Veterans Walk for Health Study

Objective: This proposal was developed at the request of, and with input from, the Research
Council of the Department of Veterans Affairs' (VA's) National Advisory Board for Nutrition
and Food Services, in an effort to address obesity, a major health problem for VA patients.
The prevalence of obesity in the United States has been increasing at an alarming rate. As a
result, obesity related chronic diseases such as diabetes are also increasing in prevalence.
While interventions that focus only on dietary changes can result in significant weight
loss, the lost weight is often rapidly regained. Physical activity, when added to a dietary
weight loss program, not only increases the initial weight loss but it also can play a
critical role in preventing weight regain. The primary objective of the proposed study is to
test the efficacy of a low-cost, innovative weight loss program targeting lifestyle physical
activity and diet in individuals with cardiovascular risk factors or disease.

Study Design and Methods: In this 3 year multi-site randomized controlled trial, the
investigators will recruit overweight and obese veterans with cardiovascular disease risk
factors or known cardiovascular disease who have been referred for nutritional counseling or
who have responded to advertisements for the study. Research participants will be randomized
to one of three study groups:

- nutritional counseling alone;

- nutritional counseling with simple pedometer feedback; and

- nutritional counseling, with both simple pedometer and enhanced pedometer (web-based)
feedback.

Each participant will have 5 visits with a dietitian in the course of 6 months. Participants
randomized to receive pedometer feedback will review objectively monitored step-count data
during their nutritional counseling sessions and will use the data to set new step-count
goals. The primary outcome, weight loss, will be assessed at the sixth and final session at
the end of the 6-month intervention. Enhanced pedometers that can monitor step-counts
throughout the day and upload time stamped step count data to a central computer will be
used to monitor adherence to a walking program.

Inclusion Criteria:

- Is newly referred from a VA physician for nutritional counseling or has responded to
an advertisement for the study - Has one of the following diagnoses: diabetes,
coronary artery disease, hypercholesterolemia, hypertension, obesity.

- Is ambulatory and able to comfortably walk at least one block.

- Has a body mass index (BMI) of 28 or greater.

- Is not already regularly active (30 minutes a day, 5 days a week of moderate
intensity physical activity).

- Is in the contemplation or preparation stage of readiness to become more physically
active.

- Is willing to try a walking program.

- Can communicate comfortably in English.

Exclusion Criteria:

- Has attended a nutritional counseling session in the past 28 days.

- May be at risk for adverse cardiovascular events with a walking program--specifically
participants who:

- have symptoms of cardiovascular disease (CVD) while walking;

- have been told by a physician that walking might be dangerous; or

- have a stress test scheduled in the next two months.