Evidence linking regular physical activity with a reduced risk of colon cancer is consistent and convincing 
. A recent meta-analysis of observational data found physical activity decreased risk of adenomatous polyps which are precursors to colon cancer 
. There is no evidence of an association for physical activity with rectal cancer 
. Despite the benefits of physical activity, nearly 75% of the population fails to meet recommended physical activity levels 
Previous studies have reported a reduced risk of colon cancer with engagement in moderate intensity activity 
. Recent analyses in the Nurses’ Health Study, the largest prospective study to examine this association, found a significant risk reduction in colon cancer incidence among women walking at least two hours per week 
. Observational data in colon cancer survivors shows a disease-free survival benefit for physical activity, but suggests that higher amounts of physical activity may be necessary to reduce risk of recurrence 
. Together, these data suggest there is a favorable role for physical activity in terms of risk reduction, at multiple stages in colon cancer carcinogenesis. However, there is little data on the role of physical activity in individuals at elevated risk of colon cancer, particularly those who have previously had colon adenomatous polyps. We therefore interpreted a need for data on whether a physical activity intervention could be successfully implemented after removal of adenomatous polyps during screening colonoscopy.
Designing such an intervention is challenging; the dose physical activity necessary to reduce risk of recurrent colon adenomas is unknown, as is whether increasing doses of physical activity would further modify the risk of adenoma recurrence. Data suggest that physical activity equivalent to 30 minutes of walking/day is adequate to reduce risk of developing colon cancer, while a higher exercise dose (60 min/day) may be necessary to reduce colon cancer recurrence and mortality. As physical activity interventions often struggle to achieve the intervention target dose, determining whether a higher dose is feasible is an important first step before broader dissemination or implementation of physical activity programs to prevent colon adenomas and cancer.
The overall objective of this study was to evaluate the feasibility of a pilot intervention to deliver two doses of physical activity delivered through an existing evidence-based walking intervention paradigm to individuals who have had colon polyps and are thus at increased risk for colon cancer. The First Step Program (FSP, also published as Manpo-Kei) is an evidence and theoretically-based two phase intervention that aims to promote uptake of and adherence to physical activity, specifically walking, using pedometers 
. FSP addresses self-efficacy, outcome expectations and social support in line with social cognitive theory and moves participants through the phases of the Transtheoretical Model 
. The intervention focuses on home-based moderate intensity walking with regular contact with study staff. FSP has repeatedly been shown to successfully increase physical activity in patient populations 
, and in community settings 
Furthermore, the intervention successfully promoted a sustained increase in steps/day when implemented in “real world” settings, using existing diabetes educators and peer leaders 
and in a community setting 
, indicating the intervention is effective and efficacious.
Pedometers are easy to use, relatively low cost, reliable and accurate 
. The combination of the high frequency of walking as a physical activity and the comparatively low cost of pedometers has made them a popular tool for population-based research, both as a motivational and measurement device. Pedometer-based interventions typically focus on a 10,000 steps per day goal, which has support in clinical and monitored populations, 
A review of 32 observational and intervention studies suggests that typical daily step counts range from: (1) 7–13,000 steps per day for healthy younger adults; (2) 6–8,500 steps per day for healthy older adults; and (3) 3,500–5,000 steps per day for sedentary individuals and those with disabilities of chronic illness 
. These findings were corroborated in a study of urban African American adults 
, but data on other racial/ethnic groups has not yet been reported. Current research suggests step counts in the range of 3000–4000 steps are accumulated during 30-minutes of walking. 
Thus, for a healthy older adult, 10,000 steps would be accumulated through usual daily activities plus a 30-minute walk, making the 10,000 steps/day recommendation parallel to the physical activity guidelines 
Reviews of walking interventions conclude that the use of pedometers 
and telephone prompts 
, as is done in the second phase of FSP, successfully increase walking 
This study tested the feasibility of a pilot physical activity intervention designed for individuals with a recently resected colon adenoma. The focus of the study was on the development of an intervention that would require minimal face-to-face contact time to potentially improve future sustainability in clinical practice yet still initiate physical activity behavior change.