Uptake of Pedometer-based Physical Activity: Success and Challenges

of a Church based Physical Activity Promotion Programme among

Overweight and Obese Adults in Kenya

Jane Wanjiku Kamau

, Peter Wanderi Mwangi

and Lucy-Joy Wachira

Department of Physical Education, Exercise and Sports Science, Kenyatta University, Nairobi, Kenya

Directorate of Corporate Services, Mount Kenya University, Thika, Kenya

Keywords: Uptake, Pedometer-based, Physical Activity, Overweight, Obesity, Church-based.

Abstract: Physical inactivity is among the modifiable risk factors to overweight and obesity. Targeting community units

in promoting active lifestyles is beneficial in offering social support. Technological devices such as

pedometers can promote physical activity at individual level by providing feedback. This paper presents the

success and challenges in implementing an on-going longitudinal pedometer- based PA programme in a

selected church in Kenya. Baseline results of 100 participants indicated that 20% were overweight and 26%

were obese with BMI scores being higher in those aged 30 years and above. There was significant correlation

between BMI and WHR (r=0.67 for females, r=0.88 in males). Physical inactivity among 46 participants in

the PA programme was at 52.4%. Most of them work in offices (81%) and use private (71.4%) or public

(19%) motorized transport. Majority of them (75%) do not use pedometers to track PA and do not follow

guidelines of the programme. Cost, time and competing priorities were cited to hinder participation. The 25%

of pedometer users acknowledge their importance and influence to their participation in PA. This paper

recommends that the church device strategies to navigate the challenges of physical inactivity while tapping

into the resources available within the church settings.

1 INTRODUCTION

Obesity has over the years become a global pandemic

with 650 million adults aged 18 years and above and

41 million children being obese in the year

2016(World Health Organization [WHO], 2020).

Although there is no conclusive and current

population-wide data on prevalence of obesity in

Kenya, the Stepwise Survey for Non-Communicable

Diseases (NCDs) Risk Factors (2015) showed that

28% of Kenyans aged 18-69 years are either

overweight or obese with women recording a higher

percentage (38.5%) than men (17.5%), while 4.1% of

children under the age of five are either overweight or

obese (Ministry of Health [MOH], 2015a).

Obesity has been associated with cardiovascular

diseases, diabetes, musculoskeletal disorders and

some forms of cancer (WHO, 2018).

These NCDs have reached pandemic levels in

Kenya accounting for more than 50% of total hospital

admissions and over 55% of hospital deaths (MOH,

2015a).They are indeed a major public health concern

with significant social and economic implications in

terms of health care needs, lost productivity and

premature death thus presenting serious setback to the

attainment of desired social, health and economic

targets outlined in the United Nations (UN) 2015

Sustainable Development goals Number 3, Kenya’s

Vision 2030 and the Kenyan Government 2017 Big

Four Agenda.

Energy imbalance between calories consumed

and calories expended are the fundamental causes of

obesity and overweight (WHO, 2020).

One proven way of increasing energy expenditure

is participation in regular physical activity (PA) that

leads to accumulation of at least 150 minutes of

moderate-intensity aerobic physical activity

throughout the week for adults and

60minutesperdayforchildren (MOH, 2017). Physical

activity is recommended to reduce excess body

weight, prevent body weight regain and decrease

subsequent risks in developing metabolic and

orthopedic conditions (Natel, Mathieu & Prince,

2011).

126

Kamau, J., Mwangi, P. and Wachira, L.

Uptake of Pedometer-based Physical Activity: Success and Challenges of a Church based Physical Activity Promotion Programme among Overweight and Obese Adults in Kenya.

DOI: 10.5220/0010026001260132

In Proceedings of the 8th International Conference on Sport Sciences Research and Technology Support (icSPORTS 2020), pages 126-132

ISBN: 978-989-758-481-7

Despite the health benefits of PA, there is reduced

participation world over with a resultant increase in

overweight and obesity. In Kenya, the rate of PA is

estimatedtobeonly10%inmalesand14% in females

(WHO 2014) with uneven distribution among rural

and urban populations where levels of physical

activity among rural populations are higher (Muthuri,

et al, 2014).

