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Meta-Analysis
. 2020 Oct 9;17(1):129.
doi: 10.1186/s12966-020-01020-8.

The effects of step-count monitoring interventions on physical activity: systematic review and meta-analysis of community-based randomised controlled trials in adults

Umar A R Chaudhry  1 , Charlotte Wahlich  2 , Rebecca Fortescue  2 , Derek G Cook  2 , Rachel Knightly  2 , Tess Harris  2
Affiliations
Meta-Analysis

The effects of step-count monitoring interventions on physical activity: systematic review and meta-analysis of community-based randomised controlled trials in adults

Umar A R Chaudhry et al. Int J Behav Nutr Phys Act. .

Abstract

Background: Step-count monitors (pedometers, body-worn trackers and smartphone applications) can increase walking, helping to tackle physical inactivity. We aimed to assess the effect of step-count monitors on physical activity (PA) in randomised controlled trials (RCTs) amongst community-dwelling adults; including longer-term effects, differences between step-count monitors, and between intervention components.

Methods: Systematic literature searches in seven databases identified RCTs in healthy adults, or those at risk of disease, published between January 2000-April 2020. Two reviewers independently selected studies, extracted data and assessed risk of bias. Outcome was mean differences (MD) with 95% confidence intervals (CI) in steps at follow-up between treatment and control groups. Our preferred outcome measure was from studies with follow-up steps adjusted for baseline steps (change studies); but we also included studies reporting follow-up differences only (end-point studies). Multivariate-meta-analysis used random-effect estimates at different time-points for change studies only. Meta-regression compared effects of different step-count monitors and intervention components amongst all studies at ≤4 months.

Results: Of 12,491 records identified, 70 RCTs (at generally low risk of bias) were included, with 57 trials (16,355 participants) included in meta-analyses: 32 provided change from baseline data; 25 provided end-point only. Multivariate meta-analysis of the 32 change studies demonstrated step-counts favoured intervention groups: MD of 1126 steps/day 95%CI [787, 1466] at ≤4 months, 1050 steps/day [602, 1498] at 6 months, 464 steps/day [301, 626] at 1 year, 121 steps/day [- 64, 306] at 2 years and 434 steps/day [191, 676] at 3-4 years. Meta-regression of the 57 trials at ≤4 months demonstrated in mutually-adjusted analyses that: end-point were similar to change studies (+ 257 steps/day [- 417, 931]); body-worn trackers/smartphone applications were less effective than pedometers (- 834 steps/day [- 1542, - 126]); and interventions providing additional counselling/incentives were not better than those without (- 812 steps/day [- 1503, - 122]).

Conclusions: Step-count monitoring leads to short and long-term step-count increases, with no evidence that either body-worn trackers/smartphone applications, or additional counselling/incentives offer further benefit over simpler pedometer-based interventions. Simple step-count monitoring interventions should be prioritised to address the public health physical inactivity challenge.

Systematic review registration: PROSPERO number CRD42017075810 .

Keywords: Fitness devices; Meta-analysis; Pedometers; Physical activity; Smartphone applications; Step-count monitoring; Systematic review.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare grant funding from the National Institute for Health Research; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work. Professor Tess Harris and Professor Derek G Cook acknowledge conflicts of interest in terms of funding from the National Institute for Health Research for the PACE-Lift and PACE-UP trials. There are no other conflicts of interest for authors.

Figures

Fig. 1
Fig. 1
PRISMA Flowchart Screening of Literature Search and Eligibility
Fig. 2
Fig. 2
Risk of Bias Decisions for Change-on-Change and End-Point Only Outcome Studies. a Change-on-Change Outcome Studies. b End-Point Only Outcome Studies
Fig. 3
Fig. 3
Mean between-group difference in change from baseline step-count (32 studies)
Fig. 4
Fig. 4
Mean between-group difference in end-point step-count (25 studies)
Fig. 5
Fig. 5
Funnel Plot of Studies reporting Mean-differences of Change-on-Change Study Outcome and End-point Only Study Outcome at ≤4 months Time-point
See this image and copyright information in PMC

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