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Workplace pedometer interventions for increasing physical activity

  1. Rosanne LA Freak-Poli1,*,
  2. Miranda Cumpston2,
  3. Anna Peeters3,
  4. Stacy A Clemes4

Editorial Group: Cochrane Occupational Safety and Health Group

Published Online: 30 APR 2013

Assessed as up-to-date: 30 JAN 2012

DOI: 10.1002/14651858.CD009209.pub2


How to Cite

Freak-Poli RLA, Cumpston M, Peeters A, Clemes SA. Workplace pedometer interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009209. DOI: 10.1002/14651858.CD009209.pub2.

Author Information

  1. 1

    Monash University, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia

  2. 2

    The Cochrane Collaboration, Cochrane Editorial Unit, Melbourne, Victoria, Australia

  3. 3

    Baker IDI Heart and Diabetes Institute, Department of Clinical Epidemiology and Diabetes, Melbourne, Victoria, Australia

  4. 4

    Loughborough University, School of Sport, Exercise and Health Sciences, Loughborough, Leicestershire, UK

*Rosanne LA Freak-Poli, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Victoria, 3004, Australia. Rosanne.Freak-Poli@monash.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 30 APR 2013

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Characteristics of included studies [ordered by study ID]
Dishman 2009

MethodsCluster-randomised controlled trial

Aim: To evaluate the efficacy of Move to Improve, a social–ecologic intervention delivered at the workplace to increase leisure-time physical activity.


ParticipantsPopulation description: Employees of The Home Depot, Inc., based at divisional offices, subsidiaries, call centres, and distribution centres, none of which dealt directly with customers.

Intervention group: Eight worksites, 885 participants (mean cluster size 111, range 49 - 387).

Control group: Eight worksites, 557 participants (mean cluster size 70, range 42 - 126).

Location: USA (Arizona, California, Colorado, Florida, Georgia, Illinois, Louisiana, Maryland, Texas) and Canada (Toronto).

Inclusion criteria: Employees without overt cardiovascular, pulmonary, or metabolic disease.

Recruitment: Twenty sites in diverse regions were identified as eligible for the study because they could be paired on number of employees and nature of work. Sixteen worksites agreed to participate, were paired and randomly assigned. Recruitment of volunteers within each worksite was performed via e-messages, onsite flyers, inter-office mail, face-to-face meetings, and posters developed and delivered by site co-ordinators who recruited and supervised team captains. All employees who completed baseline testing received an incentive (e.g. t-shirt, lunch cooler).

Demographics: Age: range 19–64 years, mean (SD) 36.2 (9.8) years.

Gender: 31% male.

Ethnicity: white (60%), black (25%), Asian (3%), Pacific Islander or Native American (1%), or other (11%); 7% identified themselves as Hispanic or Latino.

Highest level of education: high school graduate (9%), some college or technical training (34%), associate degree (12%), bachelor degree (31%), postgraduate work or degree (14%).

Job title: non–manager/supervisor (45%), supervisor (8%), manager/senior manager/ director (12%), other (35%).


InterventionsA collaborative effort with the Building Better Health (BBH) program, a pre-existing health promotion programme operating at approximately 1700 Home Depot locations.

Duration: Two-month pre-intervention phase, followed by a 12-week intervention.

Intervention

Pre-intervention phase: Project staff consulted with senior management at each worksite to discuss project objectives and to review the site selection criteria and expectations for participation. An employee was selected as a site co-ordinator during the first month of installation.

Intervention phase: Adapted from the Director’s 50th Anniversary Physical Activity Challenge implemented at the CDC in Atlanta.

1. Organisational action

  • Senior management endorsement received at the beginning of the project. Middle managers encouraged to support employee participation.
  • Joint employee–management steering committees established at the sites, consisting of 8 - 10 employees, including a site co-ordinator and a representative from each major participating work unit. The committee met regularly during both phases and was responsible for implementation of the intervention components.
  • Site co-ordinators: received orientation, project requirement training, a Handbook that served as the implementation manual and weekly contact with project staff throughout both phases.


2. Goal setting

  • Individual and team goals were self set, specific regarding performance and time, challenging but realistic and attainable, and easily assessed.
  • Participant Handbook: detailed the components, benefits and incentives, participant responsibilities and timing of the intervention. It contained six sequential, bi-weekly tools to guide and assist the participant through the intervention: (1) goal-setting, (2) overcoming obstacles, (3) sedentary temptations, (4) avoiding relapse, (5) staying motivated, and (6) keep on moving. Each tool was a practical application of behaviour modification principles built around goal-setting theory.
  • Personal goals: graduated increases in the accumulation of 10-minute blocks of moderate-to-vigorous physical activity (MVPA) and pedometer (style Yamax SW 200) steps each week, evaluated and adjusted weekly. Targeted toward meeting or exceeding established public health recommendations for physical activity: ≥150 minutes each week of (MVPA and/or ≥10,000 pedometer steps each day.
  • Team goals: Employees formed teams, usually based on organisational and workgroup structures. Team size ranged from five to 20 members with a mean of nine members. Team captains were responsible for motivating participants to set goals and earn points for their team, while serving as liaisons between participants and site co-ordinators. Team captains collected work sheets including outcome measures and revised goals every two weeks. Posters that recorded and compared team goal attainment were displayed in break rooms and were updated every two weeks by the site co-ordinator.
  • Organisational goals: Established by the steering committee at each worksite. Participation objective at each worksite was 50% of all employees. Goal attainment objective was that 75% of participating employees would accumulate 150 minutes of MVPA and 10,000 steps per day, or both on at least nine of the 12 weeks during the intervention.


3. Incentives

  • Participants received a lunch bag if they completed the bi-weekly goal-setting and assessments until the six-week mid-point, and a programme t-shirt if they did so through all 12 weeks.
  • Each member of every team that had 75% of its members reach the goal attainment target received an embroidered “winning logo” t-shirt as an incentive.
  • Team captains received another incentive if their teams met this goal. 
  • Site co-ordinators received incentives based on site participation and one site received a recognition plaque and a free catered lunch for employees having the greatest participation.


4. Environmental prompts

  • Signage that encouraged physical activity and its health benefits, emphasised the target goals for minutes and steps, and illustrated opportunities to be active, such as parking and walking, taking walk breaks, and climbing stairs.
  • Posted throughout the worksite in places with high employee traffic (e.g. break rooms, bathrooms and points of decision such as elevators and stair wells).
  • Changed bi-weekly to vary the messages within the same themes.


Control: Usual treatment control condition, including completion of the CDC health-risk appraisal and monthly newsletters describing the health benefits of physical activity. This provided a minimal treatment comparator for the intervention that has been shown to have modest or no effects on physical activity. Control sites had a programme director that dispensed monthly educational messages after baseline data collection.


OutcomesPhysical activity :

  • International Physical Activity Questionnaire (IPAQ) short form. Hourly participation each week in activities rated according to multiples of metabolic equivalent of task (METs) units. METs is a measure of energy consumption and one MET is equal to the energy produced at a standard resting metabolic rate obtained during quiet sitting (Ainsworth 2000). Can assess frequency and duration of moderate (> 4 METs) and vigorous (> 8 METs) physical activity and walking. Reliability and criterion validity judged against accelerometry is comparable to other self report measures.
  • Number of people meeting US Healthy People 2010 recommendations for moderate or vigorous physical activity.


Other outcomes not reported in this review:

  • Perceived management support (Likert scale);
  • Employee involvement (Likert scale);
  • Physical activity diary and pedometer (style Yamax SW 200) steps (intervention group only);
  • Satisfaction, confidence, commitment and intention (1 - 4 scale, intervention group only).


Statistical analysisImputation of missing data: Latent growth modelling imputation and latent transition analysis were undertaken using full-information likelihood procedures for selected variables within those returning at follow-up. Imputation was not undertaken for those lost to follow-up. The imputed data were not used in this Cochrane review.

Adjustment for clustering: As there was no substantive difference in models after covariate adjustment using the Huber–White sandwich estimator procedure, unadjusted models were presented. Hence, raw data presented were not adjusted for clustering.

Sample size calculation: Authors reported that the sample size provided adequate statistical power for latent growth model tests.


NotesSupported by Health Protection Research Initiative grant DP 000111 from the CDC. Authors stated no other financial disclosures.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"16 worksites agreed to participate and were paired and randomly assigned"

"Each of the paired sites was randomly assigned... to the intervention or a health education control condition using computer-generated random numbers. Based on past worksite intervention studies, the expected intervention enrolment and retention rates were approximately 35% and 50%, respectively, so recruitment goals at intervention and control sites were set at a 2:1 ratio."

Allocation concealment (selection bias)Unclear riskNo information provided.

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNo information provided. Although worksites were geographically dispersed and contamination was unlikely, it was unclear whether the usual treatment control group received additional information to their usual health promotion programmes. Additionally, recruitment bias may have occurred as it was unclear whether employees knew which allocation (intervention or health education control) they were offered.

Blinding of outcome assessment (detection bias)
Physical activity outcomes
High riskAll outcomes were self reported by the participants. Participants receiving the intervention would have been aware of goals set and the intention of the intervention, and may have been likely to overestimate outcomes.

Incomplete outcome data (attrition bias)
All outcomes
High riskInitial allocations were 885 to the intervention, and 557 to the control. "Percent loss to follow-up ranged from 25% to 47% at intervention sites and 32% to 56% at control sites." Reasons for loss to follow-up were not given. The authors reported that in the control group, participants who were lost to follow-up had slightly higher baseline physical activity scores than those who remained.

Selective reporting (reporting bias)Unclear riskAll outcomes described in the published papers were reported. Study protocol was not available.

Other biasHigh riskFollowing cluster-randomisation, recruitment of individuals in each worksite was voluntary. Volunteers were permitted to join the study after allocation and baseline measurement, at which point the nature of the intervention would have been clear. More participants joined the control group (138) after baseline than the intervention group (23). Volunteers for the intervention may have been more motivated to change than volunteers for the less active control programme.

Maruyama 2010

MethodsRandomised, cross-over study - first phase only.

Aim: To investigate the effectiveness of a worksite-based programme, Life Style Modification Program for Physical Activity and Nutrition (LiSM10!®), on metabolic parameters in middle-aged male Japanese white-collar workers requiring health guidance based on regular health check-up results.


ParticipantsPopulation description: Office workers belonging to the health insurance association of the Nichirei Group Corporation, aged 30 to 59 years.

Intervention group: 52 participants

Control group: 49 participants

Location: Tokyo and surrounding area, Japan

Inclusion criteria: "male, office employees of the Nichirei Group Corporation, aged 30 to 59 years, with risk factors for developing metabolic syndrome, including one or more abnormalities involving serum lipids, glucose levels and blood pressure, with visceral obesity (umbilical circumference: 85 cm or more) and/or BMI ≥ 25. Abnormal levels were defined as: triglyceride (TG) ≥150 mg/dL and/or HDL-cholesterol (HDL-C) ≥40 mg/dL, systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥85 mmHg, fasting glucose ≥110 mg/dL and/or HbA1c ≥5.5%."

