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How many steps/day are enough? Preliminary pedometer indices for public health

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Abstract

Pedometers are simple and inexpensive body-worn motion sensors that are readily being used by researchers and practitioners to assess and motivate physical activity behaviours. Pedometer-determined physical activity indices are needed to guide their efforts. Therefore, the purpose of this article is to review the rationale and evidence for general pedometer-based indices for research and practice purposes. Specifically, we evaluate popular recommendations for steps/day and attempt to translate existing physical activity guidelines into steps/day equivalents. Also, we appraise the fragmented evidence currently available from associations derived from cross-sectional studies and a limited number of interventions that have documented improvements (primarily in body composition and/or blood pressure) with increased steps/day.A value of 10000 steps/day is gaining popularity with the media and in practice and can be traced to Japanese walking clubs and a business slogan 30+ years ago. 10000 steps/day appears to be a reasonable estimate of daily activity for apparently healthy adults and studies are emerging documenting the health benefits of attaining similar levels. Preliminary evidence suggests that a goal of 10000 steps/day may not be sustainable for some groups, including older adults and those living with chronic diseases. Another concern about using 10000 steps/day as a universal step goal is that it is probably too low for children, an important target population in the war against obesity. Other approaches to pedometer-determined physical activity recommendations that are showing promise of health benefit and individual sustainability have been based on incremental improvements relative to baseline values. Based on currently available evidence, we propose the following preliminary indices be used to classify pedometer-determined physical activity in healthy adults: (i). <5000 steps/day may be used as a 'sedentary lifestyle index'; (ii). 5000-7499 steps/day is typical of daily activity excluding sports/exercise and might be considered 'low active'; (iii). 7500-9999 likely includes some volitional activities (and/or elevated occupational activity demands) and might be considered 'somewhat active'; and (iv). >or=10000 steps/day indicates the point that should be used to classify individuals as 'active'. Individuals who take >12500 steps/day are likely to be classified as 'highly active'.
Sports Med 2004; 34 (1): 1-8
C
URRENT
O
PINION
0112-1642/04/0001-0001/$31.00/0
2004 Adis Data Information BV. All rights reserved.
How Many Steps/Day Are Enough?
Preliminary Pedometer Indices for Public Health
Catrine Tudor-Locke
1
and David R. Bassett Jr
2
1 Department of Exercise and Wellness, Arizona State University, Mesa, Arizona, USA
2 Department of Health and Exercise Science, University of Tennessee, Knoxville,
Tennessee, USA
Pedometers are simple and inexpensive body-worn motion sensors that are
Abstract
readily being used by researchers and practitioners to assess and motivate physical
activity behaviours. Pedometer-determined physical activity indices are needed to
guide their efforts. Therefore, the purpose of this article is to review the rationale
and evidence for general pedometer-based indices for research and practice
purposes. Specifically, we evaluate popular recommendations for steps/day and
attempt to translate existing physical activity guidelines into steps/day
equivalents. Also, we appraise the fragmented evidence currently available from
associations derived from cross-sectional studies and a limited number of inter-
ventions that have documented improvements (primarily in body composition
and/or blood pressure) with increased steps/day.
A value of 10 000 steps/day is gaining popularity with the media and in
practice and can be traced to Japanese walking clubs and a business slogan 30+
years ago. 10 000 steps/day appears to be a reasonable estimate of daily activity
for apparently healthy adults and studies are emerging documenting the health
benefits of attaining similar levels. Preliminary evidence suggests that a goal of
10 000 steps/day may not be sustainable for some groups, including older adults
and those living with chronic diseases. Another concern about using 10 000 steps/
day as a universal step goal is that it is probably too low for children, an important
target population in the war against obesity.
Other approaches to pedometer-determined physical activity recommendations
that are showing promise of health benefit and individual sustainability have been
based on incremental improvements relative to baseline values. Based on current-
ly available evidence, we propose the following preliminary indices be used to
classify pedometer-determined physical activity in healthy adults: (i) <5000 steps/
day may be used as a ‘sedentary lifestyle index’; (ii) 5000–7499 steps/day is
typical of daily activity excluding sports/exercise and might be considered ‘low
active’; (iii) 7500–9999 likely includes some volitional activities (and/or elevated
occupational activity demands) and might be considered ‘somewhat active’; and
(iv) 10 000 steps/day indicates the point that should be used to classify individu-
als as ‘active’. Individuals who take >12 500 steps/day are likely to be classified
as ‘highly active’.
2 Tudor-Locke & Bassett
Physical inactivity, or sedentarism,
[1]
is consid- tion sensors, however, pedometers are generally
ered a major risk factor for a number of adverse
considered the more practical alternative for indi-
health outcomes including obesity, hypertension,
vidual and population health promotion efforts.
[1,7,9]
cardiovascular disease, diabetes mellitus and
They are simple to use, affordable ($US15–30), and
all-cause mortality.
[2]
Although national estimates of
the output (e.g. steps taken, steps/day) is extremely
self-reported participation in leisure-time physical
user-friendly.
[1,10]
In contrast to accelerometers, pe-
activity (derived from the 1998 Behavioral Risk
dometers are not designed to distinguish physical
Factor Surveillance System)
[3]
have remained rela-
activity intensity (an important independent contrib-
tively stable across recent decades, societal transi-
utor to health).
[11]
They do, however, detect steps
tions in occupation, transportation, household man-
taken (an indication of volume of physical activity)
agement and non-sport/exercise leisure-time activi-
accurately.
