Physical Activity: Interventions Including Activity Monitors for Adults with Overweight or Obesity

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends interventions that include activity monitors to increase physical activity in adults with overweight or obesity. More research is needed, however, to determine whether changes in physical activity are maintained over time.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Interventions Including Activity Monitors for Adults with Overweight or Obesity are available in The Community Guide Collection on CDC Stacks.

Intervention

Physical activity interventions that include activity monitors provide participants with a combination of the following:

  • Behavioral instruction in the form of counseling, group-based education, or web-based education
  • Activity monitors that are used to provide regular feedback (i.e., pedometers or accelerometers) and may include enhancements to support or promote physical activity

Interventions must focus on physical activity or promote physical activity within a weight management program. Interventions may include one or more follow-up appointments with a healthcare provider.

About The Systematic Review

The Community Preventive Services Task Force (CPSTF) uses recently published systematic reviews to conduct accelerated assessments. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity.

de Vries HJ, Kooiman TJM, van Ittersum MW, van Brussel M, de Groot M. Do activity monitors increase physical activity in adults with overweight or obesity? A systematic review and meta-analysis. Obesity 2016;24(10):2076-91.

The review included 14 randomized controlled trials and a meta-analysis of 11 of these studies (search period through July 2015).

Study Characteristics

All 14 studies were randomized controlled trials

  • Studies were generally small; the median number of recruited participants was 69
  • Studies recruited substantially more women (80% women; 9 studies), although interventions were also effective in sex-restricted studies for men (3 studies) and women (1 study)
  • The review did not include studies conducted on adults ages 60 years or older
  • Intervention and study periods were of short duration (median 12 weeks) and did not provide post-intervention follow-up
  • Studies added pedometers (10 studies) and accelerometers (4 studies) to behavioral interventions
  • Behavioral components included individual counseling (5 studies) and educational sessions (9 studies) on physical activity promotion or weight management
  • Activity monitor use was integrated through specific step count goals (7 studies), participant activity logs (10 studies), and provider review and feedback (6 studies)
  • Studies were conducted in the United States (8 studies), Australia (4 studies), Canada (1 study), and Scotland (1 study)

Summary of Results

The systematic review included 14 randomized controlled trials and a meta-analysis of 11 of these studies.

  • When compared with usual care or wait list controls, interventions reported statistically significant increases in steps per day and minutes spent engaging in moderate-to-vigorous physical activity per week (7 studies)
  • Studies that reported the incremental benefit of adding an activity monitor to a behavioral intervention reported non-significant increases in minutes spent engaging in moderate-to-vigorous physical activity per week (7 studies)
    • A subset of these studies reported favorable but small effects on weight-related outcomes (5 studies)
  • Only four studies ran longer than three months and outcomes were mixed, suggesting a need for additional research on longer-term effects

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

While additional research is warranted, the CPSTF finding is likely applicable to recruited adults in the United States.

Evidence Gaps

  • What is the longer-term effectiveness of these combined interventions (i.e., 6-12 months following intervention)?
  • What are intervention effects on clinical and health outcomes?
  • Are interventions effective with older adults?
  • How does effectiveness vary by participants’ race, ethnicity, and socioeconomic status?
  • How effective are interventions that use enhanced activity monitors, smartphones, or other newer technologies?
  • What would be the effect of integrating enhanced content and interactivity (e.g., social support networks, prompts and reminders, rewards, behavioral self-monitoring) into these interventions?

Implementation Considerations and Resources

  • The CPSTF finding supports the integration of activity monitors into behavioral interventions as an effective way to promote graduated increases in daily walking.
    • Most studies promoted gradual increases in daily or regular walking to encourage participation and reduce risks of musculoskeletal injury to participants with overweight or obesity.
  • The CPSTF finding supports the use of basic pedometers, which may be more cost-efficient for scalable interventions and more affordable for communities with limited budgets.
  • Activity monitors and related capabilities in smartphones are increasing in popularity. Clinicians and health systems are encouraged to incorporate these devices into interventions to promote and support physical activity among their patients.
  • Enhanced functions of newer activity monitors, such as interactive features and access to social support resources, may lead to improvements in recruitment, participation, and sustained engagement.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.