Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

A pedometer-based walking intervention with and without email counseling in general practice: a pilot randomized controlled trial

Authors: Tomas Vetrovsky, Jozef Cupka, Martin Dudek, Blanka Kuthanova, Klaudia Vetrovska, Vaclav Capek, Vaclav Bunc

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

General practitioners play a fundamental role in combatting the current epidemic of physical inactivity, and pedometer-based walking interventions are able to increase physical activity levels of their patients. Supplementing these interventions with email counseling driven by feedback from the pedometer has the potential to further improve their effectiveness but it has to be yet confirmed in clinical trials. Therefore, the aim of our pilot randomized controlled trial is to evaluate the feasibility and potential efficacy of future trials designed to assess the additional benefit of email counseling added to a pedometer-based intervention in a primary care setting.

Methods

Physically inactive patients were opportunistically recruited from four general practices and randomized to a 12-week pedometer-based intervention with or without email counseling. To explore the feasibility of future trials, we assessed the speed and efficiency of recruitment, adherence to wearing the pedometer, and engagement with email counseling. To evaluate the potential efficacy, daily step-count was the primary outcome and blood pressure, waist and hip circumference, and body mass were the secondary outcomes. Additionally, we conducted a qualitative analysis of structured interviews with the participating general practitioners.

Results

The opportunistic recruitment has been shown to be feasible and acceptable, but relatively slow and inefficient; moreover, general practitioners selectively recruited overweight and obese patients. Patients manifested high adherence, wearing the pedometer on 83% (± 20) of days. All patients from the counseling group actively participated in email communication and responded to 46% (± 22) of the emails they received. Both groups significantly increased their daily step-count (pedometer-plus-email, + 2119, p = 0.002; pedometer-alone, + 1336, p = 0.03), but the difference between groups was not significant (p = 0.18). When analyzing both groups combined, there was a significant decrease in body mass (− 0.68 kg, p = 0.04), waist circumference (− 1.73 cm, p = 0.03), and systolic blood pressure (− 3.48 mmHg, p = 0.045).

Conclusions

This study demonstrates that adding email counseling to a pedometer-based intervention in a primary care setting is feasible and might have the potential to increase the efficacy of such an intervention in increasing physical activity levels.

