A randomized trial comparing structured and lifestyle goals in an internet-mediated walking program for people with type 2 diabetes Taking Healthy Steps: rationale, design and baseline characteristics of a randomized trial of a pedometer-based internet-mediated walking program in veterans with chronic obstructive pulmonary disease School-based intervention to enable school children to act as change agents on weight, physical activity and diet of their mothers: a cluster randomized controlled trial Do school-based physical activity interventions increase or reduce inequalities in health? Social cognitive theory mediators of physical activity in a lifestyle program for cancer survivors and carers: findings from the ENRICH randomized controlled trial Effectiveness of pedometer use in motivating active duty and other military healthcare beneficiaries to walk more. Effects of a controlled pedometer-intervention trial for low-active adolescent girls. Short- and Long-Term Effects of Balance Training on Physical Activity in Older Adults With Osteoporosis: A Randomized Controlled Trial Short-term and long-term effects of a self-managed physical activity program using a pedometer for chronic respiratory disease: a randomized controlled trial International Mobile-Health Intervention on Physical Activity, Sitting, and Weight: The Stepathlon Cardiovascular Health Study. The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial Effects of integrating pedometers, parental materials, and E-mail support within an extracurricular school sport intervention. Habitual physical activity and health-related quality of life in older adults: interactions between the amount and intensity of activity (the Nakanojo Study) Effectiveness of a smartphone app in increasing physical activity amongst male adults: a randomised controlled trial Impact of a home-based activity and dietary intervention in people with slowly progressive neuromuscular diseases. Long-Term Effects of an Internet-Mediated Pedometer-Based Walking Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial Criterion and Concurrent Validity of the activPAL™ Professional Physical Activity Monitor in Adolescent Females Effect of physical activity intervention based on a pedometer on physical activity level and anthropometric measures after childbirth: a randomized controlled trial Effect of a 6-month pedometer-based walking intervention on functional capacity in patients with chronic heart failure with reduced (HFrEF) and with preserved (HFpEF) ejection fraction: study protocol for two multicenter randomized controlled trials Generations Exercising Together to Improve Fitness (GET FIT): A Pilot Study Designed to Increase Physical Activity and Improve Health-Related Fitness in Three Generations of Women Investigating the effect of a 3-month workplace-based pedometer-driven walking programme on health-related quality of life in meat processing workers: a feasibility study within a randomized controlled trial Does physical activity counselling enhance the effects of a pedometer-based intervention over the long-term: 12-month findings from the Walking for Wellbeing in the west study Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial.
Background The majority of individuals with type 2 diabetes do not exercise regularly . Pedometer-based walking interventions can help ; however , pedometer-based interventions targeting only total daily accumulated steps might not yield the same health benefits as physical activity programs specifying a minimum duration and intensity of physical activity bouts . Methods This pilot r and omized trial compared two goal - setting strategies : 1 ) lifestyle goals targeting total daily accumulated step counts and 2 ) structured goals targeting bout steps defined as walking that lasts for 10 minutes or longer at a pace of at least 60 steps per minute . We sought to determine which goal - setting strategy was more effective at increasing bout steps . Participants were sedentary adults with type 2 diabetes . All participants : wore enhanced pedometers with embedded USB ports ; uploaded detailed , time-stamped step-count data to a website called Stepping Up to Health ; and received automated step-count feedback , automatically calculated goals , and tailored motivational messages throughout the six-week intervention . Only the automated goal calculations and step-count feedback differed between the two groups . The primary outcome of interest was increase in steps taken during the previously defined bouts of walking ( lasting at least 10 minutes or longer at a pace of at least 60 steps per minute ) between baseline and end of the intervention . Results Thirty-five participants were r and omized and 30 ( 86 % ) completed the pilot study . Both groups significantly increased bout steps , but there was no statistically significant difference between groups . Among study completers , bout steps increased by 1921 ± 2729 steps a day . Those who received lifestyle goals were more satisfied with the intervention ( p = 0.006 ) and wore the pedometer more often ( p < 0.001 ) than those who received structured goals . Conclusion In this six-week intervention , Lifestyle Goals group participants achieved increases in bout steps comparable to the increases seen in the Structured Goals group , representing almost a mile a day of additional moderate intensity bout activity . Pedometer-based walking programs that emphasize total accumulated step counts are more acceptable to participants and are as effective at increasing moderate intensity bouts of physical activity as programs that use structured goals .Trial registration Background Low levels of physical activity are common in patients with chronic obstructive pulmonary disease ( COPD ) , and a sedentary lifestyle is associated with poor outcomes including increased mortality , frequent hospitalizations , and poor health-related quality of life .  Internet-mediated physical activity interventions may increase physical activity and improve health outcomes in persons with COPD . Methods / Design This manuscript describes the design and rationale of a r and omized controlled trial that tests the effectiveness of Taking Healthy Steps , an Internet-mediated walking program for Veterans with COPD .  Taking Healthy Steps includes an uploading pedometer , a website , and an online community .  