Chapter 10: Participant Handouts

Staying Healthy Through Education and Prevention (STEP)

Chapter 10: Coaching Session Handouts

Photograph: Two senior women

Overview

The following pages contain handouts for each STEP behavior coaching session. These sessions occur in the first 9 weeks of the STEP program. They are designed to assist participants in developing and maintaining behavior changes that will help them adopt and maintain healthier lifestyles that emphasize physical activity.

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Objectives

This chapter will:

  • Familiarize you with the different types of handouts.
  • Allow you to review the handouts for each behavior session.
  • Allow you to print the handouts for each session as needed.

Key Points

  • The handouts are labeled according to the behavior session in which they are used or distributed.
    • Some handouts are simple introductions and help describe certain aspects of the STEP program (e.g., RPE scale, balance exercises) and should be kept as reference materials.
    • Some are in-class handouts or worksheets to be discussed and completed during the behavior sessions.
    • Others are "Take Home Challenges" and should be completed at home and discussed at the following session.
  • For optimal use of these handouts, it is essential that you or your program leader are familiar with the content and lesson plan for each coaching session and come to the sessions prepared with enough handouts for all participants.
  • Two versions of the STEP tracking sheet are available (found in Session #1 handouts): the "weekly" tracking sheet and the "monthly" tracking sheet. It is up to you which tracking sheet you prefer to use at your facility.
    • Some people find it easier to track exercise by weeks. If you choose this method, distribute a fresh tracking sheet to participants on the first day of class and have them start recording their activities the same day. For the next 7 days, participants will use this sheet to track the exercise they do inside and outside of class. When their sheets are full, participants should turn them in and receive one blank sheet apiece. Completed tracking sheets should be stored in a master notebook in the classroom. That way, no sheets will be lost, and both you and the participants can view their progress over time. You can use the tracking sheets in the behavior sessions to talk about differences you see in their exercise patterns from week to week.
    • The monthly tracking sheets are an easy way to view participants' progress over a longer block of time. Monthly sheets also mean fewer copies have to be made and stored. However, there is a risk of losing valuable information if a sheet is misplaced. If you decide to use monthly tracking sheets, you may want to keep a backup copy for each participant, transfer the hours into your master notebook each week, or devise another system that works for your staff and participants.

Session #1 Handout: Overview of the STEP Physical Activity Program

STEP Schedule and Goals

WeekBehavior SessionNumber of Strength ClassesMinutes of Walking per WeekAt-Home Balance Exercises
11Intro0-30N
221-230N
331-260Y
441-260Y
551-290Y
661-290Y
771-290Y
881-2120Y
991-2120Y
10-endOptional1-2150Y

STEP begins with a 9-week program. During the 9 weeks, we will focus on the goal of increasing your physical activity to 150 minutes a week with a combination of strength exercises and walking.

You will attend class 1 or 2 times a week, where you will learn both strength exercises and behavior strategies. The behavior sessions will address issues such as motivation and help you overcome barriers that make physical activity difficult.

At the end of 9 weeks, the behavior sessions will start over with Session #1 so that newcomers can participate. As a "seasoned" participant, you should continue your strength classes, walking, and balance exercises, but the behavior sessions will be optional. Feel free to attend any or all of the behavior sessions for continued support, a refresher, or any other reason.

Session #1 Handout: Rating of Perceived Exertion (RPE) Scale

While exercising, you should monitor your RPE, that is, how strenuous the exercise feels to you. This depends on the strain and fatigue in your muscles and your feeling of breathlessness in the chest. Attend to these feelings when you rate exertion, not to the amount of weight you are using or the length of time that has passed.

StepEffort
 6Absolute Minimum
 7Very, Very Light
This requires minimal effort. It is easy and comfortable.
 8 
 9Very Light
Like walking slowly at your own pace for several minutes.
 10 
 11Fairly Light
Not especially hard. It feels fine and is no problem to continue.
Walk (11 to 13)12 
 13Somewhat Hard
You can still go on but you have to push yourself and you feel tired
 14 
 15Hard
Strength (15 to 16)16 
 17Very Hard
You are so tired that you cannot continue much longer.
 18 
 19Very, Very Hard
This is as hard as you have ever experienced.
 20Absolute Maximum

STEP Tracking Sheet—Weekly

Name: __________________________________________________________________________________

Week Start Date: ________________________

Please write in the week # and the MINUTES spent exercising each day.

