© The Author 2013. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. doi:10.1093/ntr/ntt183 ORIGINAL INVESTIGATION Comparison of Two Strategies Using Pedometers to Counteract Physical Inactivity in Smokers Juliana Zabatiero MSc, Demetria Kovelis MSc, Karina Couto Furlanetto PT, Leandro Cruz Mantoani PT, Mahara Proença MSc, Fabio Pitta PhD Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, Universidade Estadual de Londrina, Londrina, Paraná, Brazil Corresponding Author: Fabio Pitta, PhD, Departamento de Fisioterapia—CCS, Hospital Universitário de Londrina, Rua Robert Koch, 60—Vila Operária, 86038–350—Londrina, Paraná, Brazil. Telephone: 55-43-3371-2288; Fax: 55-43-3371-2459; E-mail: fabiopitta@uol.com.br Received August 18, 2013; accepted October 9, 2013 ABSTRACT Introduction: This randomized crossover trial aimed to compare the effects of 2 different protocols using pedometers and informative booklets to increase physical activity in daily life (PADL) in smokers. Methods: PADL level was assessed at baseline (A1), and subjects were randomly assigned to 2 groups for a month: booklet + pedometer (GB + P; n = 13), which started the protocol receiving a booklet with encouragement to walk as much as possible in everyday life, and pedometer + booklet (GP + B; n = 18), which started the protocol wearing a pedometer aiming to achieve 10,000 steps/day. PADL was reassessed (A2), and the interventions were crossed over for 1 month, followed by PADL reassess- ment (A3). After A3, both groups used pedometers for 3 months aiming to reach 10,000 steps/day, and final PADL assessment was performed (A4). For the analysis, each group was subdivided according to baseline PADL as physically active or inactive, according to having reached or not reached 10,000 steps/day at baseline. Results: The physically active subgroups of GB + P and GP + B showed no change in steps/day. The physically inactive sub- group of GP + B significantly increased steps/day at A2 and maintained this increase until A4. The physically inactive subgroup of GB + P initially increased to a lesser extent, reaching borderline statistical significance at A2 and A3 (p = .06) and statistically significant increase only at A4 (p = .02). Conclusions: Both strategies were effective in increasing the number of steps/day in physically inactive smokers after 5 months, although the increase was more quickly obtained in smokers who used pedometers as the first intervention. INTRODUCTION The World Health Organization defines smoking as a chronic disease caused by nicotine dependence and reports it as the lead- ing cause of preventable death (WHO, 2011). Concomitantly, it is known that regular physical activity (PA) can prevent or delay the onset of different chronic diseases (Garber et al., 2011). Thus, physical inactivity combined with smoking is believed to have an important role in morbidity and mortality rates. A study by Garcia-Aymerich, Lange, Benet, Schnohr, and Anto (2007) showed that, in smokers, regular PA is associated with lower decline of lung function overtime and, therefore, lower risk of developing chronic obstructive pulmonary dis- ease (COPD). In recent years, the importance of promoting regular PA in smokers has been highlighted in the literature (Prochaska et al., 2008; Ussher, Taylor, & Faulkner, 2008). According to the American College of Sports Medicine (ACSM) guidelines’ regarding PA, a minimum of 30 min of moderate-intensity PA is necessary to maintain or develop physical fitness (Garber et al., 2011). Individuals who do not meet these minimum standards are considered insufficiently active and have a higher risk of morbidity and mortality. In addition, the association with smoking increases even more the negative effects of physical inactivity (Garber et al., 2011). Among the actions to promote the increase of daily PA, the use of pedometers has recently emerged. By using pedome- ters, Tudor-Locke, Hatano, Pangrazi, and Kang (2008) showed that those individuals who perform 10,000 steps/day approach the minimum recommendation of the ACSM. Pedometers are small, inexpensive, and simple devices, which count the steps taken over a period of time (Bravata et al., 2007). These devices have been used not only to quantify the number of steps per- formed in the day-by-day life but also to promote and stimu- late the increase of PA levels in several populations (Araiza, Hewes, Gashetewa, Vella, & Burge, 2006; Chan, Ryan, & Tudor-Locke, 2004; Gardner & Campagna, 2011; Houle et al., Advance Access publication November 27, 2013 562 Nicotine & Tobacco Research, Volume 16, Number 5 (May 2014) 562–568 at Universidade Estadual de Londrina on July 23, 2014 http://ntr.oxfordjournals.org/ Downloaded from