1. Walk With Ease Training for Program Administrators
May 31, 2017

2. Training Content Overview of Walk With Ease Program
Program Syllabus (script)
Leader and Administrator Roles
Managing the Program
Providing support to Leaders
Teaching Tips
Post-program Strategies
Leader’s Knowledge Self-Test
Here are the topics we will cover in this session. We’ll provide an overview of the WWE program goals, target audience, components and format. Then talk about the program syllabus that the Leaders follow. We’ll also discuss various program logistics that program administrators and leaders need to address. In addition, we’ll discuss how administrators can help leaders with their teaching challenges and also with guiding participants to resources after WWE has ended. We’ll say a little bit about the Leader’s Knowledge self-test which is a tool the leader and administrator can use to gauge their mastery of the WWE program.
Along the way, we’ll reference various materials that are available to you. We hope that this training and these materials will help inform your quality assurance and fidelity monitoring activities.

3. Overview of the Walk With Ease Program
We’ll start with an overview of the Arthritis Foundation Walk With Ease Program.

4. Program Goals
Gain an understanding of the basics of arthritis, and the relationship between arthritis, exercise and pain
Learn how to exercise safely and comfortably
Use methods to make walking fun
Develop and implement a doable personal walking plan with realistic goals for improved fitness
Gather tips, strategies and resources that will help participants maintain a long term exercise routine
Learn about other programs and resources
that help participants keep up their walking
The six goals of the WWE program are to help participants:

5. Four Key Program Components
Health information
Walking
Exercises
Motivational strategies
These 4 Walk With Ease program components parallel the four goals of the program, that is:
Participants gain an understanding of the basics of arthritis, and the relationship between arthritis, exercise and pain through the health education component
They learn how to exercise safely and comfortably through the walking and exercise components
And they develop and implement a doable personal walking plan and gather tips, strategies and resources to maintain an exercise routine through the motivational component

6. Target Audience Adults with arthritis Adults who don’t have arthritis
Range from beginners to the physically fit
Able to be on their feet for 10 minutes without increased pain
Walk With Ease was developed specifically for adults who have arthritis who have the desire to incorporate walking as a routine activity into their lives. Adults who don’t have arthritis may also find the program beneficial.
The program is designed for a range of activity levels, from adults who may be new to physical activity and beginners in a walking program to those adults who have been physically active.
The Walk With Ease program does require that participants be able to be on their feet for 10 minutes without increased pain - this may be for doing things like household chores, shopping or social activities.

7. Program Structure 6 week program that meets 3 times a week
Class sessions are about 1 hour
Leaders can instruct the classes independently or with another trained Walk With Ease Leader
Follow the script in Part 2 of the Leader’s Guide
Let’s now turn to logistics of the program. This information is in Parts 1 and 3 of the Leader’s Guide.
Walk With Ease is a six-week walking program, where participants meet 3 times per week for 1 to 11/2 hours each time.
Leaders can instruct the classes solo or with another trained Walk With Ease leader. Using a team-teaching approach, leaders can take turns with the program responsibilities and with guiding participants through the exercise and walking segments of the programs.

8. This chart is in the first chapter of the WWE Workbook
This chart is in the first chapter of the WWE Workbook. The chart provides an overview of the recommended schedule for the Walk With Ease program that includes when to do each of the program components, including: when participants should read particular chapters, when certain activities should be completed, and when self-test tools need to be filled-out.
This chart can be very helpful to review with your self-directed participants to help guide them on how to read and use the Workbook.
Over on the far right column of the chart activities are listed that the participants can continue after they’ve completed the six-week program.
The discussion topics that instructors will be teaching follow the same order of the six chapters in the Walk With Ease workbook. For example, Session 1 of the Leader Guide corresponds to Chapter 1 of the Walk With Ease workbook.

