Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain The effect of pedometer use in combination with cognitive and behavioral support materials to promote physical activity. VIP in construction: systematic development and evaluation of a multifaceted health programme aiming to improve physical activity levels and dietary patterns among construction workers A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. Pilot Study of a Faith-Based Physical Activity Program Among Sedentary Blacks Pedometer-driven Walking for Chronic Low Back Pain: A Feasibility Randomized Controlled Trial Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario Health Survey. Effectiveness of a Pragmatic Education Program Designed to Promote Walking Activity in Individuals With Impaired Glucose Tolerance Musculoskeletal disorders and occupational exposures: How should we judge the evidence concerning the causal association? Steps to a better Belfast: physical activity assessment and promotion in primary care Benefits and costs of home pedometer assisted physical activity in patients with COPD. A preliminary randomized controlled trial. The effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents. Epidemiologic surveillance of upper-extremity musculoskeletal disorders in the working population. A pedometer-based physical activity intervention for patients entering a maintenance cardiac rehabilitation program: a pilot study. Psychosocial Determinants of Physical Activity in Children Attending Afterschool Programs: A Path Analysis Steps that count! : The development of a pedometer-based health promotion intervention in an employed, health insured South African population Objective measures of neighborhood environment and physical activity in older women. Exercise and Self-Esteem in Menopausal Women: A Randomized Controlled Trial Involving Walking and Yoga Shoulder muscle co-ordination during chronic and acute experimental neck-shoulder pain. An occupational pain study A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders Using step cadence goals to increase moderate-to-vigorous-intensity physical activity. Physical activity as a strategy for maintaining tobacco abstinence: a randomized trial. Physical and psychosocial risk factors for musculoskeletal disorders in New Zealand nurses, postal workers and office workers Effects of Ongoing Feedback During a 12-Month Maintenance Walking Program on Daily Physical Activity in People with COPD
Background Despite considerable knowledge about musculoskeletal disorders ( MSD ) and physical , psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD . In addition , studies of physical activity are often limited to either leisure activity or physical activity at work . Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking . This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD . Methods A question naire about musculoskeletal disorders , physical activity and background data ( employment status , age , gender , body mass index , smoking , education and physical stressors ) was completed by 2265 workers ( 58 % ) 18 to 70 years old in the Royal Norwegian Navy .  Multiple logistic regression with 95 % confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders . Results A total of 32 % of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year . The most common musculoskeletal disorders were in the lower back ( 15 % often or very often ) , shoulders ( 12 % often or very often ) and neck ( 11 % often or very often ) . After adjustment for confounders , physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows , knees and feet . Conclusion The one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low . A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders  among personnel in the Royal Norwegian Navy . Prospect i ve studies are necessary to confirm the cause and effect in this association Background Current evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery . Walking has been shown it to be an acceptable type of exercise with a low risk of injury . However , it is not known whether structured physical activity programmes are any more effective than giving advice to remain active . Methods / Design The proposed study will test the feasibility of using a pedometer-driven walking programme , as an adjunct to a st and ard education and advice session in participants with chronic low back pain . Fifty adult participants will be recruited via a number of different sources . Baseline outcome measures including self reported function ; objective physical activity levels ; fear-avoidance beliefs and health-related quality of life will be recorded . Eligible participants will be r and omly allocated under strict , double blind conditions to one of two treatments groups . Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the ' Back Book ' . Participants in group B will receive the same education and advice session . In addition , they will also receive a grade d pedometer-driven walking programme prescribed by the physiotherapist . Follow up outcomes will be recorded by the same research er , who will remain blinded to group allocation , at eight weeks and six months post r and omisation . A qualitative exploration of participants ' perception of walking will also be examined by use of focus groups at the end of the intervention . As a feasibility study , treatment effects will be represented by point estimates and confidence intervals . The assessment of participant satisfaction will be tabulated , as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists . This information will be used to modify the planned interventions to be used in a larger r and omised controlled trial . Discussion This paper describes the rationale and design of a study which will test the feasibility of using a structured , pedometer-driven walking programme in participants with chronic low back pain . Trial Registration [ IS RCT N67030896 OBJECTIVE 1 . To demonstrate that combining pedometer use with cognitive and behavioral support material s has a positive effect on  physical activity ( PA ) and attitudes towards pedometer  use . 