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The Community Intervention Strategies for Promoting Physical Activity

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					The Community Intervention Strategies for Promoting Physical Activity




                   The Community Intervention
                 Strategies for Promoting Physical
                              Activity


             Presented by: Frank Chin-Lung Fang, Ph.D.
                 National Taiwan Normal University
                  2011 ICHPERSD Asia Congress
                             2011.1. 23.
The Community Intervention Strategies for Promoting Physical Activity




       Outline
        Instruction
        Community PA intervention
         recommendations
        PA behavior modification
         models and concepts
        Physical fitness 333 project
        Village-based PA intervention
         project and model
        Conclusions
The Community Intervention Strategies for Promoting Physical Activity




                                                    Introduction
     Physical activity (PA)                                             How to encourage
          is very important                                              people to maintain
          factor to maintain                                             healthy and active
          healthy status and high                                        lifestyle is a critical
          living quality in                                              and challenge issue for
          modern sedentary                                               health promotion and
          society.                                                       exercise-related
                                                                         professionals.
The Community Intervention Strategies for Promoting Physical Activity




 PA, physical fitness and health status
 are interrelated
         In general,
         the higher the
         PA, the better
         the physical
         fitness and the
         health status.
The Community Intervention Strategies for Promoting Physical Activity




                   Dose-response relationship
 Both PA and
     cardiorespiratory fitness are
     related to the risk of CHD
     and other health outcome in a
     dose-response relationship
     (ACSM,2010).
The Community Intervention Strategies for Promoting Physical Activity




      The importance of promoting PA

     The strategy and
          knowledge that increasing
          PA results in a reduction
          in disease risk should be
          highlighted to increase the
          PA levels of the
          population.
The Community Intervention Strategies for Promoting Physical Activity




          The importance of promoting PA

       Due to the high
           prevalence of inactivity,
           the burden of sedentary
           living on health care is
           substantial.
Community physical activity
intervention
 Community PA
 intervention is
 regarded as one
 of the effective
 and substantial
 ways to enhance
 the PA.
The Community Intervention Strategies for Promoting Physical Activity




                      Definitions of community
        The spatial locations or
             institutions of group of
             people who share a common
             identity or value, such as
             worksites, schools and
             villages, are the main focus
             of community intervention.
The Community Intervention Strategies for Promoting Physical Activity




          Community intervention of PA

 Community is a place or
     organization that the people
     live, work or learn together,
     and providing proper PA
     environment, programs,
     policy and culture is
     beneficial for health
     promotion.
The Community Intervention Strategies for Promoting Physical Activity




          Community intervention of PA

     many different ways or
      strategies of PA
      intervention programs in
      the previous studies or
      campaigns.
     One systemic review had
      recommended some
      community intervention
      approaches.
The Community Intervention Strategies for Promoting Physical Activity




                   Community physical activity
                   intervention
    Increasing PA, A Report on
        Recommendations of the
        Task Force on Community
        Preventive Services,
        October 1, 2001
The Community Intervention Strategies for Promoting Physical Activity




                             6 intervention strategies
                             are recommended
     Collect 6238 related
          research articles and
          select out 94 articles.

     The Task Force either
          strongly recommends or
          recommends six
          interventions.
The Community Intervention Strategies for Promoting Physical Activity




                        2 information approaches

      1. communitywide
        campaigns and

      2. point-of-decision
        prompts to encourage
        use of stairs.
The Community Intervention Strategies for Promoting Physical Activity




             3 behavioral and social approaches
       1. school-based physical
          education
       2. social support
          interventions in
          community settings,
          and
       3. individually adapted
          health behavior change
          programs.
The Community Intervention Strategies for Promoting Physical Activity




   Environmental and policy approach

    1, Using
        environmental and
        policy approaches,
        enhanced access to
        places for PA.
Quality of life is determined by the
quality of your habits and work.
The Community Intervention Strategies for Promoting Physical Activity




      The Concepts of Promotion of PA

    PA recommendations have
     evolved over time.
    Early recommendations
     focused on higher intensity
     PA to achieve high levels
     of physical fitness
     (product).
The Community Intervention Strategies for Promoting Physical Activity




                                     PA recommendations
                        Now the move is to encourage more
                            people participating in moderate PA (the
                            process) to improve health. Because
                            engaging in the process of PA will
                            achieve the product of physical fitness.
The Community Intervention Strategies for Promoting Physical Activity




           Two approaches of promoting PA
    Physical fitness and health are
    product, the PA is the process,
    so, the process or the action
    should be emphasized first.
The Community Intervention Strategies for Promoting Physical Activity




                                                          2 approaches
 1. Structured intervention: traditional
 ACSM recommendation, arrange the
 exercise from daily schedule.
 Considering the MRFIT principle.