Some of the barriers to PA in Kenya include rapid

urbanization; wherein access to fields needed to play

such games as soccer are not available due to dense

populations and their subsequent demand for land,

poor built environment, lack of safe environment in

which to walk or cycle to work or to school or for

physical play at home, inadequate information by the

public on PA, increased use of motorized transport

and social cultural factors (WHO, 2018).A

combination of all these factors has lead Kenya to get

into the fourth pattern of the nutritional and physical

activity transition characterized by nutrition and

physical inactivity related obesity and NCDs as

identified by Popkin in2015.

1.1 Problem Statement

Although there is a lot of good information

concerning prevention and management of obesity

and associated NCDs in Kenya, including

development of important documents outlining the

strategies to be adopted at individual, community and

society level, there seems not to be a commensurate

change in occurrence of the pandemic.

If anything, the rise is on a positive incline. For

instance, Strategic objective number three (3) in the

Kenya National strategy for prevention and control of

non- communicable diseases (2015-2020) is aimed at

promoting healthy lifestyles and implementing

interventions to reduce the modifiable risk factors for

NCDs (MOH, 2015b).

There seem to be a general lack of action on the

available information with an estimated PA of only

10% in males and 14% in females (WHO 2014)

which is unevenly distributed among rural and urban

populations. Children are also showing transition

towards sedentary behavior especially those in urban

settings with only 12.6% of school children in Nairobi

City meeting the recommended levels of daily

physical activity (Muthuri et al, 2014). Onywera et al

(2012) adds that about 50% of children in urban areas

spend over 2 hours per week viewing television

compared to<10% of rural children.

With this kind of lifestyle, there is compromised

health, high cost to manage disease, loss of

productivity due to absence from work and the lack

of capacity to work as the health conditions

deteriorate. The immediate effects are felt at family

level as domestic expenditure on health increases, at

institutional level as institutions commit big parts of

their budget for health management of their

employees, and at the community level as people

come together in aid of health care expenses of the

affected individuals. This consequently thwarts

economic development of the nation.

Voluntary exercise is the most important

component of total daily energy expenditure by

individuals. This can be achieved at community level

by provision of supportive environments within the

communities where they come from. This will

collectively challenge individuals to follow

recommendations for physical activity that promotes

and or maintain health.

Such a model is outlined in the midstream

approach suggested in the Kenya National Strategy

for prevention and control of NCDs (2015-2020)

which has interventions targeting groups of people,

institutions and communities.

Churches play an important role in communities

especially in Africa; serving as primary

organizational units and sources of social support and

leadership. As such, they are potentially effective

settings for implementing community health

intervention programmes. In Kenya, the most

predominant religion is Christianity with an

adherence of 84.8% of the total population (World

Factbook, 2020). Thus, targeting churches as the

platform for the community-based lifestyle

interventions ensures that majority of the population

in terms of age group, gender and social economic

class are included.

In addition to community-based approaches,

technology has been used to promote PA and change

exercise behavior (Heyward & Gibson, 2018). For

instance, electronic pedometers are increasingly

being used to measure PA among all populations

because of their ability to count and monitor steps

taken throughout the day during ambulatory activities

such as walking, jogging and running. A study by

Bravata (2007) indicated that participation in PA

increased by 27% over baseline levels among

pedometer users. According to Masi, Peterman and

Kaminsky (2019), when adults accumulate 10,000

steps per day, this translates to an equivalent of

walking roughly 8.045kilometers. These researchers

recommend 10,000 to 12,500 steps per day for health

and wellbeing.

This paper aims at highlighting the success and

challenges of a community (church) based

programme designed to promote PA among church

Uptake of Pedometer-based Physical Activity: Success and Challenges of a Church based Physical Activity Promotion Programme among

Overweight and Obese Adults in Kenya

127

congregants using pedometers as the motivator that

provides feedback necessary to help individuals track

their levels of physical activity by tracking their step

counts, sending reminders and real time alerts

concerning their activity levels.

The paper highlights the overweight and obesity

status of the congregants, the PA levels of the

congregants as well as the success and challenges

recorded during the implementation of the programme.

2 METHODOLOGY

2.1 Study Design

This paper is developed from an on-going programme

that is longitudinal in overall design with an end point

focusing on behavior change of the congregants from

sedentary to active living. The programme is being

carried out in two phases comprising of a baseline

survey phase and intervention phase.