Recruitment: Individuals at risk were identified at regular medical check-ups conducted by the Tokyo Health Service Association (Shinjuku-ku, Tokyo), not involved in the study. 800 male employees were informed about the study, 319 showed interest in participating and agreed to use of their data. After a detailed explanation of the programme, 115 agreed to participate.

Demographics: Age: range 30 - 59 years, mean (SD) for control 35.5 (8.1), for intervention 43.1 (7.7) years.

Gender: 100% male.


InterventionsDuration: Four months

Intervention: The LiSM10!® programme was designed to promote healthy dietary habits and physical activity.

1. Professional contact/counselling

  • Monthly individual contact with a dietitian and a physical trainer, both certified health councillors for this programme.
  • Baseline: Twenty-minute session with dietitian, including self assessment of consumption of beneficial foods (Group A: fish, soy products, green/yellow/white vegetables, mushrooms/seaweed/konnyaku)) and foods recommended to be decreased (Group B: large servings of grains, confectionaries, sweet drinks, fatty meats, butter/margarine/dressing, eggs/liver, fried foods, pickles, soup, alcohol). The dietitian gave advice on the impact of consumption of each food group, and participants were assisted to identify and record an action plan to monitor and change dietary habits or both, targeting specific foods based on stages of change theory. Ten-minute session with physical trainer, including discussion of baseline physical activity measurements. Participants were assisted to identify and record an action plan to increase physical activity based on pedometer steps or other lifestyle changes.
  • Months 1 and 2: Ten-minute session with each counsellor, who assisted the participant to review the month's achievements against their action plan, consider reasons for the results and effective strategies to improve, and if necessary revise the plan.
  • Month 3: Counsellors provided advice via the website described below, including review of progress and revision of goals.


2. Personal web page

  • Enter current weight; targeted food intake and physical activity; and upload data from computer-linkable pedometer (style Omron HJ-7101T) for self monitoring throughout the study. The data obtained were automatically presented in figures.
  • Discuss awareness of their lifestyles for self monitoring throughout the intervention period.
  • Family members and counsellors could make comments and note their impressions of the data on the self monitoring page.


3. Goal setting

  • Dietary action plans: In food group A, one, two and three items selected to be increased by 20 (38.5%), 24 (46.2%) and three (5.8%) participants, respectively. Top items were white vegetables, green/deep-yellow vegetables and mushrooms/seaweed/konnyaku. In food group B, one, two, three and four items selected to be decreased by 20 (38.5%), 19 (36.5%), three (5.8%) and two (3.8%) participants, respectively. Top items were confectionaries, alcoholic drinks, sweet drinks, large servings of grain and butter/margarine/dressing/mayonnaise.
  • Physical activity action plans: All participants decided to count steps. 32 (61.6%) decided to walk more than 10,000 steps daily.


Control: No intervention


OutcomesPhysical activity :

  • Pedometer steps (average steps per day over one week). A pedometer (Walking style HJ-7101T Omron Health Care Co., Ltd. Japan) was used to count the number of steps in a week. Participants wore the pedometer at the waist from the time they woke up until they went to bed. Control group participants were only given the pedometers for two periods (at baseline and at follow-up) of one week to allow outcome measurement. At the end of the week, pedometers were returned to the study staff. Intervention group participants periodically uploaded data from pedometer electronically via website.


Anthropometrics : measured by Tokyo Health Service Association (Shinjuku-ku, Tokyo), not involved in the study.

  • Body mass index (BMI): Weight(kg)/height(m)².
  • Waist circumference: cm, umbilical circumference measured during the late exhalation phase in the standing position.
  • Blood pressure: mmHg, measured using an automatic blood pressure manometer with the subject in the seated position.


Biochemical measures: Fasting, obtained and blinded measurements were conducted in the laboratory of the Tokyo Health Service Association (Shinjuku-ku, Tokyo), not involved in the study.

  • Total cholesterol (TC): mg/dL, enzymatic method;
  • High-density lipids (HDL): mg/dL, direct method;
  • Low-density lipids (LDL): mg/dL, Friedewald equation;
  • Triglycerides (TG): mg/dL, enzymatic method;
  • Fasting plasma glucose (PG): mg/dL, hexokinase-UV method.


Other outcomes not reported in this review:

  • Additional biochemical measures: HbA1c: %, enzymatic method; fasting insulin: μU/L, chemiluminescence immunoassay; insulin resistance, homeostasis model assessment (HOMA-IR), calculated as PG (mg/dL) × insulin (IRI) (μU/L) ÷ 405); aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (γ-GTP): IU/L, UV and L-γ-glutamyl-3-carboxy-4-nitroanilide substrate methods; uric acid: mg/dL, uricase method;
  • Food intake: Current targeted food intake entered on a website for self monitoring;
  • Lifestyle: A questionnaire on lifestyle, habitual food intake, the stages and self efficacies of changes in their habitual food intakes and efforts to increase physical activity.


Statistical analysisImputation of missing data: Not reported to have been undertaken by authors

Adjustment for clustering: Adjustment not required as participants were randomised individually.

Sample size calculation: "Sample size was calculated to detect the intervention effect of a 10% change within the group and between groups, using 0.05 for the alpha and 0.20 for the beta error. The necessary sample size was 45 subjects in each group."


Notes"This study was supported by a grant from the International Life Sciences Institute Japan. We appreciate the collaborative efforts of the Meiji Dairies Corporation, Suntory Holdings Limited and Nichirei Foods Inc." Authors stated no financial interest in the subject matter, materials, or equipment.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"A randomization code with equal numbers of alternative groups was generated from a list of all participants, using software SPSS (ver.15) at Waseda University."

Allocation concealment (selection bias)Low risk"The Nichirei Inc staff members managing the study and contacting participants were not involved in this randomization process."

Blinding of participants and personnel (performance bias)
All outcomes
High risk"…as the participants received detailed explanations of the objectives and other aspects of this study, blinding to group assignments was not possible." No information was given about blinding of personnel, but it is unlikely that this was undertaken.

Awareness of the purpose of the study may have led control group participants to behave differently during the study, which may have affected the outcomes.

Blinding of outcome assessment (detection bias)
Physical activity outcomes
Low riskParticipants in the intervention group uploaded pedometer data electronically via a website. Control group participants returned the pedometer to study staff, and it is likely that results were electronically recorded. Due to electronic linkable pedometers, the uploading of incorrect pedometer steps are unlikely to be influenced by the lack of blinding.

Blinding of outcome assessment (detection bias)
Disease risk factor outcomes
Low riskNo additional information was given about blinding of outcome assessors. Anthropometric and blood test results are also objectively measured and unlikely to be affected.

Incomplete outcome data (attrition bias)
All outcomes
High riskOf 52 participants randomised to the intervention, four were lost to follow-up, and an additional four did not provide postintervention pedometer steps. 

Of 49 participants randomised to the control, two were excluded after baseline due to abnormal blood tests indicating possible hyperlipidaemia, eight were lost to follow-up, and an additional 17 did not provide pedometer steps.

The authors did not conduct intention-to-treat analysis. The reasons for most missing data were not available. For all outcomes, attrition is likely to be large enough to affect the observed results.

Selective reporting (reporting bias)Unclear riskAll outcomes described in the published papers were reported. Study protocol was not available.

Other biasUnclear riskThe control group walked on average around 1,000 fewer steps per day at baseline than the intervention group. This difference could indicate that the intervention group was already at a high level of activity and less likely to achieve significant increases (less room to move), or it could indicate a highly active or motivated group who were more likely to achieve significant increases.

Morgan 2011

MethodsCluster-randomised controlled trial

Aim: To evaluate the feasibility and efficacy of a workplace-based weight loss programme that targeted overweight and obese male shift workers.


ParticipantsPopulation description: Overweight or obese male adult shift workers at Tomago Aluminium, one of Australia's largest producers of aluminium, employing around 1200 staff.

Intervention group: Two clusters of multiple crews (15 crews across both groups), 65 participants

Control group: Two clusters of multiple crews, 45 participants

Location: The industrial suburb of Tomago, 13 km northwest of Newcastle, New South Wales, Australia.

Inclusion criteria: Overweight or obese (BMI between 25 and 40 kg/m²) men aged 18 – 65 from Tomago Aluminium without a history of major medical problems such as heart disease in the last five years, diabetes, orthopaedic or joint problems that would be a barrier to physical activity, recent weight loss of ≥ 4.5 kg, or taking medications that might affect body weight.

Recruitment: Individual recruitment via a staff email and through promotion at crew meetings, by crew leaders and health staff. Participating crews were allocated to clusters based on the timing and rotation of shifts worked, to avoid contamination within the worksite.

Demographics: Age: range 18-65 years, mean (SD) 44.4 years (8.6) years.

Gender: 100% male.

Socio-Economic Indexes for Areas (SEIFA, based on residence postcode): 1 – 2 (lowest category) 7.9%, 3 – 4 18.0%, 5 – 6 52.8%, 7 – 8 18.0%, 9 – 10 (highest) 3.4%.


InterventionsDuration: 3.5 months (14 weeks)

Intervention: The Workplace POWER (Preventing Obesity Without Eating like a Rabbit) programme is based on Social Cognitive Theory and behaviour change strategies. Adapted from a previous internet-based weight loss programme, 'SHED-IT'.

1. Professional contact/counselling

  • Information session by male researcher: 1 x 75-minute face-to-face session.
  • 60 minutes covered education about energy balance, the challenges of shift work relating to diet and physical activity, weight loss tips, and behaviour change strategies including self monitoring, goal setting and social support.
  • 15-minute technical orientation during information session to familiarise and teach participants how to use the website.


2. Personal web page

  • Study website: publicly accessible, free weight loss site http://www.calorieking.com.au. Weekly enter weight, submit online daily eating and physical activity diaries for the first four weeks, for two weeks in the second month and for one week in the third month.
  • Website user guide.
  • Weight loss handbook.
  • Pedometer (style Yamax SW 200).


3. Feedback

  • Website data given in seven weekly individualised feedback documents via email over the three months from the research team.
  • Each sheet gave weekly summary of results, suggested personalised strategies to address weight loss, reduce energy intake and increase energy expenditure.
  • A research team email was available for questions, which were answered weekly by two research assistants with qualifications in health and physical education or nutrition and dietetics.


4. Incentives

  • Group-based financial incentive.
  • The crews with the highest mean percentage weight loss after one month and at the conclusion of the programme were given a AUD 50 gift voucher per person to be spent at a local sporting equipment store.


Control: Received the intervention at 14 weeks (wait-list control group).


OutcomesPhysical activity :

  • Leisure-time physical activity. Self reported. Measured using a modified version of the Godin Leisure-Time Exercise Questionnaire. "How many times per week do you engage in strenuous, moderate, and mild physical activity for a minimum of 10 minutes per session?" The total leisure activity score was calculated by: (N·MET) moderate +(N·MET) strenuous +(N.MET) mild where N = (number of bouts per week lasting > 10 minutes multiplied by the time in minutes) for each category.
  • 'Workday' and 'usual' physical activity. Self reported. "(i) How much do you incorporate physical activity into your workday (during breaks, active commuting to and from work)?" scored on a five-point scale from 1) none to 5) a great deal; and "(ii) Is the amount of activity you did in the past month less, more, or about the same as your usual physical activity habits?" scored from 1) I am now much less active to 5) I am now much more active.    


Anthropometrics :

  • Body weight: kg, measured with men wearing light clothing, without shoes on a digital scale to 0.1 kg (Model no. UC-321PC, A&D Company Ltd., Tokyo, Japan).
  • Body mass index (BMI): Weight(kg)/height(m)², measured to 0.1 cm using a stadiometer (model KaWe 44440; Medizin Technik, Mentone Education Centre, Morrabin, Australia).
  • Waist circumference: cm, measured level with the umbilicus with a non-extensible steel tape (KDSF10-02, KDS Corporation, Osaka, Japan).
  • Blood pressure and resting heart rate: mmHg and beats per minute, measured using a NISSEI/DS-105E digital electronic blood pressure monitor (Nihon Seimitsu Sokki Co. Ltd.,Gunma, Japan).


Quality of life :

  • Health-related quality of life: 12-Item Short Form Health Survey physical and mental scales.


Adverse effects:

  • Injuries at Work: On-site incident and injury recording system at Tomago Aluminium for the 12-month period before and after programme commencement. All work-related injuries are reported by employees and recorded in an electronic database. Injuries can be the result of a single workplace exposure or event, or the result of a cumulative exposure over time. Injuries excluded were those that occurred on the journey to and from work.


Other outcomes not reported in this review:

  • Selected dietary variables: Specific foods (fruit, vegetable, bread) and beverages (milk, cola, soda, diet and alcohol).
  • Physical activity and dietary cognitions: Self efficacy, pros and cons, behavioural intention, attitudes, stage of change.
  • Daytime sleepiness: Epworth sleepiness scale, which is a valid measure of general daytime sleepiness.
  • Workplace productivity or presenteeism: Work Limitations Questionnaire (WLQ) short-form (the degree to which health problems interfere with the performance of job tasks and to estimate the related productivity loss. The WLQ generically assesses presenteeism, is validated and highly reliable).
  • Absenteeism: Personal illness or non-work-related injury were recorded in an electronic database, presented as hours of leave. Carer's leave was excluded from the analysis. Absences for the three-month period before and after programme commencement.
  • Feasibility: Recruitment (achievement of target sample size), retention (retention rates at follow-up) and attendance (at information sessions).
  • Adherence to self monitoring: Calculated from website usage data.
  • Research team emails: Frequency and topic


Statistical analysisImputation of missing data: "Analyses were performed using PASW Statistics 17 (SPSS Inc. Chicago, IL)." "Mixed models were used to assess all outcomes (primary and secondary) for the impact of group (Intervention and Control), time (treated as categorical with levels baseline and 14 weeks) and the group-by-time interaction, these three terms forming the base model. This approach was preferred to using baseline scores as covariates, as the baseline scores for subjects who dropped out at 14 weeks were retained making this an intention-to-treat analysis." The intention-to-treat analyses reported are used in this Cochrane review.

Adjustment for clustering: "To examine potential clustering of effects at the crew level, crew was nested within both the treatment and treatment-by-time terms as fixed effects and these terms were used in the final models." These adjusted results are used in this Cochrane review.

Sample size calculation: "Based on 90% power to detect a significant weight loss (primary outcome) difference between groups of 3 kg, assuming SD=5 (P=0.05, two-sided), and a correlation between pre and post scores r=0.80, a sample size of 41 participants for each group was needed."


Notes"Funding Source: This study was funded by Tomago Aluminium and the Hunter Medical Research Institute. Tomago had no involvement in study design, analysis and interpretation of data or the decision to submit the manuscript for publication. Simon Mitchell from Tomago reviewed the drafted manuscript for accuracy and also organised the data collection at Tomago." "Ethics approval was obtained from the University of Newcastle Human Research Ethics Committee and the project was supported by Tomago Aluminium management." No other potential conflict of interests stated by the authors.

Australian New Zealand Clinical Trials Registry Number: ACTRN12609001003268


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk"The random allocation sequence was generated by a computer-based random number-producing algorithm to ensure an equal chance of work crews being allocated to each group, without restriction."

"As crews were randomly allocated based on crew shift clusters, we had an uneven number of men in intervention and control conditions."

Allocation concealment (selection bias)Low risk"To ensure concealment, the sequence was generated by a statistician. Randomization and participant study arm assignment was completed by a researcher who was not involved in the assessment of participants and the allocation sequence was concealed when enrolling participants by work crew. Participants were enrolled by Health Services staff at Tomago."

Blinding of participants and personnel (performance bias)
All outcomes
High risk“Men were randomly allocated to one of two groups: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) programme or a 14-week wait-list control group. Men worked in crews (n = 15) and were randomly allocated in four crew clusters based on the timing and rotation of shifts worked, to avoid contamination within the worksite.”

It is unclear whether participants in the control group knew if they were allocated to the 14-week wait-list control group. The waiting period may have given opportunity to change their behaviour in anticipation of the programme commencement.

Some personnel would have been aware of participants’ allocation through provision of tailored support during the trial.

Blinding of outcome assessment (detection bias)
Physical activity outcomes
High riskPhysical activity outcomes were self reported. It is possible that participants in the intervention group, knowing that the intervention had begun and the direction of expected change, may have exaggerated activity levels, although obvious outliers were excluded from the analysis.

Blinding of outcome assessment (detection bias)
Disease risk factor outcomes
Low risk"Participants and assessors were blind to group allocation at baseline assessment."

It is unclear who performed these outcome measures, and whether they were blinded at follow-up; however these outcomes are sufficiently objective to present a low risk of bias.

Blinding of outcome assessment (detection bias)
Quality of life outcomes
High riskQuality of life outcomes were self reported. It is possible that participants in the intervention group, knowing that the intervention had begun and the direction of expected change, may have reported more favourably to quality of life outcomes. However, quality of life may not be perceived by participants as a direct outcome of this intervention, and hence, may not be as vulnerable to bias as an outcome directly related to the intervention goals, such as physical activity.

Blinding of outcome assessment (detection bias)
Adverse event outcomes
Low risk"Injury data were sourced from an on-site incident and injury recording system at Tomago Aluminium for the 12-month period before and after programme commencement."

Incomplete outcome data (attrition bias)
All outcomes
High riskOne hundred and ten participants were randomised (65 Intervention, 45 Control). Nineteen were lost to follow-up (10 Intervention, nine Control) due to unavailability for testing and one due to employee termination (Intervention). Reasons for unavailability were not described.

"Six men were identified as outliers in the total MET minutes variable and were omitted from the physical activity analyses as their reported physical activity levels were not plausible."

In the physical activity analyses, only 75 participants were included (allocation and reasons for additional exclusions not stated).

For anthropometric analyses, the authors undertook a mixed model approach "as the baseline scores for subjects who dropped out at 14 weeks were retained making this an intention-to-treat analysis." Imputation of follow-up scores for missing participants was not described.

At least 18.2% of the baseline sample were missing, but in some analyses up to 31.8% were missing, with the balance between intervention and control group and the reason unclear. This level of incomplete data is enough to pose a high risk to the results.

Selective reporting (reporting bias)Low riskAll outcomes described in the published papers and trial registration were reported at three months. Trial registry data stated that outcomes would be measured six-month follow-up, and that the wait-list control group would be offered the intervention immediately following that point. However, the study reported that wait-list control received the intervention at 14 weeks, and no results at six months were reported, so we assumed that six-month data collection was not undertaken. Despite this, the results reported at three months remain at low risk.

Other biasLow riskAs cluster-randomisation was utilised for a small number of clusters, there is an increased chance of baseline imbalance between the randomised groups in terms of either the clusters or the individuals. The use of a wait-list control is likely to have minimised the risk of selection bias within clusters. In addition, appropriate adjustment for clustering in statistical analyses was undertaken.

Talbot 2011

MethodsRandomised controlled trial

Aim: To compare the effects of a pedometer-based behavioral intervention (Fitness for Life, FFL) and the traditional army physical fitness (TRAD) programme on physical activity, aerobic fitness, and chronic heart disease risk factors in healthy adult men and women in the Army National Guard (ARNG) who had failed the Army Physical Fitness Test (APFT).


ParticipantsPopulation description: Volunteer, part-time Army National Guard (ARNG) members, who had failed the two-mile run component of the Army Physical Fitness Test.

Intervention group: 84 participants

Control group: 72 participants

Location: Maryland and Washington, DC, USA.

Inclusion criteria: Volunteer part-time Army National Guard members who had failed the two-mile run component of the Army Physical Fitness Test (APFT), with 12 months or longer before re-enlistment or retirement, and who had no history of CHD or stroke, were not currently taking hypertensive or cholesterol-lowering medications, had not been pregnant within the previous six months, were not post-menopausal or currently taking hormone replacement therapy, or had no major musculoskeletal disorders. Post-menopausal women and women on hormone replacement therapy were excluded owing to their small numbers and potential confounding effect on serum lipids.

Recruitment: From a pool of 261 ARNG soldiers who failed the run portion of the APFT, 156 met the criteria for inclusion in the study and were randomised into two groups.

Demographics:

Age: Mean (SD) for intervention 32.7 (10.1); for controls 32.8 (8.3) years.

Gender: 68.8% male for intervention, 80.4% for controls.

Race: Intervention 50% white, 39% African-American, 7% Asian/Pacific Islander. Controls 31% white, 50% African-American, 7% Asian/Pacific Islander.

Education: Intervention 27% high school graduate, 50% some college, 7% college graduate, 8% some postgraduate, 8% advanced degree. Controls 31% high school graduate, 50% some college, 2% college graduate, 15% some postgraduate, 2% advanced degree.


InterventionsDuration: 24 weeks (12 weeks of conditioning and 12 weeks of maintenance).

Intervention: The Fitness for Life (FFL) programme was designed specifically for the reserve components of ARNG and Reserve to teach soldiers usually working a full-time civilian job and a part-time military job to incorporate moderate intensity physical activity (PA) into their daily lives.

1. Professional contact/counselling

  • Counselling sessions: discussed various activities to increase their daily step count.
  • Weeks one to four: During brief weekly telephone counselling (< five minutes), pedometer logs were reviewed and feedback provided.
  • Weeks five to 12: Weekly booster telephone calls, monthly support meetings.
  • Weeks 13 to 24: Monthly maintenance meetings were continued; telephone calls were tapered to every two weeks, then monthly to increase autonomy.
  • Monthly group meetings: held to provide support, emphasise relapse prevention, and encourage self monitoring of steps.