2 . To investigate how familiar the study sample is with pedometers and the ' 10,000 steps/day ' recommendation . METHODS From a r and om sample , drawn from the phone book , 304 volunteered ( 18 - 75 year ) to complete a question naire about familiarity with pedometers and the ' 10,000 steps/day ' recommendation . A sample of 103 participants agreed to wear a pedometer  for 3 weeks , and was r and omly assigned to a condition with cognitive and behavioral support material s ( n=51 ) or without these material s ( n=52 ) . Participants completed the  International Physical Activity Question  naire before and after 21 days of pedometer use and an additional question naire on the attitudes towards pedometer use . RESULTS More than 58 % had never heard of a pedometer . In both conditions , walking ( F=10 , p=0.002 ) , moderate PA ( F=11 , p=0.001 ) , and vigorous PA ( F=14 , p<0.001 ) increased over time , however no interaction effects could be found . Significantly more participants in the condition with support material s had a positive attitude towards pedometer use . CONCLUSION Wearing a pedometer , with or without support material s , may increase PA . In our study , cognitive and behavioral support material s only affected attitudes towards pedometer use . PRACTICE IMPLICATION S More research is needed to investigate the effect of combining pedometer use with support material s on a longer time base and in less motivated people Background The prevalence of both overweight and musculoskeletal disorders ( MSD ) in the construction industry is high . Many interventions in the occupational setting aim at the prevention and reduction of these health problems , but it is still unclear how these programmes should be design ed . To determine the effectiveness of interventions on these health outcomes r and omised controlled trials ( RCTs ) are needed . The aim of this study is to systematic ally develop a tailored intervention for prevention and reduction of overweight and MSD among construction workers and to describe the evaluation study regarding its (cost-)effectiveness . Methods / Design The Intervention Mapping ( IM ) protocol was applied to develop and implement a tailored programme aim ed at the prevention and reduction of overweight and MSD . The ( cost- ) effectiveness of the intervention programme will be evaluated using an RCT . Furthermore , a process evaluation will be conducted . The research population will consist of blue collar workers of a large construction company in the Netherl and s . InterventionThe intervention programme will be aim ed at improving ( vigorous ) physical activity levels and healthy dietary behaviour and will consist of tailored information , face-to-face and telephone counselling , training instruction ( a fitness " card " to be used for exercises ) , and material s design ed for the intervention ( overview of the company health promoting facilities , waist circumference measuring tape , pedometer , BMI card , calorie guide , recipes , and knowledge test).Main study parameters/endpointsThe intervention effect on body weight and waist circumference ( primary outcome measures ) , as well as on lifestyle behaviour , MSD , fitness , CVD risk indicators , and work-related outcomes ( i.e. productivity , sick leave ) ( secondary outcome measures ) will be assessed . Discussion The development of the VIP in construction intervention led to a health programme tailored to the needs of construction workers . This programme , if proven effective , can be directly implemented . Trial registration Netherl and s Trial Register ( NTR ) : OBJECTIVES To determine whether a home-based pedometer-driven walking program with arthritis self-management education ( Walk + ) would increase physical activity , muscle strength , and functional performance in older adults with osteoarthritis ( OA ) of the knee as opposed to arthritis self-management education alone ( EDU ) . DESIGN A r and omized two-by-three ( group-by-time ) design with participants assigned to  Walk + ( n = 17 , mean age + /- st and ard deviation = 69.6 + /- 6.7 ) or EDU ( n = 17 , age = 70.8 + /- 4.7 ) . SETTING Community located in the Baltimore-Washington area . PARTICIPANTS Thirty-four community-dwelling adults , aged 60 and older with symptomatic knee OA and self-reported functional impairment . INTERVENTIONS Both groups received 12 hours of the Arthritis Self-Management program over 12 weeks and were followed for an additional 12 weeks . In addition , the Walk + group received individualized instruction in the use of a pedometer , with the goal of increasing their step count by 30 % of their baseline step count . MEASUREMENTS The outcome measures were physical activity ( daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac-R3D accelerometer ) , quadriceps femoris strength ( isometric peak torque ) , and functional performance tasks ( 100-foot walk-turn-walk , timed stair climb , timed chair rise , and pain status ) . RESULTS Daily steps walked showed a significant group-by-time interaction ( P = .04 ) after controlling for age . From baseline to completion of training , a 23 % increase in daily steps occurred in the Walk + group and a 15 % decrease in the EDU group . Although steps increased in the Walk + group , total activity vector magnitude was maintained , suggesting a more efficient gait . The Walk + group became quicker than the EDU group in the normal-pace walk-turn-walk ( P = .04 ) . An isometric strength gain of 21 % postintervention was seen in the Walk + group , compared with a loss of 3.5 % in the EDU group . CONCLUSION In older adults with symptomatic knee OA , Walk + appears to increase walking , with improvements in muscle strength and walking performance . The use of a home-based pedometer-driven program to increase physical activity , strength , and function in this population warrants further research Introduction Physical activity participation is low among blacks , and strategies are needed to successfully create immediate and sustained behavior change related to physical activity . Churches can play an important role in health promotion efforts among blacks because of their central role in spiritual guidance , communication , social support , and networking . This pilot study evaluated the feasibility and acceptability of implementing a physical activity program for sedentary black adults in churches . Methods We used a preintervention/postintervention single-group design to evaluate the effect of a 3-month faith-based physical activity intervention on  daily walking and moderate- and vigorous-intensity physical activity  among sedentary blacks . Eighty-seven black adults participated in eight group sessions that included discussion of physical activity-related topics , an instructor-led physical activity session , and weekly incentives to promote physical activity . We used a question naire to assess moderate and vigorous physical activity in minutes per week at baseline and after 3 months . Walking was assessed weekly in steps per day by using a pedometer . Results Participants ( mean age , 52 yrs ; mean body mass index , 35 kg/m2 ) reported 27 ± 54 and 10 ± 25 minutes per week in moderate-intensity and vigorous-intensity physical activity , respectively , and walked 4822 ± 2351 steps per day at baseline . After 12 weeks , moderate- and vigorous-intensity physical activity increased by 67 ± 78 and 44 ± 66 minutes per week , respectively ( P ≤ .01 ) , and daily walking increased by 1373 ± 728 steps per day ( P < .001 ) . Conclusion These data suggest that a faith-based physical activity intervention may be an appropriate strategy for increasing physical activity among sedentary black adults . Future research will determine the impact of this program in a r and omized , controlled design Objectives : To evaluate the feasibility of an RCT of a pedometer-driven walking program and education/advice to remain active compared with education/advice only for treatment of chronic low back pain ( CLBP ) . Methods : Fifty-seven participants with CLBP recruited from primary care were r and omly allocated to either : ( 1 ) education/advice ( E , n=17 ) or ( 2 ) education/advice plus an 8-week pedometer-driven walking program ( EWP , n=40 ) . Step targets , actual daily step counts , and adverse events were recorded in a walking diary over the 8 weeks of intervention for the EWP group only . All other outcomes ( eg , functional disability using the Oswestry Disability Question naire ( ODQ ) , pain scores , physical activity ( PA ) measurement etc . ) were recorded at baseline , week 9 ( immediately post-intervention ) , and 6 months in both groups . Results : The recruitment rate was 22 % and the dropout rate was lower than anticipated ( 13 % to 18 % at 6 mo ) . Adherence with the EWP was high , 93 % ( n=37/40 ) walked for ≥6 weeks , and increased their steps/day ( mean absolute increase in steps/d , 2776 , 95 % confidence interval [ CI ] , 1996 - 3557 ) by 59 % ( 95 % CI , 40.73%-76.25 % ) from baseline . Mean percentage adherence with weekly step targets was 70 % ( 95 % CI , 62%-77 % ) . Eight ( 20 % ) minor-related adverse events were observed in 13 % ( 5/40 ) of the participants . The EWP group participants demonstrated an 8.2 % point improvement ( 95 % CI , −13 to −3.4 ) on the ODQ at 6 months compared with 1.6 % points ( 95 % CI , –9.3 to 6.1 ) for the E group ( between group d=0.44 ) . There was also a larger mean improvement in pain ( d=0.4 ) and a larger increase in PA ( d=0.59 ) at 6 months in EWP . Discussion : This preliminary study demonstrated that a main RCT is feasible . EWP was safe and produced a real increase in walking ; CLBP function and pain improved , and participants perceived a greater improvement in their PA levels . These improvements require confirmation in a fully powered RCT OBJECTIVE Musculoskeletal disorders ( MSD ) are a leading cause of morbidity in the population , yet their prominence seems to be insufficiently appreciated . We describe the ranking compared with other major body systems of the prevalence of MSD , including arthritis and rheumatism , and back/neck disorders , as a cause of chronic health problems , longterm disability , restricted activity days , consultation with health professionals , and use of both prescription and nonprescription drugs . METHODS We analyzed data from the 1990 Ontario Health Survey , a stratified r and om sample of the household dwelling population in Ontario , based on 45,650 individuals aged 16 years and over . RESULTS MSD ranked first in prevalence as the cause of chronic health problems , longterm disabilities , and consultations with a health professional and ranked 2nd for restricted activity days and use of both prescription and nonprescription drugs . No other body systems ranked invariably within the top 2 ranks for the morbidity indices examined . Even when compared to other major disease groups , arthritis and rheumatism ranked consistently in the top 3 and back/neck disorders also ranked high . MSD were mentioned as a reason for 40 % of all chronic conditions , 54 % of all longterm disability , 24 % of restricted activity days and almost 20 % of health care utilization . The impact of MSD was even greater in the 65 and over age group . CONCLUSIONS MSD have a major role in the health profile of the population . This high burden of illness should be considered in planning health care services and setting research priorities OBJECTIVE To investigate whether a pragmatic structured education program with and without pedometer use is effective for promoting physical activity and improving glucose tolerance in those with impaired glucose tolerance ( IGT ) . RESEARCH DESIGN AND METHODS Overweight and obese individuals with IGT were recruited from ongoing screening studies at the University Hospitals of Leicester , U.K. Participants were r and omly assigned to one of three groups . Group 1 received a 3-h group-based structured education program design ed to promote walking activity using personalized steps-per-day goals and pedometers . Group 2 received a 3-h group-based structured education program design ed to promote walking activity using generic time-based goals . Group 3 received a brief information leaflet ( control condition ) . Outcomes included an oral glucose tolerance test , st and ard anthropometric measures , ambulatory activity , and psychological variables . Follow-up was conducted at 3 , 6 , and 12 months . RESULTS A total of 87 individuals ( 66 % male , mean age 65 years ) were included in this study . At 12 months , significant decreases in 2-h postchallenge glucose and fasting glucose of −1.31 mmol/l ( 95 % CI −2.20 to −0.43 ) and −0.32 mmol/l ( −0.59 to −0.03 ) , respectively , were seen in the pedometer group compared with the control group . No significant improvements in glucose control were seen in those given the st and ard education program . CONCLUSIONS This study suggests that a pragmatic structured education program that incorporates pedometer use is effective for improving glucose tolerance in those with IGT . This result is likely to have important implication s for future primary care – based diabetes prevention initiatives Musculoskeletal disorders ( MSDs ) affecting the back , upper and lower extremities are widespread in the general population , implying a variety of causal factors . Multiple causes are not mutually exclusive , and a high background rate does not preclude associations with specific factors that are uncommon in the general population . MSDs have well-documented associations with occupational ergonomic stressors such as repetitive motion , heavy lifting , non-neutral postures , and vibration . Organizational features of the work environment , such as time pressure and low decision latitude , may also play a role , at least by potentiating the effects of physical loading . Numerous systematic review s have mostly concurred with these overall findings . Nevertheless , some continue to debate whether MSDs are sometimes work-related , even for those performing jobs with repetitive and routinized tasks , heavy lifting , and /or pronounced postural strain . This article discusses ( 1 ) some epidemiologic features of MSDs that underlie that debate ; and ( 2 ) the question of what should appropriately be considered a gold st and ard for scientific evidence on an etiological question such as the health effects of a non-voluntary exposure , such as an occupational or environmental agent . In particular , r and omized clinical trials have little relevance for determining the health effects of non-therapeutic risk factors Background Low physical activity ( PA ) levels which increase the risk of chronic disease are reported by two-thirds of the general UK population . Promotion of PA by primary healthcare professionals is advocated but more evidence is needed regarding effective ways of integrating this within everyday practice . This study aims to explore the feasibility of a r and omised trial of a pedometer-based intervention , using step-count goals , recruiting patients from primary care . Method Patients , aged 35–75 , attending four practice s in socioeconomically deprived areas , were invited to complete a General Practice PA Question naire during routine consultations . Health professionals invited ‘ inactive ’ individuals to a pedometer-based intervention and were r and omly allocated to group 1 ( prescribed a self-determined goal ) or group 2 ( prescribed a specific goal of 2500 steps/day above baseline ) . Both groups kept step-count diaries and received telephone follow-up at 1 , 2 , 6 and 11 weeks . Step counts were reassessed after 12 weeks . Results Of the 2154 patients attending , 192 question naires were completed ( 8.9 % ) . Of these , 83 were classified as ‘ inactive ’ ; 41(10 men ; 31 women ) completed baseline assessment s , with the mean age of participants being 51 years .  