Key idea Step-by-Step Guide for Explaining Rx & Pedometer Note: Can vary order of sections and expand different points to fit each patient's particular needs and circumstances. Script is illustrated using the sample Basic Rx & modifications noted for Graduated Rx Why this Rx for Walking? Sample statements [reinforce PCP s reason for Rx] [give concrete example of benefits] The aim is to get you walking more, because that will improve your health. Walking is like medicine, and it s especially important for people with [specify their diagnosis]. That s why [PCP ] has prescribed it for you. For you in particular, it will (name benefits based on their particular condition). [repeat PCP s key point about the Rx] As [PCP] said, the prescription is for walking extra steps during the week, in addition to what you already do. What are patient s current walking habits? [determine where, when, and how much the patient currently walks] [reinforce active self-care mindset] Tell me about the walking you do now. It can be any kind of walking: for example, when you are doing errands, at work, visiting friends, and so on. This information is important, because later we'll talk about the kinds of extra walking that would fit best into your life and be most enjoyable. That might take some experimenting on your part. How does the Rx work? [ dosing schedule 4 elements that will be explained] Let s talk now about how much extra walking [PCP] has prescribed and the schedule s/he has set out for doing it." [use metaphor of exercise as medicine] [reinforce active self-care] It s really just like any other prescription: but instead of telling you how many pills to take and when to take them, it tells you how many extra steps to take, and how often to do so. And like any other prescription, we re not going to be feeding you the pills each day. That s your job. My job is to help you think of ways to make them tasty enough that you might even like taking them! Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12) Page 1 of 6
[1. Rx frequency number of doses of walking [4] each week] The [PCP] wants you to do the extra walking [4] days each week. It doesn t matter which [4] days you pick, as long as you do [4] days sometime during the week. [2. Rx amount number of minutes [20] in a dose ] [introduce idea of modifications, when required] [3. Rx intensity number of steps during minutes walked]. [use metaphor to help explain concept of intensity] [explain how Rx specifies intensity] The prescription is for [20] minutes of extra walking each day. So that s an extra [20] minutes, [4] days a week. If you can t do [20] minutes at one time at first, don t worry. Just do two [10]- minute walks that day instead. If that s still too much, start out with 5 minutes at a time. The most important thing is just to start getting into the habit of walking. "To be good medicine, walking needs to get your heart working a bit harder. If you spend your prescribed minutes walking as slowly as a snail, it won't do you much good. And it d be really boring besides." "That's why the Rx gives you a certain number of steps to take--in your case, [1,000 steps]--in [20] minutes. That's about [1.5] miles per hour. [explain how pedometer quantifies goals & progress toward them] "A pedometer counts how many steps you walk. It helps us set clear goals and to see--to quantify--progress toward meeting them. What matters is seeing progress, no matter how small." For Graduated RX only That s the first week. The following week s/he wants you to walk more steps not [1,000] like before, but [1,500] during [20] minutes. This means that you will have to walk faster. That s the whole idea to get your heart and legs working a bit harder. They ve gotten ready for this if you ve been able to walk the [1,000] steps in [20] minutes. You will do this for two weeks. If it takes longer than two weeks, that s OK. We ll talk about that in a minute. What matters is making progress toward your goal, not how soon you meet it. "The Rx then takes you to a third level: [2000 steps] in [20 minutes]. This is about [3] miles an hour." Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12) Page 2 of 6
[review key points of Rx] [4. Rx duration indefinite] To review, The prescription has you walk [20] minutes a day, [4] days every week. Remember, this is [20] minutes of extra walking added to what you already do." People who take medicine for chronic conditions such as [specify theirs, if appropriate] usually have to take it for the rest of their lives, if they want to stay healthy as possible. The same is true for getting exercise. It works only as long as you keep doing it. That s why your prescription says to keep doing the extra walking even after you reach the speed prescribed." What does a pedometer do? [open it] [now close it again] [shake it up and down, then open it up again to show that number has increased] [demonstrate that it records steps taken] The pedometer helps you keep track of how much you are walking. If you plan to walk 1000 steps, it will tell you when you reach 1000 steps. It does this by automatically counting how many steps you take when you are wearing it. See, here is where it records the number of steps. Right now it says steps. If I go walking, it will record how many steps I took. Here, let me show you. How is the pedometer worn? [demonstrate how to attach pedometer] [explain proper placement to get accurate recording] You attach it like this to your belt/pants/skirt. Be careful when you put on your coat, go to the bathroom, or pick something up. That s when people accidentally knock them off and lose them. The pedometer has to be level in order for to count your steps correctly. It can t be worn sideways, or upside-down, or carried in your pocket. It should also be attached at the hip over one of your legs. It has to be over a leg to count how many times you move your leg up and down. It s a kind of motion detector. How does patient use pedometer on Rx walk? [demonstrate resetting pedometer to zero before Rx walk] Here s what you do with the pedometer when you re ready to do your prescribed walks: Open it up, Press the button to make the number go back to zero, Close it, Put it on your belt." Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12) Page 3 of 6
