成人每日步行數與健康：日行萬步健康才保固？

Daily steps and health in adults: should we walk 10,000 steps per day for optimal well-being?

步行為日常生活中的重要活動，「每日一萬步、健康有保固」亦是國人常聽到的健康推廣口號。然而，日行萬步對於不少人可能是難以達成的目標，且步行對健康的實證效益是否一定需要達到日行萬步？亦有不少運動與公共衛生專家質疑。本篇綜論在於探討成人每日步行數與健康的關係，並針對以下議題進行評析與討論：(1)探討各國成人每日步行數的現況；(2)彙整國際上成人每日步行數的建議；(3)參考已發表的系統性文獻探討與統合分析的研究證據，探究每日步行數與健康關係；(4)分析影響成人每日步行數與其健康關係的重要研究議題。整體而論，目前已發表的系統性文獻探討與統合分析儘管主要來自於橫斷性研究，但已發現：每日步行數不需達到1萬步已可產生健康效益。近年的前瞻性研究更發現，相較於活動不足者（如：2,000-3,000步/日），每日步行數即便增加至4,000-5,000步左右就會產生顯著的健康效益。若能以日行至少7,000-8,000步為目標則效益更大。本文建議成人每日步行可獲取健康效益，即使未達「日行10,000步」。對活動不足者宜鼓勵其在日常生活中逐步增加步行，並以每日至少7,000-8,000步為目標。惟目前良好的研究證據仍相當缺乏，未來需更多具大型代表性樣本且涵蓋不同年齡群的前瞻性世代研究及其統合迴歸分析加以驗證。（台灣衛誌 2020；39(1)：17-26）

Walking is an essential activity for everyday life. Walking 10,000 steps per day is a frequently promoted goal for health promotion. However, this widely accepted slogan has been criticized as unrealistic. Additionally, public health professionals have not reached agreement on the effect of this goal on health outcomes in adults. The following procedures were implemented to review the evidence for the relationship between number of daily steps and health outcomes. First, the country profiles of the daily steps of adults were described. Second, guidelines for the number of daily steps issued by government authorities in various countries were reviewed. Third, evidence obtained through systematic reviews and meta-analyses was examined to explore relationships between the number of daily steps and health outcomes. Finally, research topics regarding the association between number of daily steps and health outcomes were discussed. In summary, evidence from systematic reviews and meta-analyses, which were mainly based on cross-sectional studies, revealed health benefits are likely to be gained by fewer than 10,000 steps per day in adults. Recent prospective cohort studies have indicated that as few as approximately 4,000–5,000 steps per day are significantly related to health benefits when compared with inactive individuals (i.e., 2,000–3,000 steps per day); The benefits progressively increased for those who took at least 7,000-8,000 steps per day. Overall, the current study suggested that people could reap health benefits even when taking fewer than 10,000 steps per day. Individuals who are inactive should be encouraged to progressively increase their daily steps in order to reach the goal of at least 7,000-8,000 steps per day. Because robust evidence relating daily steps and health outcomes is lacking, large-scale prospective studies based on representative samples with broader age groups and meta-regression analyses are required. (Taiwan J Public Health. 2020;39(1):17-26)