[12-14]
Aggregated evidence of convergent
ties (e.g. increased television viewing) likely
validity (relative to other measures of physical ac-
contribute to the obesity epidemic apparent in the
tivity)
[15]
and construct validity (relative to measures
US where the majority of the citizenry is either
of health outcome) provides abundant support for
overweight or obese.
[4]
Unfortunately, such
using pedometers to assess physical activity.
[15]
One
non-volitional and largely incidental activities are
caveat is that pedometers are not sensitive to
challenging to assess
[1,5]
and their relationship to
non-ambulatory activities (e.g. cycling, swimming,
weight maintenance and to overall health risk is only
weight training), so the current discussion is neces-
speculative at this time.
sarily limited to ambulatory activities.
Public health recommendations
[6]
endorsed by
Pedometers represent simple and affordable
the US Surgeon General
[2]
state that individuals
hardware, but without the software (e.g. guidelines,
accumulate 30 minutes of at least moderate-intensi-
indices/cut points/benchmarks, programmes) their
ty activity (such as brisk walking) on a daily basis.
utility is limited. To optimise their value, research-
This activity can be performed continuously or bro-
ers and practitioners require practical guidelines that
ken up into separate bouts throughout the day. This
include: (i) step indices associated with important
implies we need only track our time in at least
health-related outcomes (e.g. obesity, hypertension)
moderate-intensity activity during the day and add
and/or health-related levels of physical activity (i.e.
up the separate bouts taken. On an individual level,
translations of public health recommendations); (ii)
timing and summing scattered bouts of activity re-
simple data collection quality control protocols; and
quires constant attention that is impractical. Alterna-
(iii) feasible, acceptable and efficacious programme
tively, motion sensors (e.g. accelerometers and pe-
templates that can be adapted to multiple settings.
dometers) are unobtrusive body-worn instruments
that detect movement taken throughout the day and
These latter two points have been addressed else-
can provide summary outputs.
where;
[16,17]
this commentary is focused on the ap-
propriateness of step indices. The purpose of this
Accelerometers portray movement as a volume
commentary is to provide the rationale and evidence
of physical activity (e.g. activity counts) but they
for general pedometer-based indices (relative to im-
can also capture activity counts in very small units
portant health outcomes including obesity, hyper-
of time (e.g. 30 seconds, 1 minute) and can therefore
tension, cardiovascular disease, diabetes, etc.) for
be used to infer time spent in bouts of specific
public health research and practice purposes. In
intensity categories (e.g. light, moderate, vigor-
writing this piece, we referred to existing pedometer
ous).
[7,8]
Accelerometers have become invaluable as
studies that have been compiled in tabular form
activity assessment tools in research, notwithstand-
previously
[15,16]
and also reviewed extensively in
ing their high cost ($US450+ [2003 values]), re-
both and Bassett and Strath
[18]
and Tudor-Locke et
quired supporting hardware and software, and rele-
al.
[19]
vant data management expertise.
[1]
Of the two mo-
2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (1)
How Many Steps/Day Are Enough? 3
1. How Many Steps Are Enough? A value of 10 000 steps/day seems to be a reason-
able estimate of daily activity for apparently healthy
adults.
[16]
Welk et al.
[29]
reported that 73% of partici-
Physical activity guidelines have been tradition-
pants who recalled a minimum of 30 minutes of
ally formulated with expected benefits such as im-
moderate activity on any specific day in the previous
proved all-cause mortality
[20]
or prevention of
7 days also achieved at least 10 000 steps on that
weight gain
[21]
in mind. Presently, we lack direct
same day. The participants in that study were young-
evidence that accumulating any number of steps/day
er (average age 29 years) and were recruited from a
is associated with reductions in mortality. We are
physical activity research centre, so we would ex-
then left evaluating popular recommendations for
pect higher values for steps/day. In comparison,
steps/day, translating existing physical activity
Wilde et al.
[30]
reported that, even with a prescribed
guidelines into steps/day equivalents, and apprais-
30-minute walk, only 38–50% of women reached
ing fragmented evidence from associations derived
10 000 steps on any single day. Nevertheless, the
from cross-sectional studies and a limited number of
women increased their average physical activity
interventions that have documented improvements
from 7220–10 030 steps/day when they included a
(primarily in body composition and/or blood pres-
self-timed, 30-minute walk. This indicates a fair
sure) with increased steps/day.
degree of similarity between the 10 000 steps/day
In recent years, support for step indices based on
recommendation and current US public health
pedometer-determined physical activity have sur-
guidelines, if walking is the principal activity mode.
faced either formally (i.e. through peer-reviewed
A recommendation to accumulate 10 000 steps
literature) or more informally (i.e. through the lay
throughout the day has many advantages. It is
literature). A value of 10 000 steps/day is gaining
simple, easy to remember, and it provides people
popularity with the media
[22-25]
and in practice.
[26,27]
with a concrete goal for increasing activity. More-
Dr Yoshiro Hatano from the Kyushu University of
over, as with any daily step goal, the recommenda-
Health and Welfare in Japan made a presentation at
tion is focused on behaviour (not the metabolic cost
the annual meeting of the American College of
of that behaviour) and therefore applies to individu-
Sports Medicine in 2001. He explained that the
als of various body sizes.
[28]
In addition, there is
specific value has its roots in the popularity of
growing evidence that 10 000 steps/day is an
Japanese walking clubs and a pedometer manufac-
amount of physical activity that is associated with
turer (Yamasa Corporation, Tokyo, Japan) slogan
indicators of good health. For instance, individuals
from the 1960s. According to Dr Hatano, a pedome-
who accumulate at least this amount of activity have
ter came onto the Japanese commercial market in
less body fat
[28,31]
and lower blood pressure
[28]
than
1965 under the name of manpo-kei (literally trans-
their less active counterparts.
lated, ‘ten thousand steps meter’).
