Pedometers Increase Activity for Patients Seen at a Family Medicine Clinic

Average individual improvement was 41% over the study period.

Because of their frequent encounters with sedentary patients, family physicians are poised to be on the forefront of the medical community’s response to physical inactivity. The purpose of this pilot study was to examine whether the addition of a pedometer to brief physician counseling could help patients increase their ambulatory activity. Ninety four participants recruited from a family medicine clinic were randomly assigned to 2 groups. Both groups received a brief physician endorsement of regular physical activity, a handout on the benefits of an active lifestyle, and 3 follow-up phone calls from a health educator. In addition, the intervention group received a pedometer and was instructed to record their steps daily over the 9-week study period.

Measurements were taken for self-reported walking, walking stage-of-change, walking self-efficacy, and pedometer steps (intervention group only). Among completers, mean daily step counts in the pedometer group rose from 6779 at baseline to 8855 at study end. Average individual improvement was 41% over the study period. Both groups significantly increased blocks walked per day, stair climbing versus using the elevator, days per week walking =30 minutes, and walking for fun/leisure. The frequency of walking short trips improved significantly more in the pedometer group relative to the comparison group. The results of this pilot study highlight the benefits on the use of pedometers as a motivational tool in the context of medical encounters with inactive patients.

This pilot study was designed to test the efficacy of a physician delivered intervention using a pedometer to improve physical activity levels in patients seen for routine visits to a family medicine clinic. It was hypothesized that pedometers may serve as a motivating tool to inactive patients and thus enhance physician-based counseling. The intervention was designed to be applicable within the time constraints of modern medical practice.

Given the novelty of using pedometers in the context of primary care medicine, we were first interested in learning whether participants would be adherent with their use. Forty two percent of patients randomized to the pedometer group were adherent over the 9-week study period. In addition, we wanted to know whether those that completed the study would increase their step-counts. Completers in the pedometer group increased their steps by an average of 41% by study end. Step counts increased by an average of 2089 per day, which corresponds to approximately 20 minutes of increased walking.

To delineate the effect of the pedometer over the other interventions, a comparison group received similar treatment but was not given a pedometer and thus lacked the ability to objectively record their daily steps. The 2 groups were compared using the LWQ, along with stage-of-change and self-efficacy scales. Participants in both the pedometer and comparison groups increased several aspects of their walking behavior over the course of this 9-week study. By study end, 8 participants from each group reported walking at a level that met or exceeded the physical activity objective of Healthy People 2010.[7] Stage-of-change improvement was similar between groups. Self-efficacy decreased by a non-significant amount in the pedometer group relative to the control group. Although self-efficacy has been listed as a determinant of physical activity, it may have decreased in the pedometer group because recording daily steps may give participants more precise awareness of their physical activity barriers.[28]

Increased walking may be an especially important component of a healthy lifestyle because it is perhaps the safest and most accessible form of activity. Pedometers reflect cumulative bouts of activity, and thus are responsive to even small increases in walking.[29] Activities as short as 8 to 10 minutes, although perhaps not typically perceived as exercise, are cumulatively beneficial toward improving health.[7] Small improvements may subsequently "open the door" to more vigorous activity among inactive patients. The average body mass index for the patients in this study was in the obese range, suggesting that pedometers may be a useful tool when counseling those in need of increasing their physical activity levels for the purpose of weight management.
There were several limitations to this study, the most significant being the low completion rate. This was not particularly surprising given the recruitment procedures whereby patients presented for routine indications and had no special motivation to participate in or complete a research study. It was also comparable to similar "real-world" interventions involving physical activity promotion.[30]

Physical inactivity has clearly become an epidemic in the United States.[1,2] Family physicians are consistently faced with patients suffering the health consequences of their inactive lifestyles. Physician-based physical activity counseling has historically been limited by a perceived lack of effectiveness and concerns that it is too time-consuming.[13] Given the time and financial constraints of modern medical practice, the medical community needs to be creative in developing feasible and effective approaches. Most of the intervention procedures in this study would be feasible in modern primary care settings. Participants were patients that presented for routine visits to a family medicine clinic. The intervention was brief, requiring the principal investigator to merely review a one-page handout and, for those in the pedometer group, demonstrate its use. Pedometers are an economically viable intervention (~$20) and give providers a simple discussion point that may empower them to engage in more in-depth physical activity counseling.

Am Board Fam Pract. 2005;18(5):335-343

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