An Online Community Improves Adherence in an Internet-Mediated Walking Program. Part 1: Results of a Randomized Controlled Trial

Study Questions:

Does an online community improve adherence to an Internet-based walking program?


This study was a randomized controlled trial of sedentary, ambulatory adults who had at least one of the following: body mass index ≥25, type 2 diabetes, or coronary artery disease. All participants had to use e-mail on a regular basis. The participants wore pedometers during a 16-week walking program, with individually-tailored motivational messages and weekly calculated walking (step) goals. Participants uploaded their step counts from the pedometers to a study website on a regular basis. Participants were randomized to either the web-based walking program alone or with access to an online community where they could post and read messages with other participants (randomized to the online community) as well as study staff. The control arm received no access to the online community and could not read or post messages. The main outcome of interest was participant attrition, and average daily step counts.


A total of 324 participants were included in this study. Both treatment arms increased their total number of step counts compared to baseline, with no significant difference in change from baseline between the two study arms, using an intention-to-treat analysis. The percentage of subjects who completed the program was significantly higher in the online community arm (13%, p = 0.2). Participants randomized to the online community arm demonstrated better engagement with the program compared to the control arm (hazard ratio, 0.47; 95% confidence interval, 0.25-0.90). Subjects who reported low levels of social support were more likely to post more messages to the online community (p < 0.001) and view more posts (p < 0.001), as compared to those with higher levels of social support.


The investigators concluded that an online community added to a web-based walking program enhanced participant participation, reduced dropout from the program, and appears to be well accepted, particularly by those with lower levels of social support.


Use of online resources by patients has dramatically increased over recent years. Such resources have great potential in clinical research. This study demonstrated the potential of online communities to enhance participation in clinical research, and has potential particularly among groups with barriers to participation in such trials.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Atherosclerotic Disease (CAD/PAD), Exercise

Keywords: Motivation, Coronary Artery Disease, Walking, Body Mass Index, Social Support, Cardiology, Diabetes Mellitus, Type 2, Electronic Mail, Confidence Intervals, Patient Dropouts, Internet, Goals

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