TRACK & ACT: a pragmatic randomised controlled trial exploring the comparative effectiveness of pedometers and activity trackers for changing physical activity and sedentary behaviour in inactive individuals.

Background: Pedometers have been shown to be effective for increasing physical activity, however the potential additional effects of activity trackers, and their added capacity to simultaneously modify sedentary behaviour, has not been thoroughly explored. This study aimed to explore the comparative effectiveness of two activity trackers and a pedometer for improving daily step count and moderate-vigorous physical activity (MVPA), and reducing sedentary behaviour in inactive adults.

Methods: 48 inactive participants were allocated to one of three groups based on their workplace. Each group randomly received either a Fitbit ONE, Jawbone UP or Digi-Walker SW200 pedometer (PED) for 8-weeks and an orientation session to their respective device. Participants were informed about the study aims and were provided with their respective devices and where applicable, the associated Apps. Participants intentionally received no other active intervention components to simulate as closely as possible the experience of purchasing a device 'off the shelf'. Step count, MVPA and time in sedentary behaviour were measured using accelerometry (Actigraph GT3X+) at baseline and four-, eight- and 16-weeks. Analyses were conducted using linear mixed-effect regression models to compare changes from baseline. Post-hoc tests of model estimates compared each activity tracker group to the pedometer group. Model estimates are reported for baseline-16 week follow-up.

Results: At baseline, average (standard deviation) step count, MVPA and time spent sedentary was 6557 (2111) steps/day, 23 (13) minutes/day and 10.3 (1.0) hours/day in the PED group, 7156 (1496) steps/day, 26 (12) minutes/day and 9.3 (1.2) hours/day in the ONE group and 6853 (1281) steps/day, 29 (10) minutes/day and 10.1 (1.0) hours/day in the UP group. At 16-weeks, based on estimates from the linear mixed-effect regression model, the ONE and UP groups increased step count by 129 steps/day (95% CI - 1497, 1754) and 504 steps/day more (95% CI - 1120, 2130), respectively, than the PED group. For MVPA, the ONE and UP groups increased by 2.3 min/day (95% CI - 10.9, 15.4) and 2.7 min/day more (95% CI - 10.5, 15.8), respectively, than the PED group. For sedentary behaviour, the ONE group had 34 min/day more in time spent sedentary than the PED group (95% CI - 35, 104), while the UP group had 53 min/day more in time spent sedentary than the PED group (95% CI - 18, 123).

Conclusions: All three groups demonstrated an increase in steps and MVPA, and a decrease in time spent in sedentary behaviour, however there was substantial individual variation in these outcomes indicating considerable uncertainty about the relative effectiveness of activity trackers and pedometers in improving PA and sedentary behaviour. Randomised controlled trials with adequate sample sizes are indicated.

Trial Registration: ACTRN12623000027617 (retrospectively registered 11/1/2023).