Comparison of two email-delivered, pedometer-based interventions to promote walking among insufficiently active women. Move to Improve: a randomized workplace trial to increase physical activity. A randomized trial of telephonic counseling plus walking for depressed diabetes patients. Growing healthy families: family use of pedometers to increase physical activity and slow the rate of obesity.
Research on the effect of email-delivered, pedometer-based interventions on walking behavior and transtheoretical model (TTM) constructs is lacking. Therefore, the purpose of this study was to compare the effectiveness of two email-delivered, pedometer-based interventions designed to increase walking and TTM construct scores among insufficiently active women. Participants were randomly assigned to one of two 6-week intervention groups. Both groups wore pedometers, submitted step logs, and received weekly email reminders. One group also received in the emails suggested strategies based on TTM for increasing physical activity. Of the 74 women who began the study, 56 (age=41.5+/-7.6 years; body mass index=31.2+/-6.6kg/m(2); 86% Caucasian) completed the International Physical Activity Questionnaire and TTM questionnaires at baseline and post-intervention. Participants in both groups combined increased weekly time spent walking (p=0.002) and their scores on TTM cognitive processes, behavioral processes, pros, and cons changed (p< or =0.001) from baseline to post-intervention. The changes in walking and TTM scores did not differ between groups (p>0.05). The results of this study indicate that email-delivered, pedometer-based interventions may impact walking and most TTM scores among insufficiently active women. Although preliminary, the findings provide additional evidence that this low-cost method of intervening may be an effective approach to combat physical inactivity in women. Workplaces are important settings for interventions to increase physical activity, but effects have been modest.
                To evaluate the efficacy of Move to Improve, a social-ecologic intervention delivered at the workplace to increase leisure-time physical activity.
                A group-randomized 12-week intervention consisting of organizational action and personal and team goal-setting was implemented in Fall 2005, with a multi-racial/ethnic sample of 1442 employees at 16 worksites of The Home Depot, Inc. Change in physical activity was analyzed in Fall 2007 using latent growth modeling and latent transition analysis.
                Participants in the intervention had greater increases in moderate and vigorous physical activity and walking compared to participants in a health education control condition. The proportion of participants that met the Healthy People 2010 recommendation for regular participation in either moderate or vigorous physical activity remained near 25% at control sites during the study but increased to 51% at intervention sites. During the last 6 weeks of the study, intervention participants exceeded 300 weekly minutes of self-reported moderate-to-vigorous physical activity and 9000 daily pedometer steps.
                The results support the feasibility and efficacy of the Move to Improve intervention and the role of goal-setting for attaining increased physical activity levels. Patients with diabetes and depression often have self-management needs that require between-visit support. This study evaluated the impact of telephone-delivered cognitive behavioral therapy (CBT) targeting patients' management of depressive symptoms, physical activity levels, and diabetes-related outcomes.
                Two hundred ninety-one patients with type 2 diabetes and significant depressive symptoms (Beck Depression Inventory scores ≥ 14) were recruited from a community-based, university-based, and Veterans Affairs health care systems. A manualized telephone CBT program was delivered weekly by nurses for 12 weeks, followed by 9 monthly booster sessions. Sessions initially focused exclusively on patients' depression management and then added a pedometer-based walking program. The primary outcome was hemoglobin A1c levels measured at 12 months. Blood pressure was a secondary outcome; levels of physical activity were determined by pedometer readings; depression, coping, and health-related quality of life were measured using standardized scales.
                Baseline A1c levels were relatively good and there was no difference in A1c at follow-up. Intervention patients experienced a 4.26 mm Hg decrease in systolic blood pressure relative to controls (P=0.05). Intervention patients had significantly greater increases in step counts (mean difference, 1131 steps/d; P=0.0002) and greater reductions in depressive symptoms (58% remitted at 12 mo vs. 39%; P=0.002). Intervention patients also experienced relative improvements in coping and health-related quality of life.
                This program of telephone-delivered CBT combined with a pedometer-based walking program did not improve A1c values, but significantly decreased patients' blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients' functioning and quality of life. We conducted a study to determine if wearing a pedometer affects weight, body mass index (BMI), or mediators of physical activity among families.
                Eighty-seven families were randomized to 1 of 3 treatments: pedometer plus education (PE), pedometer (P), or control (C). Participants in the PE and P groups wore pedometers and were encouraged to walk 10,000 steps daily for 12 weeks. PE group participants attended 6 sessions on healthy eating and exercise. Participants were surveyed about their knowledge and attitudes about healthy eating and physical activity prior to randomization, at the end of the intervention, and 9 months later. Their heights and weights were measured and BMI calculated.
                Children's BMI percentile decreased from baseline to end of intervention (-0.18%) and at 9-month follow-up (-0.08%) but did not differ by treatment. Children's BMI percentile varied by parental obesity status (average BMI percentile was 88.7% for children of obese parents and 78.5% for children of non-obese parents). Parents' weight decreased slightly by intervention's end (0.6 pounds) and at 9 months (1.2 pounds), but change was similar among groups. Attitudes about their physical activity level relative to their peers improved significantly among children and parents wearing the pedometer. Self-efficacy improved for parents wearing the pedometer. Both children and parents felt the pedometer increased their activity level, but most were unlikely to wear it beyond the intervention.
                The pedometer had little impact on the activity level, weight, or BMI of participants.
There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes.