The project instructors developed personal rapport with churches and community centers' leaders to recruit program participants. Once permission was granted to conduct a program at a specific site, flyers were distributed throughout the community. Local media also were used to announce programs.
Research conducted in faith communities to increase physical activity has been successful. This research guided the development of a physical activity component of our project, such as exercise modes, and frequency of classes (14). Project instructors recognized the need to be culturally sensitive. The language used for the workshops and in the titles, as well as the activities presented, responded to what is familiar to this population (e.g., Stretch, Tone, and Relax instead of yoga because to some members of the faith community, yoga is a religious practice contrary to their beliefs). The gospel praise dance music and movement was one of the activities that worked well with this population (8,12).
PHYSICAL ACTIVITY PROGRAMS
1. Under Construction: The Rebuilding of the Body
This 12-week lifestyle modification course met weekly to teach participants how to live a physically active lifestyle. Because the target community was low income, cost was perceived as a barrier to becoming regularly physically active for many members of the community. Participants learned how to incorporate physical activities into their daily routine without the cost of owning fitness equipment or fitness facility membership.
Each weekly meeting included an on-site physical activity class along with a brief discussion of a heart-healthy topic. Activities taught were designed to assist the individual to become regularly active and self-sufficient primarily using activities that could be done at home. Participants were introduced to and performed aerobic, strength, and flexibility activities. The instructor modified each exercise for individuals as physical limitations demanded. In addition, barriers such as time constraints or the inability to go outdoors were addressed, and suggestions were presented to overcome obstacles. Handouts, with illustrations, enhanced the lessons taught in class and encouraged new behaviors. Class members conducted group discussions on the ability to carry out weekly physical activity assignments to be completed as homework.
Impact of the 12-week program
Evaluation was based on a pretest in Week 1, a posttest in Week 12, and a post posttest 6 months after the conclusion of the program. Participants were permitted to enter the program after Week 1 but were not preposttested. The number of participants who attended and completed the 12-week program was 706. However, the number of participants who completed both the pretest and post test was 257. Participants were contacted to come in for post posttesting that was conducted 6 months after the completion of the program. Only 70 of the participants returned the post posttest using a logistical regression, there were improvements in body mass index, lean body mass, and waist, hip, and abdominal circumferences (Table 3).
2. Tour de Church
Walking clubs led by community-based instructors met for 5 weeks in churches. Participants received a map and traveled a virtual walking tour of the faith community. Each participant was encouraged to set individual walking goals. As time was accumulated, incentives were earned as "checkpoints" were reached. Participants received fact sheets on topics related to walking safety, drinking water, and the health benefits of regular physical activity. Pedometers were distributed as participants successfully completed the 5 weeks. A leader from each church was recruited to carry on the club after the project's staff left the site. Four weeks after the program completion, staff returned to the club to gain feedback and provide assistance as necessary. Continued participation was disappointing. Church congregants in Las Vegas are geographically scattered, and the commitment to travel to an unstructured leaderless activity, such as a Walking Club, was not a priority in this community.
We should recognize that driving a significant distance to walk, in and of itself, may not be enough of a motivator for some populations. Coupling the walking club with a social, family, or church event that people usually attend may be the best alternative to a walking club that is an isolated event.
Impact of walking clubs
The SF-36 uses 36 questions to develop a profile of functional health and well-being. It is a generic measure in that it is not age or disease specific. This test was used before and after to help measure participants' perceptions of their health (13). This instrument measures the participants' perception of their quality of health at the beginning of the program and at the end. Participants' perception of their health improved after the 5-week program (Table 4).
3. Have a Blast With a Splash and Get a Healthy Heart Too!
Aquatic exercise classes were offered year-round at indoor municipal pools and seasonally at outdoor community center pools. For 5 years, 634 people participated in water exercises. The intensity of the classes was suited to the needs of relatively sedentary individuals, including those with special conditions. Two trained instructors were present at each class; one to lead while the other helped individuals with special needs. The format of the classes included a warm-up, cardiovascular training, peak work, strengthening, cool-down, and stretching. Many participants were nonswimmers and were initially somewhat apprehensive about being in the pool, but they quickly became more comfortable with the "head-out-of-water" exercises.
