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ArticleTitle Impact of a walking program of 10,000 steps per day and dietary counseling on health-related quality of
life, energy expenditure and anthropometric parameters in obese subjects
Article Sub-Title
Article CopyRight Italian Society of Endocrinology (SIE)
(This will be the copyright line in the final PDF)
Journal Name Journal of Endocrinological Investigation
Corresponding Author Family Name Coquart
Particle
Given Name J.
Suffix
Division UFR STAPS, CETAPS, EA3832
Organization Université de Rouen
Address Rouen, 76000, France
Division
Organization UFR STAPS, CETAPS
Address Boulevard Siegfried, Mont Saint Aignan, 76 821, France
Phone (+33)2 32 10 77 95
Fax
Email jeremy.coquart@yahoo.com
URL
ORCID
Author Family Name Castres
Particle
Given Name I.
Suffix
Division UFR STAPS, CETAPS, EA3832
Organization Université de Rouen
Address Rouen, 76000, France
Phone
Fax
Email
URL
ORCID
Author Family Name Tourny
Particle
Given Name C.
Suffix
Division UFR STAPS, CETAPS, EA3832
Organization Université de Rouen
Address Rouen, 76000, France
Phone
Fax
Email
URL
ORCID
Author Family Name Lemaitre
Particle
Given Name F.
Suffix
Division UFR STAPS, CETAPS, EA3832
Organization Université de Rouen
Address Rouen, 76000, France
Phone
Fax
Email
URL
ORCID
Schedule
Received 23 March 2016
Revised
Accepted 7 August 2016
Purpose Purpose:
The aim of this pilot study was to assess the impact of a physical activity program of walking 10,000 steps
per day along with monthly dietary counseling on the body composition, biological parameters, resting
energy expenditure (REE) and health-related quality of life (HRQoL) of obese individuals.
Methods:
Thirty-five obese adults (26 women; age: 39.2 ± 13.4 years, body mass, BM: 104.1 ± 18.7 and body mass
index, BMI: 38.3 ± 6.6 kg m−2) followed a walking program (instructions were provided so that the
participants increase their walking distance by 1000 steps each week, until to perform at least 10,000 steps
per day) and received qualitative dietary advice (cookbook presenting numerous recipes with low calories
and dietary advices was provided) for 6 months. Before and after the intervention, anthropometric (BM,
BMI, waist and hip circumferences, fat mass: FM and lean body mass: LBM) and biological data (total
cholesterol, high-density lipoprotein, low-density lipoprotein, triglyceride and glucose concentrations),
REE and HRQoL (including eight dimensions and two summaries) were assessed.
Results:
After the intervention, BM (difference: 3.8 kg or 3.7 %), BMI (difference: 1.4 kg m−2 or 3.7 %), hip
circumference (difference: 4.6 cm or 4.3 %), FM in kg (difference: 4.0 kg or 8.9 %) and FM in percentage
of BM (difference: 1.6 kg or 6.1 %) were significantly decreased, whereas number of steps (difference:
7579 steps or 135 %), LBM in percentage of BM (difference: 2.6 kg or 4.5 %) and REE (difference:
78 kcal d−1 or 4.8 %) were significantly increased (p < 0.05). Moreover, two HRQoL subdimension scores
(physical functioning and physical component summary; increase by 15.3 and 4.6, respectively, p < 0.05)
and anxiety (reduction by 1.2, p < 0.05) were also significantly improved. Conversely, the biological data
showed no significant change (p > 0.05).
Conclusion:
Walking 10,000 steps per day in association with dietary counseling improved anthropometric data, REE,
the physical domains of HRQoL and anxiety in obese adults.
