Ending Type 2 Diabetes One Exercise, Nutrition, and Gardening Class at a Time

Posts Tagged ‘Nutrition Class’

Fresh Direct, US/Mexican Style

In Nutrition Class on March 2, 2012 at 1:29 PM

One of the Diabetes Prevention Program participants, Anna for the purposes of this story, took it upon herself to prepare a distinctly Mexican salad for one of our nutrition class cooking demos this week. When collecting her receipt for the ingredients, I faintly balked. It was hand-written in pencil, and torn from a common academic three-ring binder. I sheepishly asked her whether she had a proper receipt, from the store in which she had purchased the vegetables. Then Anna tells me the most fascinating story.

Every week, she gets a call from a fruit and vegetable vendor asking whether he should come by on Saturday. Most weeks Anna says yes.

Around mid-day she hears someone knock at her front door. She descends the stairs of her own home, and proceeds to shop for good looking vegetables and fruits in the bed of this man’s pick-up truck! Indeed, the vendor brings his best vegetables and fruits to peoples’ doorsteps every Saturday for sale.

When I asked why she shops with him, as opposed to going to the store just over a mile from her home, she asks with patience how, exactly, she should shop without transportation? ‘ “Besides,” she explains, “he knows what we cook and always have exactly what we need for our favorite meals.”

Incredible the kinds of resources people with difficult circumstances create for themselves to meet their needs. If we continued to tap into this informal network, perhaps we could get even more vegetables and fruits on people’s tables on a daily basis, thereby lowering their risk for diet-related chronic disease!

The ingredients receipt!

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Diabetes Prevention Program Nutrition Classes & Cooking Demonstrations

In Nutrition Class on February 17, 2012 at 5:56 PM

Since 2007, the Fair Haven Community Health Center’s Diabetes Prevention Program (FHCHC DPP) has offered 1-hour nutrition classes once per week for participants in the 12-week Intensive Lifestyle Intervention. The nutrition curriculum is based on the National Institutes of Health’s Diabetes Prevention Program curriculum, amended by the University of Pittsburgh to fit larger groups, and further translated to fit FHCHC’s particular low literate and predominantly Latino population. Classes are taught by FHCHC DPP clinicians, and are delivered in both English and Spanish. Bilingual PowerPoint presentations and handouts support participants in understanding the content of each session, while detailed facilitator scripts and facilitator guides support facilitators in addressing the widely diverse needs and experiences of participants. Cooking demonstrations and discussions are an experiential learning component of each class, and foods prepared each week reflect the ripe produce harvested that week from the program’s garden. Between 10-20 adults attend classes on a weekly basis, and often that same group stays the next hour for a professional trainer-led exercise class. Children attend their own exercise classes during the adult nutrition and exercise classes, while infants and toddlers attend onsite childcare. Aligned with the notion that diabetes is a family-oriented disease, when one patient is invited to attend nutrition classes, DPP staff invites members of the patient’s family to attend as well.

Where have all the Registered Dietitians Gone?

In About the Program on February 6, 2012 at 4:55 PM

Interestingly, the Fair Haven Community Health Center has struggled to find a registered dietitian (RD) for our Diabetes Prevention Program vacancy. At the outset, we had no concerns about our ability to obtain qualified candidates. And yet, as search stretched from weeks to months, we discovered that we were sorely mistaken. It turns out that a “Bilingual (Spanish/English) Registered Dietician” is a rare commodity.

Why, we wondered, is it that bilingual dieticians are scarce?

Theory: the return on investment is too low.

Many folks coming from underprivileged backgrounds are interested in working in the health field. When they explore their options, two professions seem to fit their criteria: becoming a nurse and becoming a registered dietician. There is a demand in the market for both, the living is decent in either case, and in each profession provides an opportunity to make a difference in people’s health. So how do they choose?

They look at the cost and duration of each degree.

At Gateway Community College, located not far from the Fair Haven Community Health Center, a state resident can earn an associates nursing degree in 2 years, or 4 semesters, for a grand total of $6,192. This is one of many community, state, and private institutions that offer nursing degrees.

