©Journal of Sports Science and Medicine (2011) 10, 215-221
Received: 04 February 2010 / Accepted: 06 January 2011 / Published (online): 01 March 2011
Step counts and body mass index among 9-14 years old Greek schoolchildren
Maria Michalopoulou ??, Vassilios Gourgoulis, Thomas Kourtessis, Antonios Kambas, Martina
Dimitrou and Helen Gretziou
Deptartment of Physical Education and Sport Science, Democritus University of Thrace, University Campus, Greece
The main purpose of this study was the identification of the
current pedometer determined physical activity levels of a large
sample of 9 -14 years old Greek schoolchildren and the determi-
nation of the association between daily step counts and body
mass index through the comparison of step counts among over-
weight, obese and normal-weight children. A total of 532 chil-
dren (263 boys and 269 girls) were measured for height and
weight. Their activity levels were analyzed using pedometers to
measure mean steps for 7 consecutive days. Overweight and
obese status was determined using the international reference
standard (Cole et al., 2000). According to data analysis mean
step counts ranged from 15371 to10539 for boys and from
11536 to 7893 for girls. Steps per day were significantly more
for boys compared to girls. Children with normal weight per-
formed significantly more steps per day compared to their over-
weight and obese classmates. Daily step counts reported in this
study for 9 -14 year old schoolchildren were relatively low when
compared to step counts from other European countries. Only
33.9% of the participants satisfied the body mass index refer-
enced standards for recommended steps per day. Finally, the
results of this study provide baseline information on youth
pedometer determined physical activity and on youth body mass
index levels. High prevalence of low daily step counts and BMI
determined obesity was revealed prompting for further explora-
tion of the relationship between objectively measured physical
activity and adiposity in particular for children and adolescents
that experience both health risk factors.
Key words: Childhood, obesity, pedometry.
A major health threat for young people (aged 5-18) in the
21st century is physical inactivity in conjunction with the
elevated prevalence of obesity (WHO 2004). Even though
many countries exhibited low levels of physical activity
for youth (Le Masurier et al., 2005) clear differences have
been reported in levels of physical activity as recorded by
pedometer among young people form individual countries
and regions (Beets et al., 2010).
A cumulative record of steps taken over the course
of the day is a suitable marker to track accumulation of
daily physical activity in youth as has been the focus of
respective guidelines in relation to youth - appropriate
public health (McClain and Tudor-Locke, 2009). Such
guidelines made available for recommended daily step
counts are gender specific and range from 11.000 to
16.500 step.day-1 (Duncan, Schofield and Duncan, 2006;
Tudor-Locke et al., 2004; Vincent and Pangrazi, 2002a)
even though differences among countries indicate that a
single global steps/day recommendation of a given age
may by unrealistic (Beets et al., 2010).
Recent studies by CFLRI (Matthews et al., 2008)
and NHANES (Troiano, 2009) demonstrated that pe-
dometers are an inexpensive method for objective moni-
toring to be performed at a population level. Furthermore
researches have addressed several important issues related
to pedometer use as youth physical activity surveillance
tools in relation to their accuracy (Tudor-Locke et al.,
2002), reactivity (Ozdoba et al., 2004) and number of
monitoring days needed to determine habitual physical
activity (Vincent and Pangrazy, 2002b) even though fur-
ther scrutiny in this area of inquiry is needed (Tudor
Locke et al., 2009a).
Regarding age, Tudor-Locke et al. (2009b) re-
ported that the habitual activity curve formed in their
study for both sexes, indicated that the youngest age
groups appeared to take more steps per day than those
immediately older. The greatest decline in physical activ-
ity has been reported between the ages of 13-18 years
(Sallis, 2000) or during the transition from elementary to
high school years (Raustorp et al., 2004), since “high
school students are on their way of becoming sedentary
adults” (LeMasurier et al., 2005, pp.166). Contradicting
results support the idea that physical activity remains
stable throughout childhood (6-12 years) and a significant
decrease is recorded in pre-adolescent years (13-14
years), (Trost et al., 2002; Vincent et al., 2003; Vincent
and Pangrazi 2002b; Nyberg et al., 2009).
