Analysis Of TRIPPA Study On Workplace Physical Activity

Main Population and Intervention of the Study

Freak-Poli et al. (2011a) conducted a study with an aim to evaluate whether participation in pedometer based physical activity under workplace program helps in improving the overall risk factors associated with diabetes and other cardiovascular disease. They selected four month follow-up study upon the adults who are employed in Australia and primarily observe a sedentary mode of occupation. People who voluntarily enrolled in the programme were selected for the study under the physical fitness program of The Global Corporate Challenge which is aimed towards increasing the physical activity. The data mainly included the demography, behaviour and biomedical measurements of the selected group of employee. The data were compared between the baseline and four-month old data. Thus the main population selected for the studywas working adults who lead a sedentary life during their working hours. The intervention which was selected for the study includespedometer based workplace activity and the comparison was done with no activity. The main outcome selected for the study was reduction is risk factor of diabetes and cardiovascular disease (Freak-Poli et al. 2011a). 762 participants were selected for the study during the tenure of April/May 2008 with 79% returning. Freak-Poli et al. (2011a) observed improvements between baseline and four-month program in areas of physical activity, fruit intake, blood pressure, siting time, waist circumference. In contrast to these findings, Freak-Poli et al. (2011a) observed increase in the overall blood cholesterol and triglyceride level. The confidence interval selected for the demographic analysis is 1.4 with P value was 0.07 and the confidence interval for the mean data analysis include 777 (1.4) with P-value include 0.06 and 0.04. Thus, Freak-Poli et al. (2011a) concluded that pedometer-based physical activity and workplace programme helps in improving the behavioural and anthropometric risk factors associated with diabetes and cardiovascular disease. However, Freak-Poli et al. (2011) highlighted that in order to evaluate the potential of the program on non-communicable diseases, further analysis is important. The main strength was it mode of data collection. The biomedical and anthropometric data was collected with the help of trained professionals. The blood glucose levels were accessed under the supervision of independent pathology company. Self-reported independent questionnaire was in order to access the demographic data. According to Clement et al. (2015), independent analysis of the data helps in reducing selection bias and assessment bias. However, the study has its own limitations. Self-volunteered employees were selected for the study. According to Finkelstein et al. (2015), these self-volunteered participations is likely to stay self-motivated towards physical activity than average employee. Thus the obtained results might not be generalised to a comprehensive group of employees within the workplace. Chan, Ryan and Tudor-Locke (2004) are of the opinion that inactivity is a major contributor behind the increase in the chronic health problems. The aim of the study conducted by Chan, Ryan and Tudor-Locke (2004) is to examine the influence of pedometer-based physical activity interventions on the overall activity and physical health issues among 106 sedentary workers. Thus the main focused group population is sedentary workers under workplace. The interventions include pedometer-based physical activity. Outcome focused is reduction in the chronic health conditions. Chan, Ryan and Tudor-Locke (2004) recruited participants from five workplaces where majority of the jobs were moderately or highly sedentary. These subjects were divided into two groups, one is placebo group another is test group. The duration taken for the analysis of the Price-Edward Island-First Step Program (PEI-FSP) Interventions is 12-week. The effect of the improvement of the physical activity was measured on the basis of body mass index (BMI), waist girth, resting heart rate and blood pressure. Only 59% of the participants completed PEI-FSP. The analysis of the results highlighted that the use of pedometer helped to increase the overall steps counted per day however, the amount that participants were able to increase their overall steps per day was not associated with the baseline BMI. On an average, the focus group participants experienced an overall decrease in the BMI, wait circumference and resting rate of the heart and all these parameters were significantly associated with the steps counted per day. In relation to the results, Chan, Ryan and Tudor-Locke (2004) concluded that PEI-FSP help to increase the physical activity of a sedentary population and this help to decrease the vulnerability of developing chronic disease. Though Chan, Ryan and Tudor-Locke (2004), used a placebo group, but did not specified whether this placebo group is enrolled under physical wellness or fitness program. Thus it may give rise of confounding bias. According to Chan, Ryan and Tudor-Locke (2004), health benefits associated with the increase in the steps per day and the pattern of the overall improvement visualized might have been confounded by the overall loss of the confounded weight loss program. Moreover, the sample size of the study was also small. Marshall et al. (2013) low sample size increases the chances of biased results. Chan, Ryan and Tudor-Locke (2004) further highlighted that higher sample size will be important in order to establish more particular effects of FSP on any specific health outcomes over healthy or diabetic population. The strength of the study is its data presentation. Chan, Ryan and Tudor-Locke (2004) used tabular representation of the data in order to highlight the multiple regression analysis outcomes based on parameters like change in BMI, waist circumference, heart rate, systolic blood pressure, diastolic blood pressure. They also provided contour plot in order to analysis the change in the waist circumference based on steps taken per day. The P value under each of the case is taken less than 1. The background of the study conducted by Freak-Poli et al. (2011b) is based on workplace health in improving in the number of risks factors associated with the chronic health disease. The aim of the study conducted by Freak-Poli et al. (2011b) is identification of the characteristics of the participants which are associated with the improvement in the waist circumference (WC) after a four months follow up under the usage of the pedometer based physical activity. Freak-Poli et al. (2011b) selected 762 participants who are primarily employed under sedentary occupation and voluntarily enrolled under four-month follow-up study. Analysis of the results highlighted greater improvements in the WC during the 4-month program was associated with the completion of the tertiary education along with consumption of less alcoholic beverages under one occasion in 12-month before the baseline. A greater WC at the baseline was associated with more improvements in WC. Freak-Poli et al. (2011b) conducted a sub-analysis among the participants with “high-risk” baseline WC and this revealed younger age, enrolling of reasons other the physical appearance and less sitting time during the weekends at the base line and increase in the consumption of food and vegetables is associated with higher probability of WC reduction at the end of program. Freak-Poli et al. (2011b) finally concluded that employees who initiated with better health, mainly due to lifestyle or change in the health related behavior is more likely to provide positive response to the follow-up program through pedometer. The main limitation of the study is lack of proper assessment and evaluation of the program and other workplace characteristic. The article also had potential selection bias in relation to the workplace or individual recruitment and participant retention. Freak-Poli et al. (2011b) highlighted that recruitment of healthier cohort might leads to increase in the observance of the health-care programs