A meta-analysis of pedometer-based walking interventions and weight loss

Do activity monitors increase physical activity in adults with overweight or obesity? A systematic review and meta-analysis

OBJECTIVE

To systematically assess contemporary knowledge regarding behavioral physical activity interventions including an activity monitor (BPAI+) in adults with overweight or obesity.

METHODS

PubMed/MEDLINE, Embase, CINAHL, PsycINFO, CENTRAL, and PEDro were searched for eligible full-text articles up to 1 July 2015. Studies eligible for inclusion were (randomized) controlled trials describing physical activity outcomes in adults with overweight or obesity. Methodological quality was independently assessed employing the Cochrane Collaboration's tool for risk of bias.

RESULTS

Fourteen studies (1,157 participants) were included for systematic review and 11 for meta-analysis. A positive trend in BPAI+ effects on several measures of physical activity was ascertained compared with both wait list or usual care and behavioral physical activity interventions without an activity monitor (BPAI-). No convincing evidence of BPAI+ effectiveness on weight loss was found compared with BPAI-.

CONCLUSIONS

Behavioral physical activity interventions with an activity monitor increase physical activity in adults with overweight or obesity. Also, adding an activity monitor to behavioral physical activity interventions appears to increase the effect on physical activity, although current evidence has not yet provided conclusive evidence for its effectiveness.

Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation

Maternal obesity and excessive gestational weight gain (GWG) are significant contributors to the global obesity epidemic. However, isolated lifestyle interventions to address this in pregnancy appear to have only modest benefit and responses can be variable. This paper aims to address the question of why the success of lifestyle interventions to prevent excessive GWG is suboptimal and variable. We suggest that there are inherent barriers to lifestyle change within pregnancy as a life stage, including the short window available for habit formation; the choice for women not to prioritise their weight; competing demands including physiological, financial, relationship, and social situations; and lack of self-efficacy among healthcare professionals on this topic. In order to address this problem, we propose that just like all successful public health approaches seeking to change behaviour, individual lifestyle interventions must be provided in the context of a supportive environment that enables, incentivises and rewards healthy changes. Future research should focus on a systems approach that integrates the needs of individuals with the context within which they exist. Borrowing from the social marketing principle of 'audience segmentation', we also need to truly understand the needs of individuals to design appropriately tailored interventions. This approach should also be applied to the preconception period for comprehensive prevention approaches. Additionally, relevant policy needs to reflect the changing evidence-based climate. Interventions in the clinical setting need to be integrally linked to multipronged obesity prevention efforts in the community, so that healthy weight goals are reinforced throughout the system.

Effectiveness of a smartphone app in increasing physical activity amongst male adults: a randomised controlled trial

Background

Smartphones are ideal for promoting physical activity in those with little intrinsic motivation for exercise. This study tested three hypotheses: H1 – receipt of social feedback generates higher step-counts than receipt of no feedback; H2 – receipt of social feedback generates higher step-counts than only receiving feedback on one’s own walking; H3 – receipt of feedback on one’s own walking generates higher step-counts than no feedback (H3).

Methods

A parallel group randomised controlled trial measured the impact of feedback on steps-counts. Healthy male participants (n = 165) aged 18–40 were given phones pre-installed with an app that recorded steps continuously, without the need for user activation. Participants carried these with them as their main phones for a two-week run-in and six-week trial. Randomisation was to three groups: no feedback (control); personal feedback on step-counts; group feedback comparing step-counts against those taken by others in their group. The primary outcome measure, steps per day, was assessed using longitudinal multilevel regression analysis. Control variables included attitude to physical activity and perceived barriers to physical activity.

Results

Fifty-five participants were allocated to each group; 152 completed the study and were included in the analysis: n = 49, no feedback; n = 53, individual feedback; n = 50, individual and social feedback. The study provided support for H1 and H3 but not H2. Receipt of either form of feedback explained 7.7 % of between-subject variability in step-count (F = 6.626, p < 0.0005). Compared to the control, the expected step-count for the individual feedback group was 60 % higher (effect on log step-count = 0.474, 95 % CI = 0.166–0.782) and that for the social feedback group, 69 % higher (effect on log step-count = 0.526, 95 % CI = 0.212–0.840). The difference between the two feedback groups (individual vs social feedback) was not statistically significant.

Conclusions

Always-on smartphone apps that provide step-counts can increase physical activity in young to early-middle-aged men but the provision of social feedback has no apparent incremental impact. This approach may be particularly suitable for inactive people with low levels of physical activity; it should now be tested with this population.

Work out by Walking: A Pilot Exercise Program for Individuals With Schizophrenia Spectrum Disorders

The health benefits of exercise are well documented, yet annual health care costs related to physical inactivity are well within the billions. Furthermore, individuals with schizophrenia spectrum disorders (SSDs) are more likely to lead sedentary lives, exercise less than the general population, and die prematurely from preventable causes. Previous research examining the effects of exercise on individuals with SSDs has been encouraging yet limited in creating accessible and sustainable interventions. The current pilot study developed and evaluated the impact of Work out by Walking (WOW), a multicomponent group walking intervention on the health of 16 individuals with SSDs. Results indicated improvements in indicators of physical health, activity level, social support, and mental health and a high level of program satisfaction. Future research should examine multicomponent group walking programs for individuals with SSDs in larger samples and with the inclusion of a comparison condition.

Leveraging Multi-Modal Sensing for Mobile Health: A Case Review in Chronic Pain

Active and passive mobile sensing has garnered much attention in recent years. In this paper, we focus on chronic pain measurement and management as a case application to exemplify the state of the art. We present a consolidated discussion on the leveraging of various sensing modalities along with modular server-side and on-device architectures required for this task. Modalities included are: activity monitoring from accelerometry and location sensing, audio analysis of speech, image processing for facial expressions as well as modern methods for effective patient self-reporting. We review examples that deliver actionable information to clinicians and patients while addressing privacy, usability, and computational constraints. We also discuss open challenges in the higher level inferencing of patient state and effective feedback with potential directions to address them. The methods and challenges presented here are also generalizable and relevant to a broad range of other applications in mobile sensing.

Pedometer intervention and weight loss in overweight and obese adults with Type 2 diabetes: a meta-analysis

AIM

Although pedometer intervention is effective in increasing physical activity among adults with Type 2 diabetes, its impact on weight loss remains unclear. This meta-analysis was aimed to assess whether pedometer intervention promotes weight loss.

METHODS

Three different databases were searched for randomized controlled trials (RCTs) published in English up to April 2015. Studies were included if they investigated the effects of pedometer intervention on weight loss, as measured by BMI or weight. Effect sizes were aggregated using a random-effects model. Subgroup and meta-regression analyses were used to identify potential moderators. Eleven RCTs with 1258 participants were included. All enrolled participants were overweight or obese.

RESULTS

Pedometer intervention led to significantly decreased BMI [weighted mean difference (WMD) -0.15 kg/m(2) , 95% confidence interval (CI) -0.29 to -0.02 kg/m(2) ] and reduced weight (WMD -0.65 kg, 95% CI -1.12 to -0.17 kg). Dietary counselling seemed to be a key predictor of the observed changes. However, none of the following variables had a significant influence: step goal setting, baseline age, BMI, weight, sex distribution, disease duration, intervention duration, and baseline values or change scores for total or moderate-to-vigorous physical activity. After completion of the pedometer intervention, non-significant declines in BMI and weight were observed during the follow-up periods.