9. Overview of WWE Leader’s Training and Guide
Part 1 – Overview of the Program
Part 2 – Teaching the Program Syllabus
Part 3 – Managing the Program
Part 4 – Teaching Tips
Part 5 – Appendices
Part 6 – Script for Teaching Exercises
Part 7 – Leader’s Knowledge Test
There are seven parts of the Walk With Ease Leader’s Guide. We will be touching on all of these parts in this training.
Part 1 of the Guide provides an overview of the Walk With Ease program. This content includes:
Why walking is good for people with arthritis and why the Walk With Ease program was created
How the Walk With Ease program works
How a typical session is organized
And what’s expected of a Walk With Ease leader. We’ll be talking about these responsibilities later on.
Part 2 of the Guide is the program syllabus. Here you’ll find a step-by-step script for how to lead each of the 18 program sessions. Sessions include discussion, group activities, walking and short lecturettes on various topics. It’s indicated in the script when an instructor can paraphrase the information provided for a lecturette and when s/he should state the information verbatim. Instructors are told not add or delete any of the information in the script. There are also posters that accompany the lecturettes that will help instructors cover the main points of each topic.

10. Leader’s Guide: Program Syllabus Components
Session Script
Each session is organized the same way:
Topic
Objectives
Materials to Use
Session at a Glance
Outline
Posters and Handouts
Each session is organized in the exact same way and includes the following sections:
Topic-This section states the subject area and the chapter of the participant workbook that the session refers to.
Objectives-This section states what the participants should be able to do by the end of the session.
Materials to use-This section lists the materials that will be used during the session.
Session at a Glance-This section is a condensed outline of the session so the instructor gets a general idea of what s/he will be doing.
Outline-The section includes the whole step by step script for the session.
Posters, handouts- To section includes charts of the key information the instructor will be sharing in health education presentations and any additional resources s/he might use.

11. Example of Session Schedule
Order of Session Activity
Activity Duration
Pre-class Socializing & Attendance
10-15 minutes
Welcome & Announcements
2-5 minutes
Discussion Topic(s)
5-10 minutes
Walking Warm-up
3-5 minutes
Warm-up Stretches
4-5 minutes
“FITT” Walk Duration
5-30 minutes
Walking Cool-down
Cool-down Stretches
7-9 minutes
Closing
5 minutes
After-class socializing
10 to 15 minutes
Total:
Approximately
minutes
This chart shows the order of a typical Walk With Ease program session, with a general indication of the amount of time needed for each activity. The typical activities include:
Pre-class socializing & Attendance
Welcome & Announcements
Discussion Topic(s)
Walking Warm-up
Warm-up Stretches
“FITT” Walk Duration (frequency, intensity, time and type)
Walking Cool-down
Cool-down stretches
After-class Socializing
Depending on the physical capabilities of a particular group, the average session length may last as little as 50 minutes in the beginning weeks of the program but may increase to more than 1 ½ hours as the group improves their fitness level over the succeeding weeks.
Keep in mind that with the total time of the class being flexible, you need to be sure that the classroom is available, particularly if the class goes for more than an hour.

12. Examples of Lecturette Topics (May require handout and poster printing)
CDC guidelines: Amount of walking for people with arthritis
Basic health considerations
Basic facts about arthritis and exercise
Using the diaries and assessments
FITT principles (frequency, intensity, time, type)
What to do if exercise hurts
The importance of impact and the walking surface
Monitoring intensity, measuring fitness
Walking safely and comfortably
Developing and maintaining support
Continuing to walk after the program ends
5-Step Walking Pattern
Stretching/strengthening exercises
For each session, the instructor will lead
Health education lecturettes, which are short 5-10 minute lectures on a topic– throughout all of the sessions, the script provides the text and also charts to use to help cover the key points of the topics. Here’s highlights of the lecturettes topics. As you can see there is a focus on how to exercise safely and comfortably.
As we said, earlier, there are posters that accompany the lecturettes. The posters are intended to be printed on 11x18 size paper so that the print is large enough for a group to read as the instructor discusses the information. The point of the posters is to focus the participants’ attention on key concepts.
If printing on 11x18 is not possible, you can make these posters into handouts.
There are also lecturettes for the 5-step Walk Pattern and others for how to do the stretching and strengthening exercises which we’ll cover next. We’re going into a bit more detail on these particular topics because the physical activity component of the program needs to be carefully done to avoid any injury or liability issues.

