Motivating patients to activity

Clinical question

How can we motivate our patients to participate in regular physical activity?

Evidence

• A 2007 systematic review (26 studies, 2767 patients) assessed the use of pedometers to increase physical activity levels and improve health1:

  • -Pedometers increased the mean steps per day by 2491 in randomized controlled trials (P < .001) and 2183 in observational studies (P < .0001).

  • -Having a “step goal” (most commonly, working up to 10 000 steps a day) predicted increased activity (P = .001).

  • -Mean intervention duration was 18 weeks.

  • -There was heterogeneity in study design and the corresponding results (P < .001).

• A 2009, lower-quality systematic review (32 studies) of pedometers2 also found the following:

  • -an increase of approximately 2000 steps per day;

  • -the benefit of having a “step goal” (P < .001); and

  • -similar benefits in studies longer and shorter than 15 weeks.

• Newer randomized controlled trials show that using pedometers increases daily steps by approximately 2000 or more,3,4 including sustained results for up to 1 year.4

Context

In many studies, increased activity reduces mortality:

• A prospective cohort study (252 925 patients) found that regular moderate activity (brisk walking ≥ 30 min most days) was associated with a 27% (95% confidence interval [CI] 22% to 32%) relative decrease in overall mortality compared with no activity.5

  • -Regular vigorous activity reduced mortality by 50% (95% CI 46% to 54%).

• A prospective cohort study (9777 men) found the mortality rate of active men was 33% (95% CI 23% to 47%) of that of inactive men (40 vs 122 deaths per 10 000 patient years, respectively).6

Other benefits of pedometers include the following:

• weight reduction of 1.3 (95% CI 0.7 to 1.8) kg in 16 weeks7;

• reductions in systolic blood pressure of 3.8 mm Hg (P < .001) over 18 weeks1;

• improved blood glucose (BG) levels in patients with impaired glucose tolerance up to 12 months later (ie, fasting BG reduced by 0.31 (95% CI 0.03 to 0.59) mmol/L; 2-hour BG reduced by 1.3 (95% CI 0.4 to 2.2) mmol/L)4;

• can cost less than $30.

Bottom line

Pedometers, used with specific exercise goals, provide an inexpensive, tangible measure of patients’ physical activity and have been demonstrated to increase physical activity levels.

Implementation

Written goal-oriented exercise programs increase patients’ physical activity levels.8 When recommending a pedometer, prescribing a step goal will help increase activity. A sample “prescription” might look like this:

1. Wear your pedometer every day for 1 week.

2. Calculate your daily steps.

3. Add 500 steps per day to your daily average. Walk that each day for the next week.

4. Repeat step 3, adding 500 steps to last week’s daily goal, and walk that each day for the next week.

5. Continue until you reach 10 000 steps per day.