[instruct how to prepare properly for walk] [instruct to take watch] [instruct how to set finish time] [instruct to walk at comfortable speed] [instruct to look at number of steps taken at finish time] [instruct to compare outcome to goal & advise patience] Here s how to use the pedometer to follow the [PCP s] prescription. "First, decide where you are going to walk. Make sure you are wearing comfortable shoes and your pedometer! Take a water bottle if you think you will get thirsty. Consider walking with a friend or relative. Walking can be doubly rewarding and seem easier if you do." You need to time your walk ([20] minutes), so wear a watch. If you don t have one, perhaps you can walk with someone who does. Do you have a way to time your walks? When you are ready to actually start your walk, figure out what time it will be when you cross the [20] -minute finish line. If you are starting at 2:05 in the afternoon, add [20] minutes, and your finish line will be at [2:25]. That is when you will check your pedometer your pedometer check-point. For your first walk, walk at a speed that is comfortable for you. Don t worry whether you ll end up walking less than [1,000] steps or more than that. Just enjoy the walk. When you cross the [20] -minute finish line, open the pedometer. How many steps does it say you walked?" "This is your starting point in walking with the pedometer. If it was less than [1,000], then try to walk a bit faster the next day. Before too many days, your pedometer will be giving you good news you will be getting closer to [1,000] steps within [20] minutes. [instruct how & where to record steps & minutes walked] [explain why record is useful] "Write down the number of steps you walked. There is a chart on the back of the prescription. It has spaces to record the steps you took each day. Also write down the number of the minutes it took you to walk those steps." "Recording this information after every walk will help you keep track of your progress. It will also help your doctor decide how much walking to prescribe at your next visit." How does patient use results to monitor & adjust walking? Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12) Page 4 of 6
[if cannot walk prescribed minutes] [if cannot walk prescribed steps in prescribed time (that is, at prescribed intensity)] [if meets prescribed time & intensity] As I said before, don t worry if you can t go the whole [20] minutes the first time. How many minutes were you able to do? Next time you walk, see if you can add a few more minutes. Every minute you add is proof that the walks are working! "Once you can meet the goal for number of minutes walked, then pick up your speed a bit. This will increase the number of steps you take and the distance you cover." If you are able to take at least [1,000] steps during the [20] minutes, congratulations! You are off to a fast start. Try to keep up that pace every day you walk (which is [4] days of Rx walking). For Graduated RX only Once you are able to do [1,000] steps in [20] minutes for a week, pick up your speed. Work up to [1,500] steps in [20] minutes. Once you can do that for [4] days a week, for two weeks, work up to [2,000] steps in [20] minutes. How does patient modify Rx if too demanding for current fitness level? [signal need to use judgment to safely & comfortably phase in walking regimen] As I just indicated, you may need to phase in your walking more slowly than the prescription shows. That is very important." [prepare patient to phase in walking regimen based on bodily feedback] You may find that the prescription calls for more intense walking than you can handle at first. Or, it may be too easy and therefore not do you much good. What you want to aim for is moderate intensity walking. So how do you know when you are walking at moderate intensity? Easy. You just listen to what your body tells you when you are walking. Here is how. [explain meaning of moderate intensity physical activity--the "talk test"] It s often called the talk test. When you are exercising at moderate intensity, you can still talk but you can t sing. Your heart will be beating faster than usual, and you ll be huffing and puffing too much to sing. You will know when you have gone beyond moderate intensity into high intensity exercise when you can only say a few words without stopping to catch your breath. You don t need to work that hard to get the benefits of walking. But it s good if you can get up to moderate intensity. You will know you are benefiting from the walking when it gets easier to walk the same number of steps at the same pace. Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12) Page 5 of 6
For Graduated Rx only [explain how to maintain moderate intensity as fitness improves] That good news is your cue to increase how much you walk or how fast you walk. Remember that the benefits come from walking at a rate that is moderately intense for you. That s why you need to pay attention to your body. If it says, You can sing, so this is getting too easy,' then it's time to pick up the pace and get huffing-and-puffing again. [give caution when to stop an episode of walking] [give example of health problems where they might want to reduce the intensity of their walking for a while] [give other advice & cautions specific to patient's condition] Listen to your body. If you ever start feeling very out of breath, dizzy, faint, nauseous or have pain, don t walk any further that day. Sometimes your body will tell you to slow down for a few days, for example, when you haven t been feeling well. If that lasts too long or if you feel worse and worse, you need to see your doctor. [as appropriate for the patient s particular medical conditions. For instance, the December 2010 Joint Position Statement of the American College of Sports Medicine and the American Diabetes Association Exercise and Type 2 Diabetes provides specific guidance for various conditions associated with diabetes.] Can the patient formulate specific plans for Rx walking? [return to discussion of how to fit Rx to patient's interests and life style] [No samples do as appropriate for specific patient. The more that walking can be made a social affair or part of their regular schedule, the better. What types and timing of walks might they enjoy? How can they make walks a social occasion?] Other uses for pedometer? [encourage self-assessment and self-monitoring] Schedule follow-up contact? PCP record keeping? You are free to use the pedometer at other times of the day too, if you want. Many people do. For example, you might want to see how much walking you usually do in a whole day. Or maybe how many steps it is to the end of the street, and so on. It really opened my eyes when I started looking at how much actually, how little I was walking in a typical day. Some people say it helps keep them honest. They say it s harder to fool themselves about how much exercise they re actually getting. [As appropriate for patient but signal that important to you to find out how they are doing with their Rx walking] [Record in patient chart that prescription was given and explained] Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12) Page 6 of 6