13. 5-Step Basic Walking Pattern
Warm up (3 to 5 minutes)
Stretch (4 to 5 minutes)
Walk (5 to 30 minutes)
Cool down (3 to 5 minutes)
Stretch (7 to 9 minutes)
>> Total time: 22 to 54 minutes <<
In the Walk With Ease program the ultimate goal is for participants to develop the knowledge and skills necessary to walk safely and comfortably,. It’s important that rather than relying on the leader to take charge, that participants learn to do the 5-step walking pattern on their own so they can do it on days when the program doesn’t meet.
The information for this section is in Chapter 5 of the participant workbook. The exercises are in Appendix B of the workbook, and they are presented in Session 5 of the Walk With Ease program.
The 5-step walking pattern includes:
Warming up before stretching – this can be as simple as walking slowly or marching in place
Stretching before walking
Walking
Cooling down – again this is marching in place, or walking slowly
Stretching after walking
The leader emphasizes to participants that warming up before exercise and cooling down after exercise are both important parts of a good walking program. Warming up increases blood flow and elevates body temperature, thus preventing muscle injury. Cooling down helps to lower heart rate gradually and prevents blood from pooling in the legs, which can cause light headedness or fainting.
Ideally, the leader should tell participants to go through the 5-Step Walking Pattern each time they walk, even for 10-minute walking sessions. However, s/he cab tell participants that if they are pressed for time during these shorter sessions, they should stretch before and after walking at least once each day they walk. 13

14. Hints About Stretching
Remember not to touch participants if you are helping them stretch
If a participant has trouble with balance, s/he can do the seated versions of the stretches instead of standing
Participants should stretch gently/smoothly until they feel tension; then hold that position for 30 seconds on each side (no bouncing)
Remind participants not to hold their breath
The leader explains the stretching exercises that are part of the 5-step Walking Pattern. For safety and liability purposes, administrators should be aware of the caveats about both for the stretching and also for the strengthening exercises.
So on that order:
Leaders are advised not touch participants during stretches.
It’s entirely possible that some participants have had joint or back surgery or knee or hip replacements. So if participants have any concern about whether they should do the exercises, they should consult their health care provider.
Also, if participants have any concern at all about their balance, they should be encouraged to do the seated version of the stretches. If participants fall, the leader may not assist them in getting up again. If seating is not available at the site where the class is held, participants who have trouble with balance should not do the exercises. Instead, the leader can urge these participants to practice doing the seated exercises at home.
Participants should stretch gently and smoothly until they feel tension and then hold that position (no bouncing) for 30 seconds on each side.
Leaders should remind participants not to hold their breath. 14

15. Additional Important Stretches
Examples of Stretches Before Walking (All stretches in Workbook and also on CD)
Additional Important Stretches
2. Front of calf and toe stretch
Here’s some examples of the stretches. Diagrams for the stretching exercises are in Appendix B of the Workbook and are also available on CD and online at the Arthritis Foundation.
1. Bent leg calf stretch 15

16. Strengthening Exercises
Participants should check with their health practitioners if they have ongoing, severe pain in their knees, ankles or hips before they begin these exercises
Start with 5-10 reps of each exercise and increase to 30 on each side if appropriate
Do these exercises slowly and with control
Participants should remember not to hold their breath
Remember the 2-Hour Pain Rule
Remember not to touch participants
These strengthening exercises are intended to be done by participants at home and not as part of the 5 Step Walking Pattern. However, the leader demonstrates the strengthening exercises with participants and has the participants practice them.
The leader should learn how to do the exercises so s/he is comfortable with them and prepared to answer questions that the participants may ask.
The same safety and liability caveats apply (all of which are in the Leader’s Guide):
Participants should check with their health practitioners if they have ongoing, severe pain in their knees, ankles or hips before they begin these exercises.
Individuals can start with 5-10 reps of each exercise and increase to 30 on each side if appropriate.
Exercises should be done slowly and with control.
Participants should remember not to hold their breath when they do these but just breathe naturally.
As always, the instructor should remember not to touch the participants if you are helping them with the strengthening exercises.
The instructor should remind participants of the 2 hour pain rule. If participants have increased pain that lasts for more than two hours after exercising, then next time they should do fewer repetitions.

