Hearts n' Parks Community Mobilization Guide (Booklet only)

Full text

Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 01-1655). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

NHLBI Obesity Education

Initiative

COMMUNITY MOBILIZATION GUIDE

ACKNOWLEDGEMENTS

The NHLBI and the NRPA wish to acknowledge the efforts of Dr. Ellen O’ Sullivan, Southern Connecticut State University, and Ruth Bielobocky, Ion Design, in the preparation of the Hearts N’ Parks Community Mobilization Guide.

COMMUNITY MOBILIZATION GUIDE

A project of the

National Heart, Lung, and Blood Institute

and the

National Recreation and Park Association

NIH Publication Number 01-1655 June 2001

Hearts N’ Parks—Community Mobilization Guide Introduction..........................................1

The Partnership ......................................................................................................................................1

The Beginning of Hearts N’ Parks ..........................................................................................................2

Hearts N’ Parks Is Special ......................................................................................................................3

The Bad News: Cardiovascular Disease ................................................................................................4

Why Heart-Healthy Behavior? ..........................................................................................................4

The Good News: Physical Activity and Healthy Eating............................................................................8

Physical Activity ................................................................................................................................8

Heart-Healthy Eating ........................................................................................................................9

How to Use This Guide..........................................................................................................................13

How To Sign Up for Hearts N’ Parks......................................................................................................14

Frequently Asked Questions..................................................................................................................17

Hearts N’ Parks: 1st P—People ......................................................................................................19

Support Systems for Hearts N’ Parks ....................................................................................................19

Department Staff....................................................................................................................................19

Other Sources of Support......................................................................................................................20

Participants as Target Groups................................................................................................................20

Definition of Target Groups on Basis of Participation and Relationship ........................................................21

Stages of Change for Heart-Healthy Behavior ......................................................................................22

Stage(s) of Change................................................................................................................................22

At-Risk Groups ......................................................................................................................................22

Countdown Checklist: 1st P—People ....................................................................................................25

Outline of Staff Training & Meetings......................................................................................................26

Frequently Asked Questions..................................................................................................................27

Hearts N’ Parks: 2nd P—Programs and Practices..................................................................29

Program Varieties ..................................................................................................................................29

Strategies and Techniques ....................................................................................................................30

Information and Knowledge Infusion ..............................................................................................30

Raising the Potential ......................................................................................................................32

Hands-On Activity ..........................................................................................................................32

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Adapt Traditional Activities ..............................................................................................................32

Program Progression ............................................................................................................................32

Offer Opportunities ........................................................................................................................34

Breaking Barriers ............................................................................................................................34

Lifestyle Behavior Support..............................................................................................................35

From Programs to Practices ..................................................................................................................36

Countdown Checklist: 2nd P—Programs ..............................................................................................39

Staff Training/Meeting Outlines ..............................................................................................................40

Hearts N’ Parks Program Worksheet ....................................................................................................42

Frequently Asked Questions..................................................................................................................43

Hearts N’ Parks: 3rd P—Public Visibility ....................................................................................45

Who Needs To Know? ..........................................................................................................................45

Writing Hearts N’ Parks Messages ........................................................................................................45

Modifying the Messages ........................................................................................................................47

Moving the Messages............................................................................................................................48

Internal Opportunities ............................................................................................................................51

Extending Your Reach............................................................................................................................51

Holding Special Events ..........................................................................................................................52

Working With the Media ........................................................................................................................53

Media Contact Is Ongoing ....................................................................................................................58

News Releases ......................................................................................................................................59

Countdown Checklist: 3rd P—Public Visibility ......................................................................................62

Frequently Asked Questions..................................................................................................................63

Hearts N’ Parks: 4th P—Partnering ..............................................................................................65

The Partnership Advantage ..................................................................................................................65

Partnership Possibilities ........................................................................................................................65

Getting Started ......................................................................................................................................67

Types of Partnering Opportunities ........................................................................................................67

Moving Forward ....................................................................................................................................68

Program/Service Assessment ........................................................................................................68

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Moving to Action ....................................................................................................................................72

Partnership Project Plan ................................................................................................................72

Tracking ..........................................................................................................................................75

Countdown Checklist: 4th P—Partnering ..............................................................................................77

Frequently Asked Questions..................................................................................................................79

Hearts N’ Parks: 5th P—Performance Indicators ....................................................................81

Types of Indicators ................................................................................................................................81

Getting Started ......................................................................................................................................83

Conducting the Assessment ..................................................................................................................84

Performance

Selecting and Using Assessment Tools..........................................................................................84

Analyzing and Reporting Results ..........................................................................................................86

Indicators

Displaying the Results ..........................................................................................................................87

Countdown Checklist: 5th P—Performance Indicators ..........................................................................88

Outline of Staff Training for Performance Measurement........................................................................89

Recommendations for Administering Hearts N’ Parks Pretests and Posttests ....................................91

Frequently Asked Questions..................................................................................................................93

Hearts N’ Parks: Celebrating and Sharing ................................................................................95

Celebrating ............................................................................................................................................95

Celebrating

Sharing ..................................................................................................................................................95

Sustaining ..............................................................................................................................................96& Sharing

Appendices..............................................................................................................................................99

10 A. Program Design and Development: Tracking and Log Sheets, Consent Forms,

and Performance Questionnaires ..................................................................................................A–1

B. Answer Keys and Scoring Sheets ..................................................................................................B–1

C. Media Materials and Miscellaneous Forms ....................................................................................C–1

D. Additional Resources ......................................................................................................................D–1

E. Health Statistics ..............................................................................................................................E–1

F. Background Sheets..........................................................................................................................F–1

Reproducibles

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INTRODUCTION

Hearts N’ Parks is a national, community-based program supported by the National Heart, Lung, and Blood Institute (NHLBI) and the National Recreation and Park Association (NRPA). It is designed to help local agencies promote hearthealthy lifestyle changes among their residents. The objectives of Hearts N’ Parks are to increase the number of children and adults who engage in heart-healthy behavior and to demonstrate the impact that community park and recreation programs can have on behavior. The long-term goal is to decrease the number of people with heart disease. Hearts N’ Parks seeks to bring about these changes in the following ways:

• Identifying target groups
• Creating heart-healthy activities and techniques
• Raising the level of awareness of Hearts N’ Parks and its messages
• Making the most of existing community resources to extend the reach and effectiveness of Hearts N’ Parks
• Conducting an evaluation to document the results of Hearts N’ Parks’ efforts.

Hearts N’ Parks is meant to be fun and flexible. And it’s for everybody—young and old, active and nonactive. This Hearts N’ Parks Community Mobilization Guide provides the background and resources needed to implement the program. But each community can adapt the material to its own design, resources, and needs.

THE PARTNERSHIP

The National Heart, Lung, and Blood Institute is one of the Institutes of the National Institutes of Health (NIH). The mission of the NHLBI is to provide leadership for a national program in diseases of the heart, blood vessels, lungs, and blood; sleep disorders; and blood resources management. The NHLBI supports Hearts N’ Parks with a wealth of resources, including current and reliable scientific information as well as an extensive catalog of printed educational materials. The NHLBI Web site offers lots of information about adopting a heart-healthy lifestyle, plus a special Hearts N’ Parks site (http://www.nhlbi.nih.gov/health/ prof/heart/obesity/hrt_n_pk) that is updated regularly to provide participating agencies with current program information.

The National Recreation and Park Association (NRPA), a nonprofit organization, is dedicated to advancing parks, recreation, and environmental conservation efforts that enhance the quality of life for all people. Health and wellness issues are also core to the NRPA mission

(http://www.activeparks.org). Information about Hearts N’ Parks can be found at http://www.heartsnparks.org.

12 communities throughout the State utilized training and resources from the NHLBI and the NRPA to incorporate heart-healthy lifestyle messages in programs for children, adolescents, Local park and recreation departments and other and adults. More than 2,000 participants, ranging community agencies that foster Hearts N’ Parks in age from 4 to 74, took part in a number of efforts are part of the partnership. While national unique programs. Some of the agencies were agencies, such as the NHLBI and the NRPA, very small, with less than 30 people in the Hearts provide basic resources, information, and support, N’ Parks program, while one agency, Mecklenburg those who work in community programs come County Park and Recreation Department in face to face with local residents on a daily basis, Charlotte, operated a number of Hearts N’ Parks and are thus better positioned to provide inforprograms for more than 1,500 participants. mation and services, as well as raising awareness

to support and sustain healthy lifestyles. Accordingly, they are able to involve and keep people involved in heart-healthy programs, thus ensuring long-term adoption of heart-healthy behavior.

An important element of the pilot was an attempt to consider changes in attitudes, knowledge, and behaviors of the participants related to hearthealthy eating and physical activity. Despite some limitations in data collection, pre- and posttests administered by the sites provided

THE BEGINNING OF HEARTS N’ PARKS

Hearts N’ Parks began in the summer of 1999 as a pilot initiative in North Carolina called Hearts N’ Parks Y2K. Parks and recreation agencies in

N ORTH C AROLINA ,1999

The Roanoke Rapids Park and Recreation Department conducted a program for children that taught the basics of nutrition to 4 to 6 yearolds in its FLIP (Fun for Little Interested People) camp. One of the activities was an arts and craft program that helped the children learn about different kinds of foods and which ones were healthy for them.

The Garner Parks and Recreation Department sponsored both senior-citizen and youth programs. The senior fitness program, “Keep the Beat…Circle Yourself in Health,” lasted 5 weeks and included 12 participants. Participants kept a journal of their involvement and received credit for prizes as an incentive to “keep the beat” toward a healthier lifestyle. Blood pressure screenings were also offered to senior participants.

In Wilson, the Parks and Recreation Department offered a drop-in weightlifting program for adults, and participants were given a journal to track their progress. The department also partnered with local trainers and nutrition specialists to discuss the importance of proper use of weights, the role nutrition plays in building muscle, and the benefits of increasing muscle mass.

valuable insights to the program in a variety of ways. A comparison between pre- and posttests showed that the children participating in Hearts N’ Parks appeared to improve their knowledge of healthy eating and expressed greater intentions to eat healthier. The children also reported, on average, learning four new physical activities and getting better at six physical activities. Senior participants reported some improvements in nearly all the variables considered, as well as feeling healthier at the end of the program.

In the spring of 2000, the Arlington County Department of Parks, Recreation and Community Resources, a large, multifaceted agency in Northern Virginia, kicked off a second pilot initiative of Hearts N’ Parks. Arlington County was selected as the second pilot site for Hearts N’ Parks because of the variety of recreational programs at its two flagship sites: Thomas Jefferson Community Center and Barcroft Sport and Fitness Center.

Arlington’s promotion of Hearts N’ Parks included programs focused on both adults and children. It featured activities such as blood pressure screenings and a seated exercise class for adults, jumping rope and tennis for kids, and a biking program for all age groups called “Cycle Reebok.” The Hearts N’ Parks logo was printed on trail maps, mile markers, and other promotional materials for programs and facilities that offer heart-healthy activities. The “Recreation and Leisure” class catalog promoted a series of heart-healthy classes in the fall of 2000.

HEARTS N’ PARKS IS SPECIAL

Hearts N’ Parks is a unique approach to promoting healthy hearts in the United States. Cardiovascular disease is the number one killer in this country, and lifestyle change is the primary and most important step toward

There is no one size of agency or one type of staff person that works best for participation in Hearts N’ Parks. In fact, the pilot sites differed from one another on the basis of size, organizational structure, population density and, most of all, the individual who headed up the Hearts N’ Parks effort. For example:

Some of the agencies were large, countywide departments where “large” refers to either size of population or size of geographic area. Moderate to large cities as well as small and medium-sized communities have also been successful at delivering Hearts N’ Parks.

