Develop a school-based program for preventing obesity and promoting activity and fitness.? 1. Overview/background, rationale,

Target population: School-based Type of promotion: Preventing obesity and promoting physical activity and fitness

1. Overview/background, rationale, goals & objectives

● Provide an overview and rationale (e.g., need, target population) for the

proposed program, which should be rooted in existing literature.

Students must include at least 3-4 research citations at this point to

show the background and merit/support for the development for the

chosen program. (*reminder, you will be developing an authentic

program not using an already existing program, but you can utilize ideas

and principles from what already exists)

● Develop 2-3 goals (broad) and 2-3 objectives (specific) *be sure to use

the SMART principle

2. Intervention, resources, leadership plan, personal fitness self-assessment

● Describe the intervention

● Create a plan for obtaining resources for immediate and long-term

programming

● Develop a leadership plan

● Develop a personal fitness plan including self-assessment (10 points),

goal setting (10 points), and a description of how you will link this to your

proposed project (20 points).

3. Program evaluation and logic model, personal fitness goal setting

● Create and include a logic model

● Present proposed evaluation methods and indicate how they conform with or

deviate from existing literature in the area. To complete this step you should

include another 2-3 research articles.

● Develop a personal fitness plan including self-assessment (10 points), goal

setting (10 points), and a description of how you will link this to your proposed

project (20 points)

4. 8-week schedule, activities, budget and assessments.

● Complete a budget analysis (table) and show how the budget will be used

(narrative).

● Create a full schedule of activities and such (class instruction, activities, ect)

● Finalize detailed assessment methods

ANDREWS UNIVERSITY Department of Public Health

Signature Assignment-Physical Activity Promotion Plan

Presented in Partial Fulfillment of the Requirements for the class: FTES510-999 Fitness and Health Promotion

Spring 20__ Dr. Padma Tadi Uppala

Overview and rationale

Among the different types of cancer, breast cancer is the most prevalent type of cancer in

women worldwide, in both developed and developing countries. "Approximately 40,610 women

are expected to die of breast cancer in 2017 in the US. Mortality rates for 2011-2017 for breast

cancer rates for Non-Hispanic Whites was 21.2 and for Non-Hispanic Blacks was 29.8% per

100,000 women” (American Cancer Society, 2017). In Michigan, breast cancer is the most

diagnosed cancer and the second-leading cause of cancer deaths in women. According to Institute

for Health Metrics and Evaluation (2016), age-standardized breast cancer rate in 2014 was 27.2

per 100,000 women for Berrien County, above the state and national average rate. In 2011 the

prevalence of obesity in women from Berrien County exceeded the state average rate and only half

the female population meet physical activity (PA) recommendations. A large number of studies

show the relationship between obesity/sedentary lifestyle and increased risk of breast cancer.

According to research, exercise could help prevent cases and deaths caused from breast cancer.

With exercise, there is a decrease in estradiol and an increase in the binding globulin to sex

hormones, which causes reduction of inflammatory and increase of the anti-inflammatory

substances which may prevent the development of cancer (Silva, 2018).

Treatment for breast cancer, such as surgery (radical or conservative mastectomy),

chemotherapy, radiotherapy or hormone therapy, is associated with the impairment of the body,

causing physical consequences such as fatigue and pain, as well as changes in body image, psychic,

emotional and social declines (Ussher, Perz & Gilbert, 2012). In this sense, the need for

interventions that minimize such complications, coupled with a healthy lifestyle, especially in

relation to eating habits and physical activity levels, is emphasized (George et al., 2011).

Physical exercise is a useful tool to manage post-treatment complications of cancer,

because it generates an increase in cardiorespiratory fitness and flexibility, gains in self-image,

self-esteem, decrease in depression and anxiety, and improvement in sleep quality (Battaglini et

al., 2014). Physical activity has been shown to be beneficial for breast cancer survivors, women in

initial stage, and women with metastatic breast cancer (advanced stage). However, due to fear of

bone fracture and fatigue related to cancer or cancer treatment that affects normal functioning,

those with metastatic breast cancer have typically been excluded from exercise interventions (Yee,

2014).

