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Steps that count: Pedometer-measured physical activity, self-reported
physical activity and current guidelines- how do they relate?
Article in South African Sports Medicine Association · October 2014
DOI: 10.7196/sajsm.534
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ORIGINAL RESEARCH
Steps that count: Pedometer-measured physical activity, self-
reported physical activity and current physical guidelines ‒
how do they relate?
J D Pillay,1,2 PhD; T L Kolbe-Alexander,1 PhD; K I Proper,3 PhD; S A Tomaz,1 MPhil; W van Mechelen,3 PhD; E V Lambert,1 PhD
1
UCT/MRC Exercise Science and Sports Medicine Research Unit, Faculty of Health Sciences, University of Cape Town, South Africa
2
Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, South Africa
3
Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
Corresponding author: J D Pillay (pillayjd@[Link])
Background. The association between self-perceived and actual physical activity, with particular reference to physical activity
guidelines, may be an important factor in determining the extent of uptake of and compliance with physical activity.
Objectives. To examine the association between self-perceived and actual physical activity in relation to physical activity guidelines,
with reference to volume, intensity and duration of steps/day, and to establish the level of agreement between pedometer-measured and
self- reported ambulatory physical activity, in relation to current guidelines.
Methods. A convenience sample of adults (N=312; mean (standard deviation) age 37 (9) years), wore a pedometer (minimum 3
consecutive days) and completed a questionnaire that included information on physical activity patterns. Analyses of covariance,
adjusted for age and gender, compared volume- and intensity-based steps according to meeting/not meeting guidelines (self-reported).
The extent of agreement between self-reported and pedometer-measured physical activity was also determined.
Results. Average (SD) steps/day were 6 574 (3 541). Of a total of 312 participants’ self-reported data, those meeting guidelines ( n=63)
accumulated significantly more steps/day than those not meeting guidelines (8 753 (4 251) v. 6 022 (3 114) total steps/day and 1 772 (2
020)
v. 421 (1 140) aerobic steps/day, respectively; p<0.0001). More than half of the group who self-reported meeting the guidelines did not
meet guidelines as per pedometer data.
Conclusion. The use of pedometers as an alternative and/or adjunct to self-reported measures is an area for consideration. Steps/day
recommendations that consider intensity-based steps may provide significant effects in improving fitness and health.
S Afr J SM 2014;26(3):77-81. DOI:10.7196/SAJSM.534
Studies on physical activity behaviours and their
Furthermore, such studies have been accelerometer based. This is
association with morbidity and mortality rates have
primarily due to the fact that pedometers traditionally presented
largely been measured through self-reported
volume-based information, with little or no reference to intensity
(indirect) measures of physical activity using
or duration of intensity-based ambulatory physical activity or its
interviews, surveys, questionnaires and diaries/logs.[1,2]
relationship to current physical activity guidelines. With more
These measures are
recent literature providing intensity-based step recommendations
frequently used owing to their practicality, including low cost, low
(such as 3 000 steps in 30 minutes),[11-13] the need to incorporate
participant burden and general acceptance. [2] Although self-reported
elements of current guidelines, including volume, intensity,
data can provide useful insights into the physical activity levels of
duration and frequency of physical activity, into pedometer-based
populations or subgroups, these data have the tendency to over- or
messages has therefore become an area of increased research.
underestimate true physical activity energy expenditure and rates
Such research continues to strengthen so as to ensure
of inactivity.[1] Furthermore, issues around recall and differential
congruency between pedometer-based recommendations and
interpretations of terms present an evident bias.[3] Self-reported
physical activity guidelines. Recent advancements in pedometry
measures are also usually unable to capture the absolute level of
create the opportunity for its use in providing more detailed
physical activity[4] and are therefore typically considered subjective. information on physical activity patterns, rather than simply
Direct measures have the potential to provide more precise recording a tally of steps/day, even though it is limited to ambulatory
estimates of energy expenditure and may reduce/eliminate many physical activity. For example, the ability to provide information on
of the limitations of recall-and-response bias evident in indirect
intensity-based steps[14] may provide a more objective alternative, or
measures.[5] Few studies[6,7] have attempted to measure the level complement, to self-reported approaches that typically rely on
of agreement between self-reported measures and steps/day data recall. Using pedometers for such a purpose would also be less
as a direct/objective measure of ambulatory physical activity.[8-10] costly than instruments such as accelerometers, used
SAJSM VOL. 26 NO. 3 2014 77
for providing an objective measure of ambulatory physical activity.
participate in the study. Employees were provided with a
Consequently, the opportunity arose to evaluate the relationship
participant information sheet detailing the purpose, objectives,
between pedometer-determined physical activity patterns and self-
procedures, requirements and potential risks of the study. They
reported ambulatory physical activity, in terms of volume, intensity
were thereafter required to sign an informed consent form.
and duration of steps/day.
