Top

BMC Medicine

Published in:

Open Access 01-12-2014 | Research article

Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials

Authors: Shanhu Qiu, Xue Cai, Xiang Chen, Bingquan Yang, Zilin Sun

Published in: BMC Medicine | Issue 1/2014

Abstract

Background

While step counter use has become popular among type 2 diabetes (T2D) patients, its effectiveness in increasing physical activity (PA) and improving glycemic control has been poorly defined. The aim of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the association of step counter use with PA and glycemic control in T2D patients.

Methods

Articles were identified by searches of PubMed, Web of Science and Cochrane Library from January 1994 to June 2013. RCTs in the English language were included, if they had assessed the effectiveness of step counters as motivating and monitoring tools in T2D patients, with reported changes in steps per day (steps/d) or glycosylated hemoglobin A1c (HbA1c), or both. Data were independently collected by 2 authors and overall estimates were made by a random-effects model.

Results

Of the 551 articles retrieved, 11 RCTs were included. Step counter use significantly increased PA by 1,822 steps/d (7 studies, 861 participants; 95% confidence interval (CI): 751 to 2,894 steps/d) in patients with T2D. Step counter use with a PA goal showed a bigger increase in PA (weighted mean difference (WMD) 3,200 steps/d, 95% CI: 2,053 to 4,347 steps/d) than without (WMD 598 steps/d, 95% CI: −65 to 1,260 steps/d). Further subgroup analysis suggested step counter use with a self-set PA goal (WMD 2,816 steps/d, 95% CI: 1,288 to 4,344 steps/d) made no difference in increasing PA from a 10,000 steps/d goal (WMD 3,820 steps/d, 95% CI: 2,702 to 4,938 steps/d). However, no significant HbA1c change was observed by step counter use (10 studies, 1,423 participants; WMD 0.02%, 95% CI: −0.08% to 0.13%), either with (WMD 0.04%, 95% CI: −0.21% to 0.30%) or without a PA goal (WMD 0.01%, 95% CI: −0.10% to 0.13%).

Conclusions

Step counter use is associated with a significant increase in PA in patients with T2D. However, evidence regarding its effect in improving glycemic control remains insufficient.

Trial registration

PROSPERO CRD42013005236

Available only for authorised users

Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B, American College of Sports Medicine; American Diabetes Association: Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Med Sci Sports Exerc. 2010, 42: 2282-2303. 10.1249/MSS.0b013e3181eeb61c.CrossRefPubMed

Houmard JA, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Kraus WE: Effect of the volume and intensity of exercise training on insulin sensitivity. J Appl Physiol. 2004, 96: 101-106.CrossRefPubMed

Snowling NJ, Hopkins WG: Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes Care. 2006, 29: 2518-2527. 10.2337/dc06-1317.CrossRefPubMed

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. 10.1370/afm.761.CrossRefPubMedPubMedCentral

McAuley PA, Myers JN, Abella JP, Tan SY, Froelicher VF: Exercise capacity and body mass as predictors of mortality among male veterans with type 2 diabetes. Diabetes Care. 2007, 30: 1539-1543. 10.2337/dc06-2397.CrossRefPubMed

Wei M, Gibbons LW, Kampert JB, Nichaman MZ, Blair SN: Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med. 2000, 132: 605-611.CrossRefPubMed

Zhao G, Ford ES, Li C, Balluz LS: Physical activity in U.S. older adults with diabetes mellitus: prevalence and correlates of meeting physical activity recommendations. J Am Geriatr Soc. 2011, 59: 132-137. 10.1111/j.1532-5415.2010.03236.x.CrossRefPubMed

Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW: Physical activity in U.S. adults with diabetes and at risk for developing diabetes, 2003. Diabetes Care. 2007, 30: 203-209. 10.2337/dc06-1128.CrossRefPubMed

Korkiakangas EE, Alahuhta MA, Laitinen JH: Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: a systematic review. Health Promot Int. 2009, 24: 416-427. 10.1093/heapro/dap031.CrossRefPubMed

10.

Wanko NS, Brazier CW, Young-Rogers D, Dunbar VG, Boyd B, George CD, Rhee MK, el-Kebbi IM, Cook CB: Exercise preferences and barriers in urban African Americans with type 2 diabetes. Diabetes Educ. 2004, 30: 502-513. 10.1177/014572170403000322.CrossRefPubMed

11.

Allen NA, Fain JA, Braun B, Chipkin SR: Continuous glucose monitoring counseling improves physical activity behaviors of individuals with type 2 diabetes: a randomized clinical trial. Diabetes Res Clin Pract. 2008, 80: 371-379. 10.1016/j.diabres.2008.01.006.CrossRefPubMedPubMedCentral

12.

