This week we would like to spotlight the Hip Hop Healthy Heart Program for Children™ (Hip Hop), a comprehensive wellness program bringing together physical education, music, and arts in grade K-6th.

The Program Basics

Hip Hop works through wellness education that flows from teacher, to student, to family and the community at large. It requires parents/guardian/mentors to be involved in training on a daily basis, not only helping to reinforce the lessons at home, but also by personally participating in the President’s Active Lifestyle Award Program (PALA). It has 8 multidiciplinary modules and inspires kids to participate by recognizing their achievements with:

• Award certificates for completion of each module
• Certificate of Completion for the entire program.

In order to receive their final program certificate, students and an adult partner are required to register for the PALA when they start Module 1.

Measuring Success

Jyl Steinback, co-creator of the program and Executive Director of Shape Up US mentioned two ways in which Hip Hop is evaluated:

• Educational Assessment: Students are required to complete a written test to assess their comprehension of the topic. Upon passing each module test, students will receive a module certificate of completion and will be eligible for additional awards and prizes.

• Health Assessment: To make sure that the positive lifestyle lessons taught in Hip Hop are truly making a difference, Shape Up US has partnered with HeartSmartKids to track each student’s health progress. Anthropometric data, lifestyle factors, and family history are assessed and tracked using this system.
  

Challenges

Steinbeck states that, “in some cases, students may not have a parent, guardian or partner/mentor available, or able to participate.” In such cases, she suggests that instructors help students partner with another role model so that they can participate in the program: older siblings; grandparents; recent retiree volunteer - Check www.AARP.org ; student mentor from a local high school as part of the high school’s community service curriculum.

Implementing a Similar Program in Your Community

Use existing infrastructure- The Hip Hop model relies on training educators, healthcare professionals and others who work with groups of children. This creates a program with controlled costs because it builds on existing infrastructure. In your community, try building upon existing infrastructures to implement your program. 

Engage parents and guardians- To help engage partners to get the maximum benefit of Hip Hop:

• Letters to send home to parents that provides parents with information about the curriculum prior to starting it
• Parent, guardian or partner/mentor contracts for each module

Reach out to encourage participation-

• Scheduling a group meeting to discuss the curriculum
• Send home personal invitations to the group meeting and ask parent/guardians to RSVP by a specific date.
• Telephone parents who do not respond and encourage them to participate
  

Don’t forget potential resources in your community- Hip Hop is designed to be taught many different types of teachers. Programs like this can be taught by:

• Public/Private School Teachers as part of their regular curriculum
• Home School Instructors
• PE Instructors
• Fitness Instructors at Health Clubs, After School Programs, YMCA, etc.
• Park and Recreation Instructors

Have you used existing infrastructure to implement a physical activity program? How?

This week we would like to spotlight Alive!, an email-delivered intervention to help people increase their physical activity and improve their diets.

 The Program Basics

The core of the Alive! program, is individualized weekly goal-setting, according to Dr. Gladys Block. Alive! is intended for adults with access to email and the web. Currently its focus is on working adults, although it is adaptable to older persons and college students. Alive! was developed by NutritionQuest in collaboration with physical activity, nutrition and behavioral experts Barbara Sternfeld (Kaiser Permanente), Gladys Block (UC Berkeley), Abby King (Stanford), Kim Gans (Brown) and Cliff Block (NutritionQuest).

The first step in the Alive! program is to complete a detailed online physical activity and dietary practices assessment. Results are provided to participants instantly. For physical activity, the participant's minutes of moderate or vigorous activity, as well as strengthening activities, are compared with the Physical Activity Guidelines for Americans.

That feedback serves to motivate individuals to make changes and to participate in Alive!. Feedback is provided to everyone, whether or not they decide to enroll. If they do enroll, they choose a "Path" to work on for the next 12 weeks, either improving physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. At the end of each 12-week intervention period, participants may choose one of the other two Paths or continue further in the same Path.

