Movement

Walking

Walking is one of the most accessible forms of physical activity. It activates the largest muscle groups, improves circulation and oxygen supply, and reduces chronic inflammation, the stress response and insulin resistance. Working muscles take up glucose via an insulin-independent route, and regular aerobic activity lowers blood pressure and triglycerides, largely independently of weight loss[1].

The relationship between steps and mortality is curvilinear: the gain is steepest at low counts and then levels off. Health gains begin at around 2,500 to 4,000 steps per day, every additional 1,000 steps are associated with about 10 to 15% lower all-cause mortality, and by around 7,000 steps a large part of the gain is in, certainly at older ages[1], [2], [3], [4]. In the meta-analysis by Stens, the optimum lay around 8,800 steps for all-cause mortality and around 7,100 for cardiovascular disease, with a faster pace as an extra gain[1]. The most recent dose-response meta-analysis calls 7,000 steps per day a more realistic target than 10,000[5].

Guidelines

There is no official step guideline; the WHO frames its recommendation in minutes of moderate or vigorous activity per week[6]. The figure of 10,000 steps is familiar in Flanders through the Gezond Leven campaign[7], but does not go back to a dose-response study.

How Synapse assesses this

Synapse estimates the average number of steps per day from the questionnaire. Leisurely cycling trips count as walking[8]. Members whose reported sports clearly imply more movement than their reported step count suggests receive a corrected step count.

Steps per dayAssessment
≥ 10,000Optimal
7,000 to 10,000Acceptable
5,000 to 7,000Watch
< 5,000Priority
ItemReference
Steps≥ 7,000 per day below 6,000 steps, otherwise ≥ 10,000 per day
Corrected steps≥ 7,000 per day below 6,000 steps, otherwise ≥ 10,000 per day

The reference depends on the count shown: below 6,000 steps a day the next goal is ≥ 7,000, from 6,000 on it is ≥ 10,000. The reference of 10,000 steps sits at the top of the dose-response curve; most of the gain is realised earlier. The row's colour follows the reference shown; the walking score itself is still graded by the table above.

Pace and age

At the same step count, people with a faster pace do better than those who stroll[1]. In people over 60, the curve for cardiovascular disease levels off between about 6,000 and 9,000 steps per day[9].

Sedentary time

Prolonged uninterrupted sitting switches off the large leg muscles: lipoprotein lipase activity falls, contraction-mediated glucose uptake drops away and post-meal glycaemia and lipaemia rise. Inactivity also goes with reduced circulation and higher oxidative stress, which impairs endothelial function and increases the risk of cardiovascular disease[10].

Even in people who exercise regularly, prolonged sitting has a negative impact on health[11]. In a harmonised meta-analysis of more than a million people, the excess mortality risk of eight hours of sitting per day largely disappeared with 60 to 75 minutes of moderate activity per day; around the guideline norm it was attenuated but not eliminated[11]. Accelerometer data from 89,530 participants show a tipping point around 10.6 hours of sitting per day, above which heart failure and cardiovascular mortality rise steeply, even in those who meet the activity norm[12].

Guidelines

The WHO advises limiting sitting time and replacing it with activity of any intensity, without a numerical upper limit for the number of hours[6].

How Synapse assesses this

Synapse assesses not only total sitting time (work or study, travel and leisure combined) but also how often someone stands up. Standing up regularly compensates in the score for part of a long sitting time. For the sitting-breaks row Synapse shows no reference value.

ItemReference
Sitting (total)≤ 8 hours per day

Breaking up sitting and sitting less

Breaks with light activity acutely lower post-meal glucose and blood pressure, and walking does so clearly more than standing[13]. Breaking up sitting nevertheless remains less effective than sitting less and moving more[13], [14]. The comparison with smoking, which sometimes calls a sedentary lifestyle "the new smoking"[10], holds only partly: the risk of sitting depends strongly on how much someone otherwise moves[11].