Keywords (separated by '-') Physical activity - Obesity - Body mass - Walk - Anxiety
Footnote Information
Metadata of the article that will be visualized in
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UNCORRECTED PROOF
Journal : Large 40618 Dispatch : 12-8-2016 Pages : 7
Article No : 530 ¨ LE ¨ TYPESET
MS Code : JENI-D-16-00139 þ CP þ DISK
1 3
J Endocrinol Invest
DOI 10.1007/s40618-016-0530-9
ORIGINAL ARTICLE
Impact of a walking program of 10,000 steps per day and dietary
counseling on health-related quality of life, energy expenditure
and anthropometric parameters in obese subjects
I. Castres1 · C. Tourny1 · F. Lemaitre1 · J. Coquart1,2
Received: 23 March 2016 / Accepted: 7 August 2016
© Italian Society of Endocrinology (SIE) 2016
1.6 kg or 6.1 %) were significantly decreased, whereas
number of steps (difference: 7579 steps or 135 %), LBM
in percentage of BM (difference: 2.6 kg or 4.5 %) and
REE (difference: 78 kcal d−1 or 4.8 %) were significantly
increased (p < 0.05). Moreover, two HRQoL subdimension
scores (physical functioning and physical component sum-
mary; increase by 15.3 and 4.6, respectively, p < 0.05) and
anxiety (reduction by 1.2, p < 0.05) were also significantly
improved. Conversely, the biological data showed no sig-
nificant change (p > 0.05).
Conclusion Walking 10,000 steps per day in association
with dietary counseling improved anthropometric data,
REE, the physical domains of HRQoL and anxiety in obese
adults.
Keywords Physical activity · Obesity · Body mass · Walk ·
Anxiety
Introduction
Overweight and obesity are complex chronic conditions
affected by genetic, metabolic, social and behavioral fac-
tors [1]. Kolotkin et al. [2] showed that obesity has a nega-
tive impact on health-related quality of life (HRQoL),
especially on the subjective multidimensional assessment
of physical, psychological and social domains of health.
Physical functioning, such as general health perception,
vitality [3] and physical pain [4], and psychological func-
tioning (i.e., poor body image and depression) and social
well-being (i.e., stigmatization, discrimination, diminished
social interactions and lower socioeconomic status) [5] are
impaired in obese individuals. A loss in body mass often
improves their HRQoL, physical functioning, role physical,
general health, vitality and mental health scores [6].
Abstract
Purpose The aim of this pilot study was to assess the
impact of a physical activity program of walking 10,000
steps per day along with monthly dietary counseling on
the body composition, biological parameters, resting
energy expenditure (REE) and health-related quality of life
(HRQoL) of obese individuals.
Methods Thirty-five obese adults (26 women; age:
39.2 ± 13.4 years, body mass, BM: 104.1 ± 18.7 and body
mass index, BMI: 38.3 ± 6.6 kg m−2) followed a walking
program (instructions were provided so that the participants
increase their walking distance by 1000 steps each week,
until to perform at least 10,000 steps per day) and received
qualitative dietary advice (cookbook presenting numerous
recipes with low calories and dietary advices was provided)
for 6 months. Before and after the intervention, anthropo-
metric (BM, BMI, waist and hip circumferences, fat mass:
FM and lean body mass: LBM) and biological data (total
cholesterol, high-density lipoprotein, low-density lipopro-
tein, triglyceride and glucose concentrations), REE and
HRQoL (including eight dimensions and two summaries)
were assessed.
Results After the intervention, BM (difference: 3.8 kg or
3.7 %), BMI (difference: 1.4 kg m−2 or 3.7 %), hip circum-
ference (difference: 4.6 cm or 4.3 %), FM in kg (difference:
4.0 kg or 8.9 %) and FM in percentage of BM (difference:
* J. Coquart
jeremy.coquart@yahoo.com
1 UFR STAPS, CETAPS, EA3832, Université de Rouen,
76000 Rouen, France
2 UFR STAPS, CETAPS, Boulevard Siegfried,
76 821 Mont Saint Aignan, France
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Journal : Large 40618 Dispatch : 12-8-2016 Pages : 7
Article No : 530 ¨ LE ¨ TYPESET
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1 3
In addition to the positive effects on HRQoL [7], it has
been amply documented that a reduction in body mass also
decreases the risk of obesity-related comorbidities (e.g.,
arterial hypertension, cardiovascular diseases, vascular
diseases and type 2 diabetes) [7]. Reducing body mass is
encouraged by major public health agencies [8], and the
main non-pharmacological and non-surgical method is
dieting to induce a negative energy balance. Weight reduc-
tion is relatively easy to obtain by calorie restriction, hence
the popularity of very-low- or low-calorie diets [9]. How-
ever, the effects of dieting alone are transient with regard
to maintaining body mass loss [10], and over the long term,
these effects may be deleterious to lean body mass (LBM)
and resting energy expenditure (REE) [11]. To palliate
these negative effects, physical exercise is recommended.