17. Suggested Walking Progression Chart
Week Duration Times/week
1 10 minutes 3–5
2 15 minutes 3–5
3 20 minutes 3–5
4 25 minutes 3–5
5 30 minutes 3–5
6 35 to 40 minutes 3–5
The suggested progression goal is 5 minutes a week but only when participants can already walk for a total of 10 minutes.
Participants can add 5 minutes of walking time each week until they reach minutes. This increase of 5 minutes per week is only a suggestion and some participants may not be able to add walking time beyond a certain point or at this rate.
The leader should stress to participants that they need to start at their current level and slowly increase their time to their own ability in order to improve their cardiovascular fitness. 17

18. Managing the WWE Program
We’ll now move on to managing the WWE program

19. Managing the Program
Leaders agree to implement the essential components of the program
Leader and administrator determine when and where to hold sessions
Leader and administrator decide whether Leader helps with recruiting participants
Leader and administrator consider the use of incentives
Leader and administrator manage program forms and records
As an administrator you can work with your WWE Leaders to handle these program management activities
The first item pertains to the commitment of the Leader to maintain program fidelity. There is a program fidelity tool that you can discuss with your Leaders.
Together, you can decide when and were to hold sessions.
Different organizations have different expectations about how involved the Leaders are in marketing and recruitment. That is a decision you can work out with your Leaders.
Similarly, you may or may not wish to use incentives. Note, your mini-grant will pay only for pedometers as an incentive.
It is very important that your Leaders know that they must collect the Participant Information Form at the beginning of the program, the Post-Program Form at the end of six weeks. 19

20. When & Where to Hold Sessions
Consider schedule appropriate for people with arthritis
Negotiate schedule, if feasible, at first class
May need to avoid mornings
Variety of locations
Malls, senior & community centers, neighborhoods, churches, parks, etc.
Classroom set-up
Ideally large table for people to sit around; room with door; chair with no cross bars under the seat
Other considerations
Noise, places to sit, accessibility, nearby bathrooms, insured areas
Route should be an easy walking surface
Now we’ll move on to managing program logistics.
Together with your leaders, you can select the group’s meeting place and walking route. Group-led classes may meet in malls, senior & community centers, neighborhoods, churches, parks, senior centers, or wherever the leader thinks is a good and convenient meeting place to hold the pre-walk discussions and a place that has restroom facilities.
Other considerations when picking the meeting place are things like:
A place where it isn’t noisy (so that participants can hear the short health education lecturettes and also do group discussions)
Places for participants to sit (because of the pre-walk lecture time)
A place that is convenient and accessible (particularly because some participants may not drive)
Make sure there’s handicapped parking.
Pick a safe area: Avoid busy streets, construction areas, icy areas, cluttered areas, etc.
Pick an area where walking aids can be used if participants need them.
If meeting in an indoor site, determine if the facility has adequate insurance, at least $1,000,000 per occurrence
Chapter 3 of the Walk With Ease workbook and Session 3 of the Leader’s Guide contain helpful suggestions in picking walking routes and walking surfaces. The walking surface the leader chooses can greatly affect participants’ joints and their balance. Whether the surface is firm and level or soft and inclined affects their exercise intensity (how hard they work), impact (how hard their bodies come down on their feet and joints), and balance. Also, some walkers may need to make frequent stops to rest or use the bathroom, so consider either walking indoors or circling near buildings for rest stops.