2. Goal setting

  • Pedometer (style Yamax SW 200) worn for self monitoring of their daily steps. Central focus used to motivate and monitor steps through setting step goals, maintaining a daily step log, and promoting activities to increase steps.
  • Weeks one to four: focused on accumulating daily steps through short bouts of walking combined with behavioral-based PA counselling.
  • Weeks five to 12: focused on increasing the intensity of soldiers’ activities. Soldiers were taught to rate their perceived exertion while performing moderate-to-high intensity daily activities in their target heart rate range, defined as 60 to 90% of predicted maximum heart rate, calculated as 220 − age. Using the Rating of Perceived Exertion scale, participants gauged the intensity of their activities by means of feedback from their target heart rate. The pedometer continued to be the central focus of behavioral strategies for setting step goals.  
  • Weeks 13 to 24: focused on sustaining gains in the amount of steps and intensity of PA. Participants were expected to continue using the pedometer to monitor their PA. Relapse prevention, self monitoring, and reinforcement were continually emphasised during the maintenance phase.


3. Environmental prompts

  • Motivational postcards: mailed weekly (weeks one to four) and then bi-weekly to suggest various ways to increase steps.


4. Feedback

  • Through counselling sessions.
  • Taught how to gauge the intensity of their activities by means of feedback from their target heart rate.


Control: The army physical fitness (TRAD) programme follows Army Regulation 350-41, with recommendations detailed in the army’s Field Manual 21-20. The programme consists of 12 weeks of high-intensity conditioning, defined as 75 to 80% of maximum heart rate and 12 weeks of maintenance.

1. Professional contact/counselling

  • A Master Fitness Trainer, an ARNG soldier who had completed a two-week reserve component training course, oversaw the 12-week training programme.
  • 60-minute briefing.
  • A brief reminder call was made before each monthly meeting.
  • Monthly group meetings.


2. Goal setting

  • Instructed to perform vigorous physical fitness training three to six days per week, including three 30-minute sessions of aerobic training and three 30-minute strength training sessions, performed unsupervised separately or combined, during their normal work day or during leisure time.
  • Supplementary booklet on the TRAD.


OutcomesPhysical activity :

  • The seven-day physical activity recall (PAR) interview. Amount of time spent asleep (1.0 metabolic equivalent of task (METs) units) and in moderate (four METs), hard (six METs), and very hard (10 METs) intensity physical activity for the previous weekdays and weekend. The seven-day PAR is moderately correlated with an accepted standard measure for cardio-respiratory fitness, the VO₂ max which is the maximum capacity of an individual's body to transport and use oxygen during incremental physical activity. It was assumed that they spent the remaining time in light activities (1.5 METs). To estimate energy expenditure per week, the average number of minutes at each activity level was multiplied by the respective MET value for an estimate of light, moderate, hard, and very hard physical activity in kcal/kg. Total physical activity was the sum of Moderate Intensity,Hard Intensity and Very Hard Intensity physical activity because both interventions were designed to increase these three activity levels, but not Low Intensity.
  • Pedometer steps (assumed to be: average steps per day over one week). A pedometer (Digiwalker, Yamax SW 200; New Lifestyles, Lees Summit, MO) was used to count the number of steps in a day, which were recorded in a daily pedometer log. This pedometer’s accuracy is within 1% of the actual step count on a 4.88 km sidewalk course. Participants wore the pedometer at the waist from the time they woke up until they went to bed. Control group participants were only given the pedometers for two periods (at baseline and at follow-up, length of testing time unknown) to allow outcome measurement. At the end of the week, pedometers were returned to the study staff. Intervention group participants retained the pedometer throughout the intervention


Anthropometrics :

  • Weight and height: Measured using a digital scale, with participants in gym shorts and t-shirt without shoes.
  • Body mass index (BMI): Weight(kg)/height(m)².
  • Waist circumference: Measured during the late exhalation phase in the standing position.
  • Blood pressure: Measured using an automatic digital monitor (Model 6009; American diagnostic, Tokyo, Japan) on dominant arm at heart level while participants were seated. Three measurements were taken at one- to two-minute intervals, and the mean of the two closest readings was reported. Cuff sizes reflected the circumference of the participant’s arm. Extreme values were checked by trained personnel, who repeated the digital recording and then recorded blood pressure manually.


Biochemical measures: Fasting venipuncture from the anterior cubital fossa. The samples were allowed to clot at room temperature, then centrifuged at 3,000 rpm for 15 minutes, and the resulting serum was removed and stored at −80°C until analysis. The lipid panel was analysed using the Cholestech LDX system analyser (Cholestech, Hayward, CA), with a sensitivity of 0.8%. All assays were conducted at Johns Hopkins Bayview Campus in the General Clinical Research Center.

  • Total cholesterol (TC);
  • Triglycerides;
  • Low-density lipoprotein cholesterol (LDL-C);
  • High-density lipoprotein cholesterol (HDL-C);
  • TC:HDL-C ratio were calculated.


Other outcomes not reported in this review:

  • Army Physical Fitness Test (APFT): a standardised measure of cardiorespiratory fitness and muscular endurance according to standardised protocols detailed in Chapter 14 of the Army Field Manual 21-20. This is a three-event physical performance test consisting of the number of standard Army push-ups performed in two minutes; the number of standard Army sit-ups performed in two minutes; and the time to complete a two-mile run.The APFT scoring is a normative-based scale based on age and gender.


Statistical analysisImputation of missing data: "We used expectation-maximization for imputation estimates of missing data in the group of protocol completers, with SPSS Missing Value Analysis 16.0. The missing data for individual variables ranged between 1% and 19%. Missing data were determined to be missing at random, meeting expectation-maximization assumptions." Hence, expectation-maximisation was undertaken within those returning at follow-up. Imputation was not undertaken for those lost to follow-up.

Adjustment for clustering: Adjustment not required as participants were randomised individually.

Sample size calculation: "Based on the predicted effect of the intervention with projected 40% attrition, we estimated a total sample size of 156 ARNG soldiers to demonstrate a 10% improvement in APFT scores (effect size, d = 0.65) and PA (effect size d = 0.56) at an α of 0.05 and a power of 0.80."


Notes"We also acknowledge the Johns Hopkins Bayview General Clinical Research Center (which is funded by Department of Health and Human Services, National Institutes of Health [NIH], National Center for Research Resources, no. 5 M01 RR0279) for providing core laboratory and data management support and equipment, and the Intramural Research Program of the NIH, National Institute on Aging. Funding for this project was provided by Triservice Nursing Research Program, Johns Hopkins Bayview General Clinical Research Center, the Intramural Research Program of NIH, National Institute on Aging." No other potential conflict of interests stated by the authors.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskStudy described as a "randomized controlled trial". No further information given on the method used to generate the random sequence.

Allocation concealment (selection bias)Unclear riskNo information provided.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo information provided.

It is unlikely that personnel delivering the specific intervention programmes would have been blinded. Participants may have been unaware of the differences between programmes on allocation, but being colleagues in the National Guard, it is possible that communication among participants would have occurred that identified the nature of each intervention.

Although both interventions were active physical training programmes, it is possible that participants may have had a preference for the traditional training programme (control) over the new (pedometer-based) intervention, perhaps contributing to the higher drop-out rate in the pedometer group.

Blinding of outcome assessment (detection bias)
Physical activity outcomes
High riskPhysical activity outcomes were self reported. It is possible that participants in either study group, knowing that the intervention had begun and the direction of expected change, may have exaggerated activity levels. Although this applies to both groups, it may have applied more in one group than another. For example, if participants had stronger belief in the effectiveness of one programme over another (e.g. traditional versus new intervention), or depending on participants' experience of the intervention. Participants in the pedometer arm may have felt greater pressure to report increased steps per day. Participants in the control arm may have felt greater pressure to report increased periods of higher-intensity physical activity.

Blinding of outcome assessment (detection bias)
Disease risk factor outcomes
Low riskNo information is provided on blinding of assessment of these outcomes, but they are sufficiently objective to make detection bias unlikely.

Incomplete outcome data (attrition bias)
All outcomes
High riskOne hundred and fifty-six met the criteria and were randomised. 62 (40%) were lost to follow-up (at 12 weeks: 33 Intervention, 19 Control; at 24 weeks: three Intervention, seven Control) due to deployment (15), left ARNG (21), personal reasons (22), injury not related to the study (three), passing Army Physical Fitness Test (one). Reasons were provided, but not for each group.

"ARNG soldiers who dropped out of the training programme had lower baseline APFT scores, suggesting that less fit individuals require more motivation to complete such a program". This indicates the possibility that data were not missing at random.

Results were reported for participants remaining for the entire study. "We used expectation-maximization for imputation estimates of missing data in the group of protocol completers", but data were not imputed for participants who withdrew.

At least 40% of the baseline sample was missing and the reasons were not very specific. This level of incomplete data is enough to pose a high risk to the results.

Selective reporting (reporting bias)Unclear riskResults for some outcomes measured were not reported (total physical activity, heart rate, triglycerides, very low density lipoprotein), but the reported results included a range of significant and nonsignificant effects, favouring both programmes. It is unlikely that the outcomes omitted were selected based on their results. Study protocol was not available.

Other biasHigh riskBaseline data were reported separately for participants who completed or withdrew from the study, so it is difficult to assess the true levels of baseline imbalance. Of those who completed the study, those in the intervention group performed lower levels of moderate and very high intensity physical activity at baseline, which could indicate that the control group was already at a high level of activity and less likely to achieve significant increases (less room to move), or it could indicate a highly active or motivated group who were more likely to achieve significant increases. A number of smaller baseline imbalances were also observed in other outcomes.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Aittasalo 2004Pedometers were not used throughout the intervention period.

Bassey 1983Pedometers were not used throughout the intervention period. Controls also received a pedometer.

Brehm 2011Pedometers were not used throughout the intervention period. No physical activity measured as an outcome.

Brooke-Wavell 1996Pedometers were not used. 

Della 2010Controls also received a pedometer.

Erfurt 1991Pedometers were not used. No physical activity measured as an outcome.

Furukawa 2003Accelerometers were used.  Controls also received an accelerometer. Participants could not view step count.  

Gilson 2007Controls also received a pedometer.

Gilson 2008Pedometers were not used throughout the intervention period.

Hultquist 2005Not in a workplace setting. Participants could not view step count.  

Härmä 1988aPedometers were not used. 

Härmä 1988bPedometers were not used. 

Iwane 2000Controls also received a pedometer.

Johannesson 2010Controls also received a pedometer. No physical activity measured as an outcome.

Kennedy 2007Pedometers were not used. 

Lee 1997Pedometers were not used. 

Mackey 2011Controls also received a pedometer.

Molde 2003Not in a workplace setting. Pedometers were not used. 

Moreau 2001Not in a workplace setting.

Motl 2005Not in a workplace setting. Pedometers were not used. 

