NIHR Signal Patients receiving pedometers by post increased their physical activity for at least 12 months

Published on 28 March 2017

Use of pedometers, received by post, resulted in a sustained increase in walking of around 650 steps a day, equivalent to about one km or 30 minutes of moderate to vigorous physical activity per week. The study was set in London general practices and achieved similar results whether or not people had additional support from a practice nurse.

The number of people agreeing to participate was low. Of the 11,015 people invited, 1,023 took part, a take-up of just 10%. Some contacted were already meeting physical activity guidelines. Participants were mostly women and on average undertook about 80 to 100 minutes of moderate or vigorous physical activity a week. The additional steps noted in this trial were less than in other studies that had more contact with advisors. These noted an increase of about 2,000 to 2,500 steps daily.

This NIHR-funded large-scale study of people not meeting current guideline levels of moderate physical activity showed that a simple intervention can have small but lasting effects. It might be a low-cost way to motivate people to hit physical activity targets. The message delivered to participants in this trial was to aim for an additional 3,000 steps in 30 minutes on at least five days a week. This could become a measurable goal for existing public health physical activity advice and confirms the benefit of self-monitoring for some people.

Patients receiving pedometers by post increased their physical activity for at least 12 months

Why was this study needed?

Although UK adults are advised to do 150 minutes’ moderate to vigorous activity each week, many don’t hit those targets. Latest figures from the 2012 Health Survey England show only 67% of men and 55% of women in England meet these guidelines.

Lack of physical activity has been linked to obesity, type 2 diabetes and cardiovascular disease. Walking is a safe and effective form of exercise that many people can do. Walking at a pace of 5km an hour, comparable to 3000 paces in 30 minutes, is classed as moderate to vigorous activity.

Previous studies of interventions to get people walking have shown pedometers may help, although studies have been small and largely self-selecting. They have also included varying amounts of professional support. It’s helpful to know whether pedometers can increase walking without extra support, as this makes the programme cheaper to deliver at scale.

What did this study do?

This three-armed randomised controlled trial (PACE-UP) invited 11,015 people aged 45 to 75 from seven general practices in London to participate. They did not have any conditions that prevented moderate to vigorous walking. The majority, 6,399 people, did not respond; 2,918 people did not want to take part and 548 people were already meeting the physical exercise recommendations. Therefore 1,023 inactive adults were randomly assigned to either:

  • a pedometer by post group, who also received a handbook and physical activity diary
  • a nurse support group, who received the same materials plus three consultations with a nurse to set goals and discuss progress
  • a control group who didn’t get advice or receive a pedometer until the study had finished.

People’s activity levels were measured by an accelerometer for seven days at the start of the study and again 12 months later.

What did it find?

  • At the start of the study, people took an average 7,479 steps per day. After 12 months, those in the control group walked an average 7,246 steps daily, the pedometer by post group walked on average 8,010 steps a day and the nurse support group walked 8,131 steps daily.
  • People who had pedometers by post walked an additional 642 steps per day compared to those in the control group (95% confidence interval [CI] 329 to 955) and those who had pedometers and nurse support walked an extra 677 steps per day (95% CI 365 to 989). The difference between the two pedometer groups was small enough to be down to chance.
  • From a baseline average of 94 minutes of activity per week, both pedometer groups spent about 35 minutes longer doing moderate or vigorous activity each week, compared to the control group.
  • There were no major differences between the groups in terms of health measures such as body mass index, waist circumference, anxiety scores or pain.

What does current guidance say on this issue?

Physical activity guidelines for adults in the UK say people should do strength exercises twice a week, plus one of the following:

  • One hundred and fifty minutes of moderate aerobic activity a week, such as brisk walking or cycling.
  • Seventy five minutes vigorous aerobic activity a week, such as running or a game of tennis.
  • A mix of moderate and vigorous aerobic activity a week, such as two 30-minute runs plus one 30 minute brisk walk.

NICE public health guideline on walking and cycling says: “Only use pedometers as part of a package which includes support to set realistic goals (whereby the number of steps taken is gradually increased), monitoring and feedback”.