Moderate activity

Exercise is one of the most powerful preventive interventions available: regular activity lowers all-cause mortality across virtually the entire risk spectrum[15], [16]. During moderate exertion the heart rate rises slightly but a conversation remains possible. This activity relies mainly on oxidative phosphorylation, with fat as the primary fuel. It supports basal metabolism, promotes a healthy energy balance and raises VO₂max[17], [18], [19].

Guidelines

The WHO recommends that adults do 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic activity per week, combined with muscle-strengthening training at least twice a week[6].

How Synapse assesses this

Synapse measures weekly physical activity with a question set based on the IPAQ-SF[20], [21], per reported sport and pace. Walking and cycling count separately from structured exercise. Because walking is scored separately, the "optimal" threshold for moderate activity lies above 120 minutes per week; members who score well here and also have a normal movement pattern come out above the WHO norm. The reference next to the member's value follows the WHO lower limit.

Moderate activity (min/week)Assessment
> 120Optimal
60 to 120Acceptable
30 to 60Watch
< 30Priority
ItemReference
Moderate activity≥ 150 minutes per week

Self-report

The IPAQ-SF generally overestimates actual activity, which weighs in the interpretation of the cut-offs[20].

Vigorous activity

During intense exertion the heart rate rises sharply and a conversation is no longer possible. This activity relies largely on anaerobic glycolysis and improves maximal endurance, explosiveness and VO₂max[17]. High-intensity interval training raises VO₂max at least as much as continuous endurance training, with small differences between the two[22]. At the same total volume, a share of vigorous minutes above half is associated with about 17% lower mortality than moderate activity alone[23].

Guidelines

The WHO recommends 75 to 150 minutes of vigorous activity per week, and counts one vigorous minute as two moderate ones[6].

How Synapse assesses this

Synapse counts the vigorous minutes per week from the reported sports. The reference next to the member's value follows the WHO lower limit of 75 minutes.

Vigorous activity (min/week)Assessment
> 60Optimal
30 to 60Acceptable
15 to 30Watch
< 15Priority
ItemReference
Vigorous activity≥ 75 minutes per week

Strength training

Strength training converts mechanical load into muscle protein synthesis and muscle growth, enlarges the muscle as the largest store for glucose and loads the bone. It builds and preserves muscle mass, raises bone density and reduces the risk of injury. Because muscle mass declines progressively with age, progressive resistance training is the best-supported countermeasure against sarcopenia[24]. Grip strength, as a measure of general muscle strength, is a strong predictor of all-cause mortality and cardiovascular disease[25], [26].

Muscle-strengthening activity, independently of endurance training, is associated with 10 to 17% lower mortality and less cardiovascular disease, cancer and diabetes. The relationship is J-shaped: the greatest risk reduction lies around 30 to 60 minutes per week, and above about 120 to 140 minutes per week no further gain is demonstrable[27]. Any strength training versus none is associated with 15% lower all-cause and 19% lower cardiovascular mortality[28]. The combination with endurance training yields the most[24].

Guidelines

The WHO advises muscle-strengthening training for all major muscle groups at least twice a week[6].

How Synapse assesses this

Synapse counts the minutes of muscle-strengthening training per week from the reported sports and places the cut-offs in the high-yield range of the dose-response curve. Besides volume, regularity also counts, in line with the WHO frequency requirement.

Strength training (min/week)Assessment
> 60Optimal
30 to 60Acceptable
15 to 30Watch
< 15Priority
ItemReference
Strength training≥ 60 minutes per week

What counts as strength training

Exercises with body weight, resistance bands and weights, but also heavy gardening, lifting and carrying. The load must be progressive: after eight to twelve repetitions an exercise should feel heavy. The greatest muscle mass sits in the legs and hips, and that is also where the greatest gain lies for glucose storage, bone loading and fall prevention[24]. Strength training and sufficient protein reinforce each other, especially at older ages.

