for Walking with Pedometer
Version 2/7/12
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
Key idea
Sample statements
Why this Rx for Walking?
[reinforce PCP’s reason for Rx]
“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.”
[give concrete example of
benefits]
“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]
“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.”
[reinforce active self-care
mindset]
“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 “Let’s talk now about how much extra walking [PCP] has prescribed
that will be explained]
and the schedule s/he has set out for doing it."
[use metaphor of exercise as
medicine]
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.”
[reinforce active self-care]
“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!”
Developed by: Linda S. Gottfredson, PhD, School of Education, University of Delaware, Kathy Stroh, MS, RD, CDE, Diabetes
Page 1 of 6
Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12)
for Walking with Pedometer
Version 2/7/12
“The [PCP] wants you to do the extra walking [4] days each week.”
[1. Rx frequency —number of
“doses” of walking [4] each
week]
[2. Rx amount —number of
minutes [20] in a “dose”]
“It doesn’t matter which [4] days you pick, as long as you do [4] days
sometime during the week.
“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
[introduce idea of modifications, two [10]- minute walks that day instead. If that’s still too much, start
when required]
out with 5 minutes at a time. The most important thing is just to start
getting into the habit of walking.”
[3. Rx intensity —number of
steps during minutes walked]
.
[use metaphor to help explain
concept of intensity]
"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."
[explain how Rx specifies
intensity]
"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."
Developed by: Linda S. Gottfredson, PhD, School of Education, University of Delaware, Kathy Stroh, MS, RD, CDE, Diabetes
Page 2 of 6
Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12)
for Walking with Pedometer
Version 2/7/12
[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."
[Confirm understanding in some
[No sample—do as appropriate, depending on patient]
way]
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]
“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
[explain proper placement to get
your pocket. It should also be attached at the hip over one of your
accurate recording]
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."
Developed by: Linda S. Gottfredson, PhD, School of Education, University of Delaware, Kathy Stroh, MS, RD, CDE, Diabetes
Page 3 of 6
Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12)
for Walking with Pedometer
Version 2/7/12
[instruct how to prepare
properly for walk]
[instruct to take watch]
[instruct how to set finish time]
“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
[instruct to walk at comfortable
worry whether you’ll end up walking less than [1,000] steps—or
speed]
more than that. Just enjoy the walk.”
[instruct to look at number of
steps taken at finish time]
“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
[instruct to compare outcome to less than [1,000], then try to walk a bit faster the next day. Before too
goal & advise patience]
many days, your pedometer will be giving you good news—you will
be getting closer to [1,000] steps within [20] minutes.”
"Write down the number of steps you walked. There is a chart on
[instruct how & where to record the back of the prescription. It has spaces to record the steps you
steps & minutes walked]
took each day. Also write down the number of the minutes it took
you to walk those steps."
[explain why record is useful]
"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."
[Confirm understanding in some
[No sample—do as appropriate, depending on patient]
way]
How does patient use results to monitor & adjust walking?
Developed by: Linda S. Gottfredson, PhD, School of Education, University of Delaware, Kathy Stroh, MS, RD, CDE, Diabetes
Page 4 of 6
Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12)
for Walking with Pedometer
Version 2/7/12
[if cannot walk prescribed
minutes]
“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!”
[if cannot walk prescribed steps
in prescribed time (that is, at
prescribed intensity)]
"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 meets prescribed time &
intensity]
“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).”
“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
For Graduated RX only
you can do that for [4] days a week, for two weeks, work up to
[2,000] steps in [20] minutes.”
[Confirm understanding in some
[No sample—do as appropriate, depending on patient]
way]
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."
“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
[prepare patient to phase in
do you much good. What you want to aim for is “moderate intensity”
walking regimen based on bodily
walking. So how do you know when you are walking at moderate
feedback]
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.”
Developed by: Linda S. Gottfredson, PhD, School of Education, University of Delaware, Kathy Stroh, MS, RD, CDE, Diabetes
Page 5 of 6
Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12)
for Walking with Pedometer
Version 2/7/12
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]
“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.”
[give example of health
problems where they might
want to reduce the intensity of
their walking for a while]
“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.”
[give other advice & cautions
specific to patient's condition]
[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.]
[Confirm understanding in some
[No sample—do as appropriate, depending on patient]
way]
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?
“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
[encourage self-assessment and steps it is to the end of the street, and so on. It really opened my
self-monitoring]
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.”
Schedule follow-up contact?
[As appropriate for patient—but signal that important to you to find out
how they are doing with their Rx walking]
PCP record keeping?
[Record in patient chart that prescription was given and explained]
Developed by: Linda S. Gottfredson, PhD, School of Education, University of Delaware, Kathy Stroh, MS, RD, CDE, Diabetes
Page 6 of 6
Prevention and Control Program, Delaware Division of Public Health (12/08, 2/12)