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Eveliina Korkiakangas, MNSc, Maija A. Alahuhta, MNSc, Jaana H Laitinen, PhD, MSc, Päivi M. Husman, MSocSc, Sirkka Keinänen-Kiukaanniemi, and Anja M. Taanila

Sirkka Keinänen-Kiukaanniemi

University the Oulu, Oulu college Hospital and Health center of Oulu, Finland


Corresponding author.

You are watching: Discuss how the use of pedometers benefited people at high risk for type 2 diabetes.


Introduction

A pedometer helps adults exercise more, however sedentary adults need instruction and also advice come be encouraged to usage one. We conducted this qualitative research to explain the experiences of participants in ~ high danger of form 2 diabetes who started using a pedometer.


Methods

A full of 74 civilization at high hazard of kind 2 diabetes participated in 6 month of group counseling. Native April 2007 come April 2008, we collected data through questionnaires, template interviews (n = 22) and video recordings the counseling sessions. Native October 2007 with June 2008, us analyzed the data.


Results

Pedometers were useful tools because that observing level of exercise, setting an individual goals for walking, and also helping evaluate whether day-to-day goals were met. An adverse experiences were connected with useful failures, pedometers" unsuitability for exercise other than walking, and the goal of 10,000 steps, which part participants thought about too high.


Conclusions

Sedentary adults have the right to be urged to usage a pedometer if we educate them that constant users uncover it a valuable instrument for raising their level of exercise. These adult should set realistic purposes for walking and also receive sufficient instructions for using pedometers.


Introduction

Pedometers screen the number of steps take away in a job (1,2). The use of a pedometer has been presented to increase physical activity among sedentary populaces (3-7). Walking is an excellent way for many inactive world to begin regular exercise (8). The Finnish Diabetes avoidance Study prove that people at high hazard of type 2 diabetes that walked 2.5 hrs or more per week to be 63% come 69% much less likely to construct diabetes than were those that walked less than 1 hour every week (9). Consistent exercise can prevent form 2 diabetes (10-13).

Although making use of a pedometer appears to motivate world to exercise more (14,15), we perform not know exactly how to motivate people to usage one. Understanding of the experiences of inactive adults who have used a pedometer rises the efficiency of counseling, but couple of previous research studies on this worry exist (2,14). We explain the experiences of a group of sedentary adults at high danger of kind 2 diabetes who started using a pedometer, in details the factors that motivated or discouraged continual exercise.


Methods


Study design

We conducted a follow-up study of 74 human being at high hazard of kind 2 diabetes. Five videoconferencing and also 6 face-to-face teams were arranged (5-9 attendees in every group). The attendees of the videoconferencing groups gathered in the conference room that the health treatment center in ~ their location of residence (5 groups in 4 localities) 80 come 100 kilometres from the counselor, who was in a city in north Finland. In face-to-face groups, the counselor and also participants were in the very same room in the city. Lock participated in the 6-month team counseling process, which contained five 90-minute group sessions, four at 2-week intervals and also the 5th at 6 months from baseline. The participants completed a questionnaire, and blood samples to be taken at baseline and also at 6 months. Data were accumulated from April 2007 v April 2008 and analyzed native October 2007 with June 2008. The research was authorized by the ethics committee that the Hospital ar of Helsinki and Uusimaa.


Study participants

A total of 74 human being (33 men and 41 women, mean age 49 years) in ~ high threat of form 2 diabetes to be recruited from job-related or major health care by nurses and doctors. Nurses or physicians interviewed civilization at high threat of form 2 diabetes that were eligible come take part in this counseling examine if they were motivated and fulfilled the consists criteria. The participants had actually to be ready to participate; they had to score 15 points or more in the diabetes danger test score (16) or 12 point out if they had actually a danger of work impairment as assessed by an occupational nurse or physician or if they had had an elevated fasting blood glucose level or one impaired glucose yongin test an outcome during the last 12 months. Civilization with negative control the depression or who were taking medication for other mental troubles or those v severe dilemmas in their life were excluded. Participants got oral and also written info on the study, and also they provided their composed consent. The counselor repeated the details at the start of counseling, and participants agreed come confidentiality.