A community-based exercise intervention with breast cancer survivors was shown to be

feasible and improve significantly physical, psychological and functional well-being (Knobf,

Thompson, Fennie & Erdos, 2014). In Canada, a 12-week exercise program known as the “Breast

cancer patients Engaging in Activity while Undergoing Treatment” (BEAUTY) was also feasible

and effective in improving quality of life, preventing declines in physical and psychosocial

outcomes (Leach, Danyluk, Nishimura & Culos-Reed, 2015). These studies support the need to

include PA programming as part of treatment for breast cancer patients.

Given the above, the objective of this physical activity plan is to describe a structured

program of aerobic walking and resistance physical exercises for women with breast cancer in the

stage of chemotherapeutic and/or radiotherapeutic treatment.

Resilience in Overcoming Cancer! – ROC!

The objective of the project is to provide women with breast cancer a 12-week structured physical

activity program, prioritizing the physical, social and psychological well-being of this population.

Target Population: Women older than 18 years and undergoing treatment for breast cancer and

have no metastatic disease in the Berrien County.

Sample size: n=40

SMART aims and objectives

• To develop the habit of physical activity of 150 minutes per week in participants

following the 12-week intervention.

• To improve and/or maintain physical fitness of its participants by 50% following

the 12-week intervention.

• To increase knowledge about the benefits of physical activity in relation to cancer

in participants by 90% following the 12-week intervention.

• To increase psychological wellbeing in participants by 75% following the 12-week

intervention.

Logic Model

Promotion

This will be a community wide campaign that is offered to women ages 18 and older who are

currently being treated for breast cancer and have no metastatic disease.

• Flyers/ brochures will be distributed at:

§ Marie Yeager Cancer Center

§ Cancer Care Lakeland Health

§ Berrien County Cancer Service

• Small posters on community boards in the local area

• Flyers at all local Oncologist’s offices

• A 12-week exercise program with an educational support group component. Additionally,

it will be followed by a 12-week maintenance program.

§ Planned strength-training program with a personal trainer

§ Educational component at the Marie Yeager Cancer Center

Intervention

This will be a 12-week exercise program with an educational component. The educational support

group will be held on a weekly basis for the first 12 weeks. A rehabilitation cancer specialist will

help educate patients on physical activity during treatment. Participants will be encouraged to

share ideas and support each other. There will also be a 12-week follow-up maintenance program.

Initially participants will need to get clearance from their doctor to participate in the program.

Once in the program they will be given a picture identification card to show to all participating

exercise facilities to gain free entrance. Currently all local YMCA’s and CrossFit gyms are

participants. Each gym has a breast cancer patient personal trainer that has been trained by the

Marie Yeager Cancer Center on exercise prescriptions for cancer populations. The participant will

have one free training session with the personal trainer to create a strength training program. After

the first 12-weeks they will have another free meeting with the personal trainer to make any

adjustments to their plan. We have included strength training because it can help with bone mineral

density, lymphedema, and can help with “weight loss in patients undergoing treatment” (Baumann,

et al., 2013).

The 2008 Physical Activity Guidelines require 150 minutes per week of “moderate-intensity

aerobic exercise” (Harold W. Kohl & Murray, 2012). Our program is promoting 3 days of weight

training and 2 days of aerobic walking or aerobic exercise class for 30 minutes each session. This

would provide the 150 minutes that are recommended. The intensity can be determined by the

Talk Test.

Schedule

Exercise Type Low Energy Medium Energy High Energy Aerobic 3×10 minute sessions 2 x 15-minute sessions 30-minute session Strength 1-2 sets of 8-10 reps. 1-3 sets of 8-10 reps. 2-3 sets of 8-10 reps. Flexibility 5-7 days per week 5-7 days per week 5-7 days per week

(H.J. Leach, Danylu, & Culos–Reed, 2014)

Sample Schedule

Monday Tuesday Wednesda y

Thursday Friday Saturday Sunday

Pilates Strength Total Body

Pool aerobics 30 minutes

Strength Total Body

30-minute aerobic walk

Rest Strength Total Body

Educationa l Support Group

Flexibility Stretching 5-10 min.

