Pedometers and Public Health Catrine Tudor-Locke, PhD, FACSM

Pedometers and Public Health Catrine Tudor-Locke, PhD, FACSM Associate Professor of Health Promotion Walking Research Laboratory Department of Exercise and Wellness Arizona State University Internal Mechanism Mass Distribution is Not the Answer Hardware Pedometer Software

Guidelines Protocols Detailed program templates Practical Pedometry Expected values Standard protocols Screening Surveillance Program evaluation Step indices Intervention tool Summary of validity evidence Review of 25 articles since 1980

median r=.86 with different accelerometers median r=.82 with time in observed activity median r=.68 with different measures of energy expenditure median r=-.38 with self-reported sitting time median r=.33 with self-reported physical activity Tudor-Locke et al., Sports Med 2002 Free-living: Pedometer vs. accelerometer Men Women 8000 + 2 SD Differen ce (C S A - Dig i-w alker) 6000 4000

Mean diff erence 2000 0 -2000 - 2 SD -4000 -6000 -8000 0 5000 10000 15000 Avg. Steps (CSA & Digi-walker) 20000

25000 Tudor-Locke et al., MSSE 2002 Effects of walking speed 120.0 % of Actual Steps 100.0 80.0 CSA 60.0 YAM OM 40.0 SL 20.0 0.0

54 67 80 94 107 Speed (m/min) Speed (m/min) Le Masurier, Keup, Tudor-Locke Medicine and Science in Sport and Exercise, 2004 Can we use pedometers with older adults?

26 nursing home residents and 28 similarly aged community dwelling older adults Self-selected walking at slow, normal, fast paces Pedometers underestimated actual steps taken in dependent older adults by 74% (slow) to 46% (fast). The percent error for the independent older adult sample ranged from 25% (slow) to 7% (fast). Cyarto, Myers, and Tudor-Locke Medicine and Science in Sport and Exercise, 2004 Pedometer vs. dual-mode CSA Motor vehicle travel on paved roads total distance traveled was 32.6 km or 20.4 miles

Any steps detected during motor vehicle travel were considered error the CSA detected approximately 17-fold more erroneous steps than the pedometer approximately 250 vs 15 steps for the total distance traveled, P < .05 Le Masurier and Tudor-Locke MSSE 2003 Can we use pedometers with obese people? 16 normal weight, 8 overweight, 11 obese Self-selected walking at slow, normal, fast paces Percent error (NS) normal

weight= 2.64.2% overweight=1.72.8% obese=4.04.3% Elsenbaumer and Tudor-Locke, Medicine and Science in Sport and Exercise, 2003 19000-19999 18000-18999 17000-17999 16000-16999 15000-15999 14000-14999 13000-13999 12000-12999 11000-11999 10000-10999

9000-9999 8000-8999 7000-7999 6000-6999 5000-5999 4000-4999 3000-3999 2000-2999 1000-1999 0-999 Percent Distributions 14

12 10 8 6 4 2 0 Mean Steps/Day Tudor-Locke et al., Medicine and Science in Sport and Exercise, 2004 Patterns 16000 15000 12500

12000 10000

8000 7500 5000 4000 Sunday Monday Tuesday Thursday Wednesday Friday Day of the Week

Saturday Janurary March May July September November February April June August October December Month Tudor-Locke et al., Annals of Behavioral Medicine, 2004 Breaking down the patterns 10000 9000 S teps per day 8000

Steps due to w alking for exercise Steps due to exercise class Steps due to other activity 7000 6000 5000 4000 3000 2000 1000 0 Day of data collection Tudor-Locke et al., Research Quarterly for Exercise and Sport, 2001 How Many Steps are Enough? Legend Mean steps/day

14000 1=8-10 year olds 12000 2=14-16 year olds 10000 3= Healthy younger adults (approx. 20-50 years) 8000 4= Healthy older adults (>50 years) 6000 5= Individuals living with disabilities and chronic illnesses 4000 2000

0 1 2 3 4 5 Population groups Tudor-Locke, Research Digest, 2002 Sedentary lifestyle index Pedometer and BMI category 60 50 40 Percent of 30 sample 20

BMI<25 BMI=25-29.9 BMI>29.9 10 0 <5,268 5,268-9,356 >9,356 Steps/day Tudor-Locke et al., International Journal of Obesity, 2001 How Many Steps Are Equivalent to Current Public Health Recommendations? The Evidence

