elderly person power walking down the country side

How to Use Physical Activity Monitors to Facilitate Behavioural Change in Elderly

The feedback from activity monitors is suggested to facilitate result driven behavioral change through education, motivation, gamification and goal setting, but creating new and healthier habits among elderly is a complex process with a lot of unanswered questions.


Even though the overall functional decline in life cannot be prevented, elderly who engage in regular physical activity or exercise will have a lower all-cause mortality and a lower prevalence of many non-communicable diseases and disabilities [1-4]. Walking programs with elderly are effective in increasing physical activity on a short term, but the programs should be individualized to maintain long term participation [5]. 

Walking interventions based on activity monitoring are becoming more frequent and hence, an increasing number of scientific results suggest that the monitors can facilitate motivational behavioral change [6,7]. In recent years, several randomized controlled trials have been published, with positive results [8-13]. However, some heterogeneity of the results exists and the studies differ in many ways [8-13]. Other randomized controlled trials found no effect on physical activity in elderly [14-16] so in summary, as the use of activity monitoring are becoming more frequent, many questions arise on how to implement activity monitors to elderly and how to facilitate long term healthy choices related to physical activity. 

Current projects: systematic review, validation study, an intervention study and a qualitative project.

This is a PhD project at the research unit CopenRehab at faculty of Health and Medical Science. The primary objective for the project is to use multiple study designs to clarify how activity monitors can be used as facilitators to increase physical activity in elderly. 

A systematic review and a meta-analysis to estimate the effect size of using activity monitors to enhance the level of daily physical activity in elderly. The study is ongoing, registered in PROSPERO (CRD42018083648) and the protocol for the study is currently in review. 

A validation study to investigate the measurement properties of four off the shelf activity monitors. Elderly have a slower walking pace and a different step cycle than healthy younger adults and it is expected that this will affect the validity of the activity monitors in elderly. The study started in March 2018 and will include more than 100 participants.

A RCT with a customized intervention based on the findings from the systematic review, the validation study and a participatory design strategy, will be undertaken. After the intervention, participants from both groups will be interviewed in relation to their experiences with the activity monitors, which will serve as the last study.


This project is a part of the Responsive Engagement of the elderly promoting Activity Customized Healthcare (REACH 2020) and hence, received funding from European Union’s Horizon 2020 research and innovation programme under grant agreement no 690425.


  1. WHO. WHO | Physical Activity and Older Adults. WHO. http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/. Published 2011. Accessed December 18, 2017.
  2. Paterson DH, Warburton DE. Physical activity and functional limitations in older adults: a systematic review related to Canada’s Physical Activity Guidelines. Int J Behav Nutr Phys Act. 2010;7:38. doi:10.1186/1479-5868-7-38
  3. Kvaavik E, Batty GD, Ursin G, Huxley R, Gale CR. Influence of individual and combined health behaviours on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Arch Intern Med. 2010;170(8):711-718. doi:10.1001/archinternmed.2010.76
  4. Chodzko-zajko WJ, Proctor DN, Singh MAF, et al. Exercise and Physical Activity for Older Adults. Med Sci Sports Exerc. 2009;41(7):1510-1530. doi:10.1249/MSS.0b013e3181a0c95c
  5. Olanrewaju O, Kelly S, Cowan A, Brayne C, Lafortune L. Physical Activity in Community Dwelling Older People: A Systematic Review of Reviews of Interventions and Context. PLoS ONE. 2016;11(12). doi:10.1371/journal.pone.0168614
  6. Qiu S, Cai X, Ju C, et al. Step Counter Use and Sedentary Time in Adults. Medicine (Baltimore). 2015;94(35). doi:10.1097/MD.0000000000001412
  7. Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298(19):2296-2304. doi:10.1001/jama.298.19.2296
  8. Rowley TW., Lenz EK., Swartz AM., Miller NE., Maeda H., Strath SJ. Efficacy of an Individually Tailored, Internet-Mediated Physical Activity Intervention in Older Adults: A Randomized Controlled Trial. J Appl Gerontol Off J South Gerontol Soc. 2017:733464817735396. doi:10.1177/0733464817735396
  9. Tabak M., Vollenbroek-Hutten MM., van der Valk PD., van der Palen J., Hermens HJ. A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial. Clin Rehabil. 2014;28(6):582-591. doi:10.1177/0269215513512495
  10. Mutrie N., Doolin O., Fitzsimons CF., et al. Increasing older adults’ walking through primary care: results of a pilot randomized controlled trial. Fam Pract. 2012;29(6):633-642. doi:10.1093/fampra/cms038
  11. Peel NM, Paul SK, Cameron ID, Crotty M, Kurrle SE, Gray LC. Promoting Activity in Geriatric Rehabilitation: A Randomized Controlled Trial of Accelerometry. PLOS ONE. 2016;11(8):e0160906. doi:10.1371/journal.pone.0160906
  12. Nishiguchi S, Yamada M, Tanigawa T, et al. A 12-Week Physical and Cognitive Exercise Program Can Improve Cognitive Function and Neural Efficiency in Community-Dwelling Older Adults: A Randomized Controlled Trial. J Am Geriatr Soc. 2015;63(7):1355-1363. doi:10.1111/jgs.13481
  13. Furber S., Butler L., Phongsavan P., Mark A., Bauman A. Randomised controlled trial of a pedometer-based telephone intervention to increase physical activity among cardiac patients not attending cardiac rehabilitation. Patient Educ Couns. 2010;80(2):212-218. doi:10.1016/j.pec.2009.11.012
  14. Nolan CM, Maddocks M, Canavan JL, et al. Pedometer Step Count Targets during Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. A Randomized Controlled Trial. Am J Respir Crit Care Med. 2017;195(10):1344-1352. doi:10.1164/rccm.201607-1372OC
  15. Kolt GS, Schofield GM, Kerse N, Garrett N, Ashton T, Patel A. Healthy steps trial: pedometer-based advice and physical activity for low-active older adults. Ann Fam Med. 2012;10(3):206-212.
  16. McMurdo MET, Sugden J, Argo I, et al. Do pedometers increase physical activity in sedentary older women? A randomized controlled trial. J Am Geriatr Soc. 2010;58(11):2099-2106. doi:10.1111/j.1532-5415.2010.03127.x


Rasmus Tolstrup Larsen
PhD student
Department of Public Health


Henning Langberg
Professor and Director
+45 35 33 72 28