Cardio

Endurance training raises cardiorespiratory fitness (VO₂max), the strongest exercise-related predictor of all-cause mortality and cardiovascular disease[19]. Among 122,007 patients with an exercise test, the lowest fitness carried an approximately fivefold higher mortality risk than the highest, more than smoking or diabetes[29]. Combining aerobic and anaerobic training improves VO₂max the most[17], [22].

The relationship with mortality is curvilinear: going from inactive to some activity yields the greatest gain, and the near-maximal reduction lies at 150 to 300 minutes of vigorous or 300 to 600 minutes of moderate activity per week[30]. At the same volume, a greater share of vigorous minutes yields extra gain[23].

Guidelines

The WHO recommends that adults do 150 to 300 minutes of moderate or 75 to 150 minutes of vigorous activity per week, or a combination of both, with one vigorous minute counting as two moderate ones[6].

How Synapse assesses this

Cardio brings moderate and vigorous activity together. Synapse looks at the combination of moderate and vigorous exertion, not at either alone, and expresses the volume in moderate-equivalent minutes according to the WHO convention. Walking does not count here: it is scored separately.

Cardio (moderate-equivalent min/week)Assessment
> 119Optimal
89 to 119Acceptable
59 to 89Watch
< 59Priority

For the rows of this item (the reported sports) Synapse shows no reference value.

The talk test

Intensity is easy to estimate without a heart-rate monitor. Moderate means a conversation is still possible but singing is not; vigorous means only a few words at a time are possible. Brisk walking, cycling to work and heavy gardening count in full as moderate exertion.

Stability

Balance and stability training matters above all from age 65. Exercise programmes with balance and functional exercises reduce the number of falls in community-dwelling older people by about a quarter[31].

Guidelines

The WHO advises people over 65 to do varied multicomponent training on at least three days a week, with an emphasis on balance and strength[6].

How Synapse assesses this

Synapse shows stability as a separate item once the basics (walking, cardio and strength training) are in order, and counts the minutes of stability training per week.

Stability training (min/week)Assessment
> 59Optimal
29 to 59Acceptable
14 to 29Watch
< 14Priority
ItemReference
Stability training≥ 60 minutes per week

Developed and reviewed with the Synapse medical advisory board.

