Promoting walking in veterans at high risk for cardiovascular disease: Results from the Veterans Walk for Health randomized controlled trial

Background: Starting a walking program can result in weight loss and improved risk profiles for sedentary individuals at high risk for adverse cardiovascular events. However, getting patients to start and maintain a walking program is challenging. Internet-based walking programs that use enhanced uploading pedometers and Internet-based feedback provide users with detailed feedback about their walking and reduce user burden by automating the step-count tracking process. We hypothesized that the improved self-monitoring and decreased respondent burden of an enhanced, uploading pedometer-based walking program would result in greater weight loss at six months than walking programs using time-based walking goals or simple pedometers with manual step-count logging and goal setting.

Methods: The Veterans Walk for Health study is a multi-site randomized controlled trial comparing the effects of three different home-based walking programs integrated into traditional nutritional weight-loss counseling. The primary outcome was weight loss at six months. Participants were male veterans recruited from five different VA medical centers through physicians or self-referral and were ambulatory, sedentary, BMI ≥ 28, and who reported at least one cardiovascular disease (CVD) risk factor or had known CVD. All participants attended five nutritional counseling sessions during the six-month intervention. One group was given time-based walking goals and activity logs, another group wore simple pedometers (Digiwalker) with daily step-count goals and manual logging, and the third group wore enhanced uploading pedometers (Sportbrain) with online tracking and goal setting. A multivariate linear regression model was used for statistical testing, and all analyses are adjusted for clustering by site.

Results: We randomized 255 participants with mean age of 56.3 ± 10.0 years, mean BMI 36.2 ± 5.0 and a mean of 5.2 ± 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 ± 14.1 lbs) than those in the time-based group (1.9 ± 12.1 lbs, p = 0.002) and Digiwalker group (1.3 ± 11.1 lbs, p = 0.022).

Conclusion: Incorporating Internet-mediated pedometers with automatic uploading, online tracking and tailored feedback into 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.