A pedometer-based walking intervention with and without email counseling in general practice: a pilot randomized controlled trial

Abstract

BackgroundGeneral practitioners play a fundamental role in combatting the current epidemic of physical inactivity, and pedometer-based walking interventions are able to increase physical activity levels of their patients. Supplementing these interventions with email counseling driven by feedback from the pedometer has the potential to further improve their effectiveness but it has to be yet confirmed in clinical trials. Therefore, the aim of our pilot randomized controlled trial is to evaluate the feasibility and potential efficacy of future trials designed to assess the additional benefit of email counseling added to a pedometer-based intervention in a primary care setting.MethodsPhysically inactive patients were opportunistically recruited from four general practices and randomized to a 12-week pedometer-based intervention with or without email counseling. To explore the feasibility of future trials, we assessed the speed and efficiency of recruitment, adherence to wearing the pedometer, and engagement with email counseling. To evaluate the potential efficacy, daily step-count was the primary outcome and blood pressure, waist and hip circumference, and body mass were the secondary outcomes. Additionally, we conducted a qualitative analysis of structured interviews with the participating general practitioners.ResultsThe opportunistic recruitment has been shown to be feasible and acceptable, but relatively slow and inefficient; moreover, general practitioners selectively recruited overweight and obese patients. Patients manifested high adherence, wearing the pedometer on 83% (± 20) of days. All patients from the counseling group actively participated in email communication and responded to 46% (± 22) of the emails they received. Both groups significantly increased their daily step-count (pedometer-plus-email, + 2119, p = 0.002; pedometer-alone, + 1336, p = 0.03), but the difference between groups was not significant (p = 0.18). When analyzing both groups combined, there was a significant decrease in body mass (− 0.68 kg, p = 0.04), waist circumference (− 1.73 cm, p = 0.03), and systolic blood pressure (− 3.48 mmHg, p = 0.045).ConclusionsThis study demonstrates that adding email counseling to a pedometer-based intervention in a primary care setting is feasible and might have the potential to increase the efficacy of such an intervention in increasing physical activity levels.Trial registrationThe trial was retrospectively registered at ClinicalTrials.gov (ID: NCT03135561, date: April 26, 2017).

A qualitative exploration of the experiences of primary care patients engaged in email counseling meant to increase physical activity

“…The qualitative study was conducted alongside a 12-week pedometer-based walking intervention with email counseling in physically inactive adults recruited from four general practices. Details of the intervention design and its outcomes have been reported elsewhere (Vetrovsky et al, 2018). Briefly, the participants were instructed to wear the pedometer daily, check the step count every evening, and gradually increase the daily number of steps up to 10,000.…”

Validity of six consumer-level activity monitors for measuring steps in patients with chronic heart failure

“…In healthy populations, consumer-level activity monitors (i.e. pedometers and accelerometers) are frequently used as motivational tools to increase PA [6–8] and many of them have been previously shown to be valid devices for assessing daily step count both in lab-based and free-living settings [9–11]. However, since those validation studies were conducted in healthy volunteers and didn’t examine the validity of the devices at slower walking speeds, it is not clear whether their results can be applied to patients with HF, who typically walk at slower speeds and shuffle their feet [12].…”

A Pilot Randomized Trial of an Intervention to Enhance the Health-Promoting Effects of Older Adults’ Activity Portfolios: The Engaged4Life Program

“…This is a very important factor because low adherence can hinder what would be an otherwise well-designed intervention. Vetrovsky et al (2018) found 83% pedometer wear adherence and Cadmus-Bertram et al (2015) found 80%, however, neither of these studies were focused on an older adult population per se. The comparatively high adherence levels observed in our study indicate that the 1.5-hour study orientation/technology training session, which emphasized good practices for remembering to wear the pedometer and completing the daily surveys, was an effective tool for increasing adherence.…”

“…Finally, retention in our trial (83%) was similar to Buman et al (2011), who observed an 85% retention rate at the end of the trial and follow-up at 18 months was 61%. Vetrovsky et al (2018), on the other hand, reported 100% retention. However, this may be explained by their pre-randomization procedure that demanded patients to upload their pedometer data to a website prior to randomization, which 27% failed to do.…”