through pedometer and thus the obtained results might not be applicable for the general mass. The main strength of the study is its statistical analysis approach where the P-value of majority of the data were select <0.001. Moreover, the study also followed tabular presentation of the data which helps to increase the overall format of data interpretation. Afifi and Azen (2014) highlighted that having a smaller P value helps in reducing inconsistency in the data analysis. In relation to the effect of pedometer over cardiovascular disease and its effect in the physical health, Freak-Poli e al. (2014) again conducted a study. The aim of the study includesevaluation of the relationship between the workplace pedometer based physical activity program towards improving the biomedical risk factors associated with the health and well-being. The main focus group or the selected group of population for this program includes adults who were employed in primary sedentary occupation. The interventions include pedometer workplace based health improvement program through physical activity. The outcome that was measured includes improvement of the biomedical risk factor of health. The main duration of the study was 4-month long pedometer based health activity program and then the assessment of the biomedical risk factor of health after 8-months follow-up. In order to achieve the aim of their study, Freak-Poli e al. (2014) recruited 762 adults whose mean age was in between 40 and voluntarily enrolled under the physical activity program in Australia. The collection of the data was done at baseline after the completion of the four-month long physical program and after the eight months of the completion of program. The measurement of the outcome was done on the basis of WHO-Five Well-being Index (WHO-5) under self-administered five-item scale which can be dichotomized as poor or positive well-being. The analysis of the results highlighted that 75% of the participants has positive well-being. On an average, the well-being improved immediately after health program and was sustained for eight months later. 25% of the selected group of population was associated with poor well-being at the baseline. However, 49% immediately move to the positive wellbeing state after the completion of the program and this well-being was sustained even after eight months and the P-value of this significant association was less than 0.001. Thus Freak-Poli e al. (2014) concluded clinically relevant immediate yet sustained improvements in the workplace health programs with the use of the pedometer and thereby helping to improve the overall well-being. The results highlighted by Freak-Poli e al. (2014) showed a relation with the results of Freak-Poli e al. (2011). The relation is, healthy attitude of the participants help to increase the overall outcome of the pedometer-based health analysis and this health-related outcome is found the decrease the biomedical risk factor for the longer period of time even after a 8 month follow up after the completion of the health-related program. However, the Freak-Poli e al. (2014) did not highlighted any specific health-related risk factors like cardiovascular risk factors upon observance of the healthy behavior and pedometer based health analysis. The limitations of the study conducted by Freak-Poli e al. (2014) is recruitment of the self-volunteered participants this lead to selection bias (Dwan et al. 2013). Freak?Pol et al. (2013) conducted eight-month long analysis study in order to evaluate whether participation of 4-month long pedometer-based physical activity workplace health program is related with the sustained improvement in the health-related risk factors associated with the development of the type-2 diabetes mellitus and cardiovascular disease after 8-month long follow-up study. The aim of the study holds resemblance with the Freak-Poli et al. (2011) which aimed to measure the association with the pedometer-based physical activity program and its relation with reducing the cardiovascular risk factors and diabetes related risk factor. The similarity was observed in the design of the study as well. Both the study used follow-up study over the adults Australian who lead occupational life main guarded with sedentary mode of workplace culture. The only difference is Freak?Pol et al. (2013) two baseline follow-up one is after 4-month and another follow-up was done after 12-month. The sample size selected by  Freak?Pol et al. (2013) is 720, this is a standard sample size and the main data which were taken into consideration include the demography of the participants, behavioural traits of the participants, biomedical and anthropometric measurements. The analysis of the results highlighted that 76% of the participants returned for 12 months of the follow up. Sustained improvements at 12-months were visualised for self-reported vegetable diet, sitting time and independently measured blood pressure. A modest improvement from the baseline was observed was indicated in self-reported physical activity and waist circumference measured independently after 12 months of follow-up. The analysis of the results concluded that participation in the 4-month long pedometer-based physical activity, workplace health program was associated with sustained improvements in chronic disease related risk factors after 12 months. The results also showed that such program can bring in long-term health-related benefits and thus can have a potential role in prevention of chronic diseases. The main limitation of the study is lack of control group (Freak?Pol et al. 2013). According to Haneuse (2016)., lack of control group in any structure hampers the overall outcome as it fails to perform comparative analysis between the test group and placebo group. The entire study is based on the self-reported data and no independent assessment was done by any professionals recruited externally in the study Freak-Poli et al. (2011). Lack of independent assessment of the data might give rise of confounding bias leading to tampering of the main outcome of the study. The study also had selection bias associated with the recruitment in the workplace and retention of the participants (Freak?Pol et al. 2013). Apart from the studies conducted to analyse the effect of pedometer associated health related outcome over the working population, Finkelstein et al. (2015) conducted a similar study under the same background however, under different perspective. The main perspective of Finkelstein et al. (2015) was to design baseline characteristics of the participants in the pedometer trial. Finkelstein et al. (2015) mainly aimed to conduct a randomised control trial for a six month of pedometer program with financial incentive. Finkelstein et al. (2015) mainly design the procedure of the trail with special focus on the non-communicable disease which is the predominant health care concern around the world. The main focus of the trail plan was to measure the effectiveness of the wearable wireless technology, pedometer in sustaining health-related benefits. The aim of designing the randomized control trail was to measure who this wireless technology help to bring change in the overall health-related behaviour. This approach is somewhat similar to that of the study conducted by Freak-Poli e al. (2014). Freak-Poli e al. (2014) mainly measured how healthy lifestyle though process help to improve the overall health outcome. Finkelstein et al. (2015) aim focus was to analyze how financial or other privilege incentives help to increase the observance of the pedometer based physical activity program in the workplace. The design and the baseline characteristics of employee at 15 different workplaces will be used in 40arm randomized control trial. The designing of the trail was mainly done by Finkelstein et al. (2015) in order to analyze how financial incentives can provide affordable and scalable health promotion strategy for the employees seeking to increase their physical activity levels. The designing of the trail was however limited in the domain of selection of the group of participants and this can be attributed as the selection bias.  

