Intervention
Walking on prescription: The utility of a pedometer pack for increasing physical activity in primary care

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Abstract

Objective

This study used a multi-method approach to examine the effectiveness of a pedometer-based intervention delivered by health professionals for increasing walking.

Methods

Pedometer packs were distributed to 374 patients who undertook a 12-week walking programme. Changes in walking were assessed at three months (using self-reported step-counts [n = 139] and questionnaire data [n = 104]) and at six months (using patient questionnaire data [n = 112]). Qualitative data were collected at both time points to identify underlying mechanisms.

Results

After 12 weeks patients had increased their step-counts by 4532 steps/day (p < .001) and at six months were achieving 2977 more steps/day (equivalent to around 30 min/day) than at baseline. Over half the patients reported achieving this target on at least 5 days/week. Qualitative data indicated that the pedometer pack was perceived to be most effective when patients were ready to change and when ongoing support was made available.

Conclusion

These findings support the use of pedometer-based interventions in primary care and suggest that the pedometer pack could lead to sustainable changes in walking. Further investigation, using a randomised controlled trial design, is warranted.

Practice implications

Provision of social support and accurate identification of patient readiness to change are important considerations in future implementation of the intervention.

Introduction

The health benefits of regular physical activity have been consistently demonstrated across populations [1], [2], [3]. National and international guidelines recommend that adults accumulate at least 30 min of moderate intensity activity, on at least five days of the week, to promote and maintain health [3], [4], [5], and it is also likely that this level of energy expenditure will contribute to ongoing weight management [3]. However in Scotland, six out of ten men and seven out of ten women do not achieve this target [6].

Brisk walking has been described as ‘the nearest activity to perfect exercise’ [7] and is suggested as the mode of activity most likely to increase physical activity at a population level [8]. A recent systematic review [9] examined the effectiveness of interventions aimed at increasing walking and concluded that the strongest evidence exists for tailored interventions that are targeted at individuals most motivated to change, particularly involving strategies such as brief advice and the supported use of pedometers.

Pedometers are considered valid and reliable tools with which to measure physical activity [10], [11]. A large number of studies have used pedometers to promote physical activity within university and community settings, and they have also been used among patients with diabetes [12], those with osteoarthritis [13], and within general practice [14].

Findings suggest that short-term effectiveness of pedometer programmes is enhanced when a goal-setting programme is incorporated [15], [16], [17], and, although there is no clear evidence, individual goals are thought to enhance motivation more than a standardised 10,000 steps/day target. Based on the assumption that 1000 steps approximates to 10 min of moderate activity [17], a realistic goal for inactive individuals is the gradual accumulation of an additional 3000 steps on most days of the week, leading to successful achievement of the minimum recommended levels of physical activity. Despite promising short-term changes in behaviour, there is a lack of evidence to support a long-term increase in physical activity following a pedometer intervention [15].

Primary care is a valuable and effective setting in which to promote physical activity [18], [19], [20]. Moreover, heath professionals (HPs) are well positioned to disseminate physical activity-related messages among large numbers of patients [21], who in the UK are entitled to free health care through the National Health Service. One of the key priorities in Scotland's physical activity strategy is that adults who come into contact with primary care should be offered an assessment of the health risks associated with their level of physical inactivity and provided with individualised help to increase their activity level by, for example, physical activity ‘on prescription’ [5].

Two UK-based studies have provided provisional evidence for the short-term utility of physical activity on prescription using pedometers and goal-setting programmes within primary care [22], [23]; however, the effectiveness of such programmes over the longer term [15] and within different clinical settings has yet to be determined. In light of this limitation, Paths to Health, a Scottish programme that promotes walking, developed a resource for HPs to promote physical activity. The resource, or ‘pedometer pack’, contains a pedometer, step-count card, and supporting materials. Pilot data suggest that the pedometer pack is an accessible and resource-light tool and that it can help to initiate conversations about physical activity and lead to an increase in independent walking [23]. Given the value of the primary care setting for promoting physical activity, determining the potential applicability of the pedometer pack is an important line of research.

The purpose of this study is to further examine the utility of the pedometer pack in primary health care settings with patients who could benefit from increasing their physical activity, and add to the literature on the most effective methods for promoting walking. A mixed-methods approach will be used to explore implementation, underlying processes and conditions for optimal effectiveness. To address the limited literature on the longer term effectiveness of pedometer interventions the longer term, as well as short-term, effectiveness of the pedometer pack will be investigated.

Section snippets

Pedometer pack

The intervention involved two types of pedometer pack, a ‘master pack’ which was used by HPs and a patient pedometer pack (hereafter referred to as ‘pedometer pack’). The master pack comprised of a briefcase-style box containing 10 basic pedometers (Silva Step Counter 56012; to the authors’ knowledge, no reliability or validity data is available for this model), step-count record cards and supporting materials (e.g. leaflet on the benefits of walking, HP guidance, and promotional posters).

Response rate

In total, 374 (22%) out of a possible 1680 patient pedometer packs were distributed. Although this was below the expected distribution, time constraints associated with the length of the recruitment period and patient appointments in GP settings should be acknowledged. Baseline data were obtained from 34% (129; males = 33, females = 70, not completed = 26) of patients, six of whom were excluded due to step-counts >10,000 steps/day. Complete three-month step-count data were obtained from 82.9% (107)

Discussion

The pedometer pack investigated in this study was well received by both patients and HPs and was effective in producing significant increases in walking behaviour over the short- and longer term. These increases were sufficient to meet the minimum recommended levels of physical activity [4]. At three months, patients had increased their step-counts by 4484 steps to an average of 8906 steps/day, a shift from a sedentary lifestyle to being ‘somewhat active’ [26]. The average increase in

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