Advertisement

Improving Diet and Physical Activity with ALIVE

A Worksite Randomized Trial

      Context

      Healthy diets and regular physical activity confer many health benefits, but the prevalence of these behaviors is relatively low.

      Background

      Cost-effective strategies are needed to increase healthy eating and physical activity in the population.

      Design

      An RCT, conducted in 2006, of a 16-week e-mail program offered individually tailored, small-step goals; a personal homepage with tips; educational materials; and tracking and simulation tools.

      Setting/population

      Seven hundred eighty-seven employees in the administrative offices of a large healthcare organization volunteered to participate.

      Main outcome measures

      Changes were self-reported for total physical activity; moderate physical activity (MPA); vigorous physical activity (VPA); walking; sedentary behavior; and intake of fruits and vegetables, saturated and trans fats, and added sugars in the intervention group compared to the control group.

      Results

      In intent-to-treat analyses (conducted in 2007 and 2008) that set change in nonresponders to the follow-up questionnaire to zero, the intervention group reported increases of 28.0 minutes/week (min/wk) of MPA (SE=7.4, p=0.0002); 12.5 min/wk of VPA (SE=5.7, p=0.03); and 21.5 min/wk of walking (SE=5.5, p=0.0003) relative to the control group. Intake of both saturated and trans fats (grams/day [g/day]) declined (β=–0.95, SE=0.36, p=0.01; β=–0.29, SE=0.12, p=0.02, respectively). The consumption of fruits and vegetables increased significantly (p=0.03), and the consumption of added sugars decreased marginally (p=0.08). The largest changes were in participants who did not meet behavioral recommendations at baseline (increase of 55.4 min/wk of MPA and decrease of 1.15 g/day of trans fats, relative to the control group). Differences between the intervention and control groups were still observed 4 months after the intervention ended.

      Conclusions

      ALIVE is an effective program for achieving significant improvement in diet and physical activity.