Trial registration

The trial was retrospectively registered at ClinicalTrials.gov (ID: NCT03135561, date: April 26, 2017).
Literature
1.
Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25:1–72.CrossRefPubMed
2.
3.
Woodcock J, Franco OH, Orsini N, Roberts I. Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol. 2011;40:121–38.CrossRefPubMed
4.
Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity--a systematic review of longitudinal studies. BMC Public Health. 2013;13:813.CrossRefPubMedPubMedCentral
5.
van Doorslaer E, Masseria C, Koolman X. OECD health equity research group. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174:177–83.CrossRefPubMedPubMedCentral
6.
Orrow G, Kinmonth A-L, Sanderson S, Sutton S. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012;344:e1389.CrossRefPubMedPubMedCentral
7.
Gusi N, Reyes MC, Gonzalez-Guerrero JL, Herrera E, Garcia JM. Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial. BMC Public Health. 2008;8:344–10.CrossRef
8.
Hébert ET, Caughy MO, Shuval K. Primary care providers' perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med. 2012;46:625–31.CrossRefPubMed
9.
Schofield G, Croteau K, McLean G. Trust levels of physical activity information sources: a population study. Health Promot J Austr. 2005;16:221–4.CrossRefPubMed
10.
11.
12.
13.
Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298:2296–304.CrossRefPubMed
14.
Richardson CR, Newton TL, Abraham JJ, Sen A, Jimbo M, Swartz AM. A meta-analysis of pedometer-based walking interventions and weight loss. Ann Fam Med. 2008;6:69–77.CrossRefPubMedPubMedCentral
15.
Adams MA, Hurley JC, Todd M, Bhuiyan N, Jarrett CL, Tucker WJ, et al. Adaptive goal setting and financial incentives: a 2 × 2 factorial randomized controlled trial to increase adults' physical activity. BMC Public Health. 2017;17:286.CrossRefPubMedPubMedCentral
16.
Mansi S, Milosavljevic S, Baxter GD, Tumilty S, Hendrick P. A systematic review of studies using pedometers as an intervention for musculoskeletal diseases. BMC Musculoskelet Disord. 2014;15:231.CrossRefPubMedPubMedCentral
17.
Moy ML, Collins RJ, Martinez CH, Kadri R, Roman P, Holleman RG, et al. An internet-mediated pedometer-based program improves health-related quality-of-life domains and daily step counts in COPD: a randomized controlled trial. Chest. 2015;148:128–37.CrossRefPubMedPubMedCentral
18.
Houle J, Doyon O, Vadeboncoeur N, Turbide G, Diaz A, Poirier P. Effectiveness of a pedometer-based program using a socio-cognitive intervention on physical activity and quality of life in a setting of cardiac rehabilitation. Can J Cardiol. 2012;28:27–32.CrossRefPubMed
19.
Yates T, Edwardson CL, Henson J, Gray LJ, Ashra NB, Troughton J, et al. Walking away from type 2 diabetes: a cluster randomized controlled trial. Diabet Med. 2017;34:698–707.CrossRefPubMed
20.
Harris T, Kerry SM, Victor CR, Ekelund U, Woodcock A, Iliffe S, et al. A primary care nurse-delivered walking intervention in older adults: PACE (pedometer accelerometer consultation evaluation)-lift cluster randomised controlled trial. PLoS Med. 2015;12:e1001783.CrossRefPubMedPubMedCentral
21.
Harris T, Kerry SM, Limb ES, Victor CR, Iliffe S, Ussher M, et al. Effect of a primary care walking intervention with and without nurse support on physical activity levels in 45- to 75-year-olds: the pedometer and consultation evaluation (PACE-UP) cluster randomised clinical trial. PLoS Med. 2017;14:e1002210.CrossRefPubMedPubMedCentral
22.
van der Weegen S, Verwey R, Spreeuwenberg M, Tange H, van der Weijden T, de Witte L. It's LiFe! Mobile and web-based monitoring and feedback tool embedded in primary care increases physical activity: a cluster randomized controlled trial. J Med Internet Res. 2015;17:e184.CrossRefPubMedPubMedCentral
23.
Glynn LG, Hayes PS, Casey M, Glynn F, Alvarez-Iglesias A, Newell J, et al. Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial. Br J Gen Pract. 2014;64:e384–91.CrossRefPubMedPubMedCentral
24.
Morrison Z, Douglas A, Bhopal R, Sheikh A. Trial investigators. Understanding experiences of participating in a weight loss lifestyle intervention trial: a qualitative evaluation of south Asians at high risk of diabetes. BMJ Open. 2014;4:e004736–6.
25.
Normansell R, Smith J, Victor C, Cook DG, Kerry S, Iliffe S, et al. Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention. BMC Public Health. 2014;14:1272.CrossRefPubMedPubMedCentral
26.
Patel A, Schofield GM, Kolt GS, Keogh JWL. Perceived barriers, benefits, and motives for physical activity: two primary-care physical activity prescription programs. J Aging Phys Act. 2013;21:85–99.CrossRefPubMed
27.
Patel A, Kolt GS, Schofield GM, Keogh JW. General practitioners' views on the role of pedometers in health promotion. J Prim Health Care. 2014;6:152–6.PubMed
28.
