentary lifestyles and diabetes, the results support low-cost preventive strategies. The large sample size reinforces the epidemiological consistency of the findings. Therefore, the study also supports public policies aligned with the recommendations of the World Health Organization.

This study addresses a relevant public health issue by demonstrating that daily physical activity, measured in steps per day, is associated with a lower prevalence of diabetes in adults. A cutoff point of 6880 steps/day with a protective effect was identified, offering a simple metric for the population. With approximately 12,636 federal employees, the study presents good statistical robustness and external validity for urban work contexts. The findings align with WHO recommendations to increase daily movement to prevent chronic diseases and highlight the use of low-cost technologies such as pedometers and smartphones.

These findings are relevant because they indicate that a feasible number of daily steps already exerts a protective effect against diabetes, making the recommendation more accessible to the population. The cutoff point of 6880 steps/day allows scientific evidence to be transformed into simple and objective messages. In a scenario of high prevalence of sedentary lifestyles and diabetes, the results support low-cost preventive strategies. The large sample size reinforces the epidemiological consistency of the findings. Therefore, the study also supports public policies aligned with the recommendations of the World Health Organization.

Public health significance—Why is this work of significance to public health?
This study is important for public health because it demonstrates that adopting a realistic level of daily physical activity is associated with protection against diabetes. Defining a target cutoff point of 6880 steps/day facilitates communication of the recommendations to the population. Due to the large sample size, the findings have high epidemiological relevance. The results support simple, low-cost, and widely applicable interventions. In this way, they contribute to prevention policies aligned with the guidelines of the World Health Organization.Furthermore, walking is an accessible activity for most people, regardless of age, socioeconomic status, or place of residence. The study also provides scientific support for the formulation of public policies aimed at promoting active lifestyles. By reducing the incidence of diabetes, actions based on these findings can contribute to a decrease in complications associated with the disease. Consequently, there is a potential reduction in the demand for health services and in costs for the public system. Thus, this study provides evidence that strengthens sustainable strategies for health promotion and disease prevention at the population level.

This study is important for public health because it demonstrates that adopting a realistic level of daily physical activity is associated with protection against diabetes. Defining a target cutoff point of 6880 steps/day facilitates communication of the recommendations to the population. Due to the large sample size, the findings have high epidemiological relevance. The results support simple, low-cost, and widely applicable interventions. In this way, they contribute to prevention policies aligned with the guidelines of the World Health Organization.

Furthermore, walking is an accessible activity for most people, regardless of age, socioeconomic status, or place of residence. The study also provides scientific support for the formulation of public policies aimed at promoting active lifestyles. By reducing the incidence of diabetes, actions based on these findings can contribute to a decrease in complications associated with the disease. Consequently, there is a potential reduction in the demand for health services and in costs for the public system. Thus, this study provides evidence that strengthens sustainable strategies for health promotion and disease prevention at the population level.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
The study presents important messages for different public health stakeholders. For healthcare professionals, it indicates that daily step targets are a practical strategy for preventing diabetes. For managers, the cutoff point of 6880 steps/day can guide population-based physical activity promotion programs with low cost and easy monitoring, aligned with WHO guidelines. For researchers, it reinforces the importance of objective measures of physical activity and the need for longitudinal and interventional studies to confirm causality and adjust cutoff points in different populations.Furthermore, evidence-based public policies, such as campaigns to encourage active mobility and the use of monitoring devices, can reach large population groups. These actions also promote individual autonomy in self-care. Therefore, the results of this study reinforce the need to integrate the promotion of physical activity into national strategies to combat chronic non-communicable diseases.

The study presents important messages for different public health stakeholders. For healthcare professionals, it indicates that daily step targets are a practical strategy for preventing diabetes. For managers, the cutoff point of 6880 steps/day can guide population-based physical activity promotion programs with low cost and easy monitoring, aligned with WHO guidelines. For researchers, it reinforces the importance of objective measures of physical activity and the need for longitudinal and interventional studies to confirm causality and adjust cutoff points in different populations.

Furthermore, evidence-based public policies, such as campaigns to encourage active mobility and the use of monitoring devices, can reach large population groups. These actions also promote individual autonomy in self-care. Therefore, the results of this study reinforce the need to integrate the promotion of physical activity into national strategies to combat chronic non-communicable diseases.

Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia and alterations in lipid and protein metabolism. Daily step count, measured using accelerometers integrated into wearable devices with artificial intelligence support, represents an important indicator of physical activity for the prevention and management of DM when performed regularly at a minimum daily volume. Objective: We aimed to investigate the association between daily step count and DM and to determine the daily step cutoff point necessary to provide a protective effect among participants in the Longitudinal Study of Adult Health (LSAH). Methods: We performed a cross-sectional study that analyzed data from Wave 3 (2016–2018), including 12,636 participants. DM was the dependent variable, assessed by laboratory tests, and daily step count was the independent variable, measured by accelerometry. Associations were assessed using logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs). Results: A significant association was observed between daily step count and DM (OR = 0.76; 95% CI: 0.70–0.83). A cutoff point of 6880 steps/day was identified, with an area under the ROC curve of 0.58 (95% CI: 0.57–0.59). Conclusion: Daily step count appears to be associated with a protective effect against DM.