Weekend Reads: The Era of ‘Personalized Medicine’ — What Our Steps and Sleep Say About Us

by Kevin Schofield


This weekend, we have a pair of “reads” to consider, both related to activities closely associated with our health: walking and sleeping.

The rise of Fitbits and other step-counting devices has led to a large amount of research trying to characterize a “healthy” amount of walking. Our first read, a paper published by a cohort of researchers led by the University of Massachusetts, Amherst, presents the results of a long-term study of walking habits among 2,110 Black adults and white adults that began in 2005. They found that those who took 7,000 or more steps a day experienced lower mortality rates than those who took less than 7,000 steps.

Interestingly, they found that intensity of walking seemed to make no difference: Fast walkers and slow walkers saw the same benefits. However, they observed that people who walk faster also tend to walk more, so it was difficult for them to entirely tease out the difference between distance and intensity. There have been other studies recently suggesting that slow walking conferred fewer health benefits; this research contradicts that (and is good news for people who have trouble walking fast). 

The research results, when graphed, tend to show that the “sweet spot” is right around 10,000 steps per day. This is also notable because while the step-tracking industry has pushed 10,000 steps as a daily goal, some health experts have argued that there is no hard evidence backing up that number. This research suggests that 10,000 steps per day, plus or minus about 2,000, is a good target.

Graph showing dose-response association of steps per day with all-cause mortality
Sourced from “Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study,” a University of Massachusetts, Amherst, study published in JAMA Network Open.

The researchers’ data also shows that above about 12,000 steps the outcomes diverge: Mortality for some people drops even lower, but it rises for others. Unfortunately, the paper doesn’t discuss why that might be so, or whether the causes of death for those at the high end of the step range differ from those at lower levels of walking activity.

Many experts have suggested that we are now moving into a new era of “personalized medicine,” where data collected about us as individuals will factor more heavily into our health care and provide us more insights into what we can do on a daily basis to maintain our health. This research on the connection between walking and longevity is a great example of how paying attention to the details of our daily lives can make an important difference to our health.

This weekend’s second read is a Casper-Gallup report on “The State of Sleep in America.” There is, unfortunately, an epidemic of lousy sleep in our country. According to the report, only 32% of adults rate their sleep the previous night as “excellent” or “very good,” while an equal amount rate it “fair” or “poor.” And those numbers are skewed heavily by those over age 65, who tend to get much better sleep; meanwhile, 38% of adults aged 18 to 39 rated their sleep “fair or poor” versus 27–28% who rated it ”excellent” or “very good.”

A graph depicting overall descriptions of sleep last night by age
Sourced from “The State of Sleep in America,” a Casper-Gallup report.

This is despite the fact that American adults prioritize sleep highly — higher than spending time with family and friends, eating healthy, having fun, and exercising. We want good sleep, we think it’s important, and yet we’re very bad at it.

Graph depicting the typical prioritization of weekday activities for men and women, including getting good sleep, spending time with family and friends, eating healthy, having fun, and exercising
Sourced from “The State of Sleep in America,” a Casper-Gallup report.

Much of the report talks about stress and the effect it has on sleep. It notes that experiencing stress nearly doubles the likelihood of poor-quality sleep. It also dives into the vicious cycle of stress and sleep: Stress causes poor sleep, but poor sleep also causes stress. And the researchers found that 69% of the people experiencing poor sleep worry about their ability to fall asleep. And of course worrying about our ability to sleep just makes it even harder to sleep well.

The report explores some of the other factors affecting sleep quality, including mattress comfort. For example, the researchers found that having a mattress that is too hard increases the likelihood of poor sleep by 78%. And the report observes that three-quarters of the people who rate their own sleep “excellent” have a specific bedtime routine that they follow; about half of them follow that routine seven days a week. 

Finally, the report looks at the impact of the quality of sleep on a person’s mood, energy levels and outlook on life (Spoiler: It has a huge impact). 

The takeaway — and largely good news — from both of these reports is that normal, everyday activities such as sleeping and walking have an outsized impact on the length and quality of our lives. And those activities are very much within our control: There are simple things we can do to improve our health that will help us lead happier, more energetic lives for many more years. And it’s never too late to start walking more and sleeping better — though preferably not at the same time.

Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study

The State of Sleep in America


Kevin Schofield is a freelance writer and the founder of Seattle City Council Insight, a website providing independent news and analysis of the Seattle City Council and City Hall. He also co-hosts the “Seattle News, Views and Brews” podcast with Brian Callanan, and appears from time to time on Converge Media and KUOW’s Week in Review.

📸 Featured Image: Illustration by StockSmartStart/Shutterstock.com.

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