EXERCISE AND QUALITY OF LIFE
Research article
Volume 3, No. 1, 2011, 1-9
UDC 796.035-053.8(495)
NUMBER OF STEPS PER DAY AND PHYSICAL
ACTIVITY LEVELS OF ADULTS IN GREECE
Maria Michalopoulou, Nikos Ageloussis, Labrini Drolapa and Stella Exarchopoulou
Department of Physical Education and Sports Science
Democritus University of Thrace
Abstract
This study compared self reported physical activity
(PA)
(MET min/week) with
pedometer determined PA (steps/day). Participants in this study were 300 adults, (25 - 56 years
of age). PA was assessed with the IPAQ long form and the number of steps was assessed with
the Yamax model SW-200. Participants wore the pedometer for 7 consecutive days. Data
(categorical score) was analyzed using cross-tabs analysis. Two-way ANOVA (gender 2 x level
of PA 3) was performed on the number of steps/day. Significant main effect was reported only
for the factor ìlevel of PAî with adults in the moderate and the high activity group performing
more steps/day than adults in the low PA group. Adults in Greece performed less steps/day than
the international recommendations PA suggest even though the majority of them were assigned
by IPAQ long form at the moderate and very high PA groups.
Keywords: physical activity recommendations, pedometer, self report
Introduction
The importance of physical activity
(PA) in maintaining improved quality of life
(USDHHS, 1996), increased longevity (Lee, & Paffenbarger, 2000; Lee, & Skerrett 2001) and a
number of health benefits is well recognized (Blair, Cheng, & Holder, 2001; Morris, Clayton,
Everitt, Semmence, & Burgess, 1990; Thune, Njolstad, Lochen & Forde, 1998).
The effects of PA on health can be mediated by changes in fitness, but the relationships
among levels of physical activity and health are complex. Lifestyle behaviors physical and social
environmental conditions, personal attributes and genetic characteristics can also determine their
interrelations (Bouchard, Blair and Haskell, 2006).
Even though the precise amount and type of PA required to achieve specific health
related outcomes remains unclear (Haskell, 1994; Freedson, & Miller, 2000), recommendations
regarding the types and amounts of physical activity /exercise needed for health and fitness
improvement have been suggested by different organizations for different population groups
Corresponding author. Democritus University of Thrace, Department of Physical Education and Sport Science,
Campus, 69100 Komotini, Greece, e-mail: michal@phyed.duth.gr
© 2010 Faculty of Sport and Physical Education, University of Novi Sad, Serbia
M. Michalopoulou et al.
(ACSM, 1975, 1978; AHA 1975; USDHHS, 1996; ACSM/AHA 2007). These recommendations
for health enhancing physical activity/exercise included information on the frequency, intensity
and duration of either exercise or physical activity for the general population and segments of it.
The American College of Sports Medicine originally in 1975 recommended to sedentary
adults exercising 3 days per week, for 15-60 min with 60-90% max heart rate and AHA
suggested exercising 3-4 times per week for 20-60 min with 70-80 % max heart rate The ACSM
and the USDHHS/CDC recommendation was later issued suggesting exercising 3-5 times per
week with 40 - 85 % Vo2max, recommending that every US adults should accumulate 30 min or
more of moderate intensity physical activity on most preferably all days of the week (Pate, Pratt,
Blair, Haskell, Macera, Bouchard, & King, 1995).
An alternative guideline traced back to Japanese walking clubs recommends the
accumulation of
10.000 steps per day for healthy adults
(Tudor-Lock, & Bassett,
2004).
Additionally indices to classify pedometer determined physical activity suggest that <5000 steps
per day is indicative of sedentary lifestyle, 5000-7499 steps/day is considered as low active since
it is typical of daily activity excluding sports/exercise, 7500 steps per day might be considered as
ìsomewhat activeî since it likely includes some volitional activities , > 10.000 steps per day
indicates ìactiveî individuals and finally individuals who take >12.000 steps per day are likely to
be characterized as ìhighly activeî.
