Effectiveness of a Workplace Walking Program Using a Fitness Tracker Including Individual Counseling and Tailored Text Messaging

Article information

Res Community Public Health Nurs. 2019;30(3):257-270
Publication date (electronic) : 2019 September 12
doi : https://doi.org/10.12799/jkachn.2019.30.3.257
1Assistant Professor, Department of Nursing, Hanyeong College, Yeosu, Korea
2Associate Professor, College of Nursing · Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
Corresponding author: Ha, Yeongmi College of Nursing, Gyeongsang National University, 816 Beon-gil, 15 Jinju-daero, Jinju 52727 Korea. Tel: +82-55-772-8253, Fax: +82-55-772-8222, E-mail: yha@gnu.ac.kr
Received 2018 July 07; Revised 2019 May 10; Accepted 2019 May 15.

Abstract

Abstract

Purpose

This study is designed as a non-equivalent, control group pre/post-test for identifying effectiveness of a workplace walking program using a fitness tracker including individual counseling and tailored text messaging.

Methods

Seventy-nine employees from two large companies were allocated into an intervention group (n=39) and a control group (n=40). Participants were asked to wear a fitness tracker (Fitbit Charger HR) during 24-hour, 5-days per week, for 10 weeks. The intervention group was provided with daily walking steps measured by Fitbit, weekly counseling with a specifically designed workbook, and seven weekly text messaging, and the control group with the fitness tracker only.

Results

At the week 10 measurement, there were significant differences between the intervention and control groups in physical activity self-efficacy (p<.001), physical activity behavior (p<.001), daily walking steps (p<.001), systolic blood pressure (p=.033), and wellness (p<.001).

Conclusion

These results suggest that the workplace walking program using a fitness tracker including individual counseling and tailored text messaging is more effective for persons with 10,000 steps/day. Therefore, it is recommended to actively apply this workplace walking program to inactive employees for encouraging regular physical activities and improving their wellness.

Figure 1.

Conceptual framework for workplace walking program.

Workplace Walking Program using Fitness Tracker including Individual Counseling and Tailored Text Messaging

Homogeneity Test of Characteristics of the Participants (N=79)

Physiological and Cognitive Effects of Workplace Walking Program (N=79)