According to numerous authors [12–15], adults can achieve
beneficial health effects by walking 10,000 steps daily,
although many are able to achieve only slightly more than half
of this step goal, with a daily deficit of approximately 4000
steps [16]. To motivate obese individuals to reduce this deficit
and significantly decrease body mass, Bravata et al. [17] sug-
gested the use of a pedometer during walking.
Dietary counseling may further improve the effects of
daily walking on weight loss and body composition [18].
Although Melanson et al. [18] showed that 12 weeks of
walking both with and without dietary advice reduced fat
mass (FM) and waist circumference, they reported that the
walking program had to be associated with dietary coun-
seling to achieve a significant reduction in body mass. To
our knowledge, however, no study has yet evaluated the
combined effects of walking the recommended 10,000
steps per day and dietary advice on the physiological
parameters and HRQoL of obese individuals.
The aim of this pilot study was to examine the impact of
a physical activity program based on the daily accumula-
tion of 10,000 steps combined with monthly dietary coun-
seling on the anthropometric and biological data, REE and
HRQoL of obese individuals.
Subjects
Thirty-five adults [26 women; age: 39.2 ± 13.4 years,
height: 166 ± 9 cm and body mass index (BMI):
≥30 kg m−2] volunteered to take part in this study
(Table 1). Among these patients, 12, 14 and 9 were con-
sidered with 1, 2 and 3 obesity class, respectively. All had
been referred to the Nutrition Unit of a French University
Hospital for a weight loss program. The exclusion criteria
were symptomatic cardiopulmonary disease, musculoskel-
etal abnormalities and pregnancy. Patients with well-con-
trolled hypertension, dyslipidemia and/or type 2 diabetes
were eligible for study enrollment. All participants pro-
vided written informed consent, and all procedures per-
formed in this study were in accordance with the ethical
standards of the institution.
Materials and methods
Before and after the intervention program, subjects
were investigated at 08:00 after an overnight fast. The
Table 1 Anthropometric and
biological data, resting energy
expenditure, anxiety and
depression before and after the
intervention program
a p < 0.05; b p < 0.01
Before After Difference Differences (%)
Body mass (kg) 104.1 ± 18.7 100.3 ± 18.0b−3.8 −3.7
Body mass index (kg m−2) 38.3 ± 6.6 36.9 ± 6.4a−1.4 −3.7
Waist circumference (cm) 117.3 ± 16. 8 114.3 ± 18.0 −3.0 −2.6
Hip circumference (cm) 105.9 ± 12.5 101.3 ± 13.3a−4.6 −4.3
Fat mass (kg) 45.0 ± 14.6 41.0 ± 15.3a−4.0 −8.9
Fat mass (%) 42.7 ± 8.5 40.1 ± 9.8a−2.6 −6.1
Lean body mass (kg) 59.1 ± 11.2 59.4 ± 11.6 +0.3 +0.5
Lean body mass (%) 57.3 ± 8.5 59.9 ± 9.8a+2.6 +4.5
Total cholesterol (mmol L−1) 5.1 ± 1.0 5.2 ± 1.2 +0.1 +2.0
High-density lipoprotein (mmol L−1) 1.2 ± 0.3 1.2 ± 0.3 0.0 0.0
Low-density lipoprotein (mmol L−1) 3.5 ± 0.7 3.7 ± 0.8 +0.2 +5.7
Triglycerides (mmol L−1) 1.5 ± 1.0 1.5 ± 1.2 0.0 0.0
Glucose (mmol L−1) 5.4 ± 0.7 5.3 ± 0.7 −0.1 −1.9
Resting energy expenditure (kcal d−1) 1709 ± 331 1787 ± 320a+78 +4.6
Anxiety (score) 10.1 ± 4.1 8.9 ± 4.3a−1.2 −11.9
Depression (score) 5.8 ± 3.8 5.0 ± 4.0 −0.8 −13.8
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anthropometric and biological data, REE, HRQoL, anxiety
and depression were assessed.
