Strength First

A Training Program for Administrators, Trainers and Seniors:Strength Training Awareness in City Sponsored Senior Centers

GERN 5660.30

Spring I, 2007

TABLE OF CONTENTS

Proposal Summary 3

Problem Statement and Literature Review 4-8

Proposal Objectives 9

Proposal Methodology 10-11

Time Line 12

Evaluation Format 13

Future Research Implications 14

Budget 15

References 16

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PROPOSAL SUMMARY

Strength First

Research Question – Will an educational awareness program provide participants with increased knowledge about strength training? Research Goal – To increase awareness among administrators, trainers, and seniors (ATSs) of the value/benefits of strength training

Research Focus – To enhance strength training awareness among ATSs in city sponsored senior centers

Research Subjects – Individuals aged 50 and older who participate in city sponsored senior center activities, senior center administrators, and trainers

Expected Outcomes – An increase in knowledge concerning the benefits of strength training

Methodology – Establish and execute a “Strength First” campaign using a mixed method design of pre- and post-test questionnaires and post-test semi-structured open ended interviews. Questionnaires will assess current knowledge levels of strength training using quantitative analysis. Interviews will provide qualitative analysis. Conduct a one day educational event consisting of one four hour presentation by the president of the American College of Sports Medicine to present information and research concerning strength training to all participants. Additionally, UNM Football Head Coach, Rocky Long, will present a two hour seminar concerning strength training policies and procedures to be used at Albuquerque Senior and Senior Fitness Centers.

Cost and duration – Study costs for this four month program and the follow up interviews will be $250,000.

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PROBLEM STATEMENT AND LITERATURE REVIEW

With the increasing numbers of elders in the United States, by 2030 the estimate

is expected to reach 70 million people (Nied and Franklin, 2002), it stands to reason this

group would do well to investigate the impact of donning a healthy lifestyle in an effort

to prevent or forestall many non-communicable diseases. One way to accomplish such an

investigation would be to conduct comparative historical research on the effects for older

adults of creating a strength training awareness program. “Prevention of these diseases

through physical activity and healthy lifestyles, based on strong medical evidence, is the

most cost-effective and sustainable way to tackle these problems and to support positive

social development” (WHO, 2003, p.2). Researchers are concerned that national and

regional surveys reveal “70% or more of older adults do not engage in regular exercise”

(Jette, et.al, 1999, p.66), and coupled with an aging population, these sedentary physical

activity levels present a major public health threat which attracts national attention.

A lack of participation in regular physical exercise is particularly seen in women,

seniors, the disabled, and those from lower socio-economic groups. This trend is world

wide. Literature abounds in the documented benefits of participating in exercise. It lowers

blood pressure, has a positive impact on Type 2 diabetes and cardiovascular disease and

even some cancers, reduces cholesterol, aids in stress control, and weight reduction

(WHO, 2003). More specifically, strength training aids in combating the effects of

sarcopenia (loss of muscle mass), osteopenia/osteoporosis (decreased bone density), both

of which are significant contributors to falls, fractures, slower metabolism, reduction in

glucose sensitivity, and a loss of ability to perform many activities of daily living

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(dressing, feeding, bathing, walking, and toileting). The rate of muscle decline is

approximately 15% per decade during one’s sixties and seventies and then increases to

approximately 30% thereafter.  “Because sarcopenia and muscle weakness are so

prevalent in the aging population, it is important to devise strategies for preserving or

increasing muscle mass in the older adult” (American College of Sports Medicine

(ACSM), July 2000, p.2).

Nied and Franklin (2002) posit it is never too late to begin an exercise

program. They discuss a Harvard Alumni study which found subjects who began an

exercise program at the age of 75 saw a modest increase in life expectancy. They

strengthen the argument by proffering the expected results of strength training: 25-100 %

or more via muscle hypertrophy. A combination of adequate nutrition and strength

training can assist in preventing muscle loss in older adults, especially those

institutionalized. This study also witnessed the positive effects on cardiac demands in

elders.

