Does physical activity counselling enhance the effects of a pedometer-based intervention over the long-term: 12-month findings from the Walking for Wellbeing in the west study

Claire F Fitzsimons 0 Graham Baker 0 Stuart R Gray 2 Myra A Nimmo 1 Nanette Mutrie 0 for The Scottish Physical Activity Research Collaboration (SPARColl) 0 School of Psychological Sciences and Health, University of Strathclyde , 76 Southbrae Drive, Glasgow G13 1PP, Scotland , UK 1 School of Sport, Exercise and Health Sciences, Loughborough University , Loughborough , UK 2 Institute of Medical Sciences, University of Aberdeen , Aberdeen, Scotland , UK Background: Pedometers provide a simple, cost effective means of motivating individuals to increase walking yet few studies have considered if short term changes in walking behaviour can be maintained in the long-term. The role of physical activity consultations in such interventions is unclear. The purpose of this study was to assess the sustainability of pedometer-based interventions and empirically examine the role of physical activity consultations using long-term results of a community-based walking study. Methods: 79 low active Scottish men and women (63 women and 16 men) from the Walking for Wellbeing in the West intervention study were randomly assigned to receive either: Group 1; pedometer-based walking programme plus physical activity consultations or Group 2; pedometer-based walking programme and minimal advice. Step counts (Omron HJ-109E Step-O-Meter pedometer), 7 day recall of physical activity (IPAQ long), mood (PANAS) and quality of life (EuroQol EQ-5D) were assessed pre-intervention and 12, 24 and 48 weeks after receiving the intervention. Body mass, body mass index and waist and hip circumference were assessed pre-intervention and 12 and 24 weeks after receiving the intervention. Analyses were performed on an intention to treat basis (baseline value carried forward for missing data) using mixed-factorial ANOVAs and follow-up t-tests. Results: A significant main effect of time (p < 0.001) was found for step-counts attributable to significant increases in steps/day between: pre-intervention (M = 6941, SD = 3047) and 12 weeks (M = 9327, SD = 4136), t(78) = - 6.52, p < 0.001, d = 0.66; pre-intervention and 24 weeks (M = 8804, SD = 4145), t(78) = - 4.82, p < 0.001, d = 0.52; and pre-intervention and 48 weeks (M = 8450, SD = 3855), t(78) = - 4.15, p < 0.001, d = 0.44. Significant effects were found for several variables of self-reported physical activity, mood and quality of life and are discussed. No other significant effects in health related outcomes were found. Conclusion: Both interventions successfully increased and maintained step counts over 12 months. Physical activity consultations may encourage individuals to be active in other ways beyond walking and to reduce sitting time. Trial Registration Number: Current Controlled Trials Ltd ISRCTN88907382 - Background The relationship between an active lifestyle and improved health status is well established, with active individuals enjoying a plethora of health benefits [1]. Thirty minutes of moderate intensity activity on at least five days of the week has been shown to be sufficient to elicit health benefit [2,3]. Current data suggests that less than a third of the adult population in Europe achieve this level of activity [4] and 10.4% of all premature deaths in Europe could be prevented if everyone who is currently inactive became active [5]. Walking interventions can be effective in reducing body weight, body mass index (BMI) and waist and hip circumference [6-8] and may be effective in improving mood, affect [7,9,10] and quality of life [11]. Conversely, some studies have demonstrated that a walking intervention is not sufficient to influence any of these healthrelated outcomes [12,13]. 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. Pedometers provide a simple, cost effective means of motivating individuals to increase walking [14]. Recent reviews have concluded that pedometer use is associated with an increase in physical activity of approximately 2,000 - 2,500 steps/day and decreases in BMI and body mass [15-17]. Having a step goal has been identified as a key predictor of an increase in activity, although evidence is lacking on the most appropriate goal to use. Much of the evidence accumulated to date on the use of pedometers is from US based studies with relatively small sample sizes, and predominantly with clinical populations. Additionally, Bravata et al., acknowledged that previous pedometer interventions have incorporated multiple components (e.g. pedometers, step goals, physical activity counselling) and demonstrated heterogeneity in the intensity of the provision of cognitive and behavioural strategies [16]. In order to determine the most effective components the authors recommend empirically examining pedometer use with versus without physical activity counselling. Importantly, the majority of previous studies have been short-term in nature (1 - 15 weeks) [15,16] and evidence is urgently needed to demonstrate if pedometer use is associated with longer term changes in physical activity behaviour and health outcomes [18]. Prior studies have thus far demonstrated mixed effectiveness of pedometer use over a 12-month period [15,16,19-21]. Walking for Well-Being in the West The Walking for Wellbeing in the West (WWW) study is a multi-disciplinary community based walking intervention set in the West of Glasgow, Scotland. It was guided by the MRC framework for the evaluation of complex interventions [22] and incorporated behavioural, psychological, physiological, environmental, economic and qualitative elements [23,24]. The study rationale and methods have been described in detail elsewhere [23]. Briefly, WWW was designed to examine pedometer use in low-active adults utilising two approaches; one incorporating additional cognitive and behavioural support through physical activity consultations and one without. Controlled outcome evaluation of the short-term (12 week) findings showed that a pedometer-based intervention combined with a physical activity consultation led to an increase of 3,175 steps/ day compared with no significant change in a waitinglist control group [25]. Significant increases in positive affect, subjectively reported walking and decreases in subjectively reported sitting time were reported in the intervention group although no significant changes in anthropometric measures or inflammatory markers of health were found over the short-term [25,26] The purpose of this paper is to present a comparison of the effects of the two approaches over the longerterm (12 months) on physical activity levels and health outcomes. Thus, we aim to assess the sustainability of pedometer-based interventions and also empirically examine the role of physical activity counselling. Methods Design of the study Recruitment for the trial involved leaflets delivered to individual households, posters and flyers displayed (...truncated)