With the greater emphasis on the relationship of PA to health, there is an emerging need
for accurate and reliable methods of estimating and assessing PA and energy expenditure, (Sallis,
& Saelens, 2000). Questionnaires (self report instruments, daily logs and diaries) have always
been a very popular approach in assessing PA in large population samples. IPAQ (Craig,
Marshall, Sjˆstrˆm, Bauman, Booth, Ainsworth, Pratt, Ekelund, Yngve, Sallis, & Oja, 2003) is a
self-reported measure of physical activity suitable for assessing population levels of physical
activity across countries. It has been used with confidence in developed countries or in urban
samples in developing countries, but with some caution in rural or low literacy samples from
developing countries. The primary target group for IPAQ was middle-aged adults and IPAQ
measurement properties in older adults or adolescents are not known (Craig et al. 2003). This
self report questionnaire provides both a continuous MET min/week score and a categorical
according to which participants are assigned to
3 levels of PA: high, moderate and low.
According to the IPAQ Research Committee the high PA level equates to approximately at least
one hour per day or more, of at least moderate intensity activity above the basal level of PA and
can be considered for as those who move at least 12,000 steps per day or the equivalent in
moderate and vigorous activities. The moderate level of PA equates to ìhalf and hour of at least
moderate intensity PA on most daysî and the low level of PA is the lowest level of PA and
individuals who do not meet the criteria for the other two categories are assigned to this
category.
Walking, is one of the most common forms of activity for US adults (Crespo, Keteyian,
Heath & Stempos, 1996) and Canadians (CFLRI, 2004) and is readily captured by a pedometer.
Public health initiatives in these countries have emphasized this activity (Pate et al. 1995;
USHHS ,1996; CFLRI, 2004) since walking has been associated with lower risk of CHD
(Manson, Nathan, Krolewski, Stampfer, Willett, & Hennekens, 1992) and coronary events (Hakim,
Curb, Pertovitch, Rodrigez, Yano, Ross, White, & Abott, 1999). Pedometers have been useful for
examining questions about walking and in particular distance covered on physical activity
questionnaires (Bassett, Cureton, & Ainsworth, 2000). Pedometers are a type of motion sensor
that are low-cost, unobtrusive, accurate (Basset et al., 1996; Crouter et al., 2003; Schneider et al.,
2003), and their output (steps or distance) is easily comprehendible and thus are becoming
increasingly popular in physical activity research and within the general population (Bassett,
Cureton, & Ainsworth, 2000). Pedometers are typically worn on the belt or waistband and
respond to vertical accelerations of the hip during gait cycles. They provide data on steps and
some models estimate distance traveled and energy expenditure. Although pedometers measure
2
Number of steps of Greek adults
ambulatory activity, they do not capture all types of physical activity (swimming, weight lifting,
bicycling, etc.).
They can also be used to distinguish between individuals whose physical activity level
varies based on steps per day, to determine whether individuals meet step recommendations, to
measure changes in physical activity with interventions, and address several other issues in
physical activity research and applications. According to recent studies pedometer determined
steps per day activity classifications have been proposed: _5000 sedentary, 5000ñ7499 inactive,
7500ñ9999 somewhat active and 10,000 active (Tudor-Locke, & Bassett, 2004).
According to the IPAQ scoring protocol ñ categorical score, the above recommendations
are met by those that are included in the levels of moderate PA and high PA and not by those in
the low PA level. It is unclear though whether these two recommendations are congruent or
whether ì10.000 total steps per dayî is more than 30 min of moderate-intensity physical activity.
It is also unclear if the individuals that are assigned to the 2 top levels of PA with the use of
IPAQ ñ long form meet the cut-point of 10.000 steps per day. The aim of the present study was
to determine the number of steps per day taken by adults in Greece assigned in the different PA
levels that have been proposed by IPAQ and possible gender effects on the participantsí level of
PA.