Mean baseline step counts were similar in group 1 ( 5685 , SD 2945 ) and group 2 ( 6513 , SD 3350 ) . The mean increase in steps/day was greater in groups 1 than 2 ( ( 2602 , SD 1957 ) vs ( 748 , SD 1997 ) p=0.005 ) . Conclusions A trial of a pedometer-based intervention using self-determined step counts appears feasible in primary care . Pedometers appear acceptable to women , particularly at a perimenopausal age , when it is important to engage in impact loading activities such as walking to maintain bone mineral density . An increase of 2500 steps/day is achievable for inactive patients , but the effectiveness of different approaches to realistic goal - setting warrants further study BACKGROUND AND OBJECTIVE There are barriers to providing pulmonary rehabilitation for chronic obstructive pulmonary disease ( COPD ) such as the high number of patients , difficult access to health facilities and high costs of programs . Pedometers can monitor and improve  physical activity ( PA ) . The aim of this study was to evaluate benefits and costs of home pedometer assisted PA , as compared to a st and ard outpatient supervised exercise training program in patients with COPD . METHODS Patients were r and omly assigned either to home pedometer assisted PA ( Group 1 ) , or to a six-week outpatient st and ard supervised exercise training program ( Group 2 ) . Patients of Group 1 had to walk at home for 6 weeks , at least 30min daily at the fastest step pace as possible , to achieve a weekly 10 % increase in their average daily steps up to more than 6500 . Pre and post programs we assessed : the six minute walking distance ( 6MWT : primary outcome ) , daily steps count , the Medical Research Council scale ( MRC ) , the COPD assessment test score , and the BODE index ( body-mass index , airflow obstruction , dyspnea , exercise capacity ) . Costs of programs were also evaluated . RESULTS Out of 40 patients , 18 in both groups ( mean ( st and ard deviation ) ) age : 68.3 ( 6.7 ) and 61.2 ( 6.7 ) years ; FEV1 : 1.1 ( 0.5 ) and 0.9 ( 0.4 ) liters in Group 1 and 2 respectively completed the study . At the end of the program 44.5 % patients of Group 1 had reached the target daily steps , in 26.6 ( 9.5 ) days . Following the programs , both groups showed significant improvements in all outcome measures , except BODE . The home program was cheaper ( p=0.0001 ) , with a mean 76.3 euros saving per patient . CONCLUSION Home pedometer assisted PA may be a useful and cheaper alternative to outpatient supervised exercise training programs in patients with COPD AIM To study the effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity among adolescents . BACKGROUND The beneficial effects of regular physical activity on health in youths are well-documented . However , adolescence is found to be the age of greatest decline in physical activity participation . Physical activity participation among girls was generally less frequent and less intense than boys . Therefore , there is a strong need for effective interventions that can help promote physical activity in this population . DESIGN An experimental design . METHODS Two classes of female junior college students ( mean age = 16 ) were r and omly sample d from a total of four classes and , of those , one each was r and omly assigned to either the intervention ( n = 46 ) or the control group ( n = 48 ) . Self-efficacy was used as a core theoretical foundation of the intervention design , and pedometers were provided to the students in the intervention group . Distances between each domestic scenic spot were illustrated graphically in a walking log for students to mark the extent of their walking or running . Students in the control group participated in a usual physical education programme . The primary outcome was a change in the number of aerobic steps . The secondary outcomes were changes in cardiopulmonary endurance and exercise self-efficacy . RESULTS At 12-week follow-up , the mean change in aerobic steps was 371 steps and 108 steps in the intervention and control group , respectively . The difference in mean change between the two groups was 467 steps . Effects of the intervention on changes of cardiopulmonary endurance and perceived exercise self-efficacy scores were not found . CONCLUSIONS Among adolescent girls , a 12-week intervention design ed on the theoretical foundation of self-efficacy theory and provision of pedometers was found to have an effect on increasing their physical activity . The intervention , using graphs of domestic scenic spots to represent the distance of walking or running as monitored by pedometers , might enhance motivation regarding physical activity . RELEVANCE TO CLINICAL PRACTICE It is important for health professionals , including school health nurses , involved in the care of adolescent health , to design and provide a physical activity intervention combining self-efficacy theory and provision of pedometer to promote physical activity OBJECTIVE Since 2002 , an epidemiologic surveillance system of work-related , upper-limb musculoskeletal disorders ( MSDs ) has been implemented in France 's Pays de la Loire region to assess the prevalence of MSDs and their risk factors in the working population . METHODS The surveillance was based on a network of occupational physicians ( OPs ) and used the recommendations of a group of European experts ( criteria document consensus ) . In 2002 - 2003 , 80 of 400 OPs volunteered to participate . All underwent a training program to st and ardize the physical examination .  Health status was assessed by self-administered question naire and physical examination . Occupational risk factors were assessed by self-administered question naire .  