Promoting physical activity in the community:
The case of 10,000 Steps Rockhampton

by Kerry Mummery

When it comes to health and human behaviour there are a few things we know. First, physical activity is good for you. Second, smoking is bad for you. The rest of this brief paper is about the former. Along the way I will refer to the 10,000 Steps Rockhampton project -- currently the largest community-based physical activity promotion project in Australia -- as an example of application of currently perceived best practice.

It seems strange that early in the 21st Century we seem to be just coming to terms with the benefits of physical activity from a health and well-being perspective. Strange indeed since, somewhere around 400 BC, Hippocrates noted: “Health results from a harmony between food and exercise."

Unfortunately, as a race -- the human race -- we have a habit of not taking good advice. The evidence supporting the benefits of physical activity is strong. In fact the recent U.S. Department of Health and Human Services report “Physical Activity: Fundamental to Preventing Disease” emphasises the critical importance of regular physical activity, fitness and exercise for health and well-being of people of all ages (U.S. Department of Health and Human Services, 2002).

Over the past few decades the terminology surrounding physical activity, fitness and health has evolved, changing with mounting evidence and changing focus from individual capacity to population-based health. Physical activity, by definition, is any movement involving skeletal muscles. Since the use of small muscle groups – such as those that guide your television remote control – involves negligible energy expenditure, the definition is usually restricted to the use of large muscle groups involved in activities such as walking or cycling. Since the mid-1990s the focus has been on physical activity, instead of the narrower, more restricted term ‘exercise’. This seeming change in terminology reflects a change in focus from individual fitness – a relative capacity, to population health – a continuum of physical, mental and social well-being that comprises more than simply the absence of disease.

Acknowledging the importance of physical activity in the health of Queenslanders, Health Promotion Queensland (an arm of Queensland Health) sought proposals for a project to support a multi-strategy community-based health promotion project in July 2000. A team from The University of Queensland, Central Queensland University, QUT, the National Heart Foundation, Sports Medicine Australia and the community of Rockhampton submitted a proposal that secured project funding for the City of Rockhampton. Subsequently named 10,000 Steps Rockhampton, it focuses on sedentary adults, including older people, and the unemployed. It has three specific objectives.

First, it aims to create sustainable strategies for promoting physical activity at the local level by
• raising community awareness of the health benefits of moderate physical activity;
• strengthening the capacity of GPs and other health professionals to promote physical activity; and
• strengthening the capacity of the community to provide improved opportunities, social support, policies and environments for physical activity.
• strengthening the capacity of individuals to be more active, by addressing modifiable individual, social and environmental determinants of (in)activity.

Second, it aims to establish an evaluation framework to determine
• the effectiveness of the overall program, using valid and reliable outcome measures of physical activity and its major determinants, and
• the success of each of the intervention strategies in terms of engaging community partners, developing supportive policies and environments, and developing initiatives suggested by community members.

Its third objective is to ensure widespread dissemination of the findings to the community and State, national and international stakeholders so that the lessons learned from the project could be applied in other communities

From a marketing perspective it was decided that it should promote a very specific message. Unlike existing campaigns which utilise a relatively generic movement message, such as ‘Active Australia’ (Australia), Active for Life (New Zealand), Active Living (Canada), and 'Active for Life' (England), it was decided that the project would have a more prescriptive and focused message as its title. 10,000 Steps Rockhampton was selected with the intent to convey essential messages quickly relating to the quantification of accumulated daily movement, with a specific focus on walking.

The use and promotion of step-counting pedometers within the community as a means to monitor accumulated daily activity is the visible tip of the project iceberg. Use of pedometers in the measurement of physical activity is not new. The reliability and validity of the pedometer as a tool for assessing physical activity has been heavily researched (Bassett et al., 1996, Bassett et al., 2000, Freedson and Miller, 2000, Hendelman et al., 2000, Saris and Binkhorst, 1977). Its use as a motivational tool allowing for individual goal setting in terms of accumulated movement while simultaneously acting as a self-monitoring tool is, however, a relatively novel approach (Lindberg, 2000).

Early research using pedometers as a promotional/feedback tool suggested that accumulating 10,000 steps per day is comparable to meeting general physical activity guidelines (Hatano, 1993) and that this target can make a positive contribution to health (Yamanouchi et al., 1995). Hatano found that by walking 10,000 steps -- the equivalent of approximately 8 kilometres -- expends approximately 150kcal. More recent studies have shown health benefits associated with walking 10,000 steps or more per day (Iwane et al., 2000, Tudor-Locke and Myers, 2001).

