Are All Steps Created Equal? Revisiting Pedometer Use during Pulmonary Rehabilitation for Individuals Living with Chronic Obstructive Pulmonary Disease/Reply

To the Editor: We read with great interest the study by Nolan and colleagues (1) that investigated the acute and 6-month effectiveness of pedometer-directed daily step counts as an adjunct to pulmonary rehabilitation to improve physical activity (PA) levels, exercise capacity, and health-related quality of life in individuals living with chronic obstructive pulmonary disease (COPD). [...]improving physical activity levels by increasing the step count is clinically meaningful. [...]although technologies to measure and record physical activity have progressed significantly, pedometers still represent a small, user-friendly, and cheap means of storing and providing feedback about physical activity (albeit in a one-dimensional manner). [...]as discussed in the editorial accompanying our paper (7), although the use of pedometers has been validated in COPD (including the gold-standard Yamax Digiwalker CW700 pedometer used in our trial), there is a measurement error associated with a slow walking speed, and recording the step count only becomes reliable at walking speeds above 4.0-4.8 km/h (8).