{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:43:14Z","timestamp":1793122994593,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Australian National Health and Medical Research Council","award":["APP 1194510"],"award-info":[{"award-number":["APP 1194510"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine the dose-response associations of step count and stepping intensity with risk of cardiovascular mortality and incidence of heart failure (HF), myocardial infarction (MI), and stroke (major adverse cardiovascular events, MACE) in people with hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Data were obtained from participants with established hypertension from the UK Biobank accelerometry sub-study. Participants wore a wrist-worn accelerometer for seven consecutive days. Dose-response associations of daily step count and peak 30-min cadence were examined with risk of MACE. Hazard ratios (HR) and 95% confidence intervals (CI) associated with 1000-step increases in daily step count were calculated. In 36 192 participants [mean (SD) age 64 (7) years, 48% male, follow-up period 7.8 years], non-linear inverse dose-response associations with risk of MACE were observed for daily step count and peak 30-min cadence. Every 1000-step increase in daily step count led to an average lower risk of MACE, HF, MI, and stroke of 17.1% (95% CI: 10.2\u201323.2), 22.4% (95% CI: 11.0\u201331.7), 9.3% (95% CI: \u22122.8 to 19.6), and 24.5% (95% CI: 5.3\u201339.0), respectively. The magnitude of associations with increasing step count and stepping intensity was comparable between people with and without hypertension for risk of overall MACE, HF, and stroke, but of lower magnitude for MI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Incremental 1000-step increases in daily step count, up to 10 000 steps\/day, were associated with substantially lower MACE risk in adults with hypertension, particularly when accrued at a higher stepping intensity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf441","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T11:19:35Z","timestamp":1753096775000},"page":"2217-2224","source":"Crossref","is-referenced-by-count":7,"title":["Prospective associations of daily step count and stepping intensity with overall and type-specific major adverse cardiovascular events in people with hypertension"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-6891","authenticated-orcid":false,"given":"Sonia W M","family":"Cheng","sequence":"first","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre Level 6 D17, The University of Sydney , Johns Hopkins Dr, Camperdown, Sydney, New South Wales 2050 ,","place":["Australia"]},{"name":"Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raaj Kishore","family":"Biswas","sequence":"additional","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre Level 6 D17, The University of Sydney , Johns Hopkins Dr, Camperdown, Sydney, New South Wales 2050 ,","place":["Australia"]},{"name":"Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5463-6894","authenticated-orcid":false,"given":"Nicholas A","family":"Koemel","sequence":"additional","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre Level 6 D17, The University of Sydney , Johns Hopkins Dr, Camperdown, Sydney, New South Wales 2050 ,","place":["Australia"]},{"name":"Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales ,","place":["Australia"]},{"name":"Department of Cardiology, Royal Prince Alfred Hospital , Sydney, New South Wales ,","place":["Australia"]},{"name":"Department of Medicine, TU Dresden , Dresden ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Sabag","sequence":"additional","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre Level 6 D17, The University of Sydney , Johns Hopkins Dr, Camperdown, Sydney, New South Wales 2050 ,","place":["Australia"]},{"name":"Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew N","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre Level 6 D17, The University of Sydney , Johns Hopkins Dr, Camperdown, Sydney, New South Wales 2050 ,","place":["Australia"]},{"name":"Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7323-3225","authenticated-orcid":false,"given":"Emmanuel","family":"Stamatakis","sequence":"additional","affiliation":[{"name":"Mackenzie Wearables Research Hub, Charles Perkins Centre Level 6 D17, The University of Sydney , Johns Hopkins Dr, Camperdown, Sydney, New South Wales 2050 ,","place":["Australia"]},{"name":"Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney , Sydney, New South Wales ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"2026090719592422300_zwaf441-B1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1161\/HYPERTENSIONAHA.119.14240","article-title":"High blood pressure and cardiovascular disease","volume":"75","author":"Fuchs","year":"2020","journal-title":"Hypertension"},{"key":"2026090719592422300_zwaf441-B2","volume-title":"Hypertension","author":"World Health Organization"},{"key":"2026090719592422300_zwaf441-B3","volume-title":"The World Health Report 2002\u2014Reducing Risks, Promoting Healthy Life","author":"World Health Organization","year":"2002"},{"key":"2026090719592422300_zwaf441-B4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1161\/CIRCHEARTFAILURE.108.794933","article-title":"Absolute