[28]
The concept of
achieving 10 000 steps/day remains widely familiar
The study by Yamanouchi et al.
[32]
was the first to
to Japanese households today. This level of steps/
include a specific daily step goal. An exercise and
day is approximately equivalent to an energy expen-
diet group of individuals with type 2 diabetes mel-
diture of 300 and 400 kcal/day (depending on walk-
litus lived at a hospital during the study and were
ing speed and body size).
[28]
In comparison, 30
told to take 10 000 steps/day. Over a 6–8 week
minutes of moderate physical activity is approxi-
period, they averaged >19 000 steps/day and lost an
mately equal to an energy expenditure of 150 kcal.
[2]
average of 7.7kg (almost 3.6kg more than a control
The discrepancy between the two can be explained,
group that dieted only and averaged approximately
in part, by the fact that the former is a daily recom-
4000 steps/day). Although the success of this pro-
mendation that includes all activity, and the latter is
gramme in terms of goal attainment is impressive (in
a recommendation to be active ‘over and above’ an
fact, the intervened patients far exceeded the set
undisclosed minimal level of daily activity.
goal), it is not likely that this finding will translate
2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (1)
4 Tudor-Locke & Bassett
well to real-world situations. The patients in that terol/HDL-C ratio. Although the behavioural out-
come of this study and that by Moreau et al.
[34]
study lived in a hospital protected from daily sched-
approximated the 10 000 steps/day index, the focus
ules and obligations, and likely had supportive and
on an incremental change (i.e in terms of steps/day
encouraging staff members who prompted regular
and/or distance walked) in both studies makes this
walking bouts. Furthermore, although the authors
approach to physical activity recommendations
reported a linear relationship between steps/day (r =
somewhat different from previous ones.
0.7257) and a measure of insulin sensitivity, it ap-
Interventions have shown improvement in im-
pears that no one took less than 10 000 steps/day.
portant health outcomes with an increment of 4300
Overall, the impressive results must therefore be
steps/day over baseline
[34]
but also with as little as
attributed to averaging 19 000 steps/day (not to
approximately 2500 steps/day over baseline.
[37,38]
In
10 000 steps/day). Iwane et al.
[33]
reported that hy-
Canada, the First Step Program
[10,17]
advocates self-
pertensive individuals who averaged >13 000 steps/
directed goal-setting (relevant to personal baseline
day for 12 weeks significantly reduced their blood
values) and self-monitoring. This approach has gen-
pressure, providing support for taking >13 000
erated immediate and profound improvements in
steps/day.
physical activity behaviours.
[38]
Details of that pro-
More recently, however, longitudinal studies of
gramme are described in a recently published self-
sedentary women have demonstrated health benefits
help book.
[39]
Another example is available through
of increasing to 10 000 steps/day. For example, a
the Colorado on the Move campaign
[27,40]
that also
study by Moreau et al.
[34]
demonstrated that hyper-
encourages increased physical activity through pe-
tensive women who increased to 9700 steps/day
dometer self-monitoring. In their online literature,
were able to reduce their systolic blood pressure (by
they state: If we can increase our physical activity by
11mm Hg) and body mass (by 1.3kg) after 24 weeks
just 2000 steps a day, we can prevent weight gain
of walking. Another study by Swartz and Thomp-
among Coloradans and enjoy the many benefits of a
son
[35]
examined the effects of a 10 000 steps/day
more active and healthy lifestyle”. These approach-
intervention in overweight, sedentary women with a
es to recommending incremental increases to usual
family history of type 2 diabetes. The women had
daily activity (regardless of the actual magnitude of
significant improvements in glucose tolerance, de-
the increment) parallels that espoused by the US
spite no changes in body mass or percentage fat in
Surgeon General’s public health recommendations.
this 8-week study. Other studies in progress will
Unfortunately, we do not have a clear understanding
doubtless continue to inform our understanding of
of what is ‘usual daily activity’.
the efficacy and sustainability of a 10 000 step/day
recommendation. Currently, a multi-strategy con-
2. What Steps/Day Are Indicative of
trolled intervention (the 10 000 Steps Rockhampton
Usual Daily Activity?
Project
[36]
) is being evaluated by researchers at the
University of Queensland in Australia.
Aggregated reference values for steps/day indi-
Sugiura et al.
[37]
reported the results of a
cate that healthy adults take between 7000–13 000
24-month study in which 32 women (aged 40–60
steps/day.
[16]
These values may reflect individual
years) were asked to self-monitor their activity using
participation in exercise and sports as part of habitu-
a pedometer and increase their steps/day by at least
al activity. The impact of these activities must be
2000–3000 steps/day. Participants averaged 6500
considered separately if we are to identify a value
steps/day at baseline, increased their physical ac-
more typical of unintervened daily activity. Welk et
tivity to 9000 steps/day, and achieved significant
al.
[29]
reported values of approximately 7400 steps
improvements in lipid profiles, specifically im-
on days without physical activity (again in the same
provements in total cholesterol, high density lipo-
young and active sample described in section 1).
protein-cholesterol (HDL-C), and the total choles- Bassett et al.
[41]
instructed their sample (average age
2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (1)
How Many Steps/Day Are Enough? 5
40 years) to remove the pedometer during sports/ all, days of the week.
[2,6]
Welk et al.
[29]
extrapolated
recreation and reported approximately 6000 steps/
the number of steps taken in 30 minutes of walking
day. Tudor-Locke et al.
