Stepping Up To Health is an Internet-based walking program combined with an enhanced pedometer to promote walking in people with chronic diseases. This study expands the current bank of behavioral messages within the intervention to include messages for people with type 2 diabetes.

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1) To add tailored type 2 diabetes management messages to the web-based Stepping Up to Health walking intervention.

Thirty-five adults age 50 or older who have type 2 diabetes. Participants are recruited using flyers, advertisements in local newspapers, clinic-based recruitment and listing on the University of Michigan Engage web site.

Participants wear an enhanced, blinded pedometer that measures 7 days of baseline step-counts. A research coordinator helps the participant upload their baseline step data and 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.<br><br>

Participants wear the pedometer and use the web site for 6 weeks during the study. Weekly emails encourage them to read new tailored web content and upload the pedometer data. Graphs, goals, and text change weekly, and helpful walking tips are updated daily, so the site has something different anytime a participant logs in.

• Thirty-five participants were randomized and 30 (86%) completed the pilot study.
• Both groups significantly increased bout steps (no statistically significant difference between groups). Among study completers, bout steps increased by 1921 +/- 2729 steps a day.
• Those who received lifestyle goals were more satisfied with the intervention (p = 0.006) and wore the pedometer more often (p < 0.001) than those who received structured goals.

Pedometer-based walking programs that emphasize total accumulated step counts are more acceptable to participants and are as effective at increasing moderate intensity bouts of physical activity as programs that use structured goals. Thus, pedometer-based walking programs that target total steps rather than bout steps may result in similar health benefits and in more satisfied participants.

Richardson CR, Mehari KS, McIntyre LF, Janney AW, Fortlage LA, Sen A, Strecher VJ, Piette JD. A randomized trial comparing structures and lifestyle goals in an internet-mediated walking program for people with type 2 diabetes. International Journal of Behavioral Nutrition and Physical Activity, 16:4(1): 59, 2007.<br><br>

Goodrich DE, Larkin AR, Lowery JC, Holleman RG, Richardson CR. Adverse events among high-risk participants in a home-based walking study: a descriptive study. Int J Behav Nutr Phys Act. 2007 May 23;4:20.<br><br>

Piette JD, Kerr E, Richardson C, Heisler M. Veterans Affairs research on health information technologies for diabetes self-management support. J Diabetes Sci Technol. 2008;2(1):954-962.