CONCLUSIONS

Pedometer intervention promotes modest weight loss, but its association with physical activity requires further clarification. Future studies are also required to document dietary and sedentary behaviour changes to facilitate the use of pedometers for weight loss in overweight and obese adults with Type 2 diabetes.

Effect of exercise training on C reactive protein: a systematic review and meta-analysis of randomised and non-randomised controlled trials

PURPOSE

C-reactive protein (CRP) is a marker of chronic systemic inflammation frequently used in cardiovascular disease risk assessment. The purpose of this meta-analysis was to provide a quantitative estimate of the magnitude of change in CRP following participation in physical exercise interventions.

METHODS

All studies included in the meta-analysis were peer reviewed and published in English. Human participants were assigned to a non-exercise comparison group or exercise training group, with the intervention lasting ≥2 weeks. CRP levels were measured at baseline, during and/or after completion of the exercise training programme. Random-effects models were used to aggregate a mean effect size (ES), 95% CIs and potential moderators.

RESULTS

83 randomised and non-randomised controlled trials met the inclusion criteria and resulted in 143 effects (n=3769). The mean ES of 0.26 (95% CI 0.18 to 0.34, p<0.001) indicated a decrease in CRP following exercise training. A decrease in body mass index (BMI; β=1.20, SE=0.25, p<0.0001) and %Fat (β=0.76, SE=0.21, p=0.0002) were associated with a decrease in CRP, independently accounting for 11.1% and 6.6% of the variation in response, respectively. Exercise training led to a greater reduction in CRP when accompanied by a decrease in BMI (ES=0.38, 95% CI 0.26 to 0.50); however, a significant improvement in CRP occurred in the absence of weight loss (ES=0.19, 95% CI 0.10 to 0.28; both p<0.001).

CONCLUSIONS

These results suggest that engaging in exercise training is associated with a decrease in CRP levels regardless of the age or sex of the individual; however, greater improvements in CRP level occur with a decrease in BMI or %Fat.

Physical activity preferences of individuals diagnosed with schizophrenia or bipolar disorder

Background

Individuals with a severe mental illness (SMI) are at least two times more likely to suffer from metabolic co-morbidities, leading to excessive and premature deaths. In spite of the many physical and mental health benefits of physical activity (PA), individuals with SMI are less physically active and more sedentary than the general population. One key component towards increasing the acceptability, adoption, and long-term adherence to PA is to understand, tailor and incorporate the PA preferences of individuals. Therefore, the objective of this study was to determine if there are differences in PA preferences among individuals diagnosed with different psychiatric disorders, in particular schizophrenia or bipolar disorder (BD), and to identify PA design features that participants would prefer.

Methods

Participants with schizophrenia (n = 113) or BD (n = 60) completed a survey assessing their PA preferences.

Results

There were no statistical between-group differences on any preferred PA program design feature between those diagnosed with schizophrenia or BD. As such, participants with either diagnosis were collapsed into one group in order to report PA preferences. Walking (59.5 %) at moderate intensity (61.3 %) was the most popular activity and participants were receptive to using self-monitoring tools (59.0 %). Participants were also interested in incorporating strength and resistance training (58.5 %) into their PA program and preferred some level of regular contact with a fitness specialist (66.0 %).

Conclusions

These findings can be used to tailor a physical activity intervention for adults with schizophrenia or BD. Since participants with schizophrenia or BD do not differ in PA program preferences, the preferred features may have broad applicability for individuals with any SMI.

Comparative Effectiveness of Two Walking Interventions on Participation, Step Counts, and Health

Purpose:

To (1) compare the effects of two worksite-based walking interventions on employee participation rates; (2) compare average daily step counts between conditions, and; (3) examine the effects of increases in average daily step counts on biometric and psychologic outcomes.

Design:

We conducted a cluster-randomized trial in which six employer groups were randomly selected and randomly assigned to condition.

Setting:

Four manufacturing worksites and two office-based worksite served as the setting.

Subjects:

A total of 474 employees from six employer groups were included.

Intervention:

A standard walking program was compared to an enhanced program that included incentives, feedback, competitive challenges, and monthly wellness workshops.

Measures:

Walking was measured by self-reported daily step counts. Survey measures and biometric screenings were administered at baseline and 3, 6, and 9 months after baseline.

Analysis:

Analysis used linear mixed models with repeated measures.

Results:

During 9 months, participants in the enhanced condition averaged 726 more steps per day compared with those in the standard condition (p < .001). A 1000-step increase in average daily steps was associated with significant weight loss for both men (−3.8 lbs.) and women (−2.1 lbs.), and reductions in body mass index (−0.41 men, −0.31 women). Higher step counts were also associated with improvements in mood, having more energy, and higher ratings of overall health.

Conclusions:

An enhanced walking program significantly increases participation rates and daily step counts, which were associated with weight loss and reductions in body mass index.

Accuracy of the Yamax CW-701 Pedometer for measuring steps in controlled and free-living conditions

Objective

The Yamax Digi-Walker CW-701 (Yamax CW-701) is a low-cost pedometer that includes a 7-day memory, a 2-week cumulative memory, and automatically resets to zero at midnight. To date, the accuracy of the Yamax CW-701 has not been determined. The purpose of this study was to assess the accuracy of steps recorded by the Yamax CW-701 pedometer compared with actual steps and two other devices.

Methods

The study was conducted in a campus-based lab and in free-living settings with 22 students, faculty, and staff at a mid-sized university in the Southeastern US. While wearing a Yamax CW-701, Yamax Digi-Walker SW-200, and an ActiGraph GTX3 accelerometer, participants engaged in activities at variable speeds and conditions. To assess accuracy of each device, steps recorded were compared with actual step counts. Statistical tests included paired sample t-tests, percent accuracy, intraclass correlation coefficient, and Bland–Altman plots.

Results

The Yamax CW-701 demonstrated reliability and concurrent validity during walking at a fast pace and walking on a track, and in free-living conditions. Decreased accuracy was noted walking at a slow pace.

Conclusions

These findings are consistent with prior research. With most pedometers and accelerometers, adequate force and intensity must be present for a step to register. The Yamax CW-701 is accurate in recording steps taken while walking at a fast pace and in free-living settings.

Practicing Tai Chi had lower energy metabolism than walking but similar health benefits in terms of aerobic fitness, resting energy expenditure, body composition and self-perceived physical health

OBJECTIVE

To examine the effects of Tai Chi and walking training on aerobic fitness, resting energy expenditure (REE), body composition, and quality of life; as well as analyzing the energy metabolism during exercises, to determine which one had better advantage in improving health status.

METHODS

Three hundred seventy-four middle-aged Chinese subjects who were recruited from nine geographic areas in Sha Tin were randomized into Tai Chi, walking, or control groups at area level. The 12-week (45min per day, 5days per week) Tai Chi or brisk walking training were conducted in respective intervention groups. Measures were performed at baseline and end of trial. Another 30 subjects were recruited to compare the energy metabolism between practicing Tai Chi and walking.

RESULTS

The between-group difference of VO2max was 3.3ml/min/kg for Tai Chi vs. control and 3.7ml/min/kg for walking vs. control (both P<0.001). BMI, skinfold thicknesses, and SF-12 physical component scores all improved significantly compared with the control group (all P<0.01). Tai Chi had higher effect on improving REE-VO2 and REE-kilocalorie expenditure than walking. Regarding to energy metabolism test, the self-paced walking produced approximately 46% higher metabolic costs than Tai Chi.