Murphy 2006Pedometers were not used throughout the intervention period. Controls also received a pedometer.

Mutrie 2002Pedometers were not used. 

Naito 2008Pedometers were not used throughout the intervention period.

Oja 1991Not in a workplace setting. Pedometers were not used. 

Polzien 2007No physical activity measured as an outcome.

Puig-Ribera 2008Controls also received a pedometer.

Serwe 2011Controls also received a pedometer.

Slootmaker 2009Accelerometers were used.  

Speck 2001Controls also received a pedometer.

Sternfeld 2009Not in a workplace setting.

Terry 2010Pedometers were not used. 

Torstensen 1998Not in a workplace setting. Pedometers were not used. 

Tucker 2011Participants could not view step count.  

Tudor-Locke 2004aNot in a workplace setting.

Van Berkel 2011Pedometers were not used. Accelerometers were used.  

Vincent 2009Not in a workplace setting.

Wing 1996Pedometers were not used. 

 
Characteristics of studies awaiting assessment [ordered by study ID]
Adams 2012

MethodsUnclear: "A mixed methods approach was used to evaluate a sub-set of FFW projects."

Aim: To improve local environments and deliver promotional activities to increase walking for short journeys.

ParticipantsPopulation description: Deprived communities.

Intervention group: Unclear

Control group: Unclear

Location: Twelve Local Authority (LA) areas across five regions of England.

Inclusion criteria: Unclear

Recruitment: Unclear

Demographics: Unclear

InterventionsDuration: Unclear

Intervention: In the Fitter for Walking (FFW) project, coordinators located in each region delivered project activities, in conjunction with LA partners, based on the needs and interests of local residents in each community. Activities included small local-level infrastructural improvements completed by the LA; community-led environmental improvements; and awareness raising activities.

Control: Unclear

OutcomesPhysical activity:

  • Walking: Number of pedestrians using project routes; route users' perceived frequency of using project routes, transport-related walking and walking for other journey purposes; community members' perceived frequency of walking, identification of walkable destinations and observed level of others' walking in the neighbourhood.


Other outcomes not to be reported in this review:

  • Process outcomes: Delivery of environmental changes and promotional activities; community engagement; engagement.

NotesAbstract only. Full length publications yet to be identified and assessed.

Aittasalo 2012

MethodsRandomised controlled trial

Aim: To evaluate a six-month intervention to promote walking in office workers using pedometers and email messages.

ParticipantsPopulation description: Voluntary and insufficiently physically active employees at 20 office-based worksites. Worksite specifics not described.

Intervention group: 123 participants

Control group: 118 participants

Location: Southern Finland

Inclusion criteria: Respondents to the baseline questionnaire were eligible if they volunteered for the study and were insufficiently physically active for cardio-respiratory health (less than 150 minutes of moderate-intensity physical activity or less than 75 minutes of vigorous-intensity physical activity per week accumulated from fewer than three days a week) and perceived no restrictions for physical activity.

Recruitment: by 10 occupational health care units from 20 worksites with 2,230 employees.

Demographics: Age: mean (SD) for control 45.3 (9.1), for intervention 44.1 (9.4) years.

Gender: for control 22% male, for intervention 13% male.

Highest level of education: for control Basic 11%, Polytechnic or vocational school 75%, University degree 32%; for intervention Basic 7%, Polytechnic or vocational school 79%, University degree 37%.

Married: for control 96%, for intervention 99%.

InterventionsDuration: Six months

Intervention:

  • A one-hour preliminary meeting in each worksite held by a researcher and providing information on the intervention as well as on health benefits and recommendations of PA and walking. The use of stairs was emphasised from the aspect of health and easy applicability. The employees were also supplied with walking leaflets, pedometers (Omron, Walking Style II) and printed logbooks.
  • Self monitoring of physical activity with the pedometer and logbook.
  • The baseline average number of daily steps was used for the step goals, which were prompted monthly by the logbooks and email messages sent from occupational health care units.


Control: No intervention received until 12 months when a one-hour seminar took place and participants were given pedometers, logbooks, walking leaflets and additional training session options.

OutcomesPhysical activity:

  • Walking: adapted from the International Physical Activity Questionnaire (IPAQ Long) (walking at work, walking for transportation, walking for leisure) and an additional question on walking stairs.
  • Other: Vigorous- and moderate-intensity leisure PA other than walking.


Sedentary behaviour:

  • Sedentary time during working and non-working day adopted from the International Physical Activity Questionnaire (IPAQ Long).


Anthropometrics :

  • Weight.


Quality of life :

  • Self reported health status (good, fairly good, average, fairly poor, poor).


Other outcomes not to be reported in this review:

  • Subjective work ability: subjective estimation of present work ability compared with the lifetime best (scale 0 - 10).
  • Process outcomes: Reach, effectiveness, adoption, implementation, maintenance and costs.

NotesStatistical analysis:

Imputation of missing data: Not reported/undertaken by authors.

Adjustment for clustering: Not undertaken.

Sample size calculation: "According to the power calculations (significance level of 0.05, power of 80%) 175 participants in each group totaling 350 participants were needed to detect the 30% between-group difference in change in the weekly minutes of total walking."

Bort Roig 2012

MethodsUnclear. "A quasi-experimental design, with an additional Campus in each University acting as a control."

Aim: To reduce daily sitting time and increase daily step counts at work.

ParticipantsPopulation description: Inactive white-collar employees.

Intervention group: 129 participants

Control group: 135 participants

Location: Four Spanish Universities

Inclusion criteria: Unclear

Recruitment: Unclear

Demographics: Age: 42 (± 10) years

Gender: 35% male

Highest level of education:

InterventionsDuration: 20 weeks

Intervention: The "Walk&WorkSpain" intervention consisted of:

  • a ramping phase (eight weeks) to progressively increase baseline step counts to 10.000 steps per workday by integrating active working tasks, short (10 min) and long (20 min) campus walking routes at low and moderate intensities. Employees used a pedometer and a website that provided strategies, motivational materials and interactive features.
  • a maintenance phase (12 weeks) of the increased volume of step counts, with intensive researcher guidance (weekly emails).


Control: Maintain normal behaviour.

OutcomesSedentary behaviour:

  •  Sitting time: occupational, TV, transport and total sitting time


Other outcomes not to be reported in this review:

  • Qualitative participant experiences.

NotesAbstracts only. Full length publications yet to be identified and assessed.

Butler 2004

MethodsRandomised controlled trial

Aim: To investigate the effect of feedback from a pedometer as an intervention strategy to increase adherence to a walking programme.

ParticipantsPopulation description: Voluntary, 45 - 65-year olds. We do not know if the investigators recruited employees or whether the study was conducted within a worksite setting. We have queried this from the authors.

Intervention group: 17 participants

Control group: 16 participants

Location: Not reported

Inclusion criteria: Voluntary, inactive (not exercising three times 30 minutes per week), not hypertensive, able to walk unaided for 30 minutes.

Recruitment: Not reported

Demographics: Age: range 45 - 65 years, mean (SD) 52 (1.21).

Gender: 15% male.

InterventionsDuration: One month

Intervention:

  • Given normal pedometers and shown how to access the step count display.
  • A modified version of the National Heart Foundation's "Just Walk It" walking programme was promoted. Information included risks of being inactive, potential benefits of becoming more active, suggestions on fitting walking into daily life.
  • A goal of walking for 30 minutes on all or most days of the week for the first two weeks and increasing this to 40 minutes during the second two weeks. This target was also expressed as a step count (3,000 and 4,000 steps).


Control: The same intervention was given except the step count display was obscured and the walking goals were not expressed as a step count.

OutcomesPhysical activity:

  • Pedometer steps: An individually calibrated pedometer (style not reported), with the step count display obscured, was used to count the number of steps in a week during all waking hours at baseline. Intervention group participants were then given normal pedometers and shown how to access the step count display. Control group participants continued to use the obscured display pedometers.


Other outcomes not to be reported in this review:

  • Adherence: percentage of participants who met the target step count each fortnight.
  • Motivation reasons: such as wanting to experience health benefits (motivated) or tiredness (unmotivated).

NotesStatistical analysis:

Imputation of missing data: Not reported or not undertaken by authors.

Adjustment for clustering: Adjustment not required as participants were recruited individually.

Sample size calculation: Not reported or not undertaken by authors.

Kazi 2012

MethodsUnclear: "Ten worksites were recruited and allocated to a staged intervention, standard intervention or control intervention group."

Aim: To apply the health psychology Stage of Change behaviour change model to a one-year organisational intervention to promote physical activity and reduce sedentary behaviours in employees.

ParticipantsPopulation description: 1120 participants at 10 worksites

Intervention group: Unclear

Control group: Unclear

Location: Unclear

Inclusion criteria: Unclear

Recruitment: Unclear

Demographics: Gender: 54% male

InterventionsDuration: One year.

Intervention: Worksites were allocated to either a staged intervention or a standard intervention. Intervention information was delivered to participants, which was dependent on their intervention group allocation and their readiness to change physical activity behaviours.

Control: Unclear

OutcomesPhysical activity:

  • TIme spent walking


Sedentary behaviour:

  • Sitting time


Anthropometrics:

  • Weight
  • Body mass index (BMI): kg/m2
  • Body composition
  • Blood pressure
  • Resting heart rate


Other outcomes not to be reported in this review:

  • Lifestyle
  • Work ability
  • General health: self reported
  • Job attitudes

NotesAbstract only. Full length publications yet to be identified and assessed.

Leibiger 2012

MethodsUnclear: controlled trial

Aim: To increase physical activity through activities of daily living.

ParticipantsPopulation description: 99 participants

Intervention group: Unclear

Control group: Unclear

Location: Unclear

Inclusion criteria: Unclear

Recruitment: Unclear

Demographics: Unclear

InterventionsDuration: six months

Intervention: A defined step goal (an additional 3000 steps per day) was set for the participants of the intervention group. The number of steps per day was counted by pedometer and was documented in a diary. Concomitantly, a programme of health education and motivation was conducted.

Control: Unclear

OutcomesPhysical activity:

  • Steps per day


Anthropometrics:

  • Waist circumference
  • Blood pressure

NotesFull text article still awaiting translation and assessment.

Linde 2012

MethodsCluster-randomised controlled trial

Aim: To a) conduct a simultaneous test of environmental approaches to healthy weight choices (including eating, physical activity, and weight monitoring behaviours), and b) extend the test of these approaches to a more sustained time period than typically observed.

ParticipantsPopulation description: Six worksites, including two community colleges; a regional insurance office, a beauty industry corporate headquarters with an attached manufacturing and distribution centre, a utility company home office and a national headquarters for a health-related nonprofit organisation.

Intervention group: Three worksites

Control group: Three worksites

Location: Metropolitan area, USA.