Eligible and consented patients  wear a pedometer to obtain one week of baseline data and then are r and omized on a 2:1 ratio to Taking Healthy Steps or to a wait list control . The intervention arm receives iterative step-count feedback ; individualized step-count goals , motivational and informational messages , and access to an online community . Wait list controls are notified that they are enrolled , but that their intervention will start in one year ; however , they keep the pedometer and have access to a static webpage . Discussion Participants include 239 Veterans ( mean age 66.7 years , 93.7 % male ) with 155 r and omized to Taking Healthy Steps and 84 to the wait list control arm ; rural-living ( 45.2 % ) ; ever-smokers ( 93.3 % ) ; and current smokers ( 25.1 % ) . Baseline mean St. George ’s Respiratory Question naire Total Score was 46.0 ; 30.5 % reported severe dyspnea ; and the average number of comorbid conditions was 4.9 . Mean baseline daily step counts was 3497 ( + /- 2220).Veterans with COPD can be recruited to participate in an online walking program . We successfully recruited a cohort of older Veterans with a significant level of disability including Veterans who live in rural areas using a remote national recruitment strategy .Trial registration Clinical Trials.gov Background School health promotion has been shown to improve the lifestyle of students , but it remains unclear whether school-based programs can influence family health . We developed an innovative program that enables school children to act as change agents in promoting healthy lifestyles of their mothers . The objective of this study was to examine the effect of the child-initiated intervention on weight , physical activity and dietary habit of their mothers . Methods A 12-month cluster r and omized trial was conducted , with school as a cluster . Participants were mothers with grade 8 students , aged around 13 years , of 20 schools in Homagama , Sri Lanka . Students of the intervention group were trained by facilitators to acquire the ability to assess noncommunicable disease risk factors in their homes and take action to address them , whereas those of the comparison group received no intervention .  Body weight , step count and lifestyle of their mothers were assessed at baseline and post-intervention . Multi-level multivariable linear regression and logistic regression were used to assess the effects of intervention on continuous and binary outcomes , respectively . Results Of 308 study participants , 261 completed the final assessment at 12 month . There was a significantly greater decrease of weight and increase of physical activity in the intervention group . The mean ( 95 % confidence interval ) difference comparing the intervention group with the control group was −2.49 ( −3.38 to −1.60 ) kg for weight and −0.99 ( −1.40 to −0.58 ) kg/m2 for body mass index . The intervention group had a 3.25 ( 95 % confidence interval 1.87–5.62 ) times higher odds of engaging in adequate physical activity than the control group , and the former showed a greater number of steps than the latter after intervention . The intervention group showed a greater reduction of household purchase of biscuits and ice cream . Conclusions A program to motivate students to act as change agents of family ’s lifestyle was effective in decreasing weight and increasing physical activity of their mothers . Trial registration Sri Lanka Clinical Trials Registry SLCTR/2013/011 Little is known about the effectiveness of school-based health promotion on physical activity inequalities among children from low-income areas . This study compared the two-year change in physical activity among 10 - 11 year-old children attending schools with and without health promotion programs by activity level , body weight status , and socioeconomic background s to assess whether health promotion programs reduce or exacerbate health inequalities . This was a quasi-experimental trial of a Comprehensive School Health ( CSH ) program implemented in schools located in socioeconomically disadvantaged neighbourhoods in Edmonton , Alberta , Canada . In the spring of 2009 and 2011 , pedometer ( 7 full days ) and demographic data were collected from cross-sectional sample s of grade five children from 10 intervention and 20 comparison schools . Socioeconomic status was determined from parent self-report . Low-active , active , and high-active children were defined according to step-count tertiles . Multilevel linear regression methods adjusted for potential confounders were used to assess the relative inequity in physical activity and were compared between groups and over-time . In 2009 , a greater proportion of students in the intervention schools were overweight ( 38 % vs. 31 % p = 0.03 ) and were less active ( 10,827 vs. 12,265 steps/day p < 0.001 ) . Two years later , the relative difference in step-counts between intervention and comparison schools reduced from -15.5 % to 0 % among low-active students , from -13.4 % to 0 % among active students , and from -15.1 % to -2.7 % among high-active students . The relative difference between intervention and comparison schools reduced from -11.1 % to -1.6 % among normal weight students , from -16.8 % to -1.4 % among overweight students , and was balanced across socioeconomic subgroups . These findings demonstrate that CSH programs implemented in socioeconomically disadvantaged neighbourhoods reduced inequalities in physical activity . Investments in school-based health promotion are a viable , promising , and important approach to improve physical activity and prevent childhood obesity , and may also reduce inequalities in health Background Despite increasing numbers of cancer survivors and evidence that diet and physical activity improves the health of cancer survivors , most do not meet guidelines . Some social cognitive theory (SCT)-based interventions have increased physical activity behavior , however few have used objective physical activity measures . The Exercise and Nutrition Routine Improving Cancer Health ( ENRICH ) r and omized controlled trial reported a significant intervention effect for the primary outcome of pedometer-assessed step counts at post-test ( 8-weeks ) and follow-up ( 20-weeks ) . The aim of this study was to test whether the SCT constructs operationalized in the ENRICH intervention were mediators of physical activity behavior change . Methods R and omized controlled trial with 174 cancer survivors and carers assessed at baseline , post-test ( 8-weeks ) , and follow-up ( 20-weeks ) . Participants were r and omized to the ENRICH six session face-to-face healthy lifestyle program , or to a wait-list control . Hypothesized SCT mediators of physical activity behavior change ( self-efficacy , behavioral goal , outcome expectations , impediments , and social expectations ) were assessed using valid and reliable scales . Mediation was assessed using the Preacher and Hayes SPSS INDIRECT macro . Results At eight weeks , there was a significant intervention effect on behavioral goal ( A = 9.12 , p = 0.031 ) and outcome expectations ( A = 0.25 , p = 0.042 ) . At 20 weeks , the intervention had a significant effect on self-efficacy ( A = 0.31 , p = 0.049 ) and behavioral goal ( A = 13.15 , p = 0.011 ) . Only changes in social support were significantly associated with changes