MacMillan et al. BMC Public Health 2011, 11:120 http://www.biomedcentral.com/1471-2458/11/120 Page 6 of 12 Table 2 Description of the behaviour change techniques targeted in the consultations Behaviour change technique Motivation for taking part Information on the link between walking and health Self reflection on pros and cons of increasing walking Graded tasks Instruction Self-monitoring Identifying and overcoming barriers Relapse prevention How the technique was used in the consultation Discussion of why participant interested in the project Reflection on role of physical activity for health and well being Weighing up pros and cons of increasing walking Graded walking goals set tailored to each individuals baseline pedometer readings Using the pedometer Using the pedometer to monitor progress towards goals Recognising barriers and inviting participant to consider ways to overcome For immediate intervention group only at consultation two: discussion of avoiding lapses, recognising situations which make walking difficult, thinking of alternatives. participation by providing peer support and a social sup- port network. Feedback from participants in the WWW trial suggested the provision of a local walking group would have enhanced the study [23]. Paths for All (http://www.pathsforall.org.uk), a national charity which promotes walking for health, assisted in the establish- ment (including the training of walk leaders by comple- tion of a one day course) and sustainability of the walking group. An attendance record was kept to deter- mine how many participants used the group and how often. Design There were two groups in the study; an immediate intervention group (immediate group) and a 12-week waiting list group (delayed group). The design of the study was a 12-week randomised controlled trial with a 12-week follow up for the intervention group. The immediate group received the intervention when they were entered into the study. The delayed group acted as a control group and were instructed to continue with their normal physical activity behaviour for the first 12 weeks of the study before receiving the same inter- vention as the immediate group. Table 3 Details of the 12-week pedometer based graduated walking programme Week Goal Week 1-2 To increase the individual’s average daily step count by 1500 steps above their baseline value on at least 3 days of the week Week 3-4 To increase the individual’s average daily step count by 1500 steps above their baseline value on at least 5 days of the week Week 5-6 To increase the individual’s average daily step count by 3000 steps above their baseline value on at least 3 days of the week Week 7-8 To increase the individual’s average daily step count by 3000 steps above their baseline value on at least 5 days of the week Week 9- To maintain their walking level aiming for the week 7 goal 12 Procedures Participants were invited to attend six study visits over 24 weeks (Figure 1). At visit 1, participants met with the prac- tice nurse to go over the study protocol, discussed their present health with the general practitioner, completed informed consent and questionnaires and were fitted with a sealed pedometer (so that participants were unaware of their step counts before being given the intervention) and an activPAL. All participants were instructed to continue with their normal physical activity patterns. At visit 2, one week after visit 1, individuals were randomised, on a one- to-one basis, into the immediate or delayed group by selecting a sealed envelope. Those who achieved ≥70,000 steps/week at baseline were classed as regularly physically active and excluded from participation as this equates to ≥150 minutes of moderate physical activity/week [54]. Par- ticipants in the delayed group were instructed at this visit to continue with their normal physical activity patterns for the next 12 weeks. At visit 3, 11 weeks after visit 1, all par- ticipants were fitted with an activPAL and the immediate group continued to wear an unsealed pedometer (as they had had the intervention and were using the pedometer as part of the walking programme) whilst the delayed group were fitted with a sealed pedometer (because they were yet to receive the intervention). During visit 4, 12 weeks after visit 1, both groups completed 12-week questionnaires. Also at this visit the immediate group were given a second consultation whilst the delayed group were given an initial physical activity consultation, an individualised incremen- tal 12-week walking programme and a pedometer (just as the immediate group had at visit 2). At visit 5, 23 weeks after visit 1, all participants continued to wear unsealed pedometers (as they had all started the walking pro- gramme) and were fitted with an activPAL. All partici- pants completed 24-week questionnaires and were given thank-you packs (consisting of information on local physi- cal activity opportunities and a pedometer) at visit 6, 24 weeks after visit 1. In addition the delayed group were encouraged by the nurse to increase or maintain their walking levels based on whether the individual had met