Michelle Hoersch, Regional Women's Health Coordinator
Amy Dolgin, Graduate Student Intern
Angeline Widmer, Public Health Advisor

The National Prevention Summit:
Prevention, Preparedness and Promotion

September 27, 2006

• 127 million American adults are overweight or obese
• 75% of Americans participate in low levels of physical activity

• Physical inactivity - Women vs. Men
• Aging in women
• Risks of sedentary lifestyle

Addressing the gender-specific barriers and needs of women is critical in developing a physical activity intervention for women and girls.

In 2004/2005:

The WOW Challenge
Women and girls Out Walking

— a regional pedometer-based physical activity challenge

• National Women's Health Week
• Six virtual routes across the country
• 17,699 participants nationwide
• 6500 free pedometers
• 138 free arm-band pedometers
• Individual or Team participation
• Participants received:
  • Tracking log
  • Weekly motivational emails
  • Age-appropriate health information on nutrition, physical activity, disease prevention, and health promotion.
• The Challenge was free and operated through an interactive website, enabling participants to track their progress on virtual routes.

Who participated?

• 17,699 women and girls
• Every state and many U.S. territories represented

Participants chose one of two goals:

Goal 1: more than 10,000 steps/day

Goal 2: less than 10,000 steps/day

(image: bar graph titled "Participants by age and goal")

Participants chose one of six virtual routes

• Pacific Coast
• Gulf and Caribbean
• Cross Country
• Northeast
• Plains and Midwest
• Rocky Mountains

(image: WOMAN Challenge "Map of Virtual Routes")

• Capture full day's activity
• Low-cost
• Ease of use
• Immediate feedback
• Standardized

• Japanese model
• Active lifestyle

In 1983, Prochaska and DiClemente developed the SOC Model, and it has since been applied to physical activity studies. The stages include:

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

"Although I did not achieve 10,000 steps everyday, I became committed to walking everyday. Your challenge motivated me to get moving. I looked forward to seeing my progress on the map and I am proud of my accomplishment. I hope you do it again. I would love to participate."
Pam, California

1. Value of team participation

• Higher step counts
• More days logged
• commitment & accountability
• competition

(image: bar graph titled "Average daily steps by goal and team status")

2. Free Pedometers
Participants who had to provide their own pedometers, on average, logged more daily steps

Our theory:
*  Participant investment in program increases participant commitment

(image: bar graph titled "Average steps per day bytype of pedometer provided")

3. Past participants

• Higher step counts
• More days logged

(image: chart titled "Average daily steps for each week past/first-time participants")

4. Age

• Higher step counts
• More days logged

• Subject attrition and fatigue
• Behavioral change
• Problems with reaching goals
• Benefits of personalized, incremental goals

(image: chart titled "Average steps per day by age")

• Make it year-round
• Provide a discussion board for participant interaction
• Being on a team made me more motivated to log my steps each day and increase my steps each week
• We loved the motivational emails – send more of them!

• This program has really opened my eyes as to how much activity I was REALLY doing. Not nearly enough. Now my activity level has increased dramatically, and I can feel the difference. It has also been contagious. Our office is now full of people wearing pedometers. Thanks for the inspiration!
  Leasa, Illinois
• This exercise of logging steps has been a wake up call to me. I now have a clearer perspective how sedentary my lifestyle has been sitting at my desk 10 hours/day! I now walk 40 minutes day instead of sitting for lunch! I don't think I can ever return to less than 10,000 steps per day! My energy level is higher than ever! Thank you!
  Estelle, Hawaii
• This has been great! I've been able to participate in a team event with my family even though we live all over the country!
  Kimberley, Virginia

• Greater availability and earlier publicity
• Increase the # of pedometers (budget)
• Encourage team membership
• Market to older women and past participants
• Be creative to keep women and girls motivated and moving!