3,800-4,000 steps in 30 minutes extrapolated from distance walked data at different paces set externally (Welk et al., 2000) 3,100 steps during unsupervised 30 minute walk (intensity not reported) included in a typical day of activity (Wilde et al., 2001) 3,400 steps during 30 minute group continuous group walk at self-selected pace (Tudor-Locke et al., 2001) Controlled Conditions Females Males 12.00

12.00

8.00 4.00

8.00 METs METs

4.00 METs=-8.805+0.110*steps/min R-square=0.83

METs=-7.065+0.105*steps/min R-square=0.80 0.00 0.00 75 100 125 steps/min 150 175 75

100 125 150 175 steps/min Tudor-Locke et al., Canadian Journal of Applied Physiology, in press Controlled conditions (continued) Steps/min Males Females <96 <107 Moderate (3.0-5.99 METs)

96-124 107-135 Hard (6.0-8.99 METs) 125-153 136-162 >153 >162 Activity intensity Light (2.99 METs) Very Hard (9.0 METs) Field conditions: Self-select moderate pace

3,600 steps in 30 minutes of selfpaced moderate intensity walking (ICC=.96) No difference in steps taken based on gender Tudor-Locke et al., in progress The latest. Dose Response to Exercise in Women (DREW) 8kcal/kg/week = 100% of public health recommendations Free-living activity 4600 steps/day 5500 steps/session, 3 days/week

Jordan et al., Medicine and Science in Sports and Exercise, 2005 Modeling change Baseline = 5000 steps/day 30 minute walk, 3 days/week = 6200 steps/day (60 min/3 days =7500/steps/day) 30 minute walk, 5 days/week = 7100 steps/day (60min/5days = 9200 steps/day) 30 minute walk, 7 days/week = 8000 steps/day (60 min/7days =11000 steps/day) Is a Universal 10,000 Steps/day Sustainable?

Pedometer-based Interventions Yamanouchi et al. (1995) RCT First to look at 10,000 step/day goal Dieting patients (living in hospital) with type 2 diabetes took 19,200 steps/day and lost 17lbs over 6-8 weeks compared to control group that averaged 4,000 steps/day and lost 9 lbs Seems Reasonable for Healthy Adults Assembled from published literature, healthy adults take between 7,000-13,000 steps/day (Tudor-Locke and Myers, 2001) 73% of participants who reported 30 minutes of moderate activity

also achieved 10,000 steps (Welk et al., 2000) However. Even with a prescribed walk, 38-50% of sedentary women reached 10,000 steps on any single day (Wilde et al., 2001) Only half of healthy older exercisers ever achieved 10,000 steps on any single day, despite the fact that they participated in exercise class or informal walking for exercise on most days of observation (Tudor-Locke et al., 2002) Further When all accumulated minutes are considered, guidelines can be achieved within as little as 8000 steps/day (TudorLocke et al., 2002)

Although individuals achieving >10,000 steps/day are more likely to achieve guidelines, that alone is not a guarantee of meeting them (Le Masurier et al., 2003) And. Iwane et al. (2000) described experiences implementing a 10,000 step/day program in a manufacturing work place 730 volunteered to participate out of 2474 workers (approximately 30%) 306 remained in program after 4 weeks (42% drop out) Only 83 remained after 12 weeks (89% drop out from beginning of program)

Remaining Concerns Too Low for Children 8-10 year olds in the U.K. take 12,000-16,000 steps/day (Rowlands et al., 1999) 6-12 year olds in the U.S. take 11,000-13,000 steps/day (Vincent et al., 2002) 14-16 years olds in the U.S. take 11,000-12,000 steps/day (Wilde, 2002) BMI-referenced cutpoints

International sample (USA, Sweden, Australia) 995 girls, 959 boys, 6-12 years Criterion referenced analysis approach 12,000 steps/day for girls 15,000 steps/day for boys Tudor-Locke et al., Preventive Medicine, 2004 Too High for Sedentary Individuals Assembled from published literature: 3,500-5,500 steps/day for individuals living with disabilities and chronic illnesses (Tudor-Locke and Myers, 2001) Proposed sedentary lifestyle index is <5,000 steps/day (Tudor-Locke et al., 2001)

Achieving 10,000 steps/day requires a 2-3 fold increase in daily activity What are We Left With? Preliminary guidelines for adults >12,500 steps/day >10,000 steps/day 7,500-9,999 steps/day 5,000-7,499 steps/day <5,000 steps/day highly active active somewhat active low active sedentary Tudor-Locke & Bassett, Jr., Sports Medicine,

2004

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