CONCLUSION

Practicing Tai Chi consumes a smaller amount of energy metabolism but similar health benefits as self-paced brisk walking.

Testing Activity Monitors' Effect on Health: Study Protocol for a Randomized Controlled Trial Among Older Primary Care Patients

BACKGROUND

Cardiovascular disease is the leading cause of mortality in the United States. Maintaining healthy levels of physical activity is critical to cardiovascular health, but many older adults are inactive. There is a growing body of evidence linking low motivation and inactivity. Standard behavioral counseling techniques used within the primary care setting strive to increase motivation, but often do not emphasize the key component of self-control. The addition of electronic activity monitors (EAMs) to counseling protocols may provide more effective behavior change and increase overall motivation for exercise through interactive self-monitoring, feedback, and social support from other users.

OBJECTIVE

The objective of the study is to conduct a three month intervention trial that will test the feasibility of adding an EAM system to brief counseling within a primary care setting. Participants (n=40) will be randomized to receive evidence-based brief counseling plus either an EAM or a pedometer.

METHODS

Throughout the intervention, we will test its feasibility and acceptability, the change in primary outcomes (cardiovascular risk and physical activity), and the change in secondary outcomes (adherence, weight and body composition, health status, motivation, physical function, psychological feelings, and self-regulation). Upon completion of the intervention, we will also conduct focus groups with the participants and with primary care stakeholders.

RESULTS

The study started recruitment in October 2015 and is scheduled to be completed by October 2016.

CONCLUSIONS

This project will lay the groundwork and establish the infrastructure for intervention refinement and ultimately translation within the primary care setting in order to prevent cardiovascular disease on a population level.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02554435; https://clinicaltrials.gov/ct2/show/NCT02554435 (Archived by WebCite at http://www.webcitation/6fUlW5tdT).

Employee Use of a Wireless Physical Activity Tracker Within Two Incentive Designs at One Company

Physical activity provides numerous health benefits, including reducing risk factors that contribute to the leading causes of morbidity and mortality. Many employers offer incentives to employees to motivate engagement in wellness program activities. Two incentive designs to reward employees for achieving step goals were evaluated. This study used a retrospective design and the study population consisted of benefit-eligible employees at American Specialty Health ages 18 to 65 years who completed a health assessment and biometric screening during 2011 (N=396) or 2012 (N=500). A total of 320 employees participated in both years. During 2011, the incentive goal was 500,000 steps per quarter. By comparison, a 3-tier step goal plan was implemented in 2012 (ie, 400,000; 650,000; or 900,000 steps/quarter). The prevalence of participants in the step program was 64.7% in 2011 and 72.8% in 2012. The percentage of employees who reached at least 1 quarterly incentive increased from 36.3% in 2011 to 51.4% in 2012. Average steps/day was higher in 2012 (mean [M]=3573, standard deviation [SD]=3010) compared to the same employees in 2011 (M=2817, SD=2654) (P<.001). The findings suggest that a tiered incentive design may be an effective population approach to engage employees in physical activity. A multitier incentive design offers participants choices for goal setting and may help shape behavior toward what may be perceived as a difficult goal to achieve. (Population Health Management 2016;19:88-94).

Individual Health Management - A Comprehensive Lifestyle Counselling Programme for Health Promotion, Disease Prevention and Patient Education

BACKGROUND

Epidemiological data shows globally increasing numbers of obesity and stress-related diseases. In this article, a comprehensive medical lifestyle modification programme - called Individual Health Management (IHM) - is described in detail and discussed as a promising tool to individually manage and reverse such negative health trends in patients.

METHODS

The IHM programme is based on a blended learning concept. It comprises a 12-week basic training phase, followed by a 9-month maintenance phase, and includes the following key features: 1) web-based and physician-led health screenings; 2) a structured 12-week basic training with a core curriculum providing tuition in behavioural self-management strategies for weight loss and stress reduction; 3) weekly supervised group sessions during the core curriculum; 4) tailoring of materials, strategies and lifestyle goals; 5) continuous self-monitoring and feedback of the achieved progress; 6) regular contact with physicians or health professionals based on either face-to-face or distant lifestyle counselling; 7) recurrent one-day health seminars to ensure the sustainability of obtained results.

CONCLUSIONS

IHM is a multi-component lifestyle intervention programme to increase physical activity, to reduce calorie intake and to practice both self and stress management. Individual care, group support and a tailored web-based programme blend to achieve the desired goals. A randomised control study to evaluate IHM's effects on weight control is currently being conducted.

A Web-Based Intervention to Encourage Walking (StepWise): Pilot Randomized Controlled Trial

Background

Despite Internet-based interventions that incorporate pedometers with appropriate goal-setting processes and other theoretically-based behavior change strategies being proposed as a means of increasing walking behavior, few have incorporated all of these key features or assessed maintenance of behavior change.

Objective

The objective of our study was to investigate the effect of a 12-week pedometer step goal walking program individually tailored to baseline step counts, combined with an interactive support website for step counts, health parameters and motivation over 12 and 24 weeks.

Methods

Low active participants (mean [SD] 46.2 [11.2] years) were randomly assigned to the Stepwise (SW) intervention group (n=49) or a comparison (CP) group (n=48). SW received a pedometer, step goal walking program and access to the SW website (containing interactive self-monitoring and goal feedback tools, motivational messages and action and coping planning strategies). CP received a pedometer and locally available physical activity information. Step counts, BMI, resting heart rate, blood pressure and glucose, cholesterol and triglyceride levels, psychological well-being, perceived health, self-efficacy and self-determined motivation were measured at baseline, 12 and 24 weeks.

Results

Linear mixed model analysis found that both groups’ step counts increased from baseline to week 12 (β = 11,002, CI 5739-16,266, P<.001) and 24 (β = 6810, CI 1190-12,431; P=.02). Group step counts were significantly different at week 24 with SW taking 8939 (CI 274-17604, P=.04) more steps compared to CP. Compared to baseline, both groups had improved triglyceride levels (0.14 mmol/L, CI -0.25 to -0.02, P=.02) at week 12, decreased diastolic blood pressure (4.22 mmHg, CI -6.73 to -1.72) at weeks 12 and 24 (3.17 mmHg, CI -5.55 to -0.78), improved positive (β = .21, CI 0.03-0.38, P=.02) and negative affect (β = -.15, CI -0.28 to -0.03, P=.02) at week 12, and perceived health at week 12 (β = 6.37, CI 2.10-10.65, P=.004) and 24 (β = 8.52, CI 3.98-13.06, P<.001). Total cholesterol increased at week 12 (0.26 mmol/L, CI 0.099-0.423, P=.006) and week 24 (0.38 mmol/L, CI 0.20-0.56, P<.001). Repeated measures ANOVA found motivation for walking improved from baseline with higher task self-efficacy (P<.001, η² = .13) and autonomous motivation (P<.001, η²=.14) at weeks 12 and 24 and decreased controlled motivation (P=.004, η²=.08) at week 24.

Conclusions

Both groups had similar improvements in step counts and physical and psychological health after 12 weeks but only the SW group successfully maintained the increased step-counts 24 weeks post-intervention. This suggests the step-goal based walking program combined with Internet-based behavior change tools were important for sustained behavior change.

Social Entrepreneurship for Obesity Prevention: What Are the Opportunities?

