Participants received weekly e-mails in their work or home accounts for four months that were tailored to their individual needs and life situation (for example, whether they had small children at home or busy schedules that posed barriers to exercise and diet improvement.) The e-mails linked to a personal home page with tips for achieving the small-step goals the respondent had selected, educational materials and tracking and simulation tools. Reminder messages were sent between each intervention message.

The study cohort was composed of employees who worked in the regional offices of Kaiser Permanente Northern California. The employees worked in administrative, financial, regulatory, technical and professional services and were not involved with direct patient care. They tend to use computers for much of their work. Participation had no bearing on job performance, employment status, or health benefits. The participants' information was kept confidential and did not appear on medical records or employee files.

Before the program began, participants were evaluated on their eating and exercise habits by answering a short, online questionnaire, to which they received immediate feedback. They filled out the online questionnaire twice more, at the end of the program and four months later.

Another paper published in January in the Journal of Medical Internet Research found that the ALIVE e-mail program reduced presenteeism among the trial participants and reduced bodily pain. Presenteeism is lost productivity that occurs when employees come to work but perform below par due to any kind of illness. The study did not look at whether employees used the e-mail program during their lunch hour or during their regular work hour.

"Using e-mail to get people active is a great use of existing technology that is cheap and readily available," said Bob Sallis, MD, a Kaiser Permanente family physician who is the regional exercise champion for Kaiser Permanente's Southern California region and immediate past president of the American College of Sports Medicine. "Anything we can do to increase activity level is going to improve health because we know that exercise is medicine. It's medicine you can take to live a longer and healthier life."

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