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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1051 — Outcomes from the Veterans Walk for Health Trial: A Randomized Controlled Trial Comparing Three Walking Strategies for Weight Loss

Richardson CR (Ann Arbor HSR&D Center for Clinical Management Research), Goodrich DE (Ann Arbor HSR&D Center for Clinical Management Research), Holleman RG (Ann Arbor HSR&D Center for Clinical Management Research), Larkin AR (Ann Arbor HSR&D Center for Clinical Management Research), Ronis DL (Ann Arbor HSR&D Center for Clinical Management Research), Damschroder LJ (Ann Arbor HSR&D Center for Clinical Management Research), Lowery JC (Ann Arbor HSR&D Center for Clinical Management Research)

Objectives:
Walking is a safe physical activity for adults at risk for cardiovascular disease (CVD) that can be combined with dietary changes to enhance weight loss for risk factor reduction. However, it is unclear whether different strategies to self-monitor unsupervised walking increase physical activity levels and weight loss. The purpose of this study was to compare the effects of three different self-monitoring strategies in adults with or at risk for CVD.

Methods:
The Veterans Walk for Health study was a multi-site, randomized controlled trial conducted from August 2005 to May 2007 of 255 male veterans who were ambulatory but sedentary, with BMI > = 28 and >= 1 CVD risk factors. The primary outcome was weight loss at six months. All participants attended five nutritional counseling visits with a dietitian. They were also randomized to one of three self-monitoring strategies aimed at increasing physical activity: 1) time-based walking goals and activity logs; 2) simple pedometers (Digiwalker) with daily step-count goals and manual logging; and 3) web-enhanced uploadable pedometers (SportBrain) with online tracking, goal setting, and feedback reports. A multivariate linear regression model adjusted for clustering by site was used for statistical testing.

Results:
The 255 participants had a mean age of 56.3 years (SD = 10.0), mean BMI 36.2 (SD = 5.0) and a mean of 5.2 (SD = 2.3) medical co-morbidities. Forty-three percent had diabetes and 30% had known CVD. A total of 183 participants completed the intervention for a dropout rate of 28%. Dropouts were distributed evenly across the three groups. At six months, participants in the SportBrain group lost significantly more weight (-4.6 lbs, SD = 14.0) than those in the time-based group (-1.9 lbs, SD = 12.0, p = 0.004), and Digiwalker group (-1.3 lbs, SD = 11.1, p = 0.039).

Implications:
Combining web-enhanced pedometers with a traditional nutritional weight-loss program results in greater weight loss in sedentary high-risk veterans than walking programs that use time-based walking goals or simple pedometers that require manual logging.

Impacts:
Web-enhanced pedometers increase weight loss and provide objective feedback that can enhance traditional face-to-face counseling for lifestyle modification.


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