Evidence is accumulating to support 10,000 steps per day target as an achievable target in the general population. Bassett (2000) states that, generally, physically active persons take at least 10,000 steps per day, moderately active persons between 5,000 and 7, 000 steps and physically inactive people between 2,000 and 4,000 steps per day. Tudor-Locke and Myers (2001) identify higher step-counts that take into consideration age, sex and disability. Specifically, they suggest step counts of 7,000 to 13,000 steps per day for healthy adults; 6,000 to 8,500 steps per day for healthy older adults and approximately 3,500 to 5,500 steps per day for people with disabilities and/or chronic diseases. Welk et al., (Welk et al., 2000) reported average daily step counts of 11,603 in a group of adult men and women when structured vigorous activity was included in daily activity, and 8265 when only light and moderate activity were measured, suggesting the 10,000 step target achievable. Wilde, Sidman and Corbin (2001) (Wilde et al., 2001) suggest that for many people the 10,000-step count is appropriate, but acknowledge that not all populations are ‘equally inactive’, and some groups will need step counts to be tailored to their current lifestyles.

The focus on the accumulation of physical activity, measured across the day by means of a pedometer, is the public face of the project. Walking is the focus, accumulation of movement is the message, but the majority of the project effort is not in full view of the public as work aims to address the multiple constraints, at the individual, environmental and community level through a multi-strategy approach.

There is little doubt that physical activity is one of health’s “best buys” in terms of the cost-benefit ratio for health and well-being. With the demise of contagious disease and the subsequent rise in chronic, lifestyle-based disease as the main health problems in our society, we are suffering the ills of a relatively affluent lifestyle. Gradual reduction over time in the total amount of energy expended across our daily habitual patterns has led to a veritable epidemic of sedentary diseases such as cardiovascular disease and diabetes. Current health promotion approaches acknowledge the need for multi-strategy approaches to the promotion of physically active lifestyles.

The 10,000 Steps Rockhampton Project is one attempt to draw together a multi-strategy health-related physical activity promotion project at the whole-of-community level. Initial uptake of the project in the community has been very positive, but formal impact analysis evaluating the effects of individual and collective program approaches is yet to be completed.

References
Bassett, D. R., Jr., Ainsworth, B. E., Leggett, S. R., Mathien, C. A., Main, J. A., Hunter, D. C. and Duncan, G. E. (1996) Med Sci Sports Exerc, 28, 1071-7.
Bassett, D. R., Jr., Ainsworth, B. E., Swartz, A. M., Strath, S. J., O'Brien, W. L. and King, G. A. (2000) Med Sci Sports Exerc, 32, S471-80.
Freedson, P. S. and Miller, K. (2000) Res Q Exerc Sport, 71, S21-9.
Hatano, Y. (1993) International Council for Health, Physical Education and Recreation., 29.
Hendelman, D., Miller, K., Baggett, C., Debold, E. and Freedson, P. (2000) Med Sci Sports Exerc, 32, S442-9.
Iwane, M., Arita, M., Tomimoto, S., Satani, O., Matsumoto, M., Miyashita, K. and Nishio, I. (2000) Hypertens Res, 23, 573-80.
Lindberg, R. (2000) J Am Diet Assoc, 100, 878-9.
Tudor-Locke, C. E. and Myers, A. M. (2001) Res Q Exerc Sport, 72, 1-12.
U.S. Department of Health and Human Services (2002), Vol. 2002 U.S. Department of Health and Human Services.
Welk, G. J., Differding, J. A., Thompson, R. W., Blair, S. N., Dziura, J. and Hart, P. (2000) Med Sci Sports Exerc, 32, S481-8.
Wilde, B. E., Sidman, C. L. and Corbin, C. B. (2001) Res Q Exerc Sport, 72, 411-4.
Yamanouchi, K., Shinozaki, T., Chikada, K., Nishikawa, T., Ito, K., Shimizu, S., Ozawa, N., Suzuki, Y., Maeno, H., Kato, K. and et al. (1995) Diabetes Care, 18, 775-8.

Associate Professor Kerry Mummery is at the School of Health and Human Performance at Central Queensland University