Selected Article 1: Freak-Poli et al. (2011a) Study

The synthesis of the results highlighted that four month completion of the pedometer-based physical activity under the workplace settings is associated with an increase in the improvements in the behaviour and anthropometric risk factors associated with the development of non-communicable disease like diabetes and cardiovascular disease (Freak-Poli et al. 2011).This reduction in the anthropometric risk factor associated with the lifestyle diseases or non-communicable diseases promote sustained improvements in decreasing the vulnerability of developing other chronic diseases even after 12 months of follow-up post 4-month of extreme pedometer-based physical training regime. Thus such programs have long term benefits over the health-related quality of life of the people (Freak?Pol et al. 2013). However, the overall outcome of the results is mainly guided by the characteristic of the participants who are undertaking the pedometer-based physical training exercise. The participants who are health conscious are more likely to follow the rigorous health regime. This increase in the workplace based healthy fitness program through pedometer is found to promote decrease in the waist circumference and this help to decrease cardio-metabolic risk factor or risk factor behind the development of the disease (Freak-Poli et al. 2011b). However, BMI is not directly associated with drastic change in the overall health outcomes (Chan, Ryan and Tudor-Locke 2004).  Chan, Ryan and Tudor-Locke (2004) stated that people with higher BMI at the baseline achieved similar increase in the physical activity in comparison to the participants with lower BMI. The improvement physical activity level in the workplace under the influence of the wearable devises not only helps to decrease the cardiovascular risk factor but also helps in the improvements of the overall health and well-being of the participants. The improvement of the health and well-being further helps to reduce the chances of developing non-communicable disease (Freak-Poli et al. 2014). Increase in the adherence of the wearable devise among the group of population who are not self-motivated or health-conscious can be done through the use of financial incentives as proposed by the Finkelstein et al. (2015) through the design of the four arm randomized control trial. The effects of wearable devices on physical activity is yet to be established. Incentives have always been an effective strategy to change behaviors. In increasing physical activity the effects of wearable devices is not been documented and established (Sallis et. al. 2016). The research approved by the University of Prince Edward Island Human Ethics Board consisted of employees from five different workplaces. 75% of the participants claimed that their jobs are highly sedentary. The average age of the participants in the research was 43 with average BMI was 29.5. Out of 177 participants 106 completed the whole program whereas 26 partially completed the program with 45 participants dropped outs from the program. P value of p<0.07 and the confidence interval for the mean data analysis include 777 (1.4) with P value include p<0.06 and p<0.04 is indicative of huge improvement in diabetes and cardiovascular diseases among the participants. As per the funding almost 92%, 91.4% to be precise, of the participants reported huge improvement in diabetes during and after completion of the health program. In addition reduction in sitting time, increased physical activities, increase in food intake and reduction in waist circumference are number of other benefits accrued to the participants who have completed the health program. Around 75% of the participants with mean: 60 ± 19 SD WHO-5 units. (+3.5 units, p < 0.001) experienced improved wellbeing subsequent to the completion of health programs. In fact most of the results observed from the study have 95% confidence interval to vouch for its authenticity.   

Summary Table of the Selected Literature
Name	Aim of the study Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Study Characteristics	Risk of bias	Results of individual studies
Freak-Poli et al. (2011a)	The aim of the study was to evaluate whether participation in pedometer based physical activity under workplace program helps in improving the overall risk factors associated with diabetes and other cardiovascular disease.	They selected four month follow-up study upon the adults who are employed in Australia and primarily observe a sedentary mode of occupation. 762 participants were selected for the study during the tenure of April/May 2008 with 79% returning.	Self-volunteered employees were selected for the study. These self-volunteered participations is likely to stay self-motivated towards physical activity than average employee. Thus the obtained results might not be generalised to a comprehensive group of employees within the workplace.	Pedometer-based physical activity and workplace programme helps in improving the behavioural and anthropometric risk factors associated with diabetes and cardiovascular disease.
Chan, C.B., Ryan, D.A. and Tudor-Locke, C., 2004	The influence of pedometer-based physical activity interventions on the overall activity and physical health issues among 106 sedentary workers	Random selection was done between five different workplace and among them 106 sedentary workers were included however, only 59% of the workers were successful in completing the trail	The biases, which were included in the study is the small sample size which decreased further after the follow-up.	The analysis of the results indicated improvement in the physical activity as measured by body mass index (BMI), waist girth, resting heart rate and blood pressure
Freak-Poli et al. (2011b)	Identification of the characteristics of the participants which are associated with the improvement in the waist circumference (WC) after a four months follow up under the usage of the pedometer based physical activity.	762 participants who are primarily employed under sedentary occupation were selected who voluntarily enrolled under four-month follow-up study	Potential selection bias in relation to the workplace or individual recruitment and participant retention	Employees who initiated with better health, mainly due to lifestyle or change in the health related behavior is more likely to provide positive response to the follow-up program through pedometer.
Freak-Poli e al. (2014)	The aim of the study includes evaluation of the relationship between the workplace pedometer based physical activity program towards improving the biomedical risk factors associated with the health and well-being.	The main focus group or the selected group of population for this program includes adults who were employed in primary sedentary occupation. The interventions include pedometer workplace based health improvement program through physical activity. The outcome that was measured includes improvement of the biomedical risk factor of health. The main duration of the study was 4-month long pedometer based health activity program and then the assessment of the biomedical risk factor of health after 8-months follow-up.	Selection bias as the selection of the focus group was done on the basis of self-volunteered participants and health-behaviour through self-motivation might have modulated the overall results and decrease in the health-related risk factors after 8-month	Clinically relevant immediate yet sustained improvements in the workplace health programs with the use of the pedometer and thereby helping to improve the overall well-being.
Freak?Pol et al. (2013)	Evaluation whether participation of 4-month long pedometer-based physical activity workplace health program is related with the sustained improvement in the health-related risk factors associated with the development of the type-2 diabetes mellitus and cardiovascular disease after 4 months and 12 months long follow-up study.	720 adults with an average age of 40 and has sedentary job culture in Australia. The main points which are taken into consideration, self-reported demographic, diet and behavioural change	The main risk of bias in the study is confounding bias and selection bias	Participation in the 4-month long pedometer-based physical activity, workplace health program was associated with sustained improvements in chronic disease related risk factors after 12 months.
Finkelstein et al. (2015)	Study the relation between financial incentive help to increase the observance of the pedometer based physical activity program in the workplace	Four arm randomised control trial for a six month of pedometer program with financial incentive	The main risk of bias is the selection bias because only self-volunteered employees will be selected for the study and the nature of blinding of the selected groups of participants	The analysis of the trail will help to derive the relation between financial incentive with the observance of the four month long pedometer based physical activity improvements

Selected Article 2: Chan, Ryan and Tudor-Locke (2004) Study

According to Ezzati and Riboli (2013), non-communicable diseases (NCD) have emerged as one of the prominent global health challenges of 21^st century. As per the reports published by the World Health Organisation (WHO), 63% of deaths around the world occur due to the development of NCDs like cardiovascular diseases, cancers, diabetes and chronic respiratory diseases. Underlying the development of NCDs are numerous modifiable behavioural risk factors including lack of physical activity. There are innumerable references in the domain of how physical inactivity increases the risks of developing obesity which in turn increases the vulnerability of developing cardiovascular diseases and other chronic diseases. Strasser (2013) stated that physical inactivity is the fourth leading cause of premature mortality, which is again responsible to premature deaths, and other significant health complications that increases the overall health-expenditure. Since the majority of these health-care costs are financed by the employers, they are always in search of cost-effective technology to improve the level of physical activity among their employees. In this era of technology, one of the cost-effective aspects of promotion of physical activity is the use of wireless pedometers. However, despite their growing popularity in the market, there is limited evidences on the effectiveness of these technologies for the change overall change in healthy behaviour and improvement in the cardio-metabolic factor of health (Cai et al. 2016). In order to study the effect of wearable technology in improving the physical activity and cardiovascular biomarker among the office worker, 6 papers were selected for the review of literature through the search in the electronic database. All these articles mainly studied the effect of pedometer (wireless devise) in the promotion of physical activity. The majority of the articles followed four-month pedometer-based physical activity promotion under the workplace settings. According to Hallal et al. (2012), pedometer is a portable, wireless electromagnetic devise that helps to monitor the motion of an individual who is wearing that devise from the movements of his or her hands, hips and legs. It also helps to count the number of claries burned, the distance covered, the walking time and the speed per hour. It helps in automatic documentation of the number of steps taken per day when it is kept in touch with the body, be it on wrist, inside the pockets or in the bags while carrying it on shoulder. In order to ensure the accurate results in the domain of number of calories burned, it is recommended to provide actual data of age, height, weight and gender.