 2. Lifestyle intervention: increase PA
 during daily activities. Such as 10,000
 steps a day, keep doctor away.
 1000 steps of walking each day in
 Japan and Taiwan.
The Community Intervention Strategies for Promoting Physical Activity




                Social cognitive theory(SCT)

     Recently, the SCT and
          other theories that
          emphasize the interactions
          of personal, behavioral
          and environmental factors
          and conditions are
          commonly used to change
          PA behaviors.
 Personal factors
 Health and physical
  condition
 Cognition and perception
 Self-efficacy.
 Outcome efficacy belief.
 Intrinsic motivation.
 Others
Behavioral factors
 Skills and Knowledge
 Social support
 Self-monitoring.
 Relapse prevention
 Goal setting
 Enjoyment
 Behavior success
 Others
Environmental factors
                   Convenience
                   Social environment
                    (policy).
                   Physical environment.
                   Program-related
                    factors: Format (class,
                    home-based,
                    individual or group).
                    Intensity
                   Others
The Community Intervention Strategies for Promoting Physical Activity




                    Social Cognitive Theory (SCT)
               Self-efficacy. An important factor of SCT.
               Someone with high self-efficacy for PA has the
                confidence to continue exercise despite barriers.
               Outcome expectations. Another important
                factor of SCT.
The Community Intervention Strategies for Promoting Physical Activity




Community Ecological approach
       ecology is the characteristics
           and attributes of an individual
           interact with the
           characteristics and attributes
           of the surrounding social and
           physical environment
                                                 (ACSM, 2011).
The Community Intervention Strategies for Promoting Physical Activity




          Taiwan community PA intervention programs



    In Taiwan, there were
        some schools-based,
        work-site and village-
        based PA intervention
        programs used to promote
        physical fitness and PA
        behaviors for the students
        and general public.
  The promotion strategies of PA for
  students in Taiwan
 Some projects and
 strategies were persistently
 used in Taiwan for more
 than 10 years.
The Community Intervention Strategies for Promoting Physical Activity



                                        Physical fitness 333 project,
                                        Education Ministry, Taiwan.


       Main concepts:
                 1st 3: at least 3 days per week, 30 minutes each
                  session, at intensity about 130 beats/minute.
                 2nd 3: enhance the knowledge, behavior and
                  attitude toward physical activity.
                 3nd 3: teachers, parents and students working
                  together.
The Community Intervention Strategies for Promoting Physical Activity




              Main strategies for the physical
                    fitness 333 project

                     School-based community intervention.
                     Students and teachers passport.
                     Social supports.
                     Website of PA and physical fitness.
The Community Intervention Strategies for Promoting Physical Activity




                                 Knowledge website

              Website providing related information, including
                  exercise prescription, online physical fitness
                  assessment and evaluation, teaching materials.

                                        http://www.rocnspe.org.tw/
The Community Intervention Strategies for Promoting Physical Activity




                       Main strategies for the physical
                        fitness 333 project in Taiwan
                       Establishment of the physical fitness
                        battery and norm.
                       Awards for the physical fitness medals
                        ( gold, silver and bronze).
                       Improvement of Environment and Facility
                       Others.
The Community Intervention Strategies for Promoting Physical Activity




                           The happy living project

                                                                         Physical fitness and
                                                                          exercise performance is
                                                                          regarded as part of the
                                                                          entrance exam score of
                                                                          high school and university.
                                                                          Taiwan.
Physical fitness tests for students:
BMI, sit and reach (flexibility)
1 minute sit up and long jump
800 m or 1600 m run and walk test
                  More universities provide
                   the physical fitness tests;
                   and more students and
                   schools participate.
                  more high schools or
                   universities take good
                   physical fitness as one part
                   of the entrance exam
                   scores.
The Community Intervention Strategies for Promoting Physical Activity




  The purposes of life is to serve and show
       the compassion and will to help others.
                                                                        —Albert Schweitzer.
The Community Intervention Strategies for Promoting Physical Activity




                 Community intervention of PA
  successful promotion PA in
       community produces huge impact.
       However, some barriers exist in the
       community needed to be identified
       and removed for the substantial and
       long-term PA promotion program.
The Community Intervention Strategies for Promoting Physical Activity