[42]
described similar values
(approximately 3800–4000 steps) from their dis-
(i.e. 6000 steps/day) for non-exercise weekdays in a
tance-walked data but a direct measurement of this
sample whose average age was 69 years. It appears
index is preferable for implementation purposes.
then, that for otherwise healthy adults, the current
Sedentary but otherwise healthy women recorded
evidence supports 6000–7000 steps/day as indica-
approximately 3100 steps during an unsupervised
tive of usual daily activity (outside the scope of
30-minute walk (intensity not reported) included in
volitional physical activity such as sport or exer-
a typical day of activity.
[30]
Directly measured,
cise). This in turn suggests that values lower than
healthy older adults (age 59–80 years) took 3411 ±
this range could be used to classify sedentarism.
577 steps in 30 minutes of continuous, self-paced
walking in a group programme (which may have
3. How Many Steps/Day Are Indicative
influenced walking pace).
[42]
of Sedentarism?
A directly-measured and reliable index for steps
taken in 30 minutes of at least moderate-intensity
There continues to be no consensus on the defini-
walking is needed, although it is likely to fall be-
tion of sedentarism.
[1,43]
Sedentarism has been tradi-
tween 3000–4000 steps. Such an index could be
tionally inferred using comparatively low levels of
used to interpret change due to intervention and also
total energy expenditure, time or distance walked,
to prescribe an appropriate health-related physical
stairs climbed, and/or through lack of self-reported
activity increment. If used to prescribe increased
participation in vigorous leisure activities, including
physical activity, it is important to emphasise that
sports and exercise.
[43]
A specific ‘sedentary life-
this index should: (i) reflect activity that is at least of
style index’
[44]
would be helpful for screening and
moderate intensity (e.g. brisk walking); and (ii) be
recruiting purposes (i.e. to identify those who would
taken ‘over and above’ usual daily values (below
most likely benefit from appropriate intervention) as
which individuals might be classified as sedentary)
well as for surveillance. In a study of 109 adults
on a regular basis. Furthermore, if we accept that
monitored for up to 21 consecutive days, individuals
6000–7000 steps/day is indicative of usual daily
with pedometer values lower than 5000 steps/day
activity, then the addition of 3000–4000 steps/day of
(representing the 25th percentile of distribution of
moderate intensity results in 9000–11 000 steps/day,
this sample’s data) were more likely to be classified
in fair agreement with the 10 000 steps/day guide-
as obese (according to accepted body mass index
line. It remains plausible, however, that some indi-
[BMI] cut points) than individuals who took more
viduals could accumulate 30 minutes of moderate-
than 9000 steps/day (who were also more likely to
intensity activity with fewer steps/day.
[45]
be classified as normal weight). Although this evi-
dence is considered preliminary, it may be appropri-
ate to use <5000 steps/day as a sedentary lifestyle
5. Remaining Concerns
index that is likely associated with a number of
chronic conditions and untoward health outcomes.
To be considered appropriate, any endorsed step
A remaining question then is, how many steps are
index for daily activity should be both ‘efficacious’
equivalent to public health recommendations?
(i.e. it should produce the desired health benefits)
and ‘sustainable’ (i.e. it should be relatively easy to
4. How Many Steps Are Equivalent to
continue over the long term). In turn, sustainability
Public Health Recommendations?
infers that it must first be achievable ‘in the short
term’. Neither efficacy nor sustainability considered
As stated in section 1, public health guidelines
alone would be sufficient to deem any recommen-
recommend at least 30 accumulated minutes of
ded step index appropriate.
moderate-intensity physical activity on most, if not
2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (1)
6 Tudor-Locke & Bassett
Preliminary evidence suggests that a goal of step index lower than current norm references. The
2001–2002 President’s Challenge Physical Activity
10 000 steps/day may not be sustainable for some
and Fitness Awards Program
[50]
also recognised that
groups, including older adults and those living with
the popular 10 000 steps/day index was likely to be
chronic diseases. These individuals typically aver-
too low for young people by recommending instead
age between 3500–5500 steps/day
[16]
and would be
that children accumulate 11 000 steps (for girls) to
primarily classified as sedentary according the pro-
13 000 steps (for boys) at least 5 days a week for a
posed sedentary lifestyle index herein. In one
standard healthy base. Although these indices are
study,
[42]
healthy older adults achieved only 6559 ±
more in line with the published US sample,
[48]
the
2956 steps/day (and less than half attained 10 000
efficacy (i.e. to prevent or decrease overweight and
steps/day on any day of 9 days of monitoring) de-
obesity in youth) of even this echelon of steps/day is
spite attending a structured exercise class 2–3 times
unknown at this time.
during the week in addition to frequent self-initiated
informal walking for exercise. Thus, a goal of
6. Conclusions and Research Directions
10 000 steps/day might be inappropriate for this
group, although there are likely to be notable indi-
Accurate quantification of physical activity be-
vidual exceptions.
haviours is important to epidemiologists, physiolo-
We have little information about the long-term
gists and behavioural scientists, as well as to health
sustainability of 10 000 steps/day. Iwane et al.
[33]
practitioners challenged to address the public health
reported experiences with promoting a 10 000 steps/
threat of sedentarism. In addition, researchers and
day walking programme among manufacturing
practitioners require specific quantitative indices
workers. Of the initial 730 study volunteers, 306
(i.e. benchmarks, cut points) for screening, surveil-
remained in the study after 4 weeks, and only 83
lance, intervention and programme evaluation. For
remained after 12 weeks, equivalent to an 89% drop
example, <5000 steps/day may be used as a sedenta-
out rate! However, since their primary research
ry lifestyle index to screen those individuals who
question focused on the effects of walking 10 000
could most benefit from a physical activity interven-
steps/day on blood pressure, continued inclusion in
tion. In the same way, we can use such indices to
the study required unwavering compliance to the
monitor, compare and track population trends of
step goal. Such rigour likely over-exaggerates attri-
sedentarism.
tion and underestimates true sustainability of this
Indices might also be used to guide and evaluate
goal. Furthermore, few details were reported to des-
intervention efforts. Guideline statements are in-
cribe initial recruitment into the programme (e.g.
tended to assist with individual prescription but of
compulsory versus volitional workplace pro-
necessity must be general, rather than individual in
gramme). Additional studies are warranted before
nature.
