Limitations of Daily Step Count for Assessing Health in Older Adults: The Need to Consider Walking Intensity

Background/Objectives: This study explored the association between daily step count (DSC) and health outcomes in older adults in Spain. A total of 668 individuals aged 60–100 years (mean = 71.33 ± 8.11 years) participated. Methods: Participants wore a Xiaomi Mi Band 4 accelerometer continuously for seven days. Physical and cognitive tests were conducted, along with questionnaires on depression, quality of life, and physical activity. Results: On average, men walked 8919.08 ± 4455.65 steps/day, significantly more than women (7855.46 ± 7855.46 steps/day, p = 0.002). A moderate negative correlation was found between age and DSC (r = −0.460, p < 0.001). The coefficient of variation in DSC increased across age groups, indicating growing heterogeneity with advancing age. Individuals in the high International Physical Activity Questionnaire (IPAQ) category walked 1517 more steps/day than those in the low activity group (p < 0.001), confirming IPAQ level as a strong determinant of physical activity. Participation in organized physical activity was associated with an additional 909 steps/day (p = 0.004). Meeting age-specific step recommendations is associated with better anthropometric, psychosocial, and cardiometabolic markers, but many of these differences disappear after adjusting for age and sex. Conclusions: DSC in older adults is strongly influenced by age, sex, and physical activity level. DSC may not adequately assess health in older adults. Walking intensity should be considered for accurate evaluation.