# Exercise as it relates to Disease/Increasing Physical Activity in the Student Population through the use of Pedometers

This is an analysis of the journal article "Increasing Walking inc college Students Using Pedometer Intervention: Differences According to Body Mass Index" by E. M. Jackson and A. Howton (2008).

## Background

Globally there is a large issue in regards to obesity. In 2014 it was found more than 1.9 billion adults were overweight, and a further 600million of these were obese. Obesity is a preventable condition in which nutrition and levels of physical activity (PA) have large roles in maintaining. Physical inactivity is the fourth leading cause of death worldwide and has contributed to over 3million preventable deaths yearly. The global cost for 2013 was found to be US $67.5billion.
Further research has found a relationship with larger growing obesity rates within young adults. In 2011 a systematic review found reduced PA up to levels of 60-70% in adolescence consistently across the literature. This then applies 14-29 years, as these ages are associated with larger roles in work and family life. University or college aged students are thought to gain much larger independence, therefore this age population is ideal for promoting a healthier lifestyle, as it can result in healthier lifelong habits and routine.

## Where is the Research From?

This article was published in the “Journal of American College Health”. This scholarly publication is the only one available within the US that collects publications specifically catered at college students health. This journal is designed by the “American College Health Association”, whom have a vision to recognise expert opinions in college health and have their knowledge available to others.
The authors both work within the Department of Health, Physical Education and Sport Science at Kennesaw State University. The study itself took place at a Southeastern university campus in the US.

## Study Design

This is an experimental study. It involved the implementation of an intervention (without a comparative control group) and collected data and information from this.
A sample of 326 college students with a mean age of 24.3 years participated in this study. The population was 70% women, and was thoroughly described in terms of employment, living arrangements, ethnic background and marital status.
A 12 week intervention was completed, with a pedometer worn 5 days in each week. All participants were measured at the commencement of the study (baseline), the middle of the study (6 weeks) and at the end of the study (12 weeks). The hypotheses was those with a larger BMI would take less steps overall, however more steps would be taken as an average per day with the intervention of a pedometer globally in each participant.
Outcomes measured include:
| Outcome | Information this Provided | Time completed |
| Questionnaire | - Demographic information (further insight into variables) - PA habits - Attitudes towards completing the study. | Baseline + wk 12. |
| Number of Steps per day (Average) | Steps taken per day | Baseline, wk 6 + wk 12. |
| BMI | Classification: - Underweight (<20) - Normal weight (20-24.9) - Overweight (25-29.9) - Obese (>30) | Baseline, Wk 6, Wk 12 |
Some limitations in this study occurred. BMI has not been found to be accurate in detecting obesity, it does not cater for different body compositions and is a poor diagnostic tool for percentage of body fat. This causes comparisons between the groups to be inaccurate.
The outcomes in terms of steps completed per day are self-reported. This does not rule out bias, as participants may have recorded inaccurate numbers for their steps completed per day. There is no long term measurement, meaning this study does not have evidence of long term compliance and validity. There are variables that have not been controlled in this trial including: different instructors and different brands/types of pedometers used, which could alter measurement accuracy and cause bias.

## Results

This study found no significant difference between groups (BMI classification) at baseline, in terms of number of steps per day. The average amount of steps taken per day increased from week 1-6 (average 7,013 to just below 9,000 at week 6), and from week 6-12 (almost over 10,00 at week 12). The researchers reported pedometer use is an effective intervention to increase PA. All populations found significant increases in steps taken per day.
The hypothesis that overweight and obese populations would take less steps on average each day was not proven as there was not a significant difference between the overweight/obese population and the normal weight population. The underweight population reported the least amount of steps, and this difference was significant.. It was hypothesised this was due to the underweight population currently feeling healthy causing less worry about completing adequate PA. When this compares to the overweight and obese group, they may have more motivation towards this project as it had greater meaning for them to increase PA and lose weight.

## Conclusions

The above findings are fair with adequate evidence. For this intervention to be implemented some factors need to be considered. Limitations to this study design and set up have been listed above, so these need to be carefully assessed and comprehended. Implementation of a pedometer for increasing steps taken per day is valid and effective, however implementation for comparison of BMI groups is not necessarily valid.
Two recent 2014 studies looking at pedometer based interventions found similarly and resulted in increased PA of the populations tested. These studies also measured longer term effects (8months) and still found positive effects on PA and compliance.

## Practical Advice

This research corresponds to the large growing issue of today, obesity levels. With the growth of technology use in the current and upcoming generations, a device such as a pedometer can have a great effect on this issue. The relevance of this to younger generations is important, as interventions are aimed towards this population due to them having a greater chance of making a lifelong change and they are also more reliant on technology.
When implementing the use of a pedometer, users must be aware of their limits. If they are increasing PA for the first time they must be careful not to over do this. Gaining advice from a professional is recommended. It is important users do not push themselves so hard that they gain an injury or illness, as this will have a negative effect on their health as well as their motivation. The below PA and sedentary guidelines can be used as a guide.

## Further Resources

The following websites help gain further insight, firstly into the rising rates and issues of world overweight and obesity. http://www.who.int/en/.
Secondly here is a website to look at the current Australian Physical Activity and Sedentary guidelines. These can assist with a baseline for PA goals. http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines.
References:
* 1 2 3 4 5 Jackson, E. M., & Howton, A. (2008). Increasing walking in college students using a pedometer intervention: differences according to body mass index. Journal of American College Health, 57(2), 159-164.]
* 1 2 World Health organization (2016) Obesity and Overweight fact Sheet. Retrieved from WHO http://www.who.int/mediacentre/factsheets/fs311/en/
* 1 2 3 Australian Government The Department of Health (2014) Research and Statistics. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-active-evidence.htm
* 1 2 3 Freak-Poli, R. L., Wolfe, R., Wong, E., & Peeters, A. (2014). Change in well-being amongst participants in a four-month pedometer-based workplace health program. BMC public health, 14(1), 953.
* ↑ Boney, B. (2016) Physical Inactivity costs world billions of dollars, Sydney University study finds. Retrieved from ABC News http://www.abc.net.au/news/2016-07-28/physical-inactivity-costs-the-world-billions-sydney-uni-study/7666708
* 1 2 Gillison, F., Standage, M., & Verplanken, B. (2014). A cluster randomised controlled trial of an intervention to promote healthy lifestyle habits to school leavers: Study rationale, design, and methods. BMC public health, 14(1), 221.
* ↑ Dumith, S. C., Gigante, D. P., Domingues, M. R., & Kohl III, H. W. (2011). Physical activity change during adolescence: a systematic review and a pooled analysis. International journal of epidemiology, 40(3), 685-698.
* ↑ Caspersen, C. J., Pereira, M. A., & Curran, K. M. (2000). Changes in physical activity patterns in the United States, by sex and cross-sectional age. Medicine & Science in Sports & Exercise, 32(9), 1601-1609.
* 1 2 American College Health Association (2016) Journal of American College Health. Retrieved from https://www.acha.org/ACHA/Resources/Publications/Journal/ACHA/Resources/JACH.aspx
* ↑ Romero-Corral, A., Somers, V. K., Sierra-Johnson, J., Thomas, R. J., Bailey, K. R., Collazo-Clavell, M. L., ... & Lopez-Jimenez, F. (2008). Accuracy of body mass index to diagnose obesity in the US adult population. International journal of obesity (2005), 32(6), 959.
* 1 2 Kang, M., Marshall, S. J., Barreira, T. V., & Lee, J. O. (2009). Effect of pedometer-based physical activity interventions: a meta-analysis. Research quarterly for exercise and sport, 80(3), 648-655.