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Advise your patients to use a pedometer, set a step goal, and keep a step diary. This simple intervention takes only a few moments and is effective in increasing patients’ physical activity and decreasing both body-mass index (BMI) and systolic blood pressure.1
Strength of recommendation
A: Based on a meta-analysis of randomized controlled trials (RCTs) and observational studies
Bravata DM, Smith-Spangler C, Sundaram V et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007; 298:2296–2304.
Illustrative case
Your first 4 patients this morning were a 50-year-old woman with metabolic syndrome, a 62-year-old obese man with high blood pressure, a 44-year-old woman with depression, and a 75-year-old man with a recent admission for myocardial infarction. In addition to managing their medications and reviewing lab results, you have already spent a lot of time discussing the benefits of exercise with each of these patients.
As you prepare to talk with your next patient—a 28-year-old woman with a BMI of 29 whose chief complaint is “wants to lose weight”—you wonder if there are any simple, brief, effective interventions to help your patients increase their physical activity.
BACKGROUND: A long way to go
Although there is no evidence that simply advising patients to walk has any effect, primary care physicians frequently recommend walking as a form of exercise—it is free, requires no special equipment, and is readily accessible to most motivated patients.
The Centers for Disease Control and Prevention recommends that adults engage in moderate physical activity for at least 30 minutes a day, at least 5 days per week.2 Yet 40% of adults do not engage in any leisure-time physical activity. This percentage is higher in women (43%), African-Americans (52%), and Hispanics (54%).3
The health benefits of exercise are clear. Regular physical activity has been shown to decrease overweight and obesity.4 It has also been shown to improve control of type 2 diabetes5 and hypertension.6 Frequent exercise is associated with a decreased mortality rate.7 Walking has been shown to decrease the risk of cardiovascular events in women, regardless of BMI.8
Walking has similarly been shown to decrease overall mortality among men.9 Cardiovascular fitness has also been shown to decrease mortality in adults over 60, even in the absence of weight loss.10
CLINICAL CONTEXT: USPSTF: Advice alone won’t kick-start exercise
We realize, of course, that most of our adult patients could benefit from regular exercise. Exercise is included in the treatment guidelines for overweight/obesity, hypertension, type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic pain, peripheral vascular disease, and depression.11
PURLs EDITOR
Bernard Ewigman. MD, MSPH
Department of Family Medicine
The University of Chicago
[email protected]
At last, the humble pedometer gives us a brief intervention for physical exercise that works. yes, we need more research for lots of reasons (always), but this Purl gives us a practical tool that can be recommended in a few minutes, consistent with the realities of daily practice.
The outcomes from this intervention are not dramatic. No lives were saved, no catastrophic diseases averted. yet regular exercise is so fundamentally important to just feeling good and having energy for daily life, not to mention lowering blood pressure and weight.
My guess is that this could become a handy recommendation used daily in family medicine and other primary care practices.
I am interested to know whether you already recommend pedometers to your patients. If not, does this seem like a worthwhile change in your practice?
On a personal note, I made a New year’s resolution to increase my physical activity. as soon as I finish this commentary, I am ordering a pedometer.
However, few office-based interventions have been shown to lead to increased physical activity. Patients sometimes resist making lifestyle changes, and providers are uncertain how to effectively promote physical activity. Furthermore, counseling patients to exercise without a specific intervention has not been shown to lead to long-term increases in physical activity. The US Preventive Services Task Force (USPSTF) finds there is insufficient evidence to recommend behavioral counseling alone for exercise, citing the lack of evidence for long-term efficacy.12,13
STUDY SUMMARY: Pedometer users walked 2491 additional steps
This meta-analysis included 26 RCTs and observational studies of pedometer use in adult outpatients that reported a change in the number of steps walked per day. The 2767 participants in these studies were 85% women, with a mean age of 49. In the 7 studies that reported race, 93% of patients were white. At baseline, most participants were overweight, with normal blood pressure (mean 129/79 mm Hg) and relatively well-controlled lipid levels (mean total cholesterol 198 mg/dL, HDL 52 mg/dL, LDL 113 mg/dL). The mean baseline activity level was 7473 steps per day (range 2140–12,371). Duration of interventions ranged from 3 to 104 weeks, with a mean of 18 weeks. Sixteen of the studies used the Yamax pedometer, which has been validated for accuracy and reliability.