Flexibility Stretching 5-10 min.

Flexibility Stretching 5-10 min.

Flexibility Stretching 5-10 min.

Flexibility Stretching 5-10 min.

Participants can choose from many types of classes depending on what the participating

gym has to offer. Some of the different classes could include yoga, flexibility classes, step aerobics,

Zumba. Once a strength training program has been established participants can use a phone app or

hardcopy worksheet to log their weight and repetitions for each workout.

Leadership

• Co-directors of the program are Hazel Fuentes and Ana Howard

• Dr. Buck- Program Medical Doctor and an Oncologist

• Marie Yeager Cancer Center- Program Coordinator

• Program Coordinator Administrative Assistant

• Marie Yeager Cancer Center- Educator and Counselor

• Personal trainers from different gyms who will be working with the clients

Funding

Funding will be acquired through several different sources. The program will apply for grants from

Honor Credit Union, Michigan Department of Health and Human Services, and the Susan G.

Koman Foundation. We are asking participating gyms to donate a six-month to one-year

membership or provide a membership at a lower rate. We will be working with CETI the Cancer

Exercise Training Institute to certify our personal trainers. The Cancer Exercise Specialist

Certification is a value of $399 therefore we are asking personal trainers to donate their time in

exchange for the certification. Our desire is to provide this program free of cost to participants.

Evaluations

A formative evaluation will be included. Questions will be asked concerning the overall

proposal of the project. How much can exercise help in alleviating symptoms from treatments?

How often are participants willing to exercise? How inactive are patients going through treatment?

What are the barriers for participating in the program? Who will train the personal trainers on

cancer exercise prescription? How can we encourage participants to exercise? “Is there a leader in

the target population who can assist with outreach?” (Harold W. Kohl & Murray, 2012).

A process evaluation focuses on how well the program is functioning. Therefore,

attendance will be monitored. An assessment of delivery alternatives will be included (Harold W.

Kohl & Murray, 2012). The program will divide the group and in one group the Oncologist will

prescribe exercise as part of the treatment and in the other group it will just be suggested by the

Oncologist. Participants will be surveyed on the program every two weeks during the education

class. If attendance is low what program changes can take place that would be helpful? Do

participants feel competent enough with their strength training program or is more personal

training involvement needed? Which gyms are seeing better results in participants and why? What

is working in the program and what is failing?

Outcome evaluations will include the following assessments. Fatigue will be measured by

the Fatigue Symptom Inventory (FSI) which was devised for cancer populations. “Higher scores

on the FSI indicate greater fatigue” (Rajotte, et al., 2012). Quality of life was evaluated by using

the second version of SF-36. “This measure includes eight scales: Physical Functioning, Role-

Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental

Health” (Rajotte, et al., 2012). Furthermore, both the mental and physical summary are determined

by the different scales.

Pre and post assessments will be done on participants to ascertain if cancer treatment

symptoms are better after engaging in the program. Participants will evaluate their satisfaction

with the program. Personal trainers will measure resting heart rate, weight, and waist to hip ratio.

They will also assess mobility with a goniometer test, strength with a handgrip dynamometry and

1 rep maximum. Muscular endurance will be tested by the sit-ups and push-ups test. Cardio

assessments such as the YMCA 3- minute Step test will also be used (Harold W. Kohl & Murray,

2012). All of these assessments will be done before and after the program.

A cost-effectiveness evaluation will occur at the end of the program. Did participants miss

less work days due to exercise? Did participants respond better to the treatment therefore having

fewer medical complications? The costs of running the program, employees' incomes, assessment

costs, and personal training fees. Did the participants find that it was a cost-effective use of their

time? (Harold W. Kohl & Murray, 2012).