[51]
Practitioners must duly engage in both the
we rule out the sustainability of a 10 000 steps/day
art and science of physical activity prescription
or any other type of pedometer-based physical ac-
when interpreting any guidelines for individual
tivity recommendation.
application. That being said, we propose the follow-
One remaining concern about using 10 000 steps/
ing preliminary indices be used to classify pedome-
day as a universal step goal is that it is too low for
ter-determined physical activity in healthy adults: (i)
children, an important target population in the war
<5000 steps/day may be used as a ‘sedentary life-
against obesity.
[46]
UK children (aged 8–10 years)
style index’; (ii) 5000–7499 steps/day is typical of
already take 12 000–16 000 steps/day.
[47]
A com-
daily activity excluding volitional sports/exercise
parable study of 6- to 12-year-old US children re-
and might be considered ‘low active’; (iii)
ported that they typically take 11 000–13 000 steps/
7500–9999 likely includes some volitional activities
day.
[48]
Since childhood obesity is higher in the US
(and/or elevated occupational activity demands) and
than in the UK,
[49]
it does not make sense to set a might be considered ‘somewhat active’; and (iv)
2004 Adis Data Information BV. All rights reserved. Sports Med 2004; 34 (1)
How Many Steps/Day Are Enough? 7
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[52]
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Acknowledgements
theory-based daily activity intervention for individuals with
type 2 diabetes. Diabetes Educ 2001; 27 (1): 85-93
Neither author receives support from any pedometer man-
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ufacturer or distributor. Dr Tudor-Locke is the author of a
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and Science of Step Counting, Trafford Publishing, 2003).
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... Previous sarcoma studies have investigated sedentary activity or activity intensity [3]; which lacks completes understanding of ambulatory activity. Wearables could provide an efficient inexpensive solution for assessing ambulatory activity [14,15] and indicate whether patients reach recommended activity targets [16]. ...
... Whilst useful, quantifying ambulatory behaviour has its own challenges, as ambulatory behaviour can vary between different age groups [16,50], weather conditions, time of the year, socio-economic background [51], gender [51] and geography [52]. Attributes of, level of occupation, participants in sports, socio-economic factors and activities in daily life (athletes or farmers, for example, have to be active when taking care of their training regime or daily tasks) must also be carefully examined. ...
Article
Purpose of the study: Ambulatory activity (walking) is affected after sarcoma surgery yet is not routinely assessed. Small inexpensive accelerometers could bridge the gap. Study objectives investigated, whether in patients with lower extremity musculoskeletal tumours: A) It was feasible to conduct ambulatory activity assessments in patient’s homes using an accelerometer-based wearable (AX3, Axivity). B) AX3 assessments produced clinically useful data, distinguished tumour sub-groups and related to existing measures. Methods: In a prospective cross-sectional pilot, 34 patients with musculoskeletal tumours in the femur/thigh (19), pelvis/hip (3), tibia/leg (9), or ankle/foot (3) participated. 27 had limb-sparing surgery and 7 amputation. Patients were assessed using a thigh-worn monitor. Summary measures of volume (total steps/day, total ambulatory bouts/day, mean bout length), pattern (alpha) and variability (S2) of ambulatory activity were derived. Results: AX3 was well-tolerated and feasible to use. Outcomes compared to literature but did not distinguish tumour sub-groups. Alpha negatively correlated with disability [walking outside (r=-418, p=0.042*), social life (r=-0.512, p=0.010*)]. Disability negatively predicted alpha (unstandardised co-efficient = -0.001, R2=0.186, p=0.039*). Conclusion: A wearable can assess novel attributes of walking; volume, pattern and variability after sarcoma surgery. Such outcomes provides valuable information about people’s physical performance in their homes, which can guide rehabilitation.
... The goal of accumulating 10,000 steps per day was first introduced in 1965 and thought to be the amount of PA needed to reduce the risk of developing coronary artery disease (3). This recommendation has evolved based on exercise recommendations related to accumulating 30 minutes per day of at least moderate-intensity PA (1,4), PA assessments of free-living individuals (5,6), and recommendations in the newest guidelines aimed at reducing time spent engaged in sedentary behaviors (1). Estimates suggest that most adults engaging in moderate intensity PA accumulate 100 or more steps per minute (4,7). ...
... This recommendation has evolved based on exercise recommendations related to accumulating 30 minutes per day of at least moderate-intensity PA (1,4), PA assessments of free-living individuals (5,6), and recommendations in the newest guidelines aimed at reducing time spent engaged in sedentary behaviors (1). Estimates suggest that most adults engaging in moderate intensity PA accumulate 100 or more steps per minute (4,7). Therefore, evidence supports the notion that 30 minutes of moderate-intensity PA is equivalent to approximately 3,000 steps per day (7). ...
