Feasibility of an automated, website walking program for university employees at the University of Toronto

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1 Feasibility of an automated, website walking program for university employees at the University of Toronto Project Background a web based walking program, is the brainchild of a group collectively known as the International Universities Walking Project (IUWP)(Gilson et al., 2009). The IUWP is comprised of internationally based physical activity and health promotion experts from the University of Queensland (Australia), Baylor University (USA), the University of Ulster (Ireland), the University of Social Welfare and Rehabilitation Sciences (Iran) and the University of Toronto. This unique initiative aims to implement and evaluate university wide walking interventions, targeting sedentary employees at institutions around the world. Recent research indicates that, Adults can meet public health guidelines on physical activity, but if they sit for prolonged periods, their metabolic health is compromised (Owen, Healy, Matthews & Dunstan, 2010). Research has also demonstrated that there are likely metabolic health benefits of regular interruptions to sitting time (Chastin & Granat, 2010). Unfortunately, the average office workday is characterized by long periods of sitting, with minimal bouts of even low intensity exercise. The team at the University of Queensland, led by Dr. Nick Gilson, received funding to develop a webbased walking program to challenge the sedentary workplace culture of many universities. After an initial pilot of the 12 week, multi phase program in Queensland, the website was made available to administrators at other IUWP institutions to pilot. At U of T, the program was headed by Dr. Guy Faulkner of the Exercise Psychology Unit (EPU in the Faculty of Physical Education and Health. How does the program work? Participants of Walk@Work tracked their daily steps across the week with a pedometer which was provided free of charge. The object for participants was to break up prolonged periods of sitting time over the work day, and to gradually increase their average daily step counts from their baseline levels. These goals were incremental, increasing as the program progressed, and individualized for each participant. A variety of tools were available on the website to assist participants in achieving their goals. These included Support Strategies (tips about how to build small bouts of walking into the workday); a Forum where participants from all university sites could interact with one another; links to maps of local walking routes; and a step count chart, which graphed the daily step counts of participants to create a visual representation of their progress. 1

2 What did we find? The primary research objective was to measure efficacy of the program. Secondary outcome measures were levels of interest, acceptability, and feasibility of the program. At the end of the 12 week program, the following results were found. Efficacy Step Count Data There were overall increases in step counts throughout the program. Significant increases in step counts were observed from Baseline through Phases 4 and 5. Key motivators for participants: Step count graph and target line to track progress toward goals Chance to improve physical health and fitness Opportunity for creating better balance in one s day Main barriers to achieving goals: Wintry weather and poor walking conditions of sidewalks/roads Busy schedules and project deadlines at work Changes in average daily step count from Baseline to end of program: Sedentary: Low Active: Somewhat Active: Active: +672 Highly Active: +67 Increases in step counts over the course of the program are greatest, on average, for those less active at baseline. However, rates of program completion were lowest among these less active participants. Overall step counts on weekdays were higher than on weekend days. Possible explanations are that the commute to work is a major component of daily physical activity, and that more weekend activity is low impact in nature and thus is not registered by the pedometer. 2

3 Quality of Life Data Overall, participants reported higher levels of vitality following participation in compared to beforehand, as measured by the SF 12 (Ware et al., 2002) questionnaire administered pre and post program. Other reported benefits gained through participating in Step counts provided an awareness of activity levels across the day, prompting increased efforts where necessary; The program enhanced knowledge of ways to add extra activity into the day; and Healthy new habits were facilitated, such as going for winter walks, or incorporating more active transport into the commute to work. Interest With a relatively hands off approach to advertising the program, via the Organizational Development and Learning Centre (University of Toronto) Listserv and two postings in the University of Toronto s ebulletin ( newsletter), the program attracted a great deal of interest. Number of participants: Number of people who expressed interest in the program: 130 Number of officially registered participants at start of program: 96 Number of people on wait list/ first to contact list for possible follow up program: 18 Program participation by age and gender: Mean age: 44 years (Range: years) Ratio of women to men: 92 to 4 Program participation by activity level at baseline (based on Tudor Locke, 2010): 3

4 Most common reasons for taking part: Organized programs such as offer the motivation needed to get active Improve physical health (e.g. increase fitness, lose weight, help alleviate chronic pain) Long stretches of sitting time at work are unhealthy and need to be addressed Enjoy the opportunity to be involved in U of T research Acceptability Researchers were interested in whether participants would maintain their involvement throughout the program. 55 of 96 initial participants completed the full 12 weeks (57.3% of those who signed up). Length of program involvement: Active participants had the highest completion rate (84.6%), followed by Somewhat Active (72.4%), Highly Active (66.7%) and Low Active (63%). Sedentary participants had the highest rate of program drop out, with less than one third completing the full 12 weeks. Most commonly used features of the Walk@Work website: Many participants admitted to not regularly using all of the features of the website. When asked which features they used most often, nearly every respondent mentioned the step count chart; the second most visited area of the site was the Forum, followed by Support Strategies. Few participants utilized the maps of walking routes. 4

5 Feasibility Due to the web based, individualized nature of the program, a large number of participants were accommodated with minimal staffing requirements. One administrator worked full time for the recruitment and briefing of participants prior to the start of the program, and was required to monitor the program on an ongoing basis once it was underway. The greatest setback to program efficiency was technical difficulties related to the website. There were delays in addressing many of these issues, as the website and its technical support staff were based in Queensland. Technical issues can be dealt with much more proficiently in the future if the website is locally designed and operated, using the pilot website as a model. However, this requires funding to manage the cost of website development and technical support staff. Another limiting factor in the program was a necessary cap on enrollment, due to the number of available pedometers. Program capacity could be substantially increased, with minimal increases in staffing costs, with funding for the purchase of more pedometers. Next Steps Our positive assessments of program efficacy, interest, acceptability and feasibility, in addition to plenty of encouraging feedback from participants, have proven Walk@Work to be a potentially effective program. However, several issues remain to be addressed, including: Are increases in daily step counts maintained after the program has ended? How can efficacy be improved such that more participants are reaching the recommended 10,000 steps/day? Can rates of program completion be improved, especially among more sedentary participants, with enhanced website design, features and functionality? How can the program be designed and advertised in such a way to encourage more male participants? Alternatively, what variations of this program will appeal more to men? The opportunity to run an improved version of the program, building on what we have learned this time around, will rely upon securing funding and the continued support of the university community. I would close by thanking you for this opportunity; the program has a worthwhile and important goal, and I hope it is something that the university will continue to promote and offer, for the benefit of its employees. (Walk@Work participant) 5

6 References Chastin SF & Granat MH. (2010). Methods for objective measure, quantification and analysis of sedentary behavior and inactivity. Gait Posture, 31(1): Gilson ND, Brown WJ, Faulkner G, McKenna J, Murphy M, Pringle A, Proper K, Puig Ribera A and Stathis A (2009). The International Universities Walking Project: Development of a Framework for Workplace Intervention using the Delphi Technique. Journal of Physical Activity and Health, 6(4), Owen N, Healy GN, Matthews CE and Dunstan DW. (2010). Too much sitting: The population health science of sedentary behaviour. Exercise and Sport Science Reviews, 38 (3): Tudor Locke C. (2010). Steps to better cardiovascular health: How many steps does it take to achieve good health and how confident are we in this number? Curr. Cardio. Risk. Rep., 4, Ware, JE, Jr., Kosinski, M, Turner Bowker, DM, Gandek, B. SF 12v2 (2002). How to Score Version 2 of the SF 12 Health Survey (With a Supplement Documenting Version 1). Lincoln, RI: Quality Metric Incorporated. 6