Long-Term Exercise Maintenance Via Internet Support
Walking and running are behaviors that can be maintained for many years. Our national cohort of 45,704 walkers reported walking >12 mi/wk for an average (+_SD) of 9.1+_10.1 years. Our cohort of 120,000 runners ran >12 mi/wk for an average of 12.4+_7.6 years. Yet a significant portion of runners (and presumably walkers) reduces their exercise each year (41% reduced their mileage >50% during 7.6 yrs of follow-up). The risk for exercising less appears to decrease with the number of years run, race participation, and better race performance. The investigators hypothesize that an intervention that promotes participation in walking and running events, provides social support, and engenders intellectual interest and a sense of accomplishment will serve to maintain these behaviors. Moreover, the investigators hypothesize that the Internet can provide this intervention to large populations at nominal cost. The investigators propose to test this hypothesis in a 3-year randomized trial of 8,000 walkers and 8,000 runners. Subjects having Internet access will be recruited from our existing cohorts of over 160,000 walkers and runners. The treatment group will consist of 4,000 runners and 4,000 walkers who will be referred to our interactive Web site. This site will build upon the investigators' current Internet-based survey tool that provides full-function physical activity and diet logs (www.healthsurvey.org). The investigators will add the capacity to: 1) track daily mileage on a virtual cross-continental walk or run from Yorktown Virginia to Florence, Oregon and to view cross-continental progress (http//trailmaps.lbl.gov); 2) choose anonymous running and walking partners with similar goals to travel with along the virtual course; 3) communicate with partners to provide mutual support; 4) provide recognition for completing each state on an awards page; 5) download video clips of regional 10km and marathon races to entice participation (these will enable participants to visualize participation and completion of the races); 6) provide information on regional races, walking and running clubs, and mentoring services. The control group will consist of 4,000 runners and 4,000 walkers who will be referred to Road Runners of America (runners) or Volkssport Websites (walkers). Both the treatment and control groups will receive by mail baseline and follow-up surveys on physical activities. A subset of 100 runners and 100 walkers will be given pedometers with heart rate monitors to verify activity. Behavioral models will be developed by comparing walking and running activity to: 1) Web site activity; 2) additional data solicited periodically and at times of acute change in exercise level using E-mail. The investigators estimate that they will be able to detect differences in exercise cessation rates between the intervention and control group of 0.45% in runners and walkers separately (a=0.05, 80% statistical power).
Eight-thousand runners and 8,000 walkers will be assigned at random to one of two experimental conditions: 1) 4,000 of each to be directed to informational material on public Internet websites that promote running and walking (control group), and 2) 4,000 of each to receive information and interactive tools developed by us to track and promote running and walking (treatment group). All participants will receive beginning and 3year follow-up survey questionnaires by mail, which will request information on current physical activities, body weight, other health behaviors, social support, perceptions of health benefits, resiliency to training interruptions, and exercise self-efficacy. In addition, a random subset of 200 participants will receive pedometers with heart rate monitors at baseline and three-year follow-up to verify survey entries. The intervention tools will strengthen exercise adherence through education, building support groups, setting goals, tracking compliance, encourage race participation, and rewarding success. The primary hypothesis is whether there are statistically significant mean differences between treatment and control for exercise maintenance (self-reported walking and running mileages at the end of three years).
The intervention will build upon our current Internet-based survey tools (www.healthsurvey.org) for tracking physical activity and nutrition on full-function activity and diet logs. The existing software allows participants to visualize their accumulated running and walking mileage on a virtual transcontinental route starting in Yorktown, Virginia and ending in Florence, Oregon. To the existing software, we will add the ability to: 1) choose named or anonymous running and walking partners with similar goals and abilities to travel with (or race against) along the transcontinental trail, 2) communicate with partners to provide mutual support, 3) compete as part of virtual running and walking teams created by the user, and 4) be recognized for completing each state on an awards page (optional). Interest in the site will be maintained by providing regular updates on scientific research on running and walking through our proprietary software. The updates will be created from PubMed abstracts that are made more reader friendly by defining all scientific terms in pop-up balloons. In addition, the treatment group will be able to download 30-second video clips of regional and national running and walking events. Information will be provided on local running and walking groups and mentoring opportunities.