Consistent evidence of negative association exists
between objectively measured physical activity and adi-
posity. Several longitudinal as well as cross-sectional
studies using Body Mass Index (BMI) as a measure of
adiposity and pedometers (steps/day) as a measure of
habitual physical activity have supported the above nega-
tive relation (Cleland et al., 2008; Cuddihy et al., 2006;
Elgar et al., 2005; Hands and Parker, 2008; Jago et al.,
2006; Moore et al., 2003; Ziviani et al., 2008).
A recent study conducted in Greece using IOTF
criteria based on BMI status, reported a dramatic increase
(54%) in prevalence of obesity in the past decade among
8-9 year old children of both genders even though the
obesity rates were leveling off during the years 2004-2007
(Tambalis et al., , 2010). Although these cut points are not
diagnostic criteria, elevated BMI among children most
often indicates increased risk for future adverse health
outcomes and/or development of disease, (USDHHS,
Previous studies on reported physical activity lev-
els of children and adolescents in Greece reported that
Step counts and BMI in Greece
boys were more active that girls and age affects nega-
tively physical activity and participation in organized
sport (Avgerinos et al., 2002; Bertaki et al., 2007).
The need for further exploration of the relationship
between objectively measured physical activity (daily step
counts) and adiposity exists. In addition to that, no similar
study has been performed within Greek children proving
pedometer determined physical activity data. Therefore,
the main purpose of the present study was to determine
pedometer determined physical activity data and to exam-
ine its relationship to body mass index of 9 to 14 year old
Greek schoolchildren. Daily step counts and BMI levels
were used to measure physical activity and adiposity,
respectively. Comparisons were performed for age and
gender. Finally, a secondary objective was to determine
the percentage of the participants who satisfied the BMI-
referenced standards for recommended steps per day in
childhood according to cutoff points suggested by Tudor
–Locke et al. (2004).
Data were collected during the 2009 school year. Partici-
pants in this study were recruited from 8 out of 19 schools
operating in the school district of the Municipality of
Komotini, in Northern Greece. The 8 schools that partici-
pated in this study were selected based on size, proximity
and accessibility (4 of the 19 schools had less than 30
students and are located distances greater than 50km) and
issues of cultural origin since 3 of the schools operating in
this district are schools of the Muslim minority. Out of the
12 schools that satisfied the above criteria, only 8 schools
were randomly selected to participate in the study and this
selection was imposed by the number of available instru-
mentation (pedometers). Komotini is a municipality with
both urban and rural areas and 3 of the schools selected
were in the rural and 5 in the urban areas. Of the 1135
possible participants 782 volunteered to participate in the
study and finally 532 children aged 9 to 14 (263 boys and
269 girls) completed all data collection procedures. Rea-
sons for non participation were absence during the first
day of study, illness and lack of parental permission. The
parent or legal guardian of each child gave a written in-
formed consent to their child’s participation in the study.
The Ethics Committee of the Dept of Physical Education
of Sport Sciences, of the Democritus University of
Thrace, Komotini Greece and the principals of the schools
approved the study.
Instrumentation and procedures
Height and weight were assessed individually with chil-
dren dressed in light clothing and without shoes. Height
was measured to the nearest 1.0 cm using a portable sta-
diometer (SECA 242; Hamburg, Germany). Weight was
measured to the nearest 0.1 kg using a high precision
electronic scale (SECA 764; Hamburg, Germany) that
was being calibrated before each use against a standard
weight. Body Mass Index (BMI) was calculated as body
mass in kilograms divided by height in squared meters
(kg·m-2). The children then were classified as normal-
weight, overweight and obese according to the interna-
tional reference standards (Cole et al., 2000). These stan-
dards are based on average percentiles, determining BMI
cutoff points of 25 or 30 at age 18 for overweight or obe-
Pedometer determined physical activity measure
The Yamax model SW200 (Yamax Corporation Tokyo)
pedometer, was used to monitor daily step counts for
seven consecutive days (Strycker et al., 2007). Previous
research has established pedometers as a valid measure of
activity in children (Sirard and Pate, 2001), especially in
large- scale studies such as the current one. Before its
actual use, each pedometer was checked for defects and
for accuracy by observing the recorded step count after
walking 100 paces. Instrumental error did not exceed 3%
in any of the pedometers (Tudor - Locke and Myers,
2001). The type of the pedometer used in this study re-
cords within 1% of all steps taken under controlled condi-
tions (Bassett et al., 1996). Testing took place during
October and November.