The value of a combination of aerobic activity, strength training, flexibility

exercises and lifestyle modification are key to improvement in physical fitness in older

adults, as well as a method to reduce medication dependence and health care costs while

maintaining improved functional independence and quality of life. McDermott and

Mernitz’ 2006 report spells out only “31% of persons between 65 and 74 years of age

report regular engagement in moderate physical activity for 20 minutes or more 3 days

per week” as recommended for this cohort and the rate drops to “20% by age 75” (p.

437). More importantly, they say these trends have shown no improvement over the past

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decade and less than 50% of older adults report that their physicians have recommended

an exercise regimen for them.

  Documented evidence sets the stage for the WHY and WHO should participate in

a strength training awareness program. It also delves into the HOW.  The literature is

clear about elders needing to have a physical examination prior to beginning any physical

activity regimen. Nied and Franklin (2002) suggest family physicians should take a much

stronger stance in reviewing the benefits of physical activity, including strength training,

with all of their patients. Schlicht (2000) discusses the importance of all healthcare

professionals, nurse practitioners especially, becoming more aware of the benefits of

strength training. He also suggests that perhaps the definition of physical activity should

be broadened to included not only aerobic but anaerobic (strength training) activity.

Most experts agree strength training participation at least once a week will

provide minimum benefit, while the most benefit occurs when participants engage in the

training two to three times a week. Greater participation could result in injury due to not

giving the muscles time to repair themselves between the exercise/overload sessions

(Schlicht, 2000). “When developing resistance training programs for this group,

important components to consider are the various training related variables: frequency,

duration, exercises, sets, intensity, repetitions, and progression” (ACSM, April 2001,

p.1).

WHAT will a strength training program provide its participants? Increases in

muscle mass are gained when muscles are taxed beyond normal capacity; the overload

principle. When the muscle is overloaded, the body increases the size of the muscle fiber,

which in turn permits the muscle to respond to the overload with greater force.

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Correspondingly, the muscle will also be able to increase its contraction capability. Free

weights, resistance bands, and weight machines are all effective modes to accomplish

strength training routines. Beyond the basic increase in muscle mass, results of strength

training are also seen in better balance and coordination, better gait and mobility, an

increase in bone mineral density, and a reduction in falls. Strength training programs can

encourage overall health improvement or in a particular major muscle grouping (Schlicht,

2000).

An effective exercise regimen for older adults includes recommendations

concerning exercise “frequency, intensity, type, time, and progression” (McDermott and

Mernitz, 2006, p. 439), which follows disease-specific guidelines. In addition, patients

would benefit more from exercise regimens if provided with specific and appropriate

instructions concerning how to follow prescribed methods and guidelines. Research

shows that older adults who become or remain active in an exercise regimen have

significantly decreased risk of mortality compared with those remaining sedentary.

However, changes in physical activity patterns can require multiple motivational

strategies designed to stimulate the desire to participate in exercise therapy which

includes receiving appropriate instructions, individual goal setting and self monitoring

(McDermott and Mernitz, 2006).

For example, Jette, et.al.’s 1999 randomized, controlled exercise trials for the

established Strong-For-Life in-home resistance training program compared the effects of

assigning 215 out of 826 older persons contacted, to either a home-based resistance

exercise training group or a waiting list control group and told to continue their regular

routine. Assessment was conducted at program baseline and at three and six months.

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Videotaped exercise routines, performed with elastic bands of various thicknesses, were

used. Outcome measures were muscle strength, balance, functional mobility and mood

state.

Results were very promising. High rates of exercise adherence were achieved

with “89% of the recommended exercise sessions over the 6 month study” (Jette, et. al.

1999, p.69). Subjects who participated in the exercise group achieved statistically

significant lower extremity strength improvements, gait improvements, and a reduction in

overall disability. Researchers’ conclusions provide important evidence that home based

resistance exercise programs designed for older persons with disabilities hold promise as

an “effective public health strategy” (Jette, 1999, p. 71).

Helping patients identify appropriate individual activities is an important step in

the exercise process which should increase exercise continuation rates and ultimately,

improve health outcomes. In addition, quality communication between patients and

physicians will improve patient satisfaction and clinical processes. Researchers contend

that physicians should endorse the “five A’s model of assess, advise, agree, assist and

arrange” (McDermott and Mernitz, 2006, p. 440) when helping patients with exercise

regimens and therapy. This creates collaboration between the older adult and his/her

physician to achieve positive exercise results and increase the visibility and importance in

prescribing overall exercise programs.

