Project Overview +

The goal of this project is to expand the web-based Stepping Up to Health intervention to more individuals. The original intervention used enhanced pedometers and email-based tailored feedback to promote physical activity in people with type 2 diabetes. Expanding the Reach extends the tailored messages to promote physical activity to sedentary adults who are at risk for developing cancer, heart disease or diabetes, along with continuing to provide tailored messages for individuals with type 2 diabetes.

Aims +

Aim 1. Expand the target population of the original Stepping Up To Health to include individuals who do not have type 2 diabetes, with a particular focus on those who are overweight and sedentary and who are thus at increased risk of developing cancer, diabetes, and heart disease.

Aim 2. Pilot and user-test the modified and expanded Stepping Up to Health intervention in ten sedentary and overweight or obese participants who are at risk for developing cancer, diabetes, or heart disease.

Aim 3. Write and submit an RO1 proposal to conduct a larger randomized controlled study of this intervention among sedentary individuals at risk for developing cancer.

Participants +

Adults age 18 or older who are overweight or obese (BMI > 25), sedentary (exercise at a moderate intensity < 150 minutes per week), and who are at risk for developing cancer, heart disease or diabetes, or who have type 2 diabetes or coronary artery disease. Participants are recruited using community flyers, local newspapers, clinic-based recruitment and listing on the University of Michigan Engage web site (for research volunteers).

Intervention +

Participants wear a blinded enhanced pedometer that measures 7 days of baseline step-counts. Baseline step counts are uploaded to the computer by a research coordinator, who helps the participant create an account on the Stepping Up to Health website. Participants complete the baseline survey online, un-blind their pedometers, and receive their initial set of graphs and tailored messages on their personalized Stepping Up website.

For six weeks, participants receive weekly emails encouraging them to visit the website, read newly added tailored content, and upload their pedometer data. Graphs, goals, and text are updated weekly before the site reminder email messages are sent. A new tailored walking tip is added daily; allowing the site to have some new information anytime a participant decides to visit the site.

Findings +

People with multiple co-morbidities at high risk for adverse cardiovascular events can safely participate in an Internet-mediated home-based walking program.

It is feasible and acceptable to participants to tailor motivational messages for an Internet-mediated home-based walking program on multiple co-morbidities using an algorithm that takes into account severity of the disease as perceived by participants.

Conclusion +

Lifestyle step count goals (goals targeting the total number of steps accumulated throughout the day) and structured step count goals (goals that only count bouts of walking that meet minimum duration and intensity criteria) both result in increased aerobic walking, but participants were significantly more satisfied with a program using lifestyle goals.