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

The Community Preventive Services Task Force (CPSTF) uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. 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). The team examined each of the studies included in the systematic review and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the included studies, and expert input from team members and the CPSTF.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

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.

A systematic review of economic evidence has not been conducted.

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

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are 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?

• 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 within the behavioral intervention through specific step count goals (7 studies), participant activity logs (10 studies), and provider review and feedback (6 studies).
• Included studies were conducted in the United States (8 studies), Australia (4 studies), Canada (1 study), and Scotland (1 study).

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

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 number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Studies Included in the Systematic Review (de Vries et al., 2016)

Baker G, Gray SR, Wright A, et al. The effect of a pedometer-based community walking intervention ”Walking for Wellbeing in the West” on physical activity levels and health outcomes: a 12-week randomized controlled trial. Int J Behav Nutr Phys Activity 2008;5:44.

Bond DS, Vithiananthan S, Thomas JG, et al. Bari-Active: a randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients. Surg Obes Relat Dis 2014;11:169-77.

Morgan PJ, Callister R, Collins CE, et al. The SHED-IT community trial: a randomized controlled trial of internet- and paper-based weight loss programs tailored for overweight and obese men. Ann Behav Med 2013;45:139-52.

Morgan PJ, Collins CE, Plotnikoff RC, et al. Efficacy of a workplace-based weight loss program for overweight male shift workers: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial. Prev Med 2011;52:317-25.

Pal S, Cheng C, Egger G, Binns C, Donovan R. Using pedometers to increase physical activity in overweight and obese women: a pilot study. BMC Public Health 2009;9:309.

Pal S, Cheng C, Ho S. The effect of two different health messages on physical activity levels and health in sedentary overweight, middle-aged women. BMC Public Health 2011;11:204.

Paschali AA, Goodrick GK, Kalantzi-Azizi A, Papadatou D, Balasubramanyam A. Accelerometer feedback to promote physical activity in adults with type 2 diabetes: a pilot study. Percept Mot Skills 2005;100:61-8.

Patrick K, Calfas KJ, Norman GJ, et al. Outcomes of a 12-month web-based intervention for overweight and obese men. Ann Behav Med 2011;42:391-401.

Pellegrini CA, Verba SD, Otto AD, Helsel DL, Davis KK, Jakicic JM. The comparison of a technology-based system and an in-person behavioral weight loss intervention. Obesity 2012;20:356-63.

Polzien KM, Jakicic JM, Tate DF, Otto AD. The efficacy of a technology-based system in a short-term behavioral weight loss intervention. Obesity 2007;15:825-30.

Staudter M, Dramiga S, Webb L, Hernandez D, Cole R. Effectiveness of pedometer use in motivating active duty and other military healthcare beneficiaries to walk more. US Army Med Dep J 2011;108-19.

Stovitz SD, VanWormer JJ, Center BA, Bremer KL. Pedometers as a means to increase ambulatory activity for patients seen at a family medicine clinic. J Am Board Fam Pract 2005;18:335-43.

Tudor-Locke C, Bell RC, Myers AM, et al. Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes. Int J Obes Relat Metab Disord 2004;28:113-19.

Unick JL, O’Leary KC, Bond DS, Wing RR. Physical activity enhancement to a behavioral weight loss program for severely obese individuals: a preliminary investigation. ISRN Obes 2012;2012.

Effectiveness Review

Refer to the existing systematic review for information about the search strategy:

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 following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• 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.

Healthy People 2030

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

• Reduce the proportion of adults who do no physical activity in their free time — PA‑01
• Increase the proportion of adults who do enough aerobic physical activity for substantial health benefits — PA‑02
• Increase the proportion of adults who do enough aerobic physical activity for extensive health benefits — PA‑03
• Increase the proportion of adults who do enough aerobic and muscle-strengthening activity — PA‑05
• Reduce the proportion of adults with obesity — NWS‑03