Public Health Practice Strategies and Policy

Research has shown that physical activity both during and after treatment can be helpful

with the side effects of treatment, mental health, fatigue, and the reoccurrence of cancer (Mendes,

2014), (Breast Cancer, 2017), (C. Kent Osborne, 2018). This is why partnerships and advocacy

are so important in encouraging physical exercise not only among the healthy but those who have

breast cancer. The American Cancer Society, the National Breast Cancer Foundation, American

Breast Cancer foundation, CDC, and medical community should form partnerships to advocate for

policies that help implement an exercise program as part of treatment. It is important that the

medical community include exercise as part of the standard of care after diagnosis. Medical

training may have to be revised to incorporate this new method of practice. The guidelines are

present, but patients need to be reminded of the importance of physical activity. The standard of

care should include a referral to a physical therapist with a cancer specialist (National

Comprehensive Cancer Network, 2019). Policies need to be put into place so that it becomes a

routine procedure.

It is important to examine the research on breast cancer and exercise and then present the

scientific evidence to insurance companies with the hope that they are influenced to reimburse

gym memberships. It is essential that policy makers are made aware of the research. A multi-

faceted approach including the medical community, media, cancer advocates, insurance

companies, and political realm needs to be created. It is important to make the public aware through

media, foundations, and American Cancer Society of the significance that exercise can have on

cancer. Perseverance will be needed as this issue will need to be presented consistently over a long

period of time (Harold W. Kohl & Murray, 2012). The importance of physical activity on cancer

is largely substantiated in research therefore, programs like ROC can be an invaluable resource for

those with cancer.

References:

American Cancer Society. Breast Cancer Facts & Figures 2017-2018 Atlanta: American Cancer Society, Inc. 2017.Retrieved from: https://www.cancer.org/content/dam/cancer- org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and- figures-2017-2018.pdf

Battaglini, C. L., Mills, R. C., Phillips, B. L., Lee, J. T., Story, C. E., Nascimento, M. G., & Hackney, A. C. (2014). Twenty-five years of research on the effects of exercise training in breast cancer survivors: a systematic review of the literature. World journal of clinical oncology, 5(2), 177. Baumann, F. T., Bloch, W., Weissen, A., Brockhaus, M., Beulertz, J., Zimmer, P., … & Zopf, E. M. (2013). Physical activity in breast cancer patients during medical treatment and in the aftercare- a review. Breast care, 8(5), 330-334. Breast Cancer. (2017, February 18). Exercise During and After Treatment. Retrieved from Breast Cancer: https://www.breastcancer.org/tips/exercise/treatment. C. Kent Osborne, M. (2018). Exercise during adjuvant breast cancer treatment may improve cardiovascular function. San Antionio Breast Cancer Symposium (pp. https://www.healio.com/hematology-oncology/breast-cancer/news/online/%7B00d1324d-0749- 4ee3-9724-3b7200a9a5a3%7D/exercise-during-adjuvant-breast-cancer-treatment-may-improve- cardiovascular-function). Healio. George, S. M., Irwin, M. L., Smith, A. W., Neuhouser, M. L., Reedy, J., McTiernan, A., … & Moore, S. C. (2011). Postdiagnosis diet quality, the combination of diet quality and recreational physical activity, and prognosis after early-stage breast cancer. Cancer Causes & Control, 22(4), 589-598. Harold W. Kohl, I., & Murray, T. D. (2012). Foundations of Physical Activity and Public Health. Champaign, IL: Human Kinetics. Institute for Health Metrics and Evaluation [IHME]. (2016). US County Profile: Berrien County, Michigan. Seattle, WA: IHME Knobf, M. T., Thompson, A. S., Fennie, K., & Erdos, D. (2014). The effect of a community- based exercise intervention on symptoms and quality of life. Cancer nursing, 37(2), E43-50.

Leach, H. J., Danyluk, J. M., & Culos–Reed, S. N. (2014). Design and implementation of a community-based exercise program for breast cancer patients. Current Oncology, 21(5), 267.

Leach, H. J., Danyluk, J. M., Nishimura, K. C., & Culos-Reed, S. N. (2015). Evaluation of a community-based exercise program for breast cancer patients undergoing treatment. Cancer nursing, 38(6), 417-425.

