Middle-aged to older adults given pedometers and a walking programme as part of two NIHR trials continued to be active three years later. In one trial they were walking around 650 extra steps a day. In both trials, they spent about 30 minutes per week extra in moderate-to-vigorous physical activity compared to controls.
Brisk walking is a good way for older adults to achieve physical activity recommendations. This is the long-term follow-up of two large NIHR-funded trials that recruited adults aged 45 to 75 years from 10 UK general practices. Participants received pedometers for 12 weeks with activity guidance given via post or nurse support.
Around 900 people (70% of those enrolled) completed follow-up to three and four years. Controls were later given pedometers but with little instruction or support, which seems central to the effect.
This is the first evidence demonstrating that simple interventions like pedometers lead to sustained increases in physical activity required for long-term health.
Why was this study needed?
Increasing physical activity can help prevent obesity, some cancers, heart disease and diabetes. However, 2016 Health Survey data for England revealed that only 66% of men and 58% of women aged over 19 meet the NHS advised target of at least 150 minutes of moderate activity a week.
Walking is a safe and accessible way for people to meet this target. Studies suggest that pedometers can encourage people to increase their steps per day and boost their overall activity. However, long-term changes are needed to have a positive effect on health, and few studies have followed people for long enough to see whether behaviour change is sustained.
A previous Signal reported the 12-month effects of the PACE-UP trial where people were given pedometers with either postal or nurse support. This study provides continued three-year follow-up of people in both arms of that trial, along with four-year follow-up for a similar trial, PACE-Lift.
What did this study do?
Both randomised controlled trials recruited inactive adults from 10 general practices in England and initially conducted 12-week pedometer interventions with one-year follow-up.
PACE-UP involved 1,023 adults aged 45 to 75 years. Two intervention groups received a pedometer with instructions either by post or nurse consultation. A control group received no intervention but were also sent a pedometer and brief instruction at 12 months. Six hundred and eighty-one people (67%) completed three-year follow-up.
PACE-Lift included 298 adults aged 60 to 74 years who were given a pedometer and accelerometer (which measures the intensity of activity) with nurse support, or no intervention. At 12 months, control participants also received a pedometer. Four-year follow-up was available for 225 (76%).
Participants were aware of group assignment but did not see their final activity measurements.
What did it find?
- After three years in PACE-UP, both intervention groups were doing more steps than the control group. The pedometer by post group were doing 627 extra steps a day (95% confidence interval [CI] 198 to 1,056), and the nurse support group were doing 670 additional steps a day (95% CI 237 to 1,102).
- After four years in PACE-Lift, there was an indication that the pedometer group were also doing more steps than controls, but this did not reach statistical significance (407 extra steps a day, 95% CI -177 to +992).
- Intervention groups in both trials were spending more time doing moderate or vigorous physical activity each week in bouts of greater than 10 minutes. For PACE-UP, this amounted to 28 extra minutes (95% CI 7 to 49) for those posted the pedometer and 24 extra minutes (95% CI 3 to 45) for the nurse support group. In PACE-Lift, participants who received the pedometer were doing 32 extra minutes compared to controls (95% CI 5 to 60).
- There was no difference in sedentary time between groups in either trial.
- There were also no effects on pain, depression, anxiety or health-related quality of life at three or four years, which was consistent with the 12-month trial results.
What does current guidance say on this issue?
The Department of Health recommends that adults perform at least 150 minutes of moderate aerobic activity, such as brisk walking or cycling, each week. Alternatively, they may do 75 minutes of vigorous aerobic activity such as running or a mix of moderate and vigorous aerobic activity. Strengthening exercises are also recommended twice per week.
NICE public guidelines on walking and cycling recommend that one-to-one support is offered at regular intervals to help people develop a long-term walking habit. This could be provided face-to-face, via telephone, print-based materials, email, the Internet or text messaging. Support could include individual, targeted information, goal-setting (which may include the use of pedometers), monitoring and feedback.
What are the implications?
This study provides promising evidence that the beneficial effects of pedometers demonstrated in the short-term can be sustained to three or four years.
Pedometers were equally useful when instruction was given via post only or through repeated nurse consultations. However, the availability of in-depth instruction in some format seems key to effects, as the control groups also received pedometers at one year but without on-going support.
The most cost-effective way of providing follow-up and encouraging people to make sustained changes to their activity needs to be explored further.
Citation and Funding
Harris T, Kerry SM, Limb ES, et al. Physical activity levels in adults and older adults 3-4 years after pedometer-based walking interventions: Long-term follow-up of participants from two randomised controlled trials in UK primary care. PLoS Med. 2018;15(3):e1002526.
This project was funded by the National Institute for Health Research. PACE-UP trial and three-year follow-up by Health Technology Assessment (HTA) Programme (project number HTA 10/32/02 ISRCTN42122561). PACE-Lift trial by the Patient Benefit Programme (project number PB-PG-0909-20055). The PACE-UP three-year follow-up was also supported by the Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London.
Department of Health. UK physical activity guidelines. London: Department of Health; 2015.
Harris T, Kerry SM, Victor CR, 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 17;12(2):e1001783.
Harris T, Kerry SM, Limb ES, 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(1):e1002210.
NICE. Physical activity: walking and cycling. PH41. London: National Institute for Health and Care Excellence; 2012.
NIHR DC. Patients receiving pedometers by post increased their physical activity for at least 12 months. Southampton: National Institute for Health Research Dissemination Centre; 2017.
NHS Digital. Health survey for England, 2016. London: NHS Digital; 2017.
Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre