Results: Complete accelerometer data for the primary outcome was available for 571 (71%) participants. Increases in ambulatory activity of 411 (95% CI; 117, 704) steps/day and self-reported vigorous-intensity physical activity of 218 (6, 425) MET.min/week at 12 months were observed in the intervention group compared to control; differences between groups were not sustained at 36 months. No differences between groups were observed for markers of cardiometabolic health. Replacing missing data with multiple imputation did not affect the results. Conclusions:A pragmatic low-resource group-based structured education programme with pedometer use resulted in modest increases in ambulatory activity compared to control conditions after 12 months when implemented within a primary care setting to those at high risk of T2DM, however results were not maintained over 36 months.

PA of any intensity may positively influence glucose regulation and insulin sensitivity in individuals at high risk of type 2 diabetes mellitus in a dose-response manner. Further research is required to identify the intensity thresholds at which clinically relevant benefits occur in this population.