Now take a registered dietitian degree. First off, there is just one such program in Connecticut, located in Storrs at UCONN. In order to earn this degree, read the following passage taken from the program website:

To become an RD, a student must earn a four year degree and complete a didactic program in dietetics that is accredited by the Commission on Accreditation of Dietetic Education(CADE).  Upon completion, a verification statement that verifies you completed a didactic program in dietetics.  You are then eligible to apply to a supervised practice program, also called a dietetic internship that is accredited by CADE.  An internship typically lasts 9 months and consists of at least 1200 supervised practice hours in the field.   Upon completion of an internship, he/she is able to sit for the national registration examination administered by the Commission on Dietetic Registration (CDR). http://www.canr.uconn.edu/nutsci/nutsci/dietetics.html

Four years of study at $8,256 equals $33,024.

Now look again at your choices: two years to become a practicing nurse in the field for $6,192, OR a minimum of 4 years plus a 9-month internship to become a registered dietitian, at a minimum cost of $33,024.

You may be thinking yes, but I can make a lot more money as a registered dietitian once I have the degree! Think again. A registered nurse makes between $21-$45/hour. An RD earns between $15-$36/hour.

There may be many reasons that people become registered dietitians; but cost and duration of the degree are certainly not two of them. The result of these aggravating factors is a scarcity of registered dietitians. Those who are bilingual often come from economically disadvantaged conditions, and although they are precisely the kinds of job candidates we are searching for, they are the people who can scarcely afford the 4 years 9 months and $33,024 cost of becoming registered dietitions.

 

 

Community-Based Participatory Research Overview

In Intensive Lifestyle Intervention - General on October 24, 2011 at 2:17 PM

Guest blogger Rosette Chakkalakal will be posting updates on the Community-Based Participatory Research project that she is managing with the FHCHC DPP and Yale’s Bright Bodies Program. This post is an overview of the research so far:

We are using a community-based research approach to conduct a program evaluation of Fair Haven Community Health Center’s (FHCHC) Diabetes Prevention Program.  Our team includes program leadership and staff from the FHCHC Diabetes Prevention Program (DPP), the Bright Bodies program, and the Robert Wood Johnson Foundation Clinical Scholars Program at Yale.   The program evaluation specifically focuses on making the program more family-centered and improving the quality of the self-monitoring aspect of the program.  Over the summer, our project team met several times to review the processes and goals of each program and find opportunities to incorporate additional “family time” activities in each session.  Some of these activities include family food tastings of healthy recipes and exercising together.  We also devised a strategy to encourage participants to self-monitor their physical activity using quality improvement techniques to attain a goal of having 50% of our participants return their exercise diaries by the end of the 12-week program.  Right now, we are meeting twice per month to think about how these new interventions and strategies are working as we implement them with the current participants of the programs.  We are constantly thinking of ways to adapt the program to make it better—for example, we haven’t seen many of the participants return their exercise diaries so we will now be giving out “Bright Bodies Bucks” to participants who return their diaries that we will then use to enter them in raffles.  We also realize that right now, we only receive feedback from the program leaders regarding these new elements of the curriculum.  We will start handing out brief “activity evaluation” forms to the participants so they can tell us what they think of the programs as well.

Bright Bodies Bucks

In Intensive Lifestyle Intervention - General on October 24, 2011 at 2:14 PM

A Bright Bodies “Buck” is basically a raffle ticket.  We will have a raffle twice per each 12-week session.  When a participant in the Bright Bodies program does the following, they earn a buck (raffle ticket) towards a raffle prize:

  1. Weigh the same weight as you did the week before (i.e., don’t gain weight)
  2. Weigh less than you did the week before
  3. Bring in your exercise log for the staff to review

___________________________

Congratulations, you’ve earn a:

BRIGHT BODIES BUCK

 

NAME __________________

Diabetes Prevention Program Participants Featured in Opening of Fair Haven Farmers Market

In About the Program on July 8, 2011 at 5:42 PM

Yesterday, two families from the Fair Haven Community Health Center performed a cooking demo at the opening day of the Fair Haven Farmers Market. This market, run by local nonprofit City Seed, is an effort to bring fresh fruits and vegetables to some of the lower income New Haven neighborhoods. Those neighborhoods, like Fair Haven, suffer high incidences of chronic disease, and disease related to nutrition. It was fitting, therefore, that City Seed asked wether some of the families participating in the Fair Haven Community Health Center’s Diabetes Prevention Program could share with market shoppers some of the things they are learning in their nutrition and gardening classes. The families chose two recipes they learned in class that used in-season vegetables: yogurt and mint dip, and a tomato and basil salad. Both were a big hit, especially with the daughters of the DPP participants serving and promoting the nutrient-dense foods.

