Get your patients moving.

The First Step Program is a physical activity intervention for everyone who would like to improve their health. A pedometer is used in the First Step Program as a motivation and feedback tool for participants. The First Step Program is delivered and taught by a certified trainer often a diabetes educator.

This is a 2 Phase Program consisting of Adoption and Adherence

Phase 1 is 4 weeks in length and consists of facilitated group meetings once each week, combined with individual goal setting and self-monitoring, using a pedometer for feedback.

Following the initial orientation meeting, each group meeting follows a repeating agenda:

1) Individual progress reports

2) A brief group walk (10 minutes the 1st meeting, 20 minutes the 2nd meeting, and 30 minutes the 3rd and 4th meetings)

3) Discussion session to plan strategies and to personalize goal setting for the upcoming week.
Reflecting on their previous week's average pedometer values, the number of steps taken during the timed walk, and the strategies they intended to use, participants are encouraged to set new personal daily activity goals (measured in number of steps per day) each week.

Between sessions, participants are encouraged to wear their pedometers every day (while awake) and to monitor their activity using a combination of looking at the pedometer frequently for feedback and striving to reach their daily goals. Participants track progress by recording the number of steps taken each day on an activity calendar in the First Step Program participant manual.

At the last group meeting, participants are given a certificate of completion and encouraged to either increase or maintain their new activity levels using the pedometers and activity calendars.
Adherence phase

Phase 2 lasts 12 weeks. During this time participants continue with individual goal setting and self-monitoring, with limited contact (a postcard) from the First Step Program facilitator, at about weeks 6 and 10.

At the end of the 12-week adherence phase participants are encouraged to attend a 'booster session'. These booster sessions are intended to help the participants identify and overcome barriers to continuing their increased activity level so that they may continue to reap the rewards of a physically active lifestyle.

Background Information

Physical activity is identified as one of the most important components of managing type 2 diabetes. In 1997, Dr Catrine Tudor-Locke began a needs assessment to investigate the practices and experiences of diabetes educators and persons with type 2 diabetes related to physical activity guidelines. She found that concrete guidelines for diabetes educators to provide to clients were not well developed; this was frustrating their attempts to motivate clients towards a more active lifestyle. Through telephone interviews and focus groups, Dr Tudor-Locke found that diabetes educators were inconsistent in their messages about physical activity and were reluctant to give guidelines regarding exercise intensity. In addition, individuals with type 2 diabetes believed physical activity to be important, but they were confused about exercise guidelines and how to be more active. These findings led to the suggestions that 1) physical activity recommendations and education should be part of the standards for training for diabetes educators, and 2) plausible physical activity interventions that can be incorporated into the diabetes education infrastructure should be investigated. This led to the concept of the First Step Program.

The First Step Program is based upon a solid program theory. Program theory organizes and explains what happens in a program and why (Sidani & Braden, 1998). Dr. Catrine Tudor-Locke described the details of each component of the program theory. In addition to program theory, the First Step Program incorporates principles of the experiential learning cycle, and well-designed learning objectives. Please refer to “Formative evaluation of the First Step Program: A practical intervention to increase daily physical activity” in the Canadian Journal of Diabetes Care 2000; 24(4): 56-60.

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