Effects of 10,000 steps a day on physical and mental health in overweight participants in a community setting: A preliminary study

Abstract

Background:
Being overweight is associated not only with physical health problems, but also with risk of mental health problems. Increased physical activity (PA) has been recommended for the prevention of cardiovascular disease; however, little is known about the effect of walking on physical and mental health outcomes.

Objective:
The purpose of the study was to explore the effectiveness of a pedometer-based PA intervention on physical and mental health states.

Method:
Thirty-five overweight participants with body mass index (BMI) ≥25 kg•m-2 were selected and assigned to a 12-week pedometer-based walking program (10,000 steps•d-1). The profile of mood states, BMI, waist circumference (WC), body fat percentage (%BF), and lean body mass (LBM) were measured before and after the 12-week intervention. The number of step counts was recorded 5 days a week in a diary booklet.

Results:
The 30 participants who accumulated 10,000 steps•d-1 had significantly lower anxiety, depression, anger, fatigue, confusion, and total mood distress scores compared with measurements taken prior to the intervention. Further, the participants had higher vigor scores compared to baseline. Regarding physical health, the participants who accrued 10,000 steps a day had significantly lower body weight, WC, BMI, and %BP. After adjustment for gender, height, and daily steps at follow-up, changes in WC were negatively associated with depression, fatigue, confusion, and total mood distress.

Conclusions:
An increase in PA by accumulating at least 10,000 steps•d-1 over a 12-week period improves physical and mood states in sedentary, overweight individuals.

Full text

http://dx.doi.org/10.1590/bjpt-rbf.2014.0160 1
Braz J Phys Ther.
Effects of 10,000 steps a day on physical and mental
health in overweight participants in a community setting:
a preliminary study
Kornanong Yuenyongchaiwat1
ABSTRACT | Background: Being overweight is associated not only with physical health problems, but also with risk of
mental health problems. Increased physical activity (PA) has been recommended for the prevention of cardiovascular
disease; however, little is known about the effect of walking on physical and mental health outcomes. Objective: The
purpose of the study was to explore the effectiveness of a pedometer-based PA intervention on physical and mental
health states. Method: Thirty-ve overweight participants with body mass index (BMI) ≥25 kg•m–2 were selected and
assigned to a 12-week pedometer-based walking program (10,000 steps•d–1). The prole of mood states, BMI, waist
circumference (WC), body fat percentage (%BF), and lean body mass (LBM) were measured before and after the 12-week
intervention. The number of step counts was recorded 5 days a week in a diary booklet. Results: The 30 participants
who accumulated 10,000 steps•d–1 had signicantly lower anxiety, depression, anger, fatigue, confusion, and total mood
distress scores compared with measurements taken prior to the intervention. Further, the participants had higher vigor
scores compared to baseline. Regarding physical health, the participants who accrued 10,000 steps a day had signicantly
lower body weight, WC, BMI, and %BP. After adjustment for gender, height, and daily steps at follow-up, changes in
WC were negatively associated with depression, fatigue, confusion, and total mood distress. Conclusions: An increase
in PA by accumulating at least 10,000 steps•d–1 over a 12-week period improves physical and mood states in sedentary,
overweight individuals.
Keywords: physical activity; physical health; prole of mood states; overweight; walking; physical therapy.
Thai Clinical Trials Registry number: TCTR20151214002
BULLET POINTS
• To explore the effect of 10,000 steps a day in sedentary, overweight Thai subjects.
• 10,000 steps a day may help to decrease physical and mental health problems.
• They may also help to reduce risks of non-communicable disease and cardiovascular disease.
HOW TO CITE THIS ARTICLE
Yuenyongchaiwat K. Effects of 10,000 steps a day on physical and mental health in overweight participants in a community
setting: a preliminary study. Braz J Phys Ther. http://dx.doi.org/10.1590/bjpt-rbf.2014.0160
1 Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
Received: Aug. 06, 2015 Revised: Nov. 20, 2015 Accepted: Dec. 07, 2015
Introduction
Recently, overweight and obesity present major
health problems worldwide and these issues lead to
non-communicable diseases (NCDs) and cardiovascular
disease1,2. Further, evidence suggests that obesity is
associated with mental health problems (e.g. depression),
poor perceived health, low self-esteem, and body image
concern
3
. There is also evidence that obese individuals
can decrease mood disorders by controlling diet and
body weight, managing stress, improving self-esteem,
having psychological treatment, and exercising.
Physical activity (PA) has been consistently linked to
improved mood. In addition, there is strong evidence
that PA helps to decrease anxiety and depression
and improves mood, self-esteem, and body image4-6.
Regarding the relationship between obesity and PA,
several studies have shown that overweight/obesity
was inversely related to PA. For example, high body
mass index (BMI) and waist circumference (WC)
are related to decreased PA7,8. A recent systematic
review from 25 prospective cohort studies found that
PA levels including low PA (e.g. walking less than
150 minutes/week) could prevent future depression
9
.
Therefore, interventions to decrease mental and