      Trial registration

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • USDHHS
        Physical activity and health: a report of the Surgeon General.
        USDHHS, CDC, National Center for Chronic Disease Control and Prevention, Atlanta GA1996
        • Ascherio A.
        • Katan M.B.
        • Zock P.L.
        • Stampfer M.J.
        • Willett W.C.
        Trans fatty acids and coronary heart disease.
        N Engl J Med. 1999; 340: 1994-1998
        • Stampfer M.J.
        • Hu F.B.
        • Manson J.E.
        • Rimm E.B.
        • Willett W.C.
        Primary prevention of coronary heart disease in women through diet and lifestyle.
        N Engl J Med. 2000; 343: 16-22
        • Glade M.J.
        Food, nutrition, and the prevention of cancer: a global perspective.
        Nutrition. 1999; 15: 523-526
        • Powell K.E.
        • Thompson P.D.
        • Caspersen C.J.
        • Kendrick J.S.
        Physical activity and the incidence of coronary heart disease.
        Annu Rev Public Health. 1987; 8: 253-287
        • Helmrich S.P.
        • Ragland D.R.
        • Leung R.W.
        • Paffenbarger Jr, R.S.
        Physical activity and reduced occurrence of non-insulin dependent-diabetes mellitus.
        N Engl J Med. 1991; 325: 147-152
        • Thune I.
        • Brenn T.
        • Lund E.
        • Gaard M.
        Physical activity and the risk of breast cancer.
        N Engl J Med. 1997; 336: 1269-1275
        • Lee I.M.
        • Paffenbarger Jr, R.S.
        • Hsieh C.
        Physical activity and risk of developing colorectal cancer among college alumni.
        J Natl Cancer Inst. 1991; 83: 1324-1329
        • CDC
        Adult participation in recommended levels of physical activity—U.S., 2001 and 2003.
        MMWR Morb Mort Wkly Rep. 2005; 54: 1208-1212
        • Leavitt M.O.
        Physical activity and good nutrition.
        CDC, Coordinating Center for Health Promotion, Atlanta GA2007
        • McCabe-Sellers B.J.
        • Bowman S.
        • Stuff J.E.
        • Campagne C.M.
        • Simpson P.M.
        • Bogle M.L.
        Assessment of the diet quality of U.S. adults in the Lower Mississippi Delta.
        Am J Clin Nutr. 2007; 86: 697-706
        • King A.C.
        • Haskell W.L.
        • Young D.R.
        • Oka R.K.
        • Stefanick M.L.
        Long-term effects of varying intensities and formats of physical activity on participation rates, fitness and lipoproteins in men and women aged 50 to 65 years.
        Circulation. 1995; 91: 2596-2604
        • King A.C.
        • Stokols D.
        • Talen E.
        • Brassington G.S.
        • Killingsworth R.
        Theoretical approaches to the promotion of physical activity: forging a transdisciplinary paradigm.
        Am J Prev Med. 2002; 23: 15-25
        • Baranowski T.
        • Lin L.S.
        • Wetter D.W.
        • Resnicow K.
        • Hearn M.D.
        Theory as mediating variables: why aren't community interventions working as desired?.
        Ann Epidemiol. 1997; 7: S89-S95
        • Resnicow K.
        • Vaughan R.
        A chaotic view of behavior change: a quantum leap for health promotion.
        Int J Behav Nutr Phys Act. 2006; 3: 25
        • Marcus B.H.
        • Ramspach S.W.
        • Lefebvre R.C.
        • Rossi J.S.
        • Carlton R.A.
        • Abrams D.B.
        Using the stages of change model to increase the adoption of physical activity among community participants.
        Am J Health Promot. 1992; 6: 424-429
        • Marcus B.H.
        • Emmons K.M.
        • Simkin-Silverman L.R.
        • et al.
        Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace.
        Am J Health Promot. 1998; 12: 246-253
        • Prochaska J.O.
        • DiClemente C.C.
        The transtheoretical approach: crossing traditional boundaries of change.
        Dorsey Press, Homewood IL1984
        • Bandura A.
        Self-efficacy: the exercise of control.
        Freeman, New York1997
        • Block G.
        • Sternfeld B.
        • Block C.H.
        • et al.
        Development of Alive! (A Lifestyle Intervention Via Email), and its effect on health-related quality of life, presenteeism, and other behavioral outcomes: randomized controlled trial.
        J Med Internet Res. 2008; 10: e43
        • Ainsworth B.E.
        • Irwin M.L.
        • Addy C.L.
        • Whitt M.C.
        • Stolarczyk L.M.
        Moderate physical activity patterns of minority women: the Cross Cultural Activity Participation Study.
        J Womens Health Gend Based Med. 1999; 8: 805-813
        • Block G.
        • Hartman A.M.
        • Naughton D.
        A reduced dietary questionnaire: development and validation.
        Epidemiology. 1990; 1: 58-64
        • Lalonda I.
        • Graham M.
        • Slovinec-D'Angelo M.
        • Beaton L.
        • Brown J.
        • Block T.
        Validation of the block fat/sugar/fruit/vegetable screener in a cardiac rehabilitation setting.
        J Cardiopulm Rehabil Prev. 2008; 28: 340
        • Ainsworth B.E.
        • Haskell W.L.
        • Whitt M.C.
        • et al.
        Compendium of physical activities: an update of activity codes and MET intensities.
        Med Sci Sports Exerc. 2000; 32: S498-S504
      1. National Health and Nutrition Examination Survey.
        CDC, Atlanta GA2008
        • U.S. Department of Agriculture
        Food and nutrient database for dietary studies.
        Agricultural Research Service, Washington DC2008
        • Haskell W.L.
        • Lee I.M.
        • Pate R.R.
        • et al.
        Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1423-1434
        • Pate R.R.
        • Pratt M.
        • Blair S.N.
        • et al.
        Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.
        JAMA. 1995; 273: 402-407
        • USDHHS and U.S. Department of Agriculture
        Dietary guidelines for Americans.
        6th ed. U.S. Government Printing Office, Washington DC2005
        • WHO
        Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation.
        (Geneva)2003 (Report Series 916)
        • Prochaska J.O.
