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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. Hardware Pedometer. Software Guidelines Protocols

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pedometers and public health

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

mass distribution is not the answer
Hardware

Pedometer

Software

Guidelines

Protocols

Detailed program templates

Mass Distribution isNot the Answer
practical pedometry
Practical Pedometry
  • Expected values
  • Standard protocols
  • Screening
  • Surveillance
  • Program evaluation
  • Step indices
  • Intervention tool
summary of validity evidence
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
Free-living: Pedometer vs. accelerometer

Tudor-Locke et al., MSSE 2002

effects of walking speed
Effects of walking speed

Speed (m/min)

Le Masurier, Keup, Tudor-Locke

Medicine and Science in Sport and Exercise, 2004

can we use pedometers with older adults
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
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
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= 2.64.2%
    • overweight=1.72.8%
    • obese=4.04.3%

Elsenbaumer and Tudor-Locke,

Medicine and Science in Sport and Exercise, 2003

distributions
Distributions

Tudor-Locke et al., Medicine and Science in Sport and Exercise, 2004

patterns
Patterns

Tudor-Locke et al., Annals of Behavioral Medicine, 2004

breaking down the patterns
Breaking down the patterns

Tudor-Locke et al., Research Quarterly for Exercise and Sport, 2001

slide15

Legend

1=8-10 year olds

2=14-16 year olds

3= Healthy younger adults (approx. 20-50 years)

4= Healthy older adults (>50 years)

5= Individuals living with disabilities and chronic illnesses

Tudor-Locke, Research Digest, 2002

sedentary lifestyle index
Sedentary lifestyle index

Tudor-Locke et al., International Journal of Obesity, 2001

the evidence
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
Controlled Conditions

Tudor-Locke et al., Canadian Journal of Applied Physiology, in press

field conditions self select moderate pace
Field conditions: Self-select moderate pace
  • 3,600 steps in 30 minutes of self-paced moderate intensity walking (ICC=.96)
  • No difference in steps taken based on gender

Tudor-Locke et al., in progress

the latest
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
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)

pedometer based interventions
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
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
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
Further…
  • When all accumulated minutes are considered, guidelines can be achieved within as little as 8000 steps/day (Tudor-Locke 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)
slide29
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)
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)

Too Low for Children
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

BMI-referenced cutpoints

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

Too High for Sedentary Individuals
preliminary guidelines for adults
>12,500 steps/day highly active

>10,000 steps/day active

7,500-9,999 steps/day somewhat active

5,000-7,499 steps/day low active

<5,000 steps/day sedentary

Preliminary guidelines for adults

Tudor-Locke & Bassett, Jr., Sports Medicine, 2004