Research shows that the receipt of a pedometer can increase the number of steps taken daily and the amount of moderate to vigorous physical activity completed by older adults.
Participating in the recommended weekly 150 minutes of moderate to vigorous physical activity (MVPA) can help adults retain their health and improve both physical and emotional well-being. This time can be spread out over 5 days, completing 30 mins/day, or alternatively in sessions of 10 minutes which promotes the gradual increase of activity in the elderly and disabled. Walking, the most common physical activity among adults qualifies as MVPA at a rate of approximately 5km/hour or 100 steps/min, and when performed for 30 minutes can lower fasted glucose levels and gradually increase step counts with the use of a pedometer.
In the past, studies have examined the use of pedometers on physical activity but the limitations of those studies do not allow for generalization or the ability to separate the effects of social support from those of the pedometer alone. To address these limitations, a study published in PLOS medicine used primary care based interventions to answer if pedometers sent by mail increase physical activity in adults and if consultations with a practice nurse are beneficial.
This study was coined The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial. Taking place in the United Kingdom, 1023 relatively inactive adults aged 45-75 were randomly selected from 6 primary care practices. All participants of the trial had no indications of an increase in MVPA being harmful to their health and self-reported completing less than 150 minutes of MVPA per week. Due to the randomized nature of the study, participants were allowed to come from the same household, however, the second participant chosen from a single household had to be within 15 years age of the first person.
Each participant was randomly placed in; a group to receive intervention materials (a pedometer, diary, and handbook for the walking program) by mail, a group to receive the same materials by means of a practice nurse and then have 3 brief (10-20 minute) consultations with the nurse during course of the study, or a control group which received no materials or feedback for the duration of the study. Participants self-recorded pedometer data in their diaries. Using an accelerometer, researchers measured and assessed physical activity and MVPA at baseline and then 3 and 12 months post-intervention. Both intervention groups included behavioural change techniques such as encouraging social support, goals and self-monitoring, and written statements of the benefits of a daily 30-minute walk for at least 5 days per week over 3 months to satisfy the recommended physical activity amounts.
At the 3 month mark, the mail intervention group increased steps by 692 steps/day and MVPA in rounds by 43 min/week whereas the nurse intervention group increased steps by 1172 steps/day and MVPA in rounds by 61 min/week. By 12 months postintervention, the mail intervention group had 642 additional steps/day and 33 min/week of MVPA in rounds compared to the nurse intervention group which had 677 additional steps/day and 35 min/week of MVPA in rounds. At no time in the study did the amount of sedentary time of the participants’ change.
The results of the study showed that an increase in approximately 650-700 steps/day and MVPA in sessions by 33-35 min/week occurred in participants in both intervention groups. Although at 3 months the nurse intervention group showed a significant increase in physical activity compared to the mail intervention group, there was no difference at 12 months. By incorporating these increases in physical activity into day-to-day life, researchers estimate a possible decrease in the risk of coronary heart disease by 4.5% and of all cause-mortality by 4% in adults and older adults.
Several limitations of this study exist, such as the low recruitment rate of 10% which limits generalizability and the impossibility of masking those involved in the study to the interventions. Furthermore, 21% of the 1023 participants had already achieved the recommended amount of physical activity at baseline but were not excluded from participating. This was because the study was primary care-based and in that setting, self-reports of physical activity determine participation. Nonetheless, this study addressed a main issue of previous studies: separating changes in physical activity due to nurse support from changes due to the use of a pedometer alone.
To date, this is the largest population-based trial of a pedometer-based walking intervention with 12-month follow-up. The results are generalizable to a patient population and can inform health care providers and national policy makers.In the future, it would be beneficial to re-examine the same variables of this study beyond 12 months.
Written by Monica Naatey-Ahumah, BSc
Harris, T., Limb, E., Victor, C.R., Iliffe, S., Ussher, M., Whincup., P.H.,…Cook., D.G. (2017). Effect of a Primary Care Walking Intervention with and without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial. PLOS Medicine. 14(1). 1-19. doi:10.1371/ journal.pmed.1002210.