Yuenyongchaiwat K
2Braz J Phys Ther.
physical health problems by increasing PA should
be considered.
Recently, programs that increase the number of
daily walking steps have been promoted to improve
PA and a pedometer or step-counting device has been
commonly used to measure and promote PA. However,
little research has been conducted on the effects of
accumulating 10,000 steps with a pedometer on both
physical and mood states. Therefore, the aim of this
study was to determine the effect of 10,000 steps per
day with a pedometer on the prole of mood states
and physical health in overweight participants in a
community setting.
Method
Participants and design
Thirty-ve overweight adults aged 35-59 were
recruited (BMI≥25 kg•m–2). The ethics and protocol
were approved by the Ethics Committee of Thammasat
University, Pathumthani, Thailand (approval number
069/2557). All participants gave written informed
consent. The quasi-experimental study was designed
to determine whether the effect of a pedometer-based
intervention decreased mental and physical health
problems.
Measures and apparatus
Anthropometric measures, i.e. weight (kg),
height (cm), and WC, were assessed prior to and
after the intervention program. Evaluation of BMI
was used as an indicator of being overweight. WC
was measured at the level of the umbilicus. In
addition, percentage of body fat mass (%BF), lean
body mass (LBM; kg) were measured, which have
been described in detail elsewhere10.
All participants completed the Prole of Mood
States (POMS) scale11 to measure psychological
well-being at baseline and 12 weeks after baseline
assessment. The POMS is composed of 65 items
rated on a 5-point Likert scale. The checklist items
are comprised of 6 subscale scores: tension/anxiety,
depression, anger/hostility, fatigue, confusion, and
vigor. In addition, the total mood distress score
was used to evaluate an overall measure of mood
states. Subtraction of vigor scores from the sum of
the negative mood (i.e. tension, depression, anger,
fatigue, and confusion) was dened as the total
mood distress. The POMS has been found to have
good internal consistency of subscales, ranging
from 0.63 to 0.9611.
The number of walking steps per day was measured
at baseline with a pedometer (Yamax SW-200).
The participants were asked to wear their sealed
pedometer during the working day for 5 days whilst
following their normal daily routine and then record
the details in their booklet. During the 12-week
intervention, the participants were instructed to
walk at least 10,000 steps per day and record their
steps in their diary. At the end of week 12, body
weight, POMS, BMI, WC, WHR, %BF, and LBM
were assessed again.
Statistical analysis
Sample size calculations indicated that 30 participants
were needed to complete the study to ensure sufcient
power (80%) to detect an effect size (Cohen’s d=1.08).
In order to allow for attrition, 35 overweight participants
were recruited. Steps per day were calculated weekly
(i.e. 5 working days per week). The change in the
average number of steps per day over the 12-week
intervention program was modeled for each participant.
Descriptive data are presented as percentage (%),
mean, and standard deviation (SD). Data were veried
for normality of distribution (Kolmogorov-Smirnov
goodness-of-t test). Changes in physical health
outcomes were calculated by subtracting physical
health outcomes at follow-up from initial baseline
physical health values. The paired t-test was used to
determine whether the pedometer decreased signicant
changes in physical and mental health outcomes.
Pearson’s correlations coefcients were calculated
between POMS after a 12-week period and changed
physical health. To examine the association between
POMS and physical health outcomes after adjusting
for possible confounding variables (e.g. gender,
height, and daily walking steps at follow-up), partial
correlational analysis was conducted. In addition, a
regression analysis was performed to evaluate the
utility of the effects of the pedometer for improving
health outcomes in overweight participants. Multiple
regression analyses were conducted to determine
the unique contribution of 10,000 steps per day to
the improvement of mental health outcomes after
adjustment for initial POMS and daily walking steps. In
the linear regression, the assumptions of normality of
the residual scores were met. In addition, all analyses
were conducted with SPSS version 20.0 and the level
of statistical signicance was considered as p<0.05.