Children were instructed to wear the pedometer at-
tached to their waistband during waking hours for seven
consecutive days. They were also asked to continue their
typical activities and to remove the pedometer only at bed
time and bathing and to put it right back on (e.g. after
dressing each morning). The pedometer was fastening to
the waistband of the participants’ pants or shorts. When
no waistband was available a small elastic belt was worn
with the pedometer attached to the belt. Children were
also given written instructions on how to wear and to use
the pedometer. Prior to participation in the study, all par-
ticipants had the opportunity, during physical education
class, to become familiar with the pedometer. During the
study all pedometers were sealed to assure that they
would not be accidentally reset. Each day, eight trained
researchers were collecting the pedometers, recorded the
number of steps resealed them and returned them to the
participants (Tudor-Locke et al., 2002). Daily steps lower
than 1000 or above 30.000 were unlikely to be valid and
were regarded as outliers (Rowe et al., 2004). If a partici-
pant missed more than three days of step counts he/she
was excluded for the study. Mean steps per day were
computed for the whole week for each participant.
According to their (body weight and height) scores that
were recorded during this study, participants were as-
signed for analysis purposes to one of the three groups:
normal weight, overweight and obese, according to the
international reference standards (Cole et al., 2000). De-
scriptive statistics were performed for all study variables.
In order to address differences regarding the participants’
steps per day, a 3 X 2 analysis of variance was performed
with BMI (normal weight, overweight and obesity) and
gender (male and female) being the independent vari-
ables. Bonferroni post hoc tests were performed when
needed. Bivariate analysis for testing associations be-
tween variables was performed using Pearson moment
correlation. The level of significance was set at .05.
Michalopoulou et al.
Table 2. Numbers (n) and steps/day for boys and girls presented in age groups. Data are means (±SD).
Age (years) n Daily step count
9 42 15.371 (3.005) 45
10 45 14.069 (4.476) 44
11 46 13.009 (4.624) 46
12 43 13.634 (4.731) 45
13 40 12.694 (3.328) 44
14 47 10.539 (4.303) 45
Total 263 13.446 (4.549) 269
Daily step count
Daily step count
Descriptive data for the physical characteristics of the
participants are presented in Table 1.
Table 1. Participants characteristics (mean ± SD) by age and
Age (years) 11.13 (1.30)
Height (m) 1.51 (.11)
Weight (kg) 45.0 (11.8)
BMI 19.6 (3.4)
Steps per day were calculated by gender and age to de-
termine activity levels of children (Table 2). According to
one-way ANOVA significant differences in steps/day
were reported (F(5,526) = 5.276, p < 0.001, η2 = 0.45), only
between the 14year old children and the other age groups
used in this study, (p < 0.001). Bonferroni post hoc tests
revealed that 14year old children were significantly less
active when compared to the younger children that par-
ticipated in this study (Table 2).
Body Mass Index scores
International BMI cutoff points for childhood overweight
and obesity were applied to the sample (Cole et al., 2000).
Overall 69.9% of participants were classified as “normal”
weight, 23.9% were classified as “overweight” and 6.3%
as obese. In particular, for boys and girls respectively,
69.1% and 70.4% had normal weight, 23% and 24.8%
were overweight and 7.8% and 4.7% were obese. The
number and percentage of children that satisfied the ΒΜΙ-
referenced standards for pedometer steps/day in preado-
lescent youth (Tudor-Locke et al., 2004) according to
their BMI status are presented in Table 3 and only 52% of
them satisfied the classification according to their steps
per day readings and their BMI status.
According to two-way ANOVA no significant in-
teraction was revealed between the factors BMI and gen-
der (F(5,526) = 0.704, p = 0.495, η2 = 0.30). Both factors,
gender (F(1,526) = 17.490, p < 0.001, η 2= 0.56) and BMI
(F(2,526) = 15.536, p < 0.001, η2 = 0.32) had a significant
main effect on steps/day. Bonferroni post hoc test re-
vealed that the boys exhibited significantly higher scores
of steps per day than girls (p < 0.001) and children with
normal weight performed significantly more steps/day
than children classified as overweight (p < 0.001) and
obese (p < 0.001). Additionally no significant differences
in the number of steps/day performed by children classi-
fied as overweight and obese (p = 0.272) (Table 4 and
Figure 1. Steps/day of the participants according to BMI
status (1= normal weight, 2 overweight and 3 obese) accord-
ing to the international reference standards (Cole et al.,
Correlation between physical activity and body mass
The correlations between steps per day and BMI were
calculated for each age group for boys and girls. Signifi-
cant correlations were reported for both boys and girls in
different age groups. The results are presented in Table 5.