Content of exercise intervention

A clinical nutritionist detailed counseling in 55 group sessions. The exercise intervention comprised a minor component of the group counseling. The in its entirety aim of the counseling was to improve the participants" skills and services for controlling their eating and also body weight and also to boost their level of exercise. In addition, information around health actions that have the right to prevent type 2 diabetes was provided. The counselor informed the group around the outcomes of the Finnish Diabetes prevention Study, which found that kind 2 diabetes can be prevented through way of living changes. The counselor explained the reasons behind the positive impact of exercise on metabolism. In ~ the very first group session, the counselor presented every participant with an Omron Walking layout II pedometer (OMRON Corporation, Kyoto, Japan). Before the fourth session, the participants to be asked to do voluntary homework regarded exercise. They to be asked come exercise through a family members member or friend and to record the time invested on exercise and the variety of steps taken during the week. The 4th session started with pair discussions about homework: did they exercise with a friend or a household member? how much did they exercise during last week? What type of day included 10,000 steps? How deserve to an exercise diary aid one to change exercise habits? In addition, during every group session, the participants started several discussions around exercise.


Level of exercise

The level of exercise was report in method and 95% confidence intervals the weekly energy expenditure in the metabolic identical task-hours (MET-hours). We derived data on exercise level by using a questionnaire the participants perfect at baseline and also at 6 months. Structured questions concerning frequency (a 6-point scale from when a month or much more rarely, come daily) and duration (a 6-point scale from 0 to much more than 1.5 hours) of irradiate (3 as a MET coefficient) and moderate come vigorous practice (6 as a MET coefficient) were contained in a questionnaire. MET-hours were also calculated (17). Due to the fact that of nonresponse for some items the the MET-hour questions, MET-hours might be calculation for only 54 participants in ~ both 0 and at 6 months. At the 6-month follow-up, the frequency of making use of a pedometer and its impacts on the level of practice were additionally included in the questionnaire.

The combine samples t test was offered to test the significance of the change in MET-hours between 0 and also 6 months, conversely, a t test because that independent samples or analysis of variance was supplied to check the distinction in MET-hours in between groups. The analyses to be performed by utilizing SPSS variation 15.0 (SPSS, Inc, Chicago, Illinois). The number of steps taken to be not accessible for the analyses since pedometers to be given throughout the first counseling session, and also baseline information was collected before the an initial group session.


Data on experiences of pedometer use

The qualitative data ~ above the experiences were gathered from 22 design template interviews and also 54 video-recorded group counseling sessions. Discussions on participants" experiences v using a pedometer throughout group counseling sessions (n = 54) to be sampled native the video-recordings (81.5 hours). Discussions and also individual statements to be transcribed verbatim.

For the theme interviews, 2 people were selected randomly from each of the 11 counseling groups. The following questions were supplied in the theme interview: 1) have you supplied the pedometer? 2) What space your experiences v using the pedometer? 3) do you think that using the pedometer influenced your level the exercise? 4) If yes, please define how. 5) Please explain why. We additionally audiorecorded and also transcribed interviews.

We analyzed the qualitative data by inductive content analysis (18,19) with the assist of QSR NVivo version 7 (QSR global Pty Ltd, Melbourne, Australia) (20). First, every statements on experiences making use of the pedometer to be sampled native the video-recording and also transcribed interviews. Second, we review transcripts and watched the videotapes several times. Third, we extracted important statements indigenous the text. Finally, statements through the same meaning were grouped into subcategories and main categories, which were named according to your content.


Results

Participants" level of exercise differed by demography characteristics. The level of exercise was short at the start but increased considerably from 0 to 6 months. Median levels the exercise between the videoconferencing group and also face-to-face team did not differ in ~ baseline or at 6 months, and thus, the groups were combined in additional analyses. The the participants (n = 74) who responded to a question around frequency that pedometer use, 46% reported using the pedometer on regular basis at the very least once every week,  and their MET-hours increased considerably during the 6-month follow-up (P = .02).

