Steps to Better Cardiovascular Health: How Many Steps Does It Take to Achieve Good Health and How Confident Are We in This Number?

Pedometers and other types of step-counting devices are growing in popularity with both researchers and practitioners. The focus of this article is on describing the most recent pedometer-related advances in terms of cardiovascular health. The emergent body of evidence suggests that pedometer-determined physical activity is related to a number of cardiovascular health outcomes and that intervention participants can realize modest changes in body mass index and blood pressure. Taking into consideration individual baseline values, tailored messages congruent with public health recommendations should promote incremental increases in steps/day on the order of an extra 3,000 to 4,000 (approximately 30 min) of at least moderate intensity and taken in at least 10-minute bouts. Additional health benefits accrue with greater increases. Of course, even more benefits are possible from engaging in vigorous physical activity, but this seems less appealing for most people. Pedometer-based guidelines are not intended to supplant existing public health recommendations, but rather supplement them

WalkMore: a randomized controlled trial of pedometer-based interventions differing on intensity messages

Pedometer-based programs have elicited increased walking behaviors associated with improvements in blood pressure in sedentary/low active postmenopausal women, a population at increased risk of cardiovascular disease. Such programs typically encourage increasing the volume of physical activity with little regard for its intensity. Recent advances in commercially available pedometer technology now permit tracking of both steps/day and time in moderate (or greater) intensity physical activity on a daily basis. It is not known whether the dual message to increase steps/day while also increasing time spent at higher intensity walking will elicit additional improvements in blood pressure relative to a message to only focus on increasing steps/day. The purpose of this paper is to present the rationale, study design, and protocols employed in WalkMore, a 3-arm 3-month blinded and randomized controlled trial (RCT) designed to compare the effects of two community pedometer-based walking interventions (reflecting these separate and combined messages) relative to a control group on blood pressure in sedentary/low active post-menopausal women, a population at increased risk of cardiovascular disease. 120 sedentary/low active post-menopausal women (45-74 years of age) will be randomly assigned (computer-generated) to 1 of 3 groups: A) 10,000 steps/day (with no guidance on walking intensity/speed/cadence; BASIC intervention, n = 50); B) 10,000 steps/day and at least 30 minutes in moderate intensity (i.e., a cadence of at least 100 steps/min; ENHANCED intervention, n = 50); or a Control group (n = 20). An important strength of the study is the strict control and quantification of the pedometer-based physical activity interventions. The primary outcome is systolic blood pressure. Secondary outcomes include diastolic blood pressure, anthropometric measurements, fasting blood glucose and insulin, flow mediated dilation, gait speed, and accelerometer-determined physical activity and sedentary behavior. This study can make important contributions to our understanding of the relative benefits that walking volume and/or intensity may have on blood pressure in a population at risk of cardiovascular disease. ClinicalTrials.gov Record NCT01519583, January 18, 2012

A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes

The purpose of this study was to investigate the benefits of a pedometer and a cognitive-behavioural group intervention for promoting physical activity (PA) in type 2 diabetes patients. We recruited 41 participants and randomized them into an intervention group (IG) (n = 20) and a control group (CG) (n = 21). The intervention consisted of five sessions within 12 weeks, a booster session after 22 weeks and a pedometer. Primary outcome was PA assessed by accelerometer (minutes per day) and pedometer (steps per day). Secondary outcomes were weight, body mass index, blood pressure, haemoglobin A1c and total cholesterol. After 12 weeks, the IG increased with more than 2000 steps day−1 compared with the CG, whereas sedentary behaviour decreased more than 1 hour day−1 in the IG and showed no change in the CG. There was no intervention effect on the accelerometer-based PA nor on health measurements. After 1 year, the increase in steps per day remained significant in the IG, but sedentary activity increased again to baseline levels. This pilot study showed that the combination of a 12-week cognitive-behavioura intervention and a pedometer has a significant short-term impact on daily steps and sedentary behaviour but that the effects on total PA and long-term effects were limited

Patterns of impact resulting from a 'sit less, move more' web-based program in sedentary office employees.