Mendes, E. (2014, October 22). The Power of Exercise in Breast Cancer Survivors. Retrieved from American Cancer Society: https://www.cancer.org/latest-news/the-power-of-exercise-in-breast- cancer-survivors.html National Comprehensive Cancer Network. (2019). Exercising During Cancer Treatment. Retrieved from National Comprehensive Cancer Network: https://www.nccn.org/patients/resources/life_with_cancer/exercise.aspx Rajotte, E. J., Jean, C. Y., Baker, K. S., Gregerson, L., Leiserowitz, A., & Syrjala, K. L. (2012). Community-based exercise program effectiveness and safety for cancer survivors. Journal of Cancer Survivorship, 6(2), 219-228. Silva, D. A. S., Tremblay, M. S., de Souza, M. D. F. M., Guerra, M. R., Mooney, M., Naghavi, M., & Malta, D. C. (2018). Mortality and years of life lost due to breast cancer attributable to physical inactivity in the Brazilian female population (1990–2015). Scientific reports, 8(1), 11141. Ussher, J. M., Perz, J., & Gilbert, E. (2012). Changes to sexual well-being and intimacy after breast cancer. Cancer nursing, 35(6), 456-465.

Yee, J., Davis, G. M., Beith, J. M., Wilcken, N., Currow, D., Emery, J., … & Segelov, E. (2014). Physical activity and fitness in women with metastatic breast cancer. Journal of Cancer Survivorship, 8(4), 647-656.

1 From H.W. Kohl III, T.D. Murray, and D. Salvo, Foundations of Physical Activity and Public Health Instructor Guide, 2nd ed. (Champaign, IL: Human Kinetics, 2020).

Signature Assignment – Presentation & Paper Requirements Physical Activity Plan for a Municipality, County, or State The signature course assignment requires students to develop a hands-on plan to promote physical activity for a targeted community. It also encourages students to apply knowledge, skills, and abilities (KSAs) covered throughout the text. Be sure to review the National Physical Activity Plan (www.physicalactivityplan.org) as well as other physical activity and public health planning documents (e.g., http://wvphysicalactivity.org). The general idea is to adapt this work into an action plan that can be implemented to increase physical activity. This assignment should be discussed early in the semester so that students have adequate time to formulate a plan. Students’ Tasks Presentation Project Overview Each student will make a 15-minute PowerPoint presentation of their signature assignment project that focuses on a unique physical activity promotion plan for a municipality, county, or state. The proposed project must be based on principles learned in class throughout the semester and rooted in existing literature. Each project should include appropriate aspects of overview and rationale, specific aims/goals, logic model, evaluation approaches, and implications for practice and policy. Each presenter should guide the class discussion and field questions and solicit the perspectives of others throughout the presentation. A presentation schedule will be developed by week 6 when the first draft of the project is due. Class PowerPoint presentations are due at least 24 hours (1 day) before your assigned presentation time. Project Objectives Upon completion of this project, you will be able to do the following: (1) Analyze peer-reviewed research literature about physical activity and public health, (2) create a multimedia presentation to present with an oral report on an original physical activity promotion project and (3) understand and communicate the topics covered during the course. Content Guidelines for the Signature Project

1. Provide an overview and rationale (e.g., need, target population) for the proposed program, which should be rooted in existing literature. Students must include at least 3-4 research citations at this point to show the background and merit/support for the development for the chosen program. (*reminder, you will be developing an authentic program not using an already existing program, but you can utilize ideas and principles from what already exists)

2. Present well-developed and specific goals & objectives. 3. Create and include a logic model. 4. Present proposed evaluation methods and indicate how they conform with or deviate from

existing literature in the area. To complete this step you should include another 2-3 research articles.

5. Annotate with supplementary studies and data (fully referenced) where appropriate. Another 2-3 research articles should be utilized here.

6. Discuss public health practice strategies and policy considerations. Another 2-3 research articles should be utilized here.

2 From H.W. Kohl III, T.D. Murray, and D. Salvo, Foundations of Physical Activity and Public Health Instructor Guide, 2nd ed. (Champaign, IL: Human Kinetics, 2020).

7. Complete a budget analysis (table) and show how the budget will be used (narrative). 8. Develop a personal fitness plan including self-assessment (10 points), goal setting (10 points),

and a description of how you will link this to your proposed project (20 points) Format and Style Guidelines for Signature Project

1. Backgrounds: The simpler the better. 2. Text colors: Use anything except red or pink! 3. Background: With dark backgrounds, use white or yellow text. With light backgrounds, use black

text. 4. Text: Include three or four bullets per slide. 5. Tables and figures: Avoid cutting and pasting or scanning when they are reasonable to

reproduce. 6. Citations: Must follow APA guidelines 7. Pictures and video: Use these sparingly!