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Introduction: Physical activity (PA) guidelines aimed at accumulating 10,000 steps per day have become increasingly common with the advent of wristband PA monitors. However, accumulated steps measured with wristband PA monitors may not be equal to steps measured with validated, hip-worn pedometers. Consequently, evaluating and developing guidelines for step counts using wristband PA monitors for the general population is needed. We compared step counts accumulated with hip-worn pedometers with those accumulated with wrist-worn activity monitors during 1) treadmill exercise, 2) treadmill walking, and 3) activities of daily living (ADL) to determine their accuracy in meeting step count guidelines (ie, 10,000 steps/d). Methods: Eighty-six adults (aged 18-65 y; body mass index, 19-45 kg/m2) completed 30 minutes of treadmill exercise while simultaneously using a hip-worn pedometer and wrist-worn PA monitor. Remaining steps needed to reach 10,000 steps (ie, 10,000 steps minus the number of pedometer steps recorded from treadmill exercise = remainder) were completed via treadmill walking or ADL. Steps were recorded for both devices after treadmill exercise, treadmill walking, and ADL for both devices. Results: Fewer steps were accumulated via wrist-worn PA monitors than via hip-worn pedometers during treadmill exercise (3,552 [SD, 63] steps vs 3,790 [SD, 55] steps, P < .01) and treadmill walking (5,877 [SD, 83] steps vs 6,243 [SD, 49] steps, P < .01). More steps were accumulated via wrist-worn PA monitors than hip-worn pedometers during ADL (7,695 [SD, 207] steps vs 6,309 [SD, 57] steps, P < .01). Consequently, total steps were significantly higher for wristband PA monitors than hip-worn pedometers (11,247 [SD, 210] steps vs 10,099 [SD, 39] steps; P < .01). Conclusion: The widely used 10,000-step recommendation may not be accurate for all users of all activity monitors, given the discrepancy in daily step count among wrist-worn and hip-worn devices. Having a more accurate indication of number of steps taken per day based on the device used could have positive effects on health.
... Participants are instructed to record the type and amount of their PA. Pedometers provide immediate feedback, encouraging participants to gradually increase their energy expenditure and the number of steps reach the target of 10,000 steps per day [78]. Self-monitoring should be daily for the first 6 months and then intermittently during maintenance. ...
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A wide and interacting range of individual, environmental and socioeconomic factors contribute to obesity. As a consequence, weight management strategies almost always comprise a mixture of several parallel approaches, each with its challenges and unique goals. Broadly, weight management strategies comprise of two main strands. The non-pharmacotherapy approach includes various lifestyle modifications in terms of dietary therapy, exercise and behavioral modifications, including the prevention of possible relapses. Pharmacotherapy, on the other hand, involves several anti-obesity medications, employed as single or combination therapy. Generally, the goals of weight management should be realistic and individualized to patient’s experiences, abilties, and risks in order to maximize the likelihood of success. This chapter tackles these weight management strategies in turn, explaining each as well as highlighting their distinctive features and challenges, effectiveness and safety, requisites, and where appropriate, indications and contraindications. Keywords: Obesity, weight management, dietary therapy, behavioral therapy, physical activity, exercise, anti-obesity medications, pharmacotherapy Citation: Elhag W & El Ansari W. (2022) Medical Weight Management: A Multidisciplinary Approach. In: Weight Management - Challenges and Opportunities, Hassan M. Heshmati (Ed.). Intech Open. ISBN 978-1-80355-187-6
... Anecdotal evidence indicated that both parents and children thought the dog pedometer was novel and fun, and children enjoyed completing the dog steps diary. Pedometers have been previously used with success in adult population physical activity campaigns such as promoting 10,000 steps per day [36], or doing 3000 steps in 30 minutes [37]. As such, future studies could consider incorporating the use of pedometers with personalised step counts diaries to support children's involvement. ...
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Background Despite immense benefits of physical activity on health and developmental outcomes, few children achieve recommended daily levels of physical activity. Given more than half of families with children own a dog, we investigated the effect of a mobile health (mHealth) intervention to encourage dog-facilitated physical activity through increased family dog walking and children’s active play with their dog. Methods The PLAYCE PAWS study was a three-armed randomised pilot trial conducted in Perth, Western Australia. Children aged 5-10 years with a family dog were randomised to 4 weeks of either 1) SMS-only intervention, 2) ‘SMS + pedometer’ intervention or 3) ‘usual care’ control. The mHealth intervention involved SMS messages to parents; the ‘SMS + pedometer’ group also received a dog pedometer and personalised dog steps diary. Parent-reported measures were collected at baseline, 1- and 3-months post intervention. The primary outcome was weekly frequency of family dog walking and dog play; secondary outcomes were child attachment to the dog and feasibility of the intervention. Results A total of 150 children were randomised in staggered blocks to SMS-only (n = 50), ‘SMS + pedometer’ (n = 50) or usual care (n = 50). No differences were observed in family dog walking and dog play at 1-month. SMS-only children (OR 2.6, 95% CI 1.17, 5.83, P = 0.019) and all intervention children (OR 1.97, 95% CI 1.01, 3.86, P = 0.048) were more likely to increase total dog-facilitated physical activity (sum of family dog walking and dog play responses) at 3-months. The positive associations with total dog-facilitated physical activity disappeared (all P > 0.05) after adjusting for socio-demographic factors. Conclusions The PLAYCE PAWS mHealth intervention did not significantly affect dog-facilitated physical activity in children. Given high levels of dog ownership in the community, SMS prompts could be a low-cost intervention to encourage more physical activity in children. Further research is needed to understand how increased interaction with the family dog impacts on children’s overall physical activity and other health and development outcomes. Trial registration ANZCTR, ACTRN12620000288921, retrospectively registered on 4/3/2020.