and attributable risks of heart failure incidence in relation to optimal risk factors","volume":"2","author":"Folsom","year":"2009","journal-title":"Circ Heart Fail"},{"key":"2026090719592422300_zwaf441-B5","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1249\/MSS.0000000000001943","article-title":"2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE. Physical activity to prevent and treat hypertension: a systematic review","volume":"51","author":"Pescatello","year":"2019","journal-title":"Med Sci Sports Exerc"},{"key":"2026090719592422300_zwaf441-B6","doi-asserted-by":"crossref","first-page":"e127","DOI":"10.1016\/j.jacc.2017.11.006","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026090719592422300_zwaf441-B7","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1186\/s12875-022-01866-w","article-title":"Perceived barriers to physical activity behaviour among patients with diabetes and hypertension in Kosovo: a qualitative study","volume":"23","author":"Bytyci Katanolli","year":"2022","journal-title":"BMC Prim Care"},{"key":"2026090719592422300_zwaf441-B8","doi-asserted-by":"crossref","first-page":"e84238","DOI":"10.1371\/journal.pone.0084238","article-title":"Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies","volume":"9","author":"Khatib","year":"2014","journal-title":"PLoS One"},{"key":"2026090719592422300_zwaf441-B9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1123\/jmpb.2021-0012","article-title":"Should we use activity tracker data from smartphones and wearables to understand population physical activity patterns?","volume":"5","author":"Mair","year":"2022","journal-title":"J Meas Physical Behav"},{"key":"2026090719592422300_zwaf441-B10","author":"World Health Organization","year":"2020"},{"key":"2026090719592422300_zwaf441-B11","doi-asserted-by":"crossref","first-page":"e023290","DOI":"10.1161\/JAHA.121.023290","article-title":"Prospective associations of accelerometer-assessed physical activity with mortality and incidence of cardiovascular disease among adults with hypertension: the UK biobank study","volume":"11","author":"Del Pozo Cruz","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026090719592422300_zwaf441-B12","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1161\/HYPERTENSIONAHA.123.21663","article-title":"Association of device-measured physical activity with cardiovascular outcomes in individuals with hypertension","volume":"80","author":"Xiang","year":"2023","journal-title":"Hypertension"},{"key":"2026090719592422300_zwaf441-B13","doi-asserted-by":"crossref","first-page":"e1001779","DOI":"10.1371\/journal.pmed.1001779","article-title":"UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age","volume":"12","author":"Sudlow","year":"2015","journal-title":"PLoS Med"},{"key":"2026090719592422300_zwaf441-B14","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 international society of hypertension global hypertension practice guidelines","volume":"75","author":"Unger","year":"2020","journal-title":"Hypertension"},{"key":"2026090719592422300_zwaf441-B15","doi-asserted-by":"crossref","first-page":"e0169649","DOI":"10.1371\/journal.pone.0169649","article-title":"Large scale population assessment of physical activity using wrist worn accelerometers: the UK biobank study","volume":"12","author":"Doherty","year":"2017","journal-title":"PLoS One"},{"key":"2026090719592422300_zwaf441-B16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jsams.2016.06.003","article-title":"Field evaluation of a random forest activity classifier for wrist-worn accelerometer data","volume":"20","author":"Pavey","year":"2017","journal-title":"J Sci Med Sport"},{"key":"2026090719592422300_zwaf441-B17","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.gaitpost.2021.11.035","article-title":"Validation of open-source step-counting algorithms for wrist-worn tri-axial accelerometers in cardiovascular patients","volume":"92","author":"Femiano","year":"2022","journal-title":"Gait Posture"},{"key":"2026090719592422300_zwaf441-B18","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1123\/jpah.9.8.1125","article-title":"Peak stepping cadence in free-living adults: 2005\u20132006 NHANES","volume":"9","author":"Tudor-Locke","year":"2012","journal-title":"J Phys Act Health"},{"key":"2026090719592422300_zwaf441-B19","first-page":"625","article-title":"Normative peak 30-min cadence (steps per minute) values for older adults: NHANES 2005\u20132006","volume":"27","author":"Aguiar","year":"2019","journal-title":"J Aging Phys Act"},{"key":"2026090719592422300_zwaf441-B20","doi-asserted-by":"crossref","first-page":"e800","DOI":"10.1016\/S2468-2667(23)00183-4","article-title":"Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: a prospective cohort study","volume":"8","author":"Ahmadi","year":"2023","journal-title":"Lancet Public Health"},{"key":"2026090719592422300_zwaf441-B21","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780192844194.001.0001","volume-title":"Data Acquisition\u2014Observation. Credit Intelligence & Modelling: Many Paths Through the Forest of Credit Rating and