Measurements
Objectives
Anthropometric measurements included body height, waist
The objectives of our study were, therefore, to compare the volume
circumference, body weight, body mass index and percentage body
and intensity of steps/day using pedometer-measured and self-
fat. Blood pressure (BP) and finger prick blood cholesterol and
perceived (questionnaire) measures, in relation to current physical
blood glucose were also measured.
activity guidelines, and to establish the level of agreement between
pedometer-measured and self-perceived ambulatory physical activity,
Self-perceived physical activity
in relation to current guidelines.
A questionnaire, administered as part of the health screening event,
acquired information on physical activity habits. Questions relating
Methods
to patterns of ambulatory physical activity enquired about the
This was a cross-sectional study among employed South African adults.
frequency (number of sessions of physical activity bouts), duration
(approximate time spent in each bout) and intensity (estimated
Participant recruitment
level of effort performed during each bout). This information was
A convenience sample of participants was recruited through an
translated into two time-based categories, i.e. <21 minutes/day and
invitation email sent out to employees, or following the completion
≥21 minutes/day of aerobic activity, as an indicator of not meeting
of a health risk screening hosted primarily at corporate
current guidelines and meeting current guidelines, respectively.
organisations. The corporate organisations mainly comprised health-
These subgroups relate to current physical activity guidelines of 150
insured, white- collar workers. The physical activity levels required by
minutes of moderate- intensity physical activity/week,[17]
and performed in most of these jobs were low in general.
approximated to 21 minutes/day.
Pedometer wear
Pedometer data recording
Participants were requested to wear a blinded (Omron HJ 720
With particular reference to intensity-based steps, recently
ITC) pedometer, attached to the left or right hip, as worn in most
documented literature on intensity-based steps/day[18,19] suggests a
studies.[3] In order to increase the probability of obtaining at least 3
minimum of 100 steps/minute to be a reliable estimate of, and target
consecutive days of pedometer data – as a minimum criterion for
for, moderate- intensity physical activity (aerobic steps). Current
inclusion in the data analyses[11,15,16] – a 5-consecutive-day protocol
literature also suggests that the accumulation of moderate-intensity
was decided as the number of days that participants were requested to
physical activity in bouts of at least 10 minutes is acceptable in
wear the pedometer. Participants were asked to wear the pedometer
contributing towards meeting current physical activity guidelines.[17]
throughout the day and to follow their usual routine of daily
Using the graphical display of pedometer results, we considered
activities, and to remove the pedometer only when bathing or
bouts of ≥10 consecutive minutes at a minimum average intensity
showering, swimming or sleeping. Participants were also informed
of 100 steps/minute as moderate-intensity physical activity. The
that their daily results would be made available to them at the end
individual data were, as for the self-reported data, categorised into
of the study.
<21 minutes/day and ≥21 minutes/day of aerobic activity as an
indicator of not meeting and meeting current guidelines,
Inclusion and exclusion criteria
respectively.
Employees attending the health screening event and/or willing to
participate in the study were eligible for inclusion. Other inclusion
Statistical analyses
criteria included being between the ages of 21 years (inclusive) and
Both the self-reported data and the pedometer-measured data were
50 years (exclusive) and willingness to wear a blinded pedometer
grouped according to those meeting guidelines and those not
during waking hours, for the duration of the study.
meeting guidelines. Pedometer-determined steps/day were compared
Employees were excluded for the following reasons: pregnancy;
between these groups. A correlation analysis was performed to
diagnosis or treatment of cancer; any other condition that could
determine the extent of agreement between self-perceived and
impact on physical activity; non-compliance to the pedometer
pedometer-measured physical activity. In this analysis, we
wear; and participation in non-ambulatory physical activity (such as
compared those meeting current guidelines with those not meeting
swimming and cycling) that might not be captured or be inaccurate
current guidelines in both pedometer-determined and self-reported
through the pedometer reading.
data, respectively.
