A Comparative Effectiveness Trial of Three Walking Self-monitoring Strategies

PURPOSE Walking programs improve health outcomes in adults at risk for cardiovascular disease and self-monitoring strategies can improve adherence to such programs. The objective of this study was to determine if a six-month internet-based walking program using web-enhanced pedometers results in more weight loss than walking programs based on time or simple pedometer-step count goals in adults with or at risk for cardiovascular disease (CVD). METHODS This was a multi-site, randomized controlled trial of 255 male Veterans who were ambulatory, insufficiently active, BMI ≥ 28, and who reported 1 ≥ CVD risk factors. Participants were randomized to one of three self-monitoring strategies to increase walking: (1) time-based walking goals; (2) simple pedometer-based walking goals; and (3) web-enhanced pedometer feedback goals with Internet-mediated feedback. All participants also attended five individual weight loss sessions with a dietitian. The main outcome measure was change in weight at six months (kg) and secondary outcomes were change in accelerometer-measured physical activity (min) and change in health-related quality of life at six months. RESULTS The 255 participants had a mean age of 56.3 years (SD = 10.0), BMI=36.3 (SD = 5.3) with a mean of 5.2 (SD = 2.3) medical comorbidities. Dropouts were distributed evenly across the three groups and 72% of participants completed the program. At six months, participants in the web-enhanced pedometer arm lost significantly more weight (-1.9 kg, 95% CI=-2.7, -1.1) than those in the time-based group (-0.7 kg, 95% CI=-1.5, 0.0; p = 0.04) and simple pedometer group (-0.6 kg, 95% CI=-1.4, 0.2; p = 0.02). CONCLUSION Internet-enhanced pedometers result in greater weight loss in Veterans than walking programs using time-based walking goals or simple pedometers.