Abstract
The First Step Program (FSP) is a physical activity intervention for individuals with type 2 diabetes that incorporates the use of a pedometer, group meetings, individual goal-setting, self-monitoring and feedback. Previous studies in a single diabetes education center (DEC) have documented that the FSP is feasible, practical and acceptable to participants and deliverers and effective in increasing physical activity (defined as pedometer-determined steps/day). PURPOSE To determine whether the FSP is effective in increasing physical activity and improving health-related outcomes when disseminated through DEC's across Canada. METHODS Trained diabetes educators from 7 DEC's across Canada screened and recruited participants into locally facilitated FSP's. Assessments of body mass index (BMI), resting heart rate and blood pressure, waist girth, and steps/day (over 3 consecutive days; blinded protocol) were completed at baseline and 16 weeks. RESULTS Eighty-six individuals (67% female) with type 2 diabetes (age 54±7 years; BMI 36.2±7.6 kg/m2) completed the FSP. Participants self-reported 52±73 months since diagnosis. Treatment included oral hypoglycemic medications (59%), diet modification (28%), or insulin (13%). Steps/day increased from 4407±1903 at baseline to 8862±3968 (p < 0.05) after the 16-week FSP (equivalent to > 30 minutes extra walking per day). By 16 weeks there were decreases (all p < 0.05) in BMI (36.2±7.6 kg/m2 vs. 35.6±7.4 kg/m2), waist girth (111.2±15.6 cm vs. 109.3±15.7 cm), and systolic (133±17 mmHg vs. 128±15 mmHg) and diastolic (80±11 mmHg vs. 77±9 mmHg) blood pressure; resting heart rate did not change significantly. CONCLUSION Substantial within-group increases in physical activity were accompanied by positive changes in health-related outcomes. The FSP can be effectively disseminated through geographically distributed DEC's. Supported by the Canadian Diabetes Association (John J. Stevenson Grant) and Health Canada (Canadian Diabetes Strategy Grant).
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