Exposure scores were computed for each anatomic zone by summing the risk factors taken into account by the criteria document . RESULTS More than 50 % of the 2,685 men and women r and omly included in 2002 - 2003 experienced nonspecific musculoskeletal symptoms during the preceeding 12 months and approximately 30 % experienced them in the preceeding week . The prevalence of clinical ly diagnosed MSDs was high : approximately 13 % of workers experienced at least 1 of the MSDs . The most frequent disorder was rotator cuff syndrome followed by carpal tunnel syndrome and lateral epicondylitis . The prevalence of MSDs increased with age and varied widely across economic sectors and occupations . More than half of the workers were exposed to at least 2 risk factors of MSDs . Exposure varied according to industrial activity and occupation . According to the criteria document , a high percentage of MSD cases could be classified as probably work related ( 95 % in men and 89 % in women age < 50 , and 87 % in men and 69 % in women age > 50 ) . CONCLUSION Nonspecific upper-limb symptoms and specific upper-limb MSDs are common in the working population . These results show the need to implement prevention programs in most sectors to reduce the prevalence of MSDs PURPOSE To compare the effects of an individualized pedometer-driven physical activity ( PA ) intervention with the usual time-based PA recommendations given to patients entering a maintenance cardiac rehabilitation ( CR ) program . METHODS A total of 18 subjects entering a maintenance CR program were recruited and completed the study . Subjects were r and omized into pedometer feedback [ PF : n=10 ( 2 women ) , 53.3±8.1 yrs ] and usual care [ UC : n=8 ( 2 women ) , 59.4±9.9 yrs ] groups . New Lifestyles NL-1000 pedometers were used to  monitor ambulatory PA . Subjects in both groups participated in the same maintenance CR program for a total of 8 weeks and all were encouraged to obtain a minimum of 30 - 40 min/d of moderate-vigorous-intensity physical activity ( MVPA ) , on days they did not attend CR . Subjects in the PF group were given individualized daily stepcount goals ( increase 10 % of baseline steps/d each week ) for weeks 2 - 8 . Ambulatory PA  was measured with pedometers , recording both total number of steps/d and min/d of MVPA . Measures were obtained during the first week of the maintenance CR program and during the 8th week . Data were also compared between days subjects attended and on days they did not attend . RESULTS By the 8th week of CR , PF subjects increased daily stepcounts by 42 % ( 2,297±1,606 steps/d , P=0.001 ) , with a 36 % increase on CR days ( 2,654±2,089 steps/d , P=0.003 ) and a 45 % increase on days they did not attend CR ( 1,872±2,026 steps/d , P=0.017 ) . There were no changes observed in the UC group . CONCLUSIONS Providing pedometers with individualized stepcount goals to patients entering a CR program was superior to the usual time-based PA recommendations for increasing PA Background Physical activity ( PA ) is important for controlling childhood obesity , but a comprehensive PA model for school-aged children is lacking . Objectives Guided by the youth PA promotion ( YPAP ) model , this study estimated the direct and indirect effects of self-efficacy , enjoyment , parental influence , and environment on self-reported PA  and pedometer steps . A secondary purpose was to explore the association between self-reported PA and pedometer steps . Methods An observational and prospect i ve study was conducted among 133 children , aged 8–11 years old , from 10 elementary schools with afterschool programs in a Midwestern U.S. school district from August through October 2013 .  PA was assessed by a 7-day recall scale and pedometers . Other variables were assessed by vali date d question naires . Results Approximately 65 ( 49 % ) children were overweight or obese — only 17 ( 13 % ) met national PA recommendations — and body mass index z-score was negatively correlated with pedometer steps ( r = −.18 p = .04 ) . A path analysis showed that self-efficacy had a direct effect on self-reported PA and pedometer steps , enjoyment had only a direct effect on self-reported PA , and parental influence had a direct effect on pedometer steps and an indirect effect on self-reported PA through self-efficacy and enjoyment . The association between self-reported PA and pedometer steps was not significant . Discussion Because this study only partially supports the YPAP model , studies with a larger sample size and longitudinal design are essential to further examine this model . The nonsignificant relationship of self-reported PA with pedometer steps may be due to the systematic error result ing from a common method artifact of self-report . Given the importance of parental influence , enjoyment , and self-efficacy , targeting these three determinants in future interventions to increase PA among children is recommended Background  Physical activity ( PA )  has been identified as a central component in the promotion of health . PA programs can provide a low cost intervention opportunity , encouraging PA behavioral change while worksites have been shown to be an appropriate setting for implementing such health promotion programs . Along with these trends , there has been an emergence of the use of pedometers as a self-monitoring and motivational aid for PA.This study determines the effectiveness of a worksite health promotion program comprising of a 10-week , pedometer-based intervention ( “ Steps that Count ! ” ) , and individualized email-based feedback to effect PA behavioral change . Methods The study is a r and omized controlled trial in a worksite setting , using pedometers and individualized email-based feedback to increase steps per day ( steps/d ) .  Participant selection will be based on attendance at a corporate wellness event and information obtained , following the completion of a Health Risk Appraisal ( HRA ) , in keeping with inclusion criteria for the study . All participants will , at week 1 ( pre-intervention ) , be provided with a blinded pedometer to assess baseline levels of PA . Participants will be provided with feedback on pedometer data and identify strategies to improve daily PA towards current PA recommendations . Participants will thereafter be r and omly assigned to the intervention group ( INT ) or control group ( CTL ) . The INT will subsequently wear an un-blinded pedometer for 10 consecutive weeks . Individualized feedback messages based on average steps per day , derived from pedometer data ( INT ) and general supportive/motivational messages ( INT+CTL ) , will be provided via bi-weekly e-mails ; blinded pedometer-wear will be conducted at week 12 ( post-intervention : INT+CTL ) . Discussion The purpose of this paper is to outline the rationale behind , and the development of , an intervention aim ed at improving ambulatory PA through pedometer use , combined with regular , individualized , email-based feedback . Pedometer-measured PA and individualized feedback may be a practical and easily applied intervention . Trial registration Number : DOH-27 - 0112 - BACKGROUND Regular physical activity is known to help prevent chronic disease and promote healthy aging . Yet , most older women are not regularly active . This study attempts to identify objective ly measured attributes of the neighborhood environment that may be associated with physical activity levels in older women . METHODS Sociodemographics and  physical activity level , as measured by pedometer , were assessed in 158 overweight Caucasian and African-American postmenopausal women from southwestern Pennsylvania at the baseline evaluation of a r and omized clinical trial in 2002 - 2003 .  