Here are the recipes (thanks to Alex Grizas, our demo cook extraordinairre), which were also provided in English and Spanish to market shoppers:

Tomato, Orange, Basil Salad

Time to Prepare: 10 minutes                                    Serves: 4 as a side salad                                         Cost: $3.00 total

 

Fresh, ripe tomatoes bursting with both color and favor are one of the best treats of the summer. This Spanish salad can be eaten at breakfast, lunch, dinner, or as a snack.  Enjoy it alone or even better with fish or chicken.  For variety, you can add other fresh herbs, spinach, or other greens.

 

Salad:

2 tomatoes

1 orange

¼ cup basil leaves

2 Tsp Olive Oil

¼ Tsp Salt

⅛ Tsp Pepper

 

  1. Chop the tomato into bite sized pieces and place in a bowl.
  2. Peel the orange and cut into bite sized pieces, adding it to the tomatoes with the juices from the orange.
  3. Add the salt, pepper, and olive oil, and toss to coat well.
  4. Stack the basil leaves on top of each other.  Roll them up from bottom to the top.  Cut into thin slices along the length of the roll, creating ribbons of basil (this technique is called chiffonade (French term)).
  5. Stir the salad and chill in the refrigerator until serving, about 10 minutes ideally.

 

Nutrition Facts

Serving Size

1 serving (100.9 g)

 
Amount Per Serving
Calories 49                                          Calories from Fat 22

% Daily Value*

Total Fat 2.5g                                                                4%
Saturated Fat 0.4g                                                         2%
Cholesterol 0mg                                                           0%
Sodium 123mg                                                               5%
Total Carbohydrates 6.9g                                          2%
Dietary Fiber 1.6g                                                          6%
Sugars 4.6g
Protein 0.9g

Vitamin A 14%

Vitamin C 48%

Calcium 2%

Iron 2%

* Based on a 2000 calorie diet

 

 

Ensalada Con Tomates, Naranja, y Albahaca

Tiempo de preparar: 10 minutos                             Porciones: 4                                       Costo: $3.00 total

 

Ensalada:

2 tomates

1 naranja

¼ tazo hojas de albahaca

2 cdta aceite de oliva “extra virgin”

¼ cdta sal “kosher”

⅛ cdta pimienta negra

 

  1. Pique los tomates en pedacitos medianos and ponga en un tazón.
  2. Pele la naranja y pique en pedcitos medianos.  Ponga la naranja y sus jugos en el tazón con los tomatoes cortados.
  3. Adicione el sal, la pimienta negra, y el aceite, y mézclelo bien.
  4. Amontone las hojas de albahaca, arrolle las hojas del fondo a la cima, y cortelas en rajas delgadas.  Este técnica se llama “chiffonade” en francés.
  5. Mézcle la ensalada y mantengala en el refrigerador hasta que vaya a servirla, acerca de 10 minutos idealmente.

 

 

Información Nutricional

Tamaño de la Porción

1 porción  (100.9 g)

 
Cantidad por porción
Calorías 49                                         Calorías de grasa 22

% Daily Value*

Grasa total 2.5g                                                            4%
Grasa saturada  0.4g                                                     2%
Colesterol 0mg                                                              0%
Sodio 123mg                                                                   5%
Total de carbohidratos 6.9g                                     2%
Fibra dietética 1.6g                                                        6%
Azucares 4.6g
Proteínas 0.9g

Vitamina A 14%

Vitamina C 48%

Calcio 2%

Hierro 2%

* Basados en una dieta de 2,000 calorías

 

 

Homemade Plain Yogurt

Time to Cook: 3 hours                             Serves: many as a topping or snack                                                            Cost: $2.00 total

 

In Middle Eastern countries like Turkey, Syria, and Lebanon, plain yogurt is a delicious part of many dishes, including both meats and vegetables.  It is a thicker type of yogurt than what we usually see in the United States, and because it is so thick, it can be mixed with many different things to make sauces, dips, and dishes, both hot and cold.  One of the great benefits of eating yogurt is digestive health, as yogurt contains good bacteria to help process the foods we eat so we can get the most nutritional benefit from all of our healthy eating choices.  This week we will sample plain yogurt, as well as a cold cucumber dip, to be eaten with any of your vegetable fresh vegetables.  Remember, the vegetables should be the bulk of what we eat, with just a little cucumber dip to taste with each bite.