Participants in the RCTs who used pedometers increased their physical activity by 2491 steps per day more than controls. After excluding 1 study with a much higher increase in physical activity than the others, the increase was 2004 steps per day (95% confidence interval [CI], 878–3129; P<.001). In the observational studies, participants walked 2183 steps per day more than they had at baseline (95% CI, 1571–2796; P<.001). Overall, pedometer users increased their number of steps by 27% over baseline.
Step goal and step diary
Only studies that included a step goal and required participants to keep a step diary showed a significant increase in physical activity with pedometer use. There were no differences in outcomes based on duration of the intervention, inclusion of physical activity counseling, or the brand of pedometer used.
BMI and BP improved; lipids, glucose did not
Intervention participants had a statistically significant decrease in BMI of 0.38, which was associated with older age (P=.001), having a step goal (P=.04), and longer duration of the intervention (P=.07, trend). Intervention participants also had a significant decrease in systolic blood pressure of 3.8 mm Hg and diastolic blood pressure of 0.3 mm Hg (TABLE 1), which was associated with greater systolic blood pressure at baseline (P=.009).
There were no significant differences in serum lipids or fasting serum glucose in the studies that reported these variables.1
TABLE 1
Pre- and post-intervention body mass index and blood pressure
| body-mass index | 18 (562) | 30 (3.4) | –0.38 (–0.05 to –0.72) | .03 |
| systolic blood pressure | 12 (468) | 129 (7.5) | –3.8 (–1.7 to –5.9) | <.001 |
| diastolic blood pressure | 12 (468) | 79 (4.5) | –0.3 (0.02 to–0.46) | .001 |
WHAT’S NEW?: Weight loss without dieting
This study is the first large meta-analysis to show that pedometer use is an effective intervention for promoting physical activity. Another recent meta-analysis shows that pedometer use is also effective for short-term weight loss, even in the absence of dietary changes.14
Pedometers and goal-setting are simple, relatively inexpensive ways to help patients become physically active. According to systematic reviews,15,16 telephone-based programs, encouraging stair use, and creating exercise space are other effective interventions to promote physical activity. Some of these interventions are at least as effective as pedometers; however, only encouraging stair walking and pedometer use are practical office-based interventions.
CAVEATS: Price and quality
A 2004 Consumer Reports article ranked pedometers by accuracy, ease of use, and features.17 Accurate step counts allow patients and physicians to assess whether step goals are being met. Pedometers are more accurate when recording fast walking (2.5–3.0 mph), compared with slow walking. Pedometers may therefore be less accurate in the elderly, very obese, or those who walk slowly.18
TABLE 2
Consumer Reports top-rated pedometers17
| Omron healthcare HJ-112 | $28.45* |
| Freestyle Tracer | $15.99* |
| New lifestyles NL-2000 | $59.95† |
| * Price from www.pedometersusa.com, accessed December 12, 2007. | |
| † Price from newlifestyles.com, accessed December 12, 2007. | |
| Omron, Freestyle, Yamax, Walk4Life, and New Lifestyles have been shown to be reliable brands.19,20 | |
Negotiate the goal, patient keeps diary
Remember that patients must be counseled to set a step goal and keep a step diary. Most patients will have an initial step goal between 6000 and 10,000 steps per day. The step goal should be individualized to each patient’s current level of activity and gradually increased as activity level increases.
Schedule monthly or semi-monthly follow-up visits to evaluate progress towards activity or weight loss goals and to re-evaluate the step goal. Before beginning an exercise regimen, including walking, patients must be healthy enough for physical activity. In some cases, patients will need stress testing or other evaluation before using a pedometer to increase activity.
CHALLENGES TO IMPLEMENTATION: Time-wise
Counseling patients on the use of pedometers, and coaching them to set an appropriate step goal and keep a step diary, will take up time during the office visit, but it should be a brief intervention and therefore feasible.21
Omron Healthcare HJ-112
FreeStyle Tracer
New Lifestyles NL-2000
Organizing your office staff to assist you, and using a patient handout containing the basic information on pedometers, could reduce the demands on your time. Including information from the 2004 Consumer Reports article and Web sites with pedometers prices (such as www.pedometersusa.com and newlifestyles.com) should provide a good start for those patients who want more information.
