Daily Steps During Nutritional Lifestyle Modification Programs for Obesity Management: A Systematic Review and Meta-Analysis

Background and objectives: Increasing daily steps during weight management programs remains one of the most common recommendations; however, why, when and how many is still unclear. To clarify this, we aim to conduct a systematic review and meta-analysis. Methods: The study was conducted in adherence to the PRISMA guidelines on randomized controlled trials (RCTs), that included weight loss (WL) interventions based on lifestyle modification programs (LSMs), compared to “as usual care” considered as controls, to whom both daily steps and WL% were reported or retrievable at baseline (Time 0), end of WL phase (Time 1, WL1%), and weight maintenance phase (Time 2, WL2%), for both arms. Results: A total of 18 RCTs met the inclusion criteria and were included in the systematic review. Of those, 14 underwent meta-analysis and five main findings were revealed: (i) at baseline (Time 0), no significant difference was observed in mean daily steps between the LSM and controls (7280 vs. 7180, p = 0.336), reflecting a similar lifestyle between arms; (ii) at Time 1, the mean duration was 7.88 months (range = 3–12 months), and the LSM arm showed a significant increase in daily steps with respect to baseline (8454 vs. 7486 steps, p = 0.017) and a significant WL (WL1% = 4.39%, p < 0.001); (iii) at Time 2, the mean duration was 10.27 months (range = 3–24 months), and the LSM arm maintained the level of daily steps achieved by the end of WL phase (8241 vs. 8454 steps, p > 0.05), and also a significant WL% (WL2% = 3.28%, p = 0.001); (iv) the control arm showed no significant changes in daily steps and weight status at all times of assessment; and (v) the meta-regression showed in the LSM arm a positive relationship between daily steps at Time 1 (β = 1.33, p = 0.03) and Time 2 (β = 1.10, p = 0.02), both with WL2%. Conclusions: Our preliminary study results support that during LSM programs, patients should be encouraged to increase their daily steps during the WL phase, targeting approximately 8500 steps/day and maintaining these levels during the maintenance phase, since this strategy appears to be a useful behavioral approach associated with maintaining significant WL in the long term.