Photos by Dan Pelle

One step at a time. That's all it takes to walk into health.

That's the message Nancy Campbell brings to the residents of the Coeur d'Alene Reservation near Plummer, Idaho. Campbell should know. As the "walking instructor" for the Benewah Tribal Medical and Wellness Center, she spends her days counting people's steps, about 1.6 million a day, adding them up and posting them on a large billboard on the reservation for all to see.

Campbell is playing a key role in the wellness center's "Enhancing a Community Through Physical Activity" project, supported by The Robert Wood Johnson Foundation. The program is designed to increase the physical activity of residents on the reservation and surrounding Benewah County, where 26 percent of residents smoke, 15 percent engage in binge drinking, and 64 percent are overweight, all higher than national statistics.

The county's health problems are exacerbated by its economic ills. Fourteen percent of its residents live in poverty, and the county has one of the highest unemployment rates in the state, more than double the national rate. While Campbell can't resolve all those issues, she can help residents improve their physical activity levels—and thus their health—one step at a time.

Personal Fitness First

For Nancy Campbell, the wakeup call came when she turned 40 in 1999. There was no doubt about it: She needed to lose weight. "I had waited too long," she says, and the extra weight she'd put on after having three children and living a fairly sedentary life was too obvious. So she decided to check out the 43,000-square-foot, $5 million dollar Coeur d'Alene Tribal Wellness Center that had recently opened six miles from her house. There she found a plethora of fitness options, including a five-lane, 100,000-gallon lap pool; therapy pool; hot tub; basketball and racquetball courts; an indoor walking track; and programs in physical and cardiac therapy.

She started walking on the treadmill and around the track, gradually working her way up to running, and today notes that not only has she lost 25 pounds, but runs half-marathons. "Had it not been for the Wellness Center, I probably wouldn't have come as far as I have," she says. In August 2003, for instance, she participated in her first triathlon. "I feel really good. I feel better than I did 15 years ago," she says.

When Campbell accepted a position at the center heading a walking program, she found that getting her fellow citizens on the reservation and in the surrounding county to use the Wellness Center's services was more difficult. For the first three years after it opened in 1998, few people took advantage of the facility's offerings, says Wellness Center director Cheryl Weixel.

It was intimidating for the residents of rural, isolated Benewah County, she says. "People weren't used to it. It was scary." It took about three years before people caught on, three years of proving the center wasn't used only by body builders in sleek spandex, but was meant for "average, regular people trying to stay fit," Weixel says. Today, the center boasts 1,464 members, a little over one-third of them from the Coeur d'Alene and other tribes.

That's still a small percentage of the 1,500 tribal members and 10,000 residents who live in the surrounding area, many of whom get little or no physical activity. That, in turn, contributes to the higher-than-average death rates from diabetes, coronary heart disease, hypertension and colon cancer. Native Americans experience compared to the general population. Overall, life expectancy is nearly five years less for Native Americans than for all other racial or ethnic groups.

And so the idea of the walking program was born.

Simple Math

The walking program at the Benewah Tribal Medical and Wellness Center began in October 2002 with a very simple logo: "1+1= 1." The message: "One step at a time, plus one foot in front of the other, equals one community moving together." Thanks to a $294,684 grant from The Robert Wood Johnson Foundation, the center purchased 1,500 digital pedometers (one for each tribal resident) and rented a billboard in nearby Worley. And it hired Nancy Campbell, who had been working in an administrative position for the tribal council.

Campbell liked her administrative job, but knew as soon as she saw the description of the wellness position that it was a perfect fit. "It was working with the community in a positive, healthy, environment," she says. And, of course, she could count.

The idea behind using pedometers for physical activity comes from research showing that the small gadgets, which are worn on the waistband, make physical activity fun, tapping into people's competitive streak by enabling them to compete against others or themselves. For instance, one study found that when a group of sedentary people were given a daily goal of "10,000 steps of brisk activity" as measured by a pedometer, their fitness level, blood pressure, and body fat improved just as much as a group that followed a traditional gym-based aerobic program. Walking, however, is much less intimidating, and thus easier to get people to do, than taking an aerobic class.

So every week, Campbell visits the Coeur d'Alene elementary, middle and high schools, collecting steps from all the children and resetting their pedometers to zero. Most kids, she says, walk between 100,000 and 200,000 steps a month. She also spends one day a week sitting in a conference room at the tribe's largest employer, the Coeur d'Alene Casino/Hotel, waiting for employees to visit her and "turn in" their steps.

Since she began collecting step counts in November 2002, Campbell has entered between 35 million and 60 million steps a month on the enormous spreadsheet on her computer, more than 500 million steps altogether. One "very athletic" participant has logged nearly 7 million steps alone! On average, though, most adults take between 300,000 and 400,000 steps a month, she says.

Those steps add up. By late summer 2003, the tribe was halfway towards its billion-step goal, with about half the original 1,500 people who received pedometers still participating. Beyond the number of steps, the program's goal is to have at least half of tribal residents engaging in routine, moderate physical activity.

Every two weeks, Campbell and her husband toss a ladder into the back of their pickup truck and drive to the huge billboard six miles from the wellness center. There, Campbell's husband climbs up the ladder (the height scares her) and changes the numbers on the billboard.

"It's a really fun job," says Campbell, who tracks about 100,000 steps a week herself. The best part is working with the community, she says. "I wanted to work with them in a positive way, in a healthy way, and maybe in some tiny way do something to help my community members."

From 5 to 90

Tribal participants in the Coeur d'Alene "Enhancing a Community Through Physical Activity" program range in age from 5 to nearly 90. One of the most active participants, in fact, is 72-year-old Lucille Bassah. Bassah works as the tribe's mail courier, but she rarely has to leave her truck to deliver the mail, hence, she got very little physical activity. Then she joined the 1+1= 1 program. "She took our pedometer and put it on and ran with it," says Nancy Campbell, who directs the program

Today, Bassah walks at least 100,000 steps a week, about 47 miles. She does it by walking every chance she gets. For instance, even before the new golf course at the tribal casino officially opened, Bassah was out walking its trails—a seven-mile, or 14,000-step, jaunt. "Sometimes I'll look out the window and see her walking the road behind the Wellness Center,"Campbell says. Like many on the reservation, Bassah has gotten competitive about the steps, trying to beat a younger employee she works with.

That competitive spirit—whether you're competing against other people or against yourself — plays a big role in the success of the program, Campbell says. "And that's OK; it doesn't matter why they're doing it, as long as they're doing it."

She tries to help with personal encouragement, stopping people she sees in the Wellness Center to tell them how well they're doing, how great they look, and getting just as excited over someone's first 10,000 steps as over their 200,000th step.

People get their steps in unique ways, says Campbell. For instance, instead of just one person going into a store, the whole carload goes just to get the extra steps. At the casino, employees walk the entire length and breadth of the complex, a distance of about six football fields. They're usually surprised at how the steps add up, Wellness Center director Cheryl Weixel says, just from changing some of their regular, day-to-day activities without adding formal exercise.

And although the program deliberately doesn't track participants' weight or health, Campbell says she can see the changes. One woman, who was significantly overweight and had a heart condition, told Campbell she'd lost 40 pounds. The lost weight means she not only feels better physically, but can now do her housework.

And when Campbell asked Bassah what the walking had done for her, the answer came immediately: "It's changed my life."