                                                 Barriers for PA
            What is the main
                 barriers of community
                 PA intervention
                 program ?
The Community Intervention Strategies for Promoting Physical Activity




                        National Blueprint
           National Blueprint (USA): Increasing PA among
               Adults aged 50 and Older.
               (http://www.agingblueprint.org)

           Provided many good ideas and strategies of
               community PA intervention and other aspects.
The Community Intervention Strategies for Promoting Physical Activity




      Home and community strategies

        To develop
             partnerships between
             community groups and
             agencies to promote
             PA .
The Community Intervention Strategies for Promoting Physical Activity




         Home and community strategy #1

                                                                         Identify professionals
                                                                         in the community who
                                                                         can serve as resources
                                                                         for information and
                                                                         assistance to programs.
The Community Intervention Strategies for Promoting Physical Activity




         Home and community strategy #2
           http://ichpersd.asia/ne
                                                                         Establish and provide
                ws/zh_view/3
                                                                         technical assistance to
                                                                         partnerships among
                                                                         health, recreation, social
                                                                         service, and private
                                                                         sector organizations.
  Home and community strategy #3

 Provide community
 organizations with a template
 for good PA programs.
The Community Intervention Strategies for Promoting Physical Activity


                     Basic questions for community PA
                               intervention?


             Issues related to community PA intervention:
                  1.who will initiate, plan and conduct the PA programs?
                  2.exercise space and facilities ?
                  3.the need, quality and strategies of the PA programs
                    for the community residents.
                  4.financial and related resource?
                  5.short-term or long-term operation ?
                  6.others.
The Community Intervention Strategies for Promoting Physical Activity




 Study of the Promotion Strategies and Intervention Model for
 Physical Activity in Community (Fang C. L., et al., 2008)

          To evaluate the
           effectiveness of PA
           intervention program.
          To set a template of PA
           program.
          To set up the model of
           community PA program.

          supported by Department
              of Health, Taiwan
The Community Intervention Strategies for Promoting Physical Activity




                              Community intervention
     Flower Garden village in
      Taipei County
     Leader and the community
      support.
     Organize a promoting
      committee.
The Community Intervention Strategies for Promoting Physical Activity




                Community PA intervention
  12 weeks intervention
   program, meet 15-18 pm
   every Saturday afternoon.
  1.5 hours for physical
   activity related knowledge
   courses.
  1.5 hours for PA.
  30 residents participated
   this programs.
The Community Intervention Strategies for Promoting Physical Activity




                                    Intervention strategies
    Knowledge and skills of PA.
    Self-efficacy enhancement
    Perception and enjoyment of PA
    Reward.
    Monitoring. Pedometer record
     the steps of each day.
    Social support.
    Website information and
     assistance.
    Others.
The Community Intervention Strategies for Promoting Physical Activity




                                  12-week program survey
                                                                                                                         Every
    Items / degree                                                      Very disagree   disagree   So so     agree
                                                                                                                         agree

    Programs contain theory and
                                                                                                           5 (23.8%)   16 (76.2%)
    practice
    Knowledge and skills can be
                                                                                                           4 (19.0%)   17 (80.9%)
    applied
    meaningful                                                                                             4(19.0%)    17 (80.9%)

    Teaching effects                                                                                       5(23.8%)    16 (76.2%)

    Increase the physical fitness
                                                                                                           5 (23.8%)   16 (76.2%)
    knowledge and skills
    Helpful for regular exercise                                                                           5 (23.8%)   16 (76.2%)

    Benefits for health promotion                                                                          4 (19.0%)   17 (80.9%)
The Community Intervention Strategies for Promoting Physical Activity




Physical fitness Before and after 12 weeks program
                      Subjects’ variables                                Before                  After
                      BMI(kg/m2)                                         24.2±2.6             23.9±2.6
                      Grip Strength (kg)                                 31.4±6.3             33.2±6.7
                      Sit and stand test                                 24.5±4.4            31.7±5.4*
                      Arm curl test(times)                               23.5±3.4            26.6±3.6*
                      Sit and reach (cm)                                 9.8±11.1           11.7±11.1*
                      Back stretching (cm)                               3.9±9.1              3.7±11.8
                      8 foot walk test (sec)                            3.89±0.58             3.72±0.6
                      6 minutes walk(m)                                 628.5±72.3           702±63.8*

                                                                             * Statistical significance (p<0.05)
The Community Intervention Strategies for Promoting Physical Activity