Method
Participants
Participants in this study were 300 adults 150 men (44.5 + 8.3 years of age) and 150
women (34.9 + 7.5 years of age). They were requited through a posted advertising campaign that
was initiated by the Municipal Center for Recreation in 3 Greek urban centers. Before taking part
in this study participants were informed about the purpose and the content of this study and
signed an informed consent form approved by the Dept of PESS, University of Thaceís review
board. Physical and demographic characteristics of the participants are presented in Table 1.
Instruments and Procedure
Questionnaire estimated physical activity
Physical activity was assessed with the use of the long self ñ administered version of the
International Physical Activity Questionnaire (Craig et al. 2003). This long version (31 items)
was designed to collect detailed information within the domains of household and yard work
activities, occupational activity, self-powered transport, and leisure-time physical activity as well
as sedentary activity. The data collected were summed in order to estimate the total time spent in
vigorous physical activity, moderate intensity physical activity and walking. The total weekly
PA was estimated as a continuous variable by weighting the reported minutes per week within
each activity category by a MET energy expenditure estimate assigned to each category of
activity. MET levels were obtained from the 2000 Compendium of physical activities to include
walking (3.3 MET), moderate-intensity activities (4 MET) and vigorous-intensity activities (8
MET). Cut points were also used in order to create a categorical variable according to which PA
can be characterized as high, moredate and low (IPAQ Scoring protocol, 2005).
Pedometer estimated physical activity
The pedometer used in this study was the Yamax model SW- 200, Yamax Corporation,
Tokyo, Japan. This brand detects steps taken acceptably under both controlled conditions
(Crouter, Schneider, Karabulut, & Bassett, 2003; Schneider, Crouter, Lukajic & Bassett, 2003; Le
3
M. Michalopoulou et al.
Masurier, & Tudor-Locke, 2003) and free-living conditions (Schneider et al. 2003). Additionally
as an electronic pedometer it has greater accuracy than old-fashioned mechanical pedometers
(Basset, Ainsworth, Leffett, Mathien, Main, Hunter, & Duncan, 1996). Participants were instructed
how to use the pedometer for the following 7 days (remove the pedometer only while bathing,
showering, or swimming) starting the morning of following day of the meeting. When 7 24-hour
days had elapsed the participants were asked to record their 7 days-end steps taken on the
provided log and also report it by phone to the researcher. On the 8th day a meeting with the
researcher was scheduled in order for the participants to complete the IPAQ ñ long form
questionnaire, return the pedometer kit and collect data related to height and weight to compute
body mass index (BMI) as kg/m2.
Analysis of data
All statistical analyses were performed using SPSS (Statistical Packege for the Social
Sciences for Windows, 14.0, 2006, SPSS Inc., Chicago IL). Descriptive data are presented as
frequencies, means and standard deviations. Cross-tabs analysis was used in order to assess the
effect of gender of the level of physical activity (categorical score). Two way analysis of
variance was used in order to determine the effect of gender (2) x level of physical activity (3) on
the dependent variable ìnumber of steps/dayî. Post hoc analysis was performed using the LSD
test. Pearson correlation coefficient was calculated for the variables of total physical activity
(MET min/week) score, moderate physical activity (MET min/week) score, walking (MET
min/week) score and steps/day. The level of significance was set at p = .05.
Results
Physical characteristics and physical activity data in MET values of the participants
according to gender and PA level are presented in Table 1.