Geographic information systems technology was used to obtain neighborhood-level data , including  neighborhood socioeconomic status  ( SES ) indicators , the median year that homes were built ( as a proxy measure for urban form ) , and proximity to businesses and facilities . Multiple linear regression was used to test associations between individuals ' physical activity level and neighborhood characteristics . RESULTS After controlling for individual age , race/ethnicity , education , smoking status , and body mass index , indicators of low neighborhood SES , living in a neighborhood with homes built between 1950 and 1969 ( representing an urban form that is more pedestrian-friendly than after 1969 ) , and living within walking distance ( 1500 m ) of specific types of businesses and facilities were positively associated with individuals ' physical activity level measured by pedometer ( p < 0.05 ) . CONCLUSIONS Results suggest that certain aspects of the neighborhood environment may have an important influence on the physical activity levels of postmenopausal women . Results warrant future research to clarify the role of these environmental attributes in other population Purpose . To examine the effects of walking and yoga on multidimensional self-esteem and roles played by self-efficacy , body composition , and physical activity ( PA ) in changes in esteem . Design . Four-month r and omized controlled exercise trial with three arms : walking , yoga , and control . Subjects . Previously low-active middle-aged women ( n = 164 ; M age = 49.9 ; SD = 3.6 ) . Intervention . Structured and supervised walking program meeting three times per week for 1 hour and supervised yoga program meeting twice per week for 90 minutes . Measures . Body composition , fitness assessment , and battery of psychologic measures . Analysis . Panel analysis within a structural equation modeling framework using Mplus 3.0 . Results . The walking and yoga interventions failed to enhance global or physical self-esteem but improved subdomain esteem relative to physical condition and strength ( for walking ) and body attractiveness ( for both walking and yoga ) . Over time the effects of PA , self-efficacy , and body fat on changes in physical self-esteem and global esteem were mediated by changes in physical condition and body attractiveness subdomain esteem . Women reporting greater levels of self-efficacy and PA with lower body fat also reported greater enhancements in subdomain esteem . Conclusion . These results provide support for the hierarchic and multidimensional nature of self-esteem and indicate that middle-aged women may enhance certain aspects of physical self-esteem by participating in PA Abstract Little is known about the mechanisms leading to chronic neck-shoulder musculoskeletal disorders  ( MSD ) . The aim of the present study was to investigate and compare motor function during controlled , low load , repetitive work together with chronic or acute experimental neck-shoulder pain . The clinical study was performed on workers with ( n = 12 ) and without ( n = 6 ) chronic neck-shoulder pain . In the experimental study , experimental muscle pain was induced in healthy subjects by intra-muscular injection of hypertonic saline into the trapezius muscle ( n = 10 ) . The assessed parameters related to motor performance were : work task event duration , cutting forces , surface electromyogram ( EMG ) activity in four shoulder muscles , displacement of the centre of pressure , and arm and trunk 3D movements . For controlled cutting force levels , chronic and acute experimental pain provoked a series of changes : a decreased working rhythm and a protective reorganisation of muscle synergy ( experimental study ) , higher EMG frequency contents which may indicate altered motor unit recruitment , and greater postural activity and a tendency towards increased arm and trunk movements . These pain-related changes can play a role in the development of MSD . The present clinical and experimental study demonstrated similar interactions between motor co-ordination and neck-shoulder pain in occupational setting s. We therefore suggest that this experimental model can be used to study mechanisms related to MSD . Information on such modulatory processes may help in the design of new strategies aim ed at reducing the development of MSD Context Nonoccupational musculoskeletal disorders account for a large proportion of work disability and represent a major financial burden on society . Contribution A voluntary , r and omized , controlled intervention study consisted of avoidance of bed rest , early mobilization , avoidance of splints , stretching exercises , ergonomic training , provision of educational booklets , and suggestions for optimal levels of physical activity . Although return to work was never forced , temporary work disability , long-term disability , and costs were significantly decreased in the intervention group . Implication s The personal and financial impact of work disability due to musculoskeletal disorders ( not related to work injury ) may be mitigated by a voluntary program of education and rehabilitation . The Editors Musculoskeletal disorders ( MSDs ) are prevalent and potentially disabling conditions ( 1 ) that consume a large proportion of health care re sources ( 2 - 4 ) and together are the leading cause of functional loss in adults ( 3 - 8 ) . The social costs of MSDs are enormous , often overshadowing those of other chronic conditions ( 9 , 10 ) . In industrialized societies , MSDs are one of the most common causes of temporary work disability and the chief cause of permanent work disability ( 11 ) , accounting for productivity losses equivalent to 1.3 % of the U.S. gross national product ( 12 ) . Work disability related to MSDs is a challenge to employability , business productivity , and the capacity of health and social security systems . Various strategies for addressing MSD-related work disability have been promoted in the field of occupational health , including strategies involving legislation , risk management , ergonomics , prevention , education , and social work ( 13 ) . However , the role of health systems remains ill-defined in this field . The purpose of this study was to evaluate whether an intervention program , integrated into the health system and offered to the working population , could reduce the impact of recent-onset MSD-related temporary work disability . Methods Setting Of the 5.5 million persons in Madrid , Spain , 98 % receive health coverage from the Instituto Madrileo de Salud . Care is organized into 11 health districts . Patients have direct access to primary care physicians , who refer patients to specialized care if needed . Disability compensation payments are made by the Instituto Nacional de la Seguridad Social ( INSS ) , a division of the Ministry of Work . Any worker who requires sick leave is given a temporary work disability initiation form that states the diagnosis made by the primary care physician and entitles the worker to receive INSS compensation payments . The form is renewed weekly by the primary care physician until the worker 1 ) recovers and receives an ending form , 2 ) reaches a maximum of 18 months of temporary work disability , or 3 ) receives a proposal for evaluation for permanent work disability . Proposals for permanent work disability are evaluated by the INSS , which determines the need for and type of long-term compensation . Inspection services in each health district oversee all administrative aspects of these processes . Design