References

1. Ammendolia C, Cote P, Cancelliere C, Cassidy D, Hartvigsen J, Boyle E, et al. Healthy and productive workers: Using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism. BMC Public Health 2016;16(1):1190. https://doi.org/10.1186/s12889-016-3843-x.
2. World Health Organization. Fact sheets: physical activity [Internet] Geneva: World Health Organization; 2019. [cited 2018 January 15]. Available from: http://www.who.int/mediacentre/factsheets/fs385/en/.
3. U.S. Department of Health and Human Services. Physical activity guidelines for Americans. 2nd ed. [Internet] Washington.: U.S. Department of Health and Human Services; 2019. [cited 2018 January 15]. Available from: http://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf.
4. Ogilvie D, Foster CE, Rothnie H, Cavill N, Hamilton V, Fitzsi-mons CF, et al. Interventions to promote walking: Systematic review. British Medical Journal 2007;334(7605):1204. https://doi.org/10.1136/bmj.39198.722720.BE.
5. Hanson S, Jones A. Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. British Journal of Sports Medicine 2015;49(11):710–715. https://doi.org/10.1136/bjsports-2014-094157.
6. Korea Centers for Disease Control and Prevention. National health and nutrition survey, 7th year (2016) [Internet] Cheongju: Korea Centers for Disease Control and Prevention; 2017. [cited 2017 September 15]. Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.
7. Ministry of Health and Welfare. The physical activity guide for Koreans [Internet] Seoul: Ministry of Health and Welfare; 2013. [cited 2018 September 15]. Available from: http://health.cdc.go.kr/health/ReferenceRoomArea/HealthFileRoom/healthFileDetail.do?ED_NO=1851.
8. Hartman SJ, Nelson SH, Weiner LS. Patterns of Fitbit use and activity levels throughout a physical activity intervention: Exploratory analysis from a randomized controlled trial. JMIR Mhealth & Uhealth 2018;6(2):e29. https://doi.org/10.2196/mhealth.8503.
9. Riffenburg KM, Spartano NL. Physical activity and weight maintenance: The utility of wearable devices and mobile health technology in research and clinical settings. Current Opinion in Endocrinology & Diabetes and Obesity 2018;25(5):310–314. https://doi.org/10.1097/MED.0000000000000433.
10. Ghanvatkar S, Kankanhalli A, Rajan V. User models for personalized physical activity interventions: Scoping review. JMIR Mhealth & Uhealth 2019;7(1):e11098. https://doi.org/10.2196/11098.
11. Wang JB, Cadmus-Bertram LA, Natarajan L, White MM, Ma-danat H, Nichols JF, et al. Wearable sensor/device (Fitbit One) and SMS text-messaging prompts to increase physical activity in overweight and obese adults: A randomized controlled trial. Telemedicine & E-Health 2015;21(10):782–792. https://doi.org/10.1089/tmj.2014.0176.
12. Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: A systematic review of reviews. Annual Reviews of Public Health 2015;36:393–415. https://doi.org/10.1146/annurev-publhealth-031914-122855.
13. US Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. The Journal of the American Medical Association 2017;318(2):167–174. https://doi.org/10.1001/jama.2017.7171.
14. Taber DR, Meischke H, Maciejewski ML. Testing social cognitive mechanism of exercise in college students. American Journal of Health Behavior 2010;34(2):156–165.
15. Bandura A. Self-efficacy: The exercise of control New York, NY: Worth Publishers; 1997. p. 604.
16. Korea Health Promotion Institute. Final report on mobile health care [Internet] Seoul: Korea Health Promotion Institute; 2018. [cited 2018 September 15]. Available from: http://www.khealth.or.kr/kps/publish/view?menuId=MENU00888&page_no=B2017001&pageNum=1&board_idx=10052.
17. Mattila E, Orsama A, Ahtinen A, Hopsu L, Leino T, Korhonen I. Personal health technologies in employee health promotion: Usage activity, usefulness, and health-related outcomes in a 1-year randomized controlled trial. JMIR Mhealth & Uhealth 2013;1(2):e16. https://doi.org/10.2196/mhealth.2557.
18. Choi HY, Yang SJ. Effects of walking program based on social cognitive theory for office workers. Korean Journal of Adult Nursing 2013;25(6):712–724. https://doi.org/10.7475/kjan.2012.24.6.712.
19. Kim JI, Kwon YH, Jang JS, Cho YT. Evaluation study of health promotion program using smart band: focusing on the management of metabolic syndrome subjects HCI Korea 2016 conference; 2016 Jan 27-29; High1 resort, Kangwon-do. Seoul: The HCI Society of Korea. 2016. Jan. 724.
20. Willey S, Walsh JK. Outcomes of a mobile health coaching platform: 12-week results of a single-arm longitudinal study. Journal of Medical Internet Research Mhealth & Uhealth 2016;4(1):e3. https://doi.org/10.2196/mhealth.4933.
21. Hwang WJ. Cardiovascular disease in Korean blue-collar workers: Actual risk, risk perception, and risk reduction behavior [dissertation] [San Francisco, CA]: University of California at San Francisco; 2010. p. 172.
22. Kang KS, Gu MO. A study on the stages of change of exercise and its related factors in patients with diabetes mellitus - Application of transtheoretical model. The Journal of Korean Academic Society of Adult Nursing 2006;18(3):345–356.
23. Choi MJ, Son CS, Kim JS, Ha YM. Development of a wellness index for workers. Journal of Korean Academy of Nursing 2016;46(1):69–78. https://doi.org/10.4040/jkan.2016.46.1.69.
24. Morton K, Sutton S, Hardeman W, Troughton J, Yates T, Griffin S, et al. A text-messaging and pedometer program to promote physical activity in people at high risk of type 2 diabetes: The development of the PROPELS follow-on support program. Journal of Medical Internet Research Mhealth & U-health 2015;3(4):e105. https://doi.org/10.2196/mhealth.5026.
25. Sisson SB, Camhi SM, Tudor-Locek C, Johnson WD, Katzmar-zyk PT. Characteristics of step-defined physical activity categories in U.S. adults. American Journal of Health Promotion 2012;26(3):152–159. https://doi.org/10.4278/ajhp.100326-QUAN-95.
26. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis. The Lancet 2016;387(10022):957–967. https://doi.org/10.1016/S0140-6736(15)01225-8.
27. Albarrati AM, Alghamdi MSM, Nazer RI, Alkorashy MM, Alshowier N, Gale N. Effectiveness of low to moderate physical exercise training on the level of low-density lipoproteins: A systematic review. BioMed Research International 2018;5982980:1–16. https://doi.org/10.1155/2018/5982980.
28. Park DH, Kim CS, Kim KJ. Consideration about physical activity guideline and exercise intensity for adult. Exercise Science 2015;24(2):99–107. https://doi.org/10.15857/ksep.2015.24.2.99.
29. Choi ES, Jeon GS. The impacts of psychosocial work conditions on self-rated health among Korean workers. Korean Journal of Occupational Health Nursing 2016;25(4):300–310. https://doi.org/10.5807/kjohn.2016.25.4.300.
30. Wu S, Wang R, Zhao Y, Ma X, Wu M, Yan X, et al. The relationship between self-rated health and objective health status: A population-based study. BMC Public Health 2013;13:320. https://doi.org/10.1186/1471-2458-13-320.