Selected Article 3: Freak-Poli et al. (2011b) Study

Objective 1: To determine whether wearable technology device intervention will increase physical activity in office worker

In response to objective one it can be stated that use of wearable technology interventions helps to increase the overall physical activity among the office work-force. The study undertaken by Chan, Ryan and Tudor-Locke (2004) highlighted that pedometer-based physical activity intervention (Prince Edward Island-First Step Program, PEI-FSP) helps in the promotion of specific health indices among the sedentary workers. In order to access an increase in the level of physical activity, Chan, Ryan and Tudor-Locke (2004) studied the baseline ambulatory activity (pedometer-determined steps per day) before and after the use of pedometer. The Participants were asked to wear their sealed pedometer during the waking hours for two consecutive working days and one weekday. Sealed pedometers were returned directly and the program facilitators opened the pedometer, calculated the mean baseline steps. The anthropometric measurements were done based on body weight, height, waist girth, blood pressure and heart rate. The analysis of the data highlighted that number of steps taken per day increased along with a decrease in the waist girth and heart rate. However, the increase in the total number of steps per day was not associated with the total number of baseline steps. Thus it was concluded that people with higher baseline physical activity per day experienced greater decrease in the BMI (Chan, Ryan and Tudor-Locke 2004). However, promotion of the physical activity was observed upon the use of pedometer and the same was reflected through the change in BMI status and change in the waist circumference. According to Olander et al. (2013), one of the most effective techniques to detect the change in the physical activity pattern among the obese individual is change in the BMI. The same has parameter has been highlighted in the study of Chan, Ryan and Tudor-Locke (2004). In relation to weight loss, Cai et al. (2016) conducted a meta-analysis in order to study pedometer intervention over the weight loss regime among the obese adults with Type 2 diabetes mellitus. The meta-analysis conducted by Cai et al. (2016) highlighted that pedometer based analysis helps in the promotion of modest weight loss however; the association with the physical activity requires further clarification. The study conducted by Freak-Poli et al. (2011b), over adults who are employed under primarily sedentary occupations. These employees enrolled under four-month long workplace program towards improvements of physical activity through pedometer based physical activity promotion. The collection of the data was done through participants based step-counts as indicated by the pedometer and the length of bicycle ride was measured through step count as indicated by pedometer. The analysis of the results highlighted that increase in the number of steps based on pedometer count helps to reduce the waist circumference. The increase in the overall waist circumference of employees was also modulated by positional importance in the organization, tertiary education about the health-related awareness and observance of healthy yet nutritional diet (Freak-Poli et al. 2011b). The study conducted by Plotnikoff et al. (2015) also highlighted the importance of tertiary education in increasing the overall health outcomes of individuals. Plotnikoff et al. (2015) mainly conducted a systematic review and meta-analysis in order to study the effectiveness of tertiary education towards implementation of health-related awareness in the domain of physical activity and healthy diet among the university and college students. Out of 41-study included, 34 studies reported significant improvements in the key outcomes. The summative results highlighted that the studies proper tertiary education about the health-related awareness helps in increasing the initiatives of physical activity along with an increase in the overall weight-loss interventions (Plotnikoff et al. 2015). Lachat et al. (2013) conducted a study in order to study the effect of diet and physical activity for the prevention of non-communicable disease among the low and the middle-income countries. The systematic policy review highlighted that observance of healthy diet plan increases the personal motivation of conducting the physical activity and thereby helping to promote weight loss. Thus, the concept highlighted by Freak-Poli et al. (2011b) goes in accordance with the findings of Lachat et al. (2013) and Plotnikoff et al. (2015). The observance of healthy diet plan and tertiary education increase the level of self-motivation towards healthy lifestyle. This motivation towards healthy lifestyle increases the overall success of wearable devices towards the promotion of the physical activity. The study conducted by Freak-Poli et al. (2014) did not provide direct evidence of how the use wearable devise like pedometer helps in the improvement of the physical activity among the office worker. The aim of the study was mainly directed towards how the use of pedometer-based office intervention helps in improving the health and well-being of the employees. The study was a four-month long follow-up study and mainly aimed towards examining how pedometer based physical activity interventions under workplace health program help in improving the bio-medical risk factor, which is associated with the improvement in the well-being of the participants. The overall effect of the improvement in the well-being of the participants was measured after 8-month follow-up study (Freak-Poli et al. 2014). The analysis of the study highlighted substantial improvement in the well-being of the participants who are full-time office employees. This improvement in the mental well-being reflected on their physical well-being which helped them to work on their overall strength towards increasing the tenacity of physical activity (Freak-Poli et al. 2014). The results highlighted by Freak-Poli et al. (2014) are in accordance with the findings of Gunnell et al. (2014). Gunnell et al. (2014) mainly conducted a study in order to analyse the self-determination theory for over 6-month. The analysis of the 6-month long follow-up study highlighted that increase in the level of psychological needs satisfaction along with an increase in the overall well-being of the patients helps to increase the level of physical activity. Thus the overall effect of the pedometer-based interventions on the improvement in the physical activity is modulated by the psychosocial needs of the participants along with the state of mental health and well-being (Compernolle et. al. 2015).

Strengths and Limitations of the Studies

Thus in relation to objective one, it can be said that use of wearable devise like pedometer helps in improving the tendency of performing physical activity and this in turn helps to reduce the body weight of the person. The major improvement was observed upon completion of the four-month pedometer-based physical activity program under the workplace health settings include improvements in satisfying the physical activity guidelines, reduction in the waist circumference, decrease in the blood pressure, reduction in the sitting time, increase in the intake of fruits and vegetables along with decrease in the in-take of the food during the dinner time (Chan, Ryan and Tudor-Locke 2004). These health benefits were similar with males and females of all the ages. The increase in the tenure of the physical activity was highlighted in the increase in the overall steps taken per day along with the decrease in the tenure of pedometer. In relation to the promotion of the physical activity under the use of pedometer as a wearable devise under the workplace settings, it can be stated that pedometer helps in the improvement of the self-motivation (Freak-Poli et al. 2011a). According to Lee et al. (2012) pedometer is a wearable devise which shows the number of steps covered per day along the display of the heart rate and pulse rate in real time settings. Lee et al. (2012) are of the opinion that this instant display of the calorie burnt, the steps covered, or the calories burnt act as a source of self-motivation. This self-motivation under the workplace settings help the employees to stay physically active and this helps in reducing the overall sitting. All these factors count for increasing the overall health benefits. However, the use pedometer towards the promotion of the physical activity does not generate uniform results across the employees. The increase in the level of physical activity under the use of pedometer under the workplace settings is also guided by the level of self-motivation, awareness in the domain of health, tertiary education about the health and follow of the nutritional diet and healthy diet (Freak-Poli et al. 2011b).