 

Yogurt:

1 gallon whole milk

1 Tbsp plain yogurt

 

  1. Boil 1 gallon of milk in a large pot until there is a film on the top in a large pot.  Take the pot off the heat and cool until the milk is warm (not too hot and not too cold).
  2. Put 1 tablespoon plain yogurt in the warm milk and stir until completely mixed in.
  3. Place a lid on the pot, wrap the whole pot in a towel or blanket, put a plastic bag (or trash bag) around the wrapped pot, and wrap another towel or blanket around plastic bag containing the wrapped pot.  Let this sit out for 2 hours.
  4. After two hours, remove the outer towel, plastic bag, inner towel, and lid from the pot.  Place the pot in the refrigerator until the yogurt is cold and thick; then it is ready to eat!  If the yogurt is not thick enough after it becomes cold, repeat the process of covering the pot with a lid, towel, plastic bag, and another towel, and then let sit outside of the refrigerator for 30 minute to 1 hour.  Then remove all of the coverings again, and place in the refrigerator again until it is cold and thick.

 

Cucumber Dip

Time to Prepare: 10 minutes                                Serves: 8 (1 serving = 2 Tbsp)                                            Cost: $4.00 total

 

1 cup homemade plain yogurt

2 cloves garlic

1 large cucumber

½ small red onion

1 lemon

1 Tbsp mint (if you like)

Salt and Pepper, to taste

Variety of your favorite vegetables (cucumber slices, carrots, peppers, tomatoes, radish, celery, broccoli)

 

  1. Chop the garlic, mint, and red onion very small.
  2. Peel the cucumber, remove the seeds, and chop the cucumber into little pieces.
  3. Wash and cut your favorite vegetables.
  4. Mix the cucumber, onion, and garlic with the yogurt.  Add the juice of 1 lemon and mix gently.  Add black pepper to taste (about ½ Tsp) and a little salt, to taste.
  5. Chill in the refrigerator until ready to serve, and stir before serving.

 

Nutrition Facts

Serving Size

11 serving (80.3 g)

 
Amount Per Serving
Calories 28382                                            Calories from Fat 9110

% Daily Value*

Total Fat  1.0g12.2                                                               2%19
Saturated Fat  0.6g1.8                                                        3%9
Cholesterol 4mg  8                                                         1%3
Sodium 136mg557                                                               6%23
Total Carbohydrates 3.8g44.9                                         1%15
Dietary Fiber 0.6g                                                          2%15
Sugars 2.5g6.2
Protein 1.4g21.0

Vitamin A 1%72

Vitamin C 9%44

Calcium 1%52

Iron 1%11

* Based on a 2000 calorie diet

YOGURT                                                                          CUCUMBER DIP

Nutrition Facts

Serving Size

11 serving (227.3 g)

 
Amount Per Serving
Calories 142382                                        Calories from Fat 68110

% Daily Value*

Total Fat  7.6g12.2                                                             12%19
Saturated Fat  4.7g1.8                                                      23%9
Cholesterol 33mg8                                                       11%3
Sodium 118mg557                                                               5%23
Total Carbohydrates 11.4g44.9                                       4%15
Sugars 11.4g6.2
Protein 7.6g21.0

Vitamin A 6%72

Vitamin C 0%44

Calcium 28%52

Iron 0%11

* Based on a 2000 calorie diet

 

 

 

 

 

 

Yogurt Casero

Tiempo de cocinar: 3 horas                                  Porciones: se sirve como snack                                          Costo: $2.00 total

 

En países del Oriente medio como Turquía, Siria, y Líbano, el yogurt natural es parte de muchos de sus platos típicos, incluso se usa con carnes y vegetales. Este yogurt es mas espeso que el yogurt que se usa en Estados Unidos, y por su espesura es que se puede mezclar con otras cosas para hacer salsas, y platos, fríos y calientes. Uno de los muchos  beneficios del yogurt es que ayuda a mantener una Buena salud del sistema digestivo, ya que contiene Buena bacteria que nos ayuda a digerir los alimentos y obtener todos los nutrientes de nuestras comidas. Esta semana estaremos probando yogurt natural simple, también estaremos probando una salsa de pepinos  para acompañar unos vegetales frescos. Recuerda que los vegetales deben ser la mayor parte de nuestra comida  y solo usar un poco de salsa de pepinos con cada bocado.

