Choosing the stairs instead of a lift could be a small daily decision with potentially important consequences for heart health, according to a major review of existing research involving nearly half a million adults.

The systematic review and meta-analysis found that people who climbed stairs regularly had a lower risk of dying from cardiovascular disease and from any cause during the study periods.

Stair climbing was also linked with a reduced risk of heart attack, stroke and heart failure in several of the studies examined.

“Regular stair climbing was associated with a 39% lower risk of cardiovascular death. It was also associated with a 24% lower risk of death from any cause”

Published in the American Journal of Cardiovascular Drugs, the review brings fresh attention to a familiar form of movement that is free, widely available and easy to build into ordinary routines. It also strengthens a broader public-health message that physical activity does not always need to involve a gym, specialised equipment or long stretches of planned exercise.

The research does have important limits. It shows an association between stair climbing and better health outcomes. It does not prove that climbing stairs directly prevented deaths or cardiovascular disease. People who choose stairs may also be more active overall, have healthier diets, smoke less, have better access to healthcare, or differ in other ways that influence long-term health.

Still, the scale of the findings is notable.

Researchers assessed nine studies involving adults aged between 35 and 84. Participants included generally healthy people, as well as individuals with a history of heart attack or peripheral artery disease. The studies looked at several outcomes, including death from cardiovascular causes, death from any cause, heart attack, stroke and heart failure.

For the mortality analysis, researchers combined results from five studies involving 455,619 participants. Regular stair climbing was associated with a 39% lower risk of cardiovascular death. It was also associated with a 24% lower risk of death from any cause.

Those figures do not mean every person who climbs stairs will reduce their personal risk by precisely those amounts. They are population-level associations drawn from studies with different designs, different participant groups and different ways of recording stair use. Yet the pattern was sufficiently consistent to suggest that stair climbing may be a valuable marker of an active lifestyle, or a useful activity in its own right.

The review also examined non-fatal cardiovascular events. Several studies indicated that people who used stairs more often were less likely to experience a heart attack, stroke or heart failure. The researchers could not calculate one combined estimate for those conditions because the studies varied too much in their methods and measurements. Some asked participants how many flights they climbed each day. Others considered whether a person could climb stairs without stopping. Some assessed stair climbing as part of a wider measure of physical function.

That variation matters. Someone climbing six flights at a steady pace during a workday is doing something very different from someone rushing up several storeys while carrying shopping. Fitness, speed, step height, body weight, existing illness and how often stairs are climbed can all alter the physical demand.

Even so, the basic physiology is straightforward. Going upstairs forces the body to work against gravity. Muscles in the legs, hips and core must generate force to lift body weight with each step. The heart pumps faster. Breathing becomes deeper. Energy expenditure rises quickly, especially when the pace increases.

For many people, stair climbing can move from moderate to vigorous physical activity within a short time. This may be one reason it has attracted interest from cardiovascular researchers. A few minutes of climbing can raise the heart rate more sharply than a gentle walk on level ground.

The biological explanation is consistent with what is already known about exercise. Regular physical activity can help lower blood pressure, improve cholesterol levels, support healthy body weight, improve insulin sensitivity and strengthen cardiorespiratory fitness. It can also improve the efficiency with which the heart and lungs work during everyday tasks.

Stairs may offer another advantage, they remove some of the practical barriers that keep people from exercising. Many adults struggle to find an uninterrupted half-hour for a walk, cycle ride or fitness class. A staircase is often encountered naturally at work, in a block of flats, at a railway station, in a shopping centre or at home.

The activity can be divided into brief sessions. One flight in the morning. A few more after lunch. Another climb before leaving work. These short bouts may appear modest, yet they can accumulate over days and weeks.

The review highlighted evidence from a 2023 study which suggested that cardiovascular disease risk fell as stair climbing increased. The lowest risk in that study was observed among people who climbed around six flights, equivalent to approximately 60 steps, each day. Higher amounts did not appear to produce further reductions in risk within that analysis.

That does not establish six flights as a universal target. It is not a prescription. The most appropriate amount will depend on a person’s age, health, mobility, current activity level and surroundings. Someone who is sedentary may benefit from starting with one flight. Someone already physically active may comfortably climb far more.

Researchers have not yet identified the precise dose of stair climbing that delivers the greatest cardiovascular benefit. They also cannot say whether the same apparent benefit would apply equally to every population group. More research is needed, especially studies that track stair use objectively with wearable devices and account carefully for diet, smoking, income, fitness, medication use and other factors.

Yet the findings fit with another growing area of research, vigorous intermittent lifestyle physical activity. This term refers to short, energetic bursts of movement carried out during daily life rather than formal exercise sessions. Fast walking uphill, carrying heavy bags, active housework and climbing stairs can all fall into this category.

A 2022 study cited by the review followed 25,241 adults who reported no leisure-time exercise. Participants were followed for an average of almost seven years. The study found that approximately 4.4 minutes each day of vigorous intermittent lifestyle activity was associated with a 32% to 34% lower risk of cardiovascular death. It was also linked with a 26% to 30% lower risk of death from any cause.

That evidence does not mean a few minutes of movement can replace every other aspect of a healthy lifestyle. It does, however, challenge the idea that exercise only counts when it is structured, lengthy or performed in sportswear. Everyday movement has value. Small choices can be meaningful when repeated.

The US CDC recommends that adults aim for at least 150 minutes of moderate-intensity aerobic activity each week, or 75 minutes of vigorous-intensity activity. Adults should also undertake muscle-strengthening activities on at least two days a week.

Stair climbing can contribute towards those weekly totals. It may also strengthen the lower body, particularly the calves, thighs and gluteal muscles. However, it should not necessarily be viewed as a complete exercise plan. Walking, cycling, swimming, resistance training, balance work and flexibility activities can each provide benefits that stairs alone may not fully deliver.

For people hoping to include more stair climbing in their lives, a gradual approach is sensible. Start with a manageable number of steps. Pause if needed. Increase frequency before attempting greater speed or longer climbs. Taking the stairs for one or two floors while using a lift for the remainder may be an appropriate first step.

Comfortable shoes, good lighting and a secure handrail are particularly important. People should avoid rushing if they feel unsteady. Falls can cause serious injury, particularly among older adults or those with balance problems.

Stair climbing is also not suitable or accessible for everyone. People with significant knee, hip, ankle or back pain may find it aggravates symptoms. Those with severe arthritis, mobility limitations, certain neurological conditions or advanced heart and lung disease may need alternatives. Always talk to your healthcare providers for medical advice.

A healthcare professional can advise people who have chest pain, unexplained breathlessness, dizziness, known cardiovascular disease or concerns about beginning more vigorous activity.

For those unable to use stairs, the central lesson remains the same. Any safe movement that raises the heart rate can support cardiovascular health. Brisk walking, chair-based exercise, swimming, cycling, dancing, gardening or low-impact home workouts may all be useful options. The best activity is often the one a person can do safely, enjoy enough to repeat and fit into everyday life.

The new review should not be interpreted as a promise that stairs alone will prevent heart disease. Cardiovascular risk is shaped by many influences, including blood pressure, cholesterol, diabetes, smoking, sleep, diet, stress, family history and access to medical care. Regular physical activity is one powerful part of that wider picture.

Still, the appeal of stair climbing lies in its simplicity. It requires no membership, no appointment and no complicated routine. A staircase can become a practical prompt for movement in a day otherwise dominated by sitting.

For people who have delayed becoming more active because the prospect feels overwhelming, the message may be especially encouraging. Health improvement does not always begin with a dramatic transformation. Sometimes it begins with one flight of stairs.