In recent years, social entrepreneurship has emerged as a new field to address social and public health challenges. Social entrepreneurship, which harnesses traditional business practices and market forces to address social challenges, may produce solutions that are more cost-effective and sustainable than those produced by governmental and nonprofit sectors. In this paper, we discuss whether and how social entrepreneurship can be harnessed for obesity prevention by defining and briefly reviewing the rise of social entrepreneurship in the USA, outlining the threat that obesity poses to US society and offering some examples of how social ventures are addressing the problem of obesity. Additional untapped opportunities are also discussed and recommendations given for how social entrepreneurship might impact obesity prevention in the future.

Step Counter Use and Sedentary Time in Adults: A Meta-Analysis

Although step counters are increasingly being used in walking programmes to promote sedentary behavior changes in adults, their effectiveness remains unknown. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the effectiveness of step counter use in reducing sedentary time among adults.English-language RCTs from 3 databases were searched up to December 2014. Studies were included if they evaluated the effects of step counter use in adult populations and reported outcomes in sedentary time. Summary estimates (Cohen d with 95% confidence intervals [CIs]) were pooled using a random-effects model. Subgroup analyses and random-effects meta-regression analyses based on the characteristics of participants or interventions were conducted to explore their associations with sedentary time changes.Fifteen RCTs with a total sample size of 3262 adults were included. Step counter use was associated with a small but significant overall effect in reducing sedentary time (d = -0.20, 95% CI -0.33 to -0.07), equating to a reduction in sedentary time of ~23 min/d compared with controls. Subgroup analyses showed that step counter use with a step goal was associated with significantly reduced sedentary time (d =- 0.32, 95% CI -0.53 to -0.11), whereas without, it had only a trend. A greater reduction in sedentary time was observed among step counter users employing objective methods than those employing subjective methods for measurement (P = 0.03). Effects of covariates on sedentary time changes were generally unclear.Step counter use is associated with reduced sedentary time among adults. Future studies are required to specify the step goal use and to employ objective as well as subjective methods for measuring both total and domain-specific sedentary time.

When does personalized feedback make a difference? A narrative review of recent findings and their implications for promoting better diabetes self-care

Providing behavioral, biomarker, or disease risk feedback to patients is a key component of most behavioral interventions in diabetes, but it remains unclear what is necessary for such feedback to be truly engaging and effective. We sought to identify how personalized health-related feedback is most effectively designed and delivered, and how feedback may be tailored to meet the needs of individual patients with diabetes. To do so, we systematically reviewed recent findings concerning the effectiveness of feedback in eight health-related areas, including several specific to diabetes care (blood glucose monitoring and HbA1c) and others which touch on broader care dimensions (blood pressure, cholesterol, dietary intake, pedometer usage, self-weighing, and medical imaging). Five interdependent characteristics of health-related feedback were identified (clarity of the feedback message, personal meaningfulness of the feedback, frequency of feedback, guidance and support accompanying feedback, and interplay between feedback and patient characteristics) and applications for use in diabetes care were provided. Findings suggested that feedback will be most effective when it is easy for patients to understand and is personally meaningful, frequency of feedback is appropriate to the characteristics of the behavior/biomarker, guidance for using feedback is provided, and feedback is qualified by patient characteristics. We suggest that the effectiveness of feedback to promote better diabetes outcomes requires careful consideration of the feedback message, how it is delivered, and characteristics of the recipients.

Is there evidence that walking groups have health benefits? A systematic review and meta-analysis

OBJECTIVE

To assess the health benefits of outdoor walking groups.

DESIGN

Systematic review and meta-analysis of walking group interventions examining differences in commonly used physiological, psychological and well-being outcomes between baseline and intervention end.

DATA SOURCES

Seven electronic databases, clinical trial registers, grey literature and reference lists in English language up to November 2013.

ELIGIBILITY CRITERIA

Adults, group walking outdoors with outcomes directly attributable to the walking intervention.

RESULTS

Forty-two studies were identified involving 1843 participants. There is evidence that walking groups have wide-ranging health benefits. Meta-analysis showed statistically significant reductions in mean difference for systolic blood pressure -3.72 mm Hg (-5.28 to -2.17) and diastolic blood pressure -3.14 mm Hg (-4.15 to -2.13); resting heart rate -2.88 bpm (-4.13 to -1.64); body fat -1.31% (-2.10 to -0.52), body mass index -0.71 kg/m(2) (-1.19 to -0.23), total cholesterol -0.11 mmol/L (-0.22 to -0.01) and statistically significant mean increases in VO(2max) of 2.66 mL/kg/min (1.67-3.65), the SF-36 (physical functioning) score 6.02 (0.51 to 11.53) and a 6 min walk time of 79.6 m (53.37-105.84). A standardised mean difference showed a reduction in depression scores with an effect size of -0.67 (-0.97 to -0.38). The evidence was less clear for other outcomes such as waist circumference fasting glucose, SF-36 (mental health) and serum lipids such as high-density lipids. There were no notable adverse side effects reported in any of the studies.

CONCLUSIONS

Walking groups are effective and safe with good adherence and wide-ranging health benefits. They could be a promising intervention as an adjunct to other healthcare or as a proactive health-promoting activity.

The Effectiveness of a Weight Maintenance Intervention for Adults with Intellectual Disabilities and Obesity: A Single Stranded Study

BACKGROUND

The evidence base for weight management programmes incorporating a weight loss and a weight maintenance phase for adults with intellectual disabilities (ID) is limited. This study describes the weight maintenance phase of a multicomponent weight management programme for adults with intellectual disability and obesity (TAKE 5).

MATERIALS AND METHODS

Thirty-one participants who had completed the 16 week TAKE five weight loss intervention (Phase I) were invited to participate in a 12 month weight maintenance intervention (Phase II). Content included recommendations of the National Weight Control Registry.

RESULTS

Twenty-eight participants completed Phase II with 50.4% maintaining their weight (mean weight change -0.5 kg, SD 2.2), 28.7% gaining weight (mean weight gain 5.4 kg, SD 2.2) and 21.6% losing weight (mean weight loss -8.0 kg, SD 3.0) at 12 months.

CONCLUSION

Further research is justified to investigate the efficacy of weight loss maintenance interventions in adults with intellectual disability and obesity, using controlled study designs.

[Effects of a progressive walking program on physical activity, exercise tolerance, recovery, and post-operative complications in patients with a lung resection]

PURPOSE

The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection.

METHODS

A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0.

RESULTS

A higher proportion of patients in the experimental group showed adequate levels of physical activity (p=.001), shorter period of chest tube retention (≤ 7 days; p=.011), and shorter stay in the hospital (≤ 10 days; p=.036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p=.032) and lower levels of dyspnea (p=.049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications.

CONCLUSION

The findings of this study suggest that the PW could be a useful strategy for improving patients' post-operative health and reducing cost after lung resection.

Impact of physical activity interventions on anthropometric outcomes: systematic review and meta-analysis

Considerable research has tested physical activity (PA) interventions to prevent and treat overweight and obesity. This comprehensive meta-analysis synthesized the anthropometric effects of supervised exercise interventions and motivational interventions to increase PA. Eligible intervention studies included healthy participants with reported anthropometric outcomes [e.g., body mass index (BMI)]. Extensive searching located 54,642 potentially eligible studies. We included data from 535 supervised exercise and 283 motivational interventions in our syntheses, which used random-effects analyses. Exploratory moderator analyses used meta-analytic analogues of ANOVA and regression. We synthesized data from 20,494 participants in supervised exercise and 94,711 undergoing motivational interventions. The overall mean effect sizes (ES, d) for treatment versus control groups in supervised exercise interventions were 0.20 (treatment vs. control within-group comparison) and 0.22 (between-group comparison). The ES of 0.22 represents a post-intervention BMI of 26.7 kg/m(2) for treatment participants relative to 27.7 kg/m(2) for controls. The corresponding mean ES for motivational interventions was significantly smaller (d = 0.09 for between group, d = 0.10 for treatment vs. control within-group). Control group within-group comparisons revealed slightly worsening anthropometric outcomes during study participation (d = -0.03 to -0.04). Moderator analyses identified potential variables for future research. These findings document significant improvements in anthropometric effects from both supervised exercise and motivational interventions.