Table 5. Correlations (r) between steps/day and body mass
index for boys and girls presented in gender and age groups.
Age (y) Boys
10 -.398 *
11 -.455 ***
12 -.406 ***
13 -.399 *
14 -.598 *
Total -.395 ***
N 543 -.295 ***
* p < 0.05 ** p < 0.001
Table 3. Classification (n, %) of children according to BMI status and to steps/day for all the participants in the study.
Boys >15.000 daily steps
Girls > 12.000 daily steps
Boys <15.000 daily steps
Girls < 12.000 daily steps
Overweight Obese Total
149 (39.3%) 30 (23.1%) 5 (14.7%) 184 (33.9%)
230 (60.7%) 100 (76.9%) 29 (85.3%) 359 (66.1 %)
130 34 543
Step counts and BMI in Greece
Table 4. Numbers (n) and daily steps counts according to prevalence of overweight and obesity according to
the international BMI cut-off points for boys and girls.
BMI status n Daily step count
181 14.266 (4.553) 189
61 12.001 (3.877) 67
21 10.571 (4.274) 13
263 13.446 (4.549) 269
Participants’ pedometer-determined-physical activity
This study examined current activity levels of children
and pre-adolescents (9-14 years of age) using pedometry,
a low cost, user friendly, reliable and valid way to assess
suggest that the participants in this study were at the low
physical activity in youth (Tudor-Locke et al., 2002). As
for the occurrence of reactivity (when the testing process
influences behavior) that has been discussed in the litera-
ture, the procedure followed in this study satisfied the
measurement schedule for obtaining reliable pedometer
data (6 consecutive days assuming that this has been pre-
ceded by a familiarization day and both weekend days
and week days being included) (Vincent and Pangrazy,
2002a; 2002b; Rowe et al., 2004), since children in this
study wore the pedometer for 7 consecutive days.
According to the findings of this study the mean
steps/day taken by both boys and girls in Greece (13.446
and 10.656 respectively), were similar to the ones re-
ported by a previous study performed in Greek 9-11 year-
olds where boys and girls accumulated 12.362 and 10.140
steps respectively (Bertaki et al., 2009). These figures end
of pedometer-determined-physical-activity levels when
compared to data provided by other European countries:
Sweden, UK and Cyprus (Loucaides et al., 2004; Raus-
torp et al., 2004; Rowlands et al., 1999). According to
Beets et al. (2010) physical activity levels in the above
countries are notably high and young people are on aver-
age healthier. On the other hand, figures closer to the ones
of the present study have been recorded for children in US
(Le Masureir et al., 2005; Vincent et al., 2003). The low
values may be due to the fact that children in Greece have
limited opportunities to be physically active within the
school environment and participation in after school
sports programs is limited to only 1/3 of them (Avgerinos
et al., 2002). Additionally, it should be mentioned that
participants in the present study reside in one of the poor-
est and less privileged European Regions (Thrace), where
activity opportunities may be limited. Interaction between
socioeconomic status and physical activity may affect
children’s pedometer determined physical activity level
(Sallis et al., 2000; Stamatakis et al., 2005; Ziviani et al.,
In the present study, daily step-counts tended to be
leveled for ages 9-12 years, a finding which is accordance
with those of previous studies supporting a consistent
accumulation of steps throughout the ages 6 -12, (Vincent
et al., 2003; Vincent and Pangrazi 2002a; Le Masurier et
al., 2005). Different findings have been also reported for
decreasing activity levels before adolescence (Goran et
al., 1998; Hovell et al., 1999; Nyberg et al., 2009).
