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Journey of a thousand miles: from ‘Manpo-Kei’ to the first steps-based physical activity recommendations
  1. Emmanuel Stamatakis1,2,
  2. Matthew Ahmadi1,2,
  3. Marie H Murphy3,
  4. Timothy James Chico4,
  5. Karen Milton5,
  6. Borja Del Pozo Cruz6,7,
  7. Peter T Katzmarzyk8,
  8. I-Min Lee9,10,
  9. Jason Gill11
  1. 1 Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, Scotland, UK
  4. 4 Infection, Immunity, and Cardiovasccular Disease, University of Sheffield, Sheffield, UK
  5. 5 Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
  6. 6 Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
  7. 7 Faculty of Education, University of Cádiz, Cádiz, Spain
  8. 8 Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
  9. 9 Harvard Medical School, Boston, Massachusetts, USA
  10. 10 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  11. 11 British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  1. Correspondence to Emmanuel Stamatakis, Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; emmanuel.stamatakis{at}

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Stepping—encompassing walking, running and stair-climbing—is the fundamental mode of human movement. Higher stepping volume and intensity is associated with favourable health outcomes.1 2 Over the last quarter of the century, stepping has declined by over 1000 steps per day (7%–13% of total count,3 roughly equivalent to ~10 min of brisk walking). As a simple ‘objective’ measure of ambulatory physical activity, formal stepping-based recommendations may provide a target that is easy to understand and monitor. As self-monitoring of steps may be an effective physical activity intervention, such recommendations may support more people to be sufficiently active. This editorial discusses the opportunities and challenges surrounding the addition of stepping-based recommendations to future guidelines.

Daily steps: an old-new target?

Current physical activity recommendations are based on weekly duration (time) of moderate and vigorous activity (MVPA).4 For some people steps may be an easier to monitor and more concrete behavioural metric than time at a particular intensity. For example, step counting devices (pedometers, accelerometers or smartphones) have historically been more accessible than MVPA time-quantifying devices. Simple mechanical pedometers first appeared almost 60 years ago around the Tokyo 1964 Olympics, with the Yamasa company-designed ‘Manpo-Kei’ (‘10 000 steps metre’) being the first commercial step counter. The proliferation of step-counting devices in the last 20 years saw the 10 000 daily steps target being treated as an unofficial goal that increasingly attracted public attention (online supplemental image 1).

Supplemental material



As cohort studies mature, it is likely that more stepping dose–response studies will be available to inform future guidelines. Consumer …

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  • Twitter @M_Stamatakis, @MarieHMurphy, @timchico, @karenmilton8, @JasonGill74

  • Contributors All authors have contributed sufficently to warrant authorship. ES and JG conceived the idea, ES drafted the material, all coauthors reviewed the manuscript critically and redrafted parts.

  • Funding ES is funded by the National Health and Medical Research Council (Australia) through an Investigator Grant (APP1194510). BDPC is funded the Government of Andalusia (Spain), Research Talent Recruitment Programme (BdPC, EMERGIA 2020/00158).

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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