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A Systematic Review

Dena M. Bravata, MD, MS; Crystal Smith-Spangler, MD; Vandana Sundaram, MPH; Allison L. Gienger, BA; Nancy Lin, ScD; Robyn Lewis, MA; Christopher D. Stave, MLS; Ingram Olkin, PhD; John R. Sirard, PhD

JAMA. 2007;298(19):2296-2304.

Context  Without detailed evidence of their effectiveness, pedometers have recently become popular as a tool for motivating physical activity.

Objective  To evaluate the association of pedometer use with physical activity and health outcomes among outpatient adults.

Data Sources  English-language articles from MEDLINE, EMBASE, Sport Discus, PsychINFO, Cochrane Library, Thompson Scientific (formerly known as Thompson ISI), and ERIC (1966-2007); bibliographies of retrieved articles; and conference proceedings.

Study Selection  Studies were eligible for inclusion if they reported an assessment of pedometer use among adult outpatients, reported a change in steps per day, and included more than 5 participants.

Data Extraction and Data Synthesis  Two investigators independently abstracted data about the intervention; participants; number of steps per day; and presence or absence of obesity, diabetes, hypertension, or hyperlipidemia. Data were pooled using random-effects calculations, and meta-regression was performed.

Results  Our searches identified 2246 citations; 26 studies with a total of 2767 participants met inclusion criteria (8 randomized controlled trials [RCTs] and 18 observational studies). The participants' mean (SD) age was 49 (9) years and 85% were women. The mean intervention duration was 18 weeks. In the RCTs, pedometer users significantly increased their physical activity by 2491 steps per day more than control participants (95% confidence interval [CI], 1098-3885 steps per day, P < .001). Among the observational studies, pedometer users significantly increased their physical activity by 2183 steps per day over baseline (95% CI, 1571-2796 steps per day, P < .0001). Overall, pedometer users increased their physical activity by 26.9% over baseline. An important predictor of increased physical activity was having a step goal such as 10 000 steps per day (P = .001). When data from all studies were combined, pedometer users significantly decreased their body mass index by 0.38 (95% CI, 0.05-0.72; P = .03). This decrease was associated with older age (P = .001) and having a step goal (P = .04). Intervention participants significantly decreased their systolic blood pressure by 3.8 mm Hg (95% CI, 1.7-5.9 mm Hg, P < .001). This decrease was associated with greater baseline systolic blood pressure (P = .009) and change in steps per day (P = .08).

Conclusions  The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure. Whether these changes are durable over the long term is undetermined.

Author Affiliations: Center for Primary Care and Outcomes Research (Drs Bravata and Lin and Mss Sundaram, Gienger, and Lewis), Department of Internal Medicine (Dr Smith-Spangler), Stanford University School of Medicine, Lane Medical Library (Mr Stave), and Department of Statistics (Dr Olkin), Stanford University, Stanford; Department of Internal Medicine, California Pacific Medical Center, San Francisco (Dr Bravata); Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Ms Sundaram); and School of Public Health, University of Minnesota, Minneapolis (Dr Sirard).

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