# Exercise as it relates to Disease/Steps in the right direction for improved metabolic health in overweight individuals

This wiki critiques the article: MOKHTAR, ABD HALIM, H., ZAILANI, M. H., ISA, A., & FAUZI, N. F. M. (2019). A 10-Week Pedometer-Based Walking Program Induced Weight Loss and Improved Metabolic Health in Community-Dwelling Adults. Jurnal Sains Kesihatan Malaysia, 17(1), 21–29.

## What is the background to this research?

Metabolic Syndrome (MetS) is a cluster of cardiovascular pathologies that occur simultaneously. These pathologies include obesity, high blood pressure, high blood triglycerides, low levels of HDL cholesterol and insulin resistance. Although MetS is not a disease it has shown to increase risk of developing Cardiovascular disease (CVD) which is the leading cause of death worldwide. Making it essential to investigate how we can decrease MetS in this context to reduce the burden of the CVD.
Sedentary behaviour is an independent risk factor linked to an increase of many different health conditions such as Obesity, CVD and mortality. Increased sedentary behaviour and physical inactivity have also shown a rise in chances of getting MetS by around 73%. Many studies have shown walking is among the most popular physical activities in society as it offers a simple approach to exercise. Health programs around the world have embraced the use of pedometers and 10,000 steps a day as motivation to achieve the physical activity guidelines.
The purpose of the present study was to see if pedometers and a walking intervention would promote physical activity (PA) in obese/overweight subjects currently not reaching the PA guidelines. Thus resulting in lowering their body compensation and improving health indices that may result in MetS.

## Where is the research from?

This research was undertaken in Malaysia, with support from the ministry of Health Malaysia. The main author was a student at Universiti Kebangsaan Malaysia, with co-authors from the ministry of health Malaysia. Corresponding author Nor Farah Mohamad Fauzi has been apart of many past study papers mainly in the field of Physical Activity.
It is important when looking at this study to note BMI and Body fat percentages differ between ethnic groups, Especially when comparing asian groups to the western world due to differences in lifestyle behaviours. This may impact the generalisability of this study.
No conflict of interest were declared in this study.

## What kind of research was this?

The research method was an observational within subject cohort study. The study compared participants pre and post intervention. This was an open trial where the subjects were aware of the intervention in place. The intervention was a Lifestyle behavioural intervention, hoping to increase PA in obese subjects.
Participants volunteered to be apart of this study which can be a limitation as individuals were motivated to change their Physical activity behaviour which may present selection bias as the response may be different to those who are unmotivated.
Participants were excluded if they were:
* Currently following an Exercise Program
* Pregnant
* Multiple comorbid conditions
* Orthopaedic limitation that interfere was ability to walk
* BMI values <23.0kg/m2

## What did the research involve?

The intervention was based on a 10-week time frame, once participants had gone through the screening process and accepted for the study they received an Omron Pedometer to track their steps and log books that were collected weekly.
In the week prior to the interventions Participants daily steps were collected and used to establish a baseline daily steps for each participant.
During the first 2 weeks the aim was to increase walking behaviour gradually by participants walking 3000 steps above their average baseline reading.
3000 steps was chosen based on the assumption that moderate brisk walking produces 100 steps a minute therefore 3000 steps would equate to around 30mins which is inline with current PA guidelines of 30 mins of moderate PA.
During the other 8 weeks participants were required to achieve 8000-10,000 steps at least one day a week while maintaining the additional 3000 steps above baseline on the other days.
To increase motivation and daily participation the study included:
* Educational intervention - Brochures containing benefits of walking.
* Participants received daily reminders and encouragement messages through a group messaging app.
* Group evening walks were organised during weekdays.
* Participants were also encouraged to take part in one weekend activity organised by the health promotion community centre.
At the conclusion of the 10-week program subjects Anthropometric measurements of weight, height and waist circumference were taken. Resting blood pressure was measured and over night fasting blood samples to measure glucose and lipid concentrations.

## What were the basic results?

The results showed that the use of the pedometer and step goals especially 10,000 can have a positive impact on increasing PA in community dwelling adults.
When comparing the participants test results pre and post intervention, the results showed:
* Increase in physical activity of over 200% above baseline values
* Significant Reduction in body weight, BMI and waist circumference
* Significant improvements to fasting blood glucose and systolic blood pressure - significant effect on fasting blood glucose in Participants who lost weight
These results overall resulted in improved MetS parameters.
The researchers of this study acknowledged the limitations which would have an impact on the intervention of the study. This included the exclusion of a control group, a control group would have made sure the results are due to the manipulation of the variable.