What are the implications?

The study suggests that providing pedometers and goal-setting material, without additional support, can help sedentary people make a small but sustained improvement in physical activity levels.

Many people now have mobile phones or wearable activity monitors that automatically record steps or movement. So, if asked, healthcare professionals could advise people to take 3,000 steps a day in 30 minutes on five days a week, without having to supply pedometers, this would be equivalent to the level of moderate physical activity as currently advised.

This approach won’t appeal to everyone, but if the one in ten rate could be replicated or improved on around the country, it could make an important difference to public health.

Citation and Funding

Harris T, Kerry SM, Limb ES, et al. 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 Med. 2017;14(1):e1002210.

This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number HTA 10/32/02 ISRCTN42122561).

Bibliography

NHS Choices. Physical activity guidelines for adults. London: Department of Health; 2015.

NICE. Physical activity: walking and cycling. PH41. London: National Institute for Health and Care Excellence; 2012.

HSCIC. Statistics on obesity, physical activity and diet. Health and Social Care Information Centre. England; 2015.

Why was this study needed?

Although UK adults are advised to do 150 minutes’ moderate to vigorous activity each week, many don’t hit those targets. Latest figures from the 2012 Health Survey England show only 67% of men and 55% of women in England meet these guidelines.

Lack of physical activity has been linked to obesity, type 2 diabetes and cardiovascular disease. Walking is a safe and effective form of exercise that many people can do. Walking at a pace of 5km an hour, comparable to 3000 paces in 30 minutes, is classed as moderate to vigorous activity.

Previous studies of interventions to get people walking have shown pedometers may help, although studies have been small and largely self-selecting. They have also included varying amounts of professional support. It’s helpful to know whether pedometers can increase walking without extra support, as this makes the programme cheaper to deliver at scale.

What did this study do?

This three-armed randomised controlled trial (PACE-UP) invited 11,015 people aged 45 to 75 from seven general practices in London to participate. They did not have any conditions that prevented moderate to vigorous walking. The majority, 6,399 people, did not respond; 2,918 people did not want to take part and 548 people were already meeting the physical exercise recommendations. Therefore 1,023 inactive adults were randomly assigned to either:

  • a pedometer by post group, who also received a handbook and physical activity diary
  • a nurse support group, who received the same materials plus three consultations with a nurse to set goals and discuss progress
  • a control group who didn’t get advice or receive a pedometer until the study had finished.

People’s activity levels were measured by an accelerometer for seven days at the start of the study and again 12 months later.

What did it find?

  • At the start of the study, people took an average 7,479 steps per day. After 12 months, those in the control group walked an average 7,246 steps daily, the pedometer by post group walked on average 8,010 steps a day and the nurse support group walked 8,131 steps daily.
  • People who had pedometers by post walked an additional 642 steps per day compared to those in the control group (95% confidence interval [CI] 329 to 955) and those who had pedometers and nurse support walked an extra 677 steps per day (95% CI 365 to 989). The difference between the two pedometer groups was small enough to be down to chance.
  • From a baseline average of 94 minutes of activity per week, both pedometer groups spent about 35 minutes longer doing moderate or vigorous activity each week, compared to the control group.
  • There were no major differences between the groups in terms of health measures such as body mass index, waist circumference, anxiety scores or pain.

What does current guidance say on this issue?

Physical activity guidelines for adults in the UK say people should do strength exercises twice a week, plus one of the following:

  • One hundred and fifty minutes of moderate aerobic activity a week, such as brisk walking or cycling.
  • Seventy five minutes vigorous aerobic activity a week, such as running or a game of tennis.
  • A mix of moderate and vigorous aerobic activity a week, such as two 30-minute runs plus one 30 minute brisk walk.

NICE public health guideline on walking and cycling says: “Only use pedometers as part of a package which includes support to set realistic goals (whereby the number of steps taken is gradually increased), monitoring and feedback”.

What are the implications?

The study suggests that providing pedometers and goal-setting material, without additional support, can help sedentary people make a small but sustained improvement in physical activity levels.