In weekly emails, the participant is offered a choice among four small-step goals, individually tailored, to work on during the coming week. Each weekly goal is a small achievable step that will move the participant closer to the Path's behavioral target, such as increasing physical activity to national standards.  Goals are tailored to the participants' baseline activity level and to their personal characteristics and preferences. Tips for overcoming barriers and motivational support are also individualized, as is optional automated algorithm-driven phone and print support. In addition to weekly goal-setting, the Alive! program also provides weekly health information and many other resources.

Measuring Success

The developers of Alive! used a randomized controlled trial among almost 800 employees of a large firm to measure their success. Articles reporting the results of these studies can be found here and here. The evaluations showed statistically significant improvements in physical activity and dietary intake during the intervention. However, even more exciting is the fact that that those changes were sustained four months after completion of the intervention.

Challenges

According to Dr. Block, “the computer programming challenges have been enormous, because of the high degree of individual tailoring at the heart of the program. Apart from that, our biggest challenge has been to interest companies or organizations in using a low-cost, successful intervention that only improves physical activity and diet.”

Implementing a Similar Program in Your Community

If you are thinking of creating a computer based intervention for your community, Dr. Block offers the following advice:

• Algorithm-driven individualizing of most elements of such electronically delivered programs is essential.
• Developing such a tailored program is likely to require far more expert input and costly programming than anticipated.
• Be aware that today’s ever-changing web and email standards require the use of high-level programming expertise in presentation methods.
• Contact NutritionQuest to discuss tailoring the Alive! program for your community.

If you don’t feel tech savvy enough to create your own algorithm-driven, individualized e-mail- based physical activity promotion program, what are ways you could individualize programs in your community to increase program success?

There is a critical need to increase participation in physical activity for everyone, this we already know.  Unfortunately, many physical activity programs are not designed in a way that includes people with disabilities.  Recognizing the need for inclusive programming and the common barriers to physical activity for people with disabilities (cost, transportation, don’t know where/how to exercise, inaccessible facilities, lack of knowledgeable staff) the staff at the National Center on Physical Activity and Disability (NCPAD) knew it was time to put their heads together to come up with something creative, something that hadn’t been tried before. 

It quickly became clear that the internet is a growing platform for delivering health promotion programs that can tackle many of the barriers faced by people with disabilities and reach large numbers of people.  The existing web-based programs, though, didn’t seem to be providing modifications to allow people with a variety of different abilities to be able to participate.  This was NCPAD’s niche!  After much discussion and research, the 14-Week Program to a Healthier You was born; an inclusive web-based program that uses three stages of progression to promote physical activity (that can be done anywhere, without specialized equipment) and healthy eating for people of all abilities.

We had learned that, in general, the more a web-based program is tailored and interactive, the better the results.  Understanding that one of our greatest challenges was going to be providing resources and exercises that fit the needs of each participant regardless of individual fitness level, exercise experience, and type of impairment, we knew that the opportunity for individualized interaction was crucial. 

With these things in mind, the features of the program were developed. They include:

• Communication with NCPAD’s 14-Week Coaches via live chat, toll-free hotline, and/or e-mail
• SMS (text) option
• Commitment pledge
• Goal, physical activity, and dietary intake logs
• Weekly e-mails
• Weekly updates to the website, including:
  • Motivational note from the coaches
  • Resources on physical activity and nutrition
  • Strength, flexibility, and balance exercises (step-by-step instructions included written description, pictures, videos,  and modifications)
  • Aerobic exercise videos and suggestions (a sample video can be viewed at http://www.youtube.com/user/NCPAD#p/u/42/mz4
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  • Advice on frequency, intensity, and duration of physical activity
  • Video blog of one participant’s experience with the program
• Follow-up wellness coaching with one of the 14-Week Coaches after the 14 weeks had ended

The results, so far, have been fantastic!  Interest in the program far-surpassed what we ever dreamed possible, with 3,500 people registering in 2010.  Although we have yet to do a detailed evaluation of the program, preliminary review shows that people of all abilities increased their levels of physical activity, enjoyed the program, and would highly recommend it to others in their social circle!  We are excited to run the program next spring and work in new ideas to continue to assist individuals of all abilities in becoming more physically active!

How are you creatively promoting physical activity for people of all abilities?