Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes

OBJECTIVE: To conduct a randomised trial of a physical activity (PA) intervention, The First Step Program (FSP) for adults with type II diabetes. DESIGN: A 16-week intervention study and 24-week follow-up assessment. PARTICIPANTS: A total of 47 overweight/ obese, sedentary individuals ( age = 52.7 +/- 5.2 y; BMI = 33.3 +/- 5.6 kg/m(2)) recruited through a diabetes education centre. MEASUREMENTS: Primary outcome: daily PA assessed by pedometer (steps/day). Secondary outcomes: anthropometric measures ( weight, BMI, waist girth, hip girth); indicators of cardiovascular health ( resting heart rate and blood pressure); glycemic control ( fasting glucose, insulin, HbA1c, glucose concentration 120 min postglucose load); plasma lipid status ( total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides). RESULTS: Relative to the CONTROL group, FSP participants increased their PA >3000 steps/day (approximately 30 min/day) during the intervention (P<0.0001). Waist and hip girth decreased ( approximately 2 - 3 cm), but did not differ significantly between groups. Significant changes did not emerge for any of the other variables. CONCLUSIONS: The FSP is a practical intervention that elicits an immediate and profound change in walking behaviour. Such change is an important 'first step' towards increasing the volume and/or intensity of PA necessary to improve long-term health outcomes in this largely sedentary and overweight or obese population. Relapse by 24 weeks indicates that other strategies such as booster sessions are needed to maintain lifestyle change. Further research must determine realistic and responsive health outcomes for this population that are achievable through practical, real-world programming.