Ethical considerations and informed consent
Results
The study was approved by the Faculty of Health Sciences Human
In summary, 312 participants (147 men and 165 women; mean
Research Ethics Committee (REC 348/2008) of the University of
(standard deviation (SD)) 37 (9) years) were included in the
Cape Town. Permission was also obtained from corporate
analysis and completed the pedometer wear for a minimum of
organisations to provide an onsite health screening event and to
3 consecutive days, with at least 10 hours/day of wear. The mean
invite employees to
(SD) steps/day accumulated in men and women were 7 476
(4 076) steps/day and 5 769 (2 759) steps/day, respectively. A
total
of 112 participants (35.9%) accumulated an average of <5 000 steps/
Even aft er adjusting for age, gender and total steps/day, signifi cance
day, typically classifi ed as inactive. [18] Only 41 participants (13.1%)
was still noted in the diff erence between average aerobic steps/day
achieved an average of ≥10 000 steps/day, typically classifi ed as
accumulated in the two groups (p<0.001).
moderately active.[18] Within the moderately active group, most of
Participants categorised into the ≥21 minute/day group also
the participants (73%) also accumulated aerobic steps.
accumulated signifi cantly more total steps/day than those not
meeting guidelines (10 092 (3 445) steps/day v. 6 129 (3 302)
Analysis of self-reported and pedometer data
steps/day, respectively; p<0.0001).
Fig. 1 presents the self-perceived and pedometer-determined mean
steps/day data for men and women according to those meeting
Association between pedometer-determined and self-reported
current guidelines and those not meeting guidelines.
ambulatory physical activity
Those participants who reported meeting guidelines (n=63)
A correlation between self-reported and pedometer-measured
accumulated signifi cantly more steps/day than those not meeting
ambulatory physical activity, using the meeting guidelines and not
guidelines (8 753 (4 251) steps/day v. 6 022 (3 114) steps/day,
meeting guidelines categories, indicated that approximately 80%
respectively; p<0.0001). A similar fi nding was observed for aerobic
(n=249) of the total group did not meet guidelines, according to
steps (1 772 (2 020) steps/day v. 421 (1 140) steps/day, respectively;
self-reported data. Th e pedometer analysis showed that nearly 90%
p<0.0001). Even after adjusting for age, gender and total steps/
(n=277) did not meet guidelines.
day, signifi cance was still noted in the number of aerobic steps/day
Of the 63 participants (20.2%; N=312) who met guidelines (self-
between the two groups (p<0.0001).
reported), only 27% (n=17) met guidelines according to pedometer
With regard to pedometer output, only 35 participants (11.2%)
data. Th irty-fi ve participants were classifi ed as meeting guidelines
of the total study group accumulated aerobic steps for an average of
(pedometer determined), but more than half of these participants
at least 21 minutes/day, and could therefore be classifi ed as meeting
(51.4%) did not meet guidelines according to the self-reported data.
current guidelines. Th ese participants accumulated an average of
Participants who reported meeting guidelines were, however, more
3 951 (2 092) aerobic steps/day compared with 282 (603) aerobic
likely to meet guidelines (pedometer measured) (40%) than those
steps/day in the <21 minute/day group, respectively; p<0.0001.
who reported not meeting guidelines (8%).
A)22 000 16 000
20 000 14 000
18 000 12 000
16 000 10 000
14 000
Average steps/day
8 000
Average steps/day
12 000 6 000
10 000 4 000
8 000 2 000
6 000
4 000
2 000 0
0 010
1
MEN: Not meeting guidelines (0); meeting guidelines (1)WOMEN: Not meeting guidelines (0); meeting guidelines (1)
B)22 000 16 000
20 000 14 000
18 000 12 000
16 000 10 000
14 000 8 000
Average steps/day
Average steps/day
12 000 6 000
10 000 4 000
8 000 2 000
6 000
4 000
2 000 0
0 010
1
MEN: Not meeting guidelines (0); meeting guidelines (1)WOMEN: Not meeting guidelines (0); meeting guidelines (1)
Fig. 1. Steps per day in relation to physical activity guidelines: (A) self-reported; (B) pedometer determined.