Table 1
Physical characteristics and physical activity levels of the male and female participants
according to their level of physical activity
Low PA
Moderate PA High PA
Total
M (SD)
Women
(N)
41
38
71
150
PA ñMET score
924 (482)
2.318 (483)
6.562
(3.155)
4.830
(3.490)
Age (years)
47.9
(7.2)
45.6
(8.4)
43.9
(6.2)
45.8
BMI
22,73
22,28
22,33
22,38
Men
(N)
31
21
98
150
PA ñMET score
856 (562)
1.981(536)
9.654
(7.653)
5490 (4.313)
Age (years)
44.2
(5.1)
42.7
(3.3)
45.8
(7.5)
44.5
(8.3)
BMI
26,5 (4,6)
26,11 (3,3)
25,91 (3,2)
26,06 (3,05)
Gender effects on physical activity ñself report measure
Categorical MET Score
According to the results of cross-tabs analysis, chi-square was not statistically significant
(x2=1.30, p>.05) and physical activity level was independent to the factor gender. No differences
were reported between the number of male and female participants that were assigned to the 3
different levels of PA according to IPAQ categorical score.
4
Number of steps of Greek adults
Continuous MET Score
According to the results of the analysis of variance no significant effect for the factor
gender (F(1,298) = 1,762, p = .185), was revealed for the total MET score (Table 1). Additionally
MANOVA revealed a significant effect for the factor ìgenderî only on physical activity of high
intensity (F(1,298) = 4,793, p = .029) where men had significantly higher scores than women. No
gender effects were reported for physical activity of moderate intensity (F(2,298) = 3,064, p =
.081), and on walking (F(2,298) = 2,165, p = .142) (Table 2).
Table 2
Physical activity (MET min/week) of high moderate intensity and walking for men and women
participated in the study
High Intensity PA* Moderate Intensity Walking
Total Score
M (SD)
PA
Women
1.825
(2.418)
1.616
(1.477)
1.389
(1.314)
4.831
(4.993)
Men
2.553
(3.272)
1.315
(1.493)
1.622
(1.426)
5.491
(3.490)
*PA = physical activity
Number of steps
According the results of two- way ANOVA no significant interaction was revealed for
the factors ìgenderî and ìlevel of physical activityî (F(2,294) = ,234, p > .792) on the number of
steps/day taken. A significant main effect was reported only for the factor ìlevel of physical
activityî (F(2,294) = 53,168, p = .000) but not for the factor ìgenderî (F(1,294) = 1,801, p = .181).
Post hoc LSD test revealed significant differences between all three levels of the factor ìlevel of
physical activity (p<001), (Table 3).
Table 3
Number of steps per day according to the gender and level of physical activity (PA) set by IPAQ
for all the participants in this study
Low Physical Moderate Physical High PA
Total
Activity
Activity
Women (n)
41
38
71
150
5183 (1092)
6430 (2302)
8844 (2456)**
7783 (2692)
Men (n)
31
21
98
150
5309 (2379)
7206(2523)
9324 (3267)*,**
7906 (3339)
Total
72
59
169
300
5256 (1929)
6867 (2853)*
9061(2853)*,**
7845 (3029)
*= differences with low physical activity group
** = difference with moderate physical activity group
Additionally according to Pearson correlation
(r) the number of steps/day was
significantly correlated with total physical activity score (r = .50, p = .01) Correlations for men
and women between number of steps and total physical activity score, high intensity physical
activity, moderate intensity physical activity and walking are presented in Table 4.
5
M. Michalopoulou et al.
Table 4
Correlation of steps per day and physical activity assessed with IPAQ-long form for all the
participants in this study
Steps per day Walking PA
Moderate
Intensity Vigorous PA
PA
Walking PA
.40*
Moderate Intensity
.27*
.27*
PA
Vigorous PA
.41*
.26*
.34*
Total PA score
.50*
.59*
.66*
.87*
*p <.01
Discussion
According to the results of this study the majority of the participants
(76%) were
physically active enough since following the categorical scoring system of the IPAQ long form
they were assigned to the moderate and the high PA groups. Additionally the adult men and
women in this study, who were moderately and highly physically active again according to IPAQ
categorical scoring system, performed significantly more steps per day when compared to adults
who were assigned in the low physical level. Further more significant differences in the number
of steps/day were also recorded between adults who were moderately and those who were highly
active.
