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Meta-Analysis
. 2020 Jul 21;7(7):CD009209.
doi: 10.1002/14651858.CD009209.pub3.

Workplace pedometer interventions for increasing physical activity

Rosanne LA Freak-Poli  1 , Miranda Cumpston  1 , Loai Albarqouni  2 , Stacy A Clemes  3 , Anna Peeters  4
Affiliations
Meta-Analysis

Workplace pedometer interventions for increasing physical activity

Rosanne LA Freak-Poli et al. Cochrane Database Syst Rev. .

Abstract

Background: The World Health Organization (WHO) recommends undertaking 150 minutes of moderate-intensity physical activity per week, but most people do not. Workplaces present opportunities to influence behaviour and encourage physical activity, as well as other aspects of a healthy lifestyle. A pedometer is an inexpensive device that encourages physical activity by providing feedback on daily steps, although pedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.

Objectives: To assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes.

Search methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Occupational Safety and Health (OSH) UPDATE, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform from the earliest record to December 2016. We also consulted the reference lists of included studies and contacted study authors to identify additional records. We updated this search in May 2019, but these results have not yet been incorporated. One more study, previously identified as an ongoing study, was placed in 'Studies awaiting classification'.

Selection criteria: We included randomised controlled trials (RCTs) of workplace interventions with a pedometer component for employed adults, compared to no or minimal interventions, or to alternative physical activity interventions. We excluded athletes and interventions using accelerometers. The primary outcome was physical activity. Studies were excluded if physical activity was not measured.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. When studies presented more than one physical activity measure, we used a pre-specified list of preferred measures to select one measure and up to three time points for analysis. When possible, follow-up measures were taken after completion of the intervention to identify lasting effects once the intervention had ceased. Given the diversity of measures found, we used ratios of means (RoMs) as standardised effect measures for physical activity.

Main results: We included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years. All studies used multi-component health promotion interventions. Eleven studies used minimal intervention controls, and four used alternative physical activity interventions. Intervention duration ranged from one week to two years, and follow-up after completion of the intervention ranged from three to ten months. Most studies and outcomes were rated at overall unclear or high risk of bias, and only one study was rated at low risk of bias. The most frequent concerns were absence of blinding and high rates of attrition. When pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour and on quality of life (mental health component), but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions may slightly reduce anthropometry (body mass index (BMI) -0.64, 95% confidence interval (CI) -1.45 to 0.18; 3 studies; low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95% CI -3.26 to 3.11; 2 studies; moderate-certainty evidence) and may have reduced adverse effects (such as injuries; from 24 to 10 per 100 people in populations experiencing relatively frequent events; odds ratio (OR) 0.50, 95% CI 0.30 to 0.84; low-certainty evidence). No studies compared biochemical measures or disease risk scores at follow-up after completion of the intervention versus a minimal intervention. Comparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour, anthropometry (BMI or waist circumference), blood pressure (systolic or diastolic), biochemistry (low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglycerides), disease risk scores, quality of life (mental or physical health components), and adverse effects at follow-up after completion of the intervention were not compared to an alternative physical activity intervention. Some positive effects were observed immediately at completion of the intervention periods, but these effects were not consistent, and overall certainty of evidence was insufficient to assess the effectiveness of workplace pedometer interventions.

Authors' conclusions: Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated. Decision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. Future studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.

PubMed Disclaimer

Conflict of interest statement

None of the researchers have a commercial interest in the outcomes of this review. Two review authors (RFP, AP) would like to disclose that they undertook an independent research study, titled the Global Corporate Challenge® (GCC®) Evaluation Study, which evaluated the impact of a workplace pedometer intervention, which was not included in this review, as it was not a randomised controlled trial. The GCC® study was partially funded by the Australian Research Council (ARC) and the Foundation for Chronic Disease Prevention™ in the Workplace, which is associated with the Global Corporate Challenge®.

