They're tiny tools that can pack a powerful punch, particularly because they instantly measure the number of steps someone takes. But there's so much more to pedometers, which are both a quaint and futuristic driver of employee wellness programs.

These gadgets have helped boost program participation and improve outcomes at Children's Healthcare of Atlanta, the nation's largest pediatric health care system, with more than 7,500 employees. A key objective of the organization's Strong4Life employee wellness program (which has been met every year since it was created in 2008) is that participants across all types of health statuses collectively walk one billion steps. The lowly pedometer plays a big role.

Linda Matzigkeit (pictured at left), the organization's chief administration officer and wellness program architect, appreciates the pedometer's ease of use. "You don't have to do anything except put it on your shoe and go," she says, noting how some pedometers can automatically upload data to a PC.

But don't be fooled that pedometers represent some kind of panacea. Bob Merberg, who runs the employee health promotion program at Paychex, cautioned in a blog earlier this year that pedometers can be "crude instruments" whose accuracy can vary based on participant age, weight, and walking speed, as well as the quality of the unit. He also questioned whether they're "little more than the minor league of more hi-tech solutions."



Evolving technology

That could well be the case, but it's also a matter of semantics. Perhaps the most interesting aspect of pedometers is that these devices' technology has not stood still. The original pedestrian model has morphed into a digital tool that dovetails nicely into a gadget-obsessed society which celebrates the latest and greatest upgrades to smartphone, tablets, laptop computers and other devices.

"Pedometers have become rather sophisticated in nature," explains Don Powell, Ph.D., president and CEO of the American Institute for Preventive Medicine. He notes how easily they can sync up with other devices. "When they first came into use, they cost less than a dollar," he says. "They tended not to last long and weren't very accurate. Now we've got some really sophisticated ones that not only are accurate, but they also measure calories burned and [can] even monitor sleep patterns."

One such version, called the Fitbit, sells for anywhere from $80 to $100 and has set the gold standard for a new breed of sophisticated pedometers. Nike's version is known as a FuelBand, Apple has the iWatch and Jawbone also has earned kudos for its wearable technology product line.

"Eventually," Powell predicts, "you'll start seeing these same types of devices monitoring your blood pressure, heart rate and galvanic skin response, which then deals with stress levels."

The explosion of mobile apps has deepened the level of employee engagement in walking programs that feature pedometers, says LuAnn Heinen, vice president of the National Business Group on Health. She heads up the group's worksite wellness work.

More than 70% of NBGH's 350 members have walking programs, while most, if not all of them, use a pedometer or more advanced tracking device, she says. That estimate is based on a sample of 62 survey respondents from 2010.

The ease of use and data-collection capabilities of pedometer has drawn more employers to use these devices, adds Dannielle Sherrets, assistant director of the NBGH. She has led the group's work on pedometers and accelerometers and is continuing to research newer mobile apps.

"They don't just have to be worn on the hip, and they don't have a short lifespan," she says. "It's now something on peoples' phone and is always with them. They can be put in a pocket, or worn on the wrist and be more fashionable."


Embracing social media

Pedometers tie in well with the online wellness-challenge craze, Powell says. And they keep people honest. Rather than ask people to participate and record their achievements based on the honor system, he says pedometers can "automatically and accurately" prove their results.

Social media platforms also have the potential to elevate the value of next-generation pedometers, especially as younger people who grew up immersed in social media enter the workforce.

"We're social creatures," Sherrets observes. "We want to work within teams with partners and friends. [Creating] programs that make health more social will help build that culture and raise participation rates."

Powell describes pedometers as "an awareness tool that help people understand just how active or inactive they are during the course of a day." The trouble is that while many walking or activity programs set 10,000 steps as a daily target, he says most people are only doing anywhere from 2,000 to 4,000 steps a day. Still, he believes that pedometer readings can help serve to increase motivation and compliance with wellness program goals among participants with a competitive spirit or desire for instant feedback.

Any tools that prove a means of measurement are considered invaluable at a time when HR and benefit professionals face greater pressure to show their employee initiatives are delivering a healthy return on investment.

Powell puts the argument in perspective, noting $9 billion a year in excess health care costs related to obesity. "Our research has shown that an obese employee costs a company $1,351 more than a non-obese employee and a physically inactive employee costs a company $982 more than an employee who is active," he explains. Other annual per-employee costs to employers that Powell cites include diabetes (a whopping $1,176 on average), stress ($764) and other risk factors such as hypertension ($44).

He says "losing weight or exercising more with a pedometer has cost benefits" that help reduce the risk of developing chronic conditions. They also produce a modest but significant weight loss of about five pounds per year on average, according to an analysis of nine studies published in The Annals of Family Medicine in 2008.

While inactivity is frequently tied to obesity and diabetes, Sherrets says there are many other cost drivers associated with a sedentary lifestyle for employers to consider, such as circulatory and musculoskeletal issues, as well as cancers and mental health problems.

But it's also important to keep in mind that pedometers are just one of many key ingredients to wellness program success. They can also include road races for charity, subsidized fitness centers at the worksite and healthy eating initiatives such as Weight Watchers, adds NBGH's Heinen.

"The overall ROI for health and well-being programs is more clearly established in the literature for well-designed and well-executed programs," she notes. One caveat, however, is that "the ROI is only addressing costs that are measurable."

Heinen says there are other, often intangible, benefits from physical activity programs using pedometers that are hard to measure in terms of their effect on morale, retention and culture-of-health, though they're known to help improve employee well-being. People who participate in these programs usually sleep better, as well as "feel more connected and vital," she observes.



Healthy hospital

Meanwhile, back at Children's Healthcare of Atlanta, there are four pillars that support the organization's Strong4Life program. They include providing opportunities for fun, support, nutrition and physical activity.

There's also a weight-loss program called Mission Slim Possible that tracks progress and tells inspirational stories over a 12-week period. Program participants lost a net 866 pounds, with the winner losing 17% of her body weight. Others with diabetes and high blood pressure able to come off their medications, thanks to their much-improved health.

One other program component involves an invitation to 50 families to receive weekly coaching to help improve their diet and exercise regimen. Firestine says this helps broaden the appeal of participation beyond employees themselves.

Across the board, employees have lost more than 60,000 pounds since 2008, while the percentage of those with healthy body mass index has climbed from 33% in 2008 to 37% last year - the national average for adults is 31.2%. Healthy cholesterol readings also soared to 77.3% last year, versus 50% in 2008.

Given the scope of these improved outcomes, it may not come as much of a surprise that health costs have stayed flat, and there has been a reduction in the use of some drugs to treat high cholesterol and hypertension, as well as obesity-related illnesses.

Matzigkeit's efforts to improve the health of her workforce haven't gone unoticed. Children's Healthcare of Atlanta landed on a list of the Atlanta Business Chronicle's top 5 healthiest large employers for the past three years, and Kaiser Permanente's Most Fit Large Employer Award for the past two years. Other honors include gold-level status for both the Wellness Council of America's Well Workplace Awards and the American Heart Association Fit-Friendly Companies list.

One core objective is to practice what the organization preaches to patients. "Our particular population is mostly nurses, and they are focused on caring for others, not themselves," Matzigkeit says. "So we really had a culture of people that didn't make caring for themselves a priority." In recent years, however, she points to "an amazing culture change, starting with having health fairs every year."


Bruce Shutan is a Los Angeles-based freelance writer.

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