Daily step count
Daily step count
The significant drop in steps/day that was apparent
in this study only for children aged 13 -14 years, is in
accordance with other the results of studies examining
physical activity levels of preadolescent children (Le-
Masurier et al., 2005; Raustorp et al., 2004). As previ-
ously reported when children in Greece approach adoles-
cence drastically they reduce their physical activity since
opportunities to be physically active diminish (less physi-
cal education classes, and decreased discretionary time;
Avgerinos, et al., 2002).
Furthermore, regarding sex differences, the results
revealed that boys were more active that girls in all age
groups a finding reported in many studies on adolescents
and children (Duncan et al., 2006; LeMasurier et al.,
2005; Raustorp et al., 2004; Tudor-Locke et al., 2009b;
Vincent et al., 2003; Vincent and Pangrazi, 2002a).It has
been reported that 12- 19 year old girls in Greece ex-
pressed lower interest than boys for physical activity and
sports participation and higher interest for social interac-
tion (Avgerinos et al., 2002). The current finding may
reflect the above trend.
BMI and pedometry
A general finding of the present study was that, according
to the IOTF criteria based on BMI status, 23% of the boys
who participated in this study were overweight and 7.8%
were obese, while in girls the respective rates were 24.8%
and 4.7%. These findings are very alarming of high obe-
sity rates in Greek children since other recent studies
conducted in Greece reported similar overweight and
obesity prevalence rates for both sexes, (Panagiotakos et
al., 2008; Papandreou et al., 2008).
Overweight and obesity prevalence in similar stud-
ies in other countries were lower for children in New
Zealand (26.5%; Duncan et al., 2006), in South Eastern
Sweden (19%; Raustorp et al., 2004), in Australia
(14.4%) and in Sweden (6.8%). Opposite results have
been reported in U.S. where over 33% of the children
aged 6-12 years were classified as overweight/obese
(Vincent et al., 2003).
As physical activity is an important factor in
weight control (Welk and Blair, 2000), a larger and more
consistent body of evidence of significant negative asso-
ciations between habitual physical activity and adiposity,
has been reported in cross-sectional studies using pe-
dometry (Jimenez-Pavon et al., 2009). In the current
study, nine out of the fifteen correlations that were calcu-
lated between BMI and steps/day counts, were significant
but rather low to moderate. On the other hand, no signifi-
cant correlations have emerged regarding 9-year boys’
group and 9, 10, 13 and 14year girls’ groups. This may be
related to the fact that physical activity is only one of the
modifiable risk factors for obesity (along with sedentary
Michalopoulou et al.
behavior and diet; USDHHS, 2010). In addition to that,
BMI as a measure of obesity in childhood has exhibited
several limitations (Prentice and Jebb, 2001). BMI seems
to be affected by the natural increases in weight and
height that occur during growth and this may further
complicate its relationship with pedometer-determined-
physical-activity. The effect of maturity status and ado-
lescent growth spurt on body composition may be an
explanation of the limited correlations between habitual
physical activity and BMI regarding girls. More direct
measures of body fatness (% of body fat and waist cir-
cumference) may strengthen the possibility of defining
the relationship between adiposity and objectively deter-
mined physical activity. For all the other boys’ age groups
(10-14 year-olds) correlations were significant,a finding
which is accordance with a previous studies (Raustorp, et
Given the limitation of BMI as a measure of obe-
sity in youth (Prentice and Jebb, 2001), normal-weighted
participants of the current study performed significantly
more steps/day compared to their overweight and the
obese mates. These findings are in accordance with those
of previous studies (Bar-Or, 2000; Duncan et al., 2006).
The above drop in steps/day for overweight and obese
children has been also reported by Jago et al., (2006) in a
study of 11-15 year old Boy-Scouts as well as by Al-
Hazzaa (2007) in a study of 8-12 year old Saudi-Arabi
Insufficient vigorous physical activity was shown to be a
risk factor for higher BMI, and failing to meet the 60
minutes/day of moderate to vigorous physical activity
guidelines (NASPE, 2004) was associated with over-
weight status for adolescent boys and girls from the
United States (Patrick et al., 2004). The only participants
in the current study who satisfied NASPE guidelines were
normal-weighted boys and girls whereas all the other
subgroups (overweight and obese) performed signifi-
cantly less steps/day. Tzetzis et al. (2005) reported that
overweight and obese 12-13 year old Greek children
participated less in both moderate and vigorous physical
activity when compared to children with normal weight.