References

  1. [1]Stens, N. A. et al. Relationship of daily step counts to all-cause mortality and cardiovascular events. J Am Coll Cardiol 82, 1483–1494 (2023). doi.org/10.1016/j.jacc.2023.07.029
  2. [2]Banach, M. et al. The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis. Eur J Prev Cardiol 30, 1975–1985 (2023). doi.org/10.1093/eurjpc/zwad229
  3. [3]Hall, K. S. et al. Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia. Int J Behav Nutr Phys Act 17, 78 (2020). doi.org/10.1186/s12966-020-00978-9
  4. [4]Rodríguez-Gutiérrez, E. et al. Daily steps and all-cause mortality: an umbrella review and meta-analysis. Prev Med 185, 108047 (2024). doi.org/10.1016/j.ypmed.2024.108047
  5. [5]Ding, D. et al. Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis. Lancet Public Health 10, e668–e681 (2025). doi.org/10.1016/S2468-2667(25)00164-1
  6. [6]Bull, F. C. et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 54, 1451–1462 (2020). doi.org/10.1136/bjsports-2020-102955
  7. [7]Vlaams Instituut Gezond Leven. Waarom 10.000 stappen? 10000stappen.gezondleven.be (geraadpleegd 2 september 2026).
  8. [8]Vlaams Instituut Gezond Leven. 10.000 stappen: hoe begin je eraan? (2018). gezondleven.be/files/beweging/folder-10.000-stappen.pdf
  9. [9]Paluch, A. E. et al. Prospective association of daily steps with cardiovascular disease: a harmonized meta-analysis. Circulation 147, 122–131 (2023). doi.org/10.1161/CIRCULATIONAHA.122.061288
  10. [10]Park, J. H. et al. Sedentary lifestyle: overview of updated evidence of potential health risks. Korean J Fam Med 41, 365–373 (2020). doi.org/10.4082/kjfm.20.0165
  11. [11]Ekelund, U. et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 388, 1302–1310 (2016). doi.org/10.1016/S0140-6736(16)30370-1
  12. [12]Ajufo, E. et al. Accelerometer-measured sedentary behavior and risk of future cardiovascular disease. J Am Coll Cardiol 85, 473–486 (2025). doi.org/10.1016/j.jacc.2024.10.065
  13. [13]Buffey, A. J. et al. The acute effects of interrupting prolonged sitting time in adults with standing and light-intensity walking on biomarkers of cardiometabolic health in adults: a systematic review and meta-analysis. Sports Med 52, 1765–1787 (2022). doi.org/10.1007/s40279-022-01649-4
  14. [14]Ekelund, U. et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ 366, l4570 (2019). doi.org/10.1136/bmj.l4570
  15. [15]Löllgen, H. et al. Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories. Int J Sports Med 30, 213–224 (2009). doi.org/10.1055/s-0028-1128150
  16. [16]Thompson, W. R. et al. Exercise is medicine. Am J Lifestyle Med 14, 511–523 (2020). doi.org/10.1177/1559827620912192
  17. [17]Crowley, E. et al. The effect of exercise training intensity on VO2max in healthy adults: an overview of systematic reviews and meta-analyses. Transl Sports Med 2022, 9310710 (2022). doi.org/10.1155/2022/9310710
  18. [18]Woodcock, J. et al. Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol 40, 121–138 (2011). doi.org/10.1093/ije/dyq104
  19. [19]Kodama, S. et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301, 2024–2035 (2009). doi.org/10.1001/jama.2009.681
  20. [20]Ekelund, U. et al. Criterion-related validity of the last 7-day, short form of the International Physical Activity Questionnaire in Swedish adults. Public Health Nutr 9, 258–265 (2006). doi.org/10.1079/phn2005840
  21. [21]IPAQ Research Committee. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ), short and long forms (2005).
  22. [22]Poon, E. T. et al. High-intensity interval training and cardiorespiratory fitness in adults: an umbrella review of systematic reviews and meta-analyses. Scand J Med Sci Sports 34, e14652 (2024). doi.org/10.1111/sms.14652
  23. [23]Wang, Y. et al. Association of physical activity intensity with mortality: a national cohort study of 403 681 US adults. JAMA Intern Med 181, 203–211 (2021). doi.org/10.1001/jamainternmed.2020.6331
  24. [24]Paluch, A. E. et al. Resistance exercise training in individuals with and without cardiovascular disease: 2023 update: a scientific statement from the American Heart Association. Circulation 149, e217–e231 (2024). doi.org/10.1161/CIR.0000000000001189
  25. [25]Wu, Y. et al. Association of grip strength with risk of all-cause mortality, cardiovascular diseases, and cancer in community-dwelling populations: a meta-analysis of prospective cohort studies. J Am Med Dir Assoc 18, 551.e17–551.e35 (2017). doi.org/10.1016/j.jamda.2017.03.011
  26. [26]Chai, L. et al. Comparison of grip strength measurements for predicting all-cause mortality among adults aged 20+ years from the NHANES 2011–2014. Sci Rep 14, 29245 (2024). doi.org/10.1038/s41598-024-80487-y
  27. [27]Momma, H. et al. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med 56, 755–763 (2022). doi.org/10.1136/bjsports-2021-105061
  28. [28]Shailendra, P. et al. Resistance training and mortality risk: a systematic review and meta-analysis. Am J Prev Med 63, 277–285 (2022). doi.org/10.1016/j.amepre.2022.03.020
  29. [29]Mandsager, K. et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open 1, e183605 (2018). doi.org/10.1001/jamanetworkopen.2018.3605
  30. [30]Lee, D. H. et al. Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality: a prospective cohort of US adults. Circulation 146, 523–534 (2022). doi.org/10.1161/CIRCULATIONAHA.121.058162
  31. [31]Sherrington, C. et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 1, CD012424 (2019). doi.org/10.1002/14651858.CD012424.pub2

Put it into practice

Movement