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Physical activity is an essential component in the treatment of type 2 diabetes. As diabetes educators we are well aware of the benefits of physical activity. In daily practice educators face the challenge of motivating and encouraging clients to become more physically active. People with diabetes and other chronic illnesses are often very sedentary. The goal of “Project Pedometer” is to motivate, encourage and provide immediate feedback of activity for people with type 2 diabetes.

Project Pedometer was initiated in the fall of 2002. Armed with a supply of pedometers, I set off to increase an awareness of daily physical activity with clients in our diabetes clinic.

What is a Pedometer?
A pedometer is a device designed to record daily steps. Pedometers have been used in Japan for many years, nicknamed “manpo-kei” which means 10,000 steps. The pedometer is worn at the waist in line with the middle of the thigh; the device measures the number of steps through the up-and-down motion of the hips. More sophisticated models measure distance traveled (miles or kilometers), heart rate, energy expended (kcals) and some can even be used as a stopwatch. The error rate with pedometers may be increased in people with gait impairments, very slow walking speeds or extreme obesity. Most pedometers are relatively inexpensive ranging from $10-50. A pedometer is designed to get people more physically active.

How much is enough exercise?
Health Canada recommends 30-60 minutes of physical activity every day to stay healthy. Blocks of 10 minutes of activity can accumulate to reach this goal. Some of the benefits of exercise include:

• improving overall health, mood, self-esteem and decreasing stress
• reducing weight, improving glycemic control and blood pressure
• decreasing risk factors for illness such as diabetes, cardiovascular disease, osteoporosis

People choose many different forms of exercise; walking is the most common.

Why walk?
Walking is currently the most popular physical activity for adults in Canada. Benefits are similar to other forms of exercise but walking is much easier on the joints. Minimal equipment is required except for comfortable clothing and proper footwear. Best of all walking is free and it can be done almost anywhere!! Remind your clients to start slowly, warm up and stretch before and after walking.

How many steps are enough?
The number of steps people take in a day varies from person to person. Sedentary adults take between 2000 and 4000 steps per day; a healthy number of steps for an adult are 10,000 per day or about 7 kilometers. For children this goal would likely be too low as most children range from 11,000-12,000 per day. Most people need to make an effort to go out and walk to get enough steps in a day. It is estimated that 3,000-4,000 steps are equivalent to 30 minutes of moderate intensity walking. Research has demonstrated consistently that exercise, especially walking, is beneficial for overall health.

Research Studies:
Regular daily exercise and healthy nutrition has been shown in many studies to improve glycemic control, improve insulin sensitivity, promote weight loss and decrease the risk of developing type 2 diabetes. One study, the Diabetes Prevention Program (DPP) demonstrated a 58% risk reduction of developing diabetes when combined with nutrition, exercise and weight control. Another study, the DaQuing compared three lifestyle approaches: diet, exercise, and a combination of diet and exercise. All three showed a decrease in the risk of developing diabetes by 31-46%. The Finnish Diabetes Prevention Study also showed a decreased risk of developing diabetes by 58% with diet and exercise. All of these studies clearly demonstrated the benefits associated with regular physical activity.

Implementing the Program:
With my supply of pedometers, the recommendations from Health Canada, research studies and statistics, Project Pedometer was off the ground. I have been using the pedometers in two main areas: the diabetes clinic and elementary schools.

At the diabetes clinic, I offer clients the opportunity to borrow a pedometer. Clients wear the pedometer for a few days recording their normal daily number of steps. These “test days” help clients set their goals; they take the highest daily total as their starting goal, increasing by 500-1000 steps per day each week until their goal is met. The pedometers are an excellent way to remind and motivate people to add in extra activity on a daily basis. I encourage clients to set realistic goals to avoid potential failure. The most common comment I have received back from clients is that they like the self-structured approach of the program and feel a sense of accomplishment when they meet their goals each week. Praise for work well done is always given and there is encouragement for those whose goals are unmet or have slipped back into a previously set goal.

I encourage clients to incorporate exercise into their daily schedule so it becomes part of their normal routine. Some suggestions include:

• take the stairs instead of the elevator
• park further from the stores in the “diabetes parking spots”
• take a walk break every hour from desk jobs
• get up and walk around at the commercial breaks
• get off the bus a few stops earlier
• have a back-up plan in poor weather such as mall walking

The second area targeted with Project Pedometer was the elementary schools. Working with the teachers, projects have ranged from one day to two weeks. Teachers have discovered that it is a useful tool to create an awareness of activity in the school day. Students have found that if they run around at recess and lunch, they have a higher number of steps at the end of the day. The pedometers have fit into the curriculum in many different areas – science and the healthy body, social studies and plotting how long it would take to walk to a certain destination, personal planning and goal setting, math skills with better reading of numbers in the thousands, averaging, graphing and language arts with reports they have written on what they learned from Project Pedometer. One class wrote a poem:

P – People Walking
E – Energy
D – Dancing is great for exercising
O – Outside walking is great
M – Miles of walking
E – Exercise is good for you
T – Time well spent
E – Everybody tries harder
R – Running is cool

There are a number of different clinics using pedometers in their practice. Diane O’Grady at the Vernon Diabetes Clinic comments that “this is a very powerful educational tool; it is the best tool that I have had to show in a long time”. She uses the pedometers in all areas of her practice including her gestational program, type 2 children and IGT clients. Prince Edward Island’s Stepping Out Program has implemented a 12 week program, working on recording steps, working towards new goals each week and support meetings; they had 1500 participants in a 5 month period.

For more information on Pedometer Programs:

“PEI Stepping Out”
steppingout@peiactiveliving.com

Project Pedometer
Carol Stathers, RN CDE
Summerland, B.C.
carol.stathers@interiorhealth.ca

Vernon Jubilee Hospital Diabetes Clinic
Vernon, B.C.
Diane O’Grady, RN, BSN, CDE
dianeogrady@interiorhealth.ca

Studies such as Project Pedometer have been shown to encourage participants to “go the extra mile”. The use of pedometers is increasing in popularity as a measurement and motivational tool to increase physical activity. Educators and clients need to focus on the benefits of daily exercise but also explore new ways to make exercise part of the daily routine. Let’s focus on type 2 prevention and healthy living for all. Keep on stepping!!

Carol Stathers, RN CDE, is a Certified Diabetes Educator and freelance writer. She has written for a variety of health related magazines, newspapers and diabetes journals. She works as a diabetes nurse educator in Summerland and Penticton BC and teaches health related courses at Okanagan University College. She is a married mom of three young children. carol.stathers @interiorhealth.ca

References:
1. Health Canada and Canadian Society for Exercise Physiology (1998). Canada’s Physical Activity Guide to Healthy Active Living.
2. Meltzer, S.et al. (1998). Clinical Practice Guidelines for the Management of Diabetes in Canada. CMAJ 159 (8 suppl.), S1-S29.
3. Trecroci, Daniel. Walking Your Way to Health. Diabetes Interview. November 2000.
4. Uhlman, Marian. Pedometer Popularity Taking Off. The Philadelphia Inquirer. October 3, 2002.
5. Tudor-Lock, Catherine E. et al. Development of a Theory-Based Daily Activity Intervention for Individuals with Type 2 Diabetes. The Diabetes Educator. January/February 2001. Volume 27; Number 1.
6. Tudor-Lock, Catherine E. PHD, Adjunct Professor University of Western Ontario. Active Living Tips for Older Adults. Issue #1, May 2001.