Canada on the Move: a novel effort to increase physical activity among Canadians.

This issue of the Canadian Journal of Public Health contains several articles related to a novel public-private collaboration to increase physical activity among Canadians. Because physical activity plays a critical role in the reduction of chronic diseases,1 assessment of the impact of unique efforts such as this campaign to change physical activity levels provides important information that can be incorporated into future interventions. In December 2003, Kellogg Canada initiated a series of media messages to walk more and use step counters (pedometers), and in January 2004, began distributing 2 million pedometers in specially marked cereal boxes of Special K* and Special K* Red Berries. Also in December, the Canadian Institutes of Health Research (CIHR) in collaboration with Kellogg Canada and several other partners initiated a Canada on the Move (COTM) website (www.canadaonthemove.ca) that was used to collect data to assess the impact of the pedometer distribution and to promote walking. Use of the website was encouraged on Kellogg’s* cereal boxes, and separate press releases from CIHR and Kellogg Canada publicized the project and the importance of increased walking. The articles included in this issue represent some of the research supported by the Institute of Nutrition, Metabolism, and Diabetes of CIHR, and examine the campaign from a variety of perspectives, using several different and complementary sources of data. Despite the wide distribution of pedometers through a variety of programs, the uptake, duration and health effects of pedometer use have not been extensively studied. In theory, the use of a self-monitoring measure like a pedometer should reinforce walking behaviour and its health benefits. Whether pedometers successfully facilitate this outcome depends on whether the target audience for the initiative is reached and perceives a benefit in walking, whether pedometer use reinforces the behaviour, and whether the use of a pedometer with complementary messages that promote its use sustain walking sufficient to create a health benefit. Although the studies included here do not address all of these questions, they provide some useful insights into this problem. One of the first concerns is whether the pedometers distributed accurately captured the level of physical activity of those who used them. The article by Tudor-Locke et al. (in this issue) provides a useful comparison of the pedometer distributed by Kellogg Canada with another pedometer,2 as well as walking measured by an accelerometer. Unfortunately, the pedometer distributed by Kellogg Canada was 45% less accurate than the accelerometer, compared to 19% for the alternative pedometer, and detected more non-steps than the comparison pedometer. Because reduced accuracy will be counterbalanced by increased recording of movements that are not due to steps, these errors may have partially cancelled each other when pedometers are used under day-to-day circumstances. The extent to which cancellation occurred was not examined. Furthermore, the effects of the pedometer errors on the physical activity of those who used them remain uncertain. Lower recorded pedometer steps might increase walking if a user had set total number of steps as a goal. However, it is equally possible that pedometer inaccuracy might prompt some individuals to become discouraged if they made a substantial effort to increase physical activity and the pedometer did not accurately reflect their efforts. Among the most innovative aspects of the COTM initiative was the use of the COTM website to collect data regarding the initiative’s effect on factors affecting walking among those who came to the website, and the impact of campaign awareness on pedometer use. Websites have rarely been used to recruit and characterize groups targeted for intervention. Therefore, comparisons of those who came to the COTM website with the general population are essential to determine how these respondents compared to the Canadian population. Overweight, middle-aged women were over-represented among respondents who came to the COTM website. This group was not representative of the general population, but it apparently was the target market for these cereal products and may have more accurately reflected the consumers who purchased the cereals that contained the pedometers.3 Although the 3,000 individuals who provided data on the web page were a small fraction of the people who received pedometers in cereal boxes, and therefore must be considered a convenience sample, the data provided suggest several important testable hypotheses to improve the walkability of neighbourhoods.4 Among the women who responded to the survey, neighbourhood aesthetics and walking destinations such as shops significantly increased the likelihood of walking sufficient to achieve a beneficial health effect. No significant association of walking with environmental variables was observed among men. These observations suggest that sidewalks to support physical transit may not by themselves increase rates of walking unless the sidewalks and bicycle trails have attractive destinations. Physical activity that can be integrated into other daily activities may increase the likelihood of the behaviour and its consequent health benefits more than exercise performed only for its health benefits. Data regarding the impact of the publicity surrounding the campaign on pedometer use were collected from an ongoing representative survey that monitors physical activity in the Canadian population.4 Despite the limited national publicity that accompanied the campaign,5 a 6% increase 1. Director, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA Correspondence and reprint requests: Dr. William H. Dietz, Director, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS K-24, Atlanta, GA 30307, Tel: 770-488-6042, E-mail: [email protected] Disclaimer: This article represents the opinions of the author, and not the Centers for Disease Control and Prevention.