We did a r and omized , controlled study , unblinded for both patients and physicians , to test whether a clinical intervention could improve the outcome of patients with recent-onset MSD-related temporary work disability . The study began in March 1998 in health district 7 and in March 1999 in health districts 4 and 9 . Selection and r and omization of patients was done during the first year of the study in each district . Follow-up lasted for another year . Patients and Selection Criteria Health districts 4 , 7 , and 9 were chosen . Health district 4 had a total population of 508249 persons and an active working population of 192939 persons ; health district 7 had a total population of 522742 persons and an active working population of 179155 persons ; and health district 9 had a total population of 371294 persons and an active working population of 135475 persons ( 14 ) . The inclusion criterion was the issue of a common diseases temporary work disability initiation form , with an MSD-related cause reported by the primary care physician , within the inclusion period . The MSD-related causes included all arthropathies , connective tissue disorders , back disorders , soft-tissue rheumatisms , bone and cartilage disorders , musculoskeletal pain not caused by cancer , and nerve entrapment syndromes . Patients were excluded if they had a common diseases temporary work disability form with an MSD-related cause result ing from trauma or surgery . They were also excluded if they had work accidents or professional diseases noted on the temporary work disability initiation form . Work accidents are primarily sudden , external , violent causes of disease occurring at work or during travel to work , and they represent less than 27 % of cases of temporary work disability . Professional diseases include silicosis , asbestos-related mesothelioma , and noise-induced hearing loss , and they represent less than 1 % of cases of temporary work disability . R and omization All temporary work disability initiation forms meeting the selection criteria were collected daily by a study rheumatologist and coded . The patients associated with the forms were r and omly assigned to either the intervention group , which received a specific care program , or the  control group  , which received st and ard care ( Figure 1 ) . Computer-generated lists of pseudor and om numbers were produced for each district . Group assignments were r and omly done in blocks of 50 patients with intervention : control ratios of 1:1 in district 7 and 2:3 in districts 4 and 9 . This was done so that similar numbers of patients would be seen by the rheumatologists in all areas . The ratios were based on the number of episodes of MSD-related temporary work disability registered in previous years . Patients maintained their group assignments in successive episodes of MSD-related temporary work disability during follow-up . Figure 1 . Flow diagram of the study . Care in the Intervention Group A secretary contacted all patients assigned to the intervention group by telephone or mail as soon as possible after the initiation form was issued , offering them an appointment in the program . Patients who voluntarily decided to enter the program were attended by 2 rheumatologists in each district who worked full-time for the study . Patients were seen as often as necessary until the episode of temporary work disability was resolved or recovery was deemed unrealistic . Patients who were assigned to the intervention group but were unable or unwilling to participate , were already working , or could not be located were considered to be assigned to the intervention group throughout the study for statistical purpose s. Within the intervention program , care was delivered in regular visits and included education , clinical management , and administrative duties . Education At the first 45-minute visit , patients received a specific diagnosis , reassurance that no serious disease was present , instructions on self-management , instructions on taking medications on a fixed schedule , and information on indications for return to work before complete symptom remission . Return to work was negotiated with patients and was never forced on them . Instructions on self-management included instructions to avoid bed rest , instructions to promote early mobilization of the painful regions , restrictions on the use of splint and neck collars , training in stretching and strengthening exercises ( 15 - 18 ) , teaching of ergonomic care ( 19 ) , delivery of booklets in instances of back or neck pain ( 19 ) , and information on optimal levels of physical activity ( 20 ) . Patients with higher degrees of disability or abnormal pain behavior received immediate extra reassurance , information on pain-relieving positions , and a telephone call or second visit within 72 hours . Specific protocol s were created for low-back ( 21 ) , neck , shoulder , arm and h and , knee , and foot pain ( 19 , 22 - 25 ) and included the 3-level clinical -management system described later . Moving a patient from the lower to the upper levels of the system implied the need for further diagnostic or therapeutic procedures and was indicated 1 ) after a patient spent a predefined period at the lower level without return to work or substantial clinical improvement or 2 ) by the clinical judgment of the rheumatologist . At the first level of the system , patients received the clinical management started at the first visit , including a diagnosis based on clinical criteria , pharmacologic treatment of pain and inflammation , pharmacologic treatment of anxiety and depression , peripheral intra- and periarticular injections ( 26 ) , and education . Time spent at the first level averaged 2 to 6 weeks . At the second level , patients received maintenance of therapy plus referral for formal rehabilitation and laboratory tests , radiography , computerized tomography , magnetic resonance imaging , and electromyography . After 4 to 8 weeks with no improvement at the second level , patients were moved to the third level and received further diagnostic procedures or referral for surgical or other specialized care . Red flags were defined , including age older than 50 years for patients with axial pain , previous trauma , cancer , serious medical illness , inflammatory pain , night pain , drug abuse , corticosteroid use , fever , weight loss , progressively deteriorating function , and progressive neurologic deficit . The presence of a red flag precluded the use of the level system , and the patient in question was managed according to clinical criteria , with a focus on excluding serious illness . Treatment Failures Patients who did not respond to interventions at the second level of the system were examined for the presence of yellow flags , which included psychiatric illness , family problems , sociolabor conflicts , unemployment , and occupational causes of disability . The presence of a BACKGROUND Increasing moderate-to-vigorous-intensity physical activity ( MVPA ) is an important public health goal . Pedometers are evidence -based devices for increasing daily activity , but studies have not evaluated