Impact of water activity
As this program came to an end, participants requested a meeting with project investigators to emphasize the impact of this activity in their lives. Most described the social benefits and the positive changes in their health (e.g., healthier food choices). Many participated for the duration of this program and stated that they would continue on their own, although they would miss the instructors. The City of Las Vegas Department of Parks and Recreation (LVDPR) has elected to offer aquatic exercise classes as part of their ongoing activity programs.
4. Your Personal Git.Fit Plan
This personal exercise program was conducted by degreed and certified professionals. Many members of this community do not usually attend franchised workout facilities. Participants were recruited through the surrounding community, focusing on predominantly African American churches, service agencies, and local community centers. The Healthy Hearts Project exercise professionals assessed each participant at the initial orientation session to evaluate needs and goals. Participants had access to two community center gyms in the target area. At the initial appointment, an individualized program was designed, and instructions were given on the proper use of equipment. The individualized progressive exercise program included cardiovascular activity, strength training, and flexibility exercises. After 6 weeks, progress was assessed, and follow-up appointments were scheduled as needed. Once participants had their individualized program, many continued exercising at their own convenience. More than 1,900 individualized sessions were conducted during the project. Although The Healthy Hearts program has ended, many of the participants still frequent the facilities with which they had become familiar.
5. Tone, Stretch, and Relax
Mind-body forms of exercise can be effective in lowering blood pressure and improving cardiovascular health (6). The Tone, Stretch, and Relax program was ongoing, conducted in an environment that was soothing (e.g., subdued lighting and relaxing music). The target population does not commonly engage in this exercise form; this program provided an opportunity to experience an additional option to become physically active and improve health. During the 2 years of this program, 212 individuals participated. Once the project ended, the recreation centers attempted to continue the program, but certified instructors were not available.
IMPACT OF A COMMUNITY-FOCUSED PROJECT
The physical activity component of this project reached more than 4,000 African Americans, increasing knowledge, skills, and physical activity levels. The total enrollment for these five programs totals 3,613; however, this does not include special community events focusing on physical activity held throughout the life of the project. These programs impacted the community in a positive way, not only for health benefits to the participants, but also creating collaborations between the university and local government, recreational facilities, churches, and the community. As the project ended, the LVDPR has filled a gap in activities by including aquatic classes at one of the community sites. In addition, LVDPR has hired one of the former instructors to conduct physical activity classes at one of the county recreation centers.
It must be remembered that all these physical activity programs were offered at no cost. We believe this may not affect attendance if the community is ready to support a particular program. This type of project may require some adjustments but should work in most communities. A small fee for each class to offset the instructor's fee would work in some communities. It is our suggestion to begin small and build upon successes.
IMPLICATIONS FOR PRACTICE
Each community needs to be assessed before planning physical activity programs. In addition to traditional needs assessments, environmental factors, leadership commitment, and community readiness to accept and participate in programs should be measured. Community readiness is a major factor in determining whether a local program can be effectively implemented and supported (7).
The cost of physical activity and individualized exercise programs can be challenging. Physical activity professionals can address these challenges in several ways: 1) by being sensitive to their population; 2) by collaborating with local government and nonprofit agencies; and 3) providing agencies with adequate resources either by volunteering their services or working at a reduced rate. The Healthy Hearts staff was flexible and available to answer questions and to guide participants through unfamiliar and challenging activities. The relationships that developed between participants and staff accounted for the many successes described earlier; these efforts benefit the community by extending physical activity opportunities to underserved populations.
Another challenge is the need to plan early for sustainability and to be flexible as community needs change. Planning for sustainability should be considered as part of program development and should include community readiness as well as needs assessments. A community may need an intervention, but unless this community self-identifies this need, they may not want and will not attend the planned program (12). Some programs have been continued in the community recreation centers, but the programs are no longer cost free. Programs that were not continued after The Healthy Hearts Project ended may have been more of a reflection of the mission of the community recreation centers, which focuses on young people, and not necessarily a lack of commitment to other populations.
Racial and ethnic minorities can be reached successfully by culture and sometimes subculture tailoring. Fitness professionals may need to be flexible and focus on the goals of their specific population. The use of gospel music and familiar movements worked well to get this population to enjoy movement. We cannot emphasize enough the importance of building relationships with the participants. Participants frequently reported that the respectful attitude and behavior of the instructors meant as much to them as the activity. Instructors were nonjudgmental, welcoming, accepting of limitations, and encouraging to all who attended any of the five physical activity programs.
