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A randomized trial comparing structured and lifestyle goals in an internet-mediated walking program for people with type 2 diabetes

Caroline R Richardson12*, Kathleen S Mehari1, Laura G McIntyre1, Adrienne W Janney1, Laurie A Fortlage1, Ananda Sen3, Victor J Strecher4 and John D Piette25

Author Affiliations

1 Department of Family Medicine, University of Michigan Health System, Ann Arbor, MI, USA

2 HSR&D Center for Excellence, VA Health Care Medical Center, Ann Arbor, MI, USA

3 Center for Statistical Consultation and Research (CSCAR) and Department of Statistics, University of Michigan, Ann Arbor, MI, USA

4 Center for Health Communications Research, Department of Health Behavior and Health Education, University of Michigan and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA

5 Int Med-General Med, University of Michigan Health System and Michigan Diabetes Research and Training Center, Ann Arbor, MI, USA

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International Journal of Behavioral Nutrition and Physical Activity 2007, 4:59  doi:10.1186/1479-5868-4-59

Published: 16 November 2007

Abstract

Background

The majority of individuals with type 2 diabetes do not exercise regularly. Pedometer-based walking interventions can help; however, pedometer-based interventions targeting only total daily accumulated steps might not yield the same health benefits as physical activity programs specifying a minimum duration and intensity of physical activity bouts.

Methods

This pilot randomized trial compared two goal-setting strategies: 1) lifestyle goals targeting total daily accumulated step counts and 2) structured goals targeting bout steps defined as walking that lasts for 10 minutes or longer at a pace of at least 60 steps per minute. We sought to determine which goal-setting strategy was more effective at increasing bout steps. Participants were sedentary adults with type 2 diabetes. All participants: wore enhanced pedometers with embedded USB ports; uploaded detailed, time-stamped step-count data to a website called Stepping Up to Health; and received automated step-count feedback, automatically calculated goals, and tailored motivational messages throughout the six-week intervention. Only the automated goal calculations and step-count feedback differed between the two groups. The primary outcome of interest was increase in steps taken during the previously defined bouts of walking (lasting at least 10 minutes or longer at a pace of at least 60 steps per minute) between baseline and end of the intervention.

Results

Thirty-five participants were randomized and 30 (86%) completed the pilot study. Both groups significantly increased bout steps, but there was no statistically significant difference between groups. Among study completers, bout steps increased by 1921 ± 2729 steps a day. Those who received lifestyle goals were more satisfied with the intervention (p = 0.006) and wore the pedometer more often (p < 0.001) than those who received structured goals.

Conclusion

In this six-week intervention, Lifestyle Goals group participants achieved increases in bout steps comparable to the increases seen in the Structured Goals group, representing almost a mile a day of additional moderate intensity bout activity. Pedometer-based walking programs that emphasize total accumulated step counts are more acceptable to participants and are as effective at increasing moderate intensity bouts of physical activity as programs that use structured goals.

Trial registration

NCT00151021