Hobbs N, Godfrey A, Lara J, Errington L, Meyer TD, Rochester L, White M, Mathers JC, Sniehotta FF: Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Med. 2013, 11: 75-10.1186/1741-7015-11-75.CrossRefPubMedPubMedCentral

13.

McKay HG, King D, Eakin EG, Seeley JR, Glasgow RE: The diabetes network internet-based physical activity intervention: a randomized pilot study. Diabetes Care. 2001, 24: 1328-1334. 10.2337/diacare.24.8.1328.CrossRefPubMed

14.

Davis JN, Gyllenhammer LE, Vanni AA, Meija M, Tung A, Schroeder ET, Spruijt-Metz D, Goran MI: Startup circuit training program reduces metabolic risk in latino adolescents. Med Sci Sports Exerc. 2011, 43: 2195-2203. 10.1249/MSS.0b013e31821f5d4e.CrossRefPubMedPubMedCentral

15.

Van Dyck D, De Greef K, Deforche B, Ruige J, Bouckaert J, Tudor-Locke CE, Kaufman JM, De Bourdeaudhuij I: The relationship between changes in steps/day and health outcomes after a pedometer-based physical activity intervention with telephone support in type 2 diabetes patients. Health Educ Res. 2013, 28: 539-545. 10.1093/her/cyt038.CrossRefPubMed

16.

Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR: Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007, 298: 2296-2304. 10.1001/jama.298.19.2296.CrossRefPubMed

17.

Tubili C, Di Flaviani A, Morviducci L, Nardone R, Altieri N: Pedometer use is beneficial for type 2 diabetes mellitus patients if included in educational programs. Metabolism. 2010, 59: E1-E2. 10.1016/j.metabol.2010.05.005.CrossRefPubMed

18.

Bjorgaas MR, Vik JT, Stolen T, Lydersen S, Grill V: Regular use of pedometer does not enhance beneficial outcomes in a physical activity intervention study in type 2 diabetes mellitus. Metabolism. 2008, 57: 605-611. 10.1016/j.metabol.2007.12.002.CrossRefPubMed

19.

Shenoy S, Guglani R, Sandhu JS: Effectiveness of an aerobic walking program using heart rate monitor and pedometer on the parameters of diabetes control in Asian Indians with type 2 diabetes. Prim Care Diabetes. 2010, 4: 41-45. 10.1016/j.pcd.2009.10.004.CrossRefPubMed

20.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009, 151: 264-269. 10.7326/0003-4819-151-4-200908180-00135.CrossRefPubMed

21.

Tahara Y, Shima K: Kinetics of Hba(1c), Glycated Albumin, and Fructosamine and Analysis of Their Weight-Functions against Preceding Plasma-Glucose Level. Diabetes Care. 1995, 18: 440-447. 10.2337/diacare.18.4.440.CrossRefPubMed

22.

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group; Cochrane Statistical Methods Group: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011, 343: d5928-10.1136/bmj.d5928.CrossRefPubMedPubMedCentral

23.

Cochrane handbook for systematic reviews of interventions version 5.1.0. [updated March 2011] [http://handbook.cochrane.org/]

24.

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: 188-198. 10.1007/s12529-010-9124-7.CrossRefPubMed

25.

De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhuij I: A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes. Health Educ Res. 2010, 25: 724-736. 10.1093/her/cyq017.CrossRefPubMedPubMedCentral

26.

Tudor-Locke C, Bell RC, Myers AM, Harris SB, Ecclestone NA, Lauzon N, Rodger NW: Controlled outcome evaluation of the first step program: a daily physical activity intervention for individuals with type II diabetes. Int J Obes Relat Metab Disord. 2004, 28: 113-119. 10.1038/sj.ijo.0802485.CrossRefPubMed

27.

Piette JD, Richardson C, Himle J, Duffy S, Torres T, Vogel M, Barber K, Valenstein M: A randomized trial of telephonic counseling plus walking for depressed diabetes patients. Med Care. 2011, 49: 641-648. 10.1097/MLR.0b013e318215d0c9.CrossRefPubMedPubMedCentral

28.

De Greef KP, Deforche BI, Ruige JB, Bouckaert JJ, Tudor-Locke CE, Kaufman JM, De Bourdeaudhuij IM: The effects of a pedometer-based behavioral modification program with telephone support on physical activity and sedentary behavior in type 2 diabetes patients. Patient Educ Couns. 2011, 84: 275-279. 10.1016/j.pec.2010.07.010.CrossRefPubMed

29.

