Impact Of Pedometer Intervention On Physical Activity, Sedentary Time And Weight Loss In Patients With Type 2 Diabetes

Part 1. Impact of pedometer intervention on physical activity and sedentary time among inpatients with type 2 diabetesAimsThe aim of this study was to assess the impact of pedometer intervention on physical activity and sedentary time among inpatients with type 2 diabetes using a randomized controlled trial (RCT) study design.MethodsPatients were consecutively recruited from those being admitted into the department of endocrinology, Zhongda Hospital, Southeast University, and were randomized into intervention and control groups using a computer-generated random numbers. In addition to usual care, the intervention group also received pedometers to increase physical activity with individualized step goals and advices to reduce sedentary time for 7 days; while the control group only received usual care. Physical activity (that is, total physical activity), sedentary time and energy expenditure were measured with accelerometers. The associations of physical activity with sedentary time and some metabolic biomarkers were analyzed using Pearson correlation analyses. The inter-group comparison was made using paired t test, and the intra-group comparison was conducted by independent-sample t test.Results1. Forty-seven inpatients with type 2 diabetes participated in this pilot study. Baseline physical activity, sedentary time and energy expenditure were comparable between intervention (n= 24) and control groups (n= 23). Baseline physical activity was negatively associated with sedentary time (r=-0.42, P= 0.004) and positively correlated with energy expenditure (r= 0.56, P<0.001). Less sedentary time (5.3± 2.2 h/day versus 7.7±2.3h/day, P= 0.001) and more energy expenditure (762 ±334 kcal/day versus 534 ± 227 kcal/day, P= 0.02) were observed in patients with daily steps>10000 steps/day over those<10000 steps/day.2. Using intention-to-treat analysis (24 patients in intervention group and 23 in control group):no significant differences between intervention and control groups were observed among physical activity, sedentary time and energy expenditure at baseline or post-intervention (all P>0.05). However, the intervention group showed a trend towards an increase in daily steps by 747 steps/day (P= 0.23), while the control one showed a significant decline by 2518 steps/day (P= 0.02). There was a significant difference between intervention and control groups regarding physical activity using change scores from baseline (P= 0.009).3. No significant difference existed regarding sedentary time and energy expenditure within inter-or inter-group comparisons at baseline or post-intervention using intention-to-treat analysis.ConclusionsPedometer intervention helps to maintain and can slightly increase physical activity, but it has no significant effect in reducing sedentary time or increasing energy expenditure.Part 2. Impact of pedometer intervention on weight loss in outpatients with type 2 diabetes:a meta-analysisAimsThe aim of this study was to evaluate its effect on weight loss among outpatients with type 2 diabetes using a meta-analytical approach.Methods Three different databases were searched for RCTs published in English up to April 2015. Studies were included if they investigated the effects of pedometer intervention on weight loss, as measured by body mass index (BMI) or weight. Effect sizes were aggregated using a random-effects model. Subgroup and meta-regression analyses were used to identify potential moderators.Results1. Eleven RCTs with 1258 participants were included. All enrolled participants were overweight or obese.2. Pedometer intervention led to significantly decreased BMI (weighted mean difference [WMD]-0.15 kg/m2,95% confidence interval [CI]-0.29 to -0.02 kg/m2) and reduced weight (WMD-0.65 kg,95% CI-1.12 to-0.17 kg). Dietary counselling seemed to be a key predictor of the observed changes. However, none of the following variables had a significant influence:step goal setting, baseline age, BMI, weight, sex distribution, disease duration, intervention duration, and baseline values or change scores of total or moderate-to-vigorous physical activity.3. After the completion of pedometer intervention, non-significant declines in BMI (WMD-0.21 kg/m2,95% CI-1.06 to 0.65 kg/m2) and weight (WMD-0.05 kg, 95% CI-1.06 to 0.95 kg) were observed in follow-up periods.ConclusionsPedometer intervention promotes modest weight loss, but its association with physical activity requires further clarification.