Daily Step Count Should Be the Fifth Vital Sign
Daily Step Count Should Be the Fifth Vital Sign
Source: Adapted from Medscape Commentary, October 14, 2025.
Author: Dr. George D. Lundberg, MD
Former Editor-in-Chief of JAMA, with a regular commentary column under his name on Medscape Commentary.
1. Background
• Traditional vital signs: pulse, respiration, temperature, and blood pressure.
• “Pain” was once proposed as a fifth vital sign but failed because it’s subjective.
• Dr. Lundberg proposes step count (daily steps) as a new, objective fifth vital sign.
2. Rationale
• “Vital” means essential and significant — daily steps meet that definition.
• With modern wearables (Fitbit, smartwatches), step count is accurate, measurable, and continuous.
• A decline in daily steps can indicate early disease or loss of function.
3. Physiologic Basis
Daily steps integrate multiple body systems:
• Nervous system (spinal cord, peripheral nerves)
• Musculoskeletal system (bones, joints, tendons, ligaments)
• Cardiovascular system (cardiac output, vessel patency)
• Balance and proprioception (vestibular function)
Low daily steps can serve as an early warning that something may be wrong.
4. Addressing Objections
• Critics say daily steps are voluntary and subjective.
• The author argues this is a strength — they reflect motivation, stamina, and mental wellbeing.
• Like pulse or blood pressure, step count varies with conditions but remains clinically useful.
5. A Question to Reflect On
Before fully adopting daily steps as the “fifth vital sign,” one might pause and ask:
Could there be a better or complementary alternative?
Some experts point to cardiorespiratory fitness (VO₂ max), resting heart rate variability, or even sleep quality metrics as potentially stronger, more comprehensive indicators of physiologic resilience.
This question remains open for debate — and may inspire clinicians and researchers to rethink what truly defines a “vital sign” in modern medicine.
Every new idea in medicine begins with a question — what’s yours?
6. Practical Value
• Reference ranges can be set easily from global wearable data.
• Step count provides an integrated indicator of both physical and psychological health.
7. Personal Insight
• Dr. Lundberg (age 92) tracked his daily steps via Fitbit since 2018.
• Fluctuations in his step count closely matched real health changes — as reliably as other vital signs.
8. Conclusion
“Step aside, four vital signs — make room for number five: step count (daily steps).”
Simple, inexpensive, and powerful — a universal marker of vitality and function.
Walking is medicine — count your steps, protect your life.
