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.

The study aim was to investigate the health effects of a pedometer-based behavioural modification program in type 2 diabetes patients and to examine the relationship between changes in steps/day (baseline-post and baseline-follow up) and health outcomes. Ninety-two type 2 diabetes patients (69% male, mean age: 62 ± 9 years and mean BMI: 30.0 ± 2.5 kg/m(2)) were recruited and randomly assigned to an intervention or control group. The intervention consisted of one face-to-face session, pedometer use and seven telephone calls. Selection criteria included 35-75 years, 25-35 kg/m(2) and ≤12% HbA1c (108 mmol/mol). Outcome measures were assessed at baseline, post and follow up, and included systolic blood pressure, waist circumference, body mass index, glucose control (HbA1c and fasting glucose), triglycerides, total, HDL and LDL cholesterol and steps/day. The results showed no significant short- or intermediate-term differences in health outcomes between the control and intervention group. However, a threshold was identified, as HbA1c improved significantly in those who increased ≥4000 steps/day between baseline- and post-measurements (n = 18). This threshold was not applicable to any other health outcome. Hence, although the intervention successfully increased steps/day, no direct effect on health outcomes was identified. However, an increase of ≥4000 steps/day seemed a threshold to have a positive impact on HbA1c.

Mediators of physical activity change in a behavioral modification program for type 2 diabetes patients.

BACKGROUND: Many studies have reported significant behavioral impact of physical activity interventions. However, few have examined changes in potential mediators of change preceding behavioral changes, resulting in a lack of information concerning how the intervention worked. Our purpose was to examine mediation effects of changes in psychosocial variables on changes in physical activity in type 2 diabetes patients. METHODS: Ninety-two patients (62 ± 9 years, 30, 0 ± 2.5 kg/m(2), 69% males) participated in a randomized controlled trial. The 24-week intervention was based on social-cognitive constructs and consisted of a face-to-face session, telephone follow-ups, and the use of a pedometer. Social-cognitive variables and physical activity (device-based and self-reported) were collected at baseline, after the 24-week intervention and at one year post-baseline. PA was measured by pedometer, accelerometer and questionnaire. RESULTS: Post-intervention physical activity changes were mediated by coping with relapse, changes in social norm, and social modeling from family members (p ≤ 0.05). One-year physical activity changes were mediated by coping with relapse, changes in social support from family and self-efficacy towards physical activity barriers (p ≤ 0.05) CONCLUSIONS: For patients with type 2 diabetes, initiatives to increase their physical activity could usefully focus on strategies for resuming regular patterns of activity, on engaging family social support and on building confidence about dealing with actual and perceived barriers to activity. TRIAL REGISTRATION: NCT00903500, ClinicalTrials.gov.

The effects of a pedometer-based behavioral modification program with telephone support on physical activity and sedentary behavior in type 2 diabetes patients.

OBJECTIVE: Effectiveness of a behavioral modification program on physical activity (PA) and sedentary behavior in diabetes patients. METHODS: Ninety-two patients were randomly assigned to an intervention or control group. The 24-weeks intervention consisted of a face-to-face session, pedometer and seven telephone follow-ups. Mean selection criteria were 35-75 years; 25-35 kg/m(2); ≤ 12% HbA1c, treated for type 2 diabetes; no PA limitations. PA and sedentary behavior were measured by pedometer, accelerometer and questionnaire over the short- (24 weeks) and intermediate- (1 year) term. RESULTS: The intervention group increased their steps/day by 2744, their total PA by 23 min/day (p<0.001) and decreased their sedentary behavior by 23 min/day (p<0.05) post-intervention. After 1 year the intervention group still had an increase of 1872 steps/day, 11 min/day total PA and a decrease of 12 min/day in sedentary behavior (p<0.001). CONCLUSION: This pedometer-based behavioral modification program with telephone support showed lasting positive effects on steps/day, PA and sedentary behavior. PRACTICE IMPLICATIONS: This study tested a convenient way to increase PA among type 2 diabetes patients.

Translating physical activity recommendations into a pedometer-based step goal: 3000 steps in 30 minutes.

BACKGROUND: It is a public health recommendation to accumulate at least 150 minutes per week of moderate intensity physical activity. Although pedometers are widely used as a physical activity-monitoring tool, they are unable to measure activity intensity. Translating current physical activity recommendations into a pedometer-based guideline could increase the public health impact of physical activity interventions. METHODS: A community sample of 97 adults (60% women, with a mean age of 32.1 [+/-10.6] years and a mean BMI of 28.8 [+/-5.5]) completed four 6-minute incremental walking bouts on a level treadmill at 65, 80, 95, and 110 m x min(-1). A calibrated metabolic cart was used to measure energy expenditure at each speed. Steps were measured using a Yamax SW-200 pedometer. Step-rate cut points associated with minimally moderate-intensity activity (defined as 3 METs) were determined using multiple regression, mixed modeling, and receiver operating characteristic (ROC) curves. All data were collected and analyzed in 2006. RESULTS: For men, step counts per minute associated with walking at 3 METs were 92 step x min(-1) (multiple regression); 101 step x min(-1) (mixed modeling); and 102 step x min(-1) (ROC curve). For women, step counts per minute associated with walking at 3 METs were 91 step x min(-1) (multiple regression); 111 step x min(-1) (mixed modeling); and 115 step x min(-1) (ROC curve). However, for each analysis there was substantial error in model fit. CONCLUSIONS: Moderate-intensity walking appears approximately equal to at least 100 step x min(-1). However, step counts per minute is a poor proxy for METs, and so 100 step x min(-1) should be used only as a general physical activity promotion heuristic. To meet current guidelines, individuals are encouraged to walk a minimum of 3000 steps in 30 minutes on 5 days each week. Three bouts of 1000 steps in 10 minutes each day can also be used to meet the recommended goal.

Preliminary outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type 2 diabetes.

The First Step Program uses simple and inexpensive pedometers to incrementally increase walking behaviors in sedentary individuals with type 2 diabetes. The pilot sample consisted of nine individuals (six women, three men; group mean age 53+/-6; group mean body mass index=32.9+/-3.4kg/m(2)). A timed self-paced walk while wearing the pedometer allowed for the conversion of changes in pedometer steps per day to time in minutes per day. There was an immediate and dramatic increase in walking behavior (an average of 34.3min of walking a day) that was sustained even 2 months post-intervention and after withdrawal of contact (an average of 22.6min of walking a day). Improvements in other outcomes (systolic blood pressure and waist girth) support a valid change in behavior. Although preliminary, these results warrant further investigation of such approaches.

Pedometer-determined ambulatory activity in individuals with type 2 diabetes.

This cross-sectional study presents the first normative data on pedometer-determined ambulatory activity, defined as steps/day, in 160 (98 males, 62 females; age=52.4 +/- 5.3 years; BMI=32.3 +/- 5.7) free-living individuals with type 2 diabetes. Participants took 6662 +/- 3077 steps per day, less than that reported in nondiabetic samples and more than that reported for samples living with more restrictive chronic conditions including claudication, joint replacement, chronic obstructive lung disease, and chronic heart failure. Steps/day and BMI were inversely and significantly correlated (r=-0.27, P<0.01). Further, there was a significant difference between BMI categories (from normal weight to obesity class III) with regard to steps/day (F=2.96, P<0.05). The difference was most apparent between the highest obesity classes (II and III) and normal weight categories. This data is useful for sample comparison purposes. In addition the standard deviation or variance estimates can be used to calculate samples sizes for intervention efforts. Objective quantification of ambulatory activity via simple and inexpensive pedometers permits researchers and practitioners to easily screen for level of activity along a continuum. This study opens the door for future research and clinical applications including identifying threshold values related to important health outcomes and evaluating incremental change due to various interventions in this population.