Physical activity and health outcomes
3
Braz J Phys Ther.
Results
Changes in physical and mental health states
with the pedometer-based intervention
program
The mean age of the participants was 49.67±6.51 years.
A total of 30 participants (9 males and 21 females)
completed the walking program. Of the 5 participants
(14.29%) who did not complete the protocol,
one was pregnant and one had leg pain due to a
herniated disc caused by heavy lifting. Based on
the denition of PA by Tudor-Locke et al.12, the
participants were dened as a sedentary (i.e. less
than 5,000 steps a day) at baseline. As shown in
Table 1, feelings of tension, depression, anger,
confusion, fatigue, and total mood distress decreased
signicantly after the 12-week program, as did body
weight, BMI, WC, and %BF. In addition, vigor
scores increased signicantly (p<.05 in all cases).
In short, accumulating 10,000 steps a day resulted
in a signicant decrease in negative mood and
negative physical health outcomes and signicant
improvements in vigor-activity with a large effect
size (d≥.8 in all cases; Cohen13).
Correlations between daily walking steps,
profile mood states, and physical health
outcomes at follow-up
As seen in Table 2, the participants who accrued
10,000 steps a day had a modest but signicant inverse
correlation with decreased body weight, BMI, and WC
at 12 weeks. In addition, analysis of the correlation
revealed that changes in WC were negatively associated
with depression, fatigue, confusion, and total mood
distress (p<.05 in all cases). Further, negative association
was observed between %BF and anger state (p<.05;
see Table 3). Overall, there was a large (r>0.4 in all
cases, according to Cohen
13
) negative correlation
between health outcomes (e.g. WC) and prole of
mood states (e.g. depression).
To determine whether the relationship between
mental health states and physical health changes
survived adjustment, partial correlation analysis was
then computed adjusting for gender, height, and daily
walking steps at follow-up.
Partial correlations showed that the relationships
between changes in WC and depression, fatigue,
confusion, and total mood distress survived adjustment
for gender height and daily walking steps at follow-up.
Further, the relationship between %BF and anger
states also remained signicant after adjusting for
Table 1. Comparison between pre- and post-intervention programs in overweight participants.
Pre-intervention
Mean±SD
Post-intervention
Mean±SD Mean difference
95% condence
interval for the
difference
p-value
Walking (steps/day) 4,540.53±1,959.00 10,500.20±2070.54 –5,960.67 –6774.85 to -5145.49 <.001
BW (kg) 71.40±10.73 69.87±10.33 1.53 .54 to 2.52 .004
WC (cm) 92.63±9.26 90.33±8.16 2.30 .80 to 3.80 .004
WHR .88±.05 .89±.06 .01 –.01 to .03 .477
BMI (kg/m2)27.86±4.33 27.25±3.93 .62 .18 to 1.06 .007
BF (%) 32.97±6.89 29.82±7.29 3.15 2.19 to 4.12 <001
LBM (kg) 47.42±5.57 48.54±5.21 –1.12 –1.91 to -.34 .006
Prole of Mood State Scores
Tension/Anxiety 16.13±4.46 13.37±3.73 2.77 .92 to 4.61 .005
Depression 22.53±7.78 19.97±5.67 2.57 .59 to 4.54 .013
Anger 19.40±5.88 17.60±5.35 1.80 .57 to 3.03 .005
Fatigue 11.73±4.86 11.06±4.86 .67 .14 to 1.20 .016
Confusion 13.37±4.87 12.33 ± 4.10 1.03 .16 to 1.91 .022
Vigor 23.80±4.37 27.33±3.63 –3.53 –4.64 to -2.43 <.001
Total mood distress 59.37±24.83 47.10±16.41 12.27 7.95 to 16.59 <.001
BW: body weight; WC: waist circumference; WHR: waist-hip ratio; BMI: body mass index; BF: body fat; LBM: lean body mass.