Figures

1
1
PRISMA flow chart.
* Note that additional records associated with included studies were identified during the course of the review, including through author correspondence and targeted searching for study protocols.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 1: Physical activity: combined (follow‐up after completion)
1.2
1.2. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 2: Physical activity: combined (at completion of intervention)
1.3
1.3. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 3: Sedentary behaviour (min/d)
1.4
1.4. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 4: CVD risk factor: body mass index (BMI; kg/m²)
1.5
1.5. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 5: CVD risk factor: waist circumference (cm)
1.6
1.6. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 6: CVD risk factor: systolic blood pressure (mmHg)
1.7
1.7. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 7: CVD risk factor: diastolic blood pressure (mmHg)
1.8
1.8. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 8: CVD risk factor: cholesterol: LDL
1.9
1.9. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 9: CVD risk factor: cholesterol: HDL
1.10
1.10. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 10: CVD risk factor: triglycerides
1.11
1.11. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 11: Quality of life: mental health component
1.12
1.12. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 12: Quality of life: physical health component
1.13
1.13. Analysis
Comparison 1: Pedometer intervention vs minimal intervention, Outcome 13: Adverse effects
2.1
2.1. Analysis
Comparison 2: Pedometer intervention vs alternative physical activity intervention, Outcome 1: Physical activity: combined
2.2
2.2. Analysis
Comparison 2: Pedometer intervention vs alternative physical activity intervention, Outcome 2: CVD risk factor: body mass index (BMI; kg/m²)
3.1
3.1. Analysis
Comparison 3: Subgroup analyses, Outcome 1: Phyical activity: subgroup analysis by participant risk profile of Analysis 1.1 (follow‐up after completion)
3.2
3.2. Analysis
Comparison 3: Subgroup analyses, Outcome 2: Physical activity: subgroup analysis by participant risk profile of Analysis 1.2.1
See this image and copyright information in PMC

Update of

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References to studies awaiting assessment

Audrey 2019 {published data only}
    1. Audrey S, Fisher H, Cooper A, Gaunt D, Garfield K, Metcalfe C, et al. Evaluation of an intervention to promote walking during the commute to work: a cluster randomised controlled trial. BMC Public Health 2019;19:427. - PMC - PubMed
    1. Audrey S, Cooper AR, Hollingworth W, Metcalfe C, Procter S, Davis A, et al. Study protocol: the effectiveness and cost effectiveness of an employer-led intervention to increase walking during the daily commute: the Travel to Work randomised controlled trial. BMC Public Health 2015;15:154. - PMC - PubMed
    1. Gaunt D, Metcalfe C, Garfield K, Hollingworth W, Batista Ferrer H, Cooper A, et al. Travel to Work: Statistical and Health Economics Analysis Plan. University of Bristol, 2017.
Bang 2016 {published data only}
    1. Bang KS, Lee IS, Kim SJ, Song MK, Park SE. The effects of urban forest-walking program on health promotion behavior, physical health, depression, and quality of life: a randomized controlled trial of office-workers. Journal of Korean Academy of Nursing 2016;46(1):140-8. - PubMed
Mattila 2013 {published data only}
    1. Mattila E, Orsama AL, Ahtinen A, Hopsu L, Leino T, Korhonen I. Personal health technologies in employee health promotion: usage activity, usefulness, and health-related outcomes in a 1-year randomized controlled trial. JMIR Mhealth Uhealth 2013;1(2):e16. - PMC - PubMed
    1. Mattila E. Personal communication with RFP. 17 August 2016.

References to ongoing studies

ACTRN12617001395325 {published data only}
    1. ACTRN12617001395325. Activity for wellbeing: promoting wellbeing through physical activity in aged care workers [Activity for wellbeing: a randomised, controlled trial of a need-supportive, person-centred physical activity intervention for aged care workers]. apps.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12617001395325 (first received 3 October 2017).
ACTRN12618001567213 {published data only}
    1. ACTRN12618001567213. A physical activity and healthy eating program to enhance school staff health [Addressing the health risk behaviours of the education workforce: a program to enhance the wellbeing of primary school staff]. apps.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12618001567213 (first received 19 September 2018).
ACTRN12619000173190 {published data only}
    1. ACTRN12619000173190. The Virgin PulsE Global ChAllenge Study (VEGAS): a single-blind, randomised controlled trial to evaluate the health outcomes of the Virgin Pulse Global Challenge (VPGC) Programme on quality of life among healthy employees. apps.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12619000173190 (first received 6 February 2019).
Aittasalo 2017 {published data only}
    1. Aittasalo M, Tiilikainen J, Tokola K, Seimela T, Sarjala S-M, Metsapuro P, et al. Socio-ecological intervention to promote active commuting to work: protocol and baseline findings of a cluster randomized controlled trial in Finland. International Journal of Environmental Research and Public Health 2017;14(10):1257. - PMC - PubMed
Pillay 2012 {published data only}
    1. Pillay JD, Kolbe-Alexander T, Proper KI, Mechelen W, Lambert EV. Steps that count! The development of a pedometer-based health promotion intervention in an employed, health insured South African population. BMC Public Health 2012;12(1):880. - PMC - PubMed

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References to other published versions of this review

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