PURLs methodology
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURL) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.
1. Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298:2296-2304.
2. Centers for Disease Control and Prevention/National Center for Health Statistics website. FASTATS: Exercise/physical activity. Available at www.cdc.gov/nchs/fastats/exercise.htm. Accessed January 22, 2008.
3. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2010, Available at www.health.gov/healthypeople. Accessed January 22, 2008.
4. Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Rel Metabolic Disord 1997;21:941-947.
5. Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007;147:357-369.
6. Stewart KJ, Bacher AC, Turner KL, et al. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med 2005;165:756-762.
7. Paffenbarger RS, Hyde RT, Wing AL, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993;328:538-545.
8. Manson JE, Greenland P, LaCroix AZ, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002;347:716-725.
9. Hakim AA, Petrovitch H, Burchfiel CM, et al. Effects of walking on mortality among nonsmoking retired men. N Engl J Med 1998;338:94-99.
10. Sui X, LaMonte MJ, Laditka JN, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007;298:2507-2516.
11. National Guideline Clearinghouse. Available at www.guideline.gov. Accessed January 22, 2008.
12. US Preventive Services Task Force. Behavioral counseling in primary care to promote physical activity: recommendations and rationale. July 2002. Agency for Healthcare Research and Quality. Available at www.ahrq.gov/clinic/3rduspstf/physactivity/physactrr.htm. Accessed January 22, 2008.
13. Eden KB, Orleans CT, Mulrow CD, et al. Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;137:208-215.
14. Richardson CR, Newton TL, Abraham JJ, Sen A, Jimbo M, Swartz AM. Meta-analysis of pedometer-based walking interventions and weight loss. Ann Fam Med 2008;6:69-77.
15. Eakin EG, Lawler SP, Vandelanotte C, Owen N. Telephone interventions for physical activity and dietary behavior change: a systematic review. Am J Prev Med 2007;32:419-434.
16. Kahn EB, Ramsey LT, Brownson RC, et al. Effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med 2002;22(Suppl):73-107.
17. Pedometers: walking by the numbers Consumer Reports2004; Oct.
18. Melanson EL, Knoll JR, Bell ML, et al. Commercially available pedometers: considerations for accurate step counting. Prev Med 2004;39:361-368.
19. Bassett Dr, Jr, Ainsworth BE, Leggett SR, et al. Accuracy of five electronic pedometers for measuring distance walked. Med Sci Sports Exerc 1996;28:1071-1077.
20. Schneider PL, Crouter SE, Lukajic O, et al. Accuracy and reliability of 10 pedometers for measuring steps over a 400-m walk. Med Sci Sports Exerc 2003;35:1779-1784.
21. Ogilvie D, Foster CE, Rothnie H, et al. Interventions to promote walking: systematic review. BMJ 2007;334:1204.-
Advise your patients to use a pedometer, set a step goal, and keep a step diary. This simple intervention takes only a few moments and is effective in increasing patients’ physical activity and decreasing both body-mass index (BMI) and systolic blood pressure.1
Strength of recommendation
A: Based on a meta-analysis of randomized controlled trials (RCTs) and observational studies
Bravata DM, Smith-Spangler C, Sundaram V et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007; 298:2296–2304.
Illustrative case
Your first 4 patients this morning were a 50-year-old woman with metabolic syndrome, a 62-year-old obese man with high blood pressure, a 44-year-old woman with depression, and a 75-year-old man with a recent admission for myocardial infarction. In addition to managing their medications and reviewing lab results, you have already spent a lot of time discussing the benefits of exercise with each of these patients.
As you prepare to talk with your next patient—a 28-year-old woman with a BMI of 29 whose chief complaint is “wants to lose weight”—you wonder if there are any simple, brief, effective interventions to help your patients increase their physical activity.
BACKGROUND: A long way to go
Although there is no evidence that simply advising patients to walk has any effect, primary care physicians frequently recommend walking as a form of exercise—it is free, requires no special equipment, and is readily accessible to most motivated patients.
