Healthy Steps Trial: Pedometer-Based Advice and Physical Activity for Low-Active Older Adults

Gregory S. Kolt; Grant M. Schofield; Ngaire Kerse; Nicholas Garrett; Toni Ashton; Asmita Patel

doi:10.1370/afm.1345

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Figure 1
Flow of participants through each stage of the Healthy Steps trial.

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Table 1

Patient Characteristics at Baseline (N = 330)

Characteristic	Standard Green Prescription Group (n=165)	Pedometer-Based Green Prescription Group (n=165)	P Value^a
Age, mean (SD), y	73.9 (5.9)	74.3 (6.2)	.62
Couples, No.	16	15	–
Female, No. (%)	92 (55.8)	86 (52.1)	.51
New Zealand European, No. (%)	162 (98.2)	158 (95.8)	.10
Married or living with partner, No. (%)	101 (61.2)	108 (65.5)	.42
Education, No. (%)
No qualification	43 (26.1)	42 (25.4)	.89
High school qualification	33 (20.0)	30 (18.2)
Post–high school qualification	89 (53.9)	93 (56.4)
Retired, No. (%)	129 (78.2)	130 (80.3)	.65
Clinic, No. (%)			.44
Clinic 1	62 (37.6)	64 (38.8)
Clinic 2	6 (3.6)	13 (7.9)
Clinic 3	25 (15.2)	23 (13.9)
Clinic 4	6 (3.6)	5 (3.0)
Clinic 5	7 (4.2)	5 (3.0)
Clinic 6	11 (6.7)	13 (7.9)
Clinic 7	24 (14.6)	14 (8.5)
Clinic 8	12 (7.3)	8 (4.9)
Clinic 9	2 (1.2)	5 (3.0)
Clinic 10	10 (6.1)	15 (9.1)
Taking medications for heart conditions/ hypertension, No. (%)	66 (40.0)	75 (34.4)	.32
Own and use an auto-mobile, No. (%)	148 (89.7)	156 (94.6)	.10

↵a The test was a t test for age and a χ² test for other characteristics.

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Table 2

Measures of Physical Activity and Other Outcomes by Group and Time Point

		Time Point, Adjusted Mean (95% CI)			P Value

Measure	Group^a	Baseline	3 Months	12 Months	Time	Group	Time × Group
Leisure activity, min/wk
Total^b	S	92.5 (74.6–114.8)	146.3 (120.2–178.0)	147.1 (115.0–188.3)	<.001	.78	.13
Total^b	P	80.6 (63.6–102.0)	168.9 (139.4–204.8)	160.4 (125.1–205.6)	<.001	.78	.13
Moderate^b	S	69.9 (53.8–90.8)	111.4 (88.2–127.3)	99.4 (76.0–130.1)	<.001	.98	.16
Moderate^b	P	56.4 (43.4–75.5)	121.2 (93.6–157.0)	114.2 (87.4–149.3)	<.001	.98	.16
Walking^b	S	61.3 (47.2–79.6)	92.2 (73.4–116.0)	89.4 (64.5–123.9)	<.001	.70	.03
Walking^b	P	43.4 (32.7–57.7)	107.4 (82.7–139.4)	94.0 (72.0–122.7)	<.001	.70	.03
Total walking activity,^b min/wk	S	81.5 (64.2–103.6)	106.1 (87.4–129.0)	143.0 (114.0–179.3)	<.001	.27	.12
Total walking activity,^b min/wk	P	57.0 (44.3–73.3)	109.9 (87.9–137.6)	139.0 (112.0–172.5)	<.001	.27	.12
BMI, kg/m²	S	26.4 (25.7–27.2)	26.3 (25.6–27.0)	26.4 (25.6–27.1)	.06	.13	.11
BMI, kg/m²	P	27.2 (26.4–28.0)	27.2 (26.3–28.0)	27.0 (26.2–27.8)	.06	.13	.11
Blood pressure, mm Hg
Systolic	S	145.8 (140.4–151.3)	133.4 (128.6–138.1)	136.7 (132.0–141.4)	<.001	.41	.98
Systolic	P	144.2 (138.6–149.9)	131.9 (127.1–136.7)	134.8 (130.1–139.5)	<.001	.41	.98
Diastolic	S	82.4 (79.6–85.3)	76.8 (74.3–79.4)	78.8 (76.2–81.4)	<.001	.73	.55
Diastolic	P	83.5 (80.5–86.5)	77.4 (75.0–79.9)	78.3 (75.8–80.8)	<.001	.73	.55
Short Physical Performance Battery	S	8.5 (8.1–9.0)	8.5 (8.0–9.0)	8.5 (8.0–9.0)	.25	.97	.17
Short Physical Performance Battery	P	8.3 (7.8–8.8)	8.3 (7.8–8.8)	8.8 (8.4–9.3)	.25	.97	.17
SF-36 scale
Physical functioning	S	73.1 (69.5–76.7)	76.1 (72.6–79.6)	78.4 (74.8–81.9)	<.001	.22	.83
Physical functioning	P	71.2 (67.4–75.1)	73.7 (70.1–77.3)	75.3 (71.7–79.0)	<.001	.22	.83
General health	S	72.6 (69.8–75.4)	77.1 (74.3–79.8)	80.1 (77.5–82.7)	<.001	.93	.19
General health	P	73.9 (71.0–76.9)	76.7 (73.9–79.4)	78.7 (75.9–81.6)	<.001	.93	.19
Vitality	S	64.7 (61.8–67.7)	66.8 (63.8–69.7)	70.6 (67.8–73.4)	<.001	.85	.66
Vitality	P	64.4 (61.1–67.6)	68.0 (65.0–71.0)	70.6 (67.8–73.3)	<.001	.85	.66
Mental health	S	82.7 (80.5–84.9)	85.4 (83.3–87.4)	87.0 (85.2–88.7)	<.001	.50	.93
Mental health	P	82.2 (79.6–84.8)	84.7 (82.4–86.9)	86.0 (83.8–88.1)	<.001	.50	.93

BMI = body mass index; SF-36 = the 36-Item Short Form Health Survey.
Notes: Repeated measures Generalized Estimating Equation model adjusted for age, sex, partner, education, occurrence of health or other events since baseline, and clustered by physician and couple. Blood pressure also adjusted for medications and change in medications for heart conditions or hypertension. The Short Physical Performance Battery scores range from 0 to 12; higher score indicates better function. The SF-36 scales scores range from 0 to 100; higher score indicates better health-related quality of life.
↵a S = standard Green Prescription group; P = pedometer-based Green Prescription group.
↵b The 4 measures of physical activity are nonexclusive.

The Article in Brief

Gregory S. Kolt , and colleagues

Background In New Zealand, the Green Prescription is a nationally supported intervention to increase physical activity, encouraging participants to take part in 30 minutes of moderate activity per day. This study compares the effectiveness of a pedometer-based Green Prescription with the current time-based program.

What This Study Found A recommendation for physical activity with pedometer monitoring results in a greater increase in leisure walking among older adults than a Green Prescription that relies only on time-based goals. Among 330 older adults with low levels of physical activity, leisure walking increased by 50 minutes a week among the pedometer-based Green Prescription group compared with 28 minutes a week among the standard Green Prescription group. For both groups, there were significant increases in physical activity that were largely maintained throughout the 12-month study period. Body mass index did not change in either group, but significant improvements in blood pressure were observed for both groups.

Implications

Pedometers may improve the efficacy of the activity prescription by providing regular objective monitoring and feedback to assist motivation.