Yuenyongchaiwat K
4Braz J Phys Ther.
gender, height, and daily walking steps at follow-
up (see Table 4). In other words, lower WC was
still associated with lower depression, confusion,
and total mood distress scores, after controlling for
gender, height, and 10,000 steps a day. Moreover, the
participants who had higher %BF were associated with
higher anger states. In sum, the negative relationships
between physical health and prole of mood states
remained statistically signicant, albeit modest, after
controlling for gender, height, and 10,000 steps a day.
Prediction of longitudinal changes in mental
health problems over a 12 week later
In addition, the study examined whether the
contribution of walking steps•d–1 to the prediction of
follow-up mental health outcomes. As can be seen
in Table 5, future depression scores were related to
initial depression scores and daily walking steps
at follow-up (R2=.645, p<.001), and the more the
number of walking steps (≥10,000 steps per day) or PA
increased, the more the depression scores decreased.
Discussion
The present study evaluated the efficacy of
accumulating 10,000 steps per day on the mood
states and physical health outcomes of overweight
participants in a community setting. Further, these
participants were leading a sedentary lifestyle (<5,000
Table 3. Bivariate correlations between physical health changes and prole mood states after a 12-week period.
POMS Pearson correlation (r; p-value)
Δ BW Δ WC Δ WHR Δ BMI Δ %BF Δ LBM
Tension .01; .97 .06; .74 –.10; .61 .03; .86 .13; .51 –.12; .55
Depression –.02; .91 –.37; .05 .01; .94 .00; 1.00 .18; .35 –.19; .32
Anger .28; .14 –.32; .09 .16; .39 .27; .14 .43; .02 –.15; .44
Fatigue .08; .66 –.41; .02 .17; .38 .09; .64 .24; .19 –.11; .56
Confusion .08; .70 –.52; .00 .04; .85 .08; .67 .10; .62 –.02; .93
Vigor .04; .85 –.24; .20 –.15; .42 .03; .88 .08; .67 –.04; .82
TMD .12; .54 –.42; .02 .13; .51 .14; .48 .31; .10 –.17; .38
Δ: changes; POMS: prole of mood states; BW: body weight; WC: waist circumference; WHR: waist-hip ratio; BMI: body mass index; BF: body
fat; LBM: lean body mass; TMD: total mood distress.
Table 2. Bivariate correlation between daily walking steps and
physical health at the 12-week follow-up.
Physical health
outcomes
Daily walking steps at follow-up
Pearson
correlation (r)p-value
BW –.46 .01
BMI –.42 .02
WC –45 .01
WHR –.26 .16
%BF –.30 .11
LBM –.29 .12
BW: body weight; BMI: Body mass index; WC: waist circumference;
WHR: waist-hip ratio; BF: body fat; LBM: lean body mass.
Table 4. Partial correlations between psychological well-being and physical health changes controlling for height, gender, and daily
walking steps at follow-up among overweight participants.
POMS Pearson correlation (r; p-value)
Δ BW Δ WC Δ WHR Δ BMI Δ %BF Δ LBM
Tension –.02; .94 .124; .54 –.049; .81 .01; .97 .05; .80 –.09; .64
Depression .00; .99 –.449; .02 .035; .86 .03; .90 .18; .38 –.16; .41
Anger .29; .15 –.302; .13 .200; .32 .28; .15 .45; .02 –.14; .47
Fatigue .11; .58 –.407; .04 .193; .34 .12; .55 .29; .14 –.12; .56
Confusion .11; 58 –.558; .00 .001; 1.00 .13; .53 .21; .29 –.06; .77
Vigor .06; .77 –.203; .31 –.144; .47 .06; .78 .12; .55 –.06; .77
TMD .13; .51 –.437; .02 .149; .46 .15; .45 .32; .10 –.16; .43
Δ: changes; POMS: prole of mood states; BW: body weight; WC: waist circumference; WHR: waist-hip ratio; BMI: body mass index;
TMD: total mood distress; BF: body fat; LBM: lean body mass.