Article information Continued

Figure 1.

Conceptual framework for workplace walking program.

Table 1.

Workplace Walking Program using Fitness Tracker including Individual Counseling and Tailored Text Messaging

Time Methods Contents
Introduction ․ Campaign of workplace walking program using fitbit including individual counseling and tailored text messaging
․ Orientation about workplace walking program
․ Make a written pledge
․ Goal planning during workplace walking program
  - Setting on short-term and long-term goals
․ Set on counseling date and time
․ Fitbit provision and usage instruction
1st week ․ Mobile health ․ How to do stretching & aerobic exercise
workbook education ․ The importance and effect of physical activity including walking
․ Goal setting ․ Achievable goal setting on 1 week
․ Individual counseling ․ Check out own steps in the past week, identify barriers of activities, confirm or reset activity
goals, rebuild activity plan
․ Advice on employee's activity, nutrition habit, and sleep pattern
․ Customized daily text ․ Motivating text (usually monday), health information text, emotional support &
messaging with 5 areas encouragement text, supporting health behavior text, problem solving text
2nd~4th ․ Mobile health ․ Understand walking exercise guidelines (frequency, intensity, time)
week workbook education ․ Know my goal heart rate during exercise
․ Increase activity: 15~20% increase your activity every two week
․ Effects and benefits of continuous walking exercise
․ Barriers of exercise & coping strategies of exercise
․ Goal setting ․ Achievable goal setting on 2nd~4th week
․ Individual counseling ․ Check out own steps in the past week, identify barriers of activities, confirm or reset activity
goals, rebuild activity plan
․ Consult about their own goal heart rate during exercise
․ How to increase activity and maintain activity
․ Advice on employee's activity, nutrition habit, and sleep pattern
․ Customized text ․ Motivating text (usually monday), health information text, emotional support &
messaging encouragement text, supporting health behavior text, problem solving text
5th week ․ Mobile health ․ Maintain increased activity & increase exercise intensity
workbook education
․ Goal setting ․ Achievable goal setting on 5th week
․ Prompt feedback on employee's performance
․ Individual counseling ․ Check out own steps in the past week, identify barriers of activities, confirm or reset activity
goals, rebuild activity plan
․ How to increase exercise intensity & exercise course: Stairs, hill walking, fast walking
․ Advice on employee's activity, nutrition habit, and sleep pattern
․ Customized text ․ Motivating text (usually monday), health information text, emotional support &
messaging encouragement text, supporting health behavior text, problem solving text
․ Reward ․ Provide a voucher to employees with 10000 daily steps
․ Executives and an occupational health nurse encourage walking and physical activities
6th~10th ․ Mobile health ․ Nutrition: right meal eating habit
week workbook education ․ Nutrition: balanced and healthy diet
․ Nutrition: low calory diet & low cholesterol diet
․ Know my blood pressure & blood sugar
․ Preventive strategies of hypertension and diabetes
․ Know my cholesterol
․ Preventive strategies of high level of cholesterol
․ Goal setting ․ Achievable goal setting on 6th~10th week
․ Individual counseling ․ Check out own steps in the past week, identify barriers of activities, confirm or reset activity
goals, rebuild activity plan ․ Maintain exercise intensity with your goal heart rate
․ Sharing my action plan to overcome obstacles with increased activity duration
․ Advice on employee's activity, nutrition habit, and sleep pattern
․ Customized text ․ Motivating text (usually monday), health information text, emotional support &
messaging encouragement text, supporting health behavior text, problem solving text
․ Reward ․ Provide a success voucher

Table 2.