CanWalk: study protocol for a randomized feasibility trial of a walking intervention for people with recurrent or metastatic cancer

BACKGROUND

Increasing numbers of people in the UK are living with recurrent or metastatic cancer, many of whom experience reduced quality of life resulting from the physical and psychosocial consequences of cancer and its treatment. While drug treatments are important at alleviating some symptoms, there is increasing evidence of the benefits of exercise in enhancing quality of life and health outcomes. Walking is an inexpensive and accessible form of exercise. To our knowledge, no studies have investigated whether a walking intervention is sufficient to enhance quality of life and alleviate symptoms in people with recurrent or metastatic cancer across a range of tumor types. This paper describes the CanWalk study protocol, which aims to assess the feasibility and acceptability of undertaking a randomized controlled trial of a community-based walking program to enhance quality of life and well-being in people with recurrent or metastatic cancer.

METHODS

A mixed methods feasibility study includes an exploratory two-center randomized controlled trial and qualitative interviews. A minimum of 60 participants will be recruited from two London NHS Trusts and randomized 1:1 between the walking intervention and standard care using minimization. The walking intervention consists of the initial provision of written/online information followed by a short motivational interview. Participants are instructed to walk for 30 min on alternate days and attend an organized volunteer-led walk once a week. Half of all participants will be asked to use a pedometer. Postal questionnaires will be completed at baseline (pre-randomization) and at 6, 12 and 24 weeks. A subsample of participants and stakeholders will be interviewed at the end of the study.

RESULTS

Primary outcomes will be the acceptability and feasibility of the intervention and trial. A range of secondary outcome assessments needed to design a main study, including estimates of recruitment, adherence and variability in quality of life, will be evaluated.

CONCLUSIONS

Data from this study will be used to refine the walking intervention, investigate the acceptability of the intervention and study design, and determine the most appropriate outcome measures thereby providing estimates of the factors needed to design the main study.

TRIAL REGISTRATION

ISRCTN42072606.

A primary care nurse-delivered walking intervention in older adults: PACE (pedometer accelerometer consultation evaluation)-Lift cluster randomised controlled trial

BACKGROUND

Brisk walking in older people can increase step-counts and moderate to vigorous intensity physical activity (MVPA) in ≥10-minute bouts, as advised in World Health Organization guidelines. Previous interventions have reported step-count increases, but not change in objectively measured MVPA in older people. We assessed whether a primary care nurse-delivered complex intervention increased objectively measured step-counts and MVPA.

METHODS AND FINDINGS

A total of 988 60-75 year olds, able to increase walking and randomly selected from three UK family practices, were invited to participate in a parallel two-arm cluster randomised trial; randomisation was by household. Two-hundred-ninety-eight people from 250 households were randomised between 2011 and 2012; 150 individuals to the intervention group, 148 to the usual care control group. Intervention participants received four primary care nurse physical activity (PA) consultations over 3 months, incorporating behaviour change techniques, pedometer step-count and accelerometer PA intensity feedback, and an individual PA diary and plan. Assessors were not blinded to group status, but statistical analyses were conducted blind. The primary outcome was change in accelerometry assessed average daily step-counts between baseline and 3 months, with change at 12 months a secondary outcome. Other secondary outcomes were change from baseline in time in MVPA weekly in ≥10-minute bouts, accelerometer counts, and counts/minute at 3 months and 12 months. Other outcomes were adverse events, anthropometric measures, mood, and pain. Qualitative evaluations of intervention participants and practice nurses assessed the intervention's acceptability. At 3 months, eight participants had withdrawn or were lost to follow-up, 280 (94%) individuals provided primary outcome data. At 3 months changes in both average daily step-counts and weekly MVPA in ≥10-minute bouts were significantly higher in the intervention than control group: by 1,037 (95% CI 513-1,560) steps/day and 63 (95% CI 40-87) minutes/week, respectively. At 12 months corresponding differences were 609 (95% CI 104-1,115) steps/day and 40 (95% CI 17-63) minutes/week. Counts and counts/minute showed similar effects to steps and MVPA. Adverse events, anthropometry, mood, and pain were similar in the two groups. Participants and practice nurses found the intervention acceptable and enjoyable.

CONCLUSIONS

The PACE-Lift trial increased both step-counts and objectively measured MVPA in ≥10-minute bouts in 60-75 year olds at 3 and 12 months, with no effect on adverse events. To our knowledge, this is the first trial in this age group to demonstrate objective MVPA increases and highlights the value of individualised support incorporating objective PA assessment in a primary care setting.

TRIAL REGISTRATION

Controlled-Trials.com ISRCTN42122561.

Environmental Correlates of Recreational Walking in the Neighborhood

PURPOSE

To assess environmental correlates of neighborhood recreational walking.

DESIGN

The study used a cross-sectional survey.

SETTING

The study was conducted in the local community.

SUBJECTS

Participants were adults who recently relocated and walk for recreation in their current neighborhood.

MEASURES

The outcome measure was participant-reported neighborhood recreational walking in participants' prior neighborhood. Exposure measures were (1) participant-reported social and environmental characteristics of the prior neighborhood and (2) geographic information system-derived environmental characteristics assessed within a buffer around participant's prior address.

ANALYSIS

Participants reporting current neighborhood recreational walking (n = 231) were characterized by whether they walked for recreation in their prior neighborhood. Associations between neighborhood characteristics and neighborhood recreational walking were assessed using logistic regression.

RESULTS

Neighborhood recreational walking was associated with perceptions of the presence of recreational facilities (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.29-4.84), interesting things to see (OR = 2.82, 95% CI = 1.46-5.45), and others being active (OR = 3.56, 95% CI = 1.80-7.05), and was inversely associated with concerns about crime (OR = .40, 95% CI = .20-.77) and traffic (OR = .43, 95% CI = .22-.87). This behavior was associated with objectively measured presence of walking trails (OR = 3.58, 95% CI = 1.07-4.46), percentage of street length with speed limits ≤25 mph (OR = 1.31 for 10% increase, 95% CI = 1.08-1.61), and percentage of tree canopy coverage (OR = 1.55 for 10% increase, 95% CI = 1.12-2.14).

CONCLUSION

Recreational walking may be influenced by environmental factors that support a safe, enjoyable, and social experience, attributes that are not necessarily prioritized in transportation walking. Outcome and exposure specificity are important when studying recreational walking.

The feasibility and effectiveness of high-intensity boxing training versus moderate-intensity brisk walking in adults with abdominal obesity: a pilot study

Background

High-intensity interval training (HIIT) performed on exercise cycle or treadmill is considered safe and often more beneficial for fat loss and cardiometabolic health than moderate-intensity continuous training (MICT). The aim of this pilot study was to assess the feasibility and effectiveness of a 12-week boxing training (HIIT) intervention compared with an equivalent dose of brisk walking (MICT) in obese adults.