The Centers for Disease Control and Prevention recommends that adults engage in moderate physical activity for at least 30 minutes a day, at least 5 days per week.2 Yet 40% of adults do not engage in any leisure-time physical activity. This percentage is higher in women (43%), African-Americans (52%), and Hispanics (54%).3
The health benefits of exercise are clear. Regular physical activity has been shown to decrease overweight and obesity.4 It has also been shown to improve control of type 2 diabetes5 and hypertension.6 Frequent exercise is associated with a decreased mortality rate.7 Walking has been shown to decrease the risk of cardiovascular events in women, regardless of BMI.8
Walking has similarly been shown to decrease overall mortality among men.9 Cardiovascular fitness has also been shown to decrease mortality in adults over 60, even in the absence of weight loss.10
CLINICAL CONTEXT: USPSTF: Advice alone won’t kick-start exercise
We realize, of course, that most of our adult patients could benefit from regular exercise. Exercise is included in the treatment guidelines for overweight/obesity, hypertension, type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic pain, peripheral vascular disease, and depression.11
PURLs EDITOR
Bernard Ewigman. MD, MSPH
Department of Family Medicine
The University of Chicago
[email protected]
At last, the humble pedometer gives us a brief intervention for physical exercise that works. yes, we need more research for lots of reasons (always), but this Purl gives us a practical tool that can be recommended in a few minutes, consistent with the realities of daily practice.
The outcomes from this intervention are not dramatic. No lives were saved, no catastrophic diseases averted. yet regular exercise is so fundamentally important to just feeling good and having energy for daily life, not to mention lowering blood pressure and weight.
My guess is that this could become a handy recommendation used daily in family medicine and other primary care practices.
I am interested to know whether you already recommend pedometers to your patients. If not, does this seem like a worthwhile change in your practice?
On a personal note, I made a New year’s resolution to increase my physical activity. as soon as I finish this commentary, I am ordering a pedometer.
However, few office-based interventions have been shown to lead to increased physical activity. Patients sometimes resist making lifestyle changes, and providers are uncertain how to effectively promote physical activity. Furthermore, counseling patients to exercise without a specific intervention has not been shown to lead to long-term increases in physical activity. The US Preventive Services Task Force (USPSTF) finds there is insufficient evidence to recommend behavioral counseling alone for exercise, citing the lack of evidence for long-term efficacy.12,13
STUDY SUMMARY: Pedometer users walked 2491 additional steps
This meta-analysis included 26 RCTs and observational studies of pedometer use in adult outpatients that reported a change in the number of steps walked per day. The 2767 participants in these studies were 85% women, with a mean age of 49. In the 7 studies that reported race, 93% of patients were white. At baseline, most participants were overweight, with normal blood pressure (mean 129/79 mm Hg) and relatively well-controlled lipid levels (mean total cholesterol 198 mg/dL, HDL 52 mg/dL, LDL 113 mg/dL). The mean baseline activity level was 7473 steps per day (range 2140–12,371). Duration of interventions ranged from 3 to 104 weeks, with a mean of 18 weeks. Sixteen of the studies used the Yamax pedometer, which has been validated for accuracy and reliability.
Participants in the RCTs who used pedometers increased their physical activity by 2491 steps per day more than controls. After excluding 1 study with a much higher increase in physical activity than the others, the increase was 2004 steps per day (95% confidence interval [CI], 878–3129; P<.001). In the observational studies, participants walked 2183 steps per day more than they had at baseline (95% CI, 1571–2796; P<.001). Overall, pedometer users increased their number of steps by 27% over baseline.
Step goal and step diary
Only studies that included a step goal and required participants to keep a step diary showed a significant increase in physical activity with pedometer use. There were no differences in outcomes based on duration of the intervention, inclusion of physical activity counseling, or the brand of pedometer used.
BMI and BP improved; lipids, glucose did not
Intervention participants had a statistically significant decrease in BMI of 0.38, which was associated with older age (P=.001), having a step goal (P=.04), and longer duration of the intervention (P=.07, trend). Intervention participants also had a significant decrease in systolic blood pressure of 3.8 mm Hg and diastolic blood pressure of 0.3 mm Hg (TABLE 1), which was associated with greater systolic blood pressure at baseline (P=.009).
