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

Sirkka Keinänen-Kiukaanniemi

University the Oulu, Oulu college Hospital and also Health centre of Oulu, Finland


Corresponding author.

You are watching: Discuss how the use of pedometers benefited people at high risk for type 2 diabetes. (site 1)


Introduction

A pedometer helps adult exercise more, yet sedentary adults need instruction and advice come be motivated to use one. We performed this qualitative study to describe the experience of participants at high risk of kind 2 diabetes who started using a pedometer.


Methods

A total of 74 people at high risk of form 2 diabetes participated in 6 month of team counseling. Native April 2007 to April 2008, we built up data v questionnaires, template interviews (n = 22) and video clip recordings of counseling sessions. Indigenous October 2007 through June 2008, us analyzed the data.


Results

Pedometers were beneficial tools because that observing level of exercise, setting an individual goals for walking, and helping advice whether everyday goals were met. An adverse experiences were linked with sensible failures, pedometers" unsuitability for exercise various other than walking, and the score of 10,000 steps, which part participants considered too high.


Conclusions

Sedentary adults can be encouraged to use a pedometer if we notify them that consistent users discover it a useful instrument for boosting their level that exercise. These adult should collection realistic goals for walking and also receive adequate instructions for utilizing pedometers.


Introduction

Pedometers screen the number of steps taken in a day (1,2). The usage of a pedometer has actually been displayed to rise physical activity among sedentary populations (3-7). Go is great way for many inactive civilization to start regular exercise (8). The Finnish Diabetes prevention Study demonstrated that civilization at high threat of form 2 diabetes who walked 2.5 hours or more per week were 63% come 69% less likely to build diabetes 보다 were those that walked less than 1 hour every week (9). Constant exercise have the right to prevent kind 2 diabetes (10-13).

Although using a pedometer seems to motivate civilization to exercise more (14,15), we execute not know just how to motivate people to use one. Knowledge of the experiences of inactive adult who have actually used a pedometer boosts the performance of counseling, but couple of previous studies on this concern exist (2,14). We define the experiences of a group of sedentary adults at high hazard of kind 2 diabetes who started using a pedometer, in specific the determinants that encouraged or discouraged continual exercise.


Methods


Study design

We performed a follow-up study of 74 people at high hazard of form 2 diabetes. Five videoconferencing and also 6 face-to-face teams were organized (5-9 attendees in every group). The attendees of the videoconferencing teams gathered in the conference room of the health care center at their place of residence (5 teams in 4 localities) 80 to 100 kilometres from the counselor, who remained in a city in north Finland. In face-to-face groups, the counselor and participants to be in the same room in the city. They participated in the 6-month team counseling process, which contained five 90-minute team sessions, four at 2-week intervals and the fifth at 6 month from baseline. The participants completed a questionnaire, and also blood samples were taken in ~ baseline and also at 6 months. Data were built up from April 2007 v April 2008 and analyzed indigenous October 2007 with June 2008. The examine was approved by the values committee of the Hospital district of Helsinki and also Uusimaa.


Study participants

A complete of 74 civilization (33 men and 41 women, mean period 49 years) in ~ high danger of type 2 diabetes to be recruited from work-related or major health treatment by nurses and also doctors. Nurses or physicians interviewed world at high threat of form 2 diabetes that were eligible come take part in this counseling study if they to be motivated and also fulfilled the consist of criteria. The participants had to be ready to participate; they had to score 15 clues or much more in the diabetes danger test score (16) or 12 clues if they had actually a danger of work handicap as assessed through an work-related nurse or doctor or if they had had one elevated fasting blood glucose level or one impaired glucose yongin test an outcome during the last 12 months. Human being with poor control that depression or who were acquisition medication for various other mental difficulties or those through severe situations in their life were excluded. Participants received oral and written info on the study, and also they gave their composed consent. The counselor repeated the information at the beginning of counseling, and participants agreed come confidentiality.


Content of exercise intervention

A clinical nutritionist detailed counseling in 55 team sessions. The practice intervention comprised a minor component of the team counseling. The as whole aim of the counseling was to enhance the participants" an abilities and services for managing their eating and body weight and to boost their level that exercise. In addition, information around health behavior that deserve to prevent type 2 diabetes was provided. The counselor educated the group about the results of the Finnish Diabetes prevention Study, which uncovered that kind 2 diabetes can be prevent through way of living changes. The counselor defined the reasons behind the positive effect of practice on metabolism. In ~ the first group session, the counselor presented each participant with an Omron Walking format II pedometer (OMRON Corporation, Kyoto, Japan). Prior to the 4th session, the participants to be asked to perform voluntary homework related to exercise. They were asked to exercise through a family members member or friend and also to document the time spent on exercise and the variety of steps taken throughout the week. The 4th session started with pair discussions concerning homework: go they exercise v a friend or a household member? exactly how much walk they exercise throughout last week? What kind of day consisted of 10,000 steps? How can an exercise diary aid one to change exercise habits? In addition, throughout every team session, the participants began several discussions around exercise.


Level the exercise

The level of exercise was report in means and 95% confidence intervals the weekly energy expenditure in the metabolic tantamount task-hours (MET-hours). We derived data on exercise level by utilizing a questionnaire that participants perfect at baseline and at 6 months. Structured questions about frequency (a 6-point range from when a month or more rarely, to daily) and also duration (a 6-point range from 0 to much more than 1.5 hours) of light (3 together a MET coefficient) and moderate to vigorous exercise (6 together a MET coefficient) were contained in a questionnaire. MET-hours were additionally calculated (17). Due to the fact that of nonresponse for part items the the MET-hour questions, MET-hours might be calculation for just 54 participants at both 0 and at 6 months. In ~ the 6-month follow-up, the frequency of using a pedometer and also its results on the level of exercise were also included in the questionnaire.

The paired samples t test was offered to check the definition of the change in MET-hours between 0 and also 6 months, whereas a t test for independent samples or analysis of variance was provided to check the distinction in MET-hours between groups. The analyses to be performed by making use of SPSS version 15.0 (SPSS, Inc, Chicago, Illinois). The variety of steps taken was not easily accessible for the analyses because pedometers were given throughout the first counseling session, and baseline info was gathered before the an initial group session.


Data on experience of pedometer use

The qualitative data ~ above the experiences were gathered indigenous 22 theme interviews and also 54 video-recorded group counseling sessions. Discussions top top participants" experiences through using a pedometer during group counseling sessions (n = 54) to be sampled from the video-recordings (81.5 hours). Discussions and individual statements were transcribed verbatim.

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

We analyzed the qualitative data through inductive content analysis (18,19) with the help of QSR NVivo version 7 (QSR global Pty Ltd, Melbourne, Australia) (20). First, every statements top top experiences using the pedometer were sampled from the video-recording and also transcribed interviews. Second, we check out transcripts and also watched the videotapes numerous times. Third, us extracted important statements native the text. Finally, statements v the same an interpretation were grouped right into subcategories and also main categories, i beg your pardon were named according to your content.


Results

Participants" level the exercise differed by demographic characteristics. The level of practice was low at the beginning but increased substantially from 0 to 6 months. Typical levels the exercise between the videoconferencing group and face-to-face group did not differ at baseline or at 6 months, and also thus, the teams were an unified in more analyses. The the participants (n = 74) who responded come a question around frequency that pedometer use, 46% reported utilizing the pedometer consistently at least once per week,  and also their MET-hours increased considerably during the 6-month follow-up (P = .02).

At 6 months, average MET-hours for consistent users and those who used the pedometer sometimes or no at every (P = .005) were substantially different. No far-ranging sex difference in making use of the pedometer existed. The the participants, 36% claimed that using the pedometer had actually increased your level of exercise. Their MET-hours increased substantially after 6 months (P = .01), and their typical MET-hours were considerably (P < 0.001) higher than those of participants that reported that using the pedometer had not boosted their level of exercise at 6 months.

We existing the results from qualitative data evaluation by key categories, subcategories, and by making use of the participants" very own remarks as instances (Appendix).


Discussion

This study describes the experience of inactive participants in ~ high risk of kind 2 diabetes who supplied a pedometer throughout a 6-month group counseling process to promote lifestyle changes. Participants saw the pedometer together a source of feedback on your exercise. It listed immediate feedback on the lot of practice in steps, aerobic procedures (>60 steps/minute), kilometers, wade time, and also calories. By surveillance their walking, the participants listed improvements in your physical capacity, i m sorry in turn encouraged them to exercise more. Some participants particularly monitored the measures taken throughout a workday, and also many to be surprised through the low number of steps recorded.

Using the pedometer made it easier to set an individual exercise goals. These goals had increasing the quantity of exercise, working out regularly, and also exercising daily. Some participants do the efforts to rise the number of steps taken per day, conversely, others sought the goal of a minimum the 10,000 steps daily. Making use of the pedometer helped world exercise much more regularly. Much more active entrants were encouraged to more increase their exercise. Participants discovered that achieving a certain variety of steps make them want to increase their goal. The pedometer motivated sedentary human being to exercise more.

The pedometer to be not proper for all. Part were disappointed since of technological problems. Moreover, the 10,000-step referral for daily exercise was taken into consideration too complicated to achieve. In this cases, the pedometer did not increase an inspiration to exercise. Several arguments can motivate inactive adult to usage a pedometer. First, making use of the pedometer helps world monitor their very own level of exercise easily, set goals, and also track their progress. Second, to avoid negative experiences, users might be taught to use the pedometer correctly. Third, a proportional boost in the number of steps as a personal daily goal must be questioned to prevent the disappointment of not reaching the an overwhelming target of 10,000 steps.

