title: A Web-Based Intervention to Encourage Walking (StepWise): Pilot Randomized Controlled Trial.
abstract: BACKGROUND
  Despite Internet-based interventions that incorporate pedometers with appropriate goal-setting processes and other theoretically-based behavior change strategies being proposed as a means of increasing walking behavior, few have incorporated all of these key features or assessed maintenance of behavior change.
  
  
  OBJECTIVE
  The objective of our study was to investigate the effect of a 12-week pedometer step goal walking program individually tailored to baseline step counts, combined with an interactive support website for step counts, health parameters and motivation over 12 and 24 weeks.
  
  
  METHODS
  Low active participants (mean [SD] 46.2 [11.2] years) were randomly assigned to the Stepwise (SW) intervention group (n=49) or a comparison (CP) group (n=48). SW received a pedometer, step goal walking program and access to the SW website (containing interactive self-monitoring and goal feedback tools, motivational messages and action and coping planning strategies). CP received a pedometer and locally available physical activity information. Step counts, BMI, resting heart rate, blood pressure and glucose, cholesterol and triglyceride levels, psychological well-being, perceived health, self-efficacy and self-determined motivation were measured at baseline, 12 and 24 weeks.
  
  
  RESULTS
  Linear mixed model analysis found that both groups' step counts increased from baseline to week 12 (β = 11,002, CI 5739-16,266, P<.001) and 24 (β = 6810, CI 1190-12,431; P=.02). Group step counts were significantly different at week 24 with SW taking 8939 (CI 274-17604, P=.04) more steps compared to CP. Compared to baseline, both groups had improved triglyceride levels (0.14 mmol/L, CI -0.25 to -0.02, P=.02) at week 12, decreased diastolic blood pressure (4.22 mmHg, CI -6.73 to -1.72) at weeks 12 and 24 (3.17 mmHg, CI -5.55 to -0.78), improved positive (β = .21, CI 0.03-0.38, P=.02) and negative affect (β = -.15, CI -0.28 to -0.03, P=.02) at week 12, and perceived health at week 12 (β = 6.37, CI 2.10-10.65, P=.004) and 24 (β = 8.52, CI 3.98-13.06, P<.001). Total cholesterol increased at week 12 (0.26 mmol/L, CI 0.099-0.423, P=.006) and week 24 (0.38 mmol/L, CI 0.20-0.56, P<.001). Repeated measures ANOVA found motivation for walking improved from baseline with higher task self-efficacy (P<.001, η(2) = .13) and autonomous motivation (P<.001, η(2)=.14) at weeks 12 and 24 and decreased controlled motivation (P=.004, η(2)=.08) at week 24.
  
