Self-Directed Walk With Ease Workplace Wellness Program — Montana, 2015–2017

Arthritis occurs in 27% of adults in Montana, among whom 50% have activity limitations, 16% have social participation restrictions, and 23% have severe joint pain attributable to arthritis (1). Physical activity is beneficial in managing arthritis symptoms and in preventing other chronic diseases (2). Walk With Ease is a 6-week evidence-based physical activity program recommended by CDC to increase physical activity and help improve arthritis symptoms (3). In 2015, Walk With Ease was added to an ongoing workplace wellness program for Montana state employees; the results for five outcomes (minutes spent walking, engaging in other physical activity [including swimming, bicycling, other aerobic equipment use, and other aerobic exercise], stretching, pain, and fatigue) were analyzed by the Montana Department of Public Health and Human Services and CDC. Outcomes at baseline (pretest), 6 weeks after the program (posttest), and 6 months later (follow-up) were analyzed by self-reported arthritis status at the time the participant enrolled in the program. Significant increases (p<0.05) in the mean number of minutes spent per week walking and engaging in other physical activity were observed among participants with and without arthritis at the 6-week posttest. Time spent stretching did not change significantly at posttest for either group. Mean pain levels among participants without arthritis increased significantly both at the 6-week posttest and 6-month follow-up; however, pain and fatigue decreased significantly at posttest and follow-up for participants with or without arthritis who began the program with moderate or severe pain and fatigue levels. The data from these analyses suggest that, as a component of a workplace wellness program, self-directed Walk With Ease might be effective in increasing physical activity not only among adults with arthritis, but also among persons without arthritis.

Walk With Ease is a graduated walking program that can be delivered in an instructor-led group setting or through a self-directed workbook. Self-directed Walk With Ease participants communicate with a trainer by e-mail and walk on their own, reporting activity weekly. The Montana Health Care and Benefits Division has included self-directed Walk With Ease since 2015 in the established state employee wellness program, offering a health insurance premium discount as a financial incentive to participate in and complete the program.

Identical assessment surveys were conducted at the beginning of the program (at which time participants self-reported whether they had arthritis), immediately after the 6-week program, and at a 6-month follow-up. The surveys included questions on time spent engaged in six physical activities as well as levels of pain and fatigue, ranked on a scale of 0–10. The six physical activity questions asked how much time during the past week participants performed 1) stretching or strengthening exercises, 2) walking for exercise, 3) swimming or aquatic exercise, 4) bicycling (including using a stationary bike), 5) exercise using aerobic equipment other than a stationary bike, and 6) other aerobic exercise. Responses for the amount of time that participants engaged in physical activity, including walking and stretching, per week were coded as 0 (none), 1 (<30 minutes), 2 (30–60 minutes), 3 (61–180 minutes), or 4 (>180 minutes); these were converted to minutes (0, 15, 45, 120, and 240), respectively, for the analysis, using the median of each range and four hours for the highest category. Time spent engaged in other physical activity was obtained from the total number of minutes spent swimming, bicycling, using other aerobic equipment, and engaging in other aerobic exercise.

To ascertain pain and fatigue, participants were asked how much pain or fatigue they experienced during the past week, on a scale from 0 (no pain or fatigue) to 10 (severe pain or fatigue), and were grouped into mild (1–3), moderate (4–6), and severe (7–10) categories for analysis. Data were analyzed for the period 2015–2017. Pretest, 6-week posttest, and 6-month follow-up data were compared using paired t-tests, with statistical significance defined as p<0.05.

The number of participants increased from 105 in 2015 to 1,343 in 2016, and to 1,622 in 2017. The majority of the 3,070 total participants during 2015–2017 were aged >45 years (75%), white (94%), women (72%), college graduates (63%), and with no disability (90%) or arthritis (76%) (Table 1). Among those participating in the program, 2,598 (85%) completed it by submitting weekly time spent engaged in physical activity during at least 4 of 6 weeks. Overall, 1,936 (63%) and 934 (30%) participants completed the 6-week posttest or 6-month follow-up survey, respectively. Among 743 (24%) persons with arthritis who started the program, 496 (67%) completed the 6-week posttest, and 279 (38%) provided 6-month follow-up data. Of the 2,327 (76%) persons without arthritis who started the program, the 6-week posttest and 6-month follow up was completed by 1,440 (62%) and 655 (28%) participants, respectively. (Table 1).

Among participants with and without arthritis, the mean number of minutes per week spent walking and engaged in other physical activity significantly increased at posttest. Overall, 73% of persons who walked <30 minutes per week at pretest increased to >60 minutes at posttest. Similarly, the majority of those starting at <30 minutes increased to >30 minutes at the 6-month follow-up (Figure). From a baseline of no walking, 97% were walking at 6 weeks, with 65% walking >60 minutes per week; 87% continued walking at the 6-month follow-up, with 35% walking >60 minutes per week. Among all participants who began the program walking 1–3 hours and >3 hours per week, 89% and 72%, respectively, maintained or increased their time spent walking at posttest. Mean number of minutes spent stretching did not change significantly at posttest. Mean walking and other physical activity did not change significantly at 6-month follow-up, except for a significant increase in walking when considering all participants. Stretching increased significantly at 6 months only for those with no arthritis (Table 2).

Among participants without arthritis, mean reported pain level increased significantly at 6 weeks and 6 months. Mean level of fatigue decreased significantly for both those with arthritis and no arthritis at 6 weeks, but increased significantly for those without arthritis at 6 months.

Among participants who started with moderate or severe pain and fatigue levels, mean pain and fatigue decreased significantly at posttest and 6-month follow-up among participants with and without arthritis (Table 2), whereas among participants starting the program with low levels of pain and fatigue, small but significant increases in mean pain and fatigue at the 6-week posttest and 6-month follow-up occurred for participants with and without arthritis (Table 2).

Corresponding author: Robin P. Silverstein, robin.silverstein@mt.gov, 406-444-0057.

¹Chronic Disease Prevention and Health Promotion Bureau, Montana Department of Public Health and Human Services; ²National Center for Chronic Disease Prevention and Health Promotion, CDC.

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* Participants without available information were as follows: age group, 100 (3.3%); sex, 121 (3.9%); education, 141 (4.6%), and less than high school graduate excluded for six (0.2%); race, 76 (2.5%); disability status, 303 (9.9%); baseline pain, 161 (5.2%); baseline fatigue, 157 (5.1%).
^† Based on self-reported hearing, seeing, walking, climbing stairs, or cognitive disability.

FIGURE. Percentage of participants, grouped by baseline walking, by number of minutes spent walking per week at the 6-week posttest and 6-month follow-up, among state employees participating in a self-directed Walk With Ease program — Montana, 2015–2017

* Increasing pain and fatigue were ranked on a 0–10 scale. All (0–10) is the nonstratified mean value. Mean values within subcategories of baseline pain and fatigue were defined as follows: zero = 0, mild = 1–3, moderate = 4–6, and severe = 7–10.
^† p-value <0.05
^§ Total minutes spent swimming, bicycling, using exercise equipment, or engaged in other aerobic exercise.