S = STEP class
W = Walking or other aerobic activity

WeekSunMonTuesWedThursFriSat
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STEP Tracking Sheet—Monthly

Name: __________________________________________________________________________________

Week Start Date: ________________________

Please write in the week # and the MINUTES spent exercising each day.

S = STEP class
W = Walking or other aerobic activity

WeekSunMonTuesWedThursFriSat
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STEP Physical Activity Description and Expectations Agreement

Congratulations! You are now part of the STEP Physical Activity Program! As a member of the program, you will participate in activities that are designed to enhance your health and prevent physical decline. Staff will teach you how to do the exercises and how to develop of program of ongoing physical activity. The STEP Program consists of walking, strength, and balance and flexibility training.

Expectations for Participation

You will:

  • Participate in structured physical activity groups at least 1 time each week. At the beginning of the program, these sessions will also deal with building the skills that you need to make the program successful.
  • Walk on your own or in groups on a regular basis, with the goal of building up to about 30 minutes of walking each day.
  • Keep in contact with the staff so that we know how you are doing.
  • Report certain changes in your health status to the staff so that we can determine if it is safe for you to continue participating in the exercise program. These changes include if you have:
    • Seen a doctor about a new medical condition.
    • Changed your medication.
    • Experienced:
      • Chest discomfort.
      • Rapid or irregular heartbeat.
      • Shortness of breath.
      • Dizziness.
      • Swelling of both ankles.
      • Increased fatigue.

As we strive to develop programs to maximize wellness, we must ensure that safety is a priority!

Your signature below indicates that you understand what is involved in participation in the STEP program.

Signed (participant): __________________________ Date: _________

Staff: ______________________________________ Date: _________

Session #2 Take Home Challenge: Reflect on Physical Activity

Below are three questions about why you want to become a more physically active person. Please take a few minutes to reflect on each question and then write down your thoughts when you get home. The next time we meet, we will discuss your answers and how we, as a group, can motivate each other to embrace STEP and become more active.

1. How do you think you will Benefit from becoming more physically active?

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

2. What are Your Main Motivations for wanting to become more active? Why do You personally want to change your exercise habits?

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

3. Over the next couple of months, we will teach you the skills you need to become more active. Initially, How Can We Help You make these changes?

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Session #3 Handout: Balance Exercises

The following exercises are designed to improve your balance and stability on your feet. You should complete them at home using a stable surface that you can grip for support. We suggest a sink and counter in particular.

No matter your strength or physical condition, you should start at Level 1 and progress gradually through Levels 2, 3, 4, and 5. Your STEP instructor will demonstrate and help you practice all the exercises in class so that you will feel comfortable continuing at home.

Level I Balance Exercises

The Sink Hip Circle I

Drawing of a body with arrows indicating a circling motion of the hips.

  1. Stand facing kitchen sink.
  2. Hold on with both hands.
  3. Do not move shoulders or feet.
  4. Make a big circle to left with hips.
  5. Repeat 5 times.
  6. Make a big circle to right with hips.
  7. Repeat 5 times.
The Sink Heel Raise I

Drawing of a pair of legs standing on tip toes with an arrow pointing to the raised heels.

  1. Stand facing kitchen sink.
  2. Hold on with both hands.
  3. Raise your heels gently.
  4. Hold for count of 5.
  5. Then come down.
  6. Repeat 10 times.
One Leg Sink Stand I

Drawing of a pair of legs with right leg straight and left leg bent at the knee so that the heel is raised.

  1. Stand facing kitchen sink.
  2. Hold on with both hands.
  3. Stand on your left leg for count of 5.
  4. Stand on your right leg for count of 5.
  5. Repeat 10 times.
The Sink Side Step I

Drawing of a pair of legs standing straight. A drawing next to the first one has an arrow indicating movement to the left.

