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Montana Dept. of Public Health Expands Successful Worksite Walking Program

State: Montana

Submitted Date: 2020

Public Health Issue

Approximately 127 million Americans live with a musculoskeletal condition. These conditions have an associated cost of treatment, care and lost wages totaling more than $213 billion annually.1 Narrowing to arthritis specifically, this chronic disease affects one in four Americans and causes significant disability.2 Similarly, more than one in four adults in Montana, 27%, have arthritis.3 Of Montanans with arthritis, half have activity limitations and nearly a quarter have arthritis-related joint pain.3   

The negative consequences of arthritis extend beyond the individual. They lead to absenteeism, distraction and lost productivity at work. In fact, 172 million workdays are lost due to arthritis and other rheumatic conditions.2

Research recommends self-efficacy and self-management programs, such as Walk with Ease, for management of osteoarthritis.4 Likewise, physical activity has been proven to improve arthritis symptoms.5

As such, the National Association of Chronic Disease Directors (NACDD) is supporting the Montana Department of Public Health and Human Services, Chronic Disease Prevention & Health Promotion Bureau (CDPHP Bureau) in their effort to recruit partners that will increase the adoption of Walk With Ease (WWE) in workplaces across Montana. The WWE program can benefit those living with arthritis by reducing pain, improving balance and strength, and building confidence in one’s ability to be physically active.6 These individual benefits can also translate to employer benefits, including decreased absenteeism, increased productivity while at work, decreased health care costs, and increased job satisfaction.

  1. American Academy of Orthopedic Surgeons. (2016, March 1). One in two Americans have a musculoskeletal condition: New report outlines the prevalence, scope, cost and projected growth of musculoskeletal disorders in the US. ScienceDaily.
  2. Arthritis Foundation. (2018, December 20). What Americans Don't Know About Arthritis May Surprise You.
  3. Barbour KE, Moss S, Croft JB, et al. Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management — United States, 2015. MMWR Surveill Summ 2018;67(No. SS-4):1–28. DOI:
  4. Kolasinski SL, Neogi T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research 2020; 72 (2): pp 149–162 DOI: 10.1002/acr.24131
  5. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee scientific report. Washington, DC: US Department of Health and Human Services, 2018.
  6. Arthritis Foundation. About the program.
Program Action

Since 2015, the Montana Health Care and Benefits Division has offered the self-directed version of WWE in the established state employee wellness program.  Employees are offered a health insurance premium discount as a financial incentive to participate in and complete the program. Evaluation of self-reported data from participants revealed walking levels increased significantly among participants, while pain and fatigue decreased among those with moderate or severe pain at the start of the program.1 In the first year, WWE was offered to only employees with arthritis, however, in subsequent years, it was offered to all State of Montana Benefit Members who wanted to participate in a low-impact physical activity program.

In 2019, NACDD began providing the CDPHP Bureau financial support to build on the successes of Work@Health® and the State of Montana employee worksite wellness efforts, which included offering WWE as described above. Since then, NACDD has collaborated with the CDPHP Bureau to help increase the availability of WWE in employers across Montana. The CDPHP Bureau has done so by building upon existing partnerships formed during Work@Health® and through other efforts to recruit employers and partners. 

The CDPHP Bureau began by compiling a list of contacts and scheduling meetings to introduce WWE. To assist with explaining the program and benefits of adopting it as a physical activity component of workplace wellness efforts, both to employers and for employers to recruit employees, the CDPHP Bureau compiled a kit of marketing materials.

As more employers and partners engaged, the CDPHP Bureau formalized their onboarding process for new partners, offering each new site a start-up kit. Kits includes WWE participant books that were purchased using NACDD grant funding, marketing supplies, access to the WWE participant portal (described below), and other items to support the launch of their first WWE session. Additionally, the CDPHP Bureau offers technical support throughout the process to entice employers to implement the program. 

  1. Silverstein RP, VanderVos M, Welch H, Long A, Kaboré CD, Hootman JM. Self-Directed Walk With Ease Workplace Wellness Program - Montana, 2015-2017. MMWR Morb Mortal Wkly Rep 2018;67:1295-1299. DOI:



To date, the CDPHP Bureau’s efforts have been fruitful. Since 2015, they have enrolled over 6,700 employees across multiple employers as WWE participants. Over 1,000 of the participants have been engaged since the CDPHP Bureau began working with NACDD. 

All WWE participants have the opportunity to complete a voluntary pre-test, post-test, and a six-month follow-up survey. All three-assessment questionnaires are identical as a mode of comparison. There are four measurable outcomes in the questionnaires: 1) pain and fatigue levels; 2) current physical activity level; 3) self-efficacy to exercise; and 4) physical limitation. The data highlights that the participants who complete the self-directed WWE program have a significant increase in their weekly walking minutes and other physical activity, a decrease in fatigue levels and a reduction in moderate to severe pain levels. The CDPHP Bureau uses the data gathered from the assessment tools to promote self-directed WWE to potential employers by showing the benefits WWE has on employees.

Beyond the number of participants, the CDPHP Bureau has figured out a successful model for engaging employers and partners from different industry sectors, of various sizes and in geographic locations across the state. Examples of participating employers include the state government, county governments across the state, local health departments, a quality improvement organization, school districts, hospitals, and a community health center. 

The CDPHP Bureau sees the value of working with partners with connections into groups of organizations where employers are members, and to integrating WWE into other employer wellness efforts. This approach is more advantageous than cold-calling employers to participate in WWE. Partners include:

  • Montana Blue Cross, Blue Shield (BCBS): The organization has agreed to promote WWE, linking 24 employers to the broader effort. BCBS added WWE as a worksite wellness program to their menu of health and wellbeing programs that employers’ members can participate in. BCBS offers health and wellbeing programs as part of plan coverage. The programs help employees live healthier and save on health care costs. The CDPHP Bureau is hopeful that a subset of the 24 employers will begin rolling out WWE in the second half of 2020.
  • Regional Health Districts: The Worksite Wellness Coordinator for the Chronic Disease Prevention and Health Promotion Bureau has agreed to integrate WWE as an evidence-based physical activity strategy for the 13 Chronic Disease Health Regions that are supported. Each chronic disease region is tasked with working with three local employers around physical activity, nutrition, tobacco-free, and/or breast-feeding strategies. As of March 2020, 10 out of the 13 Chronic Disease Health Regions are offering the WWE program to local employers.
  • Diabetes Prevention Program: The CDPHP Bureau is working to link evidence-based interventions by partnering with community-based organizations, who are recognized Diabetes Prevention Program (DPP) providers, to market WWE as a physical activity component of the DPP lifestyle change program. DPP providers are also being targeted to implement WWE to their own employees. To date, seven DPP providers have agreed to roll out WWE to their own employees. 
  • The CDPHP Bureau is engaged in ongoing conversations with Montana Veterans Affairs to implement the WWE program. Montana Veterans Affairs has recently received approval to pilot the WWE group option in several of the homes of veteran throughout Montana. Over time, the CDPHP Bureau’s goal is to continue to have the WWE program offered to Montana veterans and eventually offer the self-directed WWE to the Montana Veterans Affairs’ employees.

Another worksite the CDPHP Bureau is working with is a large school district. The school district is currently piloting the self-directed WWE as a worksite wellness program to employees at a high school, with the potential to expand to all schools in the district in the subsequent semester.

Lisa Erck, MS
National Association of Chronic Disease Directors