... Table 2 shows descriptive characteristics of the participants at baseline of the pilot intervention. In general, participants were older (mean age 57.3 ± 10.4 years), categorized as obese (body mass index 33.6 ± 5.4 kg/m 2 ), low active (5699 ± 1583 average steps per day) [15], and varied in terms of education and employment. Two couples participated per intervention group (ET: n = 4; ES: n = 4). ...
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Exercise intervention researchers often struggle to transition participants from supervised/laboratory-based exercise to independent exercise. Research to inform this critical juncture remains underdeveloped. This qualitative case study investigated the transition from laboratory-based to home-based training in a subset of middle-aged and older African American couples whose exercise intervention experience was interrupted by the COVID-19 pandemic. All four couples (N = 8) whose study participation was interrupted participated in dyadic interviews by videoconference. Two investigators independently reviewed verbatim transcripts, and then used an iterative open coding approach to identify themes from the qualitative data. Three main themes were identified: (1) resistance training program modifications, (2) partner interactions, and (3) external pandemic-related factors. Each theme included both positive and negative feedback related to participants’ experiences. Overall, virtual, home-based training appeared acceptable and feasible in this group. Further research is needed to investigate the utility of virtual training to effectively transition participants from laboratory-based to independent exercise.
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Background : Physical inactivity is a critically important issue in today's society. Strategies are continually sought in an effort to produce changes from unhealthy behaviors. Obesity & Physical inactivity is a major public health concern in modern society with adverse health outcomes including cardiovascular diseases like hypertension, diabetes mellitus etc. Walking can be measured using simple counting popular device called a pedometer. Therefore, purpose of the study was to find out association of pedometer determined physical activity with various obesity parameters. Material and method: This was a cross sectional study. 209 young adults in the age group of 18 – 22 years were included in the study. Their physical activity was measured with the help of pedometer. Participants were instructed to wear a pedometer for 7 days to establish baseline step counts. Average activity was calculated in form of number of steps per day. Obesity parameters BMI, WC and WHR were estimated using standardized technique. Statistical analysis was done using correlation coefficient. Results: Obesity parameters like BMI, WC and WHR were negatively correlated with pedometer count though the correlation was statistically not significant. Conclusion: In the study obesity parameters like BMI, WC and WHR were negatively correlated with pedometer count though the correlation was not statistically significant. This indicates that increase in step count will be responsible for prevention of obesity.
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Importance: Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults. Objective: To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults. Design, setting, and participants: This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022. Interventions: Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers. Main outcomes and measures: The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y. Results: Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97). Conclusions and relevance: Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC. Trial registration: ClinicalTrials.gov Identifier: NCT01072500.
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Studies addressing physical activity (PA), physical fitness (PF) and motor competence (MC) relative to weight status are limited among African youth. The aim was to evaluate PA, PF and MC relative weight status among Cabo Verde youth. Height and weight were measured in 343 boys and girls 12-14 years; BMI was calculated. Youth were classified as thin, normal and overweight/obese (IOTF criteria). PF tests included grip strength, push-ups, curl-ups, sit-and-reach and one-mile-run/walk. KTK tests were the indicator of MC. PA was estimated with pedometers. ANCOVA was used to analyse PA, PF and MC by weight status. The prevalence of thinness (girls: 31.3%; boys: 35.7%) was higher than overweight/obesity (boys: 8.4%; girls: 9.6%). PA and MC did not vary consistently with weight status. Cardiorespiratory fitness and grip strength per unit mass of thin girls was significantly better than normal weight and overweight/obese girls. Underweight boys performed significantly better in grip strength per unit mass than normal and overweight/obese boys. In conclusions, differences among youth by weight status were not apparent except for the one-mile run in girls and grip strength per unit body mass in both sexes. MC differed by weight status only among girls Los estudios que abordan la actividad física (AF), la aptitud física (ApF) y la competencia motora (CM) en relación con el estado de peso son limitados entre los jóvenes africanos. El objetivo era evaluar la AF, ApF y la CM entre los jóvenes de Cabo Verde en relación con el estado de peso. La altura y el peso se midieron en 343 niños y niñas de 12 a 14 años; Se calculó el IMC. Los jóvenes se clasificaron como delgados, normales y con sobrepeso / obesidad (criterios IOTF). Las pruebas de ApF incluyeron fuerza de prensión, flexiones de brazos, abdominales, sentarse y alcanzar y una milla de carrera/caminata. Las pruebas KTK fueron el indicador de CM. La AF se estimó con podómetros. Se utilizó ANCOVA para analizar AF, ApF y CM por estado de peso. La prevalencia de delgadez (niñas: 31,3%; niños: 35,7%) fue superior a la del sobrepeso/obesidad (niños: 8,4%; niñas: 9,6%). AF y CM no variaron consistentemente con el estado de peso. La aptitud cardiorrespiratoria y la fuerza de prensión por unidad de masa de las niñas delgadas fueron significativamente mejores que las de peso normal y las niñas con sobrepeso/obesidad. Los niños con bajo peso se desempeñaron significativamente mejor en fuerza de prensión por unidad de masa que los niños normales y con sobrepeso/obesidad. En conclusión, las diferencias entre los jóvenes por estado de peso no fueron evidentes, excepto en la carrera de una milla en las niñas y la fuerza de prensión por unidad de masa corporal en ambos sexos. CM se diferenciaba por el estado de peso solo entre las niñas Os estudos que abordam a atividade física (AF), aptidão física (ApF) e competência motora (CM) em relação ao estatuto ponderal são limitados entre os jovens africanos. O objetivo foi avaliar os níveis de AF, ApF e CM entre os jovens de Cabo Verde de acordo com o estatuto ponderal. Altura e peso foram medidos em 343 meninos e meninas de 12 a 14 anos; O IMC foi calculado. Os jovens foram classificados como magros, normais e com sobrepeso/obesidade (critérios da IOTF). Os testes de ApP incluíram força de preensão, flexões de braços, elevações do tronco, sentar e alcançar e correr/caminhar uma milha. Os testes KTK foram o indicador de CM. A AF foi estimada com pedómetros. ANCOVA foi usada para analisar AF, ApF e CM por estatuto ponderal. A prevalência de magreza (meninas: 31,3%; rapazes: 35,7%) foi maior do que sobrepeso/obesidade (meninos: 8,4%; meninas: 9,6%). A AF e CM não variaram de forma consistente com o estatuto ponderal. A aptidão cardiorrespiratória e a força de preensão por unidade de massa de meninas magras foi significativamente melhor do que a das meninas com peso normal e com sobrepeso/obesidade. Rapazes com baixo peso tiveram desempenho significativamente melhor na força de preensão por unidade de massa do que rapazes normais e com sobrepeso/obesidade. Em conclusão, as diferenças entre os jovens por estatuto ponderal não foram evidentes, exceto para a corrida de uma milha em meninas e força de preensão por unidade de massa corporal em ambos os sexos. MC diferiu por estatuto ponderal apenas entre as meninas.