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PROPOSAL OBJECTIVES

Strength First

1. To create a senior center Strength First awareness campaign promoting the benefits

of participation in a strength training awareness program.

2. To provide education to ATSs with regard to the benefits of exercise specifically

designed to increase strength, balance and flexibility through strength training

programs.

3. To provide ATSs with educational materials and orientation seminars concerning the

benefits of strength training.

4. To provide a “train the trainer” “How To…” manual for all senior center individuals

responsible for conducting strength training.

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PROPOSAL METHODOLOGY

Strength First

In Step 1a, we will initiate the Strength First campaign to increase knowledge and promote awareness about the benefits of strength training, using a combination of exploratory and evaluative deductive research processes where a specific expectation will be deduced from a general premise and then tested. During the campaign, we will contract with J. Larry Durstine, Ph.D, President of the American College of Sports Medicine to deliver a four hour seminar at each Albuquerque Senior Center and Rocky Long, UNM Head Football Coach to deliver a two hour seminar at each center to acquaint ATSs with the documented benefits of strength training. We will meet with and provide an orientation to this project to Ms. Blanca Hise, Director, Albuquerque Department of Senior Affairs. We will request she and her subordinate center administrators provide a joint letter of concurrence and endorsement that we will use in Step 2.

In Step 1b, we will construct pre- and post-test electronic survey instruments hosted by Survey Monkey.com. For example, our pre-test questionnaires formulated using Likert scales will assess current levels of knowledge and understanding about strength training. We will collect standard demographic data as well as the following: the number of times per week the subjects participate in aerobic and anaerobic exercise, if there has been a diagnosis of chronic disease, permanent disability, and their cohabitation status.

Step 2 includes disseminating concurrence and endorsement letter from Hise and administrators to the actual trainers at the centers. We will post informational flyers at each of the senior centers notifying staff and center participants of the program. In Step 3 we plan to conduct cross-sectional survey research by administering electronic Survey Monkey.com questionnaires to randomly selected administrators, trainers, and cooperative seniors (units of analysis) from each of the six senior centers in Albuquerque (N=210). This pre-test questionnaire will cover levels of knowledge, understanding, and comprehension concerning strength training. Strength training has been shown to reduce blood pressure and Type 2 diabetes (if problematic for the individual), improve strength, gait, balance, flexibility, reduce osteopenia/osteoporosis risks, and increase ability to perform ADLs. To accommodate for non-respondents, we will over-sample at remaining senior centers not previously contacted.

In Step 4 we will conduct a day long educational event with Dr. J. Larry Durstine, President, American College of Sports Medicine and Rocky Long, Head Football Coach, UNM to be held at each of the six senior centers. Lunch will be served, free of charge, to all participants between the Durstine and Long presentations. We will administer post-test questionnaires to all previously surveyed ATSs immediately following the conclusion of the Rocky Long seminar.

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In Step 5 our measure of success will be recognized. We will evaluate the results of the post-test electronic questionnaires and compare the results to the pre-test survey to determine if there has been an increase in knowledge, understanding, and comprehension concerning strength training. We will conduct 30 day post-test semi-structured open-ended interviews with randomly selected (N=42) seminar participants to qualitatively analyze participant reactions to seminar content and for program evaluation.

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TIME LINE

Strength First

July 2007 - Formulation of data collection instruments using Survey Monkey.com- Contract with Durstine and Long for the day long educational event- Develop printed advertising material to announce the Strength First

program- Publicity articles will be published in the ABQ Journal and Tribune, NM Woman, NM Business Weekly, ABQ Magazine, Boomer and

Mature inserts to the Sunday Journal- Meeting with Ms. Blanca Hise, Director, Department of Senior Affairs- Campaign Kick-off party at Tamaya Resort

August - Run public service ads (PSAs) on local TV and radio channels to announce Strength First- Post informational flyers at each senior center- Conduct participant selection process- Conduct pre-test questionnaires with ATPs

September - Conduct day long educational event at six senior centers in Albuquerque- Conduct post-test questionnaires