Many differences existed among staff people, who either elected or were “selected” to coordinate Hearts N’ Parks. Successful Hearts N’ Parks coordinators ranged from people who had little or no prior experience in heart-healthy behavior or were actually new to the community service field, to individuals who had extensive backgrounds in health and wellness, experience in community service, or human services.

Congratulations to those people behind the success stories of our pilot sites in North Carolina, who included a summer intern, a newly hired college graduate, a long-time program supervisor, a department manager, a wellness coordinator, and a director of education.

That’s right. There is no one specific type of community, agency, or person needed to move forward with Hearts N’ Parks. Big or small, experienced or novice, you can become the coordinator of a successful Hearts N’ Parks project, and we’d like to help you with that endeavor.

• Cardiovascular disease is the leading cause of death for all people in the United States.
• 60.8 million Americans had one or more types of cardiovascular disease in 1998.
• Cardiovascular disease claimed 949,000 lives in the United States in 1998.
• 41 percent of all deaths in 1998 were attributable to cardiovascular disease.

Source: NHLBI FY 2000 Fact Book

prevention. However, getting the message out to those who most need to hear it is often difficult and confusing.

Hearts N’ Parks provides all the tools…

• Hearts N’ Parks provides community agencies with the resources to communicate lifestyle changes in a clear and concise way to all kinds of people.
• Hearts N’ Parks can be part of health-related programs, such as aerobic or wellness classes, but can also be part of nonhealth-related programs, such as senior center drop-in programs or day camps. It is easily integrated into existing programs, so it doesn’t require the effort involved in starting a new program.
• Hearts N’ Parks provides the information and tools to spread the word through media support and partnerships.
• Media support can be advertising your event on radio or television or in the newspaper, and even having the media cover a special event or a day in your program.
• Partnerships can be of any kind…Some examples are local hospitals providing health screenings at your community center or during a special hospital event, health professionals giving lectures, neighborhood grocery stores or restaurants donating heart-healthy snacks, or a more focused effort with one of your current partners.
• Hearts N’ Parks programs have increased credibility and visibility because they are supported by two highly respected national organizations, the NHLBI and the NRPA.
• Hearts N’ Parks is self-sustaining because it is developed by a community agency that must operate within the means of the community.
• Hearts N’ Parks provides the tools to measure what your participants have learned and done. This information helps motivate participants as well as engage partners and senior management.
• Hearts N’ Parks is meant for everyone. Information and materials are available for children, adolescents, adults, and seniors.

THE BAD NEWS: CARDIOVASCULAR DISEASE

The goal of Hearts N’ Parks is to increase the number of children and adults who engage in heart-healthy behavior.

Why Heart-Healthy Behavior?

Heart-healthy behavior can prevent the development of cardiovascular disease (CVD) and reduce its severity among those who already have it. CVD includes such diseases as high blood pressure, coronary heart disease (myocardial infarction and angina pectoris), stroke, rheumatic fever/rheumatic heart disease, and congestive heart failure.

The risk factors for cardiovascular disease include high blood cholesterol, high blood pressure, overweight, obesity, diabetes, smoking, and physical inactivity. These factors do not

R ISK FACTORS F OR H EART D ISEASE

High Blood Cholesterol

High blood cholesterol plays an important part in deciding a person’s chance or risk of getting coronary heart disease. The higher your blood cholesterol, the greater your risk. When you have too much cholesterol in your blood, the excess builds up on the walls of the arteries that carry blood to the heart. This buildup is called “atherosclerosis,” or “hardening of the arteries.” It narrows the arteries and can slow down or block blood flow to the heart. With less blood, the heart gets less oxygen. Without enough oxygen to the heart, there may be chest pain (“angina” or “angina pectoris”), heart attack (“myocardial infarction”), or death. Cholesterol buildup is the most common cause of heart disease, but it happens so slowly that people are not aware of it. Blood cholesterol level is influenced by many factors. These include:

• Diet ■ Level of physical activity ■ Age
• Weight ■ Heredity ■ Gender

High Blood Pressure

High blood pressure, also called hypertension, is a risk factor for heart and kidney diseases and stroke. Blood is carried from the heart to all of the body’s tissues and organs in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of arteries. Each time the heart beats (about 60–70 times a minute at rest), it pumps blood into the arteries. Some people have blood pressure that stays high all or most of the time. Their blood pushes against the walls of their arteries with higher-thannormal force. If untreated, this can lead to serious medical problems like atherosclerosis, heart attack, enlarged heart, kidney damage, and stroke. High blood pressure is influenced by several factors. These include:

• Diet ■ Physical activity ■ Family history
• Weight ■ Alcohol consumption ■ Ethnicity

Diabetes

Diabetes is a disorder of metabolism—the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into a simple sugar called glucose, which is the main source of fuel for the body. For the glucose to get into the body’s cells, insulin must be present. In people with diabetes the body produces little or no insulin, or the cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel, even though the blood contains large amounts of glucose.

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. Diabetes is associated with long-term complications that affect almost every major organ of the body. It contributes to blindness, heart disease, strokes, kidney failure, amputations, and nerve damage. Diabetes is not contagious. People cannot catch it from each other. However, certain factors can increase one’s risk of developing diabetes. People at risk for diabetes include:

• Those with family members who have diabetes (especially type 2 diabetes)
• Those who are overweight
• Those who are African American, Hispanic, or Native American

Overweight and Obesity

Over the past four decades, the number of overweight children, adolescents, and adults has risen. In 1998, a little over one-half of all American adults (about 97 million) and one in five children over the age of 6 were considered overweight or obese, levels unmatched in our nation’s history. In 1995, the costs attributed to obesity alone amounted to an estimated $99 billion.

R ISK FACTORS F OR H EART D ISEASE ( CONTINUED )

Being overweight or obese puts someone at risk for developing many problems, such as heart disease, stroke, diabetes, cancer, gallbladder disease, arthritis, sleep apnea, and breathing problems. Losing weight helps to prevent and control these diseases and conditions. Obesity is a complex, chronic disease that develops from an interaction of genetics and the environment. Our understanding of how and why obesity develops is incomplete, but involves the integration of social, behavioral, cultural, physiological, metabolic, and genetic factors. Assessment and classification of overweight and obesity uses three key measures:

• Body mass index (BMI)
• Waist circumference
• Risk factors for diseases and conditions associated with obesity.

Smoking

Smoking is a major risk factor in four of the five leading causes of death, including heart disease, stroke, cancer, and lung diseases like emphysema and bronchitis. For adults 60 and over, smoking is a major risk factor for 6 of the top 14 causes of death. The good news is that stopping smoking reduces these risks and improves outcomes for people who have suffered a heart attack. In some cases, ex-smokers can cut their risk of another heart attack by half or more.

Physical Inactivity

Physical inactivity increases the risk of heart disease. It contributes directly to heart-related problems and increases the chances of developing other conditions that raise heart disease risk, such as high blood pressure and diabetes. Unfortunately, too few Americans are active enough. Consider:

• About 40 percent of Americans age 18 or older reported no leisure-time physical activity in 1997.
• About 23 percent of U.S. adults engaged in regular vigorous physical activity 3 times a week for at least 20 minutes in 1997.
• Less-active, less-fit persons have a 30–50 percent greater risk of developing high blood pressure.

But the good news is that regular physical activity can help reduce the risk of coronary heart disease. Staying active helps take off extra pounds, helps to control blood pressure, boosts the level of “good” HDL-cholesterol, helps to prevent diabetes, and helps to prevent heart attacks. For those who have heart disease, regular, moderate physical activity lowers the risk of death from heart-related causes. Physical activity has many other benefits. It strengthens the lungs, tones the muscles, keep the joints in good condition, maintains bone density, improves balance, and helps prevent and treat depression. Many people find that physical activity helps them cope better with stress and anxiety.

To reap benefits from physical activity, you don’t need to train for a marathon. You need to engage in only about 30 minutes of moderate-level activity on most—and preferably all— days. A moderate-level activity is one that’s about as demanding as brisk walking.

R ISK FACTORS F OR H EART D ISEASE ( CONTINUED )

Children and Heart Disease

The evidence shows that the atherosclerotic process begins in childhood and that many American children have risk factors for coronary heart disease. A report card on the state of the cardiovascular health of America’s children revealed:

Health factor Status

High Blood Cholesterol Average blood cholesterol levels in American children and adolescents are too high. Children and adolescents with elevated blood cholesterol levels are more likely to have elevated levels as adults. Research shows that atherosclerosis develops in the late teenage years, and cholesterol levels in young adults predict the risk of coronary disease over the next 40 years.

Overweight Nearly 14 percent of children and 11.5 percent of adolescents are overweight (NHANES III), more than double the percentage of a decade ago. Up to 20 percent of overweight children remain so throughout life. One in five children over the age of 6 is considered overweight, and overweight or obesity acquired during childhood or adolescence may persist into adulthood and increase the risk for some chronic diseases later in life.

Physical Activity Most children accumulate at least 1 hour of activity daily, but a sizable percentage do not get frequent, vigorous, continuous activity. Of high school students, about 70 percent of boys and 55 percent of girls do a vigorous physical activity three or more times per week. Activity levels of girls are below those of boys and tend to decline with age.

just add up in a simple manner. Instead, each one multiplies the effects of the other risk factors. For example, if you smoke and have high blood pressure and high blood cholesterol, you’re eight times more likely to develop coronary heart disease than someone with no risk factors. The good news is that all of these risk factors, except for smoking, can be prevented or controlled by two important behaviors: heart-healthy eating and physical activity.

Hearts N’ Parks incorporates both of these behaviors and strives to make them attainable and fun.

THE GOOD NEWS: PHYSICAL ACTIVITY AND HEALTHY EATING

As you can see from the discussion about cardiovascular risks, the good news is that the likelihood of developing heart disease can be reduced by focusing on physical activity and heart-healthy eating. It’s simple, and it’s easy.

Physical Activity

Although physical activity is fundamental to cardiovascular fitness, it is important to understand that it doesn’t have to be vigorous in order to be beneficial to your health. Any moderate physical activity, if engaged in often enough, can improve and maintain cardiovascular health. This is not to say that vigorous activity such as jogging is unnecessary, but only to say that at a minimum, everyone should engage in at least 30 minutes of

The “Guide to Physical Activity” in the reproducible section of this guide gives examples of moderate amounts of physical activity and ideas for fitting physical activity into your schedule.

moderate physical activity on most, preferably all, days of the week for adequate fitness. The U.S. Surgeon General, in his 1996 “Exercise Lite” message, endorsed this recommendation, which cited the conclusions outlined in a pivotal 1995 report in the Journal of the American Medical Association.*

So what constitutes moderate physical activity in “Exercise Lite”? The most common example is brisk walking, typically at a pace of about 15 minutes per mile. Thus, walking about 2 miles (for 30 minutes) would provide a day’s worth of moderate activity.

• Consider measuring 2 miles from your home (or wherever you might walk from) using the odometer in your car. That way, you don’t have to keep track of time or distance when you walk, and you’ll know just how far you need to go to get your day’s worth of activity.

Other kinds of moderate activity might include walking your dog, playing golf, or tossing a Frisbee. Count vacuuming, but not washing dishes. Mowing your lawn with a power mower is moderate activity, but a push mower is vigorous activity. You can ride your bike to the store, play table tennis, go square dancing, or do some serious yard work, and it adds up to 30 minutes before you know it.

