With Every Heartbeat Is Life:  A Community Health Worker's Manual for African Americans

Session 3
Get Energized! Say YES to Physical Activity

Contents

• Introduction
• Session 1 — Knowledge Is Power: Know Your Risk for Heart Disease
• Session 2 — Act in Time to Heart Attack Signs
• Session 3 — Get Energized! Say YES to Physical Activity
• Session 4 — Help Your Heart: Control Your High Blood Pressure
• Session 5 — Be Heart Smart: Keep Your Cholesterol in Check
• Session 6 — Embrace Your Health! Aim for a Healthy Weight
• Session 7 — Protect Your Heart: Take Good Care of Your Diabetes for Life
• Session 8 — Make Heart Healthy Eating an Everyday Family Reunion
• Session 9 — Eat in a Heart Healthy Way—Even When Time or Money Is Tight
• Session 10 — Take Control of Your Health: Enjoy Living Smoke Free
• Session 11 — Review and Graduation
• Session 12 — Use Evaluation To Track Your Progress (Especially for Community Health Workers)
• Appendix — Activities for Training Community Health Workers

Objectives

By the end of this session, group members will learn that:

• Physical activity is good for the heart and overall health.
• Adults should be physically active for 30 to 60 minutes on most days.
• Children and adolescents should be physically active for about 60 minutes on most days, preferably daily.
• Brisk walking is a simple activity nearly everyone can do.
• There are ways to fit more activity into a busy schedule.

Materials and Supplies

To conduct this session, you will need:

• "With Every Heartbeat Is Life" manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Cool drinking water and cups
• (Optional) Tape or CD player for music during walking activity

Handouts

Give group members these handouts during this session:

• (Optional) "Health Freedom Walk Role Play"
• "Getting Started With Physical Activity"
• "Getting Started With Physical Activity: Ms. Diane's Answers"
• "Take Heart—Say Yes to Physical Activity"
• "Stretching Activities"
• "How To Be Physically Active"
• "Make Physical Activity a Habit—My Personal Record"
• "Sample Walking Program"

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week's Session
3. About This Session

Conducting the Session

1. Facts About Physical Activity
2. (Optional) Health Freedom Walk Role Play
3. Benefits of Physical Activity
4. Types of Physical Activity
5. Getting Started: Important Things To Know
6. Finding Time To Be Physically Active
7. Walking: An Activity for Almost Everyone*
   1. Discussion and Stretching
   2. Walking Activity

* Prepare for the walking activity by reading the box with "Tips for Preparing for the Walking Activity".

Review of Today's Key Points

Weekly Pledge

Closing

Note: If you have time, include a 30-minute activity, such as walking, at the beginning or end of the remaining sessions.

Introducing the Session

1. Welcome
• Welcome group members to the session.
2. Review of Last Week's Session
• Say:
  At the last session we talked about the heart attack warning signs. Who remembers the warning signs of a heart attack?
• Note: Allow about 3 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.
• Add these signs if they are not mentioned:
  • Your chest may hurt or feel squeezed.
  • You may feel like you can't breathe.
  • You may feel pain in your neck or jaw.
  • One or both of your arms, your back, or your stomach may hurt.
  • You may feel sick to your stomach.
  • You may feel light-headed or break out in a cold sweat.
• Ask:
  Who remembers what you should do if you feel these symptoms?
• Say:
  The answers are:
  • Call 9—1—1 in 5 minutes or less, even if you are not sure you are having a heart attack. Calling 9—1—1 gets you treated more quickly.
  • Do not drive yourself to the hospital.
• Say:
  At the end of the session, we pledged to do one thing to be prepared if a heart attack happens. Please share with the group what you did.
• Note: Allow 2 to 3 minutes for group members to respond.
• Ask:
  Has anyone completed the family health history?
• Note: Give a prize to group members who have completed the family health history.
• Ask:
  Does anyone want to share what you have learned about your family health history?
• Note: Allow about 5 minutes for group members to respond.
  
3. About This Session
• Say:
  Marian Wright Edelman, an African American civil rights activist and founder of the Children's Defense Fund, said, "It is time for every one of us to roll up our sleeves and put ourselves at the top of our commitment list."
• Ask:
  What does this quote mean to you?
  Note: Allow 2 to 3 minutes for group members to respond.
  