Anthropometric measures
Height was measured to the nearest 0.5 cm from a height
gauge (Tanita®, Arlington Heights, USA). Body mass was
measured to the nearest 0.1 kg on a balance scale (model
888, Seca®, Hamburg, Germany), with participants wear-
ing no shoes and only light clothing. BMI was calculated
as body mass in kilograms divided by height in squared
meters (kg m−2). Waist and hip circumferences were meas-
ured with the subjects in a standing position. Waist circum-
ference was measured at the midpoint between the lower
border of the rib cage and the iliac crest, and hip circumfer-
ences were measured at the widest part of the hip region
[19]. Body composition (FM and LBM expressed in abso-
lute and relative values) was estimated using bioelectrical
impedance (QuadScan 4000, Bodystat®, Isle of Man, UK).
Two current electrodes were placed on the dorsal surfaces
of the right hand and right foot, at the distal metacarpals
and metatarsals, respectively.
Biological measures
Blood samples were obtained from a forearm vein of each
participant. Blood was allowed to clot at room tempera-
ture for 10 min and was then centrifuged at 4000 rpm for
15 min at 0 °C to separate serum from red blood cell pel-
lets. Serum samples were immediately frozen and stored at
−70 °C until analysis. The blood lipid concentrations (total
cholesterol, high-density lipoprotein: HDL, triglyceride)
and glucose concentrations were assessed. The low-density
lipoprotein cholesterol (LDL) concentrations were com-
puted using Friedewald et al.’s formula [20].
Resting energy expenditure
REE was evaluated by indirect calorimetry after an over-
night fast [21] from open-circuit calorimeter equipped with
a canopy (Deltatrac II, Datex-Ohmeda®, Helsinki, Fin-
land). The gas collection system is based on the air dilution
technique by using a mixing chamber. Air dilution systems
take the exhaled air, dilute it with room air and then shunt
the gases into a mixing chamber for analysis. In this mix-
ing chamber, sensors sample the gas collection at factory-
selected intervals [22]. Subjects were asked to lie supine
in a comfortable position for 20 min while a canopy was
placed over their heads. Plastic fabric was placed over the
canopy so as to form a seal between the air inside and out-
side the canopy. Subjects were then asked to breathe nor-
mally. REE was then derived from the concentration dif-
ference between inspired and expired oxygen uptake and
carbon dioxide output. Software uses the Weir equation to
assess energy expenditure at rest [23].
Health-related quality of life
HRQoL was determined from the Medical Outcome Study
Short Form-36 (MOS SF-36) [24]. This internationally val-
idated instrument for generic health is often used in obesity
research [25–27]. The SF-36 contains 36 questions cover-
ing functional health status and general health. The ques-
tions are categorized into eight subscales measuring physi-
cal functioning, role physical, bodily pain, general health,
vitality, social function, role emotional and mental health
[24]. The first three subscales (i.e., physical functioning,
role physical and bodily pain) reflect the physical com-
ponent of health. Social functioning, role emotional and
mental health cover the psychosocial aspect. Vitality and
general health give an overall score of subjective health. A
score between 0 and 100 was computed for each subscale,
with 100 representing the most favorable state of health.
From the subscales, two summary scores were calculated:
the physical composite summary and the mental composite
summary.
