Have pedometer, will travel

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PURLs

Have pedometer, will travel

J Fam Pract. 2008 February;57(2):90-93

References

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.

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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.

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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.

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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

FAST TRACK

2000 steps is about 1 mile. 10,000 steps is a common daily step goal

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.

FAST TRACK

Counseling should be a brief intervention and therefore feasible

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.