in step counts at eight weeks ( B = 633.81 , p = 0.023 ) . Behavioral goal was the only SCT construct that had a significant mediating effect on step counts , and explained 22 % of the intervention effect at 20 weeks ( AB = 397.9 , 95 % CI 81.5–1025.5 ) . Conclusions SCT constructs had limited impact on objective ly-assessed step counts in a multiple health behavior change intervention for cancer survivors and their carers . Behavioral goal measured post-intervention was a significant mediator of pedometer-assessed step counts at 3-months after intervention completion , and explained 22 % of the intervention effect . Future research should examine the separate impact of goals and planning , as well as examining mediators of behavior maintenance in physical activity interventions targeting cancer survivors . Trial registration Australian and New Zeal and Clinical Trials registry ANZCTRN1260901086257 Although implementing a regular exercise program may initially seem overwhelming to individuals attempting weight loss , increasing walking with a focus on steps-per-day may be a more realistic means for encouraging physical activity . This study evaluated the effectiveness of pedometer use for motivating an increase in physical activity among overweight/obese military beneficiaries . Participants ( N=106 ) were r and omly assigned to either the " Usual Lifestyle " ( no change in activity advised ) or " Pedometer " group ( education and encouraged to obtain 10,000 steps per day ) , and both groups were assessed for changes in physical activity , anthropometric measures , and clinic measures over time . Results ( n=89 ) demonstrated improvements in physical activity and all measured indices across both groups . There was a statistically significant increase in steps per day by time ( P<.001 ) , however , no statistically significant difference between treatment groups over time ( P=.167 ) . Approximately 49.4 % of participants achieved the 10,000 steps per day goal at follow-up . All secondary measured indices , except blood pressure , demonstrated a significant change overall from baseline to posttest : weight ( P<.001 ) , BMI ( P<.001 ) , percent body fat ( P=.001 ) and heart rate ( P=.005 ) . Findings indicate that all participants made lifestyle changes , possibly as a result of frequent investigator-participant interaction , however , more likely due to the pedometer serving as a tangible tool to constantly remind the wearer to get up and walk more , regardless if a step count is tracked PURPOSE This intervention compares the effectiveness of daily step count targets with time-based prescription for increasing the health-related physical activity of low-active adolescent girls . METHODS We assigned participants ( N = 85 , mean age 15.8 + /- 0.8 yr ) depending on school attended to a control ( CON ) , pedometer ( PED ) , or minutes ( MIN ) group . The intervention groups were involved in a 12-wk physical activity self-monitoring and educative program . The only difference between the intervention groups was that the PED group set daily step count targets whereas the MIN group set daily time-based goals for physical activity involvement . Pre- , mid- , and postintervention changes in physical activity ( 4-d blinded step count and 3-d physical activity recall ) and body mass index ( BMI ) were assessed using a series of 3 ( group assignment ) x 3 ( time ) ANOVA . Where significant interactions were found , separate follow-up simple main effects tests were used . RESULTS At postintervention , only the PED group had significantly increased their total activity as measured by a 4-d step count , when compared with the control ( P = 0.03 , ES = 0.13 ) . The group , time , and interaction effects for 4-d step count were significant , indicating that although both the participants in the PED and the MIN groups significantly increased their step count across the 12-wk intervention ( P = 0.00 - 0.01 ) , the participants in the PED group had a greater increase at the midintervention time point ( P = 0.04 , ES = 0.10 ) . No pre- , mid- , or postintervention changes were reported in any group for BMI ( F = 1.18 , P = 0.32 ) . CONCLUSION The use of pedometers and daily step count targets with low-active adolescent girls may result in short-term ( 6 wk ) enhanced physical activity related outcomes when compared with traditional time-based physical activity prescriptions . However , both interventions appear to result in similar improvements in physical activity when duration of the observation is extended to 12 wk Background and Purpose : We have developed a 12-week balance training program for older adults shown to improve fall-related concerns , gait speed , balance performance , and physical function . We hypothesized that this balance training would also contribute to higher habitual physical activity ( PA ) levels and improved health-related quality of life ( HRQoL ) . The primary aim was to evaluate short- and long-term effects of the balance training program on objective ly measured habitual PA in older adults with osteoporosis . Secondary aims were to assess the effects of the balance training on HRQoL , and to study whether any effects on PA were associated with changes in HRQoL , gait speed , balance performance , fall-related concerns , and physical function . Methods : A r and omized controlled trial with follow-up at 3 , 9 , and 15 months , including 91 participants with osteoporosis ( 75.6 ± 5.4 years ) , compared a balance training group  ( n = 61 ) with a control group ( n = 30 ) . The primary outcome was effect on habitual PA measured as steps/day , dichotomized into less than 5000 or 5000 or more steps/day . Physical activity was assessed with pedometers ( Yamax ) and accelerometers ( Actigraph ) , HRQoL with the Short Form-36 ( SF-36 ) , gait with a GAITRite walkway , balance performance with Modified-Figure-Eight test and one-leg stance , fall-related concerns with Falls Efficacy Scale International , and physical function with the advanced lower extremity subscale of the question naire Late Life Function and Disability Instrument . Statistical methods used were multivariate logistic regression and logistic generalized estimating equation . Results : Sixty-eight participants completed the short-term follow-up at 3 months , and 53 participants completed the long-term follow-up at 15 months . Per- protocol analysis ( n = 68 ) showed that the odds ratio for having a daily step count of 5000 or more at 3 months was 6.17 ( 95 % confidence interval , 1.23 - 30.91 ) , P = .027 , for the intervention group compared with the control group . The longitudinal analysis ( n = 91 ) showed that the odds ratio for having a daily step count of 5000 or more at 15 months was 2.02 ( 95 % confidence interval , 0.88 - 4.64 ) , P = .096 , for the intervention group compared with the control