Physical activity and health outcomes
5
Braz J Phys Ther.
steps per day)
12
. The main ndings of the present study
were that participants displayed decreased negative
mood (i.e. anxiety, depression, anger, confusion,
and total mood distress scores), body weight, BMI,
WC, and %BF after increasing PA by accumulating
≥10,000 steps daily using the pedometer in a 12-week
walking intervention. In addition, the results found that
walking 10,000 steps a day played a role in decreasing
depression scores after controlling for gender, height,
initial depression scores, initial daily walking steps,
and changes in daily walking steps.
The results conrm recent ndings indicating that
walking 10,000 steps per day is effective in increasing
PA. In particular, a meta-analysis of 26 studies from
1966 to 2007 suggested that using a pedometer
increased PA
14
. Further, the benecial change in
weight demonstrated in the current study agrees with
other studies, which showed that 10,000 steps per day
resulted in a signicant decrease in body weight, BMI,
%BF, and WC15-17. Further, Tudor-Locke18 described
pedometer-based guidelines and cardiovascular health
outcomes and concluded that increasing walking
steps can improve BMI and cardiovascular health
outcomes
18
. Thus, accumulating at least 10,000 steps
per day may account, in part, for a reduction in WC
and BMI.
In addition, the present study results indicate that
walking 10,000 steps per day is effective in reducing
negative mood states. Previous studies have also
demonstrated positive effects following a walking
intervention. Several systematic reviews have shown
the effect of exercise (e.g. aerobic exercise, walking)
on PA on emotional states (i.e. depression, anxiety, and
mood)
4,9,19-21
. These reviews revealed that exercise/PA
is related to decreased anxiety, depression, and mood
states as well as improved psychological well-being.
In the present study, the benets of accumulating
10,000 steps a day over a 12-week period were
supported by the self-reported results of the POMS:
decreased tension, depression, anger, confusion,
fatigue, and total mood distress. Moreover, increased
vitality was observed in the participants who attained
10,000 steps a day.
It has been known that the effects of exercise
reduce stress; however, few studies have reported the
accumulation of 10,000 steps a day specically22,23.
The American College of Sports Medicine (ACSM)
and the American Heart Association (AHA) have
recommended individual accumulations of at least
30 minutes of moderate-intensity PA (e.g. brisk
walking) 5 days per week or 150 minutes per week
for all population groups
24
. Other studies have shown
that accumulating at least 10,000 steps•d
–1
meets that
minimum requirement12,25. Therefore, a daily target
of 10,000 steps has been generally suggested to
improve health outcomes in sedentary lifestyle and
promote a decrease in negative mood (e.g. anxiety
and depression).
With respect to POMS and physical outcomes, our
results indicate that participants with decreased WC
exhibited less depression, fatigue, confusion, and total
mood distress scores after a 12-week intervention. In
addition, the relationships between WC and negative
mood disorders (i.e. depression, confusion, and
total mood distress) were maintained after statistical
adjustment for baseline walking steps, increased
steps walk, gender, and age. Moreover, increasing
steps daily (accumulating up to 10,000 steps a day)
predicted future depression scores after controlling for
initial depression scores and baseline daily walking
steps. Therefore, the present study would suggest
that one mechanism linking negative mood disorders
with the 10,000 steps a day may involve changed
physical outcome (i.e. decreased WC). In addition,
WC is assumed to be a risk factor for obesity and an
indicator for cardiovascular risk (e.g. type 2 diabetes,
hypertension, cardiovascular disease)
2
. In a large
survey with U.S. adults, Zhao et al.26 reported that WC
is related to increased risk of depressive symptoms.
Hence, the present study provides some supporting
evidence for the involvement of 10,000 daily steps
in participants with negative mood: they showed a
decreased WC.
It should be noted that this study has a few limitations
that may have affected the results. The absence of
a control group is the most important limitation;
Table 5. Multiple regression analysis effect of 10,000 steps per day on depression from baseline characteristics.
Non-standardized
coefcients (B)
Standardized
Coefcients (β) p-value 95% Condence
interval for B
Baseline depression scores .54 .74 <.001 .36 to .72
Initial daily walking steps –.00 –.32 .030 .00 to .00
Changed daily walking steps –.00 –.31 .036 .00 to .00

Yuenyongchaiwat K
6Braz J Phys Ther.
therefore, the effects observed are overestimated,
given that important confounders (i.e. placebo effects,
polite patients, regression to the mean, recall bias, and
natural history) were not controlled. Therefore, a high
quality randomized controlled trial is strongly needed
to conrm our results. The study had a relatively small
sample size and most of the participants recruited
were females (70%). Therefore, results cannot be
used to draw conclusions for the whole population.
In summary, the use of a pedometer can improve
PA, and the effect of walking with the goal of
accumulating 10,000 steps per day results in improved
POMS scores (i.e. decreased tension, depression,
anger, fatigue, confusion, and total mood distress)
as well as improved vigor in overweight adults with
sedentary lifestyle.
Acknowledgements
The author acknowledges the help of Mr. Paitoon
Dhari, head of the community health service, and
Mrs. Somsong Duren, registered nurse, for organizing
and overseeing participant recruitment in the community.
The study is also thankful to Pantip Sukprasert for
her assistance in completing this study. Lastly, the
author would like to thank the participants in the
community for their participation. This study was
fully supported by a research grant from Thammasat
University No. 19/2557.
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Correspondence
Kornanong Yuenyongchaiwat
Thammasat University
Faculty of Allied Health Sciences
Physiotherapy Department
99 Moo 18, Paholyothin Road, Klong Luang, Rangsit
Prathumthani, 12120, Thailand
e-mail: ykornano@tu.ac.th, plekornanong@gmail.com