Discussion
The intensity-based output (from pedometer data) additionally
Our findings showed that those participants who met guidelines (self-
included steps accumulated over a minimum duration and
reported) accumulated an average of 2 731 more steps/day than
intensity. This allowed us to determine step/minute rates, so as to
those who did not meet guidelines (p<0.001). This difference was
closely relate to moderate-intensity physical activity and current
more marked in women (2 781 steps/day; p<0.001) than men (2 247
guidelines.[17-19] This application is also a novel application in
steps/ day; p<0.005). In a study by Miller and Brown[6] in 2004, a
pedometer-based research and provides an opportunity for further
comparable outcome was noted. Participants (N=185) who met
application and modification.
guidelines took an average of 1 357 steps/day more than those
Additionaly, we provide some estimate of the level of agreement
who did not meet guidelines. Similarly, the difference was more
between self-reported and pedometer-determined physical activity.
marked among women (1 684 steps/day) than men (1 019
steps/day).[6]
Study limitations
A popular public health message relating to pedometry is the
Pedometers measure ambulatory physical activity. Our comparison
10 000 steps/day concept, which shows positive health outcomes
was, therefore, limited to participants performing activities more
in those achieving this target compared with those not achieving
specific to ambulation and did not include activities such as
10 000 steps/day,[6,11-13] while a steps/day value of <5 000
swimming, cycling and weight training.
steps/day has generally been classified as inactive. [18] Within the
The 100 steps/minute criterion, used as a baseline criterion
context of the 10 000 steps/day guideline, Miller and Brown [6] for moderate-intensity physical activity, may not always be a true
demonstrated that the accumulation of 10 000 steps/day did not indication of moderate-intensity physical activity at an individual
always correlate with meeting guidelines. The study reported that level. For example, this estimate may likely be affected by factors
nearly 40% of participants who met guidelines did not reach the such as aerobic fitness and heart rate response to physical activity.
10 000 steps/ day target. The study also reported that ~10% of A number of studies that have directly measured moderate
participants who did achieve the 10 000 steps/day target did not intensity as three metabolic equivalents (3 METs) have, however,
meet guidelines. [6] This implies that a large proportion of people concluded that 100 steps/minute is a reasonable heuristic value
meeting current guidelines do not reach 10 000 steps/day, yet most indicative of moderate-intensity physical activity.[13,18]
people reaching 10 000 steps/day meet current guidelines. The subgrouping of data according to intensity-based categories,
Our study has shown a more exaggerated finding to that in Miller using 21 minutes/day of aerobic activity as a proxy for current
and Brown[6] in that 71.4% of participants who met guidelines (n=63) physical activity recommendations, may be viewed as a further
(self-reported), did not achieve the 10 000 steps/day target. limitation. However, this categorisation has provided some level of
With regard to those achieving 10 000 steps/day, our findings differentiation of ambulatory physical activity according to intensity
show a somewhat different outcome to that of Miller and Brown, [6] and duration of steps/day. This has allowed us to relate volume and
as 56.1% of participants who reached the 10 000 steps/day target intensity-based pedometer data to self-reported data, with
(n=41) still did not meet physical activity guidelines (self-reported). particular reference to current guidelines, as a unique application to
Only 37.1% of participants who met guidelines (n=35) according to pedometry. Pedometers are typically used to measure volume of
pedometer data achieved the 10 000 steps/day target. Consequently, steps/day. The reliability of information on intensity-based steps
68.3% of participants who did not achieve the 10 000 steps/day and the refinement of intensity-based steps through pedometry,
target (n=41) did not meet guidelines (self-reported). A large and the application thereof to current guidelines may raise concern.
proportion of those individuals achieving 10 000 steps/day were This does, however, provide some level of determining a more direct
also shown not to accumulate sufficient steps at a moderate measure of intensity- based ambulatory physical activity than self-
intensity. reported means, and is particularly valuable as a less costly alternative
Recent literature exemplifies that even in the absence of meeting to other direct measures.
the 10 000 steps/day recommendation, the impact of intensity-based
steps (moderate-intensity physical activity) is significantly greater than Conclusion
volume alone.[12] The implication of this, in keeping with our Our study highlights the association between self-reported physical
findings, emphasises the emerging importance of intensity-based activity patterns and objectively measured ambulatory physical
steps. As such, the need for public health messages that emphasise activity, with particular reference to both volume and intensity of
the importance of both intensity and volume of steps/day is steps/day, and current guidelines.
particularly pertinent. In view of our results showing a very small percentage of
participants meeting current guidelines (from both pedometer data
Study strengths and self-reported data), further studies using a similar but broader
This research is among the first pedometer-based studies conducted approach could enhance the reliability of our findings.
in South Africa, within an urban context, that establishes the The importance of intensity-defined steps/day recommendations
association between pedometer-measured ambulatory physical is highlighted. The application of such recommendations in
activity and self- reported information. pedometer- based interventions may provide useful insights on its
Our study has more specifically related self-reported physical effects in improving fitness and health.
activity and pedometer-determined steps/day, with consideration of
both volume and intensity of daily steps accumulated, and current Acknowledgements. We acknowledge the following organisations for
guidelines. The presentation of our results within this context provides funding this project: Durban University of Technology (DUT) and
a novel application to pedometer-based research that can be applied the National Research Foundation (Thuthuka).
in similar future studies.
