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Review | Clinician's Corner

Using Pedometers to Increase Physical Activity and Improve Health A Systematic Review

Dena M. Bravata, MD, MS; Crystal Smith-Spangler, MD; Vandana Sundaram, MPH; Allison L. Gienger, BA; Nancy Lin, ScD; Robyn Lewis, MA; Christopher D. Stave, MLS; Ingram Olkin, PhD; John R. Sirard, PhD
JAMA. 2007;298(19):2296-2304. doi:10.1001/jama.298.19.2296.
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Published online

Context Without detailed evidence of their effectiveness, pedometers have recently become popular as a tool for motivating physical activity.

Objective To evaluate the association of pedometer use with physical activity and health outcomes among outpatient adults.

Data Sources English-language articles from MEDLINE, EMBASE, Sport Discus, PsychINFO, Cochrane Library, Thompson Scientific (formerly known as Thompson ISI), and ERIC (1966-2007); bibliographies of retrieved articles; and conference proceedings.

Study Selection Studies were eligible for inclusion if they reported an assessment of pedometer use among adult outpatients, reported a change in steps per day, and included more than 5 participants.

Data Extraction and Data Synthesis Two investigators independently abstracted data about the intervention; participants; number of steps per day; and presence or absence of obesity, diabetes, hypertension, or hyperlipidemia. Data were pooled using random-effects calculations, and meta-regression was performed.

Results Our searches identified 2246 citations; 26 studies with a total of 2767 participants met inclusion criteria (8 randomized controlled trials [RCTs] and 18 observational studies). The participants' mean (SD) age was 49 (9) years and 85% were women. The mean intervention duration was 18 weeks. In the RCTs, pedometer users significantly increased their physical activity by 2491 steps per day more than control participants (95% confidence interval [CI], 1098-3885 steps per day, P < .001). Among the observational studies, pedometer users significantly increased their physical activity by 2183 steps per day over baseline (95% CI, 1571-2796 steps per day, P < .0001). Overall, pedometer users increased their physical activity by 26.9% over baseline. An important predictor of increased physical activity was having a step goal such as 10 000 steps per day (P = .001). When data from all studies were combined, pedometer users significantly decreased their body mass index by 0.38 (95% CI, 0.05-0.72; P = .03). This decrease was associated with older age (P = .001) and having a step goal (P = .04). Intervention participants significantly decreased their systolic blood pressure by 3.8 mm Hg (95% CI, 1.7-5.9 mm Hg, P < .001). This decrease was associated with greater baseline systolic blood pressure (P = .009) and change in steps per day (P = .08).

Conclusions The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure. Whether these changes are durable over the long term is undetermined.

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Figure 1. Study Flow Diagram
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CI indicates confidence interval; RCT, randomized controlled trial.a Six RCTs that used visible step counts in both trial cohorts were each treated as separate observational studies.

Figure 2. Increase in Physical Activity Among Participants Randomly Assigned to Pedometer Interventions vs Control Participants
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Presents the difference in the change in steps per day before and after the intervention between the participants in the experimental and control arms of the randomized controlled trials. The size of the data markers are proportional to the sample size, which represents the number of individuals who completed the trials.

Figure 3. Association of Baseline Physical Activity With Change in Physical Activity After the Intervention
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Presents the association of baseline physical activity in steps per day (x-axis) with the change in physical activity in steps per day (y-axis). The Figure includes both the RCTs and the observational studies. The data markers representing the workplace interventions include all the study groups in each trial: Butler and Dwyer17 and Croteau et al28 each had 3 study groups; Eastep et al,25 Thomas et al,34 and Wyatt et al39 each had 2 study groups. The mean change in steps per day was 1964 over baseline (P = .01).

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