October - Analyze pre- and post-test data- Prepare summary findings and determine level of success- Conduct 30 day post-test semi-structured, open-ended interviews- Publish findings- Conduct post-study celebration to recognize participation and

achievement at Santa Ana Star Casino Amphitheater

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EVALUATION FORMAT

Strength First

The Strength First program will be evaluated in several ways. Baseline data will

be gathered from pre-test survey instruments with ATSs. This data will be compared

with post-test survey data through quantitative analysis. Statistics will be gathered to

assess generalizability to the target populations based upon results of individuals

participating in Strength First. In addition, qualitative analysis will result from a semi-

structured, open-ended 30 day post-test interviews.

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FUTURE RESEARCH IMPLICATIONS

A case study/longitudinal investigation could be accomplished with adults aged

50 and older who participated in the initial strength training awareness program. We

would hope to find adults in better physical condition than before program initiation.

If the program is successful, as we expect it will be, the program would

indefinitely continue with older adults from city sponsored senior centers. In addition,

this program could be expanded to all health centers in Albuquerque and eventually to all

sports and fitness centers in N.M. A strength training orientation could become part of

each center’s initial introduction for all new enrollees. The vision would include teaching

these concepts to children in elementary school so they develop a life course of healthy

choices including aerobic exercise and strength training.

It would also be interesting to record long lasting effects of the training on trainers

and administrators. Observation and interviews could be conducted yearly with adults no

longer being trained to assess the lasting effects of their initial training. After the initial

four-month program, trainers and administrators should be given periodic strength

training refresher seminars.

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PROGRAM BUDGET

Strength First

$15,000 Kick-off party at Tamaya Resort

15,000 Supplies, printing, mailing, phone

15,000 Advertising to promote the awareness campaign

52,500 Salary for 1 part-time Strength First CEO

30,000 Salary for two part-time research coordinators

60,000 Professional four hour seminar with Dr. J. Larry Durstine, President

American College of Sports Medicine. (6 centers x $10,000 =

$60,000)

20,000 Professional stipend for Rocky Long presentations

15,000 Professional resources (equipment, journal subscriptions, etc) for trainers

6,400 Refreshments and lunch to be served during training sessions

5,000 Statistical and research assistance

5,000 Dell Lap top computer, software and internet connection

100 Survey Monkey.com instrument creations and data compilation ($20.00

monthly fee x five months usage)

0 Office space donated by city senior centers.

1,000 Transportation to/from senior centers

10,000 Study conclusion celebration at Santa Ana Star Casino Amphitheater

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$250,000. Total Expenses

REFERENCES

___________American College of Sports Medicine. (2000). Exercise and the older adult. Current Comment. July, 1-3.

___________American College of Sports Medicine. (2001). Resistance training in the older adult. Current Comment. April, 1-4.

___________American College of Sports Medicine. (2003). Exercise and the older adult, never too late to start when it comes to exercise. Fit Society Page, Summer, 1-11.

Jette, A.M., Lachman, M., Giorgetti, M.M., Assman, S.F., Harris, B.A., Levenson, C., et al. (1999). Exercise--it's never too late: The strong-for-life program. American Journal of Public Health, 89, 66-72.

McDermott, A.Y., Mernitz, H. (2006). Exercise and older patients: Prescribing guidelines. American Family Physician, 74(3), 437- 444.

Nied, R. J. and Franklin, B. (2002). Promoting and prescribing exercise for the elderly. American Family Physician, 65(3), 419-426.

Schlict, J. (2000). Strength training for older adults: Prescription guidelines for nurses in advanced practice. Journal of Gerontological Nursing. August, 25-32.

Seguin, R. and Nelson, M. E. (2003). The benefits of strength training for older adults. American Journal of Preventive Medicine. 25(3Sii), 141-149.

Wellbery, C. (2004). Weight-bearing exercise and fall prevention in the elderly. American Family Physician, 70(2), http://www.aafp.org/afp/20040715/tips/4.html

__________World Health Organization. (2003). Health and development through physical activity and sport. Noncommunicable Diseases and Mental Health, Noncommunicable Disease Prevention and Health Promotion, 1-16.

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