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Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis

Authors: Ibeneme, Sam Chidi; Mah, Juliet; Omeje, Chidimma; Fortwengel, Gerhard; Nwosu, Akachukwu Omumuagwula; Irem, Frank Onyemaechi; Ibeneme, Georgian Chiaka; +2 Authors

Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis

Abstract

Abstract Background Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults? Method Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary —physical activity level —and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects. Results The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes. Conclusion Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals. Trial registration Registration Number: INPLASY202230118

Keywords

SDG-03: Good health and well-being, Schrittzähler, Schlaganfall, 610, Health Promotion, Walking, Community-dwelling older adults, Wearable Electronic Devices, Risk Factors, Stroke prevention, Modifiable risk factors, Humans, Pedometer-based walking, Aged, Randomized Controlled Trials as Topic, Aged, 80 and over, ddc:610, RC952-954.6, Middle Aged, Actigraphy, Hohes Alter, Älterer Mensch, Modifable risk factors, Stroke, 610 Medizin, Gesundheit, Geriatrics, Systematic Review ; Aged, 80 and over [MeSH] ; Aged [MeSH] ; Humans [MeSH] ; Stroke prevention ; Randomized Controlled Trials as Topic/methods [MeSH] ; Wearable Electronic Devices [MeSH] ; Middle Aged [MeSH] ; Risk Factors [MeSH] ; Stroke/prevention ; Walking/physiology [MeSH] ; Independent Living [MeSH] ; Stroke/epidemiology [MeSH] ; Community-dwelling older adults ; Modifiable risk factors ; Actigraphy/instrumentation [MeSH] ; Pedometer-based walking ; Actigraphy/methods [MeSH] ; Health Promotion/methods [MeSH], Alter, Systematic Review, Independent Living, Randomized controlled trial (RCT), Risikofaktor, ddc: ddc:610

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
Average
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