• Say:
  During today's session, we will discuss physical activity and how important it is to your heart health. When the session ends, you will know:
  • How physical activity can help you and your family
  • What kind of activities are good for you and for your heart
  • How much activity you should do
  • How you can find time to be active
• Note: "Physical activity" and "exercise" mean the same thing.

Conducting the Session

1. Facts About Physical Activity
• Say:
  Not getting enough physical activity is a major health risk for people today.
  • Being physically inactive puts you at risk for heart disease. The good news is that you can do something about this risk factor.
  • African Americans, especially women and children, are not getting enough physical activity.
  • As a person gets older, having little or no physical activity can lead to health problems.
2. (Optional) Health Freedom Walk Role PlayFotonovela
• Note: Ask for two volunteers to be the actors in a role play. Give these two group members the "Health Freedom Walk Role Play," Read the introduction aloud. After the activity is completed, allow 5 minutes for discussion by asking the following questions:
  • What did you learn from this story?
    
  • What are some of the issues you might face in trying to be more physically active or in getting your family to be more physically active?
3. Benefits of Physical Activity
• Ask:
  How do you think physical activity can help you?
• Note: Allow about 5 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.
• Show picture card 3.1.
• Say:
  Physical activity can help you:
  • Strengthen your heart and lungs.
  • Build and maintain healthy bones, muscles, and joints.
  • Control your weight.
  • Have more energy.
• Show picture card 3.2.
• Say:
  Physical activity can also help you:
  • Lower your blood pressure.
  • Control your blood cholesterol.
  • Lower your risk of getting heart disease, diabetes, and some cancers.
    If you have any of these risk factors, it is important to talk to a doctor before starting a physical activity program.
• Show picture card 3.3.
• Say:
  People feel better when they are active. Physical activity may help you lose weight.
4. Types of Physical Activity
• Ask:
  What do you do to be physically active?
• Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.
• Say:
  There are different types of physical activity. Physical activity includes some of the things that you probably do each day, like walking, climbing stairs, or doing household chores.
• Show picture card 3.4.
• Say:
  You may want to start with moderate (medium-level) activities. Moderate activities should require you to make some physical effort, but you should be able to have a conversation comfortably while doing them. Examples of moderate activities include:
  • Walking at a brisk pace
  • Gardening (mowing, raking)
  • Dancing (African dancing, hand dancing, line dancing, or stepping)
  • Making home repairs (painting)
  • Washing and waxing a car
  • Scrubbing floors and washing windows
  • Actively playing with children (walking, running, or climbing)
  • Weightlifting
  • Taking stairs instead of the elevator
  • Doing floor exercises (pushups, situps)
  • Doing chair exercisis (for seniors or persons with physical disabilities)
• Show picture card 3.5.
• Say:
  After a while, you will be able to do more vigorous (high-level) activities. Vigorous activities require hard physical effort and make your heart rate and breathing much faster. You usually can't carry on a conversation comfortably while you are doing vigorous activities. Vigorous activities that you might enjoy include:
  • Playing basketball, baseball, or football
  • Swimming laps
  • Running or jogging
  • Bicycling fast or uphill
  • Doing aerobic dance or step aerobics
  • Jumping rope such as double dutch
  • Skating
  • Using a stair climber machine or stationary bike at a fast pac
• Say:
  All types of physical activity are good for you. Aerobic activities, such as brisk walking that speeds your heart rate and breathing, help your heart. Other activities such as weightlifting and stretching can help improve strength and flexibility.
• Say:
  Start slowly. Then move on to higher-level activities. For example, when you are comfortable walking, gradually begin to jog. You'll feel great!
• Ask:
  How much physical activity do you think you need to do each day to improve your health?
• Say:
  • Adults should have at least 30 minutes of moderate physical activity daily to lower their chances of getting heart disease.
  • Some adults need up to 60 minutes of moderate physical activity on most days to prevent unhealthy weight gain.
  • Adults who used to be overweight need 60 to 90 minutes of moderate physical activity every day to avoid regaining weight.
  • Children and adolescents need at least 60 minutes of moderate to vigorous physical activity on most days, preferably daily.
• Show picture card 3.6.
• Say:
  If you can't set aside 30 or 60 minutes at one time to be active, you can break your activity into shorter periods of 10 minutes or longer. It's the total time of physical activity that is important. Just make sure that the total time adds up to 30 or 60 minutes on most days.
• Say:
  For example, if you can only do 30 minutes of physical activity a day:
  

