Workplace pedometer interventions for increasing physical activity [Published 21 Jul 2020]

BackgroundThe World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.ObjectivesTo assess the eJectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes.Search methodsWe searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'.Selection criteriaWe included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured.Data collection and analysisWe used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken aDer completion of the intervention to identify lasting eJects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised eJect measures for physical activity.Main resultsWe included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from oJices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up aDer completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month aDer completion of the intervention, pedometers may have no eJect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the eJect is very uncertain. Pedometers may have eJects on sedentary behaviour and on quality of life (mental health component), but these eJects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no eJect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse eJects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence).No studies compared biochemical measures or disease risk scores at follow-up aDer completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month aDer completion of the intervention revealed that pedometers may have an eJect on physical activity, but the eJect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse eJects at follow-up aDer completion of the intervention were not compared to an alternative physical activity intervention. Some positive eJects were observed immediately at completion of the intervention periods, but these eJects were not consistent, and overall certainty of evidence was insuJicient to assess the eJectiveness of workplace pedometer interventions.Authors' conclusionsExercise interventions can have positive eJects on employee physical activity and health, although current evidence is insuJicient to suggestthat a pedometer-based intervention would be more eJective than other options. Itis importantto note that overthe past decade, technological advancement in accelerometers as commercial products, oDen freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should becautious about the expected benefits of incorporating a pedometer and should note that these eJects may not be sustained over the longer term. Future studies should be designed to identify the eJective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention eJects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.</div