Table 3.2 Effective Use of Pedometers (Step Counters)
Following are some points to consider when advising diabetic individuals on how to most effectively use pedometers to promote and record daily physical activity:
• Pedometers are capable of recording ambulatory activity, such as walking, jogging, or running. They will not count steps during cycling, rowing, upper body exercise, swimming, and other activities. However, steps can be estimated using metabolic equivalent (MET) levels for activities (see some equivalent values in Table 3.3).
• For most adults, 2,000 steps is the equivalent of about 1 mile of walking, but the recorded steps can be affected by stride length, pedometer accuracy, and other factors.
• The most essential feature of any pedometer is the step count. Pedometers are most accurate in counting steps, less accurate in calculating distance walked, and even less accurate at estimating caloric expenditure.
• A variety of factors can affect step=counting accuracy, such as walking speed, waistband type, and abdominal size. In general, most pedometers are fairly accurate step counters at speeds of 2.5 mph and above.
• Pedometers are more accurate at counting steps when attached to a firm waistband in an upright position and placed to the side (directly up from the knee cap on either side); attachment of pedometer to loose waistbands typically leads to an underestimation of steps taken.
• Having a large waist size can negatively impact step-counting accuracy. For anyone with a large abdomen (or for pregnant women with any type of diabetes), place the pedometer at the small of the back, or use one that can be placed in a pocket or other location (like around the knee).
• Go for simplicity, but accuracy, in a pedometer: extensive bells and whistles are not required. Recommended brands include most Accusplit, Yamax, and Omron models.
• To test a pedometer’s accuracy, an individual should position the device on his or her belt or waistband in line with one knee on either side of the body and reset the pedometer’s count to zero. When taking 20 steps at a typical walking pace, if the pedometer records between 18 and 22 steps, it is reasonably accurate. If not, reposition it and try again. If it repeatedly fails this test, look into buying another type.
• A “physically active” adult is expected to accumulate at least 10,000 steps per day (or the step equivalent if engaging in activities that a pedometer cannot easily record).
• Establish a baseline by tracking steps for a few days without intentionally increasing physical activity level.
• Set appropriate step goals by progressively increasing steps from baseline using small increases to start, such as taking an extra 500−1,000 daily steps.
Although pedometers are most suitable for tracking walking-based activities, they cannot detect changes in type, intensity, or pattern of activity. Some step equivalents for various activities are alternately given in Table 3.3 (based on metabolic equivalents, or MET levels) (Ainsworth 2011). Accelerometers and global positioning system (GPS) devices alternately may be used to detect such movements and are gaining popularity for use in determining total daily movement (Webber 2009).
Table 3.3 Step Equivalents for Various Physical Activities
Case in Point: Wrap-Up
To overcome DC’s barriers to and any possible concerns associated with being physically active, a professional makes the following suggestions to her:
1. Start with more daily movement. The best way to start is by simply doing more daily movement and by being as active as you can all day long. Every step you take during the day counts. If you are just starting out, start with 10 min a day and add extra minutes a little bit at a time. Work up to 10 min at a time, three times a day, during the day—on breaks, during lunch, or whenever you can fit it in.
2. Do not wait until you are tired to exercise. Another trick is to try to fit in more steps and movement at the time of day when you have more energy. Just try walking for as long as possible during your lunch break a few days each week. You’ll find that the more you do, the more energy you actually will have.
3. Stand up more. Also, instead of sitting down, try standing up for an extra 10 min a day—while you are talking on the phone, stuck in a meeting (stand next to the wall), or just waiting somewhere. Standing is a physical activity that most of us could afford to do more of, so start thinking about ways to stand more every day. It also helps break up your sitting time, which helps use up blood glucose and keep you healthier.
4. Be active in your home. Even at home, make physical activity part of your daily routine. For example, exercise while you watch television (even if it just consists of walking in place), do some cleaning around the house, or do something active with your family and friends.
5. Learn how to adjust your insulin dose, and be prepared to treat a low. Because you use insulin, ask your doctor or health-care provider about how much you might need to lower your insulin dose as you start to be more regularly active. Any physical activity can make insulin work better, so just make sure that you are prepared to treat a low blood glucose level if you have one. Keep some easily absorbed carbohydrates with you during your activity, such as glucose tablets, hard candy, sports drink, or even crackers.
6. Focus on activities that you can safely do indoors. Because you cannot walk outside in your neighborhood (at least part of the time), try to find an inexpensive indoor activity that you can do, such as an exercise class at a community center. Also, think of activities you can do in the safety of your home, including all types of home-based exercise programs and videos. Some programs are also shown on television channels at various times of day. You do not need expensive equipment to work out in your home either. Try walking in place, doing stretching, or using food cans or water bottles for weights. You may want to buy some inexpensive resistance bands to use at home.
7. Get support from friends and family by involving them. Finally, if you are still lacking the motivation to exercise, invite a family member or friend to exercise with you on a regular basis (like having a friend walk with you during lunch). Plan when you are going to do each type of activity.
Doing more daily movement is not as effective as most structured exercise programs in increasing fitness levels, but it is important for many other reasons, including expending extra calories, breaking up sitting time, and building a fitness base in individuals who are overweight or sedentary. Use of pedometers may motivate individuals to engage in more unstructured physical activities. In addition, once individuals have successfully implemented more physical activity into their daily lifestyle, they likely will feel more confident, ready, and able to initiate and keep participating in more structured forms of activity.
Professional Practice Pearls
• All adults should avoid inactivity. Some physical activity is better than none, and participation in any amount of physical activity bestows health and glycemic benefits.
• The best way for deconditioned or overweight individuals with diabetes to start being more physically active is to focus on increasing their daily movement first.
• Daily movement (or unstructured physical activity) includes taking more daily steps, standing more, and doing more activities of daily living like housework.
• Individuals with diabetes will benefit from simply reducing their