  Ride your stationary bike for 10 minutes before you go to work	+10
  Take a 10-minute walk with your kids after work	+10
  Do aerobic exercises for 10 minutes later in the day	+10
  	30 minutes

  
  
• Show picture card 3.7.
• Say:
  If you have more time, you can build up to 60 minutes a day with activities like these:
  

  Take an early morning jog for 10 minutes	+10
  Use your stationary bike for 10 minutes before you go to work.	+10
  Take a 15-minute walk with coworkers during your lunch break	+15
  Play basketball with your children for 15 minutes after dinner	+15
  Dance for 10 minutes later in the day	+10
  	60 minutes

  
  

  More Information

  Just Move It

  • Physical activity is important in weight control.
  • Try to be physically active for 30 to 60 minutes on most days.

  Here are some examples of how many calories you can burn from various activities for 30 minutes.

  Activity	Calories burned per 30 minutes*
  Weightlifting	110
  Walking (briskly), 31/2 miles per hour	140
  Gardening	165
  Raking leaves	165
  Dancing	240
  Bicycling (slowly), 10 miles per hour	145
  Playing basketball	220
  Jogging, 5 miles per hour	295

  * These calories are for a healthy 154-pound person. A lighter person burns fewer calories; a heavier person burns more.
  Source: "The Compendium of Physical Activities Tracking Guide," University of South Carolina, 2000.

5. Getting Started: Important Things To Know
   
Note: This session gives information for people who are just starting to be active. It also helps people add more activity to what they already do.
• Say:
  There are a few things you should know before starting to be physically active.
• Give each group member the "Getting Started With Physical Activity" handout.
• Say:
  It's very important to know when to talk with a doctor before starting a physical activity program. In the list on your handout, check which people should see a doctor before they begin physical activity.
• Read the passages below while the participants check off the boxes.

  Charles is 65 years old and had a heart attack 10 years ago, but he is fully recovered.
  Vernita is 32 years old and had a healthy baby 8 months ago.
  Darius is 38 years old and has diabetes, but he controls his condition very well with medication.
  Corretta is 35 years old and wants to start being more physically active to lower her high blood pressure and help herself to quit smoking.
  Alicia is 27 years old and in good health, and she wants to start running.
  Terrance is 57 years old and broke his leg 2 years ago, but it healed very well. He walks every day but wants to start jogging.

  
  

• Note: Allow a few minutes for group members to discuss.
• Give each group member the "Getting Started With Physical Activity: Ms. Diane's Answers" handout.
• Say:
  Let's look at the handout to see what Ms. Diane has to say about this.
• Note: Go over the answers with the group.
• Say:
  
  These are Ms. Diane's answers:

  Charles should see a doctor before starting a physical activity program because he has had a heart attack. Even though he is fully recovered, he should still check with his doctor.
  Vernita does not need to see a doctor before starting a physical activity program. Having a baby is not a risk factor, and she is young.
  Darius should see a doctor before starting a physical activity program because he has diabetes. Even though he is young and he controls his condition very well with medication, he should still check with his doctor.
  Corretta should see a doctor before starting a physical activity program because she has two risk factors: high blood pressure and smoking.
  Alicia does not need to see a doctor before starting a physical activity program. Even though she wants to start a harder activity, such as running, she is young and in good health.
  Terrance should see a doctor before starting a physical activity program. His broken leg is not a factor, but he should check with the doctor first because he wants to start a harder physical activity program, and he is more than 45 years old.
  
• Say:
  Here are some other things you should know before starting a physical activity program:
  1. Start slowly. Build up the time and effort that you put into any activity. You should not be tired the next day.
  2. Drink plenty of fluids before, during, and after physical activity, even if you are not thirsty. Drink water. Water has no calories and will prevent you from becoming dehydrated. Special sports drinks are not needed.
  3. Wear shoes and socks that give your feet support. Shoes with thick soles will cushion your feet and absorb shock.
  4. Wear comfortable clothing. You do not need to buy fancy outfits.
  5. Never wrap your body in plastic or wear clothing that is too heavy. This will not help you lose fat, but it can:
     • Make you sweat too much.
     • Make your body temperature rise.
     • Make your heart beat too fast.
     • Make you sick to your stomach.
     • Cause you to pass out.
     • Cause damage to your organs.
• Say:
  You should also know that some people who are very overweight may face special challenges in trying to be physically active, but they too have good options.
• Start with these activities:
  • Weight-bearing activities, such as walking, involve lifting or pushing your own body weight.
  • Nonweight-bearing activities, such as swimming and water workouts, put less stress on your joints because you do not have to lift or push your own weight. If your feet or joints hurt when you stand, nonweight-bearing activities may be best for you.
  • Lifestyle activities, such as gardening, do not have to be planned.
• Note: For more information on being active at any size, visit the Weight-control Information Network at http://win.niddk.nih.gov or call 1—877—946—4627 (toll free).
• Ask:
  How many of you are concerned about what will happen to your hair and hairstyle when you are physically active?
• Note: Allow 2 or 3 minutes for questions.
• Say:
  Try these hair care tips to help control moisture and salt buildup in your hair while being physically active:
  • Use a mild pH-balanced shampoo to wash your hair at least once a week. This will remove salt buildup from sweating when you are physically active.
  • Styles like braids, dreadlocks, nubian knots, twists, and cornrows may be easier to maintain and stay in place while you are physically active.
• Ask:
  Does anyone have any questions?
• Note: Allow 2 or 3 minutes for group members to respond.
6. Finding Time To Be Physically Active
• Say:
  I know that all of you have busy lives. You may be wondering how you will ever find time to be physically active. Let's look at some ways.
• Give each group member the "Take Heart—Say Yes to Physical Activity" handout. Read the handout aloud.
• Ask:
  What are some other ways to become more active even when time is limited?
• Note: Allow about 5 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.
• Add these ways if group members do not mention them.
  • Take a 15- to 20-minute walk during your lunch break at work or after dinner with your family.
  • Jump rope a few minutes each day. Work up to jumping for 10 minutes.
  • Play basketball with your children. You'll burn calories and have fun together.
• Say:
  Another way to find more time to be active is to reduce screen time. Screen time is the amount of time we spend watching TV, videos, or DVDs; using our computers; or playing video games. Instead of having too much screen time, you can use some of that time to do physical activities.
7. Walking: An Activity for Almost Everyone

Tips for Preparing for the Walking Activity

Before the start of this session:

• Review the "Stretching Activities" handout.
• Practice until you know each part well enough to teach it to the group members.
• Practice a brisk walk. Take long strides, and swing your arms.

When leading this activity, remember:

• Music can get people in the mood for being active. Use a lively song for the warmup exercises, a faster beat for the walking, and a relaxing song for the cool-down period. First, make sure that no one objects to the music.
• Be enthusiastic. Group members will pick up on your enthusiasm and feel good about exercising.
• Lead the walk in a circle if you have to do the walking indoors or if space is limited.
• Have plenty of cool drinking water available before and after the activity.

• Discussion and Stretching
• Say:
  Brisk walking is an excellent form of physical activity. It's easy to do, and you do not need special equipment. All you need are shoes for support and socks for cushioning.
• Say:
  Walking can be done outdoors or indoors. If you do not feel safe walking in your neighborhood, a school or churchyard may be a safer place to walk. Walk in well-lit areas at night. Many shopping malls let people walk inside the mall before the stores open. Some malls even have walking clubs that meet every day.
• Say:
  It's important to spend time warming up and cooling down each time you are physically active. Although the risk of injury from walking is low, the warmup gets your leg muscles ready for the activity. The cooldown lets your heart rate slowly return to normal. This also keeps your leg muscles from getting stiff.
• Note: Ask the group members to stand up and spread out, with at least 3 feet between them and other group members. Start the music.
• Say:
  It is important to warm up your muscles and stretch before you begin physical activity. First, we will warm up our muscles, and then we will stretch. Let's walk in place slowly for 3 minutes.
• Say:
  Now, I am going to show you some stretching activities. Watch me, and then try doing them yourselves. Some are easier to do than others. With time and practice, you will be able to do them all. If you have a bit of trouble at first, just do your best. You will get a handout that tells you how to do these stretching activities. Use the handout to help you do them at home.
• Walking Activity
• After the stretching activities, lead the group members on a 15- to 20- minute walk. Walk slowly for the first 5 minutes. Then show them how to do a brisk walk for 5 to 10 minutes. During the last 5 minutes, slow your pace.
• Say:
  We are slowing down now so that our bodies can gradually relax. This important part is called the cooldown period. It's usually recommended
  that you gradually slow your pace during the last 5 minutes of an activity. Doing a few stretching exercises to loosen the muscles should also be part of your cooldown.
• Say:
  For example, runners or joggers may cool down by walking for a few minutes and then stretching their leg muscles before they stop entirely.
• Ask:
  How do you feel? Do you think you could continue to walk like this? Why or why not?
• Note: Allow 3 to 5 minutes for group members to answer.
• Say:
  If you already walk three or more times a week, add other activities to become more fit. Try running, jumping rope, or doing aerobics.
• Say:
  One of the hardest parts of being more active is staying motivated. Many
  people find that having a partner helps them stay active. A partner can be a family member, neighbor, or friend. The benefits of having a partner are:
  • You can motivate each other. You can set goals together and help each other meet them.
  • It makes the time go by faster. You focus on talking rather than on the activity.
• Say:
  Walking clubs are a great way to enjoy physical activity and make friends.
• Note: See tips on how to organize a walking club, so you can share the tips with group members.
• Ask:
  • What would help you stay motivated to continue being physically active?
  • Where are some safe places in your neighborhood to be active?
• Note: Allow about 3 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.
• Give each group member the following handouts: "Stretching Activities", "How To Be Physically Active", "Make Physical Activity a Habit—My Personal Record", and "Sample Walking Program".
• Say:
  Use the "Make Physical Activity a Habit—My Personal Record" handout to track your daily progress.

