Walking is one of the simplest and most accessible forms of physical activity, and accumulating evidence supports its role in promoting both physical and psychological health. Yuenyongchaiwat (2016) demonstrated that a daily walking target of 10,000 steps improved not only anthropometric measures but also mental health outcomes in overweight community participants [1]. In line with this, Hallam et al. (2018) reported that adherence to a structured 100-day, 10,000-step challenge was associated with significant improvements in well-being and mental health indicators [2]. Earlier work by Morgan et al. (2010) also confirmed that prescribed walking at this level enhanced both physical and psychological well-being in previously inactive adults [3]. Beyond psychological outcomes, benefits extend to broader health domains. Castres et al. (2017) found that a program combining 10,000 steps per day with dietary counselling improved health-related quality of life, energy expenditure, and anthropometric parameters in obese individuals [4]. Similarly, Murphy et al. (2002) highlighted that brisk walking accumulated across the day reduced cardiovascular risk and improved psychological health [5]. More recently, Saldana et al. (2025), in a literature review, consolidated evidence linking step count with reductions in cardiovascular disease risk, underscoring the relevance of walking interventions for long-term health [6]. While the physical benefits of walking are well documented, its role as a structured intervention for mental health is still evolving. Lieser (2023) emphasized the value of walking interventions for alleviating psychological distress, highlighting their potential as scalable public health strategies [7]. However, few studies have systematically evaluated the combined physical and psychological impact of a consistent 100-day walking program with a specific target of 10,000 steps per day. The present study was conducted at FH Medical College, Agra, with the objective of assessing whether adherence to a 100-day, 10,000-step walking program could yield improvements in both physical and mental health. In addition, the dose–response relationship between adherence and outcomes was evaluated, and independent predictors of mental health change were explored. Objectives The study was designed with the following objectives: 1. To evaluate the effects of completing approximately 10,000 steps daily for 100 consecutive days on physical (weight, BMI, resting heart rate, systolic blood pressure) and psychological (PHQ-9, GAD-7, PSS) health outcomes. 2. To assess the dose–response relationship between adherence to the 10,000-step target and improvements in physical and psychological measures. 3. To determine whether adherence independently predicts changes in mental health outcomes, after adjusting for age and sex.

Study Design and Setting This was a prospective, single-centre intervention study conducted at FH Medical College, Agra, India. The study evaluated the effects of a 100-day walking program, with participants instructed to complete approximately 10,000 steps per day. Participants Adults aged 18–65 years were eligible to participate if they were ambulatory and free from acute illness, major orthopaedic limitations, or unstable cardiovascular disease. Exclusion criteria included pregnancy, severe psychiatric illness requiring hospitalization, and inability to provide informed consent. A total of 200 participants were enrolled based on evidence-based sample size estimation to detect a clinically meaningful change in PHQ-9 scores with 90% power at a two-sided α of 0.05. Intervention and Adherence Monitoring Participants were instructed to complete ~10,000 steps per day for 100 consecutive days. Step counts were monitored using validated pedometer-enabled smartphone applications or wearable devices. Adherence was defined as the proportion of days in which ≥10,000 steps were achieved. Mean daily step count was also recorded. Outcome Measures Assessments were performed at baseline and at day 100. • Physical outcomes: body weight (kg), body mass index (BMI, kg/m²), resting heart rate (RHR, bpm), and systolic blood pressure (SBP, mmHg). • Psychological outcomes: depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), anxiety using the Generalized Anxiety Disorder-7 scale (GAD-7), and perceived stress using the Perceived Stress Scale (PSS). Statistical Analysis Continuous variables were expressed as mean ± standard deviation (SD). Paired t-tests compared baseline and day-100 values, with effect sizes calculated as Cohen’s d. Pearson correlation coefficients (r) examined associations between adherence and changes in outcomes. To evaluate the independent effect of adherence on psychological outcomes, multivariable linear regression was performed with change in PHQ-9 as the dependent variable, adjusting for age and sex. Statistical significance was set at p < 0.05. Analyses were conducted using SPSS version 26 (IBM Corp., Armonk, NY, USA) and R software (R Foundation for Statistical Computing, Vienna, Austria).

