Abstract: We found four relevant studies providing data for 1809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study's usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting. Three studies compared the pedometer programme to a minimally active control group, but the results for physical activity could not be combined because each study used a different measure of activity. One study observed an increase in physical activity under a pedometer programme, but the other two did not find a significant difference. For secondary outcomes we found improvements in body mass index, waist circumference, fasting plasma glucose, the quality of life mental component and worksite injury associated with the pedometer programmes, but these results were based on limited data from one or two small studies. There were no differences between the pedometer programme and the control group for blood pressure, a number of biochemical outcomes and the quality of life physical component. Sedentary behaviour and disease risk scores were not measured by any of the included studies. One study compared a pedometer programme and an alternative physical activity programme, but baseline imbalances made it difficult to distinguish the true improvements associated with either programme. Overall, there was insufficient evidence to assess the effectiveness of pedometer interventions in the workplace. There is a need for more high quality randomised controlled trials to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. To improve the quality of the evidence available, future studies should be registered in an online trials register, publish a protocol, allocate time and financial support to reducing attrition, and try to blind personnel (especially those who undertake measurement). To better identify the effects of pedometer interventions, future studies should report a core set of outcomes (total physical activity in METs, total time sitting in hours and minutes, objectively measured cardiovascular disease and type II diabetes risk factors, quality of life and injury), assess outcomes in the long term and undertake subgroup analyses based upon demographic subgroups (e.g. age, gender, educational status). Future studies should also compare different types of active intervention to test specific intervention components (eligibility, duration, step goal, step diary, settings), and settings (occupation, intervention provider). There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.

Plain-language summary: To assess this, we searched for randomised controlled trials of workplace health promotion interventions that involved the use of a pedometer undertaken in employed adults. Between 30th January and 6th February 2012 we searched a range of electronic libraries and references of relevant papers, retrieving 3282 potential papers. We eventually included four studies in the review. One study compared pedometer programmes with an alternative physical activity programme, but there were important baseline differences between the intervention and control groups that made it difficult to distinguish the true effect. The three remaining studies compared pedometer programmes with minimally active control groups. One study observed an improvement in physical activity in the pedometer programme, but two other studies found no significant difference between the pedometer group and the control group. We could not combine these results together, as each study used a different measure for physical activity, so it is not clear what the overall effect is. Single studies found beneficial changes in body mass index, fasting plasma glucose, the mental component of quality of life and worksite injury associated with the pedometer programmes as opposed to the control group. However, none of the studies identified consistent differences between the pedometer programme and the control group for waist circumference, blood pressure and quality of life outcomes. In addition, we judged the majority of included studies to have a high risk of bias, mainly due to participants and staff knowing who was in the intervention and who was in the control group, attrition of participants and not having published a protocol prior to running the study. We conclude that there was insufficient evidence to assess whether workplace pedometer interventions are of benefit. There is a need for further high quality randomised controlled trials to be undertaken with a range of health outcomes and assessment in the long term.