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Introduction: According to studies from developed countries, post-stroke individuals commonly have a low level of physical activity. Considering the benefits of maintaining a good level of physical activity in these subjects, it is important to provide specific and complete information, based on the assessment of all dimensions of physical activity, which supports interventions. Objective: To compare the physical activity levels between individuals with stroke and matched healthy individuals that use the public health system in Brazil considering the different dimensions of physical activity. Methods: Individuals with stroke (n = 11) and matched healthy individuals (n = 11) were assessed. Physical activity levels, considering all dimensions -duration (> 3 MET), frequency (number of steps) and intensity (mean total energy expenditure per day) - were assessed using SenseWear® monitor for seven days. Descriptive statistics and between-groups comparisons were performed (α = 0.05). Results: The physical activity levels were significantly lower in individuals with stroke when compared to matched healthy individuals, considering all dimensions. The between-group differences in activity duration, frequency, and intensity were 74 minutes/day, 5,274 steps/day, and 2,134kJ/day, respectively. Conclusion: Individuals with stroke users of the Brazilian public health system have lower physical activity levels in different dimensions of physical activity than matched healthy individuals. The assessment of the physical activity level of post-stroke individuals is important for decision making in public health programs.
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Objective. —To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.
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This digest provides basic information designed to help people determine which of the many physical activity guidelines are most appropriate for use in specific situations. After an introduction, the digest focuses on: "Factors to Consider in Selecting Appropriate Physical Activity Guidelines" (group credibility and purpose, benefits to be expected if guidelines are followed, and people for whom the guidelines are intended); "Interpreting Existing Physical Activity Guidelines" (the early years: a fitness focus, and 1992 to the present: the emerging health focus); and "Making Sense of Current Recommendations": the physical activity pyramid, which offers one method of classifying guidelines and includes lifestyle physical activities; active aerobic, active sports, and recreational activities; muscle fitness and flexibility exercises; and inactivity; prevention of premature health problems; and other recommendations (e.g., physical activity recommendations for children). (Contains 34 references.) (SM)
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To conduct a randomised trial of a physical activity (PA) intervention, The First Step Program (FSP) for adults with type II diabetes. A 16-week intervention study and 24-week follow-up assessment. A total of 47 overweight/obese, sedentary individuals (age=52.7 +/- 5.2 y; BMI=33.3 +/- 5.6 kg/m2) recruited through a diabetes education centre. Primary outcome: daily PA assessed by pedometer (steps/day). Secondary outcomes: anthropometric measures (weight, BMI, waist girth, hip girth); indicators of cardiovascular health (resting heart rate and blood pressure); glycemic control (fasting glucose, insulin, HbA1c, glucose concentration 120 min postglucose load); plasma lipid status (total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides). Relative to the CONTROL group, FSP participants increased their PA >3000 steps/day (approximately 30 min/day) during the intervention (P<0.0001). Waist and hip girth decreased (approximately 2-3 cm), but did not differ significantly between groups. Significant changes did not emerge for any of the other variables. The FSP is a practical intervention that elicits an immediate and profound change in walking behaviour. Such change is an important 'first step' towards increasing the volume and/or intensity of PA necessary to improve long-term health outcomes in this largely sedentary and overweight or obese population. Relapse by 24 weeks indicates that other strategies such as booster sessions are needed to maintain lifestyle change. Further research must determine realistic and responsive health outcomes for this population that are achievable through practical, real-world programming.
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This article summarizes the findings of an exploratory meeting of 53 experts brought together under the aegis of the Women's Health Initiative to identify important issues related to measuring physical activity in minority women, women in midlife (aged 40-75), and older women (aged > 75). The findings address five areas, three dealing with measurement and two concerning the design of surveys: (1) population characteristics to consider when measuring the physical activity of women and minority populations, (2) activity dimensions relevant to physical activity surveys, (3) measuring moderate and intermittent activities, (4) designing and administering physical activity surveys for older and minority women, and (5) establishing the reliability and validity of such physical activity surveys. Although the focus of the expert panel meeting was on identifying issues related to the measurement of physical activity in women, many issues summarized here can be generalized to children and men. The panel's findings concerning measuring physical activity are timely, as they directly bear on the challenges associated with the physical activity guidelines jointly issued by the Centers for Disease Control and Prevention and the American College of Sports Medicine and the recommendations made in the Surgeon General's 1996 report, Physical Activity and Health.
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