The idea is to have an active lifestyle: don’t ride in a car when you can walk, don’t take the elevator when you can climb the stairs, don’t fax something you can deliver by hand, and don’t use automated or electronic devices just because they exist.

Seniors and Physical Activity

Moderate physical activity is important for older adults because it can help reduce the chances of developing high blood pressure,

• Centers for Disease Control and Prevention (CDC) and The American College of Sports Medicine (ACSM), Journal of American Medical Association, Feb. 1, 1995.

P HYSICAL A CTIVITY T IPS

As a Hearts N’ Parks coordinator, you have a unique and remarkable opportunity to positively impact your participants’ lives by exposing them to the fulfilling and fun rewards of physical activity. Below are a few tips to ensure that your physical activity-based programs are effective for participants of all ages:

• Encourage activities that can be done easily throughout life.
• Focus instructional feedback on process, not product.
• Offer a diverse range of competitive and noncompetitive activities appropriate for different ages and abilities.
• Provide participants with the skills and confidence they need to be physically active.
• Individualize activities.
• Make sure activities are inclusive and get everyone off the sidelines.
• Be an active role model. Get out there and join in the fun.

obesity, and other ailments. It may also help prevent problems related to mobility. It is never too late for seniors to start being physically active. Moreover, studies have

and remain aware of how active they are during the program. This will help ensure that their level of intensity does not compromise the quality of the activity or lead to injuries.

shown that when seniors visit community

parks for recreation and activity they acquire a feeling of renewal and social fulfillment, which provides further incentive to continue being physically active. Walking and playing with grandchildren are activities seniors can enjoy for moderate activity. Swimming, jogging, or biking are more intense and should only be undertaken by seniors who have checked with a doctor first.

Heart-Healthy Eating Adopting a heart-healthy eating plan provides individuals with health benefits without the necessity of giving up favorite foods. Such an eating plan balances calorie intake with physical activity and is low in saturated fat, cholesterol, and sodium, and rich in fruits and vegetables, low-fat dairy foods, and whole grains. A heart-healthy eating plan can help protect against high blood pressure, high blood Kids and Physical Activity cholesterol, and overweight. It may also protect Keep in mind that kids, especially 6- to 10-year- against cancer and other health problems. olds, are usually different from adults in the The earlier individuals take action to adopt a way they engage in physical activity. Most kids heart-healthy eating plan, the better. Research tend to have quick bursts of energy that come shows that heart disease begins early in life between longer periods of rest, which is perfectly and that, once learned, bad habits are difficult normal and should be encouraged. However, if to break. the children you work with are in the 11- to 14-year-old range, they may be active for longer

What is A Heart-Healthy Eating Plan?

periods of time. It is a good idea to try to get a To follow a heart-healthy eating plan means sense of your kids’ physical limitations early on basically eating some foods more often and

H ERE ARE A FEW SUGGESTIONS HEART- HEALTHY EATING PLAN :

TO HELP FOLLOW A

Practice balance, variety, and moderation in your eating habits.

Eat fewer high fat meats and eggs. Choose lean meats, chicken or turkey without skin, or fish.

Eat lower fat dairy items—fat-free or 1 percent milk, low-fat yogurt, and cheese.

Choose bread, rice, pasta, and other starches that are made of whole grains.

Choose whole grain and high fiber cereals that are also low in sugar.

• Avoid high fat, high sugar snacks and desserts.
• Eat a variety of fruits and vegetables daily.

Limit processed foods that have a lot of salt or fat, such as regular luncheon meats, prepared food, fast food, and canned soups and sauces.

Substitute corn, safflower, sunflower, peanut, canola, and olive oils for butter, shortening, and stick margarine.

• Avoid foods made with coconut and palm oils.
• Choose and prepare foods with less salt.

For greater variety, include healthy cultural traditions when planning meals.

other foods less often. Foods that can be eaten more often include those that are lower in calories, fat, saturated fat, cholesterol, and sodium. Examples of these foods include low-fat dairy products, lean meat, fish, and poultry, as well as high-fiber foods and complex carbohydrates, such as whole grains, starches, fruit, and vegetables. Saturated fat raises blood cholesterol levels and should be avoided. It is found mainly in fresh and processed meats; high-fat dairy products (like cheese, whole milk, cream, butter, and ice cream); lard; and in the coconut and palm oils found in many processed foods. Cholesterol is found in eggs, organ meats, and dairy fats.

Calories are the energy from carbohydrates, fats, and protein contained in foods. Fat contains more calories than these other

components, so eating high-fat foods can make it difficult to avoid excess calories. Low-fat, however, doesn’t necessarily mean low calorie. Sometimes extra sugar is added to low-fat muffins or desserts, and they may be just as high in calories. Limit portion sizes of foods high in calories, such as cookies, cakes, other sweets, french fries, and fats, oils, and spreads.

These tips are consistent with the latest version of Nutrition and Your Health: Dietary Guidelines for Americans released in May 2000 by the Department of Health and Human Services and the U.S. Department of Agriculture. These guidelines provide the basis for Federal nutrition policies, education, and dietary guidance for healthy Americans ages 2 and up. The 10 Dietary Guidelines emphasize the following ABCs for building a healthy diet and lifestyle:

Fats, Oils, & Sweets Use Sparingly

Milk, Yogurt & Cheese Group 2–3 Servings

Vegetable Group 3–5 Servings

Aim for Fitness:

1. Aim for a healthy weight.
2. Be physically active each day.

Build a Healthy Base:

1. Let the Pyramid guide your food choices.
2. Choose a variety of grains daily, especially whole grains.
3. Choose a variety of fruits and vegetables daily.
4. Keep foods safe to eat.

Choose Sensibly:

1. Choose a diet that is low in saturated fat and cholesterol and moderate in total fat.
2. Choose beverages and foods to moderate your intake of sugars.
3. Choose and prepare foods with less salt.
4. If you drink alcoholic beverages, do so in moderation.

The Dietary Guidelines include the Food Guide Pyramid to help with healthy food choices and daily servings or portion sizes.

KEY Fat (naturally occurring and added) Sugars (added)

These symbols show fats and added sugars in foods

Meat, Poultry, Fish, Dry Beans, Eggs & Nuts Group 2–3 Servings

Fruit Group 2–4 Servings

Bread, Cereal, Rice & Pasta Group 6–11 Servings

Weight Control on a Heart-Healthy Eating Plan

Balancing calorie intake with regular physical activity can help individuals achieve or maintain a healthy weight. For individuals who are overweight, even modest amounts of weight loss of approximately 10 percent of initial body weight can have health benefits. Weight loss can lower high blood pressure, high blood cholesterol levels, and high blood sugar levels. Reducing these risk factors helps to prevent cardiovascular disease and/or decrease its severity in those with existing disease.

To maintain or lose weight, it is important to watch the types and amounts of food consumed. In general:

• Begin the day with a hearty breakfast to provide energy and nutrients, and to jump-start metabolism.
• Control calories by eating smaller meals spaced throughout the day rather than eating one or two large meals.

■ Read food labels and choose foods lower in calories, total fat, and saturated fat. ■ Keep simple sugars, such as desserts and

■ Add finely chopped vegetables to favorite recipes. ■ Choose whole grain bread for sandwiches. sweetened beverages, to a minimum.

• Offer alternative desserts, such as fruit bars,

■ Be familiar with portion sizes and avoid eating second portions. ■ Balance food intake with physical activity.

ginger snaps, graham crackers, low-fat pudding, and yogurt. ■ At fast food restaurants, order a small, plain hamburger (no cheese), grilled chicken or Special Tips for Kids lean roast beef sandwich, and baked potato One in five children over the age of 6 is instead of french fries. considered overweight. Overweight and

obesity acquired in childhood may persist into adulthood and increase the risk of disease later in life. Children today are consuming excessive amounts of saturated fat, total fat, and calories from fast foods and snacks and are not getting enough physical activity. Additional heart-healthy advice for parents and kids includes:

Special Tips for Seniors It is important for seniors to follow a hearthealthy eating plan because the risk of heart disease increases with age. A heart-healthy eating plan, along with medications if needed, can help control risk factors like high blood pressure and high blood cholesterol. Maintaining a healthy body weight by consuming nutritious foods and being

• Cut back on high-fat foods by offering more physically active is also important for older fruits or vegetables as snacks. individuals.
• Offer low-fat milk and juice instead of soft drinks.

The National Heart, Lung, and Blood Institute (NHLBI) publishes a variety of educational materials for adults, children, and adolescents on ways to follow a heart-healthy eating plan and help control high blood cholesterol, high blood pressure, and overweight. Check out materials available from the NHLBI catalog, and in particular the Web page “Aim For A Healthy Weight” at www.nhlbi.nih.gov. The Web page provides information for patients and the public, and guides individuals to determine their weight and risk status and to choose lifestyle changes for losing weight. It includes a chart on diseases associated with obesity, menus and recipes, shopping lists and ideas, an interactive menu planner, and a guide to physical activity.

Nutrition and Your Health: Dietary Guidelines for Americans, May 2000, Department of Health

and Human Services and the U.S. Department of Agriculture. The Dietary Guidelines include the Food Guide Pyramid to help with healthy food choices and daily servings or portion sizes. Further information can be found at the U.S. Department of Agriculture’s nutrition Web site, www.usda.gov/cnpp. Also, check out the USDA’s Web site for kids, www.usda.gov/news/usdakids/index.html.

HOW TO USE THIS GUIDE

This Community Mobilization Guide is organized according to the 5Ps that make up the Hearts N’ Parks project. Each section contains basic information, as well as suggested steps and actions to be taken.

• 1st P—People: Identification of targeted groups

for participation in Hearts N’ Parks

• 2nd P—Programs: Techniques for creating and

delivering heart-healthy activities and alternatives to participants

• 3rd P—Public Visibility: Techniques to raise

the level of awareness of Hearts N’ Parks and its messages, as well as tools and strategies for reaching targeted groups and working with the media

• 4th P—Partnering: Methods to make the most

of existing community resources to extend the reach of Hearts N’ Parks

• 5th P—Performance Measures: Tracking

sheets, surveys, and directions for data analysis to document the results of your Hearts N’ Parks efforts.

At the end of each of the five P sections you will find a Countdown Checklist to help you implement your Hearts N’ Parks effort. The activities and actions are:

• Getting Started—Things you need to do initially.
• Moving Forward—Actions to take as you

proceed.

• Keeping the Beat—Ways to extend Hearts N’

Parks programs and practices.

The final section, Celebrating and Sharing, provides postprogram guidance.

Within each section you will find subsections that can assist you as you implement Hearts N’ Parks. They include:

SOS: Signs of Success—Examples

of successful programs or strategies related to implementation of Hearts N’ Parks projects or related activities.

Do You Know?—

Additional information or insight into a particular topic or area.

Resources—Refers you to specific

resources at the end of the section or within the guide.

Rx: Resource Examples—Excerpts from

some of the resources available either within the guide or by ordering, or accessing the Web sites of the NHLBI and the NRPA.

Focused Facts—Facts or statistics

that you may wish to refer.

FAQs (Frequently Asked Questions)—

At the end of each section.

A RLINGTON C OUNTY S LOGAN

Hearts N’ Parks—Mobilizing the Vision

“Your Community, USA, Is the Healthiest and Happiest Place to Live, Work, Learn, and Play.” (See pages 57,60, and 61 for details)

HOW TO SIGN UP FOR HEARTS N’ PARKS

Please complete and send in the registration form on the following page.

