A Comparative Effectiveness Trial of Three Walking Self-monitoring Strategies

Walking programs improve health outcomes in adults at risk for cardiovascular disease (CVD), and self-monitoring strategies can improve adherence to such programs. The objective of this study was to determine whether a 6-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 CVD. This was a multisite, randomized controlled trial of 255 male veterans who were ambulatory, insufficiently active, and with body mass index (BMI) ≥28, and who reported CVD risk factors ≥1 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 6 months (kg), and the secondary outcomes were change in accelerometer-measured physical activity (min) and change in health-related quality of life at 6 months. The 255 participants had a mean age of 56.3 yr (SD = 10.0), BMI = 36.3 (SD = 5.3), with a mean value of 5.2 (SD = 2.3) medical comorbidities. Dropouts were distributed evenly across the three groups, and 72% of participants completed the program. At 6 months, participants in the Web-enhanced pedometer arm lost significantly more weight (−1.9 kg, 95% CI, −2.7 to −1.1) than those in the time-based group (−0.7 kg, 95% CI, −1.5 to 0.0; P = 0.04) and simple pedometer group (−0.6 kg, 95% CI, −1.4 to 0.2; P = 0.02). In conclusion, Internet-enhanced pedometers result in greater weight loss in veterans than in walking programs using time-based walking goals or simple pedometers.