Encouraging Walking in Older Adults

This pilot study is a randomized controlled trial of incentive schemes delivered through a novel internet-based platform to promote walking in older adults. The four arms consist of the following: financial incentives, peer network, combined arm (financial incentive & peer network), and control.

Participation in the study will last approximately 26 weeks, including the 2-week run-in period, 4-month intervention period, and 2-month follow-up period.

The primary goals of the study are:

• To test the effects of financial incentives on older adults uptake and retention of increased levels of walking.

Hypothesis1a: Participants receiving financial incentives will increase their number of steps per day more than participants not receiving financial incentives.

• To test the effects of connection to a new peer network on older adults uptake and retention of increased levels of walking.

Hypothesis 2a: Participants connected to a new peer network of other participants will increase their number of steps per day more than participants not connected to a new network.

Hypothesis 2b: Participants connected to a new peer network of other participants will retain increases in their number of steps per day more than participants not connected to a new network.

• To test the combined effects of financial incentives and peer networks on older adults' uptake and retention of increased levels of walking.

Hypothesis 3a: Participants who receive financial incentives and are connected to a peer network will increase their number of steps per day more than participants who are only connected to a peer network.

Hypothesis 3b: Participants who receive financial incentives and are connected to a peer network will more effectively maintain increases in number of steps per day as compared with participants who only receive financial incentives.

• To develop internet, text and email messaging, and pedometer-internet interface technologies to build peer networks and provide regular feedback to subjects.

Hypothesis 4: The study platform will provide an effective mechanism for subject recruitment, data collection, communication and regular feedback.

Inclusion criteria

• Adult 65 years of age or older
• Communicates primarily in English
• Personal computer with high-speed internet connection and functional Universal Serial Bus (USB) port
• Able to walk 1/4 mile (i.e., 2 to 3 blocks) without stopping
• Currently engaging in less than 150 minutes moderate intensity exercise & less than 75 minutes vigorous intensity exercise each week
• No pedometer use in last 30 days
• Planning to stay in area for study duration

Exclusion criteria

• Myocardial infarction, stroke, transient ischemic attack, major cardiovascular surgery, deep venous thrombosis, or pulmonary embolus in the last 6 months
• New York Heart Association Class III or IV heart failure; severe aortic stenosis; history of cardiac arrest, use of cardiac defibrillator; or severe angina
• Hip fracture, total hip replacement, total knee replacement or spinal surgery in the last 6 months
• Uncontrolled hypertension
• Lung disease requiring supplemental oxygen
• Diabetes mellitus requiring insulin therapy
• Severe osteoarthritis or rheumatoid arthritis
• End stage renal disease requiring hemodialysis
• Movement disorder (e.g., Parkinson's disease)
• Dementia (e.g., Alzheimers Disease, Lewy-Body Dementia, Multi-Infarct Dementia, Picks Disease, Binswangers Disease, Frontotemporal Dementias, Parkinsons Disease Dementia, Huntingtons Disease, Dementia in HIV/AIDS, Wernicke-Korsakoff syndrome, Creutzfeldt-Jakob disease)
• Major psychiatric disorder (e.g., schizophrenia or bipolar disorder)
• Current consumption of ≥ 14 alcoholic drinks per week