Also, consider using the Hearts N’ Parks pledge on page 16, or the slogan from Arlington County, VA as a promotional item to spark interest. Make it into a large poster for display or reproduce it on colorful paper and pass it out as a flyer to potential Hearts N’ Parks participants.

TO HEARTS N ’ PARKS

The NHLBI and the NRPA are pleased that you have decided to become a Hearts N’ Parks community. To become officially designated as a Hearts N’ Parks community, please complete and mail, fax, or e-mail this form to:

National Recreation and Park Association 22377 Belmont Ridge Road, Ashburn, VA 20148 Fax: (703) 729-4753; E-mail: programs@nrpa.org

Name of City/Town/County: ______________________________________________________

Name of Agency/Organization: ____________________________________________________

Name of Contact Person: ________________________________________________________

Address: ______________________________________________________________________

Telephone:________________________________Fax: ________________________________

E-mail: ________________________________________________________________________

Population of Community:________________________________________________________

Please identify those aspects of Hearts N’ Parks that you would like to consider pursuing. Feel free to check all.

Yes, we’d like to consider all 5Ps of Hearts N’ Parks.

People—Yes, we would like to extend our impact upon people’s health and well-being.

Programs—Yes, we would like to incorporate heart-healthy information and activities

into our existing programs.

Public Visibility—Yes, we would like to share information about the benefits of physical

activity and heart-healthy behavior with our residents and the media.

Partnering—Yes, we would like to use community contacts to pull together resources to

enhance health.

Performance Indicators—Yes, we would be interested in demonstrating the impact of

our programs and services on health.

T AKE THE

I/We pledge to adopt at least three of the following

heart-healthy habits during the Hearts N’ Parks Program:

Lunch lightly! Pack or buy a low-saturated-fat, low-cholesterol lunch. Try a veggie sandwich with low-fat cheese,

Jump to it! Improve your muscular endurance by jumping rope three times a week. How long can you go?

hummus, or a fresh

green salad. Shop savvy! Read labels

before buying food to make

Take a commercial break! Work on your flexibility during television commercials three times a

healthy choices at the grocery store. Watch the calorie, fat, saturated fat, and sodium content. week. Hold each stretch for at

least 10 seconds, working up to 30 seconds in a slow, controlled manner— no bouncing!

Tip the scale! Test your muscular strength by getting into a push-up position

Stock the snack cupboard! Buy hearthealthy snacks, such as pretzels, graham crackers,

and pressing your hands down on a bathroom scale to see how high you can make it go. mini carrots, whole wheat

crackers, fresh fruit, and low-fat or fat-free dairy products.

Go green! Try a new green vegetable. Eat a green vegetable every day!

Get your heart pumping! Take a

family walk, go dancing, rake leaves, or work in the garden.

Be on the alert for mega-portions.

Learn what one serving or portion of each type of food looks like.

Pass on the salt!

Try a new spice or seasoning when cooking and leave the salt in the shaker.

Have fun! Have a heart-

healthy cookout and invite your friends.

Visit the NHLBI Web site at

Please complete and place in a visible area, such as a bulletin board for all to see!

www.nhlbi.nih.gov

?

1 What qualifications do I need to be

a Hearts N’ Parks Coordinator?

If you are enthusiastic, motivated,?

resourceful, and a good role model, you are qualified to do the job. You don’t need a special degree or certificate, and you don’t need to be a nutrition or fitness expert. Successful Hearts N’ Parks coordinators have ranged from people

?

who had little or no prior experience in heart-healthy behavior or were new to the community service field to individuals who have extensive backgrounds in health and wellness or experience in

?

community service.

?

2 What are risk factors and how do

they fit together with respect to cardiovascular disease? Risk factors are the conditions or behavior

? that increase the risk of developing

cardiovascular disease. They include high blood cholesterol, high blood pressure, overweight, obesity, diabetes, smoking, and physical inactivity. However, these factors do not exist exclusive of one another. In

fact, each factor poses a greater risk when ?

it exists alongside the others. For example, if you smoke and have high blood pressure and high blood cholesterol, you’re eight

times more likely to develop coronary ?

heart disease than someone with no risk factors. Moreover, having one of the risk factors can make you more likely to have

others. Physical inactivity, for example, ?

can contribute to overweight or obesity, which in turn may lead to diabetes.

HEARTS N’ PARKS: 1ST P—P

The common element of every human service agency, and the starting point for all services developed for the public, is people. Because Hearts N’ Parks is about making life better for people and helping them to make better decisions about their health, it is an absolute necessity that the first P of Hearts N’ Parks is people.

Every member of the community has the potential for playing a role and being involved with Hearts N’ Parks. It is important to target a variety of people who can help support the overall goals of Hearts N’ Parks and help make hearthealthy behavior a way of life in your community. There are essentially two groups of people important to this project. Some individuals and groups will serve as part of the support and delivery system for Hearts N’ Parks. Other people will be participants of the program.

SUPPORT SYSTEMS FOR HEARTS N’ PARKS

To start your Hearts N’ Parks initiative, you will need the help of many people.

Groups of people whose support you will find helpful include:

Decision-Makers Agency managers Board members Elected officials

Staff Full- and part-time Support- and front-line Volunteers

Media Those employed by local media outlets

Partners Individuals and other community organizations

EOPLE

Participants Individuals involved in your programs and activities

General Public Everyone else in the community

In order to gain community support, we need to let all of these groups know:

• Why Hearts N’ Parks is important for the community
• The relationship of park, recreation, and leisure activities to a healthier lifestyle
• How these groups can help and/or become involved.

You need to start internally, moving from decision-makers to staff whose help you will need in providing the services. Then you can work on getting external support for the project.

Internal Manager/Supervisor

→

Staff

→

External Media

→

Partners

→

Participants and the general public

DEPARTMENT STAFF

High on the list is the staff of your department. There are many ways you can help staff become engaged in this community-wide initiative:

• Orienting staff to Hearts N’ Parks so they know the specific facts about CVD and heart-healthy behavior, as well as details about the 5Ps of Hearts N’ Parks
• Brainstorming and program planning sessions where staff identify ways in which they can bring Hearts N’ Parks to participants and the general public
• Training staff in methods to incorporate heart-healthy activities into their programs
• Involving staff in the selection of resources, such as those available from NHLBI and NRPA, to assist them in achieving program goals
• Assisting staff in selecting programs to be used in outcomes assessment efforts
• Training staff about the guidelines and procedures for assessment activities
• Enabling staff to take part in various heart-healthy activities that your department sponsors.

The involvement of department staff in this project is essential. There is a direct link between the needs of targeted groups and the programs and services designed to address these needs.

OTHER SOURCES OF SUPPORT

There are many others who can and will provide support for this program. Two of those groups are the media and community partners. More extensive information about how to involve those two groups is provided later in this guide.

PARTICIPANTS AS TARGET GROUPS

Participants are an important target group to involve early. Participants differ from one another on a number of factors. These factors include:

• Relationship with department
• Participation in heart-healthy activities
• Stage of change status for heart-healthy behavior.

These factors indicate various target groups. On the basis of the relationship with your department, some people can be considered casual participants not having a formal or regular relationship with your department while others may be current or regular participants. People not involved with your department are viewed as potential participants.

People can also be categorized on the basis of the programs they choose. Some people may gravitate towards programs such as aerobics, yoga, or healthy cooking classes that have a strong emphasis on heart-healthy behavior. Other people may primarily participate in activities that do not have a specific heart-healthy focus. So participants, casual or current, can be categorized as involved either in heart-healthy or nonheart-healthy programs.

It is also important to begin to visualize people based upon their personal or individual understanding of, and relationship to, heart-healthy behavior. This can range from people with almost complete lack of knowledge or interest to people who lead very heart-healthy lifestyles. The stages of change framework will help you envision various target groups on this basis. There are a number of stages of change, including people who resist change all the way up to people who have made lifestyle changes.

Traditional program models have a tendency to focus on people who are currently enrolled or involved in existing programs and services. Since they are right there in front of you, it is easy to assume they are the only targets for programs or services. Since just about everybody has the potential to become involved in leisure or community activities, you can expand your target groups to include those

people who are either not involved or don’t appear to be involved in any way with your department. Gear up for your potential participants.

a way to distribute information, raise awareness, and even as a way to encourage family participation in physical activity and healthy eating.

People who have some contact with your facility

DEFINITION OF TARGET GROUPS ON

still must pass by bulletin boards or signboards

BASIS OF PARTICIPATION AND

that can include heart-healthy information.

RELATIONSHIP

There are plenty of opportunities to increase the range of participants by expanding your view of target groups to include those people who are casual or secondary participants. For instance, people who run in your parks or stop by your community center to attend a civic meeting may be considered casual participants. You also have a large number

There are three different types of participant groups based upon their relationship with your department: casual, current, and potential. When you look at those three groups on the basis of whether or not they participate in programs that have a heart-healthy focus or not, you create a number of target groups as follows:

of secondary participants. Just think of all those

• Casual Participants. People not formally parents who come in and out of your center or involved in any specific programs. drive by your facilities either dropping off or
• Non-Involved. Informal or infrequent picking up their children. users; may be secondary participants Many adults, among them working parents, are who know of your programs through often unable to find or make the time for heartparticipation of children or friends. healthy behavior. This provides you with a
• Heart-Healthy Independents. Frequent unique opportunity to reach these parents who users of parks or facilities for regular are secondary participants in your programs. physical activity but usually on a drop-in Don’t overlook this parent-child connection as or informal basis.

About 20 percent of the people enrolled in your programs probably account for 80 percent of your total participation? This 20/80 rule applies to almost everything, including heart-healthy behavior. For instance:

About 22 percent of American adults report regular, sustained physical activity of any intensity lasting 30 minutes or more 5 times per week. These people are the 20 percent that account for 80 percent of sustained physical activity.

About 25 percent report no leisure-time physical activity.

Sixty percent or more don’t achieve the recommended amount of physical activity (30 minutes or more of moderate physical activity at least 3 or 4 days a week).

These are the 80 percent who are not getting adequate physical activity.

Grow your market share. Don’t be fooled by the level of heart-healthy behavior you see in front of you. You may have waiting lists for your gymnastics classes and long lines during the late afternoon or early evening hours in your fitness center, but that doesn’t mean that you’ve reached everybody who needs information, support, or assistance. Be sure to target and go after the 80 percent not involved.

• Current Participants. People currently participating in programs.
• Non-Heart-Healthy Focus. Involved in a program that doesn’t target physical activity or healthy eating.
• Heart-Healthy Focus. Involved in a program that focuses on heart-healthy behavior.
• Potential Participants. People not currently involved or possibly not even aware of your programs and services. They may become target groups for information, communication, or programs.

HARACTERISTICS

Precontemplation (resisting change)

Contemplation (change on the horizon)

Preparation (getting ready)

Action (making change)

Maintenance (staying there)

Termination (end of change cycle)

STAGES OF CHANGE FOR HEART- HEALTHY BEHAVIOR

People have varying levels of information

Don’t engage in physical activity or eat heart-healthy and have little or no intention of doing so

Intend to make change in behavior; length of time in this stage can vary considerably

Planning to incorporate physical activity and hearthealthy eating into lifestyle

Engage in heart-healthy behavior on a regular basis but have been doing so for less than 6 months

Continuous engagement in heart-healthy behavior for 6 months or more

Physical activity and healthy eating as a way of life

The Stage(s) of Change model identifies six different stages as people make changes in their behavior (See Box). about and involvement in heart-healthy behavior. There may be a writer for the local newspaper

AT-RISK GROUPS

Individuals who are either unaware of heartwho always makes time for physical activity in her day or a board member with a family member who has had a stroke. These people have higher levels of awareness and involvement with heart-healthy issues and behavior than many others do. Other people may not be aware of, or interested in, making lifestyle

healthy behavior or are not interested in involvement in such behavior are at higher risk for CVD. Though essentially everyone is at some risk for CVD, it’s important to make sure that these high-risk people are targets for your information and programs. changes. One way of defining those differences is to use the “stages of change” model.