                                                              Results
              Multiple intervention strategies.
              Participants satisfied with the 12 weeks programs.
              12-week intervention program improved the
               physical fitness, attitudes and behaviors of PA.
              After 12 weeks intervention program, the
               community exercise programs had continued.
The Community Intervention Strategies for Promoting Physical Activity




  Develop the basic strategies for local community
                  PA intervention

          Literature reviews
          Questionnaire design
          Survey 63 experts of
           the PE, Health and
           administrators.
          Expert Panel
           discussions.
The Community Intervention Strategies for Promoting Physical Activity




                 Basic 4 domains of community
                         PA intervention

    Organization (term work).
    Resources.
    Programs.
    Services.
The Community Intervention Strategies for Promoting Physical Activity
The Community Intervention Strategies for Promoting Physical Activity




                                                     Organization

       Form the promoting
        organization or team.
       Team coordinator.
       Community leaders, club
        or religion leader, physical
        educators or fitness
        instructors
       Operation code
The Community Intervention Strategies for Promoting Physical Activity




                                                        Resources
       Local professional or Certificate instructors.
       Basic outdoor and indoor facilities.
       Basic exercise equipments.
       Financial supports from public or private organizations,
        if not enough, the participants will pay the fee.
       Internet information if possible.
The Community Intervention Strategies for Promoting Physical Activity




                                                             Activities
       Activities and
        programs cover theory
        and practice.
       Programs fun,
        effective and practical.
       regular weekly
        activities is preferred.
The Community Intervention Strategies for Promoting Physical Activity




                                                               Services
          Public relationship and service.
          Telephone, experts, or internet interaction to provide
           the physical activity or exercise advice.
          Establish the good relationship between participants,
           related organizations.
The Community Intervention Strategies for Promoting Physical Activity




    Sustainability and the effectiveness
          The sustainability and
              the effectiveness are
              important factors for
              community
              intervention; therefore,
              4 main questions are
              helpful to begin a
              community PA
              intervention.
The Community Intervention Strategies for Promoting Physical Activity




       Sustainability and the effectiveness
    1. For which individuals or
       group do you intend to
       increase PA as a result of the
       intervention?

    2. Who or what organization
       will need to be involved in
       decision making and
       planning?
The Community Intervention Strategies for Promoting Physical Activity




    Sustainability and the effectiveness
         3. Who will be responsible
           for delivering or
           implementing the
           strategies?
         4. What organization or
           institution will be needed
           to ensure sustainability?
           (ACSM, 2011).
The Community Intervention Strategies for Promoting Physical Activity




    Sustainability and the effectiveness
     To be more productive,
          the RE-AIM (Reach,
          Effectiveness, Adoption,
          Implementation and
          Maintenance)
          implications are
          recommended in the plan
          process of PA
          community intervention.
The Community Intervention Strategies for Promoting Physical Activity




                                                        Conclusions
 Community PA intervention is very
  important way to promote PA.
 The basic and proper theories,
  recommendations and strategies should
  be taken into consideration
 Every community has its unique
  characters, so the promotion strategies
  should be adjusted accordingly.
 .
The Community Intervention Strategies for Promoting Physical Activity




                                                     Conclusions
     People is the key factor.
     The PA substantial
          promotion team, including
          the enthusiastic
          community leaders,
          exercise experts, and
          external supporters, is
          needed to be organized for
          long-term operation.
Thanks for your attention!
Best wishes


http://www.y
 outube.com/
 watch?v=G2
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 ated
   Main references:
                                       Fang, C.L., et al, Study of the
 National Blueprint (USA):             Promotive Strategies and Interventive
  Increasing PA among Adults aged       Model for Physical Activity in
  50 and Older.                         Community, J. of Physical Education,
  (http://www.agingblueprint.org)       41.3. vol. pp.1-14, 2008.
 National Society of Physical         Fang, C.L., Yu-Yin Chen, The
  Education,                            Effects of Community Intervention
  http://www.rocnspe.org.tw/            Strategy on the Health-Related
 ACSM’s Resource Manual for            Physical Fitness in Worksite
  Guidelines for Exercise Testing and   Employees, J. of PE, V.24, pp.133-
  Prescription, 6 edition, 2011.        144, 1997.
 Estabrooks, P., community physical  Kahn EB, Ramsey, LT, Brownson
  activity intervention, in ACSM’s      RC. Et al., The effectiveness of
  Resource Manual for Guidelines        interventions to increase physical
  for Exercise Testing and              activity: a systematic review. Am. J.
  Prescription, 6 edition, 2011.        Prev Med. 2002; 22(4s): 73-107

				
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