There were no significant differences in serum lipids or fasting serum glucose in the studies that reported these variables.1
TABLE 1
Pre- and post-intervention body mass index and blood pressure
| body-mass index | 18 (562) | 30 (3.4) | –0.38 (–0.05 to –0.72) | .03 |
| systolic blood pressure | 12 (468) | 129 (7.5) | –3.8 (–1.7 to –5.9) | <.001 |
| diastolic blood pressure | 12 (468) | 79 (4.5) | –0.3 (0.02 to–0.46) | .001 |
WHAT’S NEW?: Weight loss without dieting
This study is the first large meta-analysis to show that pedometer use is an effective intervention for promoting physical activity. Another recent meta-analysis shows that pedometer use is also effective for short-term weight loss, even in the absence of dietary changes.14
Pedometers and goal-setting are simple, relatively inexpensive ways to help patients become physically active. According to systematic reviews,15,16 telephone-based programs, encouraging stair use, and creating exercise space are other effective interventions to promote physical activity. Some of these interventions are at least as effective as pedometers; however, only encouraging stair walking and pedometer use are practical office-based interventions.
CAVEATS: Price and quality
A 2004 Consumer Reports article ranked pedometers by accuracy, ease of use, and features.17 Accurate step counts allow patients and physicians to assess whether step goals are being met. Pedometers are more accurate when recording fast walking (2.5–3.0 mph), compared with slow walking. Pedometers may therefore be less accurate in the elderly, very obese, or those who walk slowly.18
TABLE 2
Consumer Reports top-rated pedometers17
| Omron healthcare HJ-112 | $28.45* |
| Freestyle Tracer | $15.99* |
| New lifestyles NL-2000 | $59.95† |
| * Price from www.pedometersusa.com, accessed December 12, 2007. | |
| † Price from newlifestyles.com, accessed December 12, 2007. | |
| Omron, Freestyle, Yamax, Walk4Life, and New Lifestyles have been shown to be reliable brands.19,20 | |
Negotiate the goal, patient keeps diary
Remember that patients must be counseled to set a step goal and keep a step diary. Most patients will have an initial step goal between 6000 and 10,000 steps per day. The step goal should be individualized to each patient’s current level of activity and gradually increased as activity level increases.
Schedule monthly or semi-monthly follow-up visits to evaluate progress towards activity or weight loss goals and to re-evaluate the step goal. Before beginning an exercise regimen, including walking, patients must be healthy enough for physical activity. In some cases, patients will need stress testing or other evaluation before using a pedometer to increase activity.
CHALLENGES TO IMPLEMENTATION: Time-wise
Counseling patients on the use of pedometers, and coaching them to set an appropriate step goal and keep a step diary, will take up time during the office visit, but it should be a brief intervention and therefore feasible.21
Omron Healthcare HJ-112
FreeStyle Tracer
New Lifestyles NL-2000
Organizing your office staff to assist you, and using a patient handout containing the basic information on pedometers, could reduce the demands on your time. Including information from the 2004 Consumer Reports article and Web sites with pedometers prices (such as www.pedometersusa.com and newlifestyles.com) should provide a good start for those patients who want more information.
PURLs methodology
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURL) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.
Advise your patients to use a pedometer, set a step goal, and keep a step diary. This simple intervention takes only a few moments and is effective in increasing patients’ physical activity and decreasing both body-mass index (BMI) and systolic blood pressure.1
Strength of recommendation
A: Based on a meta-analysis of randomized controlled trials (RCTs) and observational studies
Bravata DM, Smith-Spangler C, Sundaram V et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007; 298:2296–2304.
Illustrative case
Your first 4 patients this morning were a 50-year-old woman with metabolic syndrome, a 62-year-old obese man with high blood pressure, a 44-year-old woman with depression, and a 75-year-old man with a recent admission for myocardial infarction. In addition to managing their medications and reviewing lab results, you have already spent a lot of time discussing the benefits of exercise with each of these patients.
As you prepare to talk with your next patient—a 28-year-old woman with a BMI of 29 whose chief complaint is “wants to lose weight”—you wonder if there are any simple, brief, effective interventions to help your patients increase their physical activity.
BACKGROUND: A long way to go
Although there is no evidence that simply advising patients to walk has any effect, primary care physicians frequently recommend walking as a form of exercise—it is free, requires no special equipment, and is readily accessible to most motivated patients.