STAGE(S) OF CHANGE

Not everyone is ready to hear the same messages or to receive them in the same way. Naturally, people differ from one another and there can be a variety of reasons for these variations in motivation or lack of motivation.

People who tend to fall into the at-risk group tend to have higher than average levels of overweight or obesity and lower than average levels of physical activity, as well as high blood cholesterol levels, high blood pressure, and high rates of smoking. Lifestyle changes can have a positive impact on all risk factors.

Women in general are less active than men.

People with lower incomes and less education are typically not as physically active as those are with higher incomes and education.

African Americans and Hispanics are generally less physically active than whites.

Adults in the northeastern and southern states tend to be less active than adults in north central and western states.

People with disabilities are less physically active than people without disabilities.

By age 75, one in three men and one in two women engage in no regular physical activity.

The proportion of adolescents from poor households who are overweight is almost twice that of adolescents from middle-and high-income households.

Overweight is especially prevalent among women with lower incomes and less education.

Obesity is more common among African American and Hispanic women than among white women.

Among African Americans, the proportion of women who are obese is 80 percent higher than the proportion of men who are obese; this difference is also seen among Hispanic women and men.

NHLBI resources designed to reach groups more at risk for CVD include:

For Participants:

Preventing Heart Disease—Eight easy-to-read bilingual booklets (in Spanish and English).

Improving Cardiovascular Health in African Americans—Package of seven easy-to-read booklets.

Controlling High Blood Pressure: A Women’s Guide.

Package of four easy-to-read booklets for Native Americans and Alaska Natives from three tribes: Bristol Bay Area, Ponco Tribe, and Pueblo of Laguna

For Your Agency’s Use:

Heart-Healthy Home Cooking: African American Style.

Delicious Heart-Healthy Latino Recipes.

Working with Religious Congregations: A Guide for Health Professionals.

From Heart to Heart: A Bilingual Group Discussion Guide.

Take a look at some excerpts as presented in From Heart to Heart: A Bilingual Group Discussion Guide.

How To Start a Group Discussion

And Now for the Show! Follow This Outline:

Welcome and Introduction ..........................................5 minutes

Video Presentation ......................................................25 minutes

Discussion Series With Questions and Answers ..............................................30 minutes

Review ........................................................................10 minutes

Evaluation ....................................................................15 minutes

Screenings ..................................................................Optional

H IGHLIGHTS FROM “ F OR THE L OVE OF Y OUR H EART ” V IDEOTAPE

The video portrays the Gomez family as its members make changes in their eating and physical activity habits after the father, Pablo Gomez, suffers a heart attack. It is intended to show participants that making some changes in habits is possible. An off-camera narrator offers suggestions on adopting healthy lifestyles. Dr. Elmer Huerta appears on camera to explain other steps people can take to lower their risk of heart disease.

Key Messages From “For the Love of Your Heart”

More Latinos in the United States die of heart disease than from any other cause.

Many Latinos believe that heart attacks happen suddenly because of bad news or strong emotions. The truth is that a heart attack is the result of disease that has developed over many years. The disease often starts in childhood or adolescence. Taking steps to prevent heart disease is important.

GETTING STARTED

____Put together a Hearts N’ Parks overview packet consisting of FAQs and other general information to share with potential supporters of the process. Review talking points for your conversations with them.

____Orient your organization’s decision-makers to Hearts N’ Parks. Secure their input and get their approval.

____Make a list of current partners who might be interested in Hearts N’ Parks.

____Brainstorm some partnering possibilities from less traditional organizations.

____Hold a Hearts N’ Parks orientation for staff. Recruit volunteers interested in working on the project.

____Set up a joint meeting for potential partners. Send out invitations, Hearts N’ Parks information sheets, and the agenda for the first meeting.

MOVING FORWARD

____Meet with program staff to describe the various groups of participants and to identify specific targets. Be sure to discuss the 20/80 rule, at-risk groups, and casual participants.

____Hold a brainstorm meeting for staff to identify ways to move Hearts N’ Parks forward.

____Ask staff to select resources for Hearts N’ Parks efforts.

____Hold a potential partnering meeting (see 4th P for more specifics in this area).

____Tell staff about Tracking Sheet for Activities (page 82).

KEEPING THE BEAT

____Notify the people in your department about current initiatives and activities of Hearts N’ Parks:

• Give management a written report and verbal update on the project.
• Make a report at a board or council meeting.

____Don’t forget to go back and check out your participant groups and ask yourself if you are targeting the following groups:

• People in various stages of change.
• At-risk groups.
• The 80 percent not involved in heart-healthy behaviors.

OUTLINE OF STAFF

1. Orientation to Hearts N’ Parks

People Involved: Management, supervisors, support, front-line staff, part-time staff, and volunteers not necessarily at the same session, due to size and time constraints.

Time Allotted: 50 minutes.

Goal(s): Expose department members to this new initiative and solicit their support and involvement, as appropriate.

Materials and Resources: Overheads, FAQ handouts, Hearts N’ Parks videotape.

Suggested Agenda:

• Welcome and Expression of Support for Hearts N’ Parks: the Department Director (5 minutes).
• Warm-up and Mixer: Ask staff to find someone else in the room who practices the same type of heart-healthy physical activity (10 minutes).
• Overview of Hearts N’ Parks: Brief explanation of elements of the initiative, including FAQ handout (7 minutes).
• Show Hearts N’ Parks videotape (10 minutes).
• Questions and Comments (7 minutes).
• Volunteer Sign-up (7 minutes).
• Closing: Provide attendees with a fun heart-healthy tip (2 minutes).

1. Creating Focus on Hearts N’ Parks

People Involved: Program and front-line staff who deliver the programs and services.

Time Allotted: 75 minutes.

Goals:

1. Acquire greater depth of understanding of Hearts N’ Parks.
2. Identify ways in which the department can involve participants in Hearts N’ Parks.
3. Create staff understanding of differences among participants.
4. Provide staff with programming information for Hearts N’ Parks.

Materials and Resources:

• Reproduce “Stages of Change Characteristics” on page 22, as handout or overhead.
• Reproduce program variations, focus, and strategies and techniques from handout or overhead.
• Reproduce Check Your Weight and Heart Disease I.Q. and Check Your Physical Activity and Heart Disease I.Q. (see Reproducible Section).
• Optional: Complete packets of copies of reproducibles.

Suggested Topics and Activities:

Hearts N’ Parks (30 minutes)

• Overview of 5Ps.
• Individual activity: Complete Check Your Weight and Heart Disease I.Q. and Check Your Physical Activity and Heart Disease I.Q.
• Explain importance of heart-healthy behavior.
• Questions and answers.

People and Programs (30 minutes)

• Review different types and levels of participants.
• Update on “Stages of Change” model.
• Overview program considerations.

Wrap-Up (15 minutes)

• Questions, comments, etc.
• Review of today’s outcomes.
• Set stage for next meeting.
• Announce date and time if possible.
• Ask staff to review programming information and come ready to share ideas.
• Pass out reproducibles (optional).

1 What kind of training does my

staff require? First and foremost, make sure that your

members are motivated to work with?

Hearts N’ Parks by emphasizing the significant role they can play in improving the lives of those they will be working with. A training session for staff that provides an overview of basic CVD, physical activity,

and nutrition information that will be taught to?

program participants will be helpful. A training session in Arlington, Virginia, was carried out as follows:

• Staff members attended three training sessions. The first, led by representatives from the NHLBI and the NRPA, covered the nuts and bolts of the Hearts N’ Parks program. The second, about 2 months later and led by representatives of the Arlington Department of Parks, Recreation and Community Resources

?

(PRCR), focused on cardiovascular disease and the importance of promoting heart-healthy behavior within a recreation setting. PRCR staff had an opportunity to brainstorm activities specific to cardiovascular disease that they could do with their kids.

• During a third session at camp, materials from the Arlington County Parks and Recreation Wellness Lending Library (the WELL) were introduced to all summer day camp staff. The materials contained information and activities for different age groups on many different health topics, including nutrition and physical activity to be used in summer camp.

?

2 Should I only target people who are

at high risk for CVD? No. Everyone can benefit from learning about heart-healthy behavior, physical activity, and nutrition. Every adult, no matter how apparently healthy, is at some level of risk for CVD. People who are at greater risk will benefit more from Hearts N’ Parks than those who are low-risk, but you don’t want to exclude potential participants simply because they are low-risk.

?

?

?

?

?

Programs & Practices

P—P

Local programs are the lifeblood of Hearts N’ Parks. It is through the connection of local programs with participants that heart-healthy information can be shared and lead to hearthealthy behavior. Programs come in many shapes and sizes. Through Hearts N’ Parks, you can either create new programs or put new information and activities into existing ones. You can move people from knowledge to action by starting from where they are and supporting them as they move to a heart-healthy lifestyle.

PROGRAM VARIETIES

There can be a number of variations within program offerings. Two of those relate to whether programs are new or existing, and whether or not the focus of a program is specifically upon heart-healthy behavior. This results in a framework for program possibilities:

New to You. If you cosponsor a healthy cooking program for the first time with the Cooperative Extension Service, it may not be new to your area but will certainly be new to your department and possibly new to your

New

New to You Innovations

target groups. If your department has never offered programs or activities on healthy eating or managing weight and diet, that would be another example.

Innovations. The only limit here is imagination. The Albemarle (North Carolina) Parks and Recreation Department partnered with a local hospital to create a series of evening strolls in various locations in the county. Residents visited places they hadn’t been recently while engaging in a physical activity, meeting old or making new friends, and being screened for high blood pressure.

Heart-Healthy. Programs with a major emphasis on physical activity or learning about healthful eating. Examples: aerobics, volleyball, low-fat cooking class.

Non-Heart-Healthy. Programs that do not focus on physical activity skills or participation or nutrition or weight loss. Examples: arts and crafts, day camp, bridge club, etc.

Focus

Heart-Healthy Non-Heart-Healthy

Three science-based health/recreation resources include the curriculum from the Child and Adolescent Trial

for Cardiovascular Health (CATCH), JumpSTART, and JumpSTART Afterschool.

CATCH was a multisite study that demonstrated the effectiveness of school health education for motivating heart-healthy behavior in elementary school age children. CATCH’s field tested materials include:

1. a physical education curriculum with lesson plans and a set of more than 350, 5x8" cards showing fun, easy-to-teach activities; 2) heart-healthy classroom curriculum with family components for grades 3, 4, and 5; and 3) an eat smart school cafeteria program guide. The CATCH physical education component offers a blend of moderate to vigorous physical activities, sports adaptations, and suggestions for hula hoops, jump ropes, and parachutes. The CATCH program offers a successful blend of physical education, classroom curriculum, nutrition awareness, student-directed activities, and P.E. equipment designed to promote and maintain cardiovascular health in children, grades K–5.