Review of Today's Key Points

• Say:
  Let's review what we have learned today.
• What are some of the benefits of regular physical activity?
• Regular physical activity can:
  • Strengthen your heart and lungs.
  • Build and maintain healthy bones, muscles, and joints.
  • Help you lose excess weight and prevent weight gain.
  • Control blood cholesterol and lower blood pressure.
  • Help you sleep better, reduce stress, increase energy, and reduce feelings of depression.
  • Lower your chance for heart disease, diabetes, and cancer.
• What is an activity that just about everyone can do?
  • Brisk walking
• What are simple ways to become more active throughout the day?
  • Take a walk.
  • Get off the bus early and walk.
  • Dance to your favorite music.
• What is the minimum amount of physical activity recommended for you to do every day?
  • Adults need at least 30 minutes, and children and adolescents need at least 60 minutes daily.

Weekly Pledge

• Say:
  You have learned a lot today about how you can become more physically active. Now let's think about how you can apply what you have learned. Please think of one change you can make in your everyday life to increase your level of physical activity. This will be your pledge for the week.
• Say:
  Be specific about what you plan to do, how you plan to do it, and when you will start. Examples include:
  • I will talk to family members and friends this weekend about taking regular walks together.
  • I will start walking for at least 20 minutes during my lunch break at work, starting tomorrow.
• Say:
  Write your pledge on the "Take Heart—Say Yes to Physical Activity" handout. Keep this handout in a special place so you can review your pledges and keep your goal in mind.
• Note: Allow 5 minutes for group members to think of a pledge and write it down.
• Ask:
  Would anyone like to share his or her pledge with the group?
• Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.
• (Optional) Say:
  Keeping a personal value in mind can help you make changes in your everyday life to become more physically active. Remember that a personal value is a quality that you consider important.
• Remember today's quote from Marian Wright Edelman: "It is time for every one of us to roll up our sleeves and put ourselves at the top of our commitment list." Although challenges will come, you must stay focused on your physical activity goal. Today the value is perseverance. Perseverance helps you have the willpower to keep your pledge, even if it means starting again after a slip. It helps you set a routine to keep you focused on your goal to improve your health.
• Ask:
  How could you use perseverance or another value to help you keep your pledge?
• Note: Allow 3 minutes for group members to share their thoughts.
• Say:
  We will talk about how you did with your pledge at the next session. Remember to keep working on your pledge to be prepared if a heart attack happens.

Closing

• Say:
  Thank you for coming today. What did you think of today's session?
• Note: Allow a moment for group members to respond.
• Say:
  I am looking forward to seeing you at the next session. The next session will be about how to cut back on salt and sodium to prevent and control high blood pressure. Please continue to work on your family health history.
• Note: Think about today's class. What worked? What didn't work? Have you made any changes in your own life that were covered in today's session?

Handouts

Last Updated December 2010