  1. Stand facing kitchen sink.
  2. Hold on with both hands.
  3. Move hands along kitchen sink as you step to left 5 steps.
  4. Step to right 5 steps.
  5. Repeat 5 times.

Level II Balance Exercises

The Sink Heel Raise II

 Drawing of a pair of legs standing on tip toes with an arrow pointing to the raised heels.

  1. Stand facing kitchen sink.
  2. Hold on with one hand.
  3. Raise your heels gently.
  4. Hold for count of 5.
  5. Then come down.
  6. Repeat 10 times.
One Leg Sink Stand II

Drawing of a pair of legs with right leg straight and left leg bent at the knee so that the heel is raised.

  1. Stand facing kitchen sink.
  2. Hold on with one hand.
  3. Bend the knee and lift your left leg for count of 5.
  4. Bend the knee and lift your right leg for count of 5.
  5. Repeat 10 times.
The Sink Side Step II

Drawing of a pair of legs standing straight. A drawing next to the first one has an arrow indicating movement to the left.

  1. Stand facing kitchen sink.
  2. Hold on with one hand.
  3. Move hand along kitchen sink as you step to left 5 steps.
  4. Step to right 5 steps.
  5. Repeat 5 times.
Step Forward II

Drawing showing a person stepping forward with right leg. Arrows indicate forward and backward movement.

  1. Stand with right side toward kitchen sink.
  2. Hold onto the sink with your right hand.
  3. Step forward with your left leg; shift your weight forward over the left leg.
  4. Do not step forward with the right leg.
  5. Return the left leg to the starting position.
  6. Repeat on opposite side.
  7. Continue to alternate each leg.
  8. Repeat 10 times.
Step Backward II
  1. Stand with right side toward kitchen sink.
  2. Hold onto the sink with your right hand.
  3. Step backward with your left leg; shift your weight backward over the left leg.
  4. Do not step backward with the right leg.
  5. Return the left leg to the starting position.
  6. Repeat on opposite leg.
  7. Continue to alternate each leg.
  8. Repeat 10 times.

Level III Balance Exercises

The Sink Leg Cross III

Drawing of a person standing with right leg crossing over left.

  1. Stand facing kitchen sink.
  2. Hold on with both hands.
  3. Move hands along kitchen sink as you step.
  4. Cross left foot in front of right foot.
  5. Take a side step with your right foot, passing it out from behind your left foot.
  6. Repeat steps 4 and 5 three times.
  7. Now, cross right foot in front of left foot (reverse directions).
  8. Take a side step with your left foot, passing it out from behind your right foot.
  9. Repeat steps 7 and 8 three times.
Sink Side Step III

Drawing of a pair of legs standing straight. A drawing next to the first one has an arrow indicating movement to the left.

  1. Stand facing kitchen sink.
  2. Do not hold onto sink.
  3. Step to left 5 steps.
  4. Step to right 5 steps.
  5. Repeat 5 times.
The Sink Toe Stand III

Drawing of a pair of legs standing on tip toes with an arrow pointing to the raised heels.

  1. Stand facing kitchen sink.
  2. Do not hold onto the sink.
  3. Go up on your toes.
  4. Hold for count of 5.
  5. Then come down.
  6. Repeat 10 times.
Step Forward III

Drawing showing a person stepping forward with right leg. Arrows indicate forward and backward movement.

  1. Stand with right side toward kitchen sink.
  2. Balance with fingertips of the right hand.
  3. Step forward with your left leg; shift your weight forward over the left leg.
  4. Do not step forward with the right leg.
  5. Return the left leg to the starting position.
  6. Repeat on opposite side.
  7. Continue to alternate each leg.
  8. Repeat 10 times.
Step Backward III
  1. Stand with right side toward kitchen sink.
  2. Balance with fingertips of the right hand.
  3. Step backward with your left leg; shift your weight backward over the left leg.
  4. Do not step backward with the right leg.
  5. Return the left leg to the starting position.
  6. Repeat on opposite leg.
  7. Continue to alternate each leg.
  8. Repeat 10 times.

Level IV Balance Exercises

One Leg Sink Stand IV

Drawing of a pair of legs with right leg straight and left leg bent at the knee so that the heel is raised.