The baseline survey phase adopted a cross-

sectional analytical design to conduct a Health Risk

Appraisal (HRA) on overweight and obesity among

the church members. Participation in PA was

determined among other modifiable risk factors

associated with overweight and obesity. This was

followed by physical measurement of height, weight,

waist circumference and waist to hip ratio for risk to

CVD determination.

The intervention phase involved among other

interventions use of pedometers to track daily PA

levels of the participants.

2.2 Target Population

The baseline survey targeted all members of the

selected church while the intervention phase targeted

the overweight and obese adults identified during the

health risk appraisal. Parents and guardians as well as

the youth were to act as champions of wellbeing at

family level serving as models to their children and

siblings.

2.2.1 Inclusion and Exclusion Criteria

The programme included all congregants who

consented. The programme excluded pregnant

women because of the natural weight gain that

accompanies pregnancy thus affecting the body mass

index as well as the change in body morphology that

may not allow objective assessment of waist

circumference and determination of waist to hip ratio

(WHR).

2.3 Sampling and Sample Size

Census sampling was used to include all the

congregants (100) who took part in the first phase of

the baseline study. Purposive sampling was used to

target all the (46) youth and adult congregants within

the overweight and obese category following the

results of the baseline health risk appraisal.

Convenience sampling was used to enroll willing and

motivated congregants into the health promotion

programme.

2.4 Data Collection Instruments

The baseline data on PA was obtained using a

questionnaire where respondents self-reported on PA

among other modifiable risk factors to obesity and

NCDs. Physical activity related questions assessed

the nature of occupation/work (either office or

manual work), the means of transport to work

(walking, motorized transport; either private or

public) and involvement in other forms of physical

activity apart from work (either at the gymnasium,

jogging or other sports).

Anthropometric measurements of body weight,

height and waist circumference were taken using

portable digital Seca Robusta 813 weighing scales

(Hamburg Germany), Seca 214 portable stadiometer

(Hamburg, Germany) and anthropometric tapes

respectively. Overweight and obesity was determined

using BMI.

Classification for risk category was followed by

measuring waist and hip circumferences using

anthropometric tapes. These measurements were then

used to determine the WHR.

Given the different financial abilities of the

participants, they were advised to purchase

pedometers of their choice, so long as they would take

step counts and provide distance covered per day in

kilometers. The pedometers were also required to be

able to give alerts on sedentarism when participants

were seated for too long without walking. The

pedometers were also supposed to have the ability to

synchronize with mobile phone applications that

would allow data interpretation and sharing on the

WhatsApp platform.

2.5 Study Procedure

Permission was sought from the church leadership to

conduct a church-wide one day health risk appraisal

camp for the congregants at the church premises in

August, 2019. During this camp, the participants were

presented with a talk on obesity and its associated risk

icSPORTS 2020 - 8th International Conference on Sport Sciences Research and Technology Support

128

factors and NCDs. The camp was a diagnostic and not

curative forum with the aim of collecting baseline

information that would inform development of the

pedometer-based PA promotion programme. General

feedback on the health risk appraisal was presented

on another day to the church after analysis. It is during

this feedback meeting that congregants were recruited

to the PA promotion programme. During the launch

of the programme, participants signed the informed

consent for the intervention and guided on the basic

specifications of the pedometers and how to acquire

them. The participants were allowed to purchase

pedometers of their choice so long as they could take

step counts, distance in kilometers, give real time

alerts on sedentarism and could be synchronized with

mobile phone applications to allow data sharing and

report their engagement in PA on a daily basis. A

WhatsApp account was created and all the consenting

participants registered.

The participants were to engage in self- directed

PA throughout the week from their homes or work,

and were to take screenshots of their workouts as

recorded by their pedometers and post them on the

WhatsApp forum. They were encouraged to share

their experiences in the forum. They were also

provided with an opportunity to ask questions or

discuss topics related to PA and obesity in the forum.

Once every week on Saturday morning from 7.00am,

they were taken through a one hour aerobic dance

session by a qualified fitness instructor. This allowed

for a face to face interaction with one another.

2.6 Data Analysis

Anthropometric data was analyzed in Microsoft excel

programme. Frequencies were used to summarize the

raw data. Pearson product moment correlation

coefficient was used to relate BMI scores with the

WHR scores. Self-report data on participation in PA

was analyzed using Google forms to accord the study

real time responses from the participants. Data on

uptake of pedometer-based PA at community level

(church) were analyzed under two main themes

namely; success and challenges. The results are

presented in tables, charts and bar-graphs.

