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Prescribing daily step count benefits patients’ health

People prescribed steps moved 20% more and had lower HbA1c and insulin resistance

Louise Prime

Friday, 24 February 2017

A doctor’s “prescription” for a daily step count led people with type 2 diabetes and/or hypertension to walk 20% more steps, and produced measurable health benefits including reduced blood glucose levels and insulin resistance, research from Canada has shown. The researchers behind the study,* published online in Diabetes, Obesity, and Metabolism, said their idea was “to use step counts almost as a medication”.

The research team, led from McGill University in Montreal, recruited 364 adult patients with a diagnosis of type 2 diabetes, hypertension, or both; a body mass index (BMI) of 25-40 kg/m2; and who reported doing <150 minutes of leisure-time physical activity/week. At baseline, more than 66% of participants had type 2 diabetes and more than 90% had hypertension. Patients were randomised to either the control group (who received the usual advice to engage in 30-60 minutes of activity daily) or to usual care plus a doctor’s step count prescription and a pedometer.

The aim was to achieve a net increase over baseline of 3,000 steps/day over 1 year, but the speed at which this overall step target should be achieved was determined during discussions between the patient and doctor at the initial and follow-up clinic visits. The prescription was for a recommended increase of 3,000 steps/day for 10 months for sedentary participants (who at baseline did only <5,000 steps/day); for seven months for low-active participants (5,000-7,499 steps/day at baseline); and for five months for somewhat active participants (7,500-9,999 steps/day at baseline).

The researchers evaluated the effects of a step count prescription on participants’ step counts, carotid femoral pulse wave velocity (cfPWV, primary) and other cardiometabolic indicators including haemoglobin A1c in diabetes (HbA1c) and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) in participants not receiving insulin therapy.

Of the original 347 participants, 275 (79%) completed final evaluations. There was a net 20% increase in steps/day in active vs control arm participants, although this was below the 3,000 steps/day targeted increment. Active vs control arm participants with type 2 diabetes experienced a significant decrease (−0.38%) in HbA1c. HOMA-IR, assessed in all participants not treated with insulin, also significantly declined in the active arm vs the control arm (−0.96). However, changes in cfPWV were inconclusive.

The study authors concluded: “While conclusive effects on cfPWV were not observed, there were conclusive improvements in both A1c and insulin sensitivity. Future studies will evaluate an amplified intervention to further increase step counts, to achieve greater impact on cardiovascular health.”

Lead author Dr Kaberi Dasgupta commented: “As physicians, we have to face reality and admit that for many patients, just telling them to be more physically active simply doesn’t work. A lot of people want to be active, but it is very difficult to change health behaviours. The idea in this study is to use step counts almost as a medication.” She added: “If we want doctors to prescribe physical activities, it needs to be aligned and integrated in the medical routine and added to health guidelines, which we plan on doing in the near future.”


* Dasgupta K, Rosenberg E, Joseph L, et al. Physician step prescription and monitoring to improve ARTERial health (SMARTER): a randomized controlled trial in type 2 diabetes and hypertension. Diabetes Obes Metab, 2017. doi: 10.1111/dom.12874

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