Scoring","author":"Anderson","year":"2021"},{"key":"2026090719592422300_zwaf441-B22","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s12889-024-21216-y","article-title":"Associations of daily step count with all-cause mortality and cardiovascular mortality in hypertensive US adults: a cohort study from NHANES 2005\u20132006","volume":"25","author":"Guo","year":"2025","journal-title":"BMC Public Health"},{"key":"2026090719592422300_zwaf441-B23","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1093\/eurjpc\/zwad229","article-title":"The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis","volume":"30","author":"Banach","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"2026090719592422300_zwaf441-B24","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1016\/j.jacc.2023.07.029","article-title":"Relationship of daily step counts to all-cause mortality and cardiovascular events","volume":"82","author":"Stens","year":"2023","journal-title":"JACC"},{"key":"2026090719592422300_zwaf441-B25","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12966-020-00978-9","article-title":"Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia","volume":"17","author":"Hall","year":"2020","journal-title":"Int J Behav Nutr Phys Act"},{"key":"2026090719592422300_zwaf441-B26","doi-asserted-by":"crossref","first-page":"e0219933","DOI":"10.1371\/journal.pone.0219933","article-title":"Cardiometabolic thresholds for peak 30-min cadence and steps\/day","volume":"14","author":"Adams","year":"2019","journal-title":"PLoS One"},{"key":"2026090719592422300_zwaf441-B27","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"2026090719592422300_zwaf441-B28","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1161\/CIRCULATIONAHA.117.030617","article-title":"Reversing the cardiac effects of sedentary aging in middle age-A randomized controlled trial: implications for heart failure prevention","volume":"137","author":"Howden","year":"2018","journal-title":"Circulation"},{"key":"2026090719592422300_zwaf441-B29","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1161\/CIRCHEARTFAILURE.114.001615","article-title":"Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials","volume":"8","author":"Pandey","year":"2015","journal-title":"Circ Heart Fail"},{"key":"2026090719592422300_zwaf441-B30","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1001\/jamacardio.2023.5692","article-title":"Accelerometer-measured physical activity, sedentary time, and heart failure risk in women aged 63 to 99 years","volume":"9","author":"LaMonte","year":"2024","journal-title":"JAMA Cardiol"},{"key":"2026090719592422300_zwaf441-B31","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1161\/STROKEAHA.115.006317","article-title":"Physical activity in primary stroke prevention","volume":"46","author":"Howard","year":"2015","journal-title":"Stroke"},{"key":"2026090719592422300_zwaf441-B32","doi-asserted-by":"crossref","first-page":"i3857","DOI":"10.1136\/bmj.i3857","article-title":"Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the global burden of disease study 2013","volume":"354","author":"Kyu","year":"2016","journal-title":"BMJ"},{"key":"2026090719592422300_zwaf441-B33","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/ijs.12392","article-title":"Predictive impact of daily physical activity on new vascular events in patients with mild ischemic stroke","volume":"10","author":"Kono","year":"2015","journal-title":"Int J Stroke"},{"key":"2026090719592422300_zwaf441-B34","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1038\/s41591-020-1012-3","article-title":"Wearable-device-measured physical activity and future health risk","volume":"26","author":"Strain","year":"2020","journal-title":"Nat Med"},{"key":"2026090719592422300_zwaf441-B35","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/aje\/kwx246","article-title":"Comparison of sociodemographic and health-related characteristics of UK biobank participants with those of the general population","volume":"186","author":"Fry","year":"2017","journal-title":"Am J Epidemiol"},{"key":"2026090719592422300_zwaf441-B36","doi-asserted-by":"crossref","first-page":"8220","DOI":"10.3390\/s21248220","article-title":"Clustering accelerometer activity patterns from the UK Biobank Cohort","volume":"21","author":"Clark","year":"2021","journal-title":"Sensors"},{"key":"2026090719592422300_zwaf441-B37","doi-asserted-by":"crossref","first-page":"m131","DOI":"10.1136\/bmj.m131","article-title":"Comparison of risk factor associations in UK biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis","volume":"368","author":"Batty","year":"2020","journal-title":"BMJ"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwaf441\/63965796\/zwaf441.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/33\/12\/2217\/63965796\/zwaf441.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/article-pdf\/33\/12\/2217\/63965796\/zwaf441.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T23:59:38Z","timestamp":1788825578000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/article\/33\/12\/2217\/8223012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,8,6]]},"published-print":{"date-parts":[[2026,9,8]]}},"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwaf441","relation":{},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2025,8,6]]}}}