Pedometer Programs: 10,000-Steps-Per-Day or Individualized Goals?

February 4, 2013 in Employee Wellness Programs, Uncategorized

pedometer

[This post was first published back when analog pedometers were more common than accelerometer-based trackers like Fitbits. Most of the information about effectiveness and step counts still holds true.]

I don’t advise pedometer program participants to strive for 10,000 steps per day.

Having each individual aspire to an identical goal flies in the face of everything I’ve learned — or is it assumed?– about behavioral change. But participants have heard the 10,000-step mantra, and sometimes adopt it as a goal. Ultimately, many report getting discouraged when they clip on their pedometers and realize they only walk a baseline of 2,000 or 3,000 steps per day, at which point a 10,000-step goal can be a real motivation crusher.

Where did this 10,000-step goal come from? What are the alternatives? And what’s been shown to work? Pedometer programs are reasonably effective, but solving these mysteries may lead toeven greater effectiveness and may even influence how we think about goal-setting and self-tracking.

Back in the 1960s, a Japanese pedometer manufacturer dubbed one of its products manpo-kei, which translates to “ten thousand steps meter.” There was no known reason  the company settled on 10,000 for its product name, but shortly thereafter, Japanese researchers did determine that habitually active walkers typically accumulate something in the neighborhood of 10,000 steps per day.

Since then, evidence has shown that it takes approximately 3,000 steps over and above the average steps taken by typical sedentary people to meet the standard recommendation for physical activity — namely, getting at least 30 minutes of moderate-intensity activity each day. Anything less than 5,000 steps a day is considered sedentary. So a daily recommendation for physical activity — 3,000 steps over and above a baseline of 5,000 — would be 8,000 steps.

The Institutes of Medicine, however, advises that 60 minutes of daily activity is necessary to maintain a healthy weight. This would be equivalent to 6,000 steps, which, when added to the baseline 5,000, means participants should accumulate 11,000 or so steps per day to prevent weight gain.

This establishes that 8,000 to 11,000 steps, a guideline subject to individual variation, is equivalent to the minimum amount of physical activity people should get to maintain good health.  The question remains: How do you motivate sedentary employees to achieve this level?

An alternate to the 10,000-steps-per-day goal has been popularized by one of the first widescale pedometer programs, America On the Move, founded by obesity researchers James Hill and John Peters. AOM encouraged participants to wear their pedometers for three days prior to the program, then to set a goal 2,000 steps above their average for these three days. When they achieve this goal, they can set a goal 2,000 steps higher. It’s individualized and incremental.

But research has not shown individualized, incremental step goals to be more effective.

One randomized, controlled study compared participants who had 10,000-step goals to participants who had individualized goals. It found that, although previously sedentary participants rarely reached their goal of 10,000 steps per day, they increased their steps as much as those with the more modest, individualized goal.

Referring to this study, the authors of a 2007 meta-analysis concluded, “Given the relatively similar increases in physical activity among those pedometer users given the 10,000-step goal and users given other goals, we conclude that the relative benefits of setting different goals remains unclear.”

The specific goal didn’t make a difference. What about people who didn’t have any goal whatsoever? The authors of the meta-analysis reported:

“Pedometer users who were given a goal, whether the 10,000-step goal or an alternative personalized step goal, significantly increased their physical activity over baseline, whereas pedometer users who were not given a goal did not increase their physical activity.”

In 2011, Catrine Tudor-Locke and a team of distinguished researchers, in their comprehensive scientific review, “How Many Steps/Day Are Enough? for Adults,” added:

“…It may be premature to make firm conclusions about the efficacy, effectiveness, or appropriateness of any specific step-based goal in terms of behaviour change…Regardless of the number of steps per day, effective programs, informed by the best research on critical moderators and mediators of behaviour change (i.e., what works best for whom under what conditions and at what cost) remain implicitly necessary in terms of increasing individual and population levels of ambulatory activity.”

In the end, it may not be the ambitiousness of the goal, but the existence of the goal — any goal — and a behaviorally sound program, that make the difference.

The significance of this conclusion may go beyond employee pedometer programs. For example: with all the talk these days about the quantified self movement — and people strapping on accelerometers, body sensors, and all sorts of biometric devices — we should not assume that tracking organically leads to improved behavior.

We all know that goals don’t amount to much without measurement. Now we also know that measurement — in this case, step tracking — may not amount to much without goals.

Counting on Pedometers for Workplace Wellness

January 27, 2013 in Employee Wellness Programs, Uncategorized

Activity Trackers

[This post was first published back when analog pedometers were more common than accelerometer-based trackers like Fitbits. Most of the information about effectiveness and step counts still holds true.]

With all the chatter these days about whiz-bang innovations in employee wellness — mobile apps, body sensors, social media, and such — overshadowed is the lowly pedometer program. But why? I’d venture to guess that most employers running robust wellness programs, and even smaller employers just getting started, are offering some sort of pedometer-based program.

What are we to make of these programs, in which employees — usually in teams —  wear a pedometer for several weeks and record the total number of steps they take each day? Are they little more than the minor league of more hi-tech solutions?

Given my penchant for evidence-based approaches, you may assume I’d balk at pedometer programs. Not so.

The great challenge of implementing evidence-based employee wellness solutions is that there aren’t many of them. After reviewing the evidence, we frequently have to go with where it is strongest — even if it’s not very strong — as we factor in what’s most feasible and the best fit for our purposes. The “best fit” analysis may include employees’ needs, employees’ wants, resource availability, occupational factors (Do employees have internet access? Are they working on a manufacturing line? Are they in vehicles all day? What’s their educational level?), our organization’s goals and, of course, cultural fit.

I categorize pedometer programs as low-resource/modest-impact. As such, I believe they have a place in many, if not most, employee wellness programs, certainly compared to many of the high-resource/low-impact programs that have grown popular.

Here are some things we know:

  • Evidence is mixed regarding the effectiveness of pedometer programs. A limited meta-analyses of programs conducted in various settings — published in the Journal of the American Medical Association (JAMA) — found “significant increases in physical activity and significant decreases in body mass index and blood pressure.” (A 2012 Finnish study concluded that a pedometer intervention “was able to affect only modestly some of the outcomes of walking,” but acknowledged, “The intervention seemed safe, inexpensive and highly adoptable in worksite setting.”)
  • Pedometers can be crude instruments. Their accuracy depends on the quality of the unit. It can vary based on participant age, weight, and walking speed. But, generally, they are sufficiently accurate to be effective in promoting physical activity.
  • Employees enjoy pedometer programs, and team-based challenges using pedometers may help foster camaraderie and a culture of health at the workplace.

Pedometer programs are affordable, scalable, well received by participants, and work about as well as anything else.

One of the more interesting, unresolved questions, about pedometer programs has to do with the goal — number of steps — recommended to participants. Employee wellness programs commonly implore participants to strive for 10,000 steps a day. Is this based on evidence? Does it work as a motivational strategy?

The question of pedometer programs’ “step goal” goes to the heart of our understanding of motivation and behavior change. We’ll get to some answers in my next blog post.

♦♦♦♦♦

Much to my surprise, these little devices were shown to increase physical activity by just over 2,000 steps, or about 1 mile of walking, per day.

— Dena Bravada, MD, lead researcher of a Stanford meta-analysis