Good indict for making use of the pedometer space essential because functional errors to be a obstacle to that use. The effects of the pedometer"s useful errors top top the physical task of individuals were previously uncertain (21). Only a few negative experiences through using a pedometer developed during team sessions and also theme interviews, although less than fifty percent of the attendees (46%) supplied the pedometer frequently at the finish of the process. Others might not have been encouraged to highlight an adverse experiences, might have had actually a neutral attitude, or might not have used a pedometer in ~ all, and thus had no negative experiences to report.

A limitation that this study frequently seen in qualitative researches is the tiny sample size, which stays clear of the results from being applicable to every exercisers. One more limitation is that we were no able to usage objective procedures of physics activity. Part participants to be inactive also at 6 months, return they might have overreported your level of practice on the questionnaires (22). Us based the main study results on qualitative data gathered by videorecordings from team sessions and also by layout interviews, which boosted the border of the data. The atmosphere during counseling sessions and also interviews to be relaxed, and participants knew that all conversations to be confidential. During group sessions, everyone had actually the possibility to take part in the discussion and to to express opinions, experiences, and feelings, although part were quiet. Qualitative evaluation has been defined as accurately as possible. Plenty of situation-specific factors likewise influenced team discussions (eg, age and sex the participants, the counselor"s role, group kind , the contents of the intervention, and also the counseling methods). These factors have been documented and taken into account in the interpretation of results. Nevertheless, positive experiences might be exaggerated.

Experiences through using the pedometer were mainly positive. The pedometer promoted exercise and was considered effortless, easy to use, and also its attributes were easily adopted. The pedometer aided participants save track of your amount of exercise and find instances in which that was simpler to acquire the required number of steps and situations in which it was basic to increase the variety of daily steps.


Experiences v Pedometer as supporting Physical Activity
Positive experiences making use of the pedometer"You just put that in your pocket in the morning and also take it the end in the night — That"s all! At least that"s just how I have done it.""After I an initial hung the pedometer roughly my neck, only 1 job went by there is no me using it, when we attend a wedding. . . . My an initial reaction was shock that the number of steps ns take to be so small. . . . Nowadays I control 7,000 to 10,000 actions every day. I just will no tolerate less than 7,000 actions for any type of day.""I can inspect the an outcome at any kind of time, and also not getting sufficient steps can make me pretty upset. The pedometer is like a silent motivator. . . . It makes me exercise." Feedback on an individual physical activity"You have the right to see your level the exercise. It motivates you to preserve the very same level.""The pedometer shows you concrete results."Increasing the objectives for physics activity"I believed I was taking much more steps everyday than i really was. In truth it was much less. . . . It to be a an excellent wake-up speak to for me: I must walk lot more.""The pedometer is just excellent. You feel favor every work you want to have the ability to take much more steps."Motivation to rise exercise"My work is rather physical: during a working day ns walk around 7,000 come 9,000 steps. . . . Many thanks to the pedometer and also the referrals we acquired . . . I have started walking additionally on weekends and also jogging in the pool on Thursday evenings.""It is just a program that I have to learn in mine life. Ns count steps and write down the number. . . . It offers me a new interest in exercising. As soon as you have internalized it, going because that a walk becomes a an ext positive experience."A beneficial tool because that observing an individual physical activity"I provided the pedometer because that a entirety week at work. I had the pedometer at my waist. During the entirety work job it counts something favor 3,400 to 8,600 steps depending upon what kind of job it is. Yesterday I had actually a busy day, and also it counted 8,600 steps. I unloaded one cargo and also loaded one more one — walked roughly the car quite a few times.""Fortunately there to be a bed alongside me . . . I virtually fainted when I saw the numbers: so couple of steps!""Without the pedometer it would be daunting to evaluate the variety of steps.""If i don"t specifically go for a walk, I gain less 보다 3,000 procedures per day. The pedometer is a good tool for me due to the fact that it reminds me come walk for a longer time, if i don"t have sufficient steps. . . . That"s its key significance for me, really." 
Experiences of Pedometer as Unsuitable Instrument
Unsuitability that pedometer for various other exercise than walking"I beat football and also volleyball, and also I need to take turn off the pedometer so it does no break."Negative experiences (technical errors) on using the pedometer"Just a few steps . . . It has actually errors . . . The goes come zero.""I can"t usage the pedometer. . . . You"ve gained to stomp so greatly to get it to react. . . . I simply can"t walk like that. I realized that the numbers were simply not make sense. . . . After the I have just preserved it ~ above the table. Ns can"t usage it."The goal of 10,000 actions per day is too high"I should manage 2,000 steps more every day. . . . It"s as well demanding because that me. . . .Sometimes it can be an extremely hard work obtaining that 2,000 steps during the day. . . And also I should obtain still more.""Ten thousand measures is difficult for a human being in sedentary work.""Ten thousand is just too high. . . . I"m not going to use that as my goal. . . . It"s as well stressful."Person walk not want to use pedometer at all"Think about it! would you have any type of interest in using a pedometer if friend didn"t walk in ~ all? Why measure simply a few steps?"

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