Recommending pedometers to patients

The more brisk the activity, the greater the benefits on lipids, BP, glucose, weight loss goals and fitness levels.

The pedometer is a relatively simple tool that can be used to assess physical activity and motivate patients to achieve goals.

Just as we often ask our patients to count calories and make sure they do not exceed a certain level, we should ask them to keep track of how active they really are and try to set minimal goals for physical activity.

It is important to recommend a minimum amount of walking for each day to get the patient to maintain a certain level of activity and to improve their risk factor status. Pedometers are associated with considerable improvements in physical activity with 2,000 to 2,500 steps equal to approximately one mile of walking per day depending on the average stride length that a person takes. Information from both small clinical trials and observational studies that looked at the benefits of pedometers showed significant reductions in a number of risk factors for cardiovascular disease.

Studies show promise

Results of randomized, control trials showed that individuals assigned to track and increase their physical activity through pedometer use increased their physical activity by about 2,400 steps per day compared with controls. Pedometers significantly affected weight loss on the magnitude of a decrease in BMI by 0.4; the decrease in weight was associated with having a minimum step goal and longer duration of the program.

Roger S. Blumenthal

Pedometers were also shown to significantly decrease systolic blood pressure by 4 mm Hg (a decrease in systolic BP by 2 mm Hg is associated with a 10% reduction in stroke mortality based on observational data). The reduction in systolic BP was independent of decreases in weight.

In terms of diabetes, when obese men and women with diabetes undergo walking on the order of about 19,000 steps per day combined with caloric restriction, a significant decrease in basal blood glucose levels (–0.9 mmol/L) and improved insulin sensitivity were observed. Walking 11,400 steps a day combined with resistance training has also lowered plasma glucose and insulin values in patients with diabetes.

In studies looking at the utilization of pedometers, neither sex, race/ethnicity or baseline BMI were significant predictors of increased activity. In fact, among study participants there was a trend for those with less baseline activity to have the greatest increase in physical activity, thus pointing to the important potential of pedometers to motivate even the most sedentary of individuals. Wearing a pedometer is associated with weight loss even in patients who do not diet. These changes are sustained over time as patients continue to participate in a pedometer-based walking program.

Having a step goal is the key predictor of increased physical activity, and advising the patient to set a minimum goal whether that be 5,000 steps or 10,000 steps or some personally tailored goal significantly increases the chances that they will increase their physical activity. The use of a step diary may be another key motivational factor for increasing physical activity. Keeping records of the number of steps or distance covered relative to each day may stimulate increased future activity. This can be done with a simple diary or by utilizing some of the online walking pedometer programs offered.

The exact type of pedometer is less important than getting the patient appropriately engaged in the importance of meeting a daily goal.

We generally recommend a pedometer that is simple to use and just counts steps. It is also important that the pedometer have an attachment that can clip on to one’s belt or slacks and have another attachment tied to a string that can loop around a belt loop to make it less likely that one would use. The display should also be easy to read without having to remove it each time from the waist band.

In summary, a pedometer can give a patient important feedback on how active they really are during the course of a day. A faster pace is better for the cardiovascular system and it allows one to accumulate more steps more quickly.

The more brisk activity that a patient does, the greater the benefits on their lipids, BP, glucose and fitness levels. If patients have not achieved a minimum goal for the day by the early evening, they should then discipline themselves to set aside at least another 15 minutes for brisk activity to reach their goal. A good pedometer can empower patients to be more fit-friendly.

Garth Graham, MD, is a Post Doctoral Fellow at The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.

Roger S. Blumenthal, MD, is Professor of Medicine and Director at The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.

For more information:

• Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health. JAMA. 2007;298:2296-2304.
• Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-1913.
• Richardson, C. Pedometers get you moving. Ann of Family Medicine. 2008;6:69-77.
• Swartz AM, Strath SJ, Bassett DR, et al. Increasing daily walking improves glucose tolerance in overweight women. Prev Med. 2003;37:356-362.
• Taniguchi A, Fukushima M, Sakai M, et al., Effect of physical training on insulin sensitivity in Japanese type 2 diabetic patients: role of serum triglyceride levels. Diabetes Care. 2000;23:857-858.