## What conclusions can we take from this research?

Overall this study proves that walking with the use of a pedometer and a step goal can lead to improved parameters associated with metabolic health resulting in reduced chances of being diagnosed with MetS.
Accumulation of results from current research on MetS, Have proven that an increase in PA and decrease in sedentary behaviour will result in a decrease in weight and have a significant reduction in metabolic syndrome risk factors. The method used was successful although any PA that can result in weight loss would show similar results.
In the future it would be helpful to include a control group to increase reliability and decrease limitations. It is unknown if there were appetite changes due to more movement or subjects being motivated to change diet habits during the intervention. Non-exercise energy thermogenesis (NEAT) would also be helpful to track as people can still be physically active but sedentary. Tracking diet and NEAT would impact the reliability of this study. Although a study by Richard et al. 2008 found that pedometer based walking did lead to weight loss without having a dietary intervention in place.

## Practical advice

From this study people who are overweight should increase their PA levels to decrease MetS risk factors. If you are implementing PA and are unaccustomed to activity, walking is the perfect place to start it's gentle, won't over exert you and is the perfect PA to gradually build on.
Recommendations include:
* Increase daily steps by a minimum of 3000 steps a day, approximately 30 minutes of moderate physical activity everyday
* A step goal and pedometer is a good visual motivator to help monitor your goal.
* The use of a social aspect such as organised group walks are good ways to motivate participants.
* Brochures and motivating messages about the benefits of walking are a beneficial educational tool to promote motivation.
Make sure to consult with Medical professionals if you have any limitations stopping you from walking, May effect step goal or another Physical Activity intervention may need to be put in place.

## Further Reading

Physical activity guidelines and Walking tips:
https://walking.heartfoundation.org.au/benefits-of-walking/walking-tips/
https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians
Metabolic syndrome - If you are concerned about your health please seek medical guidance:
https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome
http://exerciseismedicine.com.au/wp-content/uploads/2020/10/EIM-fact-sheet_Metabolic-Syndrome_Professional.pdf

## References

* 1 2 What is Metabolic Syndrome?. (2021). Retrieved 7 September 2022, from https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome
* ↑ Cardiovascular diseases. (2022). Retrieved 8 September 2022, from https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
* ↑ Physical inactivity a leading cause of disease and disability, warns WHO. (2002). Retrieved 4 September 2022, from https://www.who.int/news/item/04-04-2002-physical-inactivity-a-leading-cause-of-disease-and-disability-warns-who#:~:text=Sedentary%20lifestyles%20increase%20all%20causes,lipid%20disorders%2C%20depression%20and%20anxiety.
* ↑ Edwardson, C. L., Gorely, T., Davies, M. J., Gray, L. J., Khunti, K., Wilmot, E. G., Yates, T., & Biddle, S. J. (2012). Association of sedentary behaviour with metabolic syndrome: a meta-analysis. PloS one, 7(4), e34916. https://doi.org/10.1371/journal.pone.0034916
* 1 2 Hart, J. (2009). The health benefits of walking. Alternative and Complementary Therapies, 15(1), 7-10.
* ↑ Yeh, W. T., & Weng, L. C. (2008). Epidemiology of metabolic syndrome in Asia. Asia Pacific journal of clinical nutrition, 17, 37-42.
* ↑ Marshall, S. J., Levy, S. S., Tudor-Locke, C. E., Kolkhorst, F. W., Wooten, K. M., Ji, M., ... & Ainsworth, B. E. (2009). Translating physical activity recommendations into a pedometer-based step goal: 3000 steps in 30 minutes. American journal of preventive medicine, 36(5), 410-415.
* ↑ Case, C. C., Jones, P. H., Nelson, K. A. T. H. I. E., O'Brian Smith, E., & Ballantyne, C. M. (2002). Impact of weight loss on the metabolic syndrome. Diabetes, obesity and metabolism, 4(6), 407-414.
* 1 2 Busetto, L. (2001). Visceral obesity and the metabolic syndrome: effects of weight loss. Nutrition, metabolism, and cardiovascular diseases: NMCD, 11(3), 195-204. Chicago
* ↑ Richardson, C. R., Newton, T. L., Abraham, J. J., Sen, A., Jimbo, M., & Swartz, A. M. (2008). A meta-analysis of pedometer-based walking interventions and weight loss. The Annals of Family Medicine, 6(1), 69-77.