CATCH Recreation is an adaptation of the original curriculum developed specifically for park and

recreation personnel and provides hundreds of youth activities promoting physical activity. A special recreation leaders guide complements the program material and supports the Hearts N’ Parks program. All of the CATCH materials can be obtained from Flaghouse at http://www.flaghouse.com or at (800) 793-7900.

JumpSTART is a school-based program adapted from CATCH developed by NHLBI and NRPA in

collaboration with Scholastic magazine that provides teachers with a variety of ways to include physical activity and healthy eating components into their language arts, social studies, math, and science classes. Another

component to JumpSTART is the back-pack stuffers on heart-healthy behaviors for children to bring home to their parents. The target age group is third through sixth grade. JumpSTART is available from NHLBI at

http://www.nhlbi.nih.gov/health/prof/heart/other/jumpstrt.htm.

JumpSTART Afterschool is a program also developed by NHLBI and NRPA with assistance from the

National Recreation Foundation to help children and youth get active, have fun, and be healthy. The booklet (also available in Spanish) includes a series of activities selected to augment current after-school programming. The activities encourage physical activity and recreation as well as heart-healthy eating habits by using creative discovery techniques that are applicable to indoor and outdoor environments.

The target age group is third through sixth grade. Information on JumpSTART Afterschool is available

on the NRPA Web site www.activeparks.org under programs and partners.

STRATEGIES AND TECHNIQUES Whether your department decides to create new programs or continue existing ones, there are a number of techniques that can be used to make all

had a heart-healthy focus and those that did not. Some of the ways you can infuse information and build knowledge within programs include:

department programs a part of Hearts N’ Parks.

Existing Programs (heart-healthy focus)

Information and Knowledge Infusion ■ Have participants in exercise classes monitor One approach that the North Carolina pilot their pulse periodically. sites found particularly effective was to infuse

• Suggest that participants in summer day knowledge and activity into existing programs. camps substitute healthier foods for high-fat The pilot sites did this both with programs that snacks.

To give you an idea of the wealth of information available within CATCH Recreation

(JumpSTART Afterschool)

Objective:

Benefits:

Equipment:

Directions:

To use persuasive writing techniques to spread nutrition information.

Reinforces participants’ knowledge of heart-healthy food choices.

Construction paper, posterboard, markers and other art supplies, tape recorder, and video camera.

Have groups of kids think of interesting and fun ways (e.g., billboard, magazine, or TV advertisement) to ‘advertise’ their snacks, and convince others of their heart-healthy properties.

The Great Alphabet Hunt

Objective:

Benefit:

Directions:

Reinforce language arts and spelling.

Environmental appreciation.

As you walk or jog, look for objects whose first letters spell out the alphabet in order (i.e., acorn, bird, cloud). See how far you can get in a given time or distance.

Go Fitness Fast Games 2

Activity:

Equipment:

Skills Emphasized:

Organization:

Description:

Elbow Tag Grade Level: 3–5

Four cones, scarves, or objects to identify children that are “it.”

Fleeing, dodging, chasing, running.

Designate boundaries and reentry task zone; designate one of five kids to be “it”; kids scatter.

On signal, children that are “it” try to tag the others. At any time the other children may find a partner and link elbows. For 10 seconds, while elbows are linked, kids are safe from the person chasing them (count out loud). While linked, pairs should continue to walk. When participants are tagged, they go to the reentry task zone and complete the designated reentry task (e.g., 10 jumping jacks or 10 sit-ups).

Go Activity Aerobic Games 5

Activity:

Equipment:

Skills Emphasized:

Organization:

Description:

Circulation Grade Level: 3–4

Bean bag or similar safe object.

Various locomotor movements.

Children form large circle in an open space with bean bag in the center. Divide the class into two teams: half are Team A, the other Team B. Players on each team are numbered 1–15.

On signal, all kids walk in the same direction around the circle. Call out a number. The player with the same number on each team runs out and tries to take the bean bag back to their group on the perimeter of the circle. If a player succeeds, that team gets 2 points. If the player that took the bean bag is tagged by an opposing player before getting back to the circle, the other team gets one point. All other players continue to walk in a circle.

• Expose program participants to myths about exercise, such as the need to engage in vigorous activity to have cardiovascular benefit.

Existing Programs (non-heart-healthy focus)

• Have participants complete health quizzes, such as Check Your High Blood Pressure Prevention I.Q. or Check Your Healthy Heart I.Q., (in reproducible section), so they can transform information into knowledge about their own health.
• Have instructors begin or end class sessions with a heart-healthy tip from such resources as “Nutrition Tip Sheets” or Exercise and Your Heart.
• Teach participants a new skill, such as how to read a food label for fat and sugar content, or how to determine a “moderate” level of physical activity.

Raising the Potential

Another strategy for infusing Hearts N’ Parks into local programs, particularly existing ones, is to raise the potential of programs for helping the project reach its goals. There are a couple of ways to do this. Programs with a captive audience over an extended period of time, such as afterschool, daycare, or latchkey programs, summer camps or playgrounds, adaptive or therapeutic recreation, and senior citizen meal programs and clubs provide opportunities for providing heart-healthy information.

And take advantage of commemorations, such as American Heart Month, National Nutrition Month, or National Cookout Month. These can be used to help people boost their activity levels or learn to prepare healthier meals. Some of the national organizations on the NHLBI partner’s list sponsor such annual events. These events include:

• February is American Heart Month.
• March is National Nutrition Month.
• May is National High Blood Pressure Education Month.
• September is National Cholesterol Education Month.
• November is National Diabetes Month.

The NRPA also has a number of national program partners that sponsor events that could work well for you.

• May is USA Tennis Month and National Physical Fitness and Sports Month.
• July is Recreation and Parks Month and National Cookout Month.

Hands-On Activity

Emphasize “doing.” The value of a healthy eating tip is enhanced with a copy of a related heart-healthy recipe.

Adapt Traditional Activities

Substitute soccer for softball to get more participants actively involved in the game. Frozen tag involves more physical activity than Red Light, Green Light. Serve bite-sized snacks at camp or social meetings. Encourage concessionaires to provide a wider range of heart-healthy snacks, meals, and beverages.

PROGRAM PROGRESSION

Being exposed to a fact sheet about a healthy diet is not the same as knowing how to shop for one. Knowing how to shop for healthier foods is not the same as choosing to eat those foods. People pass through a number of stages from learning about the importance of CVD until they attain a heart-healthy lifestyle. We can help them move along that continuum:

ROGRAM

Information Knowledge

Intention Activity Lifestyle

S IGNS OF S UCCESS

Many of the North Carolina communities utilized existing programs that involved participants over a period of time.

Day Camps and Playgrounds

• Mecklenburg County incorporated healthy snacks into its programs.
• Garner Parks and Recreation focused on fitness and reading food labels during one week at Camp Geko.
• Roanoke Rapids taught nutrition basics to children ages 4 through 6 at the FLIP (Fun for Little Interested People) Camp.

Senior Programs

• Garner Parks and Recreation revamped an existing program, calling it "Keep the Beat-Circle Yourself in Health" and had seniors keep a journal and receive credit for prizes as an incentive.
• Roanoke Rapids incorporated heart-healthy information into its "Aquacise" program for seniors.
• The mall-walking program in Mecklenburg County provided hearthealthy information and activities.

Other Programs

• The Summer Youth Basketball League, a joint venture of the Raleigh Police Department and the Parks and Recreation Department, incorporated physical activity testing and offered the youths fruit and a sports drink.
• Hickory included information and activities at Kindergym, a preschool physical activity program.
• Winston-Salem featured heart-healthy activities as part of its Weed and Seed Summer Youth Academy, with healthy snacks, educational sessions, and instruction in physical activity.
• Wilson Parks and Recreation incorporated information and instruction in both their summer sports day camp and its weightlifting program for adults.

Providing people with information about the value of dietary changes and physical activity may not be enough to persuade them to make changes in how they live. People know that they should be more active or eat healthier meals, but they don’t always act on this knowledge.

Offer Opportunities

The goal of Hearts N’ Parks is to move people along from having information to acting upon it. Three ways to accomplish this progression are as follows: The first is to provide people with more opportunities to become involved in programs. Think of these as introductory versions of your programs that are designed to attract people who may lack the time, money, confidence, or level of commitment needed to adopt a healthier lifestyle. Possibilities include:

• Offer A Taste of one or more of your programs. That is, offer “miniclasses” in the heart-healthy programs currently offered by your department.
• Offer invitations that are Good for One Free Session. That is, invite people to attend a heart-healthy class at no charge.
• Hold a Get Started series of programs. These could include “getting started” on shopping for healthier food, “getting started” on healthier ways to eat fast foods, or “getting started” on reducing fat eaten during meals.
• Hold a Special Event. For example, sponsor a “Get Ready for Summer Fun” event where people can try out the various physical activities offered by your department.
• Hold an Open House. At one of your facilities, include sessions on heart-healthy behavior as part of an open house.
• Reach Out. Sometimes the people who are most in need of involvement in heart-healthy

There are various ways to infuse information, knowledge, and activity into existing efforts, such as:

Information

Low-fat foods should be included in your daily diet.

Reduce amount of fat and sugar in snacks.

It is important to warm up before physical activity.

Activity

Cooking demonstration and sampling from 4–6 p.m., when parents pick up children.

Serve a healthy snack at camp with a “mini” reminder about why it’s good for you.

Ministretching and warm-up lesson at drop-in volleyball.

Skill/Knowledge

Low-fat food tastes good and is easy to prepare.

Can recognize a snack that tastes good and is good for you.

Practice appropriate warm-up techniques.

programs are those who are most difficult to reach by traditional methods. Don’t wait for them to come to you, find a way to go to them where they are most comfortable and accessible.

Breaking Barriers

The second way to help people progress from knowledge to action is to help people break down their personal barriers to adopting hearthealthy behavior. These barriers may include a long list of “don’ts,” as in:

Some North Carolina communities created new programs as part of the Hearts N’ Parks projects:

• Albemarle Parks and Recreation teamed with a local hospital to create “walk about” programs that transported residents to different parts of Albermarle County and provided opportunities for health education and free screening of blood pressure and blood glucose as part of the evening out.
• Staff from the Madison-Mayodan Recreation Department created a special version of Hearts N’ Parks for sixth to eighth graders. The program included fun, lifetime physical activity skill opportunities as well as games, such as “design your personal pizza.”
• The Smithfield Parks Department collaborated with the county health department and a fitness center to create a 6-week senior physical activity program that offered screening for blood pressure, cholesterol, and body fat.

Don’t have the... time ■ Programs that help reinforce their ... money progress. ... ability

• Recognition of milestones achieved or Don’t know ... how continued participation. ... if I can
• Prizes as incentives. Offer people some ... if I’ll like it kind of small gift or giveaway. Don’t want to ... look/feel silly or stupid
• Suggest Alternatives. People sometimes ... invest too much time, money, tire of the same activities and the same or effort in something I may heart-healthy recipes. Suggest to treadmill not like or be able to do fans that they might enjoy cycling or hiking. Distribute new heart-healthy recipes and meal ideas. Fight against boredom and Lifestyle Behavior Support repetitiveness as a reason for sliding back The third way to help people progress from into old habits. knowledge to action is to help them maintain
• “Welcome Back-We Missed You.” There their new lifestyle. There are ways to do that, are always people who slip out of newly such as: acquired patterns. Often they feel bad about
• Special events that reinforce social support it but think they can’t start anew. Make sure for people with similar interests and goals. you try to get them back.

The following excerpt from The Practical Guide to the Identification, Evaluation and Treatment of Overweight and Obesity in Adults suggests ways to respond to some of the standard reasons why people don’t engage in physical activity.