At 6 months, typical MET-hours for consistent users and also those who offered the pedometer occasionally or no at all (P = .005) were significantly different. No far-reaching sex distinction in making use of the pedometer existed. The the participants, 36% claimed that utilizing the pedometer had actually increased your level of exercise. Their MET-hours increased significantly after 6 months (P = .01), and their mean MET-hours were substantially (P < 0.001) higher than those the participants who reported that making use of the pedometer had not raised their level of practice at 6 months.

We current the results from qualitative data analysis by main categories, subcategories, and also by using the participants" own remarks as examples (Appendix).


Discussion

This study explains the experience of inactive participants at high threat of form 2 diabetes who used a pedometer during a 6-month group counseling process to promote way of living changes. Participants saw the pedometer together a resource of feedback on their exercise. It provided immediate feedback top top the amount of exercise in steps, aerobic actions (>60 steps/minute), kilometers, go time, and calories. By security their walking, the participants provided improvements in your physical capacity, i m sorry in turn motivated them to practice more. Part participants specifically monitored the steps taken throughout a workday, and many to be surprised by the low number of steps recorded.

Using the pedometer do it less complicated to set an individual exercise goals. These goals had increasing the amount of exercise, exercising regularly, and also exercising daily. Some participants do the efforts to boost the number of steps taken every day, whereas others pursued the score of a minimum the 10,000 steps daily. Utilizing the pedometer helped human being exercise more regularly. Much more active attendees were urged to additional increase their exercise. Participants discovered that achieve a certain number of steps make them want to increase their goal. The pedometer urged sedentary world to exercise more.

The pedometer to be not ideal for all. Part were disappointed due to the fact that of technological problems. Moreover, the 10,000-step reference for everyday exercise was considered too daunting to achieve. In this cases, the pedometer did no increase an ideas to exercise. Several disagreements can motivate inactive adults to usage a pedometer. First, utilizing the pedometer helps civilization monitor their own level of practice easily, collection goals, and also track your progress. Second, come avoid negative experiences, users could be teach to usage the pedometer correctly. Third, a proportional rise in the number of steps together a personal daily goal need to be debated to prevent the disappointment of not getting to the an overwhelming target of 10,000 steps.

Good instructions for utilizing the pedometer space essential due to the fact that functional errors to be a obstacle to that use. The impacts of the pedometer"s sensible errors ~ above the physical activity of users were formerly uncertain (21). Just a few negative experiences with using a pedometer arose during team sessions and theme interviews, although less than fifty percent of the entrants (46%) used the pedometer on regular basis at the end of the process. Others may not have actually been encouraged to highlight an adverse experiences, might have had a neutral attitude, or might not have used a pedometer in ~ all, and thus had actually no an unfavorable experiences come report.

A limitation that this study frequently seen in qualitative research studies is the little sample size, which avoids the results from being applicable to every exercisers. An additional limitation is that us were no able to use objective procedures of physical activity. Part participants were inactive also at 6 months, return they might have overreported their level of exercise on the questionnaires (22). Us based the main study results on qualitative data collected by videorecordings from group sessions and also by template interviews, which boosted the scope of the data. The atmosphere throughout counseling sessions and interviews to be relaxed, and also participants knew the all conversations were confidential. Throughout group sessions, everyone had actually the opportunity to participate in the discussion and to refer opinions, experiences, and feelings, although part were quiet. Qualitative analysis has been explained as accurately as possible. Many situation-specific factors additionally influenced group discussions (eg, age and also sex of participants, the counselor"s role, group form , the content of the intervention, and the counseling methods). These factors have to be documented and taken right into account in the interpretation of results. Nevertheless, positive experiences might be exaggerated.