2.7 Logistical and Ethical

Considerations

Permission to recruit the congregants was sought

from the Vicar In-charge of the selected church.

Members were provided with information concerning

the program and given opportunity to give written

informed consent. For sustainability, it is hoped that,

promotion of self-directed active lifestyle will ensure

that congregants are in control of their weight and

health in general. The church will play the role of

social support structure offering the desired social

environment for continued engagement of its

members on healthy active practices beyond the

programme. The documented success of the

intervention will act as evidence for scaling up to

other community settings countrywide.

3 RESULTS

Figure 1 indicates that a total of 100 congregants were

assessed of their weight status, out of which 20 were

overweight with a BMI=25˂30 while 26 were obese

with their BMI ≥30.00.

Figure 1: Overweight and Obesity Status of the

congregants.

BMI scores for the participants in the obese

category were distributed against age and the results

presented in figure2.

The results in figure 2 indicate that out of the 26

obese participants, 6 participants (11-20years), 5

participants (21-30 years), 4 participants (31-40

years) and 2 participants (51-60 years) were in the

class 1 of obesity (BMI=30˂35). Two participants (41-

50years) and 1 participant (51-60 years) were in class

II of obesity (BMI=35˂40. One participant (31-40

years) was in category III of obesity (BMI=40) while

1 participant (41-50years) was in the category for

morbid obesity (BMI˃40.

Figure 2: Overweight and Obesity Status by Age and

Gender.

Uptake of Pedometer-based Physical Activity: Success and Challenges of a Church based Physical Activity Promotion Programme among

Overweight and Obese Adults in Kenya

129

3.1 Self-report on PA

Out of the 46 congregants who consented to take part

in the health promotion programme, 21 completed the

self-report questionnaire on participation in PA and

their results are presented in figures 3, 4 and 5. Figure

3 indicates that out of the 21 respondents, 19% are

involved in manual work while 81% work in the

offices.

Figure 3: Type of Work/Occupation.

Figure 4 indicates that out of the 81% respondents

who work in the office, 9.5% walk to the office, 19%

use public means while 71.4% use private vehicles to

travel to work.

Figure 4: Means of travel to work.

Figure 5 shows that other than work 19% engage

in jogging activity, 21.8% are engaged in activities at

the gymnasium, 4.8% are engaged in other sports

while 52.4% are not involved in any other physical

activity.

Figure 5: Activities other than work.

To determine the risk status of the recruited

congregants to disease, waist to hip ratios were

measured against their BMI by gender.

Out of the 16 female participants, 9 were under

the high-risk category, 3 were in the low risk while 4

were in the very low risk. On the other hand, out of

the 6 male participants, 2 were in the high-risk

category, 2 in the low while 2 were in the very low

risk category.

In addition, a relationship between BMI and waist

to hip ratio was determined using the Pearson product

moment correlation coefficient for each gender. The

analysis indicated a significant relationship between

BMI scores and WHR scores for females(r=0.67) and

males (r=0.88).

3.2 Uptake of Pedometer-based PA at

the Church

Although all the participants were sufficiently

sensitized on the role of wearable technology devices

such as pedometers and their importance in

monitoring an individual’s PA level and volume, it

was solely based on voluntary acquisition and self-

motivated daily use of the gadget. This was important

for a sustainable self-driven approach that can be

carried forward even after the intervention period

lapses. However, this study shows a poor uptake of

the recommended pedometer based PA monitoring

approach with 75% opting not to acquire or use the

device. They cited conflicting demands of resources

(money and time) while directing their focus on other

non-health and wellness needs.

There was however a positive adoption by a

quarter (25%) of the sample who found pedometers

valuable and a positive influence in PA participation.

This included 2 males and 2 female participants aged

between 25 and 35 years. It is interesting to note that

all the 25% of the pedometer users were in the

overweight category and all were in the very low risk

to development of CVDs as categorized by their waist

to hip ratios. One would expect to see the obese

individuals being enthusiastic about taking PA as a

weight remedy and using pedometers for motivation,

however is was not the case so far in this study.

