Physical activity: walking and cycling

Reasons for the decision

The purpose of this exceptional review was to examine the impact of 2 recently published studies, A pedometer-based walking intervention in 45- to 75-year-olds, with and without practice nurse support: the PACE-UP three-arm cluster RCT (Harris et al. 2018a) and the follow up study, Physical activity levels in adults and older adults 3–4 years after pedometer-based walking interventions (Harris et al. 2018b) on NICE's guideline on walking and cycling. The first study involved 956 participants who were aged between 45 and 75 taking part in a 3-armed trial. One group was the control. One group received a pedometer and 3 sessions of nurse support to help increase physical activity. The final group received a pedometer and further documentation via post including a pedometer based walking programme and a goal setting diary. Both intervention groups significantly increased their physical activity after 12 months and the effects were still seen 3 years later. The postal group intervention was significantly more cost effective than the nurse support group. There were low levels of Asian and socioeconomically deprived participants however, which limits the generalisability of the findings. The follow-up study requested that participants of the first study and 1 other study that had not involved a 'postal' group (entitled PACE-LIFT), monitor their activity levels over 1 week, 3 years later, with the aid of a pedometer. Participation was over 65% of the original participants from both studies. It was noted that activity levels remained significantly higher than they had been at baseline in all intervention groups.

The studies were considered to be relevant to recommendation 7 in NICE's guideline on walking: individual support, including the use of pedometers. This recommendation currently states that individual support should be made available and could include individual, targeted information and goal-setting (which may or may not include the use of pedometers). It also advises that pedometers should only be used as part of a package, which includes support to set realistic goals (whereby the number of steps taken is gradually increased), monitoring and feedback.

After considering this new evidence it is believed that the studies reinforce NICE's current recommendations. The new evidence supports the use of print-based materials and pedometers as part of a package that delivers effective walking interventions that can increase levels of physical activity in sedentary older adults. The studies highlight the importance of monitoring progress and setting goals when using pedometers. The results do not conflict with current NICE advice and therefore no amendments to the guideline are necessary.

At the time of publication of NICE's guideline, it was noted within the considerations that "The Programme Development Group discussed the role of other technologies that might replicate pedometers, including mobile phone apps. While these may have a role to play in getting people to walk more, there is a lack of robust evidence to indicate whether or not they are effective." This remains, as, to date, there appears to be little research published on the effectiveness of these types of activity monitors at increasing walking. According to Harris et al. (2018b), implementation work is currently being conducted to look at online resources and mobile apps. NICE is also developing a guideline on behaviour change: digital and mobile health interventions, publishing in August 2020. It is suggested that this is an area that should be revisited at the next surveillance review.