Experiences through using the pedometer were largely positive. The pedometer promoted exercise and also was thought about effortless, simple to use, and also its features were easily adopted. The pedometer aided participants save track of their amount the exercise and also find instances in which it was simpler to achieve the required number of steps and also situations in which that was basic to rise the number of daily steps.


Experiences v Pedometer as sustaining Physical Activity
Positive experiences utilizing the pedometer"You just put that in her pocket in the morning and also take it out in the evening — That"s all! At the very least that"s exactly how I have done it.""After I first hung the pedometer roughly my neck, just 1 work went by there is no me utilizing it, once we to visit a wedding. . . . My an initial reaction to be shock that the number of steps i take was so small. . . . Recently I regulate 7,000 come 10,000 measures every day. I simply will not tolerate much less than 7,000 measures for any kind of day.""I can check the an outcome at any type of time, and not getting enough steps deserve to make me nice upset. The pedometer is like a quiet motivator. . . . It renders me exercise." Feedback on an individual physical activity"You have the right to see her level of exercise. It urges you to preserve the very same level.""The pedometer mirrors you concrete results."Increasing the objectives for physical activity"I believed I to be taking more steps day-to-day than ns really was. In fact it was much less. . . . It was a good wake-up call for me: I must walk much more.""The pedometer is just excellent. Friend feel like every work you want to be able to take more steps."Motivation to increase exercise"My work is fairly physical: throughout a functioning day i walk around 7,000 come 9,000 steps. . . . Thanks to the pedometer and the recommendations we obtained . . . I have actually started walking additionally on weekends and jogging in the swimming pool on Thursday evenings.""It is simply a routine that I have to learn in mine life. Ns count steps and write down the number. . . . It gives me a brand-new interest in exercising. When you have actually internalized it, going because that a walk becomes a more positive experience."A useful tool for observing personal physical activity"I provided the pedometer for a whole week in ~ work. I had the pedometer at my waist. During the whole work work it counts something like 3,400 come 8,600 steps depending on what sort of job it is. Yesterday I had a busy day, and also it counted 8,600 steps. I unloaded one cargo and loaded another one — walked around the vehicle quite a couple of times.""Fortunately there was a bed next to me . . . I nearly fainted once I witnessed the numbers: so few steps!""Without the pedometer it would be difficult to evaluate the variety of steps.""If ns don"t especially go because that a walk, I obtain less 보다 3,000 steps per day. The pedometer is a an excellent tool because that me because it reminds me come walk because that a longer time, if ns don"t have enough steps. . . . That"s its main significance because that me, really." 
Experiences the Pedometer as Unsuitable Instrument
Unsuitability of pedometer for other exercise than walking"I pat football and also volleyball, and I need to take turn off the pedometer so that does no break."Negative experience (technical errors) on utilizing the pedometer"Just a few steps . . . It has actually errors . . . It goes come zero.""I can"t usage the pedometer. . . . You"ve got to stomp so heavily to gain it to react. . . . I simply can"t walk prefer that. I realized the the figures were simply not do sense. . . . After that I have just preserved it on the table. I can"t usage it."The score of 10,000 steps per work is too high"I should manage 2,000 steps much more every day. . . . It"s as well demanding because that me. . . .Sometimes it have the right to be really hard work obtaining that 2,000 steps throughout the day. . . And I should gain still more.""Ten thousand actions is complicated for a person in sedentary work.""Ten thousands is just too high. . . . I"m no going to use that as my goal. . . . It"s also stressful."Person go not want to usage pedometer in ~ all"Think about it! would certainly you have any interest in utilizing a pedometer if you didn"t walk in ~ all? Why measure just a few steps?"

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Suggested citation for this article: Korkiakangas EE, Alahuhta MA, Husman PM, Keinänen-Kiukaanniemi S, Taanila AM, Laitinen JH. Pedometer use among adults at high risk of type 2 diabetes, Finland, 2007-2008. Prev Chronic Dis 2010;7(2). Http://www.cdc.gov/pcd/issues/2010/mar/09_0035.htm. Accessed <date>.