Anxiety and depression
The Hospital Anxiety Depression (HAD) questionnaire
[28] determined the patient’s psychological state in terms
of anxiety and depression. This questionnaire has a total
of 14 items (7 items for each psychological state), with
responses being scored on a scale of 0–3 to indicate symp-
tom frequency (the higher the score is, the higher the fre-
quency). Consequently, scores for both subscales may
range from 0 to 21.
Intervention program
After these initial measures, participants were enrolled in a
6-month program with dietary counseling and the expecta-
tion that they would walk 10,000 steps per day (7 days per
week). To achieve this goal, the patients should increase
their walking distance by 1000 steps each week, until to
perform at least 10,000 steps per day. To increase the walk-
ing distance, the instructions were, for example, to: shop on
foot (e.g., to go to the bakery, butcher shop and school), to
drive less (if possible), stop at previous bus/subway stop to
then walk…). To motivate the participants and help them
to follow these recommendations, pedometers were lent
to them. We have collected the number of steps during the
first and last weeks of program.
Qualitative dietary counseling was offered once a month
and included such topics as making changes in eating
behaviors, diversifying food intake and the components of
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Article No : 530 ¨ LE ¨ TYPESET
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1 3
a balanced diet (55 % glucose, 30 % lipids and 15 % pro-
teins). Moreover, a cookbook presenting numerous reci-
pes with low calories (approximately 40 recipes of usual
meals) was offered at each participant. In this cookbook
(which was developed by dietitians and nutritionists), die-
tary advices were provided. For example, the recommenda-
tions were to: avoid to skip a meal, eat at a regular time,
eat slowly (at least 20 min), drink at least 1.5 L of water
each day and avoid the sweetened drinks and alcoholic
beverages.
Statistical analysis
Data are presented as means and standard deviation. For
all data, normal Gaussian distributions (Shapiro–Wilk
test) and homogeneity (Levene’s test) were verified.
Moreover, we have also checked the sphericity from the
Mauchley test. A one-way ANOVA for repeated measures
was used to compare each variable before and after the
intervention period. When the data did not pass the test
for normality, homogeneity of variance and/or spheric-
ity, the Wilcoxon test was used. Statistical significance
was set at p < 0.05, and all analyses were performed with
Minitab 14.10.
Results
After the intervention, body mass (difference: 3.8 kg or
3.7 %), BMI (difference: 1.4 kg m−2 or 3.7 %), hip circum-
ference (difference: 4.6 cm or 4.3 %), FM in kg (differ-
ence: 4.0 kg or 8.9 %) and FM in percentage of body mass
(difference: 1.6 kg or 6.1 %) were significantly decreased,
whereas number of steps (difference: 7579 steps or 135 %)
and LBM expressed in percentage of body mass (differ-
ence: 2.6 or 4.5 %) were significantly increased (Table 1).
No significant change was observed in waist circumference
(difference: −3.0 or −2.6 %) or LBM in kg (difference:
+0.3 kg or +0.5 %, p > 0.05, Table 1).
Similarly, no significant change was noted for the bio-
logical data (p > 0.05, Table 1).
REE was significantly increased after the intervention
(difference: 78 kcal d−1, Table 1).
The effect of the intervention program on HRQoL is
summarized in Fig. 1. After the program, physical func-
tioning and physical component summary were signifi-
cantly improved (p < 0.05, Fig. 1), although other scores
for HRQoL had not significantly changed (p > 0.05,
Fig. 1).
Although depression was unaltered, anxiety was signifi-
cantly improved (reduction by 1.2 or 11.9 %, Table 1).
Discussion
The main finding of this study was that accumulation of
10,000 steps per day associated with dietary counseling
improves the anthropometric data, REE, some physical
domains of HRQoL and anxiety in obese adults.