In further detail, in relation to gender, male participants who were assigned as highly
active performed significantly more steps/day than the other two male groups (low PA and
moderate PA) and the moderately active males performed more steps/day than the low activity
group. As for female participants, significant differences were reported between the low physical
activity group and the highly active women and between the moderately active group without
though reporting significant differences between women who were assigned in the low and
moderate activity group.
All the above results support the use of the IPAQ long form as a self report instrument
used by adults, in assessing PA level. By interpreting these results a rather positive conclusion
can be formed concerning the overall PA level of the participants since only 24% had a low PA
level that is likely to translate into unfavorable health outcomes whereas the converse would be
true for participants in the moderate and high level of PAî (Bouchard, et al. 2006).
This finding of health ensuring physical activity level for the majority of the Greek
adults is unfortunately being contradicted by those of recent studies performed in Greece and in
other European countries according to which a smaller percentage of Greek adults is active
enough to ensure health related benefits
(Makavelou, Michalopoulou, Makavelou, Ifantidou,
Kourtesis, & Zetou, 2005; Varo, Martinez-Gonzalez, de Irala-Estevez, Kearney, Gibner, & Martinez,
2003). According to the recently published Euro barometer Report (2010), 67% of the Greek
responders replayed ìneverî to the question ìHow often do you exercise or play sportî.
Additionally the number of daily steps that were recorded for the two groups of
participants in the high PA and the moderate PA groups that are supposed according to IPAQ
scoring protocol to meet the 30 min (-1day) recommendations for health enhancing PA, are lower
from what has been suggested by the literature (Tudor-Locke, & Bassett, 2004). In more detail if
the participantsí compliance with pedometer determined recommendations, in this study, was to
be based upon the number of steps they performed daily, the results would differ significantly
6
Number of steps of Greek adults
from the ones that became available with the use of IPAQ long form. Using the cut points in
daily step counts suggested by Tudor-Locke, & Bassett (2004), both participants in low and the
moderate PA groups would be characterized as ì inactiveî since their mean daily step counts
were within the 5000-7499 range, (5309 and 6867 steps/day respectively). Previous studies have
presented contradicting results according to which, adults in Australia who achieve current PA
guidelines also achieve 10.000 steps/day (Mc Cormak, Giles-Cort, & Milligan, 2006) and on the
other hand self report adherence estimates in a representative sample in US adults, were much
higher that those measured by accelerometer, (Troiano, Berrigan, Dodd, Masse, Tilert, & McDowell,
2008).
The use of PA recommendations may be closer to the findings of this study if we
consider that
8,000 steps day(-1) might be a more valid screening tool as a proxy for classifying
those meeting public health physical activity recommendations of 30 min.day(-1) of moderate
activity as suggested by previous studies
(Macfarlane, Chan, Chan, Ho, & Lee, 2008; Tudor-
Locke, Ainsworth, Thomson, & Matthews, 2002). Additionally, the use of IPAQ long form, a
self-report instrument that categorizes participantsí PA by level of exertion (light, moderate,
vigorous) and a direct method (pedometer), results in increased differences between the mean
percent of the higher category levels of intensity (Prince, Adamo, Hamel, Hardt, Gober, &
Trambley, 2008).
In conclusion, due to limited convergent validity between the two instruments
(Macfarlane, Lee, Ho, Chan, & Chan, 2006) these measures are measuring different levels of
habitual PA and care is needed when comparing their results in particular since both instruments
address PA recommendations that are being used in lifestyle PA interventions in different
population and in determining relationships between PA and health outcomes (Kahn, Ramsey,
Brownson, Howze, Powell, Stone, Rajab, & Corso, 2002; Prince et al. 2008).
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Submitted 3 Februar, 2011
Accepted 21 March, 2011
9