 

Yogurt:

1 galón de leche entera

1 Cucharada de yogurt simple-sin sabor

 

  1. Hervir 1 galón de leche en una olla grande hasta ver una capa gruesa en la parte de arriba. Remueva la olla del calor y espere a que enfríe la leche y este tibia (no muy caliente, no muy fría)
  2. Ponga 1 cucharada de yogurt simple en la leche tibia y revuelva hasta que se disuelva completamente
  3. Ponga una tapa sobre la olla, envuelva la olla con una toalla o manta, luego ponga una bolsa plástica (o bolsa para la basura) alrededor de la olla ya envuelta y ponga nuevamente otra toalla o manta alrededor de esta. Permita que se quede así por 2 horas.
  4. Después de 2 horas, remueva las toallas, la bolsa plástica y la tapa de la olla. Ponga la olla en el refrigerador hasta que el yogurt este frío y espeso; y luego ¡estará listo para comer! Si el yogurt no llegara a estar lo suficientemente espeso después de enfriar, repita el proceso de cubrir la olla con una tapa, toalla, una bolsa plástica y otra toalla, y luego permita que se quede por fuera del refrigerador por 30 minutos o una hora. Luego remueva todo lo que cubre la olla, y ponga en el refrigerador otra vez hasta que enfrié y espese.

 

Salsa de Pepinos

Tiempo de preparación: 10 minutos                     Porciones: 8 (1 porcion = 2 cda)                            Costo: $4.00 total

 

1 taza de yogurt casero simple

2 clavos de ajo

1 pepino largo

½ cebolla roja pequeño

1 limón

1 cucharada de menta (si le gusta)

Sal y pimienta, al gusto

Vegetales variados, sus favoritos (rebanadas de pepino, zanahorias, pimentones, tomates, rábanos, apio, brócoli)

 

  1. Picar el ajo, menta, y la cebolla roja en pedazos pequeños.
  2. Pelar el pepino, remueva las semillas, y pique en pedazos pequeños.  Luego, lave y corte sus vegetales frescos.
  3. Combine el pepino, cebolla, y el ajo picado con el yogurt. Adicione el jugo de 1 limón y mezcle suavemente. Adicione pimienta negra al gusto (alrededor de ½ cucharadita) y un poco de sal, al gusto.
  4. Deje que la mezcla enfríe en el refrigerador hasta que vaya a servir, revuelva antes de servir.

Información Nutricional

Tamaño de la Porción

11 porción  (80.3 g)

 
Cantidad por porción
Calorías 28382                                           Calorías de grasa 9110

% Daily Value*

Grasa total 1.0g 12.2                                                           2%19
Grasa saturada   0.6g1.8                                                    3%9
Colesterol 4mg8                                                             1%3
Sodio 136mg557                                                                   6%23
Total de carbohidratos 3.8g  44.9                                   1%15
Fibre 0.6g                                                                       2%
Azucares 2.5g6.2
Proteínas 1.4g21.0

Vitamina A 1%72

Vitamina C 9%44

Calcio 1%52

Hierro 1%11

* Basados en una dieta de 2,000 calorías

YOGURT                                                                  SALSA DE PEPINOS

Información Nutricional

Tamaño de la Porción

11 porción  (227.3 g)

 
Cantidad por porción
Calorías 142382                                       Calorías de grasa 68110

% Daily Value*

Grasa total 7.6g 12.2                                                         12%19
Grasa saturada   4.7g1.8                                                  23%9
Colesterol 33mg8                                                         11%3
Sodio 118mg557                                                                   5%23
Total de carbohidratos 11.4g44.9                                   4%15
Azucares 11.4g6.2
Proteínas 7.6g21.0

Vitamina A 6%72

Vitamina C 0%44

Calcio 28%52

Hierro 0%11

* Basados en una dieta de 2,000 calorías

 

Photo Food Diaries – Do You See Any Difference In Food Intake?