PURPOSE: Encouraging office workers to 'sit less and move more' encompasses two public health priorities. However, there is little evidence on the effectiveness of workplace interventions for reducing sitting, even less about the longer term effects of such interventions and still less on dual-focused interventions. This study assessed the short and mid-term impacts of a workplace web-based intervention (Walk@WorkSpain, W@WS; 2010-11) on self-reported sitting time, step counts and physical risk factors (waist circumference, BMI, blood pressure) for chronic disease. METHODS: Employees at six Spanish university campuses (n=264; 42±10 years; 171 female) were randomly assigned by worksite and campus to an Intervention (used W@WS; n=129; 87 female) or a Comparison group (maintained normal behavior; n=135; 84 female). This phased, 19-week program aimed to decrease occupational sitting time through increased incidental movement and short walks. A linear mixed model assessed changes in outcome measures between the baseline, ramping (8 weeks), maintenance (11 weeks) and follow-up (two months) phases for Intervention versus Comparison groups. RESULTS: A significant 2 (group) × 2 (program phases) interaction was found for self-reported occupational sitting (F[3]=7.97, p=0.046), daily step counts (F[3]=15.68, p=0.0013) and waist circumference (F[3]=11.67, p=0.0086). The Intervention group decreased minutes of daily occupational sitting while also increasing step counts from baseline (446±126; 8,862±2,475) through ramping (+425±120; 9,345±2,435), maintenance (+422±123; 9,638±3,131) and follow-up (+414±129; 9,786±3,205). In the Comparison group, compared to baseline (404±106), sitting time remained unchanged through ramping and maintenance, but decreased at follow-up (-388±120), while step counts diminished across all phases. The Intervention group significantly reduced waist circumference by 2.1cms from baseline to follow-up while the Comparison group reduced waist circumference by 1.3cms over the same period. CONCLUSIONS: W@WS is a feasible and effective evidence-based intervention that can be successfully deployed with sedentary employees to elicit sustained changes on "sitting less and moving more"

Acceptability and feasibility of wearing activity monitors in community-dwelling older adults with dementia

Objectives Measuring physical activity is complicated particularly in people with dementia, where activity levels are low and subjective measures are susceptible to inaccurate recall. Activity monitors are increasingly being used within research; however, it is unclear how people with dementia view wearing such devices and what aspects of the device effect wear time. The aim of the study was to evaluate the acceptability and feasibility of people with dementia wearing activity monitors. Methods Twenty‐six, community‐dwelling, people with mild dementia were asked to wear an activity monitor (GENEactiv Original) over a 1‐month period. Perceptions of the device were measured using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0, alongside qualitative interviews. Device diary and activity monitor data were used to assess compliance. Results Participants tended to find wearing the activity monitors acceptable, with only three participants (12%) withdrawing prior to the study end date. Participants were generally satisfied with wearing the devices as measured by the QUEST (Mdn = 4.4, IQR = 1.1). Four themes were identified that influenced perceptions of wearing the device: external influences, design, routine, and perceived benefits. Discussion Asking people with dementia to wear a wrist‐worn activity monitor for prolonged periods appears to be both feasible and acceptable. Researchers need to consider the needs and preferences of the sample population prior to selecting activity monitors

ActiGraph-Measured Breaks in Sedentary Behavior; Are They Real Transitions From Sitting to Standing?

Please view abstract in the attached PDF file

Classification of occupational activity categories using accelerometry: NHANES 2003–2004

Background An individual’s occupational activity (OA) may contribute significantly to daily physical activity (PA) and sedentary behavior (SB). However, there is little consensus about which occupational categories involve high OA or low OA, and the majority of categories are unclassifiable with current methods. The purpose of this study was to present population estimates of accelerometer-derived PA and SB variables for adults (n = 1112, 20–60 years) working the 40 occupational categories collected during the 2003–2004 National Health and Nutrition Examination Survey (NHANES). Methods ActiGraph accelerometer-derived total activity counts/day (TAC), activity counts/minute, and proportion of wear time spent in moderate-to-vigorous PA [MVPA], lifestyle, and light PA organized by occupational category were ranked in ascending order and SB was ranked in descending order. Summing the ranks of the six accelerometer-derived variables generated a summary score for each occupational category, which was re-ranked in ascending order. Higher rankings indicated higher levels of OA, lower rankings indicated lower levels of OA. Tertiles of the summary score were used to establish three mutually exclusive accelerometer-determined OA groupings: high OA, intermediate OA, and low OA. Results According to their summary score, ‘farm and nursery workers’ were classified as high OA and ‘secretaries, stenographers, and typists’ were classified as low OA. Consistent with previous research, some low OA occupational categories (e.g., ‘engineers, architects, and scientists’, ‘technicians and related support occupations’, ‘management related occupations’, ‘executives, administrators, and managers’, ‘protective services’, and ‘writers, artists, entertainers, and athletes’) associated with higher education and income had relatively greater amounts of MVPA compared to other low OA occupational categories, likely due to the greater percentage of men in those occupations and/or the influence of higher levels of leisure time PA. Men had more TAC, activity counts/minute and time in MVPA, but similar proportions of SB compared to women in all three OA groupings. Conclusions Objectively measured PA allowed for a more precise estimate of the amount of PA and SB associated with different occupations and facilitated systematic classification of the 40 different occupational categories into three distinct OA groupings. This information provides new opportunities to explore the relationship between OA and health outcomes