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
Open accessAbstract
BACKGROUND: Physical inactivity is an important cause of noncommunicable diseases. Interventions can increase short-term physical activity (PA), but health benefits require maintenance. Few interventions have evaluated PA objectively beyond 12 months. We followed up two pedometer interventions with positive 12-month effects to examine objective PA levels at 3-4 years. METHODS AND FINDINGS: Long-term follow-up of two completed trials: Pedometer And Consultation Evaluation-UP (PACE-UP) 3-arm (postal, nurse support, control) at 3 years and Pedometer Accelerometer Consultation Evaluation-Lift (PACE-Lift) 2-arm (nurse support, control) at 4 years post-baseline. Randomly selected patients from 10 United Kingdom primary care practices were recruited (PACE-UP: 45-75 years, PACE-Lift: 60-75 years). Intervention arms received 12-week walking programmes (pedometer, handbooks, PA diaries) postally (PACE-UP) or with nurse support (PACE-UP, PACE-Lift). Main outcomes were changes in 7-day accelerometer average daily step counts and weekly time in moderate-to-vigorous PA (MVPA) in ≥10-minute bouts in intervention versus control groups, between baseline and 3 years (PACE-UP) and 4 years (PACE-Lift). PACE-UP 3-year follow-up was 67% (681/1,023) (mean age: 59, 64% female), and PACE-Lift 4-year follow-up was 76% (225/298) (mean age: 67, 53% female). PACE-UP 3-year intervention versus control comparisons were as follows: additional steps/day postal +627 (95% CI: 198-1,056), p = 0.004, nurse +670 (95% CI: 237-1,102), p = 0.002; total weekly MVPA in bouts (minutes/week) postal +28 (95% CI: 7-49), p = 0.009, nurse +24 (95% CI: 3-45), p = 0.03. PACE-Lift 4-year intervention versus control comparisons were: +407 (95% CI: -177-992), p = 0.17 steps/day, and +32 (95% CI: 5-60), p = 0.02 minutes/week MVPA in bouts. Neither trial showed sedentary or wear-time differences. Main study limitation was incomplete follow-up; however, results were robust to missing data sensitivity analyses. CONCLUSIONS: Intervention participants followed up from both trials demonstrated higher levels of objectively measured PA at 3-4 years than controls, similar to previously reported 12-month trial effects. Pedometer interventions, delivered by post or with nurse support, can help address the public health physical inactivity challenge. TRIAL REGISTRATIONS: PACE-UP isrctn.com ISRCTN98538934; PACE-Lift isrctn.com ISRCTN42122561.
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In these walking intervention studies, the intervention failed to significantly improve CVD risk factors and other surrogate outcomes.
“However, in these studies, the intervention failed to significantly improve CVD risk factors and other surrogate outcomes (8)(9)(10)”
Counseling interventions designed to promote walking through pedometers in the general population or in individuals with prediabetes or type 2 diabetes resulted in up to about 8 min/day increases in MVPA after 1 year and smaller (about 4 min/day), or even no, increments after longer follow-up, together with no change in SED-time.
“Counseling interventions designed to promote walking through the provision of pedometers in the general population (8) or in individuals with prediabetes (9) or type 2 diabetes (10,11) resulted in up to $8 min Á day À1 increases in MVPA after 1 year and smaller ($4 min Á day À1 ), or even no, increments after longer follow-up, together with no change in SED-time.”
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- Authors
- Harris, T., Kerry, S. M., Limb, E. S., Furness, C., Wahlich, C., Victor, C. R., Iliffe, S., Whincup, P. H., Ussher, M., Ekelund, U., Fox-Rushby, J., Ibison, J., DeWilde, S., McKay, C., & Cook, D. G.
- Affiliations
- St George's, University of London (GB)
- Queen Mary University of London (GB)
- Brunel University of London (GB)
- University College London (GB)
- University of Cambridge (GB)
- Corresponding author
- Harris, Tess
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-03-09
- Volume
- 15
- Issue
- 3
- Pages
- e1002526
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC5844512
- OpenAlex
- W2790906676
- Cited by
- 95
- References
- 43
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 8 · 2023: 10 · 2022: 20 · 2021: 18 · 2020: 16 · 2019: 9 · 2018: 5
- FWCI
- 8.19
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Stirling Online Research Repository (University of Stirling) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion)
- Funders
- Health Technology Assessment Programme (10/32/02)
- Research for Patient Benefit Programme (PB-PG-0909-20055)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
- Social Sciences › Transportation › Urban Transport and Accessibility
- Keywords
- physical activity, walking program, long-term follow-up, step count, moderate-to-vigorous physical activity, nursing support, primary care, physical inactivity, older adults, adults, physical activity maintenance, accelerometer-measured activity, health behavior change, non-communicable diseases
- MeSH terms
- Noncommunicable Diseases, Aftercare, Aged, Exercise Therapy, Female, Health Promotion, Humans, Male, Middle Aged, Nursing Care, Primary Health Care, Referral and Consultation, Program Evaluation, Exercise, Walking, Actigraphy, Accelerometry
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