Additionally, all the pedometer users were among the

youth category aged 25 to 35 years who may find

technology use easy and friendly in offering

solutions. Probably the older congregants, besides the

financial challenge, found the use of pedometers to be

technically challenging.

icSPORTS 2020 - 8th International Conference on Sport Sciences Research and Technology Support

130

3.2.1 Success

The following successes emanated from an interview

conducted among the 21 participants of the

pedometer-based PA promotion programme. They

opined that:

i. The programme has been useful in creating

awareness about overweight and obesity

status of the congregants

ii. It has been useful in helping the congregants

understand the role of exercise among other

interventions in management of overweight

and obesity

iii. It has brought people together to work

towards a common goal of leading healthy

active lives.

3.2.2 Challenges

The participants cited the following as challenges that

are possibly slowing down the program.

i. There is lack of capacity at institutional level

to support frequent mass activities.

ii. The uptake of the PA has not been felt at the

health club level.

iii. Conflicting demand for resources (time and

money) whereby investing in pedometers,

PA support equipment and facilities are

considered as opportunity cost over other

priorities.

4 DISCUSSION

4.1 Overweight and Obesity Status of

the Congregants

Twenty percent of the congregants are overweight

while 26% are obese indicating that the pandemic is

increasing in Kenyan communities. Although there

are cases of obesity among younger populations (6 in

11-20years) the serious cases of obesity (categories,

II, III and morbid obesity) are more prevalent in later

years especially 30- 60 years. This finding agrees with

that of Mkuu et al, (2018) who observed high

prevalence of overweight (20.5%) and obesity (9.1%)

among Kenyan women aged 35-44years.

4.2 Physical Activity Status

From the self-report on participation in PA, most

congregants are inactive with majority working in

offices (81%) where they probably sit all day long.

They also use motorized transport (90%) to and from

work with majority of them using private vehicles

(71%) offering them less or no opportunity to be

active. Worse still, majority of the congregants

(52.4%) do not engage in PA other than office work

further compromising their activity levels leaving no

avenue for energy expenditure.

This provides good ground for overweight and

obesity to develop and blossom. These results agree

with the observations by King and Jacobson (2017)

who in their review observed that though fast and

convenient, automobiles are replacing PA involved in

walking or cycling with sedentary activity of driving

thus increasing obesity by reducing energy

expenditure.

4.3 Uptake of Pedometer-based PA at

the Church

On use of objective monitoring of PA using wearable

devices such as pedometers proposed in this project,

it is noteworthy that although this represents a

valuable mode of monitoring volumes and

influencing participation, its uptake at community

level may be low and poor at the beginning due to

other competing priorities (costs and time). This may

be addressed through continuous sensitization,

encouragement and follow-up by peers until lasting

habits and appreciation of the initiatives are

established. The 25% of the participants who used

pedometers were mainly youth aged 25-35 years.

This pointed to the fact that younger generation may

embrace technology faster and better than the older

ones. The use of pedometers was equal among gender

on a ratio of 1:1 and therefore the use of pedometer

may not be influenced by gender. However, those that

used pedometers were the young and were all in the

overweight category with none from the obese

category. This indicates the need to continuously

target the older congregants in promoting the PA

programme while encouraging them to use the

pedometers for they are likely to sustain the

motivation for self-directed PA. Another area of

focus in this study would be to encourage the obese

congregants to engage in PA and offer personalized

support to them towards developing a self-directed

PA routine. The 25% who used pedometers referred

to them as useful and had significant influence on

their daily participation in PA. This finding is similar

to that of Baker et al., (2008) who observed

significant increases in step counts among the

intervention group as well as the time spent in leisure

walking and a reduction in sitting time among

pedometer users.

Uptake of Pedometer-based Physical Activity: Success and Challenges of a Church based Physical Activity Promotion Programme among

Overweight and Obese Adults in Kenya

131

5 CONCLUSIONS

The uptake of pedometer-based PA promotion

programme is slow at the community-church level even

though cases of overweight and obesity are

increasing. The few congregants that have embraced

pedometer use to monitor their PA levels are among

the youth age category and are mainly in the overweight

category. This leaves out a key population of the church;

the older where majority of obesity cases lie. There is a

noticeable percentage of physical inactivity among

the congregants a reason that can be associated with

the high levels of overweight and obesity. The

increase in overweight and obesity is likely to

predispose most of the congregants to developing one

or more of NCDs whose risk factors include among

others physical inactivity.