Linking with objective 2: To determine whether wearable technology device intervention will improve in cardio-metabolic biomarker in office worker?

The study conducted by Chan, Ryan and Tudor-Locke (2004) increase the overall physical activity per day as counted by the baseline steps is not associated with the change in the blood pressure. Chan, Ryan and Tudor-Locke (2004) highlighted that longer duration of observation, more than 4-month of follow-up is required to be undertaken in order to detect the amount of change in blood pressure in response to physical activity. Thus the direct relation of cardio-metabolic biomarker and use of wireless wearable technology was not directly established. However, the study conducted by Freak-Poli et al. (2011b) highlighted that use of pedometer helps to increase the overall physical activity among the full-time employed personnel in Australia. This increase in the physical activity helps in reducing the overall waist circumference. This waist circumference is denoted as important modifier or the cardio-metabolic risk factor. However, the systematic review and meta-analysis conducted by Ashwell, Gunn and Gibson (2012) highlighted that weight-to-height ratio is a better screening tool in comparison waist circumference and BMI in order to measure the cardio-metabolic risk factors. Freak-Poli et al. (2011a) conducted a quantitative study in order to examine the effect of pedometer-based workplace health program over the cardiovascular and diabetes risk profile. The analysis before and after (4 months) of the follow-up study was collected by the trained professionals. The main mode of data collection was done through anthropometric data and biomedical. The biomedical data measurements include fasting blood glucose done through veni-puncture and the subsequent data has been independent collected by a pathology company has assessed the same. The self-reported internet questionnaire was used to collect the demographic information. The analysis of the results showed improvements in the domains of meeting the guidelines of the physical activity under the use of wearable pedometer workplace based program. These improvements of the physical activity has been found to improve the waist circumference, blood pressure, with a decrease in sitting time along with an increase in the intake of fruits and vegetables. These health-benefits was reflected among adult men and women of all the ages. However, level of fasting cholesterol and fasting triglycerides have been found to increase. Although significant change was observed for individual risk factors, no significant change was observed in the domain of composite Cardio-vascular disease (CVD) risk and diabetes risk prediction scores. Freak-Poli et al. 2014 conducted a study in order to evaluate the four-month long pedometer intervention under workplace health promotion program in order to improve the biomedical risk factor along with the improvement of the mental health and well-being. In order to measure the bio-medical risk factor, Freak-Poli et al. (2014) took into consideration several factors like the demographic factor like the age, gender, house-hold status, marital status and occupation. The behavioural measures which were taken into consideration for the measurement of the biomedical risk factor include smoking of tobacco, consumption of alcohol, overall eating behaviour, the tenacity of physical activity and sedentary behaviour. The physical measurements which were recorded include the blood pressure, waist circumference and the weight. Freak-Poli et al. (2014) also studied the mental health state through the analysis of self-reported WHO-Five Well-being index. The analysis of the parameters highlighted that increase in the level of physical activity under the action of wearable technology devise helps in improving the bio-medical risk factors of an individual under workplace based interventions. These findings do not provide a direct relevance of how the use of wearable devise like pedometer based activity helps in improving the cardio-metabolic biomarker of health. However, the relation of the improvement in the physical factor has direct relation towards the cardio-metabolic risk factor have been highlighted under several studies. Abed et al. (2013) conducted a single-blinded randomized control trial in order to study whether reduction in weight helps in the effective management of the cardio-metabolic risk factor. The analysis of the study highlighted that the reduction in weight among the obese individual helps in reducing the overall threat of developing arterial fibrillation or severity of developing cardio-metabolic complications. Hence, Abed et al. (2013) concluded that reduction in the weight of the individuals have significance towards reducing the cardio-metabolic risk factor. In relation to this, it can be said that in the study conducted by Freak-Poli et al. (2014), showed that use of pedometer-based physical activity interventions among the workplace settings helps in the reduction of weight along with a decrease in the waist circumference. This decrease in the weight in turn is associated with the reduction in the cardio metabolic risk factor. According to Inzucchi et al. (2015), diabetes especially type 2 diabetes is regarded as an important modulating factor behind the development of the cardio-vascular diseases. Inzucchi et al. (2015) stated that prolong effect of the type-2 diabetes or untreated type-2 diabetes along with unhealthy life style and high level of blood glucose increases the chances of developing marco-vascular and micro-vascular complications of diabetes. The development of the macro and micro-vascular complication of diabetes is associated threats of developing cardio-vascular risk factor. Inzucchi et al. (2015) stated that the development of the macro and micro-vascular complications of type-2 diabetes is mainly guided by the deposition of the extra amount of cholesterol in the arteries, which carriers blood towards the heart. Increase in the cholesterol deposition over the arteries leads to narrowing of the arteries which hampers the flow of the blood. This obstruction in the flow of the blood through the arteries increase the blood pressure and this increases the vulnerability of developing cardio-vascular accident. Thus it can be said the reduction in the threats or severity of developing diabetes is associated with the overall improvement of the cardio-metabolic risk factor. The eight month long post-program follow up study conducted by Freak?Poli et al. (2013), mainly aimed towards the study the change in the risk factor for the development of chronic disease among the workplace place health promotion program conducted over the use of pedometer. The study was mainly conducted centring on type 2 Diabetes as the chronic disease. The change in the risk-factor of development of chronic disease was observed from the baseline to 12 months long intervention period. The measures which were taken include the anthropometric measurements, biomedical measurements and a list of self-reported questionnaire in order to study the state of health from personal point of view. Under the self-reported improvements, the participants highlighted increase in the intake of vegetables and fruits along with the decrease in the tendency of consuming alcohol and tobacco. The participants also reported that the while using the pedometer, there is decrease in the overall sitting-time as influence by a motivation to increase the physical activity. The self-reported blood pressure was also decrease, however, no change was observed in the wait circumference and level of blood cholesterol and blood triglycerides. However, these improvements in the lifestyle under the action of the pedometer based physical activity promotion helps to decrease the overall threats of developing cardio-metabolic risk factor and thereby helping to reduce the vulnerability of developing chronic disease like type2 diabetes.

