The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial

International Journal of Behavioral Nutrition and Physical Activity BioMed Central Research Open Access The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial Graham Baker*1,3, Stuart R Gray2,4, Annemarie Wright1, Claire Fitzsimons1, Myra Nimmo2,4, Ruth Lowry1,5, Nanette Mutrie1 for the Scottish Physical Activity Research Collaboration (SPARColl) Address: 1Department of Sport, Culture and the Arts, University of Strathclyde, 76 Southbrae Drive, Glasgow, G13 1PP, UK , 2Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, The John Arbuthnott Building, 27 Taylor Street, Glasgow, G4 0NR, UK, 3MRC Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK , 4School of Sport and Exercise Sciences at Loughborough University, Ashby Road, Loughborough, Leicestershire, LE11 3TU, UK and 5Faculty of Sport, Education & Social Sciences, University of Chichester, Bishop Otter Campus, College Lane, Chichester, West Sussex, PO19 6PE, UK Email: Graham Baker* - ; Stuart R Gray - ; Annemarie Wright - ; Claire Fitzsimons - ; Myra Nimmo - ; Ruth Lowry - ; Nanette Mutrie - * Corresponding author Published: 5 September 2008 International Journal of Behavioral Nutrition and Physical Activity 2008, 5:44 doi:10.1186/1479-5868-5-44 Received: 18 January 2008 Accepted: 5 September 2008 This article is available from: http://www.ijbnpa.org/content/5/1/44 © 2008 Baker et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Recent systematic reviews have suggested that pedometers may be effective motivational tools to promote walking. However, studies tend to be of a relatively short duration, with small clinical based samples. Further research is required to demonstrate their effectiveness in adequately powered, community based studies. Objective: Using a randomized controlled trial design, this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts, self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations. Method: Sixty-three women and 16 men (49.2 years ± 8.8) were randomly assigned to either an intervention (physical activity consultation and 12-week pedometer-based walking program) or control (no action) group. Measures for step-counts, 7-day physical activity recall, affect, quality of life (n = 79), body mass, BMI, % body fat, waist and hip circumference (n = 76), systolic/diastolic blood pressure, total cholesterol and HDL cholesterol (n = 66) were taken at baseline and week 12. Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data. Results: Significant increases were found in the intervention group for step-counts (p < .001), time spent in leisure walking (p = .02) and positive affect (p = .027). Significant decreases were found in this group for time spent in weekday (p = .003), weekend (p = .001) and total sitting (p = .001) with no corresponding changes in the control group. No significant changes in any other health outcomes were found in either group. In comparison with the control group at week 12, the intervention group reported a significantly greater number of minutes spent in leisure time (p = Page 1 of 15 (page number not for citation purposes) International Journal of Behavioral Nutrition and Physical Activity 2008, 5:44 http://www.ijbnpa.org/content/5/1/44 .008), occupational (p = .045) and total walking (p = .03), and significantly fewer minutes in time spent in weekend (p = .003) and total sitting (p = .022). Conclusion: A pedometer-based walking program, incorporating a physical activity consultation, is effective in promoting walking and improving positive affect over 12 weeks in community based individuals. The discussion examines possible explanations for the lack of significant changes in health outcomes. Continued follow-up of this study will examine adherence to the intervention and possible resulting effects on health outcomes. Background Recent position statements have re-affirmed the benefits of an active lifestyle [1,2]. The current physical activity recommendation for adults, aged between 18–65 years, to promote and maintain health is to accumulate at least 30 minutes of moderately intense physical activity on at least five days of the week. Promoting accumulative, lifestyle physical activity is an ideal approach to combat the high levels of inactivity evident in global populations [3,4]. Brisk walking has been suggested as the mode of physical activity most likely to increase physical activity at a population level [5] and is the most commonly reported mode of physical activity amongst adults in many populations [3,6]. It is available to almost all individuals with little risk of injury, is a no cost activity and it can be incorporated into peoples' daily routines [7]. Researchers have identified that self determined brisk walking, even in short bouts of 10 minutes, for 30 minutes a day (including simple everyday walking activities such as walking a dog) produce moderate physical activity at the intensity required to achieve health benefits [8,9]. Walking interventions can be effective in reducing body weight, body mass index (BMI), waist and hip circumference, body fat, blood pressure and the cholesterol:highdensity lipoprotein (HDL) ratio [10-16] and may be effective in improving mood, affect [14,17,18] and quality of life [19]. Conversely, some studies have demonstrated that a walking intervention is not sufficient to affect any of these health-related outcomes [20-24]. The reasons for such equivocal results are unclear, therefore determining the potential health benefits that can be achieved through walking is crucial to the public health message. Whilst several meta-analytical and systematic reviews exist that examine how best to promote physical activity [25,26] there is comparatively limited evidence on the most effective methods to specifically promote walking. A recent systematic review from Ogilvie and colleagues (2007) examined the effectiveness of interventions aimed at increasing walking at both an individual and population level. The review concluded that the strongest evidence exists for tailored interventions that are targeted at individuals most motivated to change. The authors suggested that future studies should also attempt to examine whether walking interventions "are sufficiently frequent, intense, or sustained to produc (...truncated)