3 From H.W. Kohl III, T.D. Murray, and D. Salvo, Foundations of Physical Activity and Public Health Instructor Guide, 2nd ed. (Champaign, IL: Human Kinetics, 2020).

Evaluation Criteria for Signature Assignment

Presenters Name:

Score: ____ out of ___.

Scoring

0 = No credit: did not follow assignment instructions for section or it was not completed

1 = Poor: barely met criteria

2 = Average: met but lacked clear understanding of the requirement

3 = Good: showed basic understanding of the criteria for the section as shown in the rubric

4 = Excellent: high-quality work was completed for the section the criteria in the rubric

Statement of the problem: describe your population, the type of promotion, period and overview of your project.

0 1 2 3 4

Logic model: state your goals/objectives 0 1 2 3 4

Promotion & Intervention: briefly explain your project, how the intervention will be run and promoted

0 1 2 3 4

Schedule: show a well-developed schedule that describes the implementation for each facet of your program (i.e. physical activity assessment, implementation strategies, evaluation, ect.)

0 1 2 3 4

Leadership plan: share your leadership plan 0 1 2 3 4

A plan for getting resources and a detailed budget analysis of how those resources will be utilized. Also describe how the program will be sustained overtime.

0 1 2 3 4

An evaluation plan was included, highlighting the loop of tying the program goals/objectives to assessment. Physical activity assessment tools should also be discussed.

0 1 2 3 4

The plan was evidence based—was there good sources of information that influenced the project and were referenced

0 1 2 3 4

Timeliness & Organization: Student is well prepared for the presentation. Powerpoint slides were turned in ahead of time. The project was well organized and easy to follow. The presentation meet the 15 minute time frame.

0 1 2 3 4

Personal Fitness Plan: Student briefly describes what they learned through assessment and goal setting and describes how their personal fitness journey will be tied in or related to the proposed project.

0 1 2 3 4

4 From H.W. Kohl III, T.D. Murray, and D. Salvo, Foundations of Physical Activity and Public Health Instructor Guide, 2nd ed. (Champaign, IL: Human Kinetics, 2020).

Students’ Tasks Paper Your semester project that focuses on a unique physical activity promotion plan for a municipality, county, state or school. The proposed project must be based on principles learned in class throughout the semester and rooted in existing literature. Your Paper based on your project should include appropriate aspects of:

1. Overview/background, rationale, goals & objectives (due week 2) 2. Intervention, resources, leadership plan, personal fitness self-assessment (due week 3) 3. Program evaluation and logic model, personal fitness goal setting (due week 4) 4. 8-week schedule, activities, budget and assessments (due week 5) 5. First draft, all areas previously plus include for first time personal fitness link to project (due

week 6) 6. Final draft (due week 7)

*During weeks 2-5 please turn in your entire paper with all sections included, not only the sections due for that particular week. Include any feedback provided by the instructor in each week’s paper and highlight any changes that were made in response to the instructor’s feedback each week. Project Objectives

• Upon completion of this project, you will be able to do the following: o Analyze peer-reviewed research literature about physical activity and public health. o Create and write a paper or give a multimedia presentation format to give an oral report

of an original physical activity promotion project. o Understand and communicate the topics covered during the course. o Create a personalized fitness plan that you can carry out and share with others

See additional requirements below.

5 From H.W. Kohl III, T.D. Murray, and D. Salvo, Foundations of Physical Activity and Public Health Instructor Guide, 2nd ed. (Champaign, IL: Human Kinetics, 2020).

Final Paper Requirements: Times New Roman, 12 point font, double spaced, 1 inch margins, APA Citations Required Sections (please follow order)

Title Page Table of Contents Target Population

Type of Promotion

Time Frame (should be 8 weeks)

Overview/background

Rationale

Goals & Objectives

Logic Model

Promotion

Intervention

Schedule

Assessments

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