I don’t have time to exercise.

Physical activity does take time, but only about 1 hour per week of vigorous activity can greatly benefit your heart, lungs, muscles, and weight. Consider the amount of time you spend watching TV. Many forms of physical activity can be done while watching TV, such as riding an exercise bike or using handweights.

I don’t like to exercise.

You have bad memories of doing situps or running in high school, sweating, puffing, and panting. Now we know that you can get plenty of gain without pain. Activities you already do, such as gardening and walking, can improve your health, so just do more of the activities you like.

I don’t have the energy to be more active.

Once you become a little more active, you should have more energy. As you progress, daily tasks will seem easier.

Source: The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Pub. No. 00-4084

• Goal Attainment. You can help people Some possibilities include: understand that behavior change isn’t the
• Mission Statement. Include the health and easiest thing to do but that setting measurable well-being of department employees as part goals that are reasonable can help them of the department’s mission statement. maintain new behavior.
• Vision Statement. Make a heart-healthy,
• Barrier Bashing. Continue to provide active community a mainstay of your information and program alternatives to department’s vision for the future. assist in breaking through barriers to physical activity and healthy eating. ■ Planning. Be sure that issues related to heart-healthy behavior are discussed in your
• Social Support Alternatives. Facilitate the department’s strategic plan. organization of walking clubs, cooking clubs, dining-out clubs, or any other way ■ Communication. Include statistics, informathat people can help one another. tion, and awareness-building messages about community health and physical fitness

FROM PROGRAMS TO PRACTICES It is likely that your department has provided information and oriented decision-makers and

in annual reports, newsletters, brochures, press releases, and other forms of communication. staff. You’ve adapted existing programs and

• Personnel. Staff orientation and staff created new ones. But organizations must also training should emphasize the importance adopt Hearts N’ Parks into their lifestyle. of heart-healthy behavior.
• Resources. Link budget requests, grant proposals, and fundraising efforts to the role of your programs and services in promoting community health.

Fitting Activity Into Your Schedule

Try walking before going to work or school. Or maybe you prefer evenings. Even a few minutes of walking counts. Try to build up to 30 minutes a day. You can walk whenever it is convenient for you, or you can take an aerobics class instead. Whatever works for you is fine. There is no one right time of day to exercise. The important thing is that you try to be more active.

Try to think about the little things that you can do to add more activity to your daily life. For instance, take the stairs instead of the elevator at work, park farther away from the entrance to the mall, or walk instead of driving to work or shopping. These little things add up and are easy to fit into your schedule.

Source: The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Pub. No. 00-4084

■ Policy and Procedures. Review, and modify if necessary, policies and procedures to ensure safe, convenient, and equitable access to areas, facilities, programs, and services that contribute to individual and

■ Advocate. Assume the role of advocate for physical activity facilities, such as bike paths, walking or jogging paths, lighted facilities for evening use, and indoor facilities for exercise during bad weather.

community health.

Arlington County Vision Statement

The Department of Parks, Recreation and Community Resources is vital to the enrichment of Arlington as a vibrant and enjoyable community.

Arlington County Mission Statement

We work to make Arlington the happiest, healthiest place to live, work, and play through dynamic programs, public spaces, and collaborations that:

• Provide healthy and fun recreation, sport, and leisure choices.
• Cultivate, maintain, and protect natural and cultural resources.
• Provide opportunities for creative expression.

GETTING STARTED

____Involve staff in the identification of heart-healthy and non-heart-healthy programs that might lend themselves to heart-healthy activities.

____Have staff identify resources within those programs that could be used for a Hearts N’ Parks focus.

____Identify ways in which program activities could become more “hands-on” heart-healthy or adapted to support more heart-healthy behavior.

____Create a plan adding Hearts N’ Parks information and activities to those programs.

____Make plans for staff training and program modifications.

MOVING FORWARD

____Identify high-potential programs, such as after-school, day camp, or senior meals, where Hearts N’ Parks might be incorporated.

____Plan specific activities and techniques for these high-potential programs.

____Identify possibilities for incorporating national observances in your program schedule.

____Create a schedule for implementing these programs.

KEEP THE BEAT

____Offer special events/opportunities to introduce people to heart-healthy behavior and programs.

____Ask staff to identify possible barriers to participation in programs and suggest ways to break down those barriers.

____Identify reproducible materials that could be used to encourage people to move from knowledge to action.

____Create recognition or incentive programs to sustain the involvement of participants.

____Offer programs or activities to attract people who lapse from a heart-healthy lifestyle.

____Provide decision-makers in your department with ways in which they can help to make that happen. Share with them the suggestions in “From Programs to Practices.”

STAFF TRAINING/MEETING OUTLINES

People Involved: Program and front-line staff

Time Allotted: 2 hours

Goals:

1. Identify existing programs where heart-healthy information and activity can be added.
2. Identify resources that can be used for this purpose.
3. Create a schedule and system for doing so.
4. Identify high potential programs for heart-healthy behavior.
5. Brainstorm ways to incorporate heart-healthy activities into these programs.

Materials and Resources:

• List of current programs (Program Worksheet, page 42)
• Program plan form (Program Worksheet, page 42)
• Copy of reproducible materials

Suggested Topics and Activities:

• Review differences between new and existing programs and heart-healthy and non-heart-healthy programs.
• Overview of ways to move knowledge about heart health to existing programs.
• Individual or small group: identify existing programs where heart-healthy information and activity could be added.
• Share list of programs identified.
• Individual or small group: create a plan and schedule for integrating heart-healthy information and activity.
• Group brainstorming: possible high potential programs to be incorporated into Hearts N’ Parks.
• Wrap-up: questions and comments.

STAFF TRAINING/MEETING OUTLINES

People Involved: Program supervisors and programmers

Time Allotted: 2 hours

Goals:

1. Identify high-potential programs for involvement with Hearts N’ Parks.
2. Identify possible national programs or celebrations for incorporation into the department’s offerings.
3. Develop plans and activities for both high potential and national programs.
4. Create a schedule for implementation of these programs.

Materials and Resources: Information from this section

Suggested Topics and Activities:

• Share progress and challenges on incorporation of heart-healthy information into programs.
• Make adjustments and make plans for continuation.

High Potential and Profile Programs

• Group brainstorming: List potential programs for both high potential and profile; refer to information in this section on those two areas, if needed.
• Group decision: On the basis of department criteria—that is, resources, number of people reached, ease of access to target group, etc., decide to place greater-than-average emphasis on heart-healthy behavior in several existing programs.
• Program plans: Identify one or more national programs or celebrations which the department plans to incorporate into its offerings. Develop an action plan.

Wrap-up

• Questions and comments.
• Set a date and time to reconvene to finalize plans for incorporation.

Overall Goal: If more than one, indicate priority by designating the first goal as #1 and also check secondary goals.

____Add heart-healthy information and activities to existing programs

____Target high potential or national programs

____Move people from information to action

____Reach potential participants

____Support heart-healthy lifestyle

____Identify possibilities for partnerships

____Utilize opportunities for building public visibility

Program List:

List each of the major programs or services under your supervision.

Mark as follows under the heading Designation:

strong possibility to reach goal(s)

•

X possible alternative for goal(s) attainment

List suggestions for possible information, activities, or modifications.

Program Designation Possible Activities

Designate programs selected for Hearts N’ Parks, along with major goal or focus and types of activities.

Program Major Goal/Focus Activities

Designate actions that need to be taken to implement the Hearts N’ Parks program. Include due date and person responsible.

Action By When By Whom

?

1 We have a tight budget. How can we

implement Heart N’ Parks without going over budget?

?

Work to achieve some flexibility in your program so that costly rearranging or replanning is minimized; try to be creative. For example, as part of its Hearts N’ Parks program, the Winston-Salem (North Carolina) Parks and Recreation Department

partnered with the Wake Forest University?

Baptist Medical Center to provide blood pressure and cholesterol checks for adults in a “Healthy Strider” mall-walking program. The medical center used a

storefront in the mall as a place to ?

provide walkers with healthy snacks

and information. This joining of resources ?

and facilities enabled both groups to keep costs down while reaching out to a larger segment of the community.

Obtain educational materials and program

?

ideas from the Web and see the 4th P starting on page 65 for information about forming partnerships.

2 How many participants can

participate?

There is no set number, but it is better for ?

evaluation purposes to start off with a small group (15–30) and allow the program to grow.

?

?

P—P

“If a tree falls in the forest and there’s nobody there to hear it, does it still make a sound?” That old question highlights the challenge for Hearts N’ Parks. This project doesn’t exist unless people hear about it. The relationship between CVD and heart-healthy programs is worthy of great visibility.

Take up the challenge of raising awareness of cardiovascular disease and the role individuals can play in reducing their disease risk. Now is the best time to raise the visibility of Hearts N’ Parks and to show people in your community how you are working to improve their health.

WHO NEEDS TO KNOW?

Who needs to know about Hearts N’ Parks? Somewhere between lots of people and everybody.

Given the large audience, you need to use many different strategies for getting the word out. Hearts N’ Parks offers five approaches to greater program visibility:

• Defining Hearts N’ Parks messages
• Modifying the messages
• Moving the messages
• Holding special events
• Working with the media.

Elaboration of these approaches is provided in the following sections.

WRITING HEARTS N’ PARKS MESSAGES

Some people who know a great deal about the causes of CVD will live in your community along with people who are unaware that CVD is a serious health threat or that people can reduce their risk. Other people may be aware of ways they can reduce their risk for CVD who aren’t interested in making any changes in their behavior. The “stages of change” in the “1st P—People” come into play here.

Although the program’s overall message is the value of adopting heart-healthy behavior, the program uses various levels of the message to move people from awareness to action.

At the broadest level, the goal is to raise awareness of the seriousness of cardiovascular disease. The hope is that a progression of messages will result in people participating in activities that support heart-healthy behaviors.

Heart disease is the leading cause of death in the United States.

→

Risk factors for heart disease are: High Blood Cholesterol High Blood Pressure Smoking Diabetes Being Overweight and Lack of Physical Activity.

→

Fortunately, there are steps you can take to reduce your risk of heart disease.

→

Two of those actions you can take involve increased leisure-time physical activity and heart-healthy eating.

→

Your community is involved in a National program, Hearts N’ Parks, that addresses heart-healthy eating and physical activity.

→

There are individuals or community groups who can play a part in the Hearts N’ Parks program and its success.

→

People can learn more and become involved in physical activity and heart-healthy eating activities at your department.

→

Types of activities and programs offered along with dates, times and locations.

The table on page 47 shows each stage of change and the corresponding message goal and suggestions.

Stages of Change Message Goals and Suggestions

Precontemplation To raise awareness of CVD. “Heart disease is the leading cause of death in

the United States.”

Contemplation To raise awareness of the important role of the individual in relation to the risk factors. “You can make a positive change.”

Preparation To encourage involvement in heart-healthy behavior and encourage

individuals to participate in your programs. “These programs are accessible, and activities are easy to start—no experience or skill required.”

Action To tell individuals how to get started and help them stay involved. Introduce

other activities and options for them as well as ways to break barriers, etc.

Maintenance To focus on sustained, continued activity. “Keep up the good work.”

Termination To offer continued access and availability. “We’re your partners in healthy

lifestyles.”

Another stage of change is quite common: relapse. For a variety of reasons, people with the best of intentions stop their involvement. It’s important that we don’t overlook this natural, human progression.

Relapse To give options for restarting healthy habits and behavior. “Don’t let periodic

lapses become a reason to give up.”