21. Consider Partnerships
Advertising/Recruiting
Identifying partners who can help with marketing
Sponsorship
Provide a variety of assistance (staffing, financing, space)
Incentives
Donated items
As part of our CDC grant, we want to track ways that programs can be sustained beyond the one-year project period. Partnerships can help to provide a range of resources to support ongoing programming. Partners can help with…

22. Examples of WWE Marketing Marketing
These and other tools can be found on the OAAA Website:
“Class Zero” Slides, Script, and Video
Issue briefs for Community Partners and for Clinical Providers
AF Walk with Ease Program Flyer, Worksite Brochure, and Press Kit
Marketing plan template
Sample materials from organizations across the country
The Community Organization section of the OsteoArthritis Action Alliance webpage has many resources to help with program marketing and implementation. The url link is noted on the top of the slide. This slide summarizes some of the WWE program materials.

23. Managing Program Forms and Records
Review with your Leaders the forms they need to be using
Participant Information Form (baseline)
Post-program Form
Fidelity Form
Local forms (e.g., attendance log, site forms)
The Leader’s Guide contains AF forms, most of which we’re NOT using.
What we’re showing here are the forms that are associated with the CDC grant that we are using. These include the baseline participant form and the post-program evaluation form. You may wish to use the WWE attendance log. These forms are available on the community partner section of the OAAA website.
You may wish to create your own attendance logs and site forms.

24. Teaching Tips
Review the teaching tips provided to Leaders to help them:
Promote a positive learning environment
Encourage and Support participants
Instill motivation
Conduct 3-Step Problem Solving Strategy
Address common problems and how to solve them
Handling problem situations
Information about effective leadership and teaching can be found in Part 4 of the Leader’s Guide. There are six areas covered in this section of the Leader Guide, including…
Sometimes Leaders have difficulty with group dynamics. You may wish to review Part 4 of the Guide so you can help your leaders with these types of issues.

25. Post Program Strategies
Leaders are provided a series of strategies for participants to take charge of, including:
Encouraging participants to use the walking contract as a tool to focus on their post-program goals and priorities
Encouraging the group to consider formally keeping in touch with each other
Suggesting that the group set up a walking distance theme and hold celebrations when the group achieves certain milestones in reaching that theme
Introducing participants to other programs that are designed for people with arthritis
Because WWE focuses on self-management as well as physical activity, it’s important for the Leaders to encourage participants to take charge of what they want to do after the program has ended. One of the last sessions of the WWE classes focuses on this topic. Leaders are provided as series…
As an administrator you may wish to have available a listing of other programs that your organizations or your community offers that can be distributed as a resource.

26. Leader’s Self-Knowledge Test
For the Leader’s use only after reviewing the program materials
Covers program content
Two versions: with and without answers
A handy way for administrators to learn the scope of the training
Part 7 of the Leader’s Guide includes a post-training knowledge test that leaders can use to measure their mastery of the syllabus content. It is a self-test. There are two versions of the test: one with and one without the answers.
As a program administrator, you may want to take a look at the test to get a better sense of the content the Leader is expected to master.
As part of your fidelity monitoring you have the option of asking the leader if he or she is having problems with mastering any of the content.

27. Self-Directed Format of WWE
Self-directed participants receive the WWE Workbook
They can do the walking on their own or you might consider a “hybrid” where they walk with a group, but read workbook on their own
Could be an alternative for those who drop out of class or are unable to commit to the group version
Must complete the same baseline and post-program forms
Sample weekly s to help keep self-directed participants engaged are on the OAAA website:
In the self-directed format of WWE, participants do the program on their own. Features of or considerations for the self-directed format include:
If you decide to hold walking sessions for participants, for QA purposes, it would be ideal to have a certified WWE leader guide the walking

28. Questions or Comments? OAAA Walk With Ease Expansion Staff Mary Altpeter Serena Weisner
If you have any questions or comments about the WWE program, please contact: