CDC-inspired fitness program sets goal of thousands of participants
Incentive-based offering seeks movement through stages of change
If you’re going to dream, you may as well dream big. And the dream of Bruce Leonard, MPH, CHES, is truly on the grand scale. Leonard, a physical activity interventionist with the Atlanta-based Centers for Disease Control and Prevention (CDC), is spearheading a campaign whose ultimate goal is to get employees at thousands of companies across the country to participate in an incentive-based work site fitness program. His current, more "modest" goal is to get 2,000 companies in Atlanta to participate in a community-based intervention by spring 2000.
Leonard has been involved in behavior change programming for 23 years, including an early effort aimed at getting drug addicts to start a running program. But this current undertaking actually got its start in 1995, when as a CDC employee he was assigned as a public health advisor to the Georgia Division of Public Health.
Leonard helped develop the program, named The Lifestyle Challenge. The incentive-based program was 10 weeks long, as it is today, but in its original form the CDC "prescribed" the exercise contract: three days of aerobic activity 20 minutes a day for nine out of 10 weeks. Today, employees write their own contracts.
Report brings changes
The Surgeon General’s report on physical fitness, released in 1996, brought about a paradigm change in the program, Leonard recalls. "We came up with goal-setting and evaluation components; we began to use the stages of change model; and included credit for more moderate exercise," he says.
Then, in 1996, Leonard helped launch the CDC’s 50th anniversary Director’s Physical Activity Challenge. "We realized that one of the critical pieces to our success was to get management support," he explains. "This program gave the director more ownership, and he became one of its champions."
Nearly 65% of the CDC’s 5,822 employees participated in the program. Of those employees, 80.1% reached their goals at the end of the 50-day period; 86% of those in the "contemplation" stage of change moved forward, and 33% in the "action" stage moved to maintenance.
Encouraged by these results, Leonard then exported the program to state health departments in New York and Maryland in 1997. "We realized that with minimal support, work sites could take the written descriptions of the CDC program, along with evaluation forms and instruments from the director’s challenge, and succeed," he notes.
New York got 40% of it 8,000 employees to participate. Maryland exported its program to 100 work sites, and reported in raw numbers as opposed to percentages.
Expanding the reach
The next phase of the project evolved in 1998, when Leonard was appointed project director for the National Coalition for Promoting Physical Activity (NCPPA) — whose members include the American Heart Association, the American College of Sports Medicine, the American Cancer Society, the Association for Worksite Health Promotion, the National Governors Council for Physical Fitness and Sports, and the American Alliance for Health, Physical Education, Recreation and Dance (school-based health educators). "I sold them on the idea that they should have a specific program they could endorse and promote," he says.
The CDC provided the coalition with a $30,000 grant to develop an implementation manual, which was written by the Dallas-based Cooper Institute for Aerobics Research. Then, pilot sites were selected — large corporations that have significant experience in health promotion, schools, health departments, and other government facilities. Corporate pilot sites in the program, "March into May," included Applied Materials, Santa Clara, CA; Home Depot (three sites); Chevron, Houston; Union Pacific, Omaha, NE; Light and Power Electric, Fort Collins, CO; CitiCorp (three sites); Fairchild/Semiconductor, Portland, ME; Brookhaven National Labs, Upton, NY; New Jersey-based Medifit Corporate Services; and Houston-based Enron.
"It went great," Leonard recalls. "The average participation rate was 43%, and the range was from 98% to about 15%." (For more details on the program’s results, see the chart on p. 87.)
Why are the rates so high? "We specifically require that management is involved, and that an executive officer participates and serves on a team," Leonard explains. "Also, there is one peer leader for every 25 employees, which really creates a connection with people."
Employees were motivated when they joined the program, again at the halfway point, and finally at the end. There were also incentives offered for team leaders if their team achieved at least 50% participation.
Data collection is built into the program, Leonard explains, because in order to join the program the employee must set their goal and identify their baseline stage of change. "At the end, you need the final point accumulation and the exit stage of change. A lot of health promotion programs don’t link evaluation to incentives in this way," notes Leonard. The 38 pilot sites also conducted evaluations that included surveys for participants, captains, management and site coordinators.
Leonard’s master plan unfolds in five stages. The first, developing and fine-tuning the intervention, took place in 1995-97. The second stage was the 1998 pilot program. Now, comes Atlanta.
The program, "Take Charge," is already well under way and achieving impressive results. "Our program officially ended June 20, so we’re still tallying results; but at midpoint, we had about 50% participation," reports Paul Boehning, workplace wellness coordinator for the Georgia regional office of Kaiser Permanente, which has about 2,400 employees. "Usually, programs like this see participation in the 30s — or even lower."
The keys to success explained
Some of the keys to success? "For one, the employees are trying to achieve their own goals, not goals set by the program itself," he explains. "Also, there hasn’t been a program like this for our employees in the past."
The team structure and the facility atmosphere at Kaiser helped, too. "We set up the teams so our 10 different facilities were competing against one another," says Boehning. "At midpoint, one facility had as high as 88% participation, and five were above 55%."
The employees earned points based on moderate to vigorous levels of activity; they had a wide range of exercise options, derived originally from the Surgeon General’s report and now incorporated into the CDC program. "We got feedback on exercises from walking to jogging to riding bikes — even housework," Boehning says. "You got the same points for all of them, but they had to be at least moderate exercise."
As an offshoot of the program, Boehning has formed an employee work site council to go through the data and identify the employee population’s greatest needs. "This program gave me a great opportunity to piggyback," he says.
The American Cancer Society’s national office, also in Atlanta, is in its second round with the program, having participated in the 1998 pilot program as well.
"We had about 300 participants out of 500 in 1998," recalls Alexis Williams, MPH, CHES, project assistant for nutrition and physical activity promotion. "People wanted to support their teams and be a part of the team. The incentives helped, too." Incentives at the National Cancer Society included T-shirts, hats, and movie passes.
The program is tied into the society’s "Relay for Life" campaign, so it is given the name "Active for Life." The 10 weeks of the fitness program lead up to the relay, a community cancer control event in which people on teams spend 24 hours walking around a track.
Williams is glad to be doing the program again, because she admits that employees tended to backslide after the last one.
This year’s program is also drawing about 75% participation, and includes satellite offices in Washington, DC, and Austin, TX, and a media office in New York City. "People can set their own goals; it’s easier to work towards something they can achieve," says Williams, citing the main causes for the high participation rate. "And the fact that people have to keep track of their activity is very important. They didn’t realize how inactive they were, and this really motivated them." Next year, she says, her program will seek to partner with local corporations.
Sometimes numbers don’t tell the whole story. At Georgia State University in Atlanta, there were 50 participants out of a total of about 2,000. "But I was happy to get the 50," says Debbie Rupp, MeD, associate director at Georgia State’s Center for Sports Medicine, Science & Technology.
"This campus really presents a challenge. Schedules are already packed, and we still don’t have a campus where kids hang out," she explains.
Rupp used graduate assistants and staff members of the fitness center as team captains. "We were very pleased," she says. "Those who followed through moved in a positive direction through the stages of change."
Rupp says the fact that people "didn’t necessarily have to jog three days a week or do heavy weightlifting" was a real plus. "Many of them said, Oh, I get credit for this?’" she recalls.
Moderate activity can include: ballroom and other types of dancing; playing Frisbee; archery; playing on school playground equipment; playing musical instruments or singing while actively moving, grocery shopping with a grocery cart, and so forth.
Looking ahead
This fall, Leonard plans to expand the Atlanta program by launching pilot programs at "change agent" work sites — volunteer organizations, health insurance companies, universities, schools, hospitals, and the media.
"We have two large coalitions that have embraced the program and have ownership — the Georgia Governor’s Council for Physical Fitness and Sports, and the Georgia Coalition for Nutrition Education," Leonard explains. "Then, they will diffuse the program through district health departments. Fortunately, most community health coalitions have recognized that cardiovascular disease is an extremely important issue, and they want to address it through physical activity and nutrition education. And, we have convinced them that this program is the vehicle."
In each district and county, partnerships are being developed with chambers of commerce, the United Way, The Atlanta Journal-Constitution, large hospitals, the American Heart Association and the American Cancer Society, and managed care organizations. "We’ve also received some funding from Merck to host CEO breakfasts in each of these districts," says Leonard. "There will be trainings every other week on how to implement Take Charge, and all the materials they need. If a company wants to do it, we’ll train them for free." The final phase? A media campaign to spread awareness.
And that’s how Leonard plans to get 2,000 Atlanta companies involved by next spring. After that? "The fourth stage will be a statewide program, and the fifth will be national," he says. "We want this to culminate as a national behavior change campaign."
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