Title: Association of Daily Step Counts and Step Intensity with Mortality Among US Adults:
a cross–sectional study of NHANES 2005–2006
Version: 0 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The study concludes that there is no significant association between step intensity and mortality
after controlling for confounding variables; however, this finding merits further examination.
Initially, the hypothesis suggested that higher step intensity would correlate with reduced
mortality rates, yet the study does not sufficiently clarify why this association dissipated post-
adjustment. The absence of significant findings in the highest intensity group (e.g., #107 steps
per minute) warrants additional investigation. Factors such as overexertion, increased fatigue,
and potential reverse causality—where individuals with poorer health may naturally gravitate
toward lower-intensity physical activities—could influence these results.
-Although the study indicates that it has adjusted for various covariates, it would be
advantageous to provide more detailed information regarding the specific factors included in
the analysis. It would enhance the study's rigor to clarify whether lifestyle factors such as diet,
alcohol consumption, medication adherence, and the presence of comorbid conditions were
considered. These variables are critical in understanding how they may affect the relationship
between step count, intensity, and mortality risk.
-Moreover, the study does not sufficiently explore the underlying mechanisms that could explain
the lack of significant associations between step intensity and mortality risk. While moderate-
intensity activity is often associated with improved cardiovascular health, vigorous-intensity
activity may not confer the same benefits across all populations, particularly among those with
chronic conditions such as metabolic associated fatty liver disease (MASLD). Thus, providing
additional mechanistic insights into why step intensity did not serve as a predictor of mortality
would be beneficial.
-Lastly, the authors acknowledge that the study found no significant results regarding low step
counts due to a lack of data at these levels. This limitation is a pivotal aspect that requires a more
comprehensive discussion. The authors should address the implications of this limitation for the
interpretation of the findings, particularly whether the results are applicable to individuals who
are extremely sedentary or if further data at lower activity levels would be necessary to draw
more definitive conclusions about the benefits of minimal physical activity.
Title: Association of Daily Step Counts and Step Intensity with Mortality Among US Adults:
a cross–sectional study of NHANES 2005–2006
Version: 0 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The study concludes that there is no significant association between step intensity and mortality
after controlling for confounding variables; however, this finding merits further examination.
Initially, the hypothesis suggested that higher step intensity would correlate with reduced
mortality rates, yet the study does not sufficiently clarify why this association dissipated post-
adjustment. The absence of significant findings in the highest intensity group (e.g., #107 steps
per minute) warrants additional investigation. Factors such as overexertion, increased fatigue,
and potential reverse causality—where individuals with poorer health may naturally gravitate
toward lower-intensity physical activities—could influence these results.
-Although the study indicates that it has adjusted for various covariates, it would be
advantageous to provide more detailed information regarding the specific factors included in
the analysis. It would enhance the study's rigor to clarify whether lifestyle factors such as diet,
alcohol consumption, medication adherence, and the presence of comorbid conditions were
considered. These variables are critical in understanding how they may affect the relationship
between step count, intensity, and mortality risk.
-Moreover, the study does not sufficiently explore the underlying mechanisms that could explain
the lack of significant associations between step intensity and mortality risk. While moderate-
intensity activity is often associated with improved cardiovascular health, vigorous-intensity
activity may not confer the same benefits across all populations, particularly among those with
chronic conditions such as metabolic associated fatty liver disease (MASLD). Thus, providing
additional mechanistic insights into why step intensity did not serve as a predictor of mortality
would be beneficial.
-Lastly, the authors acknowledge that the study found no significant results regarding low step
counts due to a lack of data at these levels. This limitation is a pivotal aspect that requires a more
comprehensive discussion. The authors should address the implications of this limitation for the
interpretation of the findings, particularly whether the results are applicable to individuals who
are extremely sedentary or if further data at lower activity levels would be necessary to draw
more definitive conclusions about the benefits of minimal physical activity.
Please review this paper.
user
Title: Association of Daily Step Counts and Step Intensity with Mortality Among US Adults:
a cross–sectional study of NHANES 2005–2006
Version: 0 Date: 09 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The study concludes that there is no significant association between step intensity and mortality
after controlling for confounding variables; however, this finding merits further examination.
Initially, the hypothesis suggested that higher step intensity would correlate with reduced
mortality rates, yet the study does not sufficiently clarify why this association dissipated post-
adjustment. The absence of significant findings in the highest intensity group (e.g., #107 steps
per minute) warrants additional investigation. Factors such as overexertion, increased fatigue,
and potential reverse causality—where individuals with poorer health may naturally gravitate
toward lower-intensity physical activities—could influence these results.
-Although the study indicates that it has adjusted for various covariates, it would be
advantageous to provide more detailed information regarding the specific factors included in
the analysis. It would enhance the study's rigor to clarify whether lifestyle factors such as diet,
alcohol consumption, medication adherence, and the presence of comorbid conditions were
considered. These variables are critical in understanding how they may affect the relationship
between step count, intensity, and mortality risk.
-Moreover, the study does not sufficiently explore the underlying mechanisms that could explain
the lack of significant associations between step intensity and mortality risk. While moderate-
intensity activity is often associated with improved cardiovascular health, vigorous-intensity
activity may not confer the same benefits across all populations, particularly among those with
chronic conditions such as metabolic associated fatty liver disease (MASLD). Thus, providing
additional mechanistic insights into why step intensity did not serve as a predictor of mortality
would be beneficial.
-Lastly, the authors acknowledge that the study found no significant results regarding low step
counts due to a lack of data at these levels. This limitation is a pivotal aspect that requires a more
comprehensive discussion. The authors should address the implications of this limitation for the
interpretation of the findings, particularly whether the results are applicable to individuals who
are extremely sedentary or if further data at lower activity levels would be necessary to draw
more definitive conclusions about the benefits of minimal physical activity.
assistant