Daily step count and the need for hospital care in subsequent years in a community-based sample of older Australians

Ben D Ewald, Christopher Oldmeadow and John R Attia
Med J Aust 2017; 206 (3): 126-130. || doi: 10.5694/mja16.00640


Objectives: To determine the extent to which physical activity reduces the number of hospital bed-days for Australians over 55, using an objective measure of activity.

Design, setting and participants: 9784 Newcastle residents aged 55 years or more were invited to participate. 3253 responders were eligible and wore pedometers for one week during 2005–2007; their hospital data from recruitment to 31 March 2015 were analysed (mean follow-up time: 8.2 years). Complete data for 2110 people were available for analysis.

Main outcome measures: Mean annual hospital bed-days, according to individual step count.

Results: There was a statistically significant reduction in the number of hospital bed-days associated with higher step counts; the incidence rate ratio per extra 1000 steps per day at baseline was 0.91 (95% CI, 0.90–0.94). The disease-specific reductions were significant for admissions for cancer and diabetes, but not for cardiovascular disease. The difference between 4500 and 8800 steps per day (the upper and lower quartile boundaries for step count) was 0.36 bed-days per person per year, after adjusting for age, sex, number of medications, number of comorbidities, smoking and alcohol status, and education. When analysis was restricted to hospital admissions after the first 2 years of follow-up, the difference was 0.29 bed-days per person per year.

Conclusions: More active people require less hospital care, and an achievable extra 4300 steps per day would result in an average of one less day in hospital for each 3 years of life.

Please login with your free MJA account to view this article in full

  • Ben D Ewald1
  • Christopher Oldmeadow1
  • John R Attia1,2

  • 1 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW
  • 2 John Hunter Hospital, Newcastle, NSW

Competing interests:

No relevant disclosures.

  • 1. Brukner PD, Brown WJ. Is exercise good for you? Med J Aust 2005; 183: 538-541. <MJA full text>
  • 2. Stephenson J, Baumann A, Armstrong T, et al. The costs of illness attributable to physical inactivity in Australia. A preliminary study [report]. Canberra: Commonwealth Department of Health and Aged Care, 2000.$File/phys_costofillness.pdf (accessed Sept 2016).
  • 3. Garcia-Aymerich J, Lange P, Benet M, et al. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population-based cohort study. Thorax 2006; 61: 772-778.
  • 4. Armstrong M, Cairns B, Green J. Association between reported baseline physical activity and hospital admission for [venous] thromboembolism in a prospective cohort study. Eur J Epidemiol 2013; 28 (Suppl): s23-s24.
  • 5. Wollcott J, Ashe M, Miller W, et al. Does physical activity reduce seniors need for health care? A study of 24 281 Canadians. Br J Sports Med 2010; 44: 902-904.
  • 6. Tsuji I, Takahashi K, Nishino Y, et al. Impact of walking upon medical care expenditure in Japan: the Ohsaki Cohort Study. Int J Epidemiol 2003; 32: 809-814.
  • 7. Chevan J, Roberts D. No short term saving in health care expenditures for physically active adults. Prev Med 2014; 63: 1-5.
  • 8. Simmonds B, Fox K, David M, et al. Objectively assessed physical activity and subsequent health service use of UK adults aged 70 and over: a four to five year follow up study. PLoS One 2014; 9: e97676.
  • 9. Australian Electoral Commission. Annual report 2006–07. Canberra: AEC, 2007. (accessed Sept 2016).
  • 10. Hoddinott SN, Bass MJ. The Dillman Total Design Survey Method: a sure-fire way to get high survey return rates. Can Fam Physician 1986; 32: 2366-2368.
  • 11. McEvoy M, Smith W, D’Este K, et al. Cohort profile: the Hunter Community Study. Int J Epidemiol 2010; 39: 1452-1463.
  • 12. Ewald B, McEvoy M, Attia J. Step counts superior to physical activity scale for identifying health markers in older adults. Br J Sports Med 2010; 44: 756-761.
  • 13. Independent Hospital Pricing Authority. National Hospital Cost Data Collection. Australian public hospitals cost report 2012–13, round 17. Commonwealth of Australia, 2015. (accessed Sept 2016).
  • 14. Ewald B, Attia J, McElduff P. How many steps are enough? Dose–response curves for pedometer steps and multiple health markers in a community-based sample of older Australians. J Phys Act Health 2014; 11: 509-518.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.