Workplace pedometer interventions for increasing physical activity New search for studies and content updated (conclusions changed)

Abstract

Abstract 

Background 

The World Health Organization (WHO) recommends undertaking 150 minutes of moderate‐intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.

Objectives 

To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long‐term health outcomes.

Search methods 

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'.

Selection criteria 

We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured.

Data collection and analysis 

We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre‐specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow‐up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity.

Main results 

We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high‐income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi‐component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow‐up after completion of the intervention ranged from three to ten months.

Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition.

When pedometer interventions are compared to minimal interventions at follow‐up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low‐certainty evidence; no meta‐analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low‐certainty evidence).

Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) ‐0.64, 95% confidence interval (CI) ‐1.45 to 0.18; 3 studies; low‐certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: ‐0.08 mmHg, 95% CI ‐3.26 to 3.11; 2 studies; moderate‐certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low‐certainty evidence). No studies compared biochemical measures or disease risk scores at follow‐up after completion of the intervention versus a minimal intervention.

Comparison of pedometer interventions to alternative physical activity interventions at follow‐up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low‐certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low‐density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow‐up after completion of the intervention were not compared to an alternative physical activity intervention.

Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions.

Authors' conclusions 

Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer‐based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision‐makers considering allocating resources to large‐scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term.

Future studies should be designed to identify the effective components of multi‐component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.

Author(s)

Rosanne LA Freak-Poli, Miranda Cumpston, Loai Albarqouni, Stacy A Clemes, Anna Peeters

Abstract

Plain language summary 

Do health promotion programmes in the workplace increase people's physical activity if they include a pedometer? 

Key messages 

Overall, there is not enough evidence to show whether workplace health promotion programmes involving a pedometer affect people's physical activity, especially in the long term.

What is a pedometer? 

A pedometer is a small, portable electronic device that counts the number of steps a person takes, but unlike an accelerometer, there is no record of intensity. Pedometers aim to encourage people to increase their physical activity by giving them feedback on their daily steps.

Why we did this review 

Most people do not do enough physical activity. According to the World Health Organization, doing at least 30 minutes of moderately intense physical activity on most days can reduce a person's risk of developing cardiovascular disease, diabetes, and some cancers. We wanted to find out if workplace health promotion programmes that involve wearing pedometers would motivate people to increase their physical activity.

What did we do? 

We searched for studies of workplace programmes that used pedometers to promote health in employees. We looked for randomised controlled studies, where the treatment each person receives is decided randomly.

Search date:  We included evidence published up to December 2016.

What we found 

We found 14 studies including 4762 people in different workplaces, ranging from offices to construction sites, mostly in high‐income countries. In all studies, pedometers were part of a health programme that included other components, such as walking groups, counselling, or dietary advice. Studies compared the effects of participating in pedometer programmes with:

‐ receiving no or a minimal health programme such as regular advice about the benefits of physical activity; and

‐ participating in other health programmes, that did not include a pedometer.

The programmes lasted from two weeks to two years; assessments continued for three to ten months afterwards.

We were most interested to see whether there pedometers had a lasting effect on physical activity and health. We were also interested in learning about effects on sedentary behaviour (time spent sitting), risk factors for cardiovascular disease and diabetes (blood pressure, body mass index (BMI) and levels of cholesterol in the blood), quality of life (well‐being) and adverse (unwanted) effects.

What are the results of our review? 

Compared with no or a minimal health programme

Pedometer programmes may not affect physical activity at least one month after the programme end (6 studies), but they may reduce sedentary behaviour and may improve people's well‐being (1 study). We have very little certainty about these results.

Pedometer programmes may slightly reduce body mass index (3 studies, low certainty), but probably make little to no difference in blood pressure (2 studies, moderate certainty) and may reduce unwanted effects such as injuries (2 studies, low certainty).

No studies measured cholesterol or disease risk scores at least one month after the programme ended.

Compared with another health programme:

Pedometer programmes may affect physical activity after at least one month since the programme end (1 study), but we have very little certainty about this result.

We could not draw conclusions about unwanted effects. The evidence was not good enough for us to be certain about effects on sedentary behaviour, BMI, blood pressure, cholesterol, cardiovascular disease risk and well‐being. Some effects were seen but findings were not consistent.

Conclusions 

Exercise programmes can have positive effects on an employee's physical activity and health, but we did not find enough reliable evidence to be certain whether a pedometer programme is better than other types of health programmes, especially for achieving long‐term changes in behaviour.

Evidence is uncertain because results were reported by a small number of studies — sometimes only one study. In most studies, the people involved knew which study group they were in, which can affect results. Many people dropped out of studies before the studies ended, so not enough results were collected. Some studies did not report any results for some measures we were interested in or did not assess/evaluate if benefits were maintained after the program ended.

As pedometers are largely being replaced by more sophisticated devices such as accelerometers and Smartphone apps, we will not update this review again.

Author(s)

Rosanne LA Freak-Poli, Miranda Cumpston, Loai Albarqouni, Stacy A Clemes, Anna Peeters

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

Evidence was insufficient to justify clear conclusions about the effectiveness of pedometer interventions in a workplace setting for increasing physical activity and improving subsequent health outcomes.

When compared to minimal intervention, some immediate benefits are seen to occur during a pedometer‐based intervention, but evidence is insufficient to show whether these effects are sustained following completion of the active intervention period, and sustainability during very long interventions (longer than one year) is not assured. This comparison does not demonstrate whether the pedometer is a critical component of physical activity interventions, or whether any similar multi‐component intervention would achieve similar outcomes. When compared to alternative physical activity interventions, the effects overall are very uncertain.

Exercise interventions can have positive effects on employee physical activity and health, although there is currently no reason to suggest that a pedometer‐based intervention would be more effective than other options. Decision‐makers considering allocating resources to large‐scale programmes of this kind should balance expected benefits with realistic expectations about participation (including high levels of withdrawals), and should note that effects may not be sustained over the longer term.

Implications for research 

Several factors could be considered for planning future research in this field. In terms of participants, the existing literature has successfully included a diversity of workplaces and countries and both healthy and higher‐risk populations. In terms of interventions to be investigated, we suggest that more studies are needed that have been designed to identify the core effective components of multi‐component interventions. Pedometers may not be the highest priority component to test for future research, especially given the increased availability of low‐cost accelerometers. Approaches to increase the sustainability of and engagement with the intervention over longer terms should be considered. If the aim of physical activity interventions is to prevent obesity and chronic disease, then the theoretical basis for intervention components and the role of other lifestyle components such as diet could also be considered.

Future research should consider measuring sustained outcomes after completion of the active intervention period and should include more consistently meaningful measures of physical activity (such as total metabolic equivalents (METs)), as well as important outcomes that indicate that increased physical activity is achieving desired outcomes (including anthropometry, blood pressure, quality of life, and reduced risk of adverse effects).

Future studies should ensure that they are designed to achieve low risk of bias. Particular challenges involving research in physical activity include the difficulty of blinding (although this is less important if the intention is to measure the effect of introducing a physical activity programme in a real workplace setting, where uptake would be variable) and high levels of attrition (which may be linked to issues with sustainability of the intervention), both of which could be considered in future intervention designs. Studies should be sufficiently powered to enable subgroup analyses (including intervention components or population categories) in this context of high attrition.

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