the comparative efficacy of step cadence goals for increasing MVPA . PURPOSE This study aim ed to evaluate the efficacy of three pedometer-based step goals for increasing MVPA . METHODS Latina women ( n = 180 ; 18 - 55 yr , mean body mass index = 31.1 , SD = 6.5 ) were recruited to 12 community centers , which were r and omly assigned to one of three conditions . Each group received an identical 12-wk theory-based physical activity ( PA ) intervention that differed only on the type of daily step goal : 1 ) a self-selected goal ( SELF ) ; 2 ) a goal of 10,000 steps per day ( FREQUENCY ) ; or 3 ) a goal of 3000 steps in 30 min ( CADENCE ) . Accelerometer-based PA  was measured at baseline and after 12 wk . RESULTS Adjusted multilevel pattern-mixture models using generalized estimating equations revealed that participants in the CADENCE condition engaged in similar levels of postintervention MVPA to those in the SELF and FREQUENCY goal conditions . However , MVPA of participants in the CADENCE condition was more likely to occur in bouts lasting greater than 10 consecutive minutes compared with the MVPA of participants in the SELF ( P = 0.01 ) or FREQUENCY ( P = 0001 ) conditions . CONCLUSIONS PA interventions should consider including a step cadence goal to help individuals accumulate bout-based MVPA and meet national PA guidelines OBJECTIVES For smoking cessation , physical activity ( PA ) may help manage withdrawal symptoms , mood , stress , and weight ; yet studies of PA as an aid for smoking cessation have been mixed . This study examined : ( 1 ) the impact of an extended relapse prevention program on increasing moderate to vigorous PA ( MVPA ) in adults enrolled in a tobacco cessation treatment trial ; ( 2 ) whether changes in MVPA were associated with sustained abstinence from smoking ; and ( 3 ) mechanisms by which MVPA may support sustained abstinence from smoking . METHODS In a r and omized controlled trial conducted from 2003 - 2006 in San Francisco , California , 407 adult smokers received a 12 week group-based smoking cessation treatment with bupropion and nicotine patch with the quit date set at week 3 . At week 12 , participants were r and omized to no further treatment or to 40 weeks of bupropion or placebo with or without an 11-session relapse prevention intervention of which 2 sessions ( held at weeks 16 and 20 ) focused on PA . Participants receiving the PA intervention ( n=163 ) received a pedometer , counseling to increase steps 10 % biweekly towards a 10,000 steps/day goal , and personalized reports graphing progress with individualized goals . The International Physical Activity Question naire assessed weekly minutes of MVPA at baseline and weeks 12 and 24 . Sustained abstinence from tobacco at week 24 was vali date d with expired carbon monoxide . RESULTS In a repeated mixed model analysis , intervention participants significantly increased their MVPA relative to control participants , F(1,475)=3.95 , p=.047 . Pedometer step counts also increased significantly , t(23)=2.36 , p=.027 , though only 15 % of intervention participants provided 6 weeks of pedometer monitoring . Controlling for treatment condition , increased MVPA predicted sustained smoking abstinence at week 24 , odds ratio=1.84 ( 95 % CI : 1.07 , 3.05 ) . Among participants with sustained abstinence , increased MVPA was associated with increased vigor ( r=0.23 , p=.025 ) and decreased perceived difficulty with staying smoke-free ( r=-0.21 , p=.038 ) . CONCLUSION PA promotion as an adjunct to tobacco treatment increases MVPA levels ; changes in MVPA predict sustained abstinence , perhaps by improving mood and self-efficacy Objective To investigate the association of physical and psychosocial risk factors with musculoskeletal disorders ( MSDs ) in New Zeal and nurses , postal workers and office workers . Design A cross-sectional postal survey asking about demographic , physical and psychosocial factors and MSDs . Participants A total of 911 participants was r and omly selected ; nurses from the Nursing Council of New Zeal and data base ( n=280 ) , postal workers from their employer 's data base ( n=280 ) and office workers from the 2005 electoral roll ( n=351 ) . Outcome Measures Self-reported pain in the low back , neck , shoulder , elbow , wrist/h and or knee lasting more than 1 day in the month before the survey . Results The response rate was 58 % , 443 from 770 potential participants . 70 % ( n=310 ) reported at least one MSDs . Physical work tasks were associated with low back ( odds ratio ( OR ) 1.35 , 95 % CI 1.14 to 1.6 ) , shoulder ( OR 1.41 , 95 % CI 1.17 to 1.69 ) , elbow ( OR 1.14 , 95 % CI 1.13 to 1.83 ) and wrist/h and pain ( OR 1.39 , 95 % CI 1.15 to 1.69 ) . Job strain had the strongest association with neck pain ( OR 3.46 , 95 % CI 1.30 to 9.21 ) and wrist/h and pain . Somatisation was weakly associated with MSDs at most sites . Better general and mental health status were weakly associated with lower odds of MSDs . Conclusions In injury prevention and rehabilitation the physical nature of the work needs to be addressed for most MSDs , with modest decreases in risk seemingly possible . Addressing job strain could provide significant benefit for those with neck and wrist/h and pain , while the effects of somatisation and the promotion of good mental health may provide smaller but global benefits This multi-centred , r and omised controlled trial explored the effects of adding ongoing feedback to a 12-month unsupervised maintenance walking program , on daily physical activity ( PA ) in people with chronic obstructive pulmonary disease . Participants were r and omised to either an intervention group ( IG ) or a usual care group ( UCG ) . During the maintenance program , the IG received ongoing feedback ( telephone calls , biofeedback provided via pedometer and progressive goal setting ) and the UCG received no feedback . The SenseWear ® Pro3 Armb and was used to measure PA .  Of the 86 participants { IG = 42 , ( mean [ SD ] : age 70 [ 7 ] years ; FEV1 43 [ 16 ] % predicted ) ; UCG = 44 , ( age 69 [ 9 ] years ; FEV1 44 [ 15 ] % predicted ) } included at baseline , 43 had sufficient data to be included in the final analysis . There were no between-group differences in any of the PA variables from baseline to completion of the program ( all p > 0.05 ) . Ongoing feedback was no more effective than no feedback in improving PA during a 12-month unsupervised walking program . Trial Registration : The trial was registered in the Australia and New Zeal and Clinical Trials Registry ( ACTRN12609000472279 )
Conclusion This study provides strong evidence for the effectiveness of pedometer walking interventions in increasing PA levels for patients with MSDs .
Our findings suggest that a combination of interventions is likely to be the most effective strategy to maximize health benefits in the short term .
Background Physical activity ( PA ) plays an important role in the prevention and management of a number of chronic conditions .
Aim : to investigate the evidence for effectiveness of pedometer-driven walking programs to promote physical activity among patients with musculoskeletal disorders ( MSDs ) .