  
  CONCLUSIONS
  Both groups had similar improvements in step counts and physical and psychological health after 12 weeks but only the SW group successfully maintained the increased step-counts 24 weeks post-intervention. This suggests the step-goal based walking program combined with Internet-based behavior change tools were important for sustained behavior change.
authors.affiliation: School of Physical Education, Sport & Exercise Sciences, University of Otago, Dunedin, New Zealand. elaine.hargreaves@otago.ac.nz.
authors.forename: Elaine Anne
authors.identifier: http://orcid.org/0000-0001-9588-0431
authors.initials: EA
authors.lastname: Hargreaves
authors.forename: Nanette
authors.identifier: http://orcid.org/0000-0002-5018-6398
authors.initials: N
authors.lastname: Mutrie
authors.forename: Jade Dallas
authors.identifier: http://orcid.org/0000-0002-9043-4608
authors.initials: JD
authors.lastname: Fleming
keywords: physical activity, behavior change strategies, pedometer, self-monitoring, step goal walking program
references.citation: Prev Med. 2007 May;44(5):377-85
references.pmid: 17275896
references.citation: BMC Public Health. 2012 Mar 19;12:206
references.pmid: 22429600
references.citation: Annu Rev Public Health. 2011;32:349-65
references.pmid: 21128761
references.citation: Ann Fam Med. 2008 Jan-Feb;6(1):69-77
references.pmid: 18195317
references.citation: Med Sci Sports Exerc. 2009 Mar;41(3):674-80
references.pmid: 19204581
references.citation: Health Psychol. 2009 Nov;28(6):690-701
references.pmid: 19916637
references.citation: Prev Med. 2004 May;38(5):651-61
references.pmid: 15066369
references.citation: Br J Health Psychol. 2010 May;15(Pt 2):265-88
references.pmid: 19586583
references.citation: J Med Internet Res. 2010 Feb 17;12(1):e4
references.pmid: 20164043
references.citation: Arch Intern Med. 1995 Apr 10;155(7):701-9
references.pmid: 7695458
references.citation: Health Educ Res. 2008 Jun;23(3):371-81
references.pmid: 18349032
references.citation: Prev Med. 2003 Oct;37(4):356-62
references.pmid: 14507493
references.citation: Health Psychol. 2013 Mar;32(3):328-36
references.pmid: 22823069
references.citation: Int J Behav Nutr Phys Act. 2011 Dec 15;8:137
references.pmid: 22171531
references.citation: J Med Internet Res. 2011 Jan 06;13(1):e2
references.pmid: 21212045
references.citation: Prev Med. 2001 Aug;33(2 Pt 1):120-7
references.pmid: 11493045
references.citation: Prev Med. 2008 May;46(5):431-8
references.pmid: 18207228
references.citation: Nurs Res. 2000 May-Jun;49(3):154-9
references.pmid: 10882320
references.citation: Am J Prev Med. 2007 Jul;33(1):54-64
references.pmid: 17572313
references.citation: Int J Behav Nutr Phys Act. 2008 Sep 05;5:44
references.pmid: 18775062
references.citation: Res Q Exerc Sport. 2009 Sep;80(3):648-55
references.pmid: 19791652
references.citation: Int J Behav Nutr Phys Act. 2012 Jun 22;9:78
references.pmid: 22726453
references.citation: Health Policy. 1990 Dec;16(3):199-208
references.pmid: 10109801
references.citation: JAMA. 2001 May 16;285(19):2486-97
references.pmid: 11368702
references.citation: Health Educ Res. 2011 Apr;26(2):308-22
references.pmid: 21321008
references.citation: Int J Behav Nutr Phys Act. 2011 Jul 28;8:79
references.pmid: 21798015
references.citation: J Occup Med. 1989 Jun;31(6):536-46
references.pmid: 2786559
references.citation: Br J Sports Med. 1996 Jun;30(2):84-9
references.pmid: 8799589
references.citation: Patient Educ Couns. 2008 Feb;70(2):209-14
references.pmid: 18036764
references.citation: J Phys Act Health. 2009 Jul;6(4):444-55
references.pmid: 19842458
references.citation: Ann Intern Med. 2015 Aug 18;163(4):291-7
references.pmid: 26099117
references.citation: Annu Rev Public Health. 2009;30:273-92
references.pmid: 19296777
references.citation: Prev Med. 2012 Feb;54(2):125-30
references.pmid: 22200586
references.citation: Women Health. 2005;41(2):97-116
references.pmid: 16219590
references.citation: Ann Behav Med. 2009 Aug;38(1):18-27
references.pmid: 19802647
references.citation: J Diabetes Investig. 2010 Oct 19;1(5):208-11
references.pmid: 24843434
references.citation: J Sport Exerc Psychol. 2008 Aug;30(4):337-52
references.pmid: 18723896
references.citation: Int J Behav Nutr Phys Act. 2007 Nov 16;4:59
references.pmid: 18021411
references.citation: Prev Med. 2015 Mar;72:34-43
references.pmid: 25579505
references.citation: J Phys Act Health. 2008 Sep;5(5):675-687
references.pmid: 18820340
references.citation: BMJ. 2007 Jun 9;334(7605):1204
references.pmid: 17540909
references.citation: JAMA. 2007 Nov 21;298(19):2296-304
references.pmid: 18029834
references.citation: Can J Sport Sci. 1992 Dec;17(4):338-45
references.pmid: 1330274
references.citation: Behav Res Methods. 2007 May;39(2):175-91
references.pmid: 17695343
references.citation: Health Psychol. 2013 Aug;32(8):829-38
references.pmid: 23477577
references.citation: BMC Public Health. 2008 Jul 26;8:259
references.pmid: 18655723
references.citation: CMAJ. 2006 Mar 14;174(6):801-9
references.pmid: 16534088
references.citation: Sports Med. 2009;39(12):981-93
references.pmid: 19902981
references.citation: J Pers Soc Psychol. 1988 Jun;54(6):1063-70
references.pmid: 3397865