1. Baseline Characteristics A total of 200 participants completed the 100-day walking program. The mean age was 45 years (SD 12), and 52% were female. At baseline, participants were generally overweight with mildly elevated cardiovascular parameters and mild to moderate psychological symptom scores. By day 100, all physical and psychological measures showed statistically significant improvement compared with baseline. These changes, along with their effect sizes, are summarized in Table 1. Table 1. Baseline and Day-100 Outcomes with Paired Comparisons (Day-100 – Baseline; paired t-test) Variable Baseline Mean Day-100 Mean Mean Change t p-value Cohen’s d Weight (kg) 75.2 73.6 −1.6 −22.3 <0.0001 −1.58 BMI (kg/m²) 26.0 25.4 −0.6 −27.2 <0.0001 −1.93 Resting HR (bpm) 78.0 75.2 −2.8 −26.7 <0.0001 −1.89 SBP (mmHg) 130.0 127.0 −3.0 −21.5 <0.0001 −1.52 PHQ-9 10.0 8.4 −1.6 −14.9 <0.0001 −1.05 GAD-7 9.0 7.2 −1.8 −15.5 <0.0001 −1.10 PSS 20.0 17.1 −2.9 −18.0 <0.0001 −1.27 Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale (PSS). 2. Physical Outcomes At the end of 100 days, participants demonstrated significant improvements in all measured physical health parameters. Mean weight, body mass index, resting heart rate, and systolic blood pressure were all reduced compared with baseline. The effect sizes were in the moderate to large range, consistent with clinically meaningful benefits of sustained daily walking. These findings are detailed in Table 1.and visualised in figure1. Figure 1. Mean changes in physical and mental health outcomes after 100 days of 10,000-step walking. Mean changes (Day-100 – Baseline) with 95% confidence intervals are shown for weight, BMI, resting heart rate, systolic blood pressure, PHQ-9, GAD-7, and PSS. Negative values indicate improvement. 3. Mental Health Outcomes Psychological well-being improved significantly over the 100-day walking program. Scores on the PHQ-9, GAD-7, and PSS were all reduced compared with baseline, corresponding to moderate effect sizes and statistically significant differences (all p < 0.0001). These improvements are summarized in Table 1 and visually depicted in Figure 1, which shows consistent reductions across all three measures. 4. Dose–Response Analysis Higher adherence to the 10,000-step goal was associated with greater improvements across multiple outcomes. Adherence correlated significantly with reductions in weight (r = −0.34, p < 0.0001), BMI (r = −0.23, p = 0.001), resting heart rate (r = −0.17, p = 0.014), GAD-7 (r = −0.25, p < 0.001), and PSS (r = −0.20, p = 0.004). The relationship with systolic blood pressure did not reach statistical significance (r = −0.13, p = 0.076). Importantly, adherence was also significantly associated with reduction in PHQ-9 scores (r = −0.32, p < 0.0001), highlighting a clear dose–response effect for depressive symptoms. These associations are detailed in Table 2 and visually shown in the figure2. Table 2. Correlation of Adherence with Changes in Physical and Mental Outcomes (Pearson correlation coefficients; negative values indicate greater improvement with higher adherence) Outcome r p-value Weight (kg) −0.340 <0.0001 BMI (kg/m²) −0.231 0.001 Resting HR (bpm) −0.174 0.014 SBP (mmHg) −0.126 0.076 PHQ-9 −0.320 <0.0001 GAD-7 −0.251 0.0003 PSS −0.201 0.004 Scatterplot showing the association between adherence to the 10,000-step target and change in PHQ-9 score (Day-100 – Baseline). Higher adherence was significantly associated with greater reductions in depressive symptoms (p < 0.0001). 5. Multivariable Analysis To evaluate whether the observed association between adherence and improvements in mental health was independent of demographic factors, we performed a multivariable linear regression with PHQ-9 change as the dependent variable, adjusted for age and sex. In this model, adherence remained a strong and independent predictor of PHQ-9 reduction (β = −3.30, p = 0.0003). Neither age nor sex was significantly associated with changes in depressive symptoms. The full model results are presented in Table 3. Table 3. Multivariable Linear Regression for PHQ-9 Change Association of adherence, age, and sex with change in PHQ-9 score after 100 days. Negative β values indicate greater reductions in depressive symptoms. Predictor β (Coefficient) SE t p-value Intercept −0.503 0.826 −0.61 0.543 Adherence −3.297 0.897 −3.68 0.0003* Age (years) −0.004 0.007 −0.58 0.564 Female sex +0.148 0.150 +0.99 0.324 Adherence to the 10,000-step target was independently associated with greater reductions in PHQ-9 scores after 100 days, while age and sex were not significant predictors. 6. Summary of Key Findings Across 200 participants completing the 100-day walking program, significant improvements were observed in both physical and psychological health outcomes. Paired comparisons demonstrated reductions in weight, BMI, resting heart rate, systolic blood pressure, PHQ-9, GAD-7, and PSS scores (all p < 0.0001). Higher adherence to the 10,000-step goal was associated with greater improvements in several outcomes, including weight, BMI, resting heart rate, PHQ-9, GAD-7, and PSS, as shown in Table 2 and Figure 2. In multivariable regression, adherence remained an independent predictor of PHQ-9 reduction after adjustment for age and sex (Table 3).