The intervention program decreased body mass, FM in
kg, FM in percentage of body mass and hip circumference
by 3.7 % (or 3.8 kg), 8.9 % (or 4.0 kg), 2.6 % (or 6.1 %)
and 4.3 % (or 4.6 cm), respectively (Table 1). Similar
results were observed by Miyatake et al. [29] after a 1-year
program that increased energy expenditure by 1000 steps
per day in addition to the daily baseline walking (−4.5 %
body mass and −8.6 % FM).
In Richardson et al.’s meta-analysis [30], the average
participant adhering to a pedometer-based walking pro-
gram could expect to lose about 0.05 kg of body mass per
week, whereas in the current study, weight loss was 0.15 kg
per week. It should nevertheless be noted that in their meta-
analysis [30], only two out of nine studies included more
than 10,000 steps per day, explaining the greater body mass
loss of the current study. Moreover, associating a dietary
component and daily walking may yield more weight loss.
Indeed, Melanson et al. [18] showed that 12 weeks of walk-
ing (5 days per week) without dietary counseling decreased
FM and waist circumference, although body mass did not
significantly reduce. When this training program was asso-
ciated with a weight loss diet, body mass was also reduced
(−8 %). Therefore, the current study, in agreement with the
findings of Melanson et al. [18], suggests that walking is
an effective therapeutic for obese patients when it is associ-
ated with diet counseling.
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PF RP BP GH VT SF RE MH PCSMCS
Before
After
a
a
Fig. 1 Health-related quality of life before and after the interven-
tion program. ap < 0.01, PF physical functioning, RP role physical,
BP bodily pain, GH general health, VT vitality, SF social functioning,
RE role emotional, MH mental health, PCS physical component sum-
mary, MCS mental component summary
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Article No : 530 ¨ LE ¨ TYPESET
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1 3
Our intervention program did not improve the biologi-
cal parameters. According to Bravata et al.’s meta-analysis
[17], walking does not significantly improve the lipid pro-
file or decrease the fasting glucose concentration. Although
physical exercise at low-to-moderate intensity was not
shown to significantly decrease glycaemia, it probably
allows for better control of it [31] and reduces the risk of
developing type 2 diabetes [32, 33]. In Swartz et al.’s study
[34], fasting glucose concentration did not change, but the
area under the curve for glucose and 2-h post-load glucose
concentration decreased after an 8-week walking program
with the goal of accumulating 10,000 steps per day. The
authors therefore suggested that this type of intervention
was effective to improve glucose tolerance in inactive over-
weight women.
Weight loss in obese individuals has been associated
with a reduction in REE in many studies [11, 35, 36]. In
contrast, REE was increased after the current intervention
(difference: 78 kcal d−1 or 4.6 %). Generally, 70–80 % of
variance in REE is assumed to explain by fat-free mass
(FFM) [37]. Each kg of LBM (which is included in LBM)
exerts a 1.5–7 times greater effect on REE than each kg of
FM. Consequently, the loss in LBM associated with calo-
rie-restricted diets might be responsible for the decline in
REE [11], but our intervention program (which included
walking) slightly and nonsignificantly increased LBM in
kg (difference: +0.3 kg or +0.5 %, p > 0.05). Thus, the
increase in REE in our study did not seem mainly linked to
training effects on LBM. Araiza et al. [38] suggested that
the improvement in REE (without change in LBM) might
be explained by excess post-exercise oxygen consumption.
Indeed, REE can be temporarily increased by 5–10 % for
up to 24 h after the last exercise session [39]. It is there-
fore possible that the significant increase in REE after the
intervention period was linked to the slight (nonsignifi-
cant) increase in LBM, but also and more importantly to
the excess post-exercise oxygen consumption that was
detected, as proposed by Araiza et al. [38].
The physical functioning and physical content sum-
mary dimensions of HRQoL and the anxiety state were
improved after 6 months of 10,000 steps per day and
monthly dietary counseling. The intervention programs
in other studies have also improved the mental and physi-
cal domains. For example, 13 weeks of a weight loss pro-
gram (lifestyle physical activity and calorie-restricted
diet) improved six of eight subscales of the MOS SF-36
questionnaire (physical functioning, role physical, gen-
eral health, vitality, social function and mental health) [6].