The Centers for Disease Control and Prevention recommends that adults engage in moderate physical activity for at least 30 minutes a day, at least 5 days per week.2 Yet 40% of adults do not engage in any leisure-time physical activity. This percentage is higher in women (43%), African-Americans (52%), and Hispanics (54%).3
The health benefits of exercise are clear. Regular physical activity has been shown to decrease overweight and obesity.4 It has also been shown to improve control of type 2 diabetes5 and hypertension.6 Frequent exercise is associated with a decreased mortality rate.7 Walking has been shown to decrease the risk of cardiovascular events in women, regardless of BMI.8
Walking has similarly been shown to decrease overall mortality among men.9 Cardiovascular fitness has also been shown to decrease mortality in adults over 60, even in the absence of weight loss.10
CLINICAL CONTEXT: USPSTF: Advice alone won’t kick-start exercise
We realize, of course, that most of our adult patients could benefit from regular exercise. Exercise is included in the treatment guidelines for overweight/obesity, hypertension, type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic pain, peripheral vascular disease, and depression.11
PURLs EDITOR
Bernard Ewigman. MD, MSPH
Department of Family Medicine
The University of Chicago
[email protected]
At last, the humble pedometer gives us a brief intervention for physical exercise that works. yes, we need more research for lots of reasons (always), but this Purl gives us a practical tool that can be recommended in a few minutes, consistent with the realities of daily practice.
The outcomes from this intervention are not dramatic. No lives were saved, no catastrophic diseases averted. yet regular exercise is so fundamentally important to just feeling good and having energy for daily life, not to mention lowering blood pressure and weight.
My guess is that this could become a handy recommendation used daily in family medicine and other primary care practices.
I am interested to know whether you already recommend pedometers to your patients. If not, does this seem like a worthwhile change in your practice?
On a personal note, I made a New year’s resolution to increase my physical activity. as soon as I finish this commentary, I am ordering a pedometer.
However, few office-based interventions have been shown to lead to increased physical activity. Patients sometimes resist making lifestyle changes, and providers are uncertain how to effectively promote physical activity. Furthermore, counseling patients to exercise without a specific intervention has not been shown to lead to long-term increases in physical activity. The US Preventive Services Task Force (USPSTF) finds there is insufficient evidence to recommend behavioral counseling alone for exercise, citing the lack of evidence for long-term efficacy.12,13
STUDY SUMMARY: Pedometer users walked 2491 additional steps
This meta-analysis included 26 RCTs and observational studies of pedometer use in adult outpatients that reported a change in the number of steps walked per day. The 2767 participants in these studies were 85% women, with a mean age of 49. In the 7 studies that reported race, 93% of patients were white. At baseline, most participants were overweight, with normal blood pressure (mean 129/79 mm Hg) and relatively well-controlled lipid levels (mean total cholesterol 198 mg/dL, HDL 52 mg/dL, LDL 113 mg/dL). The mean baseline activity level was 7473 steps per day (range 2140–12,371). Duration of interventions ranged from 3 to 104 weeks, with a mean of 18 weeks. Sixteen of the studies used the Yamax pedometer, which has been validated for accuracy and reliability.
Participants in the RCTs who used pedometers increased their physical activity by 2491 steps per day more than controls. After excluding 1 study with a much higher increase in physical activity than the others, the increase was 2004 steps per day (95% confidence interval [CI], 878–3129; P<.001). In the observational studies, participants walked 2183 steps per day more than they had at baseline (95% CI, 1571–2796; P<.001). Overall, pedometer users increased their number of steps by 27% over baseline.
Step goal and step diary
Only studies that included a step goal and required participants to keep a step diary showed a significant increase in physical activity with pedometer use. There were no differences in outcomes based on duration of the intervention, inclusion of physical activity counseling, or the brand of pedometer used.
BMI and BP improved; lipids, glucose did not
Intervention participants had a statistically significant decrease in BMI of 0.38, which was associated with older age (P=.001), having a step goal (P=.04), and longer duration of the intervention (P=.07, trend). Intervention participants also had a significant decrease in systolic blood pressure of 3.8 mm Hg and diastolic blood pressure of 0.3 mm Hg (TABLE 1), which was associated with greater systolic blood pressure at baseline (P=.009).
