Introduction
Health statistics are frightening! Cardiovascular disease (CVD) is the number one killer in the United States (US), and African American women are particularly at risk for CVD, with an age-adjusted rate of CVD 72% higher than for white women (Center for Disease Control [CDC], 2016). African American women are also twice as likely as white women to have a heart attack (American Heart Association [AHA], 2016). On average, 82% of African American women are classified as overweight (NCHS, 2014). Regular physical activity prevents risks for developing CVD and obesity. Nevertheless, physical inactivity is an ongoing challenge in the US, particularly so among minorities and women (Ward, Clarke, Freeman, & Schiller, 2013). In the U.S., African American women aged 20–59 years accumulate an average of only 20 daily minutes of moderate to vigorous physical activity and 63% fail to meet the recommended physical activity guidelines. This story aims to look back at the experience facilitated by undergraduate students, especially those with a desire to work in fitness administration or careers in Kinesiology. It may seem logical to assume that people exercise for long term health reasons, and students of Kinesiology initially assume so, but research supports that this is just not the case. The aim of this case study was to explore precursors for exercise adherence, especially for African American adult women, and how undergraduate students made it easier for them to do so.
Why people do not exercise and what could 11 college students do to change that
Students discovered from reading research that found lack of childcare, others to exercise with, space at home or at work, and motivation as major barriers to be physically active. Students embarked on a truly immersive project by listening to the needs of the community at a neighborhood monthly meeting. Suggestions from the executive director of the recreation center recommendations mirrored those from the neighborhood residents. Additional factors include high cost, and “feeling out of place” in exercise facilities outside of their neighborhoods. Recent research in health behavior has revealed that African American women may adhere to long term, comprehensive and structured programs that cover both exercise and nutrition, and keep them motivated by means of ongoing social support. The notion of support typically costs money, unless people have a devoted group of friends; however this is hard to come by, especially with the working poor with children to support. Barriers associated with low socioeconomic status may set an even increased prevalence of sedentariness (NCHS, 2014). There are so many dynamic variables to consider when making time for oneself to be physical active for the sake of one’s health. With all this data, students hypothesized that if their exercise program offered nutritional education and food sampling, and a safe place for their children, community residents would attend, spread the word, and continue for the fourteen weeks.
To that end, community programs with goals to engage racially diverse populations in physical activity have highlighted the importance of involving the target community on an individual level, however when grant funding runs out support systems disappear. This was another important consideration for the sustainability piece of the program. Students were told of stories about lost trust experienced by individuals in community exercise programs. Some participants shared they felt “abandoned” and lose what wellness gains they have made in previous experiences.
Immersive Learning
Eleven undergraduate students facilitated, “Zumba @ the Buley,” a 14-week exercise and nutrition education program. Students completed IRB training which allowed them to design surveys and health questionnaires. Given the limited knowledge on potential physical activity participation and health indicators of African American women, the students used a semi-structured survey with greater emphasis on qualitative items. Open ended questionnaires helped discover how the participants make sense of events and assign meaning to their experiences.
Of 90 individuals (average age 45), only 12 respondents added to the qualitative section of the surveys. The students had difficulty understanding why we partially completed questionnaires or questionnaires without consent forms. This was a teachable moment about ethics in research. We taught the students how to use Statistical Package for Social Science (SPSS), as well as a qualitative analysis tool for the open ended questions pertaining to preferences and requests for the future.
Students were responsible for marketing the program. Potential participants were recruited via radio public service announcements, advertisement flyers, and public speaking engagements at local churches, high school sport games, and civic events. Students bought airtime and produced their own radio spots at a local radio station. Marketing campaigns informed them about the purpose of the study, defined what the participation would entail, and solicited them to participate. Subsequently, students presented information about the study at the select community center both verbally and in the participation packets handed to participants.
Up and Running
Upwards of 100 participants engaged in rhythmic aerobics (i.e., Zumba) 2 times per week for 4 consecutive months at a local community center. The center was less than one mile for 75% of participants and 50% walked to and from the center for 82% of the program. Classes were free of charge. Each class took 60–70 minutes. Two students choreographed and taught the Zumba classes. Nine students planned menus, shopped for locally bought food, cooked, and taught basic cooking tips to participants after the exercise portion of the program. Complimentary meal samplings followed each exercise session. Recipes with nutritional information were provided in a published cookbook for participants. As well, free babysitting services were provided. Also, participants with an 85% attendance rate had the opportunity obtain Zumba instructor certification for themselves to become group exercise instructors. This was funded by an external grant. At the completion of the program, participants were administered a semi-structured questionnaire. Participants responded the questionnaire individually and completion of the questionnaire took 15 minutes.
Results and Discussion
Most participants reported joining the program because they found it either fun or cost effective while some reported joining it because they found it convenient. The students were not surprised with these findings. As the student experience came to an end, the most pivotal moment arrived: students realized they had established a successful exercise and nutrition program within the African-American community and to make it sustainable there were several variables the participants would need for adherence. Students suggested providing free childcare, nutrition and food sampling, and instructional classes close to home as positive predictors of exercise adherence. Ten women were certified as Level 1 Zumba instructors. Their “contract” was to pay-it-forward with free exercise classes at the same time at the same recreation center. Women participants take turns in the child-care room or older children watch them while their mothers dance for an hour. The program, after three years is still sustainable via offering free exercise classes. In fact, the program has a cult following and many people from the city take classes there. Donations put money in the instructors pocket and pay utilities costs.
Our approach seemed to benefit from integrating an existing local facility that was easy to reach, safe and available for the type of program offered, as well as extending free child care services for participating members, and finally a Zumba instructor certification for ten who strongly expressed the desire to teach. Noteworthy, many of the participants reported high enjoyment and high satisfaction with the program. Although the marketing focus of this program was on the physical activity portion of the program, the powerful combination of physical activity and nutritional education programs are integral to increasing community health behaviors (AHA, 2016). Both physical and nutritional educational components are important strategies for creating active living environments in communities (Stirling, Lobstein, & Millstone, 2007; Viswanath & Bond, 2007). Without funding, there was no way for the participants to regularly sample nutritional foods. Students suggested participants take turns bringing in food but this never transpired due to cost, effort, and organization.
Consistent with this view, the students and participants found it beneficial to offer both activity and nutrition programs for obtaining overall health and continued health behaviors. Very few studies have specifically examined the perceptions and experiences of low income African American women to physical activity (Ainsworth, Wilcox, Thompson, Richter, & Henderson, 2003; Jackson et al., 2016). Students were able to present their findings to state and regional nutrition and dietetics conferences, publish and distribute 70 cookbooks, and speak to faculty at the University.
In sum, it appears that nutritional education is an important determinant of these initiatives and deserves more attention in future program designs. Students were exposed to so much in a short period of time. Not only did they determine the need in the community, design and execute a 14 week exercise and nutrition program, but conducted and presented the research. More importantly, they are able to discuss the limitations of the program and what future programs could offer to instill physical activity adherence for African American women. What a unique experience!
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