References
10. Matton L, Wijndaele K, Duvigneaud N, Duquet W, Philippaerts R, Thomis M. Reliability
1. Prince SA, Adamo KB, Hamel ME, Hardt J, Gorber SC, Tremblay MS. A comparison
and validity of the Flemish Physical Activity Computerized Questionnaire in adults. Res
of direct versus self-report measures for assessing physical activity in adults: A
Q Exerc Sport 2007;78(4):293-306. [[Link]
systematic review. Int J Behav Nutri Phys Act 2008;5(1):56.
11. Tudor-Locke C, Bassett DRJ. How many steps/day are enough? Preliminary
[[Link] 5868-5-56]
pedometer indices for public health. Sports Med 2004;34(1):1-8. [[Link]
2. Dishman RK, Washburn RA, Schoeller DA. Measurement of physical activity. Quest
org/10.2165/00007256-200434010-00001]
2001;53(3):295-309. [[Link]
12. Wilde BE, Sidman CL, Corbin CB. A 10 000 step count as a physical activity
3. Tudor-Locke C. Taking Steps Toward Increased Physical Activity: Using
target for sedentary women. Res Q Exerc Sport 2001;72(4):411-414.
Pedometers to Measure and Motivate. Washington DC: President’s Council on
[[Link] 080/02701367.2001.10608977]
Physical Fitness and Sports, 2002.
13. Tudor-Locke C, Craig CL, Brown WJ, et al. How many steps/day are enough?
4. Ainslie PN, Reilly T, Westerterp KR. Estimating human energy expenditure: A
For adults. Int J Behav Nutr Phys Act 2011;8:79-97.
review of techniques with particular references to doubly labelled water. Sports Med
[[Link] 5868-8-79]
2003;33(9):683-698.
14. Incorporated Omron Health. Instruction manual: Pocket pedometer-model HJ-
5. Shephard RJ. Limits to the measurement of habitual physical activity by
720ITC2007. The Netherlands: Incorporated Omron Health, 2007.
questionnaires. Br J Sports Med 2003;37(3):197-206. [[Link]
15. Rowe DA, Kemble CD, Robinson TS, Mahar MT. Daily walking in older adults: Day-
bjsm.37.3.197]
to-day variability and criterion-referenced validity of total daily step counts. J Phys
6. Miller R, Brown W. Meeting physical activity guidelines and average daily steps in a
Act Health 2007;4(4):434-446.
working population. J Phys Act Health 2004;1(3):218-226.
16. Hart TL, Swartz AM, Cashin SE, Strath SJ. How many days of monitoring
7. Strycker LA, Duncan SC, Chaumeton NR, Duncan TE, Toobert DJ. Reliability of
predict physical activity and sedentary behaviour in older adults? Int J Behav Nutr
pedometer data in samples of youth and older women. Int J Behav Nutr Phys
Phys Act 2011;8:62. [[Link]
Act 2007;4:4-11. [[Link]
17. World Health Organization. Global Recommendations on Physical Activity for
8. Tudor-Locke C, Ainsworth BE, Thompson RW, Matthews CE. Comparison
Health. Geneva: World Health Organization, 2010.
of pedometer and accelerometer measures of free-living physical activity.
18. Tudor-Locke C, Sisson SB, Collova T, Lee SM, Swan PD. Pedometer-determined
Med Sci Sports Exerc 2002;34(12):2045-2051. [[Link]
step count guidelines for classifying walking intensity in a young ostensibly healthy
MSS.0000039300.76400.16]
population. Can J Appl Physiol 2005;30(6):666-676.
9. Matthews CE, Chen KY, Freedson PS, et al. Amount of time spent in sedentary
19. Marshall SJ, Levy SS, Tudor-Locke CE, et al. Translating physical activity
behaviors in the United States, 2003-2004. Am J Epidemiol 2008;167(7):875-881.
recommendations into a pedometer-based step goal: 3 000 steps in 30 minutes. Am
[[Link]
J Prev Med 2009;36(5):410-415. [[Link]
SAJSM VOL. 26 NO. 3 2014 81
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