Gao S, Stone RA, Hough LJ, Haibach JP, Marcus BH, Ciccolo JT, et al. Physical activity counseling in overweight and obese primary care patients: outcomes of the VA-STRIDE randomized controlled trial. Prev Med Rep. 2016;3:113–20.CrossRefPubMed
29.
Richards EA, Cai Y. Integrative review of nurse-delivered physical activity interventions in primary care. West J Nurs Res. 2016;38:484–507.CrossRefPubMed
30.
James EL, Ewald BD, Johnson NA, Stacey FG, Brown WJ, Holliday EG, et al. Referral for expert physical activity counseling: a pragmatic RCT. Am J Prev Med. 2017;53:490–9.CrossRefPubMed
31.
McMurdo MET, Sugden J, Argo I, Boyle P, Johnston DW, Sniehotta FF, et al. Do pedometers increase physical activity in sedentary older women? A randomized controlled trial. J Am Geriatr Soc. 2010;58:2099–106.CrossRefPubMed
32.
Croteau KA, Suresh V, Farnham E. Efficacy of using physical activity mentors to increase the daily steps of older adults in the primary care setting: a pilot study. J Aging Phys Act. 2014;22:16–24.CrossRefPubMed
33.
De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhuij I. Increasing physical activity in Belgian type 2 diabetes patients: a three-arm randomized controlled trial. Int J Behav Med. 2011;18:188–98.CrossRefPubMed
34.
Pears S, Bijker M, Morton K, Vasconcelos J, Parker RA, Westgate K, et al. A randomised controlled trial of three very brief interventions for physical activity in primary care. BMC Public Health. 2016;16:1033.CrossRefPubMedPubMedCentral
35.
Bhimani RH, Cross LJS, Taylor BC, Meis LA, Fu SS, Allen KD, et al. Taking ACTION to reduce pain: ACTION study rationale, design and protocol of a randomized trial of a proactive telephone-based coaching intervention for chronic musculoskeletal pain among African Americans. BMC Musculoskelet Disord. 2017;18:15.CrossRefPubMedPubMedCentral
36.
Gill DP, Blunt W, Bartol C, Pulford RW, De Cruz A, Simmavong PK, et al. HealtheSteps™ study protocol: a pragmatic randomized controlled trial promoting active living and healthy lifestyles in at-risk Canadian adults delivered in primary care and community-based clinics. BMC Public Health. 2017;17:173.CrossRefPubMedPubMedCentral
37.
Geidl W, Semrau J, Streber R, Lehbert N, Wingart S, Tallner A, et al. Effects of a brief, pedometer-based behavioral intervention for individuals with COPD during inpatient pulmonary rehabilitation on 6-week and 6-month objectively measured physical activity: study protocol for a randomized controlled trial. Trials. 2017;18:396.CrossRefPubMedPubMedCentral
38.
Vetrovsky T, Siranec M, Parenica J, Griva M, Stastny J, Precek J, et al. Effect of a 6-month pedometer-based walking intervention on functional capacity in patients with chronic heart failure with reduced (HFrEF) and with preserved (HFpEF) ejection fraction: study protocol for two multicenter randomized controlled trials. J Transl Med. 2017;15:153–62.CrossRefPubMedPubMedCentral
39.
van Kessel K, Wouldes T, Moss-Morris R. A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue. Clin Rehabil. 2016;30:454–62.CrossRefPubMed
40.
Tate DF, Jackvony EH, Wing RR. Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003;289:1833–6.CrossRefPubMed
41.
Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an internet weight loss program. Arch Intern Med. 2006;166:1620–17.CrossRefPubMed
42.
Hageman PA, Pullen CH, Hertzog M, Pozehl B, Eisenhauer C, Boeckner LS. Web-based interventions alone or supplemented with peer-led support or professional email counseling for weight loss and weight maintenance in women from rural communities: results of a clinical trial. J Obes. 2017;2017:1602627.CrossRefPubMedPubMedCentral
43.
Schweitzer AL, Ross JT, Klein CJ, Lei KY, Mackey ER. An electronic wellness program to improve diet and exercise in college students: a pilot study. JMIR Res Protoc. 2016;5:e29.CrossRefPubMedPubMedCentral
44.
Marcus BH, Ciccolo JT, Sciamanna CN. Using electronic/computer interventions to promote physical activity. Br J Sports Med. 2009;43:102–5.CrossRefPubMed
45.
van den Berg MH, Schoones JW, Vliet Vlieland TPM. Internet-based physical activity interventions: a systematic review of the literature. J Med Internet Res. 2007;9:e26.CrossRefPubMedPubMedCentral
46.
Foster C, Richards J, Thorogood M, Hillsdon M. Remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev. 2013;9:CD010395.PubMed
47.
Joseph RP, Durant NH, Benitez TJ, Pekmezi DW. Internet-based physical activity interventions. Am J Lifestyle Med. 2014;8:42–68.CrossRefPubMed
48.
Plotnikoff RC, McCargar LJ, Wilson PM, Loucaides CA. Efficacy of an E-mail intervention for the promotion of physical activity and nutrition behavior in the workplace context. Am J Health Promot. 2005;19:422–9.CrossRefPubMed
49.
Dinger MK, Heesch KC, Cipriani G, Qualls M. Comparison of two email-delivered, pedometer-based interventions to promote walking among insufficiently active women. J Sci Med Sport. 2007;10:297–302.CrossRefPubMed