Thus in relation to objective 2 it can be said that there is a mixed review regarding how wearable technology devise interventions help in the improvement of the cardio-metabolic biomarker among the office workers. This is because the majority of the studies, which are conducted, with a follow-up period of 4 months highlighted that overall change in the level of physical activity is not directly associated with the change in the cardio-metabolic risk factor (Freak?Poli et al. 2011a). However, the studies, which are conducted with a longer follow-up period for about 8-month or 12 months highlighted that under the influence of the wearable technology, the level of physical activity among the office employees increased. This increase in the level of physical activity helps to reduce weight and waist circumference. This reduction in the body weight along with waist circumference also helps to promote inclination towards the healthy lifestyle factors like tobacco smoking and alcohol consumption (Freak?Poli et al. 20140. These healthy lifestyles, with decrease in the sitting time among the office workers and decrease in the body weight and waist circumference helped to decrease the threat of developing chronic diseases like the type-2 diabetes. This reduction in the threat of developing type 2 diabetes helps to improve the cardio-metabolic biomarker like the blood pressure level, blood cholesterol and body mass index. However, Freak?Poli et al. (2013) highlighted that increased in the level of physical activity under the application of wearable devises like the pedometer under office based health promotion program among the employees who lead a sedentary life has no significant contribution towards the triglycerides level and the level of blood cholesterol. Further studies in this domain are required to be elucidated or studied thoroughly in order to provide a detailed comment in this domain.

Linking with objective 3: To determine whether wearable technology device intervention will be helpful in dealing with mental and other physical issues faced by the workers at the work place?  

Participants who recorded their experience after completion of the health program claimed significant improvement in dealing with mental issues. In fact in a study conducted on 177 participants who were given pedometer to keep track of physical exertion reported significant improvement in dealing mental issues. All of these participants used pedometer to check the estimated distances travelled by them by feet along with number of steps taken. Almost 83% of the participants acknowledged huge improvement in mental stress in the form of reduction of mental dress due to increase amount of distance covered by foot (Case et. al. 2015). The participants have reported that participation in physical activities including covering distance by foot have reduced the risk of diabetes in the participants. With 91.4% of the participants reported huge reduction in risk of diabetes in the participants (Mansi et. al. 2015). The employees and workers participated in the physical activities by using pedometer have all observed increase in appetite. Thus, fruit intake have increased significantly of the participants due as they have covered distance by using foot (Vallance et. al. 2016). Almost 92% of the participants have reported increase in fruit intake. The sitting time of employees in a place or cabin has reduced significantly due to the physical activities. Each step taken by the participants have resulted in reduction of sitting time. With each step of participant accounted for with help of pedometer, it was possible to assess the impact of such physical activities on the health of the participants (Mosalman Haghighi, Mavros, and Fiatarone Singh, 2018). The level of blood sugar has reduced significantly in the participants subsequent to participation in physical activities. Use of pedometer keep track of distance cover by foot and the steps taken. Thus, the number of steps taken and distance covered by a person can be tracked (Mendoza et. al. 2015).  The risk of diabetes, mental stress, high pressure, high cholesterol level and other mental health related issues have been found to be common occurrence in office goers. The participation by office stuff in pedometer based physical activities has provided important information that confirms the huge benefit of physical activities in improving the physical and mental health of employees and workers working in the office and factories  

The main strength of this systematic review is, it covered six papers which specifically studied the effect of pedometer as a wearable devise over the office employees who mainly lead a sedentary life. All the papers, which were selected for the review has a standard sample size. However, the review it suffers from poor sample size. According to Finkelstein et al. (2015) sample size below 10 in case of systematic review and meta-analysis is not comprehensive to provide a valid yet significant outcome. Other limitations mainly arise in the selection of the paper. The majority of the paper did not have a control group. According to Finkelstein et al. (2015), lack of control group might result in the generation of biased outcome as there are no scope of comparison with the placebo. The only comparison that was done was between the baseline data. Moreover, the most of the outcomes was self-reported. Proper assessment of the outcome through generation of the blinded trail in the study might have been helpful in eliminating the chance of encountering reviewer bias. The selected set of papers for the review mainly selected the focus group of the study from the group of employees who self-volunteered for the study. Finkelstein et al. (2015) argued that this self-volunteered group of people and themselves motivated towards leading a healthy lifestyle. This self-motivation can act as a driving force behind the increase in the tendency of physical activity and this can subsides the effect or the influence of pedometer over physical activity.

Critical appraisal table provided below will put some light on the various aspects of the research and findings of different workplace health programs:

Freak?Poli et. al. 2013. Eight?month postprogram completion: Change in risk factors for chronic disease amongst participants in a 4?month pedometer?based workplace health program. 

A clearly focussed issue addressed or not.	Long term health improvement such as diabetes and cardiovascular complications subsequent to the participation in the pedometer based physical activities has been documented in the study. Thus counting the steps taken by the participants by using pedometer was the main focus of the study and it was directed towards that specifically.
Cohort recruited.	In 2008 those who participated in GCCVR event were considered for the study. The organization took the responsibility of conducting the study using pedometer.
Exposure measured accurately or not.	With compulsory use of pedometer for all the participants in the workplace for a duration of 4 months there was no bias in measurement. The measurement truly reflects the actual outcome which the researchers wanted.
Outcome accurately measured or not.	Collected information even after 8 months from completion of the study to ensure there is no bias in measuring outcome.    Use of objective measurements were used to measure the impact of the program on the health of the participants.
All confounding factors considered or not.	Age, gender, educational qualification, household status, occupation, personal habits, drugs problem, eating behaviour, physical activity, food habits, lifestyle, sugar level, blood pressure, and cardiovascular disease were considered in the study by the researchers.
Confounding factors considered in design or not.	Health benefits of bio medication were not properly considered by the researchers. No sensitivity analysis was conducted to make adjustment for the compounding factors is a weakness of the study (Sallis et. al. 2016).
Follow up subject of the study.	With only 315 completed the whole program out of 734 participants the follow up was not fully complete. It’s almost 50% of the population which was not subjected to the final assessment thus, follow up is not comprehensive.
Follow up subject long enough or not.	Participants were recorded health benefits even after 12 months hence there was complete and long follow up of subjects.
Results of the study.	Improvement in food intake, self-measurement of blood pressure, setting of time in pedometer by self after 12 months were successfully observed among 76% of participants. Improvement in waist circumference, blood pressure among the participants who completed the whole program was extra-ordinary (Fukushima et. al. 2016).
Precision of results	With 95% confidence interval the probability of obtaining similar results is 0.95 thus, repetition of the study with different people is expected to provide similar result to the extent of 95%.
Acceptability of results.	It is difficult to comment on whether to belief in the outcome of the study completely. There is no doubt about the effectiveness of pedometer based physical activities on improvement of diabetes, waist circumference, food intake and other aspects of health but the absence of confirmation from control groups restricts from fully believing the results.
Application of results to local population.	Results are fully applicable on local population as the study involved employees who participated in the Global Corporate Challenge from local population.
Results of the study and evidence.	Findings from other study also confirm the findings of this particular study.
Implication of the study	Enhancement and improvement in food intake, intake of vegetables, sitting time, cardiovascular diseases and other complications in the participants (Case et. al. 2015).