Many people now have mobile phones or wearable activity monitors that automatically record steps or movement. So, if asked, healthcare professionals could advise people to take 3,000 steps a day in 30 minutes on five days a week, without having to supply pedometers, this would be equivalent to the level of moderate physical activity as currently advised.

This approach won’t appeal to everyone, but if the one in ten rate could be replicated or improved on around the country, it could make an important difference to public health.

Citation and Funding

Harris T, Kerry SM, Limb ES, et al. 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 Med. 2017;14(1):e1002210.

This project was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme (project number HTA 10/32/02 ISRCTN42122561).

Bibliography

NHS Choices. Physical activity guidelines for adults. London: Department of Health; 2015.

NICE. Physical activity: walking and cycling. PH41. London: National Institute for Health and Care Excellence; 2012.

HSCIC. Statistics on obesity, physical activity and diet. Health and Social Care Information Centre. England; 2015.

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

Published on 3 January 2017

T Harris, S. Kerry, E. Limb, C. Victor, S Iliffe, M Ussher, P. Whincup, U Ekelund, J Fox-Rushby, C Furness, N Anokye, J Ibison, S DeWilde, L David, E Howard, R Dale, J Smith, D. Cook

PLoS One , 2017

Background Pedometers can increase walking and moderate-to-vigorous physical activity (MVPA) levels, but their effectiveness with or without support has not been rigorously evaluated. We assessed the effectiveness of a pedometer-based walking intervention in predominantly inactive adults, delivered by post or through primary care nurse-supported physical activity (PA) consultations. Methods and Findings A parallel three-arm cluster randomised trial was randomised by household, with 12-mo follow-up, in seven London, United Kingdom, primary care practices. Eleven thousand fifteen randomly selected patients aged 45–75 y without PA contraindications were invited. Five hundred forty-eight self-reporting achieving PA guidelines were excluded. One thousand twenty-three people from 922 households were randomised between 2012–2013 to one of the following groups: usual care (n = 338); postal pedometer intervention (n = 339); and nurse-supported pedometer intervention (n = 346). Of these, 956 participants (93%) provided outcome data (usual care n = 323, postal n = 312, nurse-supported n = 321). Both intervention groups received pedometers, 12-wk walking programmes, and PA diaries. The nurse group was offered three PA consultations. Primary and main secondary outcomes were changes from baseline to 12 mo in average daily step-counts and time in MVPA (in ≥10-min bouts), respectively, measured objectively by accelerometry. Only statisticians were masked to group. Analysis was by intention-to-treat. Average baseline daily step-count was 7,479 (standard deviation [s.d.] 2,671), and average time in MVPA bouts was 94 (s.d. 102) min/wk. At 12 mo, mean steps/d, with s.d. in parentheses, were as follows: control 7,246 (2,671); postal 8,010 (2,922); and nurse support 8,131 (3,228). PA increased in both intervention groups compared with the control group; additional steps/d were 642 for postal (95% CI 329–955) and 677 for nurse support (95% CI 365–989); additional MVPA in bouts (min/wk) were 33 for postal (95% CI 17–49) and 35 for nurse support (95% CI 19–51). There were no significant differences between the two interventions at 12 mo. The 10% (1,023/10,467) recruitment rate was a study limitation. Conclusions A primary care pedometer-based walking intervention in predominantly inactive 45- to 75-y-olds increased step-counts by about one-tenth and time in MVPA in bouts by about one-third. Nurse and postal delivery achieved similar 12-mo PA outcomes. A primary care pedometer intervention delivered by post or with minimal support could help address the public health physical inactivity challenge.

Expert commentary

This is an important study, providing rigorous evidence that simple support including using a pedometer and a diary, mailed or given by a nurse, can increase moderate or vigorous physical activity for at least 12 months. The increase of over 30 minutes per week, compared with those receiving usual care, could be expected to be associated with concurrent improvements in physical (weight) and mental (anxiety, depression) health but none were evident. Since only 10% of those invited took part in the research it is unclear how large the changes would be if the intervention was routinely adopted by GP surgeries.

Adrian Taylor, Professor of Health Services Research, Plymouth University

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