Methods

Men and women with abdominal obesity and body mass index >25 kg/m² were randomized to either a boxing group or a brisk walking (control) group for 12 weeks. Each group engaged in 4 training sessions per week, equated for total physical activity. Feasibility outcomes included recruitment rates, assessment of training intensities, adherence and adverse events. Effectiveness was assessed pre and post intervention via pertinent obesity-, cardiovascular-, and health-related quality of life (HRQoL) outcomes.

Results

Nineteen individuals expressed an interest and 63% (n = 12) consented. Recruitment was slower than anticipated (1.3 participants/week). The boxing group trained at a significantly higher intensity each week versus the brisk walking group (p < 0.05). Two participants in the boxing group experienced an adverse event; both continued to exercise with modifications to the exercise program. No other adverse events were noted. The boxing group attended more sessions (79% vs. 55%) and had a lower attrition rate (n = 0 vs. n = 2) than the walking group. Analysis of covariance revealed that the boxing group significantly improved body fat percentage (p = 0.047), systolic blood pressure (p = 0.026), augmentation index (AIx; p < 0.001), absolute VO_2max (p = 0.015), and Physical Functioning (p = 0.042) and Vitality (p = 0.024) domains of HRQoL over time. The walking group did not improve any clinical outcomes, and experienced a worsening of Vitality (p = 0.043).

Conclusions

Boxing training (HIIT) in adults with abdominal obesity is feasible and may elicit a better therapeutic effect on obesity, cardiovascular, and HRQoL outcomes than an equivalent dose of brisk walking (MICT). Robustly designed randomized controlled trials are required to confirm these findings and inform clinical guidelines and practice for obesity treatment.

Trial registration

Trial registration: ACTRN12615000007538

Technology-assisted weight loss interventions in primary care: a systematic review

BACKGROUND

The US Preventive Services Task Force recommends screening for and treating obesity. However, there are many barriers to successfully treating obesity in primary care (PC). Technology-assisted weight loss interventions offer novel ways of improving treatment, but trials are overwhelmingly conducted outside of PC and may not translate well into this setting. We conducted a systematic review of technology-assisted weight loss interventions specifically tested in PC settings.

METHODS

We searched the literature from January 2000 to March 2014.

INCLUSION CRITERIA

(1) Randomized controlled trial; (2) trials that utilized the Internet, personal computer, and/or mobile device; and (3) occurred in an ambulatory PC setting. We applied the Cochrane Effective Practice and Organization of Care (EPOC) and Delphi criteria to assess bias and the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) criteria to assess pragmatism (whether trials occurred in the real world versus under ideal circumstances). Given heterogeneity, results were not pooled quantitatively.

RESULTS

Sixteen trials met inclusion criteria. Twelve (75 %) interventions achieved weight loss (range: 0.08 kg - 5.4 kg) compared to controls, while 5-45 % of patients lost at least 5 % of baseline weight. Trial duration and attrition ranged from 3-36 months and 6-80 %, respectively. Ten (63 %) studies reported results after at least 1 year of follow-up. Interventions used various forms of personnel, technology modalities, and behavior change elements; trials most frequently utilized medical doctors (MDs) (44 %), web-based applications (63 %), and self-monitoring (81 %), respectively. Interventions that included clinician-guiding software or feedback from personnel appeared to promote more weight loss than fully automated interventions. Only two (13 %) studies used publically available technologies. Many studies had fair pragmatism scores (mean: 2.8/4), despite occurring in primary care.

DISCUSSION

Compared to usual care, technology-assisted interventions in the PC setting help patients achieve weight loss, offering evidence-based options to PC providers. However, best practices remain undetermined. Despite occurring in PC, studies often fall short in utilizing pragmatic methodology and rarely provide publically available technology. Longitudinal, pragmatic, interdisciplinary, and open-source interventions are needed.

Change in weight and adiposity in college students: a systematic review and meta-analysis

CONTEXT

The purpose of this systematic review and meta-analysis was to assess changes in body weight and relative adiposity (%FAT) during college and identify potential moderating variables.

EVIDENCE ACQUISITION

A review of peer-reviewed articles published before June 28, 2013 identified 49 studies evaluating the effect of the first year of college on the dependent variables of body weight (137 effects from 48 studies) and %FAT (48 effects from 19 studies). Statistical analysis was conducted between July 1, 2013, and May 1, 2014. Effect sizes were calculated by subtracting the mean pre-test measurements from the mean post-test measurements.

EVIDENCE SYNTHESIS

Participants' weight increased 1.55 kg (95% CI=1.3, 1.8 kg) during college, with a 1.17% increase in %FAT (95% CI=0.7, 1.6%). Meta-regression analysis concluded that changes in body weight and %FAT were positively associated with study duration, suggesting that effects measuring change over a longer duration yielded larger effects when compared to effects with shorter observations. Sex and baseline BMI were not associated with change in weight or %FAT after accounting for study duration.

CONCLUSIONS

The increase in weight and %FAT during the college years is equal to 1.55 kg and 1.17%, respectively. Change in body weight during the first year of college is significantly less than that during the cumulative remaining years of college. By understanding the magnitude of change, appropriate prevention efforts can be designed for the college population, which may be beneficial in reducing adult overweight and obesity rates.

Health promotion through primary care: enhancing self-management with activity prescription and mHealth

BACKGROUND

It is well established in the literature that regular participation in physical activity is effective for chronic disease management and prevention. Remote monitoring technologies (ie, mHealth) hold promise for engaging patients in self-management of many chronic diseases. The purpose of this study was to test the effectiveness of an mHealth study with tailored physical activity prescription targeting changes in various intensities of physical activity (eg, exercise, sedentary behavior, or both) for improving physiological and behavioral markers of lifestyle-related disease risk.

METHODS

Forty-five older adults (aged 55-75 years; mean age 63 ± 5 years) were randomly assigned to receive a personal activity program targeting changes to either daily exercise, sedentary behavior, or both. All participants received an mHealth technology kit including smartphone, blood pressure monitor, glucometer, and pedometer. Participants engaged in physical activity programming at home during the 12-week intervention period and submitted physical activity (steps/day), blood pressure (mm Hg), body weight (kg), and blood glucose (mmol/L) measures remotely using study-provided devices.

RESULTS

There were no differences between groups at baseline (P > 0.05). The intervention had a significant effect (F(10 488) = 2.947, P = 0.001, ηP² = 0.057), with similar changes across all groups for physical activity, body weight, and blood pressure (P > 0.05). Changes in blood glucose were significantly different between groups, with groups prescribed high-intensity activity (ie, exercise) demonstrating greater reductions in blood glucose than the group prescribed changes to sedentary behavior alone (P < 0.05).

CONCLUSIONS

Findings demonstrate the utility of pairing mHealth technologies with activity prescription for prevention of lifestyle-related chronic diseases among an at-risk group of older men and women. RESULTS support the novel approach of prescribing changes to sedentary behaviors (alone, and in conjunction with exercise) to reduce risk of developing lifestyle-related chronic conditions.