Inclusion criteria: Worksites were eligible if they had between 250 and 1,000 employees, within the study location; with food service on site, located in a building with at least two floors (to ensure presence of stairs), with minimal seasonal fluctuation of employees, expecting stability of location and workforce over the next several years, and willing to provide employees’ work contact information. Employees were eligible if they were employed at least 50% time on-site during a daytime shift.

Recruitment: Worksites were identified using a business directory and contacted by phone to ascertain eligibility. A letter was then sent to human resources (HR) personnel (identified in the initial screening call) to provide basic study information and request contact to discuss the study and eligibility requirements further. The next telephone contact confirmed basic site eligibility criteria and explained the purpose and nature of the study. The principal investigator and project director then visited sites for one-hour visits with site executives and HR staff, to present the study design and aims and field questions. For those sites then agreeing to participate in the trial, HR provided worksite contact information (email and telephone) for all eligible employees. Study staff distributed a company-wide email announcement, via company email address, to all eligible employees. The message described the partnership, gave a brief description of the study, notified employees that a study staff member would contact them within two weeks and gave the option to call study staff in advance to opt out or enrol in the study. Staff followed a protocol of up to nine contact attempts (either by telephone or email) of each employee during the scheduling process. Following baseline data collection for consenting participants, worksites were paired and randomised to the intervention or control group according to time to study entry.

Demographics: Age: mean 42.9 years, range 18-75

Gender: 37.4% male

Marital status: 68.5% married or cohabiting

Race: 88.6% white, 2.1% Hispanic

InterventionsThe HealthWorks program. Participants were compensated $10 for completion of each measurement visit and $10 for completion of each survey.

Duration: Two years.

Intervention: Intervention components were primarily targeted at making changes at the worksite level:

  • Food environment: Baseline food data were used to determine targets for healthy food pricing and availability. Benchmarks for calorie smart food presence (i.e., 50% or greater) were determined from prior research and were communicated to worksites by intervention staff, primarily the lead interventionist who had extensive food service experience, who worked directly with site food managers and vending delivery drivers to facilitate changes. Targets were:


  1. To increase the availability of 'calorie smart foods' to at least 50% of all cafeteria and vending machine offerings, as defined based on guidelines from the California School Nutrition Association standards (http://www.calsna.org/) for healthy portion sizes, according to the following categories: entrée (e.g. meat, egg, large soup, vegetarian meat substitute; ≤ 500 calories), side dish (e.g. small soup, bread, potato, rice, vegetable; ≤ 250 calories), snack (e.g. chips, granola bar, yogurt; ≤ 150 calories), beverage (e.g. coffee, dairy drinks, fruit drinks, soda; ≤ 150 calories), desserts (e.g. cookies, pie, cakes, ice cream, sweet rolls; ≤ 200 calories), condiments (e.g. ketchup, salad dressing; ≤ 40 calories), and combination foods (e.g. packaged meals consisting of entrée and side dish, with or without beverage, for a reduced meal price; ≤ 750 calories).
  2. To reduce the price of calorie smart foods by 15% while increasing the price of non-calorie smart foods by 15%.
  3. To offer smaller portion sizes as substitutes (e.g. 12 oz. to replace 20 oz. soda).
  4. To label and promote calorie smart items at the point of purchase (e.g. table tents in cafeteria, posters near vending machines).


  • Physical activity environment: The primary aims of the activity environment intervention were to promote walking at work (via organized group walks, competition between co-workers, and activity monitoring) and to encourage stair use. Participants were provided with pedometers and access to a free online step tracking site http://www.americaonthemove.org for use throughout the intervention. Up to seven 6- to 8-week walking challenges were implemented, with input from study staff. Employees were grouped into competitive teams (self-selected or based on worksite units) and tracked step counts collected during challenge periods; other walks were staged around charitable giving events or fun activities at work (e.g. games played outdoors while walking). In addition, regular walking was encouraged as a means of meeting activity goals during the workday (e.g. by promotion of walking meetings, taking time from lunch to walk, or walking before or after shifts). Motivational signs, decorative posters, and music were placed in select stairwells to enhance the stair environment and promote use.


  • Body weight tracking environment: Weight scales, BMI charts and weight tracking forms were placed at four accessible yet private locations (e.g. restroom or break room) to promote knowledge of healthy weight parameters and self monitoring. Up to three weight tracking competitions, framed around maintaining current weight (e.g. during the winter holidays) were held to encourage social support.


  • Health media environment. In addition to placement of signs and posters previously mentioned, a two-page digital monthly newsletter was distributed via email for 24 months. The first page of the newsletter addressed general information related to healthy eating, activity, or other relevant behaviours with a section for site-specific information regarding upcoming events. The second page reported recent site-specific activities (e.g. competition results, co-worker testimonials).


  • Advisory panels: 8-11 worksite employees at each site, including the worksite liaison, were instituted as advisory panels and met every second month to provide guidance and ongoing feedback to study staff on planning, implementation, and acceptability of all intervention activities. Efforts were made to ensure that the advisory panel represented a cross-section of employee classifications and organisational units.


Control: No contact except to engage in evaluation procedures. Following the last round of data collection, control sites were offered a DVD containing intervention materials (e.g., poster templates, newsletter content, descriptions of intervention activity procedures) and an opportunity to ask questions of intervention staff as needed.

OutcomesPhysical activity:

  • Physical activity behaviours: online survey
  • Stair use: infrared beam sensor count


Anthropometrics:

  • Weight
  • Body mass index (BMI)
  • Percentage of participants overweight


Other outcomes not to be reported in this review:

  • Dietary intake: online survey
  • Weight awareness: frequency of self-weighing
  • Food inventory: available foods, price, portion size, and calories per portion.
  • Health media environment: presence of media (signs, posters, magazines, videos, etc.) related to eating, physical activity, or other health behaviours

NotesFull text article still awaiting assessment.

Imputation of missing data: Not reported or not undertaken by authors.

Adjustment for clustering: All data were analysed using mixed-model analysis of covariance (ANCOVA), assuming a Gaussian distribution of error terms. Models were estimated in SAS 9.2 using the PROC MIXED command. Treatment condition (intervention vs. control) was modelled as a fixed effect, with worksite included as a random effect and individuals clustered within worksites.

Sample size calculation: The primary outcome examined here was BMI change between baseline and follow-up; based on the known weight gain trajectory of free-living adults without intervention, the study was powered to detect a 1.5 kilogram difference in body weight between intervention vs. control sites at two years, accounting for approximately 15% attrition from worksites and adjusted for the worksite component of variance (80% power, P < 0.05, one-tailed).

Puhkala 2011

MethodsRandomised controlled trial

Aim: To study if modifications in diet and promotion of walking and sleep hygiene lead to weight loss and improved cardiometabolic health and alertness among obese long-distance drivers. In addition feasibility of the intervention was studied.

ParticipantsPopulation description: 113 truck and bus drivers.

Intervention group: 56 participants

Control group: 57 participants

Location: Unclear

Inclusion criteria: Without self-reported sleep apnoea or diabetes.

Recruitment: Unclear

Demographics: Age: range 30-62 years

Gender: 100% male

InterventionsDuration: 12 months

Intervention: Individual lifestyle counselling comprising of monthly face-to-face and telephone contacts with a dietician. Counselling is structured and based on a counselling manual. Control: Wait list control. After the intervention period, participants receive three-month telephone counselling during a second year (four times).

OutcomesAnthropometrics:

  • Weight: weight loss of 10%


Other outcomes not to be reported in this review:

  • Physical fitness: 2-km Walk Test
  • Health-related fitness
  • Occurrence of metabolic syndrome
  • Diet: food diary (3 days)
  • Sleep: 2-week sleep monitoring (Actiwatch) with sleep diary
  • Alertness
  • Feasibility: realization of counselling, participant responsiveness, applicability and patient safety

NotesAbstract only. Full length publications yet to be identified and assessed.

Thorndike 2012

MethodsRandomised controlled trial followed by combined intervention period for all participants

Aim: Unclear

ParticipantsPopulation description: 102 internal medicine residents

Intervention group: Unclear

Control group: Unclear

Location: Unclear

Inclusion criteria: Unclear

Recruitment: Unclear

Demographics: Age: mean 29 years

Gender: 46% male

InterventionsDuration: 12 weeks (first six week phase: RCT; second six-week phase: combined intervention for all participants)

Intervention: First phase: participants wore a monitor with visible feedback (steps, calories, activity level). Second phase: a team competition, in which all residents were unblinded and divided into three teams (interns, juniors, seniors) that competed on weekly steps. To increase compliance over 12 weeks, a weekly lottery of two $10 gift cards given among subjects who wore the monitor for at least five of seven days.

Control: First phase: participants wore a blinded monitor. Second phase: as for intervention group.

OutcomesPhysical activity:

  •  Steps per day


Other outcomes not to be reported in this review:

  • Compliance

NotesAbstract only. Full length publications yet to be identified and assessed.

Viester 2012

MethodsRandomised controlled trial

Aim: To systematically develop a tailored intervention for prevention and reduction of overweight and musculoskeletal disorders (MSD) among construction workers and to describe the evaluation study regarding its (cost)effectiveness

ParticipantsPopulation description: Blue collar construction and factory workers at a large construction company.

Intervention group: Unclear

Control group: Unclear

Location: The Netherlands

Inclusion criteria: Unclear

Recruitment: Conducted through the usual communication channels of the company at a non-compulsory Periodic Health Screening (PHS). Together with the invitation for the PHS, all workers will receive a brochure about the study, an informed consent form, and an additional questionnaire in order to measure baseline variables not included in the PHS.

Demographics: Unclear

InterventionsThe 'VIP in Construction' programme. An extensive development phase was conducted based on a preliminary survey and focus groups with a sample of workers, as well as theoretical models of behaviour change and a review of evidence on effective intervention models. An adoption and implementation plan was also developed to accomplish programme adoption and implementation by influencing behaviour of individuals who will make decisions about adopting and using the programme and the individuals who deliver the programme. This includes engagement of company human resources and management staff, and efforts to ensure compliance of participants, including communication via company channels and linking the programme to the company's existing PHS programme.

Duration: six months

Intervention: The intervention consisted of materials and tailored information on physical activity and diet, personal health coaching, and training instruction. Materials and coaching protocols were developed to be able to tailor the intervention to the individual risk factors and wishes of the participants based on baseline measurements and questionnaires.

