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Am Fam Physician. 2008;78(5):639-640

Background: Despite the documented health benefits of exercise, more than one half of U.S. adults do not meet the U.S. Department of Health and Human Services' recommendation 30 minutes or more of exercise on most days of the week, and one fourth of adults do not exercise at all. Pedometers are used to motivate patients and monitor walking. Some guidelines recommend using pedometers to set goals (e.g., walking 10,000 steps daily). Bravata and colleagues investigated the association between pedometer use and physical activity, lipid levels, glucose control, and body weight. They also examined the association between setting step goals and health outcomes.

The Study: The systematic review included a database search for English-language studies assessing pedometer use. The review excluded studies confined to hospitals or research centers, those with an intervention group using sealed pedometers (blinding participants in the intervention and control groups to the number of steps taken), and those using pedometers to measure exercise tolerance in the evaluation of medications. The primary outcome was mean difference in steps taken pre-and postintervention.

Results: The search found 26 studies, including a total of 2,767 participants, most of whom were relatively inactive at baseline. The mean age of participants was 49 years. The study designs were highly heterogeneous, with eight randomized controlled trials (RCTs) comparing step counts in participants using sealed versus nonsealed pedometers, six RCTs using only nonsealed pedometers (these trials were treated as observational studies), and 12 observational studies. Some studies included physical activity counseling, although only three included dietary counseling.

After one highly heterogeneous trial was excluded, the RCTs showed that pedometer users increased physical activity by 2,004 more steps per day than the control group (95% confidence interval [CI], 878 to 3,129 steps per day; P < .001). In the observational studies, the pedometer users increased physical activity by 2,183 steps compared with non-pedometer users (95% CI, 1,571 to 2,796 steps per day; P < .001). These findings represent an overall 26.9 percent increase in physical activity over baseline in pedometer users compared with non-pedometer users.

Having a step goal was highly predictive of increased physical activity. Interventions outside the workplace were also predictive of physical activity, possibly because participants in the workplace studies had a high level of baseline physical activity. Older age, white ethnicity, having a step goal, and trial duration were associated with a lower body mass index. Blood pressure also decreased by 3.8 mm Hg (P < .001) in pedometer users. Lipid levels and fasting glucose concentration did not change; however, they were fairly close to normal at baseline.

Conclusion: The authors conclude that pedometer use increases physical activity by approximately one mile of walking per day compared with persons who do not use a pedometer. Pedometer use is associated with weight loss and a decrease in blood pressure. A key factor to these positive findings is setting a step goal. Durability of the benefits over time is unknown.

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Copyright © 2008 by the American Academy of Family Physicians.

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