Using Pedometers for Measuring and Increasing Physical Activity in Children and Adolescents

The science and practice of step counting in children (typically aged 6-11 years) and adolescents (typically aged 12-19 years) has evolved rapidly over a relatively brief period with the commercial availability of research-grade pedometers and accelerometers. Recent reviews have summarized considerations for assessing physical activity using pedometers in young people (both children and adolescents), but 3 areas have received little attention: pedometer monitoring protocols, minimal (as opposed to optimal) step counts necessary for maintaining basal levels of health, and appropriate pedometer-based interventions for young people. Therefore, the objective of this review was to evaluate the current evidence and identify future research directions in these areas. The challenges of objective monitoring of physical activity in children and adolescents reinforce the importance of using protocols that minimize participant burden and the potential for tampering/reactivity. Evidence for a sedentary lifestyle cut point is limited; researchers are therefore encouraged to investigate several cut points (ie, <5000, <6000, <7000 steps/d) in children and adolescents to identify the health consequences of very low levels of ambulatory activity. Personalized messages may be necessary for health behavior change in pedometer-based interventions, but there is a need for more high-quality studies to develop the existing evidence base.

A systematic review of studies using pedometers as an intervention for musculoskeletal diseases

Background

Physical activity (PA) plays an important role in the prevention and management of a number of chronic conditions. Aim: to investigate the evidence for effectiveness of pedometer-driven walking programs to promote physical activity among patients with musculoskeletal disorders (MSDs).

Method

A comprehensive systematic review was performed using 11 electronic databases up to 20 February 2014. Keywords and MeSH terms included “musculoskeletal disorders”, “walking”, and “pedometer”. Randomized controlled trials, published in English, that examined the effects of a pedometer-based walking intervention to increase physical activity levels and improve physical function and pain in patients with musculoskeletal disorders were included.

Result

Of the 1996 articles retrieved, seven studies ranging in date of publication from 1998 to 2013 met the inclusion criteria, allowing data extraction on 484 participants with an age range of 40 to 82 years. Interventions lasted from 4 weeks to 12 months and the results across studies showed significant increases in step count (p < 0.05) following the intervention. Across these studies, there was a mean increase in PA of 1950 steps per day relative to baseline. Four studies reported improved scores for pain and/or physical function at the intervention completion point relative to controls.

Conclusion

This study provides strong evidence for the effectiveness of pedometer walking interventions in increasing PA levels for patients with MSDs. Our findings suggest that a combination of interventions is likely to be the most effective strategy to maximize health benefits in the short term. Further research should include larger sample sizes, and longer intervention durations are required to support the role of pedometer walking interventions as a long term intervention for management of musculoskeletal disorders.

Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials

BACKGROUND

While step counter use has become popular among type 2 diabetes (T2D) patients, its effectiveness in increasing physical activity (PA) and improving glycemic control has been poorly defined. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the association of step counter use with PA and glycemic control in T2D patients.

METHODS

Articles were identified by searches of PubMed, Web of Science and Cochrane Library from January 1994 to June 2013. RCTs in the English language were included, if they had assessed the effectiveness of step counters as motivating and monitoring tools in T2D patients, with reported changes in steps per day (steps/d) or glycosylated hemoglobin A1c (HbA1c), or both. Data were independently collected by 2 authors and overall estimates were made by a random-effects model.

RESULTS

Of the 551 articles retrieved, 11 RCTs were included. Step counter use significantly increased PA by 1,822 steps/d (7 studies, 861 participants; 95% confidence interval (CI): 751 to 2,894 steps/d) in patients with T2D. Step counter use with a PA goal showed a bigger increase in PA (weighted mean difference (WMD) 3,200 steps/d, 95% CI: 2,053 to 4,347 steps/d) than without (WMD 598 steps/d, 95% CI: -65 to 1,260 steps/d). Further subgroup analysis suggested step counter use with a self-set PA goal (WMD 2,816 steps/d, 95% CI: 1,288 to 4,344 steps/d) made no difference in increasing PA from a 10,000 steps/d goal (WMD 3,820 steps/d, 95% CI: 2,702 to 4,938 steps/d). However, no significant HbA1c change was observed by step counter use (10 studies, 1,423 participants; WMD 0.02%, 95% CI: -0.08% to 0.13%), either with (WMD 0.04%, 95% CI: -0.21% to 0.30%) or without a PA goal (WMD 0.01%, 95% CI: -0.10% to 0.13%).

CONCLUSIONS

Step counter use is associated with a significant increase in PA in patients with T2D. However, evidence regarding its effect in improving glycemic control remains insufficient.

TRIAL REGISTRATION

PROSPERO CRD42013005236.

The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women

OBJECTIVE

The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain (GWG) in obese pregnant women by comparing with a control group.

STUDY DESIGN

This study was a randomized controlled trial of 425 obese pregnant women comparing 3 groups: (1) PA plus D, physical activity and dietary intervention (n = 142); (2) PA, physical activity intervention (n = 142); and (3) C, a control group receiving standard care (n = 141). All participants routinely in gestational weeks 11-14 had an initial dietary counseling session and were advised to limit GWG to less than 5 kg. Physical activity intervention included encouragement to increase physical activity, aiming at a daily step count of 11,000, monitored by pedometer assessment on 7 consecutive days every 4 weeks. Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet. Instruction was given by a dietician every 2 weeks. The primary outcome measure was GWG, and the secondary outcome measures were complications of pregnancy and delivery and neonatal outcome.

RESULTS

The study was completed by 389 patients (92%). Median values of GWG (ranges) were lower in each of the intervention groups (PA plus D, 8.6 [-9.6 to 34.1] kg, and group PA, 9.4 [-3.4 to 28.2] kg) compared with the control group (10.9 [-4.4 to 28.7] kg [PA+D vs C]; P = .01; PA vs C; P = .042). No significant difference was found between the 2 intervention groups. In a multivariate analysis, physical activity intervention decreased GWG by a mean of 1.38 kg (P = .040). The Institute of Medicine's recommendations for GWG were more frequently followed in the intervention groups.

CONCLUSION

Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women.

Clinical use of objective measures of physical activity

With measurement of physical activity becoming more common in clinical practice, it is imperative that healthcare professionals become more knowledgeable about the different methods available to objectively measure physical activity behaviour. Objective measures do not rely on information provided by the patient, but instead measure and record the biomechanical or physiological consequences of performing physical activity, often in real time. As such, objective measures are not subject to the reporting bias or recall problems associated with self-report methods. The purpose of this article was to provide an overview of the different methods used to objectively measure physical activity in clinical practice. The review was delimited to heart rate monitoring, accelerometers and pedometers since their small size, low participant burden and relatively low cost make these objective measures appropriate for use in clinical practice settings. For each measure, strengths and weakness were discussed; and whenever possible, literature-based examples of implementation were provided.

Positive effect of the use of accelerometry on lifestyle awareness of overweight hypertensive patients

PURPOSE

Sedentary habits are strongly associated with increase of cardiovascular risk factors. The present study aimed to verify the role of accelerometry in identifying sedentary behavior, and the possible short term positive effect of this intervention on some anthropometric variables in a group of patients with cardiovascular risks factors.

METHODS

To quantify daily Spontaneous Motor Activity (SMA) levels and identify sedentary behavior, an accelerometer was employed, in addition to a simple questionnaire, in a group of overweight, hypertensive subjects. A personalized unsupervised 3 month long physical exercise program was planned. After this time, acceleroometry was again undertaken to analyze the impact of the intervention on some life style parameters, including the number of the steps taken daily, and Physical Activity Level (PAL). In addition, body water balance, weight, and Body Mass Index (BMI) were also evaluated.

RESULTS

Assessment of physical activity by accelerometry identifies sedentary behaviors in a larger number of individuals. After three months of regular unsupervised aerobic exercise, PAL improved from 1.56 ±0.1 to 1.68±0.2 with P<0.005, weight (kg) reduced from 85.13 ± 20 to 83.10 ± 19 (P<0.05), BMI from 29.58 to 28.7 (P<0.05).

