Alive! (A Lifestyle Intervention Via Email): An effective tailored intervention for diet and physical activity

Background. Cost-effective methods to improve diet and physical activity are needed. E-mailed interventions can reach large populations at little cost, and can apply behavior-change principles. Methods. We developed and tested in a randomized controlled trial an automated intervention program (Alive!) commercially available to worksites or groups, designed to move people toward more healthful diet and physical activity (PA). Baseline questionnaires provide instant feedback on diet and PA, provide individual relevance, and serve as a basis for tailoring the four-month intervention. Alive! includes weekly commitment to small achievable behaviors tailored to the individual, weekly information on the relation of diet/PA to health, interactive simulations, and social support through a discussion board and optional enrollment of family members. Participants choose to work on PA, fruits and vegetables (FV), or harmful fats and sugar. Baseline questionnaires were repeated after the intervention. Employees of Northern California Kaiser Permanente (n=797, mean age 44, 74% female) were recruited by email in three weeks, and randomized to Intervention or Control groups. Results. In Intent-to-treat analysis that assumed no change in non-responders, the intervention group had significant increases in FV (p=0.01) and decreases in saturated fat (p=0.008) and trans fat (p=0.045). Total and moderate-intensity activity and minutes/week of walking increased (p<0.001). Among responders to the follow-up, saturated fat decreased by 4.05g and trans by 0.77g, and FV increased by 0.57 cup-equivalents. Significant changes were also seen in the SF-8 Physical Score. Conclusions: Alive! is an effective program for promoting healthful changes in diet and physical activity.