        A transtheoretical model of behavior change: implications for diet interventions.
        in: Henderson M.M. Bowen D.J. DeRoss K.K. Promoting dietary change in communities: applying existing models of dietary change to population-based interventions. Fred Hutchinson Cancer Research Center, Seattle1992
        • Bandura A.
        Social foundations of thought and action: a social cognitive theory.
        Prentice-Hall, Englewood Cliffs NJ1986
        • King A.C.
        • Blair S.N.
        • Bild D.E.
        • et al.
        Determinants of physical activity and interventions in adults.
        Med Sci Sports Exerc. 1992; 24: S221-S236
        • Marcus B.H.
        • Williams D.M.
        • Dubbert P.M.
        • et al.
        Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research.
        Circulation. 2006; 114: 2739-2752
        • Martin S.B.
        • Morrow Jr, J.R.
        • Jackson A.W.
        • Dunn A.L.
        Variables related to meeting the CDC/ACSM physical activity guidelines.
        Med Sci Sports Exerc. 2000; 32: 2087-2092
        • King A.C.
        • Castro C.
        • Wilcox S.
        • Eyler A.A.
        • Sallis J.F.
        • Brownson R.C.
        Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women.
        Health Psychol. 2000; 19: 354-364
        • King A.C.
        • Taylor C.B.
        • Haskell W.L.
        • DeBusk R.F.
        Identifying strategies for increasing employee physical activity levels: findings from the Stanford/Lockheed Exercise Survey.
        Health Educ Q. 1990; 17: 269-285
        • Curry S.J.
        • Kristal A.R.
        • Bowen D.J.
        An application of the stage model of behavior change to dietary fat reduction.
        Health Educ Res. 1992; 7: 97-105
        • Brownell K.D.
        • Marlatt G.A.
        • Lichtenstein E.
        • Wilson G.T.
        Understanding and preventing relapse.
        Am Psychol. 1986; 41: 765-782
        • Shannon J.
        • Kirkley B.
        • Ammerman A.
        • et al.
        Self-efficacy as a predictor of dietary change in a low-socioeconomic-status Southern adult population.
        Health Educ Behav. 1997; 24: 357-368
        • Shilts M.K.
        • Horowitz M.
        • Townsend M.S.
        Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature.
        Am J Health Promot. 2004; 19: 81-93
        • Dzewaltowski D.A.
        • Noble J.M.
        • Shaw J.M.
        Physical activity participation: social cognitive theory versus the theories of reasoned action and planned behavior.
        J Sport Exerc Psychol. 1990; 12: 388-405
        • Sallis J.F.
        • Haskell W.L.
        • Fortmann S.P.
        • Vranizan K.M.
        • Taylor C.B.
        • Solomon D.S.
        Predictors of adoption and maintenance of physical activity in a community sample.
        Prev Med. 1986; 15: 331-341
        • AbuSabha R.
        • Achterberg C.
        Review of self-efficacy and locus of control for nutrition- and health-related behavior.
        J Am Diet Assoc. 1997; 97: 1122-1132
        • Brug J.
        • Steenhuis I.
        • van Assema P.
        • De Vries H.
        The impact of a computer-tailored nutrition intervention.
        Prev Med. 1996; 25: 236-242
        • Wangberg S.C.
        An Internet-based diabetes self-care intervention tailored to self-efficacy.
        Health Educ Res. 2008; 23: 170-179
        • Brug J.
        • van Assema P.
        Differences in use and impact of computer-tailored dietary fat-feedback according to stage of change and education.
        Appetite. 2000; 34: 285-293
        • Brug J.
        • Oenema A.
        • Campbell M.
        Past, present, and future of computer-tailored nutrition education.
        Am J Clin Nutr. 2003; 77: 1028S-1034S
        • Oenema A.
        • Brug J.
        • Dijkstra A.
        • de Weerdt I.
        • De Vries H.
        Efficacy and use of an Internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: a randomized controlled trial.
        Ann Behav Med. 2008; 35: 125-135
        • Spittaels H.
        • De Bourdeaudhuij I.
        • Vandelanotte C.
        Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population.
        Prev Med. 2007; 44: 209-217
        • van den Berg M.H.
        • Schoones J.W.
        • Vliet Vlieland T.P.
        Internet-based physical activity interventions: a systematic review of the literature.
        J Med Internet Res. 2007; 9: e26
        • Revere D.
        • Dunbar P.J.
        Review of computer-generated outpatient health behavior interventions: clinical encounters “in absentia.”.
        J Am Med Inform Assoc. 2001; 8: 62-79
        • Marcus B.H.
        • Lewis B.A.
        • Williams D.M.
        • et al.
        A comparison of Internet and print-based physical activity interventions.
        Arch Intern Med. 2007; 167: 944-949
        • Marcus B.H.
        • Lewis B.A.
        • Williams D.M.
        • et al.
        Step into motion: a randomized trial examining the relative efficacy of Internet vs. print-based physical activity interventions.
        Contemp Clin Trials. 2007; 28: 737-747
        • Kroeze W.
        • Oenema A.
        • Campbell M.
        • Brug J.
        The efficacy of web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a randomized, controlled trial.
        J Nutr Educ Behav. 2008; 40: 226-236
        • Kim C.J.
        • Kang D.H.
        Utility of a web-based intervention for individuals with type 2 diabetes: the impact on physical activity levels and glycemic control.
        Comput Inform Nurs. 2006; 24: 337-345
        • Dishman R.K.
        • Oldenburg B.
        • O'Neal H.
        • Shephard R.J.
        Worksite physical activity interventions.
        Am J Prev Med. 1998; 15: 344-361
        • Hennrikus D.J.
        • Jeffery R.W.
        Worksite intervention for weight control: a review of the literature.
        Am J Health Promot. 1996; 10: 471-498
        • Armstrong B.K.
        • White E.
        • Saracci R.
        Principles of exposure measurement in epidemiology.
        Oxford University Press, Oxford1994