6 RECOMMENDATIONS

This paper recommends that the church by virtue of

being an organized and well- structured social unit in

the society should promote and device strategies to

help the congregants navigate the challenges of

physical inactivity while at the same time tapping into

the resources available to it including facilities and

health experts within its reach to address the rising

cases of obesity and related comorbidities in the

society. Among the proposed recommendations is

continued sensitization on use of pedometers by the

congregants and the importance of acquiring

pedometers for PA promotion. One of the main

limitations of this programme is lack of provision of

pedometers to the participants. May be if this was

achieved, there would be a higher level of uptake

which would enable the researcher to track the step

counts attained by the participants against the

recommended number of 10,000 steps per day. This

would help address issues of adherence and allow

further analysis of the uptake of pedometer-based PA

promotion on health outcomes especially on

overweight and obesity status of the congregants.

REFERENCES

Baker, G., Gray, S. R., Wright, A., Fitzsimons, C., Ninimo,

M., Lowry, R, Mutrie, N & Scottish Physical Activity

Research Collaboration [SPARColl] (2008). The Effect

of a Pedometer-based Community Walking

intervention “walking for wellbeing in the west” on

physical activity levels and health outcomes: a 12 week

randomized control trial. International Journal of

Behavioral Nutrition and Physical Activity. Vol 5 no.44

Bravata, D. M., Smith-Spangler, C., Sundaram, V.,

Gienger, A. L., Lin, N., Lewis, R., & Sirard, J. R.

(2007). Using pedometers to increase physical activity

and improve health: a systematic review. Jama,

298(19), 2296-2304.

Heyward, V. H. & Gibson A. L. (2020). Advanced Fitness

Assessment and Exercise Prescription: Technology can

Boost Physical Activity Promotion. Human Kinetics.

US. Humankinetics.com

King, D. M., & Jacobson, S. H. (2017). What is driving

obesity? A review on the connections between obesity

and motorized transportation. Current obesity reports,

6(1), 3-9.

Masi, E., Peterman, J. E. & Kaminsky, L. A. (2019). The

Health Benefits of a Pedometer- Based 100,000 Steps

per week Physical Activity Program. Journal of Science

in Sports and Exercise, Vol 1pg176-183

Ministry of Health (2018) National Physical Activity

Action Plan 2018-2023.World Health Organization

Ministry of Health (2017). National Guidelines for Healthy

Diets and Physical Activity. Government of Kenya.

Nairobi.

Ministry of Health (2015a). Kenya Stepwise Survey for

Non- Communicable Diseases Risk Factors 2015

Report. Division of NCDs, Afya House, Cathedral

Road, Nairobi, Kenya.

Ministry of Health (2015b) Kenya National Strategy for the

Prevention and Control of Non- Communicable

Diseases, 2015- 2020. International Institute of

Legislative Affairs.

Mkuu, R. S., Epnere, K., & Chowdhury, M. A. B. (2018).

Peer reviewed: prevalence and predictors of overweight

and obesity among Kenyan women. Preventing chronic

disease, 15.

Muthuri, S. K., Wachira, L. J. M., Leblanc, A. G., Francis,

C. E., Sampson, M., Onywera, V. O., & Tremblay, M.

S. (2014). Temporal trends and correlates of physical

activity, sedentary behaviour, and physical fitness

among school-aged children in Sub-Saharan Africa: a

systematic review. International Journal of

environmental research and public health, 11(3), 3327-

3359.

Onywera, V. O., Adamo, K. B., Sheel, A. W., Waudo, J. N.,

Boit, M. K., & Tremblay, M. S. (2012). Emerging

evidence of the physical activity transition in Kenya.

Journal of physical activity and health, 9(4), 554-562.

Popkin, B. M. (2015). Nutrition transition and the global

diabetes epidemic. Current diabetes reports, 15(9), 64.

World Health Organization (2020). Obesity and Overweight

Fact sheet. https://www.who.int/news-room/fact-sheets/

detail/obesity-and-overweight

World Factbook (2020) -Central Intelligence Agency:

Kenya People. https://Theodora.com

icSPORTS 2020 - 8th International Conference on Sport Sciences Research and Technology Support

132