CONCLUSION

Accelerometry allows to objectify PAL, and can be used to monitor improvement of variables strongly related to cardiovascular risk.

A pedometer-based physical activity intervention for patients entering a maintenance cardiac rehabilitation program: a pilot study

PURPOSE

To compare the effects of an individualized pedometer-driven physical activity (PA) intervention with the usual time-based PA recommendations given to patients entering a maintenance cardiac rehabilitation (CR) program.

METHODS

A total of 18 subjects entering a maintenance CR program were recruited and completed the study. Subjects were randomized into pedometer feedback [PF: n=10 (2 women), 53.3±8.1 yrs] and usual care [UC: n=8 (2 women), 59.4±9.9 yrs] groups. New Lifestyles NL-1000 pedometers were used to monitor ambulatory PA. Subjects in both groups participated in the same maintenance CR program for a total of 8 weeks and all were encouraged to obtain a minimum of 30-40 min/d of moderate-vigorous-intensity physical activity (MVPA), on days they did not attend CR. Subjects in the PF group were given individualized daily stepcount goals (increase 10% of baseline steps/d each week) for weeks 2-8. Ambulatory PA was measured with pedometers, recording both total number of steps/d and min/d of MVPA. Measures were obtained during the first week of the maintenance CR program and during the 8th week. Data were also compared between days subjects attended and on days they did not attend.

RESULTS

By the 8th week of CR, PF subjects increased daily stepcounts by 42% (2,297±1,606 steps/d, P=0.001), with a 36% increase on CR days (2,654±2,089 steps/d, P=0.003) and a 45% increase on days they did not attend CR (1,872±2,026 steps/d, P=0.017). There were no changes observed in the UC group.

CONCLUSIONS

Providing pedometers with individualized stepcount goals to patients entering a CR program was superior to the usual time-based PA recommendations for increasing PA.

The impact of a managed care obesity intervention on clinical outcomes and costs: a prospective observational study

OBJECTIVE

To evaluate the impact of a managed care obesity intervention that requires enrollment in an intensive medical weight management program, a commercial weight loss program, or a commercial pedometer-based walking program to maintain enhanced benefits.

DESIGN AND METHODS

Prospective observational study involving 1,138 adults with BMI ≥ 32 kg m(-2) with one or more comorbidities or BMI ≥ 35 kg m(-2) enrolled in a commercial, independent practice association-model health maintenance organization. Body mass index, blood pressure, lipids, HbA1c or fasting glucose, and per-member per-month costs were assessed 1 year before and 1 year after program implementation.

RESULTS

Program uptake (90%) and 1 year adherence (79%) were excellent. Enrollees in all three programs exhibited improved clinical outcomes and reduced rates of increase in direct medical costs compared to members who did not enroll in any program.

CONCLUSIONS

A managed care obesity intervention that offered financial incentives for participation and a variety of programs was associated with excellent program uptake and adherence, improvements in cardiovascular risk factors, and a lower rate of increase in direct medical costs over 1 year.

A randomized study of reinforcing ambulatory exercise in older adults

Many older adults do not meet physical activity recommendations and suffer from health-related complications. Reinforcement interventions can have pronounced effects on promoting behavior change; this study evaluated the efficacy of a reinforcement intervention to enhance walking in older adults. Forty-five sedentary adults with mild to moderate hypertension were randomized to 12-week interventions consisting of pedometers and guidelines to walk 10,000 steps/day or that same intervention with chances to win $1-$100 prizes for meeting recommendations. Patients walked an average of about 4,000 steps/day at baseline. Throughout the intervention, participants in the reinforcement intervention met walking goals on 82.5% ± 25.8% of days versus 55.3% ± 37.1% of days in the control condition, p < .01. Even though steps walked increased significantly in both groups relative to baseline, participants in the reinforcement condition walked an average of about 2,000 more steps/day than participants in the control condition, p < .02. Beneficial effects of the reinforcement condition relative to the control condition persisted at a 24-week follow-up evaluation, p < .02, although steps/day were lower than during the intervention period in both groups. Participants in the reinforcement intervention also evidenced greater reductions in blood pressure and weight over time and improvements in fitness indices, ps < .05. This reinforcement-based intervention substantially increased walking and improved clinical parameters, suggesting that larger-scale evaluations of reinforcement-based interventions for enhancing active lifestyles in older adults are warranted. Ultimately, economic analyses may reveal reinforcement interventions to be cost-effective, especially in high-risk populations of older adults.

The role of exercise and physical activity in weight loss and maintenance

This review explores the role of physical activity (PA) and exercise training (ET) in the prevention of weight gain, initial weight loss, weight maintenance, and the obesity paradox. In particular, we will focus the discussion on the expected initial weight loss from different ET programs, and explore intensity/volume relationships. Based on the present literature, unless the overall volume of aerobic ET is very high, clinically significant weight loss is unlikely to occur. Also, ET also has an important role in weight regain after initial weight loss. Overall, aerobic ET programs consistent with public health recommendations may promote up to modest weight loss (~2 kg), however the weight loss on an individual level is highly heterogeneous. Clinicians should educate their patients on reasonable expectations of weight loss based on their physical activity program and emphasize that numerous health benefits occur from PA programs in the absence of weight loss.

Physical Activity and Exercise for Secondary Prevention among Patients with Cardiovascular Disease

Most adults do not achieve the recommended levels of physical activity, including patients with cardiovascular disease (CVD). Furthermore, healthcare providers often do not understand the benefits of physical activity in CVD patients, rather over emphasizing the potential risks related to activity. Recent studies suggest reductions in cardiovascular events including mortality with concomitant improvements in quality of life for many vascular conditions. However gaps in our current knowledge base remain. Recent research on physical activity including use of novel internet based interventions are developing areas of interest have moved to reduce such knowledge gaps.

A life-style physical activity intervention and the antibody response to pneumococcal vaccination in women

OBJECTIVE

To assess whether a life-style physical activity intervention improved antibody response to a pneumococcal vaccination in sedentary middle-aged women.

METHODS

Eighty-nine sedentary women completed a 16-week exercise (physical activity consultation, pedometer, telephone/e-mail prompts; n = 44) or control (advisory leaflet; n = 45) intervention. Pneumococcal vaccination was administered at 12 weeks, and antibody titers (11 of the 23 contained in the pneumococcal vaccine) were determined before vaccination and 4 weeks and 6 months later. Physical activity, aerobic fitness, body composition, and psychological factors were measured before and after the intervention.

RESULTS

The intervention group displayed a greater increase in walking behavior (from mean [standard deviation] = 82.16 [90.90] to 251.87 [202.13]) compared with the control condition (111.67 [94.64] to 165.16 [117.22]; time by group interaction: F(1,68) = 11.25, p = .001, η(2) = 0.14). Quality of life also improved in the intervention group (from 19.37 [3.22] to 16.70 [4.29]) compared with the control condition (19.97 [4.22] to 19.48 [5.37]; time by group interaction: F(1,66) = 4.44, p = .039, η(2) = 0.06). However, no significant effects of the intervention on antibody response were found (time by group η(2) for each of the 11 pneumococcal strains ranged from 0.001 to 0.018; p values all >.264).

CONCLUSIONS

Participation in a life-style physical activity intervention increased subjective and objective physical activity levels and quality of life but did not affect antibody response to pneumococcal vaccination.