Freak-Poli et. al. 2014 Change in well-being amongst participants in a four-month pedometer-based workplace health program. 

CASP items	Observations
A clearly focussed issue addressed or not.	A clearly focussed article on compliance of health programs to prevent chronic diseases. The contribution of sedentary lifestyle on increasing the risk of different diseases including blood sugar, obesity and other chronic diseases.
Cohort recruited.	The cohort was recruited from the employees who participated Global Corporate Challenge with the objective to encourage the employees at the workplace to undertake physical activities to improve physical and mental health.
Exposure measured accurately or not.	Each participant was given a daily target of 10000 steps as per the recommendations of WHO and all participants were provided with daily encouragement emails to motivate them to achieve their targets without any bias.     However, the participants were not classified into different exposure groups as all were measured with same yardsticks.
Outcome accurately measured or not.	The psychological measures were not considered in counting the daily steps of the participants over the 4 month period to measure the impact of physical activities on the health (Compernolle et. al. 2015).
All confounding factors considered or not.	Age, gender, marital status, personal habits, tertiary education and personal motivation of the participants were considered.
Confounding factors considered in design or not.	Workplace characteristics, absences of participants, team assessment and other such confounding factors were not considered in designing. Thus, regression analysis has not considered these important confounding factors.
Follow up subject of the study.	Only 55% of the participants, i.e. 407 employees out of 734 employees of the study complied with the WHO recommendations of 10000 steps for the entire duration of 12 months. Hence, follow up of the study was not complete (Mansi et. al. 2015).
Follow up subject long enough or not.	Since the follow up period extended to 12 months after completion of the program hence, the follow up subject was long enough.
Results of the study.	Positive wellbeing was noticed in 75% of the participants with mean: 60 ± 19 SD WHO-5 units. (+3.5 units, p < 0.001) is the wellbeing observed immediately after implementation of the program. Participants experienced wellbeing after completion of 8 months in the program (p < 0.001).
Precision of results	With 95% confidence interval the results are expected to be true to the extent of 0.95.
Acceptability of results.	Clinical improvements were definitely experienced among the participants but it is difficult to state that such clinical benefits were mainly due to the participation in the physical activities.
Application of results to local population.	The findings from the study is applicable on the local population as the employees of GCC are mainly local on whom the study was conducted (Vallance et. al. 2016).
Results of the study and evidence.	The health improvements experienced from the study is in line with the findings from other such health studies.
Implication of the study	It is beneficial for the participants to participate in pedometer based physical activities in the work place.

Freak-Poli, et. al. 2011 Impact of a pedometer-based workplace health program on cardiovascular and diabetes risk profile

CASP items	Observations
A clearly focussed issue addressed or not.	Yes, the study was completely focussed on assessing the impact of four month pedometer based physical activities on the diabetes and cardiovascular diseases.
Cohort recruited.	Yes with specific preference to the employees participating in Global Corporate Challenge® 762 participants were selected for the purpose of the study (Chan, Ryan and Tudor-Locke, 2004).
Exposure measured accurately or not.	Yes, 704 participants completed baseline anthropometric measurements with 80% of the participants returning and recording the effects of the study. The exposure was accurately measured.
Outcome accurately measured or not.	Yes, the data was collected after completion of each week. The data collected were analysed to observe the impact of pedometer based physical activities on diabetes and cardiovascular diseases without any bias.
All confounding factors considered or not.	Yes, all the confounding factors such as the age of the participants, tobacco use and other personal habits were identified in the study (Mosalman Haghighi, Mavros, and Fiatarone Singh, 2018).
Confounding factors considered in design or not.	Yes, the authors have considered all the above factors in the study to assess the actual impact of physical activities using pedometer on diabetes and cardiovascular disease.
Follow up subject of the study.	No, the follow up was not complete enough as only 68% of the participants completed all four months measurements (Finkelstein et al., 2015).
Follow up subject long enough or not.	The 4 month period is significantly less and thus, the follow up of subjects was not long enough.
Results of the study.	With 79% return of 762 participants in the program due to the major improvement in the following lines: blood pressure (systolic: −1.8(−3.1, −.05) mmHg; diastolic: −1.8(−2.4, −1.3) mmHg). Cholesterol levels (0.3(0.1, 0.4) mmol/L) and triglyceride levels (0.1(0.0, 0.1) mmol/L).
Precision of results	The mean values of the program supported by 95% confidence interval. However, the sample size bigger than the one considered in this program would have provided better results (Mendoza et. al. 2015).
Acceptability of results.	Difficult to say as there was motivational program to recruit workplace employees thus, the results were bound to be influenced due to the bias in recruiting particular employees instead of employees in general. The fact that the participants have different problems also make the results susceptible from generalization.
Application of results to local population.	Yes as the participants were mainly from the local workplaces.
Results of the study and evidence.	The findings of the other study is very much consistent with the findings of this particular study. Hence, yes the results very much fit with other evidences (Freak-Poli et al., 2011).
Implication of the study	Avoiding employees from attracting chronic diseases by pedometer based physical activities is the primary objective behind the study.

Chan, C.B., Ryan, D.A. and Tudor-Locke, C., 2004. Health benefits of a pedometer-based physical activity intervention in sedentary workers. 

CASP items	Observations
A clearly focussed issue addressed or not.	The issue is clearly focussed on specific impact on health indices such as waist circumference, body mass index, heart rate, blood pressure and other indices.
Cohort recruited.	Employees from different workplaces were classified under mild to moderate sedentary working condition. However, no specific definition of sedentary working condition was given.
Exposure measured accurately or not.	Prince Edward Island-First Step Program has been used to measure the exposure by minimizing bias.
Outcome accurately measured or not.	The results of the study was measured from the data collected from pedometer which were attached to the participants. Thus outcome was accurately measured without any bias.
All confounding factors considered or not.	Confounding factors such as body mass index and the eating habits of the participants were not considered.
Confounding factors considered in design or not.	No since BMI and diet were not considered as confounding factors the design and method used in study was not inclusive of all confounding factors.
Follow up subject of the study.	Only 59% of the participants have completed the program hence, the follow up of the subject was not fully complete.
Follow up subject long enough or not.	With 12 weeks intervention plan the follow up subject was quite long enough for the purpose of the study.
Results of the study.	From 7,029 F 3,100 steps prior to the program to 10,480 F 3,224 steps after completion of the program shows that use of pedometer helped in increasing physical activities of the workers in the workplace.
Precision of results	The precision of results was questionable with mean of the results greater than 10.
Acceptability of results.	Increase in number of steps per day subsequent to the health program is very clear. With p value and >95% confidence interval the results of the study is acceptable.
Application of results to local population.	With local employees as the participants in the work program the applicability of results on local population is not questionable.
Results of the study and evidence.	The available evidence from other study are not contradictory with the findings of the study.
Implication of the study	Reduction in chronic or non-communicable diseases to the employees with increased physical activities due to the pedometer based health program.

