CONTEXT: Without detailed evidence of their effectiveness, pedometers have recently become popular as a tool for motivating physical activity. OBJECTIVE: To evaluate the association of pedometer use with physical activity and health outcomes among outpatient adults. DATA SOURCES: English-language articles from Medline, Embase, SPORTDiscus, PsycINFO, Cochrane Library, Thompson Scientific (formerly known as Thompson ISI), and ERIC (1966 to 2007); bibliographies of retrieved articles; and conference proceedings. STUDY SELECTION: Studies were eligible for inclusion if they reported an assessment of pedometer use among adult outpatients, reported a change in steps per day, and included more than 5 participants. DATA EXTRACTION AND DATA SYNTHESIS: Two investigators independently abstracted data about the intervention; participants; number of steps per day; and presence or absence of obesity, diabetes, hypertension, or hyperlipidemia. Data were pooled using random-effects calculations, and meta-regression was performed. RESULTS: Our searches identified 2,246 citations; 26 studies with a total of 2,767 participants met inclusion criteria (8 randomized controlled trials (RCTs) and 18 observational studies). The participants' mean (SD) age was 49 (9) years and 85% were women. The mean intervention duration was 18 weeks. In the RCTs, pedometer users significantly increased their physical activity by 2491 steps per day more than control participants (95% confidence interval (CI) 1,098 to 3,885 steps per day, p < 0.001). Among the observational studies, pedometer users significantly increased their physical activity by 2,183 steps per day over baseline (95% CI 1,571 to 2,796 steps per day, p < 0.0001). Overall, pedometer users increased their physical activity by 26.9% over baseline. An important predictor of increased physical activity was having a step goal such as 10,000 steps per day (p = 0.001). When data from all studies were combined, pedometer users significantly decreased their body mass index by 0.38 (95% CI 0.05 to 0.72; p = 0.03). This decrease was associated with older age (p = 0.001) and having a step goal (p = 0.04). Intervention participants significantly decreased their systolic blood pressure by 3.8 mmHg (95% CI 1.7 to 5.9 mmHg, p < 0.001). This decrease was associated with greater baseline systolic blood pressure (p = 0.009) and change in steps per day (p = 0.08). CONCLUSIONS: The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure. Whether these changes are durable over the long term is undetermined.

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