  1. Stand facing kitchen sink.
  2. Do not hold onto the kitchen sink.
  3. Stand on your left leg for count of 5.
  4. Stand on your right leg for count of 5.
  5. Repeat 10 times for each leg.
Tandem Walking IV

Drawing of a pair of legs with right leg directly in front of left so that heel of right foot is against toes of left foot.

  1. Stand with left side toward kitchen sink.
  2. Hold on with left hand.
  3. Move hand along kitchen sink as you step.
  4. Place right heel directly in front of toes of left foot.
  5. Now place left heel directly in front of toes of right foot.
  6. Repeat steps 4 and 5 three times.
  7. Turn around.
  8. Hold with right hand.
  9. Repeat steps 4 and 5 three times.
Cross-Over Walk IV

Drawing of a pair of legs with right leg directly in front of left so that heel of right foot is against toes of left foot. Arrows indicate that right foot crosses over left and left foot crosses over right.

  1. Stand with left side toward kitchen sink.
  2. Hold on with left hand.
  3. Move hand along kitchen sink as you step forward.
  4. Cross left foot over right foot.
  5. Cross right foot over left foot.
  6. Repeat steps 4 and 5 three times.
  7. Turn around.
  8. Hold with right hand.
  9. Repeat steps 4 and 5 three times.
Modified Step-Up IV

Drawing of a person stepping up onto a slightly raised platform.

  1. Stand with your right side toward the sink.
  2. Hold onto the sink with your right hand.
  3. Have a step stool or large book (such as a phone book) on the floor in front of you.
  4. Lift the right foot up and tap it on the stool/book.
  5. Lower the right foot back to the floor.
  6. Repeat with the left foot.
  7. Alternate right and left steps.
  8. Repeat 10 times.

Level V Balance Exercises

Walk With Head Turns V
  1. Stand with right side toward sink.
  2. Hold on with the right hand.
  3. Move hand along sink as you step.
  4. Take 5 steps forward.
  5. While stepping forward, turn your head to the right and then to the left one time.
  6. Turn around.
  7. Hold the sink with the left hand.
  8. Repeat steps 4 and 5.
  9. Repeat entire sequence 5 times.
Forward Lunge V

Drawing of a person standing with right leg bent forward and left leg back. Arrows indicate that person alternates forward and back.

  1. Stand with one side to kitchen sink.
  2. Place one hand on the sink, one on your hip.
  3. Lunge forward with right foot.
  4. Return to start position.
  5. Lunge forward with left foot.
  6. Return to start position.
  7. Repeat 10 times.
Side Lunge, Hands on Hips V

Drawing of a person standing facing a sink with hands on hips and left leg out to the side.

  1. Stand near kitchen sink.
  2. Put your hands on your hips.
  3. Lunge to side on left foot.
  4. Return to upright position.
  5. Lunge to side on right.
  6. Return to upright position.
  7. Repeat 10 times.
Step Backward and Forward V

Drawing showing a person stepping forward with right leg. Arrows indicate forward and backward movement.

  1. Stand with your right side toward the kitchen sink.
  2. Balance with fingertips of your right hand.
  3. Step backward with your left leg, shift your weight backward over the left leg, and pause.
  4. Step forward with the left leg, past the right leg.
  5. Shift your weight forward over the left leg.
  6. Return the left leg to the starting position.
  7. Repeat on opposite leg.
  8. Continue to alternate each leg.
  9. Repeat 10 times.
Modified Step-Up V

Drawing of a person stepping up onto a slightly raised platform.

  1. Stand with your right side toward the sink.
  2. Balance with fingertips of your right hand.
  3. Have a step stool or large book (such as a phone book) on the floor in front of you.
  4. Lift the right foot up and tap it on the stool/book.
  5. Lower the right foot back to the floor.
  6. Repeat with the left foot.
  7. Alternate right and left steps.
  8. Repeat 10 times.
Current as of February 2011
Internet Citation: Chapter 10: Participant Handouts: Staying Healthy Through Education and Prevention (STEP). February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/stepmanual/step10.html