Freak-Poli et. al. 2011. Participant characteristics associated with greater reductions in waist circumference during a four-month, pedometer-based, workplace health program. 

CASP items	Observations
A clearly focussed issue addressed or not.	Yes with the study aiming to find out the impact of four month pedometer based physical activities on waist circumference of the participants.
Cohort recruited.	762 adults were recruited under the sedentary occupations for four-month based workplace intervention program with the objective of promotion of physical health. The risk of biased outcome cannot be ignored though as the volunteers were also recruited who have self-motivation (Freak-Poli et al., 2014).
Exposure measured accurately or not.	The demographic data were properly taken into account without any bias thus, the exposure was accurately measured to evaluate the effects of pedometer based activity on physical activities.
Outcome accurately measured or not.	All steps have been taken to reduce the bias in the study to accurately measure the outcome. The age, gender and lifestyle were considered since the Body Mass Index (BMI) is effected due to these factors. Hence, outcome was accurately measured to minimise bias.
All confounding factors considered or not.	Age, gender, lifestyle and tenure of working all confounding factors have been mentioned.
Confounding factors considered in design or not.	Yes, all confounding factors as mentioned above have been considered in design and analysis.
Follow up subject of the study.	The four month long program was not complied by many of the participants hence, the follow up of subjects was not complete (Freak-Poli et al., 2011).
Follow up subject long enough or not.	No, the follow up subjects was not long enough as 4 months period is not long enough to evaluate the impact of physical activities on waist circumference.
Results of the study.	Multivariable linear and logistic regression were used to measure the results of the four month long program. As per the results the participants who have tertiary education showed significantly higher reduction in waist circumference also the youth reported higher reduction in waist with extra motivation to look good.
Precision of results	Multivariable regression analysis used for calculation thus, the results are quite precise.
Acceptability of results.	Yes, with appropriate use of regression analysis the risk of wrong observation is significantly less (Olsho et al., 2016).
Application of results to local population.	The results are equally applicable for local population as the participants are all local people.
Results of the study and evidence.	The evidence from the study of Freak-Poli et al. (2014) shows reduction in weight loss thus, the results of the study fit with available evidence from other studies.
Implication of the study	With proper tertiary education the weight loss and reduction in waist circumference can be accelerated.

Finkelstein et. al. 2015 Design and baseline characteristics of participants in the TRial of Economic Incentives to Promote Physical Activity (TRIPPA).  

CASP items	Observations
A clearly focussed issue addressed or not.	Quantification of effectiveness of using wireless pedometer on physical activities of the participants of the study was the main focus of this study.
Cohort recruited.	The participants selected for the purpose of the study were classified into incentive and non-incentive groups thus, cohort was recruited effectively for the purpose of the study.
Exposure measured accurately or not.	The measurement methodology was used properly to ensure that the findings are proper.
Outcome accurately measured or not.	The regression analysis helped in measuring outcome of the study accurately.
All confounding factors considered or not.	The motivational effects, the health issues, the personal habits and other such confounding factors were not considered in the study.
Confounding factors considered in design or not.	Most of the confounding factors not being considered in the design of the study.
Follow up subject of the study.	Again with significant proportion of the total population failed to complete the health program the follow up subject was not complete enough.
Follow up subject long enough or not.	With 12 weeks intervention period the follow up subject was certainly long enough.
Results of the study.	Huge improvement on the waist circumference, food intake, blood sugar level, and increase in physical activities have been experienced among the participants subsequent to completion of the physical activities.
Precision of results	Confidence interval of 95% suggests that 95 out of 100 times the results of this study is applicable to appropriate cases.
Acceptability of results.	With p value and >95% confidence interval the results of the study is acceptable.
Application of results to local population.	The findings of the study is applicable on the local population.
Results of the study and evidence.	All the evidence collected from other studies including the one conducted by Freak-Poli et al. 2014 are all complementary to the findings in the specific results.
Implication of the study	Incentives have always been an effective strategy to change behaviors.Number of health benefits expected to increase significantly in the future.

Conclusion

Thus from the analysis of the above literature review, it can be concluded that the use of pedometer under the workplace settings help to decrease the sitting time of the employees through increasing the overall physical activity of the individuals. This increase in the level of physical activity is mainly attributed through the increase in the level of self-motivation for the conduction of the physical activity as highlighted from the change in parameters of pedometer like the amount of calories burnt, the distance covered and the number of steps counted. The increase in the level of physical activity is reflected in the change in the waist circumference, decrease in the weight, decrease in the blood pressure along with improvement in the overall physical and the mental health status. The analysis of the articles also highlighted that the people who are self-motivated and are aware about the importance of the weight management in relation to the healthy lifestyle are more prone to indulge in physical activity under the action of the pedometer. However, different in BMI of the individuals has no significant influence over the change in the physical activity. In relation to objective two it can be stated that more analysis are required to be undertaken in order to analyze how increase in the physical activity under the influence of pedometer is helpful in improving the cardio-metabolic risk factors. This reason behind this, change in the waist circumference or change in the body weight is not direct indicators of the reduction of the cardio-metabolic risk factor. Moreover, the analysis of the results highlighted that there is no significant change in the level of blood cholesterol and blood triglycerides under the influence of the increase in the physical activity at the baseline level among the pedometer users. However, the use of pedometer and decrease in the level of physical activity is also found to decrease the vulnerability of developing type 2 diabetes mellitus, one of the common chronic diseases. However, proper analysis are required to be undertaken in order to analyse how the use of pedometer and increase in the level of physical activity among the offices goes who lead a sedentary life is helpful in improving the cardio-metabolic risk factor.

Physical inactivity is an important contributor to non-communicable diseases. Promotion of physical activity among the physically active and physically inactive individuals is different (Bauman et al. 2012). The influence of physical activity under the influence of the pedometer is mainly driven by age, gender, BMI, health status, motivation and self-efficacy. Thus in order to promote proper health and well-being among the individuals who are not physically active, the use of pedometer under the office-based set-up is not comprehensive. Proper promotion of self-motivation under the action of the health-related awareness and tertiary education is important (Bauman et al. 2012). Moreover, it is also the duty of the employer to arrange proper health-awareness in the diet plan and healthy lifestyle in order to increase the overall physical activity under the influence of the pedometer. Such in future the research must be designed in such a way that it aims of elucidate an individual who are following a healthy lifestyle is cable of entry into regular physical activity under the workplace settings with the help of pedometer use. Moreover, the efforts must also be taken to measure the vital parameter apart from self-reported details to take into account the effect of physical activity over the change or improvement in the cardio-metabolic factor of the body (Bauman et al. 2012). 

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