group . The mental component sum of the SF-36 improved significantly from baseline to 3 months in the intervention group , and the physical component sum improved in both groups , but no statistically significant differences were found between groups . No associations were found between PA and changes in covariates . Discussion and Conclusions : The short-term evaluation showed that balance training increased habitual PA in community-dwelling older adults with osteoporosis . A significantly higher proportion of participants in the intervention group reached a level of 5000 or more steps/day , which is important for overall health . This effect was not associated with improvements in HRQoL , gait speed , balance performance , or fall-related concerns , and did not persist through the long-term follow-up . To accomplish a sustained PA change , a prolonged intervention or more support regarding habitual PA may be required , such as reinforcement with personalized behavior change counseling or PA on prescription [ Purpose ] The aim of this study was to evaluate the effects of a self-managed physical activity program using a pedometer and diary on physical function , ADL , and QOL in patients with chronic respiratory disease . [ Subjects and Methods ] 17 out patients with chronic respiratory disease were assessed for dyspnea , muscle strength , exercise tolerance , ADL , and QOL at baseline , after 3- , and 6-months after the start of the program . Patients were r and omly assigned to “ Control ” or “ Diary ” group . In the Diary group , the number of steps was counted with a pedometer and recorded in a diary together with self-evaluation of physical activity  , while patients assigned to the Control group did not use a pedometer or keep a diary . [ Results ] The Diary group showed significant improvement in the daily step count over time . The Diary group showed significant improvement of the dyspnea , muscle strength , and exercise tolerance at 3 months , dyspnea and muscle strength at 6 months . Significant differences found between two groups with regard to the extent of change in the muscle strength , exercise tolerance , and QOL at 3 months . [ Conclusion ] This study suggests that a self-managed physical activity program using a pedometer and diary can increase the level of physical activity BACKGROUND Although proof-of-concept for mobile health ( mHealth ) life-style programs targeting physical inactivity and overweight/obesity has been established in r and omized trials , the feasibility and effect of a globally distributed , large-scale , mass-participation mHealth implementation has not been investigated . OBJECTIVES The purpose of this study was to determine the effect of Stepathlon , an international , low-cost , mass-participation mHealth intervention , on physical activity , sitting , and weight . METHODS We prospect ively collected cohort data from participants completing Stepathlon , an annual 100-day global event in 2012 , 2013 , and 2014 . Participants were organized in worksite-based teams , issued pedometers , and encouraged to increase daily steps and physical activity as part of the team-based race . The program was conducted via an interactive multiplatform application available on mobile devices and the Internet . Analysis was performed according to a pre-specified plan . RESULTS A total of 69,219 subjects participated ( 481 employers , 1,481 cities , 64 countries , all populated continents , age 36 ± 9 years , 23.9 % female , 8.0 % high-income countries , and 92.0 % lower-middle income countries ) . After Stepathlon completion , participants recorded improved step count ( + 3,519 steps/day ; 95 % confidence interval [ CI ] : 3,484 to 3,553 steps/day ; p < 0.0001 ) , exercise days ( + 0.89 days ; 95 % CI : 0.87 to 0.92 days ; p < 0.0001 ) , sitting duration ( -0.74 h ; 95 % CI : -0.78 to -0.71 h ; p < 0.0001 ) and weight ( -1.45 kg ; 95 % CI : -1.53 to -1.38 kg ; p < 0.0001 ) . Improvements occurred in women and men , in all geographic regions , and in both high and lower-middle income countries , and the results were reproduced in 2012 , 2013 , and 2014 cohorts . Predictors of weight loss included step increase , sitting duration decrease , and increase in exercise days ( all p < 0.0001 ) . CONCLUSIONS Distributed mHealth implementation of a low-cost life-style intervention is associated with short-term , reproducible , large-scale improvements in physical activity , sitting , and weight . ( Effect of the Stepathlon Pedometer Program on Physical Activity , Weight and Well-Being ; ACTRN12615001310550 ) Background Recent systematic review s have suggested that pedometers may be effective motivational tools to promote walking . However , studies tend to be of a relatively short duration , with small clinical based sample s. Further research is required to demonstrate their effectiveness in adequately powered , community based studies . Objective Using a r and omized controlled trial design , this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts , self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations . MethodS ixty-three women and 16 men ( 49.2 years ± 8.8 ) were r and omly assigned to either an intervention ( physical activity consultation and 12-week pedometer-based walking program ) or control ( no action ) group . Measures for step-counts , 7-day physical activity recall , affect , quality of life ( n = 79 ) , body mass , BMI , % body fat , waist and hip circumference ( n = 76 ) , systolic/diastolic blood pressure , total cholesterol and HDL cholesterol ( n = 66 ) were taken at baseline and week 12 . Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data . Results Significant increases were found in the intervention group for step-counts ( p < .001 ) , time spent in leisure walking ( p = .02 ) and positive affect ( p = .027 ) . Significant decreases were found in this group for time spent in weekday ( p = .003 ) , weekend ( p = .001 ) and total sitting ( p = .001 ) with no corresponding changes in the control group . No significant changes in any other health outcomes were found in either group . In comparison with the control group at week 12 , the intervention group reported a significantly greater number of minutes spent in leisure time ( p = .008 ) , occupational ( p = .045 ) and total walking ( p = .03 ) , and significantly fewer minutes in time spent in weekend ( p = .003 ) and total sitting ( p = .022 ) . Conclusion A pedometer-based walking program , incorporating a physical activity consultation , is effective in promoting walking and improving positive affect over 12 weeks in community based individuals . The discussion examines possible explanations for the lack of significant changes in health outcomes . Continued follow-up of this study will examine adherence to the intervention and possible result ing effects on health outcomes PURPOSE The objective of this study was to evaluate the impact of a school-based intervention ( Program X ) incorporating pedometers and e-mail support on physical activity , sedentary behavior , and healthy eating  in adolescents . METHODS A r and omized control trial was used to evaluate the impact of the Program X intervention .  Six schools ( N = 124 participants ; mean age 14.1 + /- .8 years ) were r and omized to intervention or control conditions for the 6-month study period . Objective ly recorded physical activity ( mean steps/day ) , self-reported sedentary behavior , and dietary habits were measured at baseline and at 6-month follow-up and intervention effects were assessed using repeated- measures analysis of variance and chi(2 ) tests . RESULTS Participants in the intervention group increased their step counts by 956 + /- 4107 steps/day ( boys ) and 999 + /- 1999 ( girls ) . Repeated- measures analysis of variance revealed significant group-by-time interactions for boys ( F = 7.4 , p = .01 , d = .80 ) and girls ( F = 29.6 , p < .001 , d = 1.27 ) for mean steps/day . The intervention significantly decreased the number of energy-dense/low-nutrient snacks consumed by boys ( chi(2 ) = 4.0 , p = .043 ) and increased the number of fruit serves among girls ( chi(2 ) = 4.8 , p = .028 ) . The intervention did not have a statistically significant effect on sedentary behavior . CONCLUSION A school-based intervention incorporating physical activity monitoring using pedometers and e-mail support was successful in promoting physical activity and selected healthy eating behaviors in adolescent boys and girls Purpose This study examined relationships between health-related quality of life ( HRQOL ) and objective assessment s of habitual physical activity in older adults , focusing on interactions between the amount and intensity of activity . Methods Subjects were healthy Japanese aged 65–85 years ( 74 men and 109 women ) .  Pedometer/accelerometers measured their step counts and the intensity of physical activity in metabolic equivalents ( METs ) continuously 24 h per day for 1 year . Each individual ’s final HRQOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) instrument . Results The daily step count and the daily duration of physical activity at an intensity > 3 METs were quite closely correlated ( quadratic r2 = 0.93 , P < 0.05 ) . After controlling for age , sex , and daily step count , the overall SF-36 score and four constituent dimensions ( physical functioning , freedom from pain , vitality , and mental health ) were all significantly higher in individuals spending > 25 % of their total activity at an intensity > 3 METs . However , engagement in activity > 3 METs was not significantly associated with the remaining SF-36 components ( physical limitations , general health , social functioning , and emotional limitations ) . Conclusions Associations between moderate-intensity physical activity and HRQOL in older adults merit further evaluation by prospect i ve studies and /or r and omized controlled trials Background Smartphones are ideal for promoting physical activity in those with little intrinsic motivation for exercise . This study tested three hypotheses : H1 – receipt of social feedback generates higher step-counts than receipt of no feedback ; H2 – receipt of social feedback generates higher step-counts than only receiving feedback on one ’s own walking ; H3 – receipt of feedback on one ’s own walking generates higher step-counts than no feedback ( H3 ) . Methods A parallel group r and omised controlled trial measured the impact of feedback on steps-counts .  Healthy male participants ( n = 165 ) aged 18–40 were given phones pre-installed with an app that recorded steps continuously , without the need for user activation . Participants carried these with them as their main phones for a two-week run-in and six-week trial . R and omisation was to three groups : no feedback ( control ) ; personal feedback on step-counts ; group feedback comparing step-counts against those taken by others in their group . The primary outcome measure , steps per day , was assessed using longitudinal multilevel regression analysis . Control variables included attitude to physical activity and perceived barriers to physical activity . Results Fifty-five participants were allocated to each group ; 152 completed the study and were included in the analysis : n = 49 , no feedback ; n = 53 , individual feedback ; n = 50 , individual and social feedback . The study provided support for H1 and H3 but not H2 . Receipt of either form of feedback explained 7.7 % of between-subject variability in step-count ( F = 6.626 , p < 0.0005 ) . Compared to the control , the expected step-count for the individual feedback group was 60 % higher ( effect on log step-count = 0.474 , 95 % CI = 0.166–0.782 ) and that for the social feedback group , 69 % higher ( effect on log step-count = 0.526 , 95 % CI = 0.212–0.840 ) . The difference between the two feedback groups ( individual vs social feedback ) was not statistically significant . Conclusions Always-on smartphone apps that provide step-counts can increase physical activity in young to early-middle-aged men but the provision of social feedback has no apparent incremental impact . This approach may be particularly suitable for inactive people with low levels of physical activity ; it should now be tested with this population OBJECTIVE To determine whether a home-based activity and dietary intervention can increase activity level , reduce caloric intake , and impact positively components of metabolic syndrome  in a disabled population . DESIGN Testing occurred at 3 points during the 6-month intervention period ( baseline , 3mo , 6mo ) and at 6 months postintervention . Each test point included laboratory testing of anthropometric and metabolic variables and 3 days of home-based activity and dietary monitoring . A personally tailored activity and dietary prescription based on baseline testing was implemented during the 6-month intervention period . SETTING Human performance laboratory of a university and each subject 's home . PARTICIPANTS Twenty adult volunteer ambulatory subjects with several types of slowly progressive neuromuscular disease ( NMD ) . INTERVENTION Using a pedometer , subjects were instructed to increase number of steps by 25 % over their baseline determined from home monitoring . An individualized dietary prescription was provided focusing on problematic issues identified from the baseline dietary profile . MAIN OUTCOME MEASURES Body composition , physical activity , dietary intake , energy expenditure , gait efficiency , metabolic variables , and quality of life . RESULTS At the end of the protocol , mean step count increased approximately 27 % above baseline ( P=.001 ) and caloric intake decreased over 300kcal/d ( P=.002 ) . Body fat percentage significantly decreased ( from 33.3%+/-1.5 % to 32.6%+/-1.6 % , P=.032 ) . Gait efficiency did not change , and metabolic variables did not show statistically significant improvement , although 2 of the 5 subjects originally meeting the criteria for metabolic syndrome at baseline no longer met the criteria at the end of the intervention period . Six months after completing the protocol , caloric intake remained significantly reduced ( P=.02 ) , but although mean step count remained elevated , it was not statistically significant . CONCLUSIONS Using a home-based protocol , people with NMD can increase activity and reduce caloric intake . Although this 6-month program showed positive changes , it was insufficient to affect risk factors associated with metabolic syndrome . It remains to be seen if a program longer than 6 months or a more rigorous program could lead to a reduction in the risk factors associated with metabolic syndrome Background Regular physical activity ( PA ) is recommended for persons with chronic obstructive pulmonary disease ( COPD ) . Interventions that promote PA and sustain long-term adherence to PA are needed . Objective We examined the effects of an Internet-mediated , pedometer-based walking intervention , called Taking Healthy Steps , at 12 months . Methods Veterans with COPD ( N=239 ) were r and omized in a 2:1 ratio to the  intervention  or wait-list control . During the first 4 months , participants in the intervention group were instructed to wear the pedometer every day , upload daily step counts at least once a week , and were provided access to a website with four key components : individualized goal setting , iterative feedback , educational and motivational content , and an online community forum . The subsequent 8-month maintenance phase was the same except that participants no longer received new educational content . Participants r and omized to the wait-list control group were instructed to wear the pedometer , but they did not receive step-count goals or instructions to increase PA . The primary outcome was health-related quality of life ( HRQL ) assessed by the St George ’s Respiratory Question naire Total Score ( SGRQ-TS ) ; the secondary outcome was daily step count . Linear mixed-effect models assessed the effect of intervention over time . One participant was excluded from the analysis because he was an outlier . Within the intervention group , we assessed pedometer adherence and website engagement by examining percent of days with valid step-count data , number of log-ins to the website each month , use of the online community forum , and responses to a structured survey . Results Participants were 93.7 % male ( 223/238 ) with a mean age of 67 ( SD 9 ) years . At 12 months , there were no significant between-group differences in SGRQ-TS or daily step count . Between-group difference in daily step count was maximal and statistically significant at month 4 ( P<.001 ) , but approached zero in months 8 - 12 . Within the intervention group , mean 76.7 % ( SD 29.5 ) of 366 days had valid step-count data , which decreased over the months of study ( P<.001 ) . Mean number of log-ins to the website each month also significantly decreased over the months of study ( P<.001 ) . The online community forum was used at least once during the study by 83.8 % ( 129/154 ) of participants . Responses to questions assessing participants ’ goal commitment and intervention engagement were not significantly different at 12 months compared to 4 months . Conclusions An Internet-mediated , pedometer-based PA intervention , although efficacious at 4 months , does not maintain improvements in HRQL and daily step counts at 12 months . Waning pedometer adherence and website engagement by the intervention group were observed . Future efforts should focus on improving features of PA interventions to promote long-term behavior change and sustain engagement in PA . Clinical Trial Clinical trials.gov NCT01102777 ; https:// clinical trials.gov/ct2/show/NCT01102777 ( Archived by WebCite at http://www.webcitation.org/6iyNP9KUC Background The activPAL has been identified as an accurate and reliable measure of sedentary behaviour . However , only limited information is available on the accuracy of the activPAL activity count function as a measure of physical activity , while no unit calibration of the activPAL has been completed to date . This study aim ed to investigate the criterion validity of the activPAL , examine the concurrent validity of the activPAL , and perform and vali date a value calibration of the activPAL in an adolescent female population . The performance of the activPAL in estimating posture was also compared with sedentary thresholds used with the ActiGraph accelerometer . Method ologies Thirty adolescent females ( 15 developmental ; 15 cross-validation ) aged 15–18 years performed 5 activities while wearing the activPAL , ActiGraph GT3X , and the Cosmed K4B2 . A r and om coefficient statistics model examined the relationship between metabolic equivalent ( MET ) values and activPAL counts . Receiver operating characteristic analysis was used to determine activity thresholds and for cross-validation . The r and om coefficient statistics model showed a concordance correlation coefficient of 0.93 ( st and ard error of the estimate = 1.13 ) . An optimal moderate threshold of 2997 was determined using mixed regression , while an optimal vigorous threshold of 8229 was determined using receiver operating statistics . The activPAL count function demonstrated very high concurrent validity ( r = 0.96 , p<0.01 ) with the ActiGraph count function . Levels of agreement for sitting , st and ing , and stepping between direct observation and the activPAL and ActiGraph were 100 % , 98.1 % , 99.2 % and 100 % , 0 % , 100 % , respectively . Conclusions These findings suggest that the activPAL is a valid , objective measurement tool that can be used for both the measurement of physical activity and sedentary behaviours in an adolescent female population Background Pregnancy and childbirth are associated with weight gain in women , and retention of weight gained during pregnancy can lead to obesity in later life . Diet and physical activity are factors that can influence the loss of retained pregnancy weight after birth . Exercise guidelines exist for pregnancy , but recommendations for exercise after childbirth are virtually nonexistent . The aim of this study was to evaluate the effect of physical activity intervention based on pedometer on physical activity level and anthropometric measures of women after childbirth . Methods We conducted a r and omized controlled trial in which 66 women who had given birth 6 weeks to 6 months prior were r and omly assigned to receive either a 12 week tailored program encouraging increased walking using a pedometer ( intervention group , n = 32 ) or routine postpartum care ( control group , n = 34 ) . During the 12-week study period , each woman in the intervention group wore a  pedometer and recorded her daily step count .  The women were advised to increase their steps by 500 per week until they achieved the first target of 5000 steps per day and then continued to increase it to minimum of 10,000 steps per day by the end of 12th week . Assessed outcomes included anthropometric measures , physical activity level , and energy expenditure per week . Data were analyzed using the paired t-test , independent t-test , Mann-Whitney , chi-square , Wilcoxon , covariance analysis , and the general linear model repeated measures procedure as appropriate . Results After 12 weeks , women in the intervention group had significantly increased their physical activity and energy expenditure per week ( 4394 vs. 1651 calorie , p < 0.001 ) . Significant differences between-group in weight ( P = 0.001 ) , Body Mass Index ( P = 0.001 ) , waist circumference ( P = 0.001 ) , hip circumference ( P = 0.032 ) and waist-hip ratio ( P = 0.02 ) were presented after the intervention . The intervention group significantly increased their mean daily step count over the study period ( from 3249 before , to 9960 after the intervention , p < 0.001 ) . Conclusion A physical activity intervention based on pedometer is an effective means to increase physical activity ; reducing retention of weight gained during pregnancy and can improve anthropometric measures in postpartum women . Trial registration IS RCT N : I RCT Abstract Background Regular physical activity is recommended for patients with chronic heart failure to improve their functional capacity , and walking is a popular , effective , and safe form of physical activity . Pedometers have shown potential to increase the amount of walking across a range of chronic diseases , but it is unknown whether a pedometer-based intervention improves functional capacity and neurohumoral modulation in heart failure patients . Methods Two multicenter r and omized controlled trials will be conducted in parallel : one in patients with chronic heart failure with reduced ejection fraction ( HFrEF ) , the other in patients with chronic heart failure with preserved ejection fraction ( HFpEF ) . Each trial will consist of a 6-month intervention with an assessment at baseline , at 3 months , at the end of the intervention , and 6 months after completing the intervention . Each trial will aim to include a total of 200 physically inactive participants with chronic heart failure who will be r and omly assigned to intervention or control arms . The 6-month intervention will consist of an individualized pedometer-based walking program with weekly step goals , behavioral face-to-face sessions with a physician , and regular telephone calls with a research nurse . The intervention will be based on effective behavioral principles ( goal setting , self-monitoring , personalized feedback ) . The primary outcome is the change in 6-min walk distance at the end of the 6-month intervention . Secondary outcomes include changes in serum biomarkers levels , pulmonary congestion assessed by ultrasound , average daily step count measured by accelerometry , anthropometric measures , symptoms of depression , health-related quality of life , self-efficacy , and MAGGIC risk score . Discussion To our knowledge , these are the first studies to evaluate a pedometer-based walking intervention in patients with chronic heart failure with either reduced or preserved ejection fraction . The studies will contribute to a better underst and ing of physical activity promotion in heart failure patients to inform future physical activity recommendations and heart failure guidelines . Trial registration The trials are registered in Clinical Trials.gov , identifiers : NCT03041610 , registered 29 January 2017 ( HFrEF ) , NCT03041376 , registered 1 February 2017 ( HFpEF ABSTRACT A 6-month home-based ( HB ) physical activity program was compared to a control ( CTL ) condition in terms of effect on physical activity and health-related fitness in three generations of women ( daughter/mother/maternal gr and mother ) . Volunteers were r and omly assigned to a HB or CTL condition . HB participants ( n = 28 ) were asked to participate in lifestyle , aerobic , muscular strength , and flexibility activities at least 3 times per week and they completed 73 % of the recommended PA bouts . CTL condition participants ( n = 9 ) were asked to continue their usual pattern of physical activity . Changes in physical activity were measured pre- and post-intervention using the Physical Best question naire and pedometer step counts ( 3-day average ) . Changes in health-related fitness were assessed using Fitnessgram tests . Group × Time interactions were significant for changes in participation in flexibility activity ( d/wk ) and steps/day , indicating that the HB group experienced significant positive changes in the expected direction ( + 305 % and + 37 % , respectively ) , while the CTL group regressed ( −15 % and −13 % , respectively ) . The G × T interaction for mile time was significant , although not in the expected direction ( CTL group < by 14 % and HB group < by 5 % ) . Findings should be interpreted with caution due to several limitations of the study , but several suggestions are made for more effectively study ing this topic in the future Background In New Zeal and , meat processing population s face many health problems as a result of the nature of work in meat processing industries . The primary aim of this study was to examine the feasibility of using a pedometer-based intervention to increase physical activity and improve health-related outcomes in a population of meat processing workers . Methods A single-blinded r and omized controlled trial ( RCT ) was conducted . A convenience sample of meat workers ( n = 58 ; mean age 41.0 years ; range : 18 - 65 ) participated in the trial . Participants were r and omly allocated into two groups . Intervention participants ( n = 29 ) utilized a pedometer to self monitor their activity , whilst undertaking a brief intervention , and educational material .  Control participants ( n = 29 ) received educational material only . The primary outcomes of ambulatory activity , and health-related quality of life , were evaluated at baseline , immediately following the 12-week intervention and three months post-intervention . Results Fifty three participants completed the program ( 91.3 % adherence ) . Adherence with the intervention group was high , 93 % ( n = 27/29 ) , and this group increased their mean daily step count from 5993 to 9792 steps per day , while the control group steps changed from 5788 to 6551 steps per day from baseline . This increase in step counts remained significant within the intervention group p < 0.005 ; at three months post-intervention representing a 59 % increase over baseline scores . There were significant group changes with large effect sizes for step count change ( d = 1.94 ) and self-reported physical activity ( p < 0.005 ; d = 2.59 ) at 12 weeks intervention . Further , results showed non-significant between-group differences in physical component ( PCS ) and mental component ( MCS ) scores ( PCS : p = 0.44 ; MGD = 0.99 , 95 % CI , -1.6 to 3.6 ; ES = 0.14 , and MCS : p = 0.90 , MGD = 0.15 ; 95 % CI , -2.3 to 2.6 , ES = 0.022 ) at 12 weeks intervention . Conclusions This research provides important information for a larger ( RCT ) in the future : results demonstrated that a pedometer-driven walking intervention in combination with goal setting , and self-monitoring supported by weekly e-mails are feasible and potentially effective in increasing step count within the workplace setting over the short term . Trial registration numberAustralian New Zeal and Clinical Trials Registry ( ANZCTR ) ACTRN12613000087752 Background Pedometers provide a simple , cost effective means of motivating individuals to increase walking yet few studies have considered if short term changes in walking behaviour can be maintained in the long-term . The role of physical activity consultations in such interventions is unclear . The purpose of this study was to assess the sustainability of pedometer-based interventions and empirically examine the role of physical activity consultations using long-term results of a community-based walking study . Methods 79 low active Scottish men and women ( 63 women and 16 men ) from the Walking for Wellbeing in the West intervention study were r and omly assigned to receive either : Group 1 ; pedometer-based walking programme plus physical activity consultations or Group 2 ; pedometer-based walking programme and minimal advice .  Step counts ( Omron HJ-109E Step-O-Meter pedometer ) , 7 day recall of physical activity ( IPAQ long ) , mood ( PANAS ) and quality of life ( EuroQol EQ-5D ) were assessed pre-intervention and 12 , 24 and 48 weeks after receiving the intervention . Body mass , body mass index and waist and hip circumference were assessed pre-intervention and 12 and 24 weeks after receiving the intervention . Analyses were performed on an intention to treat basis ( baseline value carried forward for missing data ) using mixed-factorial ANOVAs and follow-up t-tests . Results A significant main effect of time ( p < 0.001 ) was found for step-counts attributable to significant increases in steps/day between : pre-intervention ( M = 6941 , SD = 3047 ) and 12 weeks ( M = 9327 , SD = 4136 ) , t(78 ) = - 6.52 , p < 0.001 , d = 0.66 ; pre-intervention and 24 weeks ( M = 8804 , SD = 4145 ) , t(78 ) = - 4.82 , p < 0.001 , d = 0.52 ; and pre-intervention and 48 weeks ( M = 8450 , SD = 3855 ) , t(78 ) = - 4.15 , p < 0.001 , d = 0.44 . Significant effects were found for several variables of self-reported physical activity , mood and quality of life and are discussed . No other significant effects in health related outcomes were found . Conclusion Both interventions successfully increased and maintained step counts over 12 months . Physical activity consultations may encourage individuals to be active in other ways beyond walking and to reduce sitting time . Trial Registration NumberCurrent Controlled Trials Ltd IS RCT BACKGROUND Physical inactivity is a major , potentially modifiable , risk factor for cardiovascular disease , cancer , and other chronic diseases . Effective , simple , and generalisable interventions that will increase physical activity in population s are needed . AIM To evaluate the effectiveness of a smartphone application ( app ) to increase physical activity in primary care . DESIGN AND SETTING An 8-week , open-label , r and omised controlled trial in rural , primary care in the west of Irel and . METHOD And roid smartphone users > 16 years of age were recruited . All participants were provided with similar physical activity goals and information on the benefits of exercise . The intervention group was provided with a smartphone app and detailed instructions on how to use it to achieve these goals . The primary outcome was change in physical activity , as measured by a daily step count between baseline and follow-up . RESULTS A total of 139 patients were referred by their primary care health professional or self-referred . In total , 37 ( 27 % ) were screened out and 12 ( 9 % ) declined to participate , leaving 90 ( 65 % ) patients who were r and omised . Of these , 78 provided baseline data ( intervention = 37 ; control = 41 ) and 77 provided outcome data ( intervention = 37 ; control = 40 ) . The mean daily step count at baseline for intervention and control groups was 4365 and 5138 steps per day respectively . After adjusting , there was evidence of a significant treatment effect ( P = 0.009 ) ; the difference in mean improvement in daily step count from week 1 to week 8 inclusive was 1029 ( 95 % confidence interval 214 to 1843 ) steps per day , favouring the intervention . Improvements in physical activity in the intervention group were sustained until the end of the trial . CONCLUSION A simple smartphone app significantly increased physical activity over 8 weeks in a primary care population
Surprisingly no use was made of time series analysis for analysing step count data .
The review also suggested several strategies for the personalisation of physical activity programs .
Conclusions Overall , it appears that the physical activity levels of people involved in such programs vary across individuals depending on psychosocial , demographic , weather and climatic factors .
Statistical models can provide a better underst and ing of the impact of these factors , allowing for the provision of more personalised physical activity programs , which are expected to produce better immediate and long-term outcomes for participants .
Background Physical activity reduces the risk of noncommunicable diseases and is therefore an essential component of a healthy lifestyle .
Regular engagement in physical activity can produce immediate and long term health benefits .
However , physical activity levels are not as high as might be expected .
For example , according to the global World Health Organization ( WHO ) 2017 statistics , more than 80 % of the world ’s adolescents are insufficiently physically active .
In response to this problem , physical activity programs have become popular , with step counts commonly used to measure program performance .
Analysing step count data and the statistical modeling of this data is therefore important for evaluating individual and program performance .
This study review s the statistical methods that are used to model and evaluate physical activity programs , using step counts .