50.
Napolitano MA, Fotheringham M, Tate D, Sciamanna C, LESLIE E, Owen N, et al. Evaluation of an internet-based physical activity intervention: a preliminary investigation. Ann Behav Med. 2003;25:92–9.CrossRefPubMed
51.
Richards EA, Ogata N, Cheng C-W. Randomized controlled theory-based, E-mail-mediated walking intervention. Clin Nurs Res. 2017;26:47–67.CrossRefPubMed
52.
Devi R, Powell J, Singh S. A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial. J Med Internet Res. 2014;16:e186.CrossRefPubMedPubMedCentral
53.
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152:726.CrossRefPubMed
54.
Rose SB, Elley CR, Lawton BA, Dowell AC. A single question reliably identifies physically inactive women in primary care. N Z Med J. 2008;121:U2897.PubMed
55.
De Cocker KA, De Meyer J, De Bourdeaudhuij IM, Cardon GM. Non-traditional wearing positions of pedometers: validity and reliability of the Omron HJ-203-ED pedometer under controlled and free-living conditions. J Sci Med Sport. 2012;15:418–24.CrossRefPubMed
56.
Michie S, Abraham C, Whittington C, McAteer J, Gupta S. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009;28:690–701.CrossRefPubMed
57.
Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour--and are they the same? Health Educ Res. 2011;26:308–22.CrossRefPubMed
58.
Vetrovsky T, Čupka J, Dudek M, Kuthanova B, Vetrovska K, Capek V, et al. Mental health and quality of life benefits of a pedometer-based walking intervention delivered in a primary care setting. Acta Gymnica. 2017;47:138–43.CrossRef
59.
World Health Organisation. Waist Circumference and Waist-hip Ratio: Report of a WHO Expert Consultation. Geneva: World Health Organization; 2011.
60.
Fletcher B, Gheorghe A, Moore D, Wilson S, Damery S. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review. BMJ Open. 2012;2:e000496–15.CrossRefPubMedPubMedCentral
61.
Cadmus-Bertram L, Marcus BH, Patterson RE, Parker BA, Morey BL. Use of the Fitbit to measure adherence to a physical activity intervention among overweight or obese, postmenopausal women: self-monitoring trajectory during 16 weeks. JMIR mHealth uHealth. 2015;3:e96–7.CrossRefPubMedPubMedCentral
62.
McDonald AM, Knight RC, Campbell MK, Entwistle VA, Grant AM, Cook JA, et al. What influences recruitment to randomised controlled trials? A review of trials funded by two UK funding agencies. Trials. 2006;7:1017–8.CrossRef
63.
Warren FC, Stych K, Thorogood M, Sharp DJ, Murphy M, Turner KM, et al. Evaluation of different recruitment and randomisation methods in a trial of general practitioner-led interventions to increase physical activity: a randomised controlled feasibility study with factorial design. Trials. 2014;15:134.CrossRefPubMedPubMedCentral
64.
Sallis JF, SAELENS BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2015;71:1–14.CrossRef
65.
66.
Rendell JM, Merritt RD, Geddes JR. In: Rendell JM, editor. Incentives and disincentives to participation by clinicians in randomised controlled trials, Cochrane database Syst rev, vol. 3. Chichester, UK: Wiley; 2007. p. MR000021.
67.
Pears S, Morton K, Bijker M, Sutton S, Hardeman W. VBI Programme team. Development and feasibility study of very brief interventions for physical activity in primary care. BMC Public Health. 2015;15:333.CrossRefPubMedPubMedCentral
68.
Foy R, Parry J, McAvoy B. Clinical trials in primary care: targeted payments for trials might help improve recruitment and quality. BMJ. 1998;317:1168–9.CrossRefPubMedPubMedCentral
Metadata
Title
A pedometer-based walking intervention with and without email counseling in general practice: a pilot randomized controlled trial
Authors
Tomas Vetrovsky
Jozef Cupka
Martin Dudek
Blanka Kuthanova
Klaudia Vetrovska
Vaclav Capek
Vaclav Bunc
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5520-8

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue

Research article

Physical activity and sedentary behavior legislation in Canadian childcare facilities: an update

Research article

The design and implementation of the re-vitalised integrated disease surveillance and response (IDSR) in Uganda, 2013–2016

Research article

Discrimination and avoidance due to disability in Australia: evidence from a National Cross Sectional Survey

Research article

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: a systematic review and meta-analysis of cohort studies

Research article

Effects of cardiorespiratory fitness and weight status on knowledge of physical activity and fitness, attitude toward physical education, and physical activity

Research article

Raising cigarette excise tax to reduce consumption in low-and middle-income countries of the Asia-Pacific region:a simulation of the anticipated health and taxation revenues impacts