Homogeneity Test of Characteristics of the Participants (N=79)

Characteristics Int. (n=39)
Cont. (n=40)
x2 or t (p)
n (%) or M±SD n (%) or M±SD
Age (year) 42.02±7.38 41.97±7.19 0.03 (.975)
Marital status 0.41 (.521)
  Married 31 (79.5) 34 (85.0)
  Single 8 (20.5) 6 (15.0)
Educational level 4.23 (.121)
  ≤High school 8 (20.5) 16 (40.0)
  College 11 (28.2) 6 (15.0)
  ≥University 20 (51.3) 18 (45.0)
Shift work 2.15 (.142)
  Yes 4 (10.3) 9 (22.5)
  No 35 (89.7) 31 (77.5)
Physical activity behavior 2.27±0.74 2.00±0.47 1.95 (.055)
Daily walking steps (steps/day) 9,724.00±2,953.00 9,582.00±2,796.00 0.22 (.827)
  5,000~9,999 7,838.00±1,349.00 7,482.00±1,463.00 0.86 (.396)
  <10,000 13,092.00±1,756.00 11,903.00±1,932.00 1.81 (.079)
Physical activity self-efficacy 3.09±0.90 2.78±0.68 1.74 (.086)
Self-rated health 4.17±0.60 4.15±0.62 0.21 (.831)
Systolic blood pressure (mmHg) 130.30±11.66 129.25±10.54 0.42 (.673)
Diastolic blood pressure (mmHg) 82.66±6.67 79.55±7.39 1.97 (.052)
Total cholesterol 195.00±44.39 195.22±37.06 -0.02 (.980)
Wellness 3.35±0.52 3.21±0.38 1.38 (.171)

Int.=Intervention group; Cont.=Control group;

Int. (n=25), Cont. (n=21);

Int. (n=14), Cont. (n=19).

Table 3.

Physiological and Cognitive Effects of Workplace Walking Program (N=79)

Variables Group Pretest
Posttest
Effect by point
Intergroup effect
M±SD M±SD t (p) t (p)
Physical activity behavior Int. 2.27±0.74 3.16±0.42 6.88 (<.001) 10.28 (<.001)
Cont. 2.00±0.47 2.11±0.48 1.58 (.121)
Daily walking steps Int. 9,724.00±2,953.00 13,584.00±3,562.00 6.57 (<.001) 3.43 (<.001)
Cont. 9,582.00±2,796.00 10,683.00±3,937.00 1.56 (.127)
  5,000~9,999 steps Int. 7,838.00±1,349.00 12,819.00±3,622.00 6.89 (<.001) 2.67 (.010)
Cont. 7,482.00±1,463.00 9,899.00±3,786.00 2.79 (.011)
  ≥10,000 steps Int. 13,092.00±1,756.00 14,951.00±1,756.00 2.39 (.032) 1.81 (.079)
Cont. 11,903.00±1,932.00 11,550.00±4,017.00 -0.33 (.744)
Physical activity self-efficacy Int. 3.09±0.90 4.21±0.45 6.92 (<.001) 9.96 (<.001)
Cont. 2.78±0.68 2.90±0.67 1.08 (.285)
Self-rated health Int. 4.17±0.60 4.33±0.52 1.64 (.109) 0.26 (.795)
Cont. 4.15±0.62 4.30±0.60 1.43 (.159)
Systolic blood pressure Int. 130.30±11.66 120.89±9.79 -8.07 (<.001) -2.17 (.033)
Cont. 129.25±10.54 125.50±9.04 -5.01 (<.001)
Diastolic blood pressure Int. 82.66±6.67 78.84±8.69 -3.98 (<.001) 0.99 (.326)
Cont. 79.55±7.39 77.00±7.91 -3.48 (<.001)
Total cholesterol Int. 195.00±44.39 200.16±39.65 -1.21 (.103) -0.59 (.553)
Cont. 195.22±37.06 200.33±35.12 -0.89 (.418)
Wellness Int. 3.35±0.52 4.20±0.42 7.88 (<.001) 10.76 (<.001)
Cont. 3.21±0.38 3.27±0.34 0.79 (.432)

Int.=Intervention group; Cont.=Control group;

Int. (n=25), Cont. (n=21);

Int. (n=14), Cont. (n=19).