Kirk A, Barnett J, Leese G, Mutrie N: A randomized trial investigating the 12-month changes in physical activity and health outcomes following a physical activity consultation delivered by a person or in written form in Type 2 diabetes: Time2Act. Diabet Med. 2009, 26: 293-301. 10.1111/j.1464-5491.2009.02675.x.CrossRefPubMed

30.

Plotnikoff RC, Karunamuni N, Courneya KS, Sigal RJ, Johnson JA, Johnson ST: The Alberta Diabetes and Physical Activity Trial (ADAPT): a randomized trial evaluating theory-based interventions to increase physical activity in adults with type 2 diabetes. Ann Behav Med. 2013, 45: 45-56. 10.1007/s12160-012-9405-2.CrossRefPubMed

31.

Engel L, Lindner H: Impact of using a pedometer on time spent walking in older adults with type 2 diabetes. Diabetes Educ. 2006, 32: 98-107. 10.1177/0145721705284373.CrossRefPubMed

32.

Andrews RC, Cooper AR, Montgomery AA, Norcross AJ, Peters TJ, Sharp DJ, Jackson N, Fitzsimons K, Bright J, Coulman K, England CY, Gorton J, McLenaghan A, Paxton E, Polet A, Thompson C, Dayan CM: Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the early ACTID randomised controlled trial. Lancet. 2011, 378: 129-139. 10.1016/S0140-6736(11)60442-X.CrossRefPubMed

33.

Diedrich A, Munroe DJ, Romano M: Promoting physical activity for persons with diabetes. Diabetes Educ. 2010, 36: 132-140. 10.1177/0145721709352382.CrossRefPubMed

34.

Bohannon RW: Number of pedometer-assessed steps taken per day by adults: a descriptive meta-analysis. Phys Ther. 2007, 87: 1642-1650. 10.2522/ptj.20060037.CrossRefPubMed

35.

Weinstock RS, Brooks G, Palmas W, Morin PC, Teresi JA, Eimicke JP, Silver S, Izquierdo R, Goland R, Shea S: Lessened decline in physical activity and impairment of older adults with diabetes with telemedicine and pedometer use: results from the IDEATel study. Age Ageing. 2011, 40: 98-105. 10.1093/ageing/afq147.CrossRefPubMed

36.

Gusso S, Hofman P, Lalande S, Cutfield W, Robinson E, Baldi JC: Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus. Diabetologia. 2008, 51: 1317-1320. 10.1007/s00125-008-1012-1.CrossRefPubMed

37.

Tudor-Locke C, Bassett DR: How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004, 34: 1-8. 10.2165/00007256-200434010-00001.CrossRefPubMed

38.

Coffman MJ, Ferguson BL, Steinman L, Talbot LA, Dunbar-Jacob J: A health education pilot for Latina women with diabetes. Clin Nurs Res. 2013, 22: 70-81. 10.1177/1054773812451746.CrossRefPubMed

39.

Manjoo P, Joseph L, Dasgupta K: Abdominal adiposity and daily step counts as determinants of glycemic control in a cohort of patients with type 2 diabetes mellitus. Nutr Diabetes. 2012, 2: e25-10.1038/nutd.2011.22.CrossRefPubMedPubMedCentral

40.

Sung K, Bae S: Effects of a regular walking exercise program on behavioral and biochemical aspects in elderly people with type II diabetes. Nurs Health Sci. 2012, 14: 438-445. 10.1111/j.1442-2018.2012.00690.x.CrossRefPubMed

41.

Boule NG, Kenny GP, Haddad E, Wells GA, Sigal RJ: Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia. 2003, 46: 1071-1081. 10.1007/s00125-003-1160-2.CrossRefPubMed

42.

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF: Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement, Quality of Reporting of Meta-analyses. Lancet. 1999, 354: 1896-1900. 10.1016/S0140-6736(99)04149-5.CrossRefPubMed

43.

Nalysnyk L, Hernandez-Medina M, Krishnarajah G: Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Diabetes Obes Metab. 2010, 12: 288-298. 10.1111/j.1463-1326.2009.01160.x.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1741-7015/12/36/prepub

Title: Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials
Authors: Shanhu Qiu
Xue Cai
Xiang Chen
Bingquan Yang
Zilin Sun
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2014
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/1741-7015-12-36

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2014

Additive effects of blood glucose lowering drugs, statins and renin-angiotensin system blockers on all-site cancer risk in patients with type 2 diabetes

Why training and specialization is needed for peer review: a case study of peer review for randomized controlled trials

Advances in treating HER2-positive breast cancer: an interview with Sunil Verma

Non-invasive score identifies ultrasonography-diagnosed non-alcoholic fatty liver disease and predicts mortality in the USA

Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study

Atypical antipsychotic agents; Peas in a pod or chalk and cheese?