  • Programme materials were made attractive and recognisable for the target group by using a standard lay-out and logo. The "VIP in Construction toolbox” consisted of tailored brochures, a calorie guide, a pedometer, a BMI card, waist circumference measuring tape, recipes, a knowledge test, an overview of the company health promoting facilities, PEP forms, and exercise card describing abdominal and dorsal strengthening and stabilisation exercises. It was intended that the exercises be performed three times a week and be easily fitted in daily life routines, performed at home without additional expense.
  • Personal Health Coaching (PHC) consisted of: 1) feedback on the participants' health screening and current lifestyle behaviour; 2) support for goal setting by helping participants to formulate a written personal motivation and action plan containing physical activities or healthy food choices or a combination, targeting behaviour that is not at the desired level, as well as providing information on the company’s health promoting activities and distributing the intervention materials; 3) feedback and evaluation of formulated goals during follow-up contacts, and discussion of possible barriers or new goals or both; 4) instructions for self-monitoring using the PEP forms and materials; 5) instructions how to use the exercise card. Participants were coached face-to-face at the first visit (60 minutes). Follow-up contacts (feedback and motivating) were conducted by telephone with a minimum of two and a maximum of four contacts (10 to 30 minutes), varying according to participants' stage of change. To ensure that a standardised protocol will be used by the PHCs, all coaches received a training session and a manual describing the protocol and goals in detail.


Control: Care as usual, including the PHS programme.

OutcomesPhysical activity:

  • Physical activity: energy output quantity and quality measured as: frequency of vigorous activities (PHS questionnaire); moderate physical activity (number of days per week activities performed, e.g. walking and cycling, for at least 30 mins); Short Questionnaire to Assess Health enhancing physical activity (SQUASH): validated, duration, frequency and intensity of different domains of physical activity (active work transportation, occupational physical activity, household activities, and leisure time activities) MET mins/week; accelerometry (random sample of participants (25 intervention, 25 control) over seven days).


Sedentary behaviour:

  • Sedentary behaviour: accelerometry (random sample of participants (25 intervention, 25 control) over seven days).


Anthropometrics:

  • Weight
  • Body mass index (BMI)
  • Waist circumference
  • Cardiovascular disease risk indicators: European Systematic Coronary Risk Evaluation (SCORE, based on smoking, systolic blood pressure, and blood cholesterol levels (either total cholesterol or the ratio total/HDL cholesterol)).


Other outcomes not to be reported in this review:

  • Musculoskeletal disorders: prevalence of regular pain or stiffness in upper and lower extremity regions (dichotomous scale (yes/no)); prevalence of MSD during the past three months for the different body regions (Dutch Musculoskeletal Questionnaire, validated), intensity of pain (Von Korff scales, average pain and worst pain experienced on an 11-point numerical scale (0-10)).
  • Dietary intake: energy intake quantity and quality measured as: alcohol consumption (PHS questionnaire, average glasses per week); portion size at dinner, number of beverages and slices of bread, consumption of energy dense snacks, average weekly intake and daily portions of several food groups during a usual week during the past month (questions also used in the Health under Construction study); fruit and vegetable consumption (Short Fruit and Vegetable questionnaire, validated, number of days per week and the number of daily servings of fruit, vegetables and fruit juice using five items on citrus fruit, other fruits, cooked vegetables, raw vegetables, and fruit juice).
  • Determinants of energy balance-related behaviour: knowledge, attitudes, self-efficacy and stage-of-change for physical activity and dietary behaviours.
  • Physical functioning: physical functioning, social functioning, role limitations (physical problem), role limitations (emotional problem), mental health, pain, general health perception, and health change (RAND-36, validated, Dutch version).
  • Fitness: non-exercise test estimation model including age, BMI, resting heart rate, and self-reported physical activity.
  • Workplace productivity loss: sickness absence (company a records), presenteeism (reduced productivity while at work, WHO Work Performance Questionnaire (WHO-HPQ) and PROductivity and DISease Questionnaire (PRODISQ).
  • Work ability: Work Ability Index
  • Work engagement, work satisfaction & vitality: vitality (Utrecht Engagement Scale (UWES, high levels of energy and resilience, the willingness to invest effort, not being easily fatigued and persistence in the face of difficulties); organisational commitment; work satisfaction.
  • Use of company facilities: use of company health promoting facilities (e.g. company sponsored fitness)
  • Cost: Intervention costs; other workplace health promotion costs (use of company facilities); health care costs (care by general practitioner, allied health care, medical specialist, complementary and alternative medicine, hospitalisation and medications based on three-monthly retrospective questionnaires. Dutch standard costs will be used to value services, or prices according to professional organisations if not available. Medication use will be valued using unit prices provided by the Dutch Society of Pharmacy); productivity-related costs (i.e. work absenteeism and presenteeism, salaries of the participants sued for the employer’s perspective, average salaries per gender and five-year age group used for the societal perspective); participant costs (self-reported costs related to sports activities (membership fees and sports equipment costs)).
  • Process outcomes: context, recruitment, reach, dose delivered, dose received, satisfaction about the intervention, and fidelity (RE-AIM framework; Steckler and Linnan framework).

NotesFull text article still awaiting assessment.

Imputation of missing data: Not reported/undertaken by authors.

Adjustment for clustering: Adjustment not required as participants were randomised individually.

Sample size calculation: Sample size was based on detecting a difference in change in body weight between the intervention and the control group. In each group (intervention and control) 130 participants will be needed, based on a power of 80% and an alpha of 5%, and an expected weight loss of 1.5 kg (SD 4.3 kg) as result of the intervention. The used standard deviation was subtracted from previous work from the same research group, studying construction workers. Taking into account a loss to follow-up of 20%, 324 workers should be included in this study.

 
Characteristics of ongoing studies [ordered by study ID]
Pillay 2012

Trial name or titleSteps that Count!

MethodsRandomised controlled trial

Aim: To investigate the effectiveness of a ten-week pedometer-based worksite health promotion programme (Steps that Count!) and individualised email-based feedback to effect physical activity behavioral change (protocol).

ParticipantsPopulation description: Employed adults, further description not reported.

Intervention group: Not reported.

Control group: Not reported.

Location: Selected worksite settings based in the province of KwaZulu-Natal, RSA, South Africa.

Inclusion criteria: Employees attending the wellness event and willing to participate were eligible if aged between 21 to 49 years; identified as being in the contemplation stage of the Transtheoretical Model towards improved physical activity; and who have a contract with their employer until end of the twelve-week measurement period. In addition, participants must not be pregnant; not be under diagnosis or treatment of cancer; not have any other condition that makes physical activity difficult or impossible; be non-compliant for three or more days during the pre-intervention blinded wearing of a pedometer.

Recruitment: To be undertaken through a Health Risk Appraisal available to all employees attending a corporate wellness event.

Demographics: Age: mean 32 (SD 8).

Gender: 50% male

InterventionsDuration: Three months

Intervention:

  • Participants will be encouraged to steadily increase their steps by approximately 10% per week until the target of at least 30 minutes of aerobic steps is achieved and maintained until the end of the intervention.
  • Un-blinded pedometer (Omron HJ 750 ITC), data to be uploaded bi-weekly.
  • Bi-weekly email: Individualised feedback will be given via a personalised email and will include information on the average daily steps accumulated; the number of days (if any) that aerobic steps were accumulated, and the volume thereof; the highest number of steps per day accumulated by the individual over the past two weeks; the category within which the average steps per day fall; general supportive and motivational messages; and a few strategies to achieve the step goals.


Control: No intervention received.

OutcomesPhysical activity :

  • Pedometer steps: Participants (intervention and control groups) to wear a blinded pedometer (Omron HJ 750 ITC), attached to the left or right hip during weeks one and twelve. Data will be downloaded electronically, and the pedometer output will be expressed as steps per day. Step counts will be classified as aerobic (at least 60 steps per minute, minimum duration of one minute) and non-aerobic (less than 60 steps per minute and less than one minute duration or both). Total time spent accumulating aerobic steps in minutes per day (aerobic time) and the number (in hours) of sedentary time will be calculated.


Anthropometrics : Specifics not reported

  • Body mass index (BMI)
  • Percentage body fat (%BF)
  • Waist circumference (WC)
  • Blood pressure: systolic and diastolic

Starting dateNot reported

Contact informationJulian David Pillay
UCT/MRC Research Unit for Exercise Science and Sports Medicine
Faculty of Health Sciences
University of Cape Town
Cape Town, South Africa
E-mail: pillayjd@dut.ac.za

NotesStatistical analysis:

Imputation of missing data: Not reported

Adjustment for clustering: Not reported

Sample size calculation: "A sample size of 30 participants per arm of the study is required to ensure 80% statistical power and with a p-value set at <0.05. However, if a modest improvement of 1500 steps/d is considered, a sample size of approximately 85 participants per arm is required. In order to achieve this, 1200 employees attending wellness events will be targeted. Of these, a minimum of 480 employees (40%) will be identified to be in the contemplation stage of the Transtheoretical Model"

Thøgersen-Ntoumani 2010

Trial name or titleStep by Step

MethodsRandomised controlled trial

Aim: To assess the feasibility and effectiveness of a 16-week lunchtime walking intervention to increase (and sustain) walking behaviour, improve general and work-related wellbeing, and enhance work performance levels in insufficiently physically active non-academic University employees.

ParticipantsPopulation description: Non-academic, insufficiently physically active adults employed full-time at a large University.

Intervention group: 35 participants

Control group: 40 participants

Location: West Midlands, UK.

Inclusion criteria: Healthy, mobile, 18- to 65-year-old, full-time employees (non-academic), engaging in less than 30 minutes of moderate intensity physical activity on five days per week (i.e. insufficiently physically active), with no significant auditory or visual problems and no severe musculoskeletal disorders that prevent them from engaging in physical activity. Medical clearance was requested for those who reported any cardiovascular disease or back pain preventing them from exercising.

Recruitment:

  • Open stall in a one-day health fair taking place at the University; collected email addresses and sent a link to an online survey;
  • Staff University newspaper;
  • Brief messages on the back of all staff pay-slips;
  • Brief messages on electronic totems (information stands) at  the main University campus;
  • University-wide electronic newsletters and departmental newsletters;
  • Posters and flyers at targeted University locations (e.g., refectories, staff bar, main administrative centre of the University);
  • University induction sessions for new staff;
  • University web-based information portal for all employees;
  • Website targeted to interested participants.


Demographics: Age: range 18 - 65 years.

InterventionsDuration: Four months (10-week intervention phase followed by a six-week independence phase).

Intervention: Designed using an autonomy supportive exercise leader style and to meet national recommendations of 150 minutes per week of physical activity.

1. Professional contact or counselling

  • 10-week intervention phase: 3 x 30 minutes per week group lunchtime walks, facilitated by a nationally qualified walk leader (e.g. already walk leader-trained by nationally recognised organisations, such as Natural England), maximum 12 participants per group. Registration required through doodle via website with days (Mondays to Thursdays) and times (12.30 or 1.15 pm) offered. Different route for each of these walks had been mapped and could be viewed through the website.
  • Six-week independence phase: participants were encouraged to form informal walk groups.
  • Six-week independence phase: encouraged to make use of the walk routes they had been made aware of during the 10-week phase, as well as explore new ones.
  • Six-week independence phase: encouraged to contact the research team if they needed.