There is a need for fitness professionals to actively participate in community planning, such as participating in programs and serving on planning boards. For example, who else but physical activity specialists would be knowledgeable enough to recommend well-lit sidewalks wide enough and safe enough to encourage walking to neighborhood shops? This could add a new dimension to the role physical activity professionals can play to address inactivity. Those who want to make a difference are encouraged to think "out of the gym," try new environments, and be innovative. The challenges and benefits will be rewarding to the physical activity professional and the community.
The American College of Sports Medicine urges public health professionals, urban planners, and policy-making organizations to work together to review the available, safe, and adequate resources of physical activity and to increase these resources. The numbers of participants in The Healthy Hearts Project should be encouraging. The practical recommendation for exercise professionals is to help educate underserved and difficult-to-reach populations to reduce the risks of developing chronic diseases. The benefits of regular physical activity are many and can be incorporated simply and effectively in their home, church, or community recreation centers. Exercise professionals need to be creative in their approach to specific communities and targeted populations.
CONDENSED VERSION AND BOTTOM LINE
The incidence of chronic disease can be reduced by moderate physical activity. Minority populations, who have the highest incidence of chronic disease, engage in less physical activity than the general population. Physical fitness professionals can serve an important role in decreasing the disparity in chronic disease by expanding their audiences to include programs for minorities.
4. Crespo CJ, Smith E, Andersen RE, Carter-Pokras O, Ainsworth BE. Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey. 1988-1994. Am J Prev Med
5. Kjellgren A, Bood SA, Axelsson KT, Norlander T, Saatcioglu F. Wellness through a comprehensive yogic breathing program: a controlled pilot trial. BMC Complement Altern. Med.
6. Ostchega Y, Yoon SS, Hughes J, Louis T. Centers of Disease Control and Prevention. NCHS data brief, hypertension awareness, treatment, and control - continued disparities in adults: United States, 2005-2006; [cited 2009 July 14]. Available from: http://www.cdc.gov/nchs/data/databriefs/db03.pdf(conference
7. Plested BJ, Edwards RW, Jumper-Thurman P. Community Readiness: A Handbook for Successful Change
. Fort Collins, CO: Tri-Ethnic Center for Prevention Research, 2006.
9. U.S. Department of Health and Human Services. Healthy People 2010
(Conference Edition, in Two Volumes). 2000;2:22-4.
10. U.S. Department of Health and Human Services, Physical Activity and Fitness, Healthy People 2010 (Conference Edition, Volume II). Washington, DC, January 22-24, 2000.
12. Van Duyn MAS, McCrae T, Wingrove BK, et al.
Adapting evidence-based strategies to increase physical activity among African Americans, Hispanics, Hmong, and Native Hawaiians: a social marketing approach. Prev Chronic Dis
. 2007;4(4); [2009 July 14] Available from: http://www.cdc.gov/pcd/issues/2007/oct/07_0025.htm
14. Yanek LR, Becker DM, Moy TF, Gittelsohn JM, Koffman DM. Project Joy: faith-based cardiovascular health promotion for African American women. Public Health Rep
. 2001;116(Suppl 1):68-81.
Estabrooks PA, Lee RE, Gyurcsik NG. Resources for physical activity participation: does availability and accessibility differ by neighborhood socioeconomic status? Ann Behav Med.
Woodson JM, Braxton-Calhoun M. Techniques for establishing educational programs through the African American Faith Community. J Extension.
2006;44(1). Available from: http://www.joe.org/joe/2006february/
. Accessed July 8, 2009.
Woodson JM, Braxton-Calhoun M, Black J, Marinelli R, O'Hair A, Constantino N. Challenges of collaboration to address health disparities
in the rapidly growing community of Las Vegas, Nevada. J Health Care Poor Underserved
Yanek LR, Becker DM, Moy TF, Gittelsohn JM, Koffman DM. Project Joy: faith-based cardiovascular health promotion for African American Women. Public Health Rep
Keywords:© 2010 American College of Sports Medicine.
Community Based; Underserved Populations; Culturally Sensitive Programming; Chronic Disease Prevention; Health Disparities