We shared an introductory guide about “Walking & Diabetes” on The DX and recently featured the story of Wendy Bumgardner, the walking guru at About.com, here on Discuss Diabetes. Today I’d like to share with you “Rx for Walking with a Pedometer,” a really interesting healthcare provider toolkit for “prescribing” walking. The toolkit can be seen as encouraging and doable, and it also has the ability to document measurable results.
“Rx for Walking with a Pedometer” was designed by Kathy Stroh, MS, RD, CDE*, of the Delaware Division of Public Health Diabetes Prevention and Control Program, in collaboration with Linda S. Gottfredson, PhD, of the University of Delaware, School of Education.
“We noticed that some people may not understand basic, important tasks associated with diabetes, such as how to become more physically active,” Kathy said. “Many primary care physicians talk to their patients about increasing physical activity by asking them to ‘walk more.’ So we picked a simple tool – using a pedometer – to help us quantify how much patients were walking and if they achieved the ‘prescribed’ amount. I think it’s helpful to attach metrics to as many aspects of diabetes self-management as possible, whether it’s grams on a label or steps per day.”
The program begins with taking a prescribed number of steps within a specified amount of time for a specified number of days per week, then incrementally adds more steps. For example, the healthcare professional may initially prescribe walking 1,000 steps in 20 minutes, four days a week. Then after a week or two, the prescription may increase to 1,500 steps in 20 minutes, so the individual must increase their walking pace. The initial recommendation and subsequent increases depend on the person’s physical abilities.
This kind of specific prescription offers someone a concrete goal to work toward, and may enhance feelings of confidence as they see their progress. “It’s the same thing with writing down what you eat,” said Kathy. “There’s value in having a written record of what you do. If they see they’re now up to 3,000 steps a day, or if they’re up to 1,000 steps in 15 minutes, that’s evidence of their progress. They are more likely to have a feeling of success, and there’s also a clear measure of progress to share with their clinician.”
Kathy and Linda created a script for healthcare professionals to use, to speak with their patients about therapeutic walking. “The idea was to introduce the concept that physical activity is an important part of helping control your diabetes,” Kathy said. “They would make the connection between increased physical activity and improved glucose control.” After the initial introduction by a physician, a CDE or RN would then lead the individual through the entire script, training the person on tasks such as where to wear a pedometer for optimal results and how to record steps using the pedometer. The Rx for Walking with a Pedometer Toolkit for Providers, including the script, is available via the Delaware Division of Public Health’s Healthy Eating and Active Living (HEAL) website.
Education about how to wear a pedometer is important. “You have to wear it over the side seam of your pants or skirt,” she said. “A lot of people wear it in front and that misaligns the pedometer for optimal reading. The device needs to be perpendicular, pointing straight down to the ground, or it won’t measure your steps accurately. If you wear it on a side seam, you’re more likely to catch every time your hip and your knee moves.”
While the program was designed for people living with diabetes or pre-diabetes, Kathy believes it is suitable for anyone looking to increase their physical activity and says all anyone really needs is a simple pedometer that counts steps. Anyone interested in starting a new exercise program, including walking, should always speak with their doctor before they begin.
I’m encouraged by Kathy and Linda’s initiative in putting together a simple yet measurable program, and for providing healthcare professionals with another tool that may assist in meaningful dialogue with their patients. Many thanks to Kathy for taking the time to explain the prescription to us.
All the best,
Disclosure: Kathy Stroh received no compensation for this post. All opinions contained in this post reflect those of the interviewee, and not of Sanofi US, its employees, agencies or affiliates.
*“Certified Diabetes Educator” and “CDE” are certification marks owned and registered by the National Certification Board for Diabetes Educators (NCBDE). NCBDE is not affiliated in any way with Sanofi US. NCBDE does not sponsor or endorse any diabetes-related products or services.