Another example was reported by Blissmer et al. [40], who
observed improvements in physical functioning, general
health, vitality, mental health, physical content summary
and mental composite summary. In our program, weight
loss (−3.8 kg or −3.7 %) was lower than both previous
studies (i.e., −11.2 and −6.1 %, respectively). Kolotkin
et al. [41] reported that only two weight loss categories
(i.e., body mass losses of 5–9.9 % and 10 %) had posi-
tive effects on HRQoL, whereas losses under 5.0 % had
no effect. As the weight loss in our study was −3.8 kg
or 3.7 %, it is therefore unsurprising that improvements
in only two HRQoL subscales were observed. Moreover,
Kolotkin et al. [41] also reported that physical functioning
and physical content summary were more linked to weight
loss than social function, role emotional, mental health and
mental composite summary. Our results agree with these
findings because only physical functioning and physical
content summary were improved.
To detect smaller changes in HRQoL linked to moderate
weight loss (−3.8 kg or 3.7 %), it might be better to meas-
ure HRQoL with a questionnaire especially developed for
the obese population. Indeed, Kaukua et al. [42] reported
a stronger correlation between weight change and an obe-
sity-specific measure than physical functioning of the MOS
SF-36.
Although our results are promising, the current study
presents some limitations. Indeed, all participants were
referred by the Nutrition Unit for a weight loss program. To
benefit from the present intervention program, the patient
was recommended by his familial medical doctor. This
recommendation was often based on avoiding of possible
complications linked to obesity (e.g., myocardial infarction
and type 2 diabetes). Consequently, many participants were
aware that if the program did not respect, their health status
will be probably deteriorated in few months or years. Con-
sequently, the participants were probably more motivated
than general population, explaining why the number of
steps has considerably been increased. It would have been
much better if we had compared our participants to a con-
trol group.
Similarly, the high motivation of our participants for a
weight loss and avoiding of complications have maybe
influenced their diet. It is possible that a drastic reduction
in number of intake calories has been executed in several
participants.
Since several years, the public authorities set up educa-
tional interventions (e.g., television advertising campaigns
and Web-interactive programs) toward healthy eating habits
and physical activity. These strategies of interventions have
already showed to be effective in children [43]. In obese
adults, these educational interventions have also probably
an impact on the lifestyle, and thus, it is possible that the
benefits noted in our study are partially linked to these
interventions. Consequently, further studies are required to
investigate whether our beneficial effects are only linked to
our intervention program and/or a societal trend.
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Author Proof
UNCORRECTED PROOF
Journal : Large 40618 Dispatch : 12-8-2016 Pages : 7
Article No : 530 ¨ LE ¨ TYPESET
MS Code : JENI-D-16-00139 þ CP þ DISK
J Endocrinol Invest
1 3
Conclusion
The main finding of this study was that the accumulation
of 10,000 steps per day associated with diet counseling
improved (i.e., body mass, BMI, hip circumferences and
FM) or preserved (i.e., LBM) the anthropometric data,
REE, physical domains of HRQoL (i.e., physical func-
tioning and physical content summary) and anxiety in
obese adults. Our study demonstrated that the implemen-
tation of a program of 10,000 steps per day with monthly
dietary counseling was enough to start obesity man-
agement. This should incite clinicians to educate their
patients on the importance of daily walking to improve
their clinical state, HRQoL and anxiety. Future studies
should investigate the potential of these recommendations
for long-term benefits in each obesity class or in weight
loss maintenance.
Acknowledgments This project was not directly supported by any
Grants or other financial assistance. Special thanks are given to Pro-
fessor Pierre Dechelotte (Service de Nutrition, CHU Rouen; INSERM
U1073) and Doctor Vanessa Folope (Service de Nutrition, CHU
Rouen) for recruiting of subjects, the provision of materials and die-
tary counseling, but also the subjects for their cooperation.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
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