This 100-day, 10,000-step walking program demonstrated significant improvements in both physical and psychological health outcomes, with a clear dose–response effect linked to adherence. These findings are consistent with previous research emphasizing the broad benefits of walking interventions. Bunc (2022) highlighted walking as an effective means of improving fitness, well-being, and mental well-being, particularly because of its accessibility across populations [8]. Similarly, Sykes (2009) described walking initiatives as practical approaches to enhancing occupational health and overall wellness [9]. The mental health improvements observed in our cohort, including reductions in depression, anxiety, and perceived stress, align with the broader literature. Kelly et al. (2018) demonstrated in a scoping review that walking interventions consistently support mental health across diverse populations [10]. In a meta-analysis, Robertson et al. (2012) further confirmed that walking specifically reduced depressive symptoms, supporting our observed decrease of nearly 1.6 points on the PHQ-9 [11]. Our findings also resonate with studies in older adults. Aoyagi and Shephard (2009) established that step count targets, including 10,000 steps per day, are strongly associated with improved senior health outcomes [12]. While our study involved middle-aged adults, the direction of effect appears consistent across age groups. In addition, combining walking with other modalities may yield synergistic effects; Oftedal et al. (2019) showed that aerobic activity combined with resistance training was associated with lower rates of depression and anxiety in women [13]. This suggests that while walking alone confers substantial benefit, integrated programs may optimize outcomes. The observed reductions in cardiovascular parameters, including systolic blood pressure and resting heart rate, are consistent with prior findings. Varma et al. (2014) reported that even low-intensity walking was associated with better cardiometabolic profiles and overall health [14]. Similarly, Otto et al. (2007) reviewed evidence supporting the role of exercise, including walking, in improving mood and reducing anxiety disorders [15]. Together, these findings reinforce the biological plausibility of our results, likely mediated through autonomic regulation, improved endothelial function, and reduced systemic stress. Importantly, step-based interventions have shown particular value in quality of life domains. Vallance et al. (2013) found that higher daily step counts were positively correlated with health-related quality of life and psychosocial health among older men [16], consistent with the improvement in perceived stress and anxiety scores in our participants. More recently, Yanar and Güler (2021) reported that daily step counts during the COVID-19 pandemic were associated with both body composition and mental well-being in university students [17]. These findings underscore the robustness of walking as a low-cost, scalable intervention across varied populations and contexts. Overall, our study adds to the growing body of evidence confirming that consistent walking at the 10,000-step target not only supports weight and blood pressure control but also meaningfully improves mental health. By linking adherence directly to outcomes, our results extend prior observations by demonstrating a dose–response effect over a sustained 100-day period. Limitations and Future Directions This study has several limitations. It was conducted at a single centre, which may limit generalizability. Outcomes were assessed only at baseline and after 100 days, without intermediate or long-term follow-up to determine sustainability. Adherence was based on step-count devices, which, while practical, may be subject to measurement variability. Finally, the study did not include additional lifestyle factors such as diet or sleep, which could influence outcomes. Future multicentre studies with longer follow-up and integration of broader behavioural measures are warranted.

A consistent 100-day program targeting 10,000 steps per day was associated with significant improvements in both physical and psychological health. Participants experienced reductions in weight, body mass index, resting heart rate, and systolic blood pressure, alongside meaningful decreases in depression, anxiety, and perceived stress scores. Higher adherence to the step goal was linked to greater improvements, and adherence independently predicted reductions in depressive symptoms after adjusting for age and sex. These findings support the role of structured step-based walking programs as a practical, low-cost, and scalable strategy for improving cardiometabolic and mental health.

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