2. Goal setting

  • 10-week intervention phase: Challenge to accumulate 60 minutes of walking during the week-ends.
  • 10-week intervention phase: Pedometers (style Yamax Digi-Walker 351) the week prior to the start of the intervention.
  • 10-week intervention phase: A motivational booklet; educational information about adoption and maintenance of physical activity (e.g. identifying or countering barriers and goal-setting principles); "Am I on track?" table; logbook; record of participants' personal reasons for walking; record of favourite walks; new places or areas to walk.


3. Personal web page

4. Environmental prompts

  • 10-week intervention phase: Two per week autonomy-supportive text messages (times were randomly allocated) were sent to the participants via a smart phone (Nokia 2730 Classic). Self-Determination Theory principles (e.g. offering choice, supporting individual volition, minimising pressure and control, acknowledging participants' perspectives and feelings, and providing a meaningful rationale for engaging in walking) informed the tone.
  • Six-week independence phase: Three per week autonomy-supportive text messages (times were randomly allocated). Self-Determination Theory principles (e.g. offering choice, supporting individual volition, minimising pressure and control, acknowledging participants' perspectives and feelings, and providing a meaningful rationale for engaging in walking) informed the tone.


Control: Received intervention at 10 weeks (delayed treatment control group). No intervention received during control period and were asked to continue their usual behaviours. They knew that they would be contacted in a few months regarding the start of their programme. smart phones received at the beginning of their control period, but no text messages, as the phones were also used as a monitoring tool to survey work-related wellbeing.

OutcomesPhysical activity : administered via internal post self report questionnaire at baseline and four months

  • International Physical Activity Questionnaire (IPAQ) short form. Continuous or categorical. Hourly participation each week in activities rated according to multiples of metabolic equivalent task units (METS). Reliability and criterion validity judged against accelerometry is comparable to other self report measures.


Quality of Life: administered via internal post self report questionnaire at baseline and 16 weeks.

  • Current health perceptions: One item from the MOS SF-36.
  • Satisfaction With Life Scale
  • Subjective Vitality scale
  • Positive and Negative Affect Schedule


Other outcomes not reported in this review:

  • Two kilometre field-based walking tests: "participants were instructed to walk 2 km (e.g. five laps) on an outdoor 400 metre track as fast as they could with a steady pace. After each lap, participants were provided prompts on the number of laps left to be completed."
  • Work-related well-being scales (administered via internal post self-report questionnaire at baseline, 16 weeks and four months): a job satisfaction scale, the Job Affect Scale (participants rate their levels of affect during the past week, which can be categorised into four factors: enthusiasm, relaxation, nervousness and fatigue at work), a 16-item instrument developed specifically for the present study (participants rate their own levels of work quality in the past four weeks), overall perceptions of work performance (one item regarding the past four weeks taken from the WHO-HPQ).
  • Manager-rated scales (administered at baseline and at 16 weeks): manager-rated work quality, managers' views WHO-HPQ (work quality in the previous four weeks), three most important characteristics of the employee's job(s) and subsequent rating of the employee on those characteristics (qualitative).
  • Smart phone 'real time' questionnaire: a momentary, real time work-related affect which was administered via a smart phone. The Job Affect Scale and a single question relating to perceived daily work load was administered twice weekly.
  • Work Extrinsic and Intrinsic Motivation Scale

Starting dateResults were expected in January 2011.

Contact informationDr Cecilie Thøgersen-Ntoumani

School of Sport and Exercise Sciences
University of Birmingham, United Kingdom

E-mail c.thogersen@bham.ac.uk

NotesStatistical analysis:

Imputation of missing data: Not reported

Adjustment for clustering: Adjustment not required as participants were randomised individually.

Sample size calculation: "This was a feasibility trial as specified by the MRC guidelines for designing complex interventions. Consequently the sample size was determined by a consideration of the results of King, Ahn, Oliveira, Atienza, Castro, and Gardner who reported a large effect of an 8-week physical activity intervention on minutes per week in moderate intensity physical activity. We also consulted the corporate partner to confirm a realistic target number for a feasibility study. Thus, we aimed to recruit a total sample of 68 participants given an effect size of d = .70, statistical power of 80% at a significance level of 5%, with a potential loss to follow up of 25%."

Notes:

"This work was supported by The BUPA Foundation (grant number TBF08004)." Authors stated no competing interests.

 
Comparison 1. Pedometer programme vs 'no intervention' control

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 CVD risk factor: Body Mass Index (BMI; kg/m²)2197Mean Difference (IV, Random, 95% CI)-0.92 [-1.82, -0.02]

 2 CVD risk factor: Waist circumference (cm)2196Mean Difference (IV, Random, 95% CI)-3.35 [-8.34, 1.65]

 3 CVD risk factor: Systolic blood pressure (mmHg)2197Mean Difference (IV, Random, 95% CI)-3.11 [-8.39, 2.17]

 4 CVD risk factor: Diastolic blood pressure (mmHg)2197Mean Difference (IV, Random, 95% CI)-1.14 [-3.45, 1.16]

 
Summary of findings for the main comparison. Workplace pedometer programs compared to 'no intervention' control for increasing physical activity

Workplace pedometer programmes compared to 'no intervention' control for increasing physical activity

Patient or population: Employees
Settings: In the workplace
Intervention: Workplace pedometer programmes
Comparison: No intervention

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

No interventionWorkplace pedometer programs

Physical activity
Follow-up: 3 - 4 months
See commentSee commentNot estimable1045
(3 studies)
⊕⊝⊝⊝
very low1,2,3,4,5,6,7
Studies used different measures and consequently their results could not be combined in meta-analysis. One study found pedometer programmes significantly increased activity; two others found no effect.

Sedentary behaviour - not measuredSee commentSee commentNot estimable-See commentNone of the included studies measured this outcome.

Body Mass Index (BMI)
(CVD and diabetes risk factor)
Follow-up: 3 - 4 months
The median change in BMI in the control groups was
-0.8 kg/m²
The mean BMI in the intervention groups was
0.92 lower
(1.82 to 0.02 lower)
197
(2 studies)
⊕⊝⊝⊝
very low2,5,8,9,10,11

Systolic blood pressure
(CVD and diabetes risk factor)
Follow-up: 3 - 4 months
The median change in systolic blood pressure in the control groups was
-1.05 mmHg
The mean systolic blood pressure in the intervention groups was
3.11 lower
(8.39 lower to 2.17 higher)
197
(2 studies)
⊕⊕⊝⊝
low2,5,8,11,12

Low-density lipid (LDL) cholesterol
(CVD and diabetes risk factor)
Follow-up: 4 months
The mean change in LDL cholesterol in the control group was
-2.2 mg/dL
The mean LDL cholesterol in the intervention group was
3.60 lower
(11.78 lower to 4.58 higher)
83
(1 study)
⊕⊕⊝⊝
low2,5,8,10,11

Quality of life
SF-12 physical component. Scale from: 0 to 100.
Follow-up: 3 months
The mean quality of life in the control group was
50.7 points
The mean quality of life in the intervention group was
2.80 higher
(0.24 lower to 5.84 higher)
110
(1 study)
⊕⊕⊕⊝
moderate2,10,11,13,14
Higher scores on the SF-12 scale indicate better quality of life.

Worksite injuries
(Adverse effects)
Follow-up: 12 months
The mean number of worksite injuries in the control group was
0.4 injuries per person
The mean number of worksite injuries in the intervention group was
0.30 lower
(0.52 to 0.08 lower)
110
(1 study)
⊕⊕⊕⊝
moderate2,11,13,14

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 Allocation concealment was unclear for one study. The study was also at additional risk of selection bias during recruitment, as the allocation of clusters to the intervention or control group was known at the time of individual recruitment.
2 No study successfully blinded participants and personnel. All studies had high levels of incomplete outcome data.
3 Two studies did not use blinded or objective outcome assessment for this outcome.
4 Two studies could not be assessed for selective outcome reporting as protocols were not available.
5 One study had substantial baseline imbalance in levels of physical activity.
6 One study found a significant benefit for the pedometer programme, while the other two found no significant effect. These results could not be combined via meta-analysis or directly compared due to the use of different measures of physical activity.
7 The results of the studies encompassed a range of effects including the possibility of both benefit and harm from pedometer programmes.
8 One study could not be assessed for selective outcome reporting as the protocol was not available.
9 Heterogeneity between studies was high (I² = 89%).
10 The results of the studies encompassed a range of effects including the possibility of either a clinically significant benefit or a negligible effect for pedometer programmes.
11 The overall sample size for this outcome is small.
12 This result does not encompass either a clinically significant improvement or harm.
13 This study did not use blinded or objective outcome assessment for this outcome.
14 Despite issues noted, we judged this study to be overall at low risk of bias.
 
Summary of findings 2. Workplace pedometer programmes vs alternative physical activity programme

Workplace pedometer programmes vs alternative physical activity programme

Patient or population: Employees
Settings: In the workplace
Intervention: Workplace pedometer programmes
Comparison: Alternative physical activity programmes

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

Alternative physical activity programsWorkplace pedometer programmes

Physical activity
Pedometer steps per week
Follow-up: six months
The mean physical activity in the control group was
7478 steps
The mean physical activity in the intervention groups was
224 higher
(954.79 lower to 1402.79 higher)
94
(1 study)
⊕⊕⊝⊝
low1,2,3,4

Sedentary behaviour - not measuredSee commentSee commentNot estimable-See commentThe included study did not measure this outcome.

Body Mass Index
(CVD and diabetes risk factor)
Follow-up: six months
The mean body mass index in the control group was
29.8 kg/m²
The mean body mass index in the intervention groups was
1.10 lower
(2.86 lower to 0.66 higher)
94
(1 study)
⊕⊕⊝⊝
low1,4,5

Systolic blood pressure
(CVD and diabetes risk factor)
Follow-up: six months
The mean systolic blood pressure in the control group was
124.5 mmHg
The mean systolic blood pressure in the intervention groups was
4.00 lower
(10.15 lower to 2.15 higher)
94
(1 study)
⊕⊕⊝⊝
low1,4,5

Low-density lipid (LDL) cholesterol
(CVD and diabetes risk factor)
Follow-up: six months
The mean LDL cholesterol in the control group was
112.6 mg/dL
The mean LDL cholesterol in the intervention groups was
0.60 higher
(15.08 lower to 16.28 higher)
94
(1 study)
⊕⊕⊝⊝
low1,3,4

Quality of life - not measuredSee commentSee commentNot estimable-See commentThe included study did not measure this outcome.

Adverse effects - not measuredSee commentSee commentNot estimable-See commentThe included study did not measure this outcome.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1 Random sequence generation and allocation concealment were unclear. The study did not successfully blind participants or personnel and had a high level of incomplete outcome data. Some planned outcome measures were not reported but the risk of bias was unclear as those reported included a mix of significant and nonsignificant results. The study had important baseline imbalances making the results difficult to interpret.
2 The study did not use blinded or objective outcome assessment for this outcome.
3 This result encompasses a range of possible effects including both significant benefit and harm.
4 The sample size for this outcome is small.
5 This result encompasses a range of possible outcomes including both significant improvement and negligible harm.