• American Obesity Association. "AOA Fact Sheets: Obesity in the U.S." 2002. Available: www.obesity.org/subs/fastfacts/obesity_US.shtml. Accessed on June 19, 2006.
• Bassuk SS, Manson JE. Preventing Cardiovascular Disease in Women: How much physical activity is "good enough"? President's Council on Physical Fitness and Sports Research Digest 2004, 5(4): 1-9.
• Centers for Disease Control and Prevention. Overweight and Obesity: Home. Available: http://www.cdc.gov/nccdphp/dnpa/obesity. Accessed on June 19, 2006.
• Croteau KA. A Preliminary Study on the Impact of a Pedometer-based Intervention on Daily Steps. American Journal of Health Promotion 2004; 18(3): 217 – 20.
• Hultquist CN, Albright C, Thompson DL. Comparison of Walking Recommendations in Previously Inactive Women. Medicine and Science in Sports and Exercise 2005; 37(4):676-683.
• Institute of Medicine. Fact Sheet: Childhood Obesity in the United States: Facts and Figures. Institute of Medicine, National Academies of Science. Washington, DC: National Academies Press; September 2004.
• Manson JE, Hu FB, Rich-Edwards JW, Colditz GA, Stampfer MJ, Willett WC, Speizer FE, Hennekens CH. A Prospective Study of Walking as Compared with Vigorous Exercise in the Prevention of Coronary Heart Disease in Women. The New England Journal of Medicine 1999, 341(9):650-658.
• Marcus BH, Lewis BA. Physical Activity and The Stages of Motivational Readiness for Change Model. President's Council on Physical Fitness and Sports Research Digest 2003: 4(1):1-8.
• Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH. Physical Activity and Public Health. JAMA 1995; 273(5): 402-407.
• Prochaska JO, Velicer WF. Behavior Change: The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion 1998, 12 (1): 38–48.
• Pronk N. One Step at a Time – The 10,000 Steps Program Increases Physical Activity. The Permanente Journal 2003; 7(2): 35-36.

• Rodearmel SJ, Grotz VL, Goldsmith LA, Smith SM, Ogden LG, Wyatt HR, Moran JR, and Hill JO. America on the Move Family Study. Presented at the Pediatric Academic Societies Meeting in San Francisco, CA, May 2006.
• Rooney BR, Smalley K, Larson J, Havens S. Is Knowing Enough? Increasing Physical Activity by Wearing a Pedometer. Wisconsin Medical Journal 2003; 102(4): 31-36.
• Segar M, Jayaratne T, Hanlon J, Richardson CR. Fitting Fitness into Women's Lives: Effects of a Gender-tailored Physical Activity Intervention. Women's Health Issues 2002; 12 (6): 338-347.
• Speck BJ, Harrell JS. Maintaining Regular Physical Activity in Women. Journal of Cardiovascular Nursing 2003; 18(4): 282-291.
• Speck BJ, Looney SW. Self-Reported Physical Activity Validated by Pedometer: A Pilot Study. Public Health Nursing 2006; 23(1):88-94.
• Speck BJ, Looney SW. Effects of a Minimal Intervention to Increase Physical Activity in Women. Nursing Research 2001; 50(6): 374-378.
• Tudor-Locke C, Marshall S, and Vehige T. Pedometers and Public Health. Teleconference presented by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity; December 2005.
• Tudor-Locke C. Taking Steps Toward Increased Physical Activity: Using Pedometers to Measure and Motivate. President's Council on Physical Fitness and Sports Research Digest 2002; 3(17): 1-8.
• Tudor-Locke C, Myers AM, Bell RC, Harris SV, Rodger NW. Preliminary Outcome Evaluation of the First Step Program. Patient Education and Counseling 2002; 47: 23-28.
• Wilbur J, Chandler P, Miller AM. Measuring Adherence to a Women's Walking Program. Western Journal of Nursing Research 2001; 23(1): 8-32.
• Wyatt HR, Peters JC, Reed GW, Barry M, Hill JO. A Colorado Statewide Survey of Walking and Its Relation to Excessive Weight. Medicine and Science in Sports and Exercise 2005; 37(5): 724-730.

Michelle D. Hoersch, M.S.
Office on Women's Health - Region V
U.S. Department of Health and Human Services
233 N. Michigan Ave, Suite 1300
Chicago, IL  60601
312-353-8122
312-353-7800 fax
michelle.hoersch@hhs.gov

Thank you so much, I am really looking forward to this challenge! What a wonderful country to live in that my government cares so much about my health!

Robin, Texas