There were no significant differences in serum lipids or fasting serum glucose in the studies that reported these variables.1
TABLE 1
Pre- and post-intervention body mass index and blood pressure
| body-mass index | 18 (562) | 30 (3.4) | –0.38 (–0.05 to –0.72) | .03 |
| systolic blood pressure | 12 (468) | 129 (7.5) | –3.8 (–1.7 to –5.9) | <.001 |
| diastolic blood pressure | 12 (468) | 79 (4.5) | –0.3 (0.02 to–0.46) | .001 |
WHAT’S NEW?: Weight loss without dieting
This study is the first large meta-analysis to show that pedometer use is an effective intervention for promoting physical activity. Another recent meta-analysis shows that pedometer use is also effective for short-term weight loss, even in the absence of dietary changes.14
Pedometers and goal-setting are simple, relatively inexpensive ways to help patients become physically active. According to systematic reviews,15,16 telephone-based programs, encouraging stair use, and creating exercise space are other effective interventions to promote physical activity. Some of these interventions are at least as effective as pedometers; however, only encouraging stair walking and pedometer use are practical office-based interventions.
CAVEATS: Price and quality
A 2004 Consumer Reports article ranked pedometers by accuracy, ease of use, and features.17 Accurate step counts allow patients and physicians to assess whether step goals are being met. Pedometers are more accurate when recording fast walking (2.5–3.0 mph), compared with slow walking. Pedometers may therefore be less accurate in the elderly, very obese, or those who walk slowly.18
TABLE 2
Consumer Reports top-rated pedometers17
| Omron healthcare HJ-112 | $28.45* |
| Freestyle Tracer | $15.99* |
| New lifestyles NL-2000 | $59.95† |
| * Price from www.pedometersusa.com, accessed December 12, 2007. | |
| † Price from newlifestyles.com, accessed December 12, 2007. | |
| Omron, Freestyle, Yamax, Walk4Life, and New Lifestyles have been shown to be reliable brands.19,20 | |
Negotiate the goal, patient keeps diary
Remember that patients must be counseled to set a step goal and keep a step diary. Most patients will have an initial step goal between 6000 and 10,000 steps per day. The step goal should be individualized to each patient’s current level of activity and gradually increased as activity level increases.
Schedule monthly or semi-monthly follow-up visits to evaluate progress towards activity or weight loss goals and to re-evaluate the step goal. Before beginning an exercise regimen, including walking, patients must be healthy enough for physical activity. In some cases, patients will need stress testing or other evaluation before using a pedometer to increase activity.
CHALLENGES TO IMPLEMENTATION: Time-wise
Counseling patients on the use of pedometers, and coaching them to set an appropriate step goal and keep a step diary, will take up time during the office visit, but it should be a brief intervention and therefore feasible.21
Omron Healthcare HJ-112
FreeStyle Tracer
New Lifestyles NL-2000
Organizing your office staff to assist you, and using a patient handout containing the basic information on pedometers, could reduce the demands on your time. Including information from the 2004 Consumer Reports article and Web sites with pedometers prices (such as www.pedometersusa.com and newlifestyles.com) should provide a good start for those patients who want more information.
PURLs methodology
This study was selected and evaluated using FPIN’s Priority Updates from the Research Literature (PURL) Surveillance System methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed at www.jfponline.com/purls.
1. Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298:2296-2304.
2. Centers for Disease Control and Prevention/National Center for Health Statistics website. FASTATS: Exercise/physical activity. Available at www.cdc.gov/nchs/fastats/exercise.htm. Accessed January 22, 2008.
3. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2010, Available at www.health.gov/healthypeople. Accessed January 22, 2008.
4. Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Rel Metabolic Disord 1997;21:941-947.
5. Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007;147:357-369.
6. Stewart KJ, Bacher AC, Turner KL, et al. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med 2005;165:756-762.
7. Paffenbarger RS, Hyde RT, Wing AL, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993;328:538-545.
8. Manson JE, Greenland P, LaCroix AZ, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002;347:716-725.
9. Hakim AA, Petrovitch H, Burchfiel CM, et al. Effects of walking on mortality among nonsmoking retired men. N Engl J Med 1998;338:94-99.
10. Sui X, LaMonte MJ, Laditka JN, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007;298:2507-2516.
11. National Guideline Clearinghouse. Available at www.guideline.gov. Accessed January 22, 2008.
12. US Preventive Services Task Force. Behavioral counseling in primary care to promote physical activity: recommendations and rationale. July 2002. Agency for Healthcare Research and Quality. Available at www.ahrq.gov/clinic/3rduspstf/physactivity/physactrr.htm. Accessed January 22, 2008.
