A pedometer-based walking program in an assisted-living setting: A pilot study

Purpose Physical activity is a key to independent functional ability among older adults but few interventions have been conducted in assisted‑living residences. A pedometer has been stated to be ‘a good-enough’ measuring device for the assessment of walking activity in older populations. Research has, however, focused more on community dwelling older adults than on those residing in assisted-living facilities. The aim of this pilot study was to assess the feasibility of a pedometer‑based walking program in an assisted-living facility, and to explore the challenges and obstacles for the implementation of such a program.  Materials and methods A pilot intervention study was done with 8 residents between 68 and 89 years of age residing in one assisted‑living facility in Finland. The participants were given pedometers and were asked to walk as usual for a period of one week in order to measure the baseline number of steps. Then, personal goals were assessed based on these baseline figures. Motivational materials and meetings with the participants and attendant nurses were also provided. Participants were encouraged to increase their daily number of steps from their baseline levels by 5% weekly for a period of 6 weeks. Post intervention, seven of the participants and their nurses (n=13) filled in questionnaires concerning the use and usability of the pedometer.  Results At baseline, the median number of steps taken by the participants was 800 per day, the daily average being 1369. Post intervention the median was 884 and daily average 1458 steps, demonstrating an increase but no statistically significant changes in the number of steps. Most of the nurses (9/13) believed the pedometer actually encouraged the residents to walk more, but because of technical difficulties, fewer nurses (5/13) found the pedometer to be useful in practice in terms of encouragement for more activity. The participants and nurses found the pedometer easy to use but reported problems with it falling off, underestimating step counts, and inaccuracy. Conclusion Motivating sedentary older adults living in an assisted‑living facility to walk more by employing a pedometer-based walking program is possible but challenging. Integrating the program into daily routines and systematic communication between the research team and the staff of the participating site are needed in order to support the adoption and sustained usage of the new technology. The accuracy and reliability of the pedometer need improvement in terms of use by people with shuffling and low-impact gaits. Better clips to prevent dislodging as well as easier to read numbers are also recommended. Overall, the findings from this study suggest that there is a need for improved pedometer technology to be used with older adults residing in assisted-living residences.