In Food Diaries on May 2, 2011 at 1:18 PM

The photos below were taken by the same people , once in the first few weeks of the FHCHC DPP and once in the last few weeks.
Do you see any differences?

January 2011 Participant #1

March 2011 Participant #1

January 2011 Participant #1

March 2011 Participant #1

January 2011 Participant #2

March 2011 Participant #2

January 2011 Participant #2

March 2011 Participant #2

January 2011 Participant #3

March 2011 Participant #3

January 2011 Participant #3

March 2011 Participant #3

Photo Food Diaries

In Food Diaries, Nutrition Class on March 29, 2011 at 10:22 AM

The FHCHC Diabetes Prevention Program is testing the effectiveness of photo food diaries, and comparing the results with written food diaries. According to the NIH:

“All participants are asked to record their intake daily…because of the extensive evidence that self-monitoring is highly correlated with success in reaching dietary change goals. Numerous studies have shown a dose-response relationship between frequency of self-monitoring and level of success in losing weight and/or improving cardiovascular risk factors. Many experts consider self-monitoring the single most effective approach to changing dietary intake.” NIH DPP

For many FHCHC DPP participants, writing their daily food intake and the amounts of those foods they consume, occurs as very challenging. Indeed, it is rare that 100% of participants present their food diaries in any given week. Knowing the importance of self-monitoring, and the challenging nature of food diaries for our participants, we handed out disposable cameras with explicit directions on how to document their food consumption. Use the flash! Take a picture of everything you eat, even if it’s a snack or beverage. Bring it back next week.
Below are some examples of the photos women took in the first couple weeks of their participation in the FHCHC DPP program. In a week, participants will return their second set of disposable cameras, and the Lead Provider and nutritionist will analyze the results to see whether photo food diaries are a more effective self-monitoring strategy than written food diaries. They will look at rate of return, as well as glean any changes in food consumption that may have taken place since the first couple weeks of the program.

 

 

 

 

 

January 9, 2011 Intensive Lifestyle Intervention Group – The Players

In Intensive Lifestyle Intervention - General on January 18, 2011 at 10:59 AM

The FHCHC Diabetes Prevention Program has launched its latest Intensive Lifestlye Intervention! It’s a strong group, half of whom are returning to participate again from previous programs. Below are the players, adults and children, whom we will follow via video for the next 12 weeks. Whoo hoo!

FHCHC’s DPP Intensive Lifestyle Intervention – An Overview

In Intensive Lifestyle Intervention - General on December 8, 2010 at 4:01 PM

ILI Overview & Intake Procedure

If a Hispanic woman between the ages of 18-55 has had a blood test in the past three months that has rendered her pre-diabetic, and she is a patient at the Fair Haven Community Health Center, she is eligible to participate in the Diabetes Prevention Program’s Intensive Lifestyle Intervention (DPP’s ILI). There are two study tracks: delayed and immediate. Those randomized to participate in the delayed group see their provider every three months for a year, as well as a nutritionist once during that time. Those in the immediate track participate in a 12-week exercise and nutrition program, seeing a provider weekly and having the opportunity to continue participating after the initial 12-weeks. At the end of one year, all delayed and immediate-track ILI participants have an OGTT screening to distinguish any changes in their physical wellbeing. Those in the delayed group can then enter into the immediate track if they choose. Those randomized to participate in the immediate study group begin their weekly nutrition and exercise classes immediately.

Prior to the randomization process, pre-diabetic patients are invited to the clinic for an intake (click here to see the Intake Checklist). There, their labs are confirmed, vitals taken, and they are given the opportunity to join the ILI study (click here to see intake checklist). These intakes are free, and are scheduled by the DPP staff, rendering most of the process outside the clinic’s traditional admission and billing processes. Typically, the appointment takes around 30 minutes, and is conducted by a trained DPP administrator.

The intention of the intake is to determine whether a pre-diabetic patient is interested in participating in the ILI study, and if so, collect all the essential study data to get them started. The consent form solidifies their participation, after which vitals and other medical-related data is collected, and physical activity and nutrition-related questionnaires are filled out. As part of the initial data collection, patients are also given pedometers and a pedometer tracking form, the data from which will indicate the amount of walking each patient does on a typical weekday or weekend. The DPP awards $10 gift certificates to Walmart if they return the pedometers and the pedometer tracking form after a complete week, a strategy that has fueled participation.

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