Furthermore, according to the results of a recent study
performed in Greece, obese adolescent girls performed
3.000+895 steps/day, a daily step count that is surprising
low (Agorastou and Avgerinos, 2009).
Further attention should be given to the fact that
only 33.9% of the participants (184 children), satisfied the
Tudor-Locke et al., (2004) criterion-referenced standards
(12.000 steps/day for girls and 15.000 steps/day for boys)
based on BMI categories in children. Additionally, 230
children who had normal weight (42.4% of the total sam-
ple), did not satisfy the step/day standard and 81% of the
184 children that satisfied the step/day standard had nor-
mal weight, 16,3% were overweight and 2,7% were
obese. Even though steps/day values in this study were
close to the ones reported for U.S. youth, the aforemen-
tioned cut off points failed to distinguish between youth
classified as healthy- or unhealthy-weighted according to
international BMI age - and-sex-specific categories. Simi-
lar results have been reported by Beets et al. (2008),
where these steps/day cut off points were unable to dis-
tinguish between U.S. youth classified as healthy- or
unhealthy-weighted and thus they should be used with
Several limitations should be noted regarding this
study. First, the findings can be generalized strictly to the
specific sample since convenience sampling concerning
city and school selection was used in this study. Second,
this was a cross sectional study and therefore the temporal
relationship between pedometer determined physical
activity and obesity cannot be certain and any assumption
of causality between inactivity and obesity indices is
precluded. It remains unclear whether the obesity of the
participants in this study was due to reduced levels of
pedometer determined physical activity or the low
step/day readings were the result of being obese. Third,
although pedometry provides a low cost and objective
measure of habitual physical activity (steps/day), the
choices for interpretation of data are rather limited since
we were unable to assess intensity, frequency and dura-
tion of activity or to estimate energy expenditure. Fourth,
even thought preliminary evidence suggests that anthro-
pometric differences in leg length should be accounted for
since they provide a closer approximation of the individu-
alized steps·min-1, no adjustments were made for respec-
tive differences in participants leg length. Finally, BMI is
a limited indicator of childhood obesity since it is only a
surrogate and not a direct measure of body fatness.
In conclusion the results of this study provide baseline
information on young’s people pedometer determined
physical activity and BMI levels according to interna-
tional cut of points. These findings are alarming due to
very low pedometer determined physical activity levels of
children’s as proposed in the literature, although the ap-
plicability of the BMI references pedometer step-count
recommendations to children and adolescents in Greece
needs to be further examined. Further understanding of
how low activity levels and body composition of children
relate to a healthy life style will allow us to define the
modifiable risk factors for obesity in order to mitigate the
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• The mean steps/day taken by both boys and girls in
Greece 9-14 years old were 13.446 and 10.656 re-
• Daily step counts tended to be leveled for ages 9-12
years and a significant drop in steps/day was appar-
ent for children aged 13 -14 years.
• According to the IOTF criteria, 23% of the boys that
participated in this study were overweight and 7.8%
were obese, while in girls the respective rates were
24.8% and 4.7%.
• Children with normal weight performed signifi-
cantly more steps/day than the overweight and the
Assoc. Professor, in Skill Acquisition in Physical Activity and
Sport, Democritus University of Thrace, Dept. of Physical
Education and Sport Science.
Motor learning, methodology of physical activity assessment
and physical activity in youth.
Assoc. Professor in Analysis of Technical Elements of Sports
Democritus University of Thrace, Dept. of Physical Education
and Sport Science.
Sports biomechanics, swimming and methodology of physical
Assoc. Professor, in Motor Coordination Democritus Univer-
sity of Thrace, Dept. of Physical Education and Sport Science.
Motor learning, movement awkwardness, children’s physical
Assist. Professor, in Exercise Science and Motor Development
Democritus University of Thrace, Dept. of Physical Education
and Sport Science.
Coordination in young children and physical activity in pre-
Democritus University of Thrace
Motor abilities and physical activity in youth.
Democritus University of Thrace
Body composition and physical activity in youth.
?? Maria Michalopoulou, PhD
Dept. of Physical Education and Sport Science, Democritus
University of Thrace, University Campus, Komotini 69100