Eastern Maine Medical Center established the Move & Improve program in 1996 to motivate individuals to increase their physical activity and to make healthier lifestyle choices. Move & Improve became a program of Eastern Maine Healthcare Systems in 2004. Move & Improve is a free 12-week program beginning in March each year that is designed to improve health by reducing participants' risk of chronic diseases and obesity. Individuals become involved with the program primarily, though not exclusively, through affiliations with worksites. Other Move & Improve sites include schools and community organizations. Yearly recruitment efforts include reaching out to past and new participants through the mail, statewide newsletters, and collaborating partners statewide who promote the program locally. Under the guidance of volunteer site coordinators who are identified internally by worksites, participants are asked to engage voluntarily in at least 30 minutes of physical activity for at least 4 days per week for a minimum of 8 weeks of the 12-week program. Participants are asked to track their physical activity on a log (either on paper or through an interactive online activity log) and receive encouragement and tips for continued participation and physical activity throughout the program. In addition, the program offers participants community-based stretch breaks at the local mall, statewide monthly walking clinics or clubs, various exercise programs, physical fitness assessments, educational sessions, and other events.
Various communication tools have been used over the past 8 years to convey helpful information to participants. These include a quarterly newspaper that features a tip of the week, good-for-you recipes, nutritional information, book reviews, and profiles of program participants and a weekly online newsletter. Move & Improve health promotion tips are shared communitywide and statewide through local newspapers (Bangor Daily News), the local CBS affiliate (WABI–TV 5), collaborating partners (i.e., Eastern Maine Medical Center, Sebasticook Valley Hospital, Inland Hospital, The Aroostook Medical Center, and the Healthy Hancock coalition), various program sponsors, Move & Improve coalition members, the Move & Improve Web site, and the e-mail systems of some participating worksites.
Move & Improve has collected data about the program since its inception. The number of participating individuals, participating sites, the number of individuals completing the program, and postprogram stage of change have been tracked since 1997. During the first 7 years, the program offered a paper-and-pencil evaluation to participants and site coordinators. In the eighth year, Move & Improve began offering all participants and coordinators an online evaluation.
Program participation and completion rates have continued to increase. In 1997, approximately 1000 participants registered for the program; in 2003, Move & Improve had more than 9000 participants, and in 2004 it had more than 11,000 participants. In 2003, almost half were first-time participants, and in 2004, approximately one third were first-time participants. In 2003, physical activity stage of change was measured using a five-stage algorithm (precontemplation, contemplation, preparation, action, and maintenance) based on exercising 4 days per week for 30 minutes per day, adapted from previous stage-of-change research (15
). In 2004, however, Move & Improve staff became interested in describing participants' physical activity in greater detail and adopted a new measure of physical activity stage of change (using the same five-stage algorithm) which included an additional goal of exercising 5 days per week for 45 minutes per day. The program used current guidelines published by the American College of Sports Medicine to establish the goal levels (available from www.acsm.org
). In both 2003 and 2004, a general forward movement through the stages of change was observed.
Since the program's inception, participants have reported anecdotally positive effects, such as weight loss, reduced stress, and reduced absenteeism. A technical report compiled by the University of Maine in 2001 (16
) reported statistically significant differences in mean systolic blood pressure, total cholesterol, the ratio of total cholesterol to high-density lipoproteins, number of sit-ups in 1 minute, number of push-ups in 1 minute, and 3-minute recovery heart rate between pretest and posttest scores among a self-selected group of participants.
In early 2003, the Move & Improve program director approached the M-HPRC to help improve the evaluation design and process with the ultimate goal of contributing to general knowledge about worksite health promotion programs such as this one. The M-HPRC contributed some staff time and a small stipend to help with data analysis. A statistician from Colby College was engaged to help with data entry and analysis. M-HPRC and Colby College used principles of CBPR for carrying out this phase of the evaluation.
The objectives of this phase of the evaluation were to 1) characterize Move & Improve participants and participation in the program; 2) learn which worksite and coordinator policies seemed to make a difference to participants; 3) explore whether physical activity and stage of change were affected; 4) learn whether participants experienced other lifestyle outcomes such as weight change, better nutrition, stress reduction, or reduced absenteeism; and 5) explore whether multiyear participation was more likely to sustain greater levels of physical activity.