13. Eden KB, Orleans CT, Mulrow CD, et al. Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;137:208-215.
14. Richardson CR, Newton TL, Abraham JJ, Sen A, Jimbo M, Swartz AM. Meta-analysis of pedometer-based walking interventions and weight loss. Ann Fam Med 2008;6:69-77.
15. Eakin EG, Lawler SP, Vandelanotte C, Owen N. Telephone interventions for physical activity and dietary behavior change: a systematic review. Am J Prev Med 2007;32:419-434.
16. Kahn EB, Ramsey LT, Brownson RC, et al. Effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med 2002;22(Suppl):73-107.
17. Pedometers: walking by the numbers Consumer Reports2004; Oct.
18. Melanson EL, Knoll JR, Bell ML, et al. Commercially available pedometers: considerations for accurate step counting. Prev Med 2004;39:361-368.
19. Bassett Dr, Jr, Ainsworth BE, Leggett SR, et al. Accuracy of five electronic pedometers for measuring distance walked. Med Sci Sports Exerc 1996;28:1071-1077.
20. Schneider PL, Crouter SE, Lukajic O, et al. Accuracy and reliability of 10 pedometers for measuring steps over a 400-m walk. Med Sci Sports Exerc 2003;35:1779-1784.
21. Ogilvie D, Foster CE, Rothnie H, et al. Interventions to promote walking: systematic review. BMJ 2007;334:1204.-
1. Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298:2296-2304.
2. Centers for Disease Control and Prevention/National Center for Health Statistics website. FASTATS: Exercise/physical activity. Available at www.cdc.gov/nchs/fastats/exercise.htm. Accessed January 22, 2008.
3. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2010, Available at www.health.gov/healthypeople. Accessed January 22, 2008.
4. Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Rel Metabolic Disord 1997;21:941-947.
5. Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med 2007;147:357-369.
6. Stewart KJ, Bacher AC, Turner KL, et al. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med 2005;165:756-762.
7. Paffenbarger RS, Hyde RT, Wing AL, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993;328:538-545.
8. Manson JE, Greenland P, LaCroix AZ, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med 2002;347:716-725.
9. Hakim AA, Petrovitch H, Burchfiel CM, et al. Effects of walking on mortality among nonsmoking retired men. N Engl J Med 1998;338:94-99.
10. Sui X, LaMonte MJ, Laditka JN, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007;298:2507-2516.
11. National Guideline Clearinghouse. Available at www.guideline.gov. Accessed January 22, 2008.
12. US Preventive Services Task Force. Behavioral counseling in primary care to promote physical activity: recommendations and rationale. July 2002. Agency for Healthcare Research and Quality. Available at www.ahrq.gov/clinic/3rduspstf/physactivity/physactrr.htm. Accessed January 22, 2008.
13. Eden KB, Orleans CT, Mulrow CD, et al. Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;137:208-215.
14. Richardson CR, Newton TL, Abraham JJ, Sen A, Jimbo M, Swartz AM. Meta-analysis of pedometer-based walking interventions and weight loss. Ann Fam Med 2008;6:69-77.
15. Eakin EG, Lawler SP, Vandelanotte C, Owen N. Telephone interventions for physical activity and dietary behavior change: a systematic review. Am J Prev Med 2007;32:419-434.
16. Kahn EB, Ramsey LT, Brownson RC, et al. Effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med 2002;22(Suppl):73-107.
17. Pedometers: walking by the numbers Consumer Reports2004; Oct.
18. Melanson EL, Knoll JR, Bell ML, et al. Commercially available pedometers: considerations for accurate step counting. Prev Med 2004;39:361-368.
19. Bassett Dr, Jr, Ainsworth BE, Leggett SR, et al. Accuracy of five electronic pedometers for measuring distance walked. Med Sci Sports Exerc 1996;28:1071-1077.
20. Schneider PL, Crouter SE, Lukajic O, et al. Accuracy and reliability of 10 pedometers for measuring steps over a 400-m walk. Med Sci Sports Exerc 2003;35:1779-1784.
21. Ogilvie D, Foster CE, Rothnie H, et al. Interventions to promote walking: systematic review. BMJ 2007;334:1204.-
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