MODIFYING THE MESSAGES ■ Keeping at It (Walking, Aerobics, etc.)

Initially, the messages are intended to provide

• Moving from Walking to Hiking information and create awareness, but over
• Now On to Healthy Cooking time you want to influence people to move

through the stages of change. Strategies for modifying the messages: Program Titles—Change the names of your programs. Rather than just listing the name of the program—Walking, Ethnic Cooking, etc.—

■ Learning More About (Biking, Low-Fat Cooking, etc.). Program descriptions—These too can be modified. To reach people who are thinking about getting started, the description could address: consider adding some of the following phrases:

• Assistance in overcoming reluctance to
• Getting Started...(Walking, Aerobics, etc.)
• Time To Try...(Hiking, Biking, etc.)
• How About...(Healthy Food Shopping, etc.).

Program titles for those who have already

adopted heart-healthy behavior might focus on

words of encouragement:

change behavior

• Techniques for learning skills
• Methods of making the behavior doable.

Example

“Have you thought about becoming more

physically active? How about walking as a way to improve your health and well-being? Join us in an easy walking plan.”

The Practical Guide on Overweight and Obesity in Adults offers information that

can be used to help people change their behavior.

Set the Right Goals

Setting the right goals is an important first step. Most people trying to lose weight focus on just that one goal: weight loss. The most productive areas to focus on, however, are the dietary and physical activity changes that will lead to that long-term weight change. Successful weight managers select two or three goals at a time that meet the following criteria of useful goals:

Effective goals are (1) specific; (2) attainable; and (3) forgiving (less than perfect). “Exercise more” is a commendable ideal, but it’s not specific. “Walk 5 miles everyday” is specific and measurable, but is it attainable if you ’re just starting out? “Walk 30 minutes every day” is more attainable, but what happens if you’re held up at work one day and there’s a thunderstorm during your walking time another day? “Walk 30 minutes, 5 days each week” is specific, attainable, and forgiving. In short, a great goal!

To influence people to sustain a heart-healthy behavior, program descriptions could incorporate language on:

more about biking OR taking the next step in aerobics OR looking for more tasty, low-fat meal ideas.”

• Reinforcing skills

MOVING THE MESSAGES

• Making the new behavior manageable There are a number of ways available to help
• Keeping activities enjoyable you reach the intended audiences for Hearts N’ Parks messages:
• Encouraging mutual support.
• Existing resources

Example

• Internal opportunities “Looking for ways to continue your venture into physical activity? How about learning ■ Extension strategies.

The NHLBI has prepared a substantial number of fact and information sheets on heart-healthy activities and heart-healthy eating. You can order these from NHLBI or reproduce many of the sheets in the reproducible section in this guide and distribute them. The NRPA also has materials that can be helpful to your audience.

I NFORMATION S HEETS

Children

• Eat Right for a Healthy Heart
• Snacks Like These Are Okay
• Find the Foods HealthyEating
• Get Moving Fast

PhysicalActivity

Obesity & Overweight

High BloodPressure

High BloodCholesterol

Adolescents Adults

• Stay Young at Heart Menu • Heart Healthy Eating Plan
• Dining Out—How to Choose • Help Your Family to Better Heart Health
• Foods in the Fast Lane
• Cooking the Heart-Healthy Way
• Putting Heart Healthy Eating Habits Into Play • Shop to Your Heart’s Content
• Dining Out—How to Choose
• Stay Young at Heart Menu
• Physical Activity and Heart

Disease I.Q.

• Get Physical
• Help Your Family to Better

Heart Health

• Physical Activity and Heart Disease I.Q.
• Guide to Physical Activity
• Guide to Physical Activity
• Check Your Weight and • Guidelines on Overweight and Heart Disease I.Q. Obesity
• Check Your Weight and Heart Disease I.Q.
• Heart Healthy Eating Plan
• Healthy Heart I.Q.
• High Blood Pressure

Prevention I.Q.

• Healthy Heart I.Q.
• Healthy Heart I.Q.
• High Blood Pressure

Prevention I.Q.

• Tips to Help Older Americans Control Cholesterol
• Cholesterol and Heart Disease I.Q. • Healthy Heart I.Q.
• Cholesterol and Heart Disease I.Q.

C ONSUMER F RIENDLY M ESSAGE

The message below is in the Surgeon General’s report on physical activity. It attempts to make people aware that even a small amount of time spent in physical activity is worth the effort. It also reminds people that moderate physical activity can be enjoyable. Consider using this language for a display item targeting current, casual, and potential participants in your program.

Life is short. So is 30 minutes. 30 minutes of “moderate” physical activity a day. A brisk walk. A romp with the kids. A dance break. Hard to believe that so much fun can dramatically reduce your risk of serious disease and early death. Even if it’s done 10 minutes at a time. And considering that it decreases stress and increases your energy, you may not only live longer, you’ll probably enjoy it more. Physical Activity. A little goes a long way.

Source: Physical Activity and Health: A Report of the Surgeon General; DHHS 1996.

Exercise boosts our immune system, releases endorphins and serotonin which all help elevate our feeling of well-being and energy level.

from Setting the Course

Neenah Parks & Recreation

Bene-E-Fit Bear, Mascot Incline Village, Nevada Parks and Recreation Department, from Setting the Course

from Setting the Course Grant Park—Sign Board

The NHLBI Web site is a good source of information. You can use this excerpt from the site as a model for turning information into heart-healthy activity. (The information included here is not presented in its entirety. You can find it at the NHLBI Web site as part of a set of

Improving the Cardiovascular Health of African Americans.

booklets for

Move Your Body!

Change your habits by adding activity to your daily routine. Any movement burns calories. The more you move, the better. Try some of these simple activities to get you started today.

Perk up:

Get up 15 minutes earlier in the morning and stretch. Jog in place. Ride your stationary bike while watching TV. Work out along with an exercise video.

Do a quick workout:

Use the stairs instead of the elevator. Walk to the bus or train stop. Walk to each end of the mall when you go shopping. Park your car a few blocks away from your destination and walk.

Have fun:

Play your favorite dance music. Do the old steps you love—add some new moves. Jump rope or play tag with your kids or grandkids. Use handheld arm weights during a phone conversation with a friend.

, NHLBI, and NIH Office of Research on Minority Health

INTERNAL OPPORTUNITIES

Use the resources in this guide to reinforce the Hearts N’ Parks message inside your agency. Try to have the message incorporated into departmental vehicles, such as:

• Flyers, brochures, bulletin boards, sign boards, newsletters, etc.
• Printed forms, such as fax cover sheets, meeting agendas, and registration forms.
• High-tech messages—voice mail, recorded updates, e-mail messages.
• Personal contact—continue to meet face to face with decision-makers, partners, and staff involved in the project.

EXTENDING YOUR REACH

Hundreds of people enroll in your programs— hundreds more pass by your parks and

facilities. Extend your reach by placing messages in places where they can be seen, such as:

• Posters and information near rest rooms and refreshment facilities.
• Fact and tip sheets in high traffic locations.
• Brochures at special events and community occasions.
• Hearts N’ Parks video as part of a display or part of a talk to a local civic or service club. (See “Holding Special Events” for more information.)
• In the mail, accompanying local utility bills, paychecks, and brochures and the newsletters of other human services agencies.

Remember to vary the message to reach people with different degrees of knowledge and readiness. By identifying places frequented by at-risk groups, casual participants, or nonparticipants, you can extend your reach even further. Some possibilities might include:

TARGET G ROUP P LACE OF C ONTACT

Teens Area or center where they drop in to play pool, etc.

Park where they “hang out” afternoons or evenings.

Parents dropping Sign boards outside building. off children Message in take-home flyers or forms.

Distribute information at youth sports games.

Families

Signs at family picnic spots or child play areas.

Announcements at social gatherings.

Senior citizens Fact sheets at meal programs.

Contact individuals or agencies that may have Here are some examples: contact with at-risk individuals and nonpartici-

• A health and wellness fair pants. This may involve providing materials for distribution by a social club, a self-help club, ■ An awards ceremony or a church.
• A ribbon-cutting event for new equipment or building(s)

HOLDING SPECIAL EVENTS

• A news conference You can tap into the popularity of existing special events or create some new ones for Hearts ■ A Fourth of July festival. N’ Parks. Special events: In addition to each of these being an event by
• Attract larger than usual numbers of people itself, each can be a part of a larger event. For example, at Arlington County, Virginia’s,
• Attract the interest of the media Hearts N’ Parks launch, a news conference

■ May reach people at higher than average risk for CVD ■ Can attract volunteers who learn more about CVD and heart-healthy behavior through their involvement ■ Are opportunities to bring many community resources together.

kicked off a full day of heart-healthy activities, including a health and wellness fair where people from local hospitals and other organizations performed blood pressure screenings and provided heart-healthy educational materials. Remember, combining your activity with another event can be a win-win situation. Perhaps there’s a community awareness day in Just remember that you don’t necessarily have your town—why not ask to participate in the to create something new. Almost any existing same way as part of a health and wellness fair? special event can be transformed into a Hearts Or, hold your awards ceremony for participants N’ Parks opportunity. in your Hearts N’ Parks programs during half- What is a special event? A special event can time at the local high school sporting event. last an hour, a day, or a week.

Regardless of which activities comprise the event, there are common steps that must be taken to make it successful:

S TEPS FOR A S UCCESSFUL E VENT

1. Identify your goals, target audiences(s), key messages, and activities. An event takes a lot of time and other resources, and it should be a tool to reach goals, not an end in and of itself.
2. Identify and contact potential partners, cosponsors, and presenters, if appropriate.
3. Assemble a task force or committee for your event. Recruit from within your department or organization, potential partnering organizations, representatives from groups that are connected to your target audiences, community volunteers, etc.
4. Choose a date and location. Find out what else is going on around the time you want to hold your event and plan accordingly. You might be able to turn what would otherwise be a competing event into a partnership! (If you plan to have a legislator, local sports figure, or other celebrity participate, you may need to choose a date and location that best meets his or her needs.)
5. Promote your event to encourage attendance and media coverage.
6. Coordinate logistics.
7. Promote your event afterwards.

Documenting the event with photographs or videotape may be useful for future promotions. So you need to factor in the logistics for doing so, such as hiring a photographer. Keep in

students. Because the school’s football games typically draw people from the entire community, the program was able to reach a sizable percentage of the population.

mind that you should obtain signed consent

forms from individuals whose image or voice are recorded. Parents or guardians must provide consent forms for minors. This guide contains a sample consent and waiver form, as well as a

WORKING WITH THE MEDIA Media coverage of Hearts N’ Parks raises the visibility of your agency and helps to set the stage for recruiting partners or sponsors. sample cover letter in appendix C. Successful media outreach is a multifaceted

Thinking at least one step ahead is key. Use the Prototype Plan for Launching Your Program in appendix C, especially the timeline and check list to help stay on track.

effort. First, identify your target audience and tailor your message accordingly. Remember that the audience is not the news media but their readers, listeners, and viewers. Reporters, editors, and producers are your messengers, Using Baltimore’s SOS program as a model, but you must show them why your message is the Medical University of South Carolina important. To do so, you must tailor your Blood Pressure Pilot Project conducted a messages to key audiences and use an appropriate similar program during a football game at a “hook” or angle to interest the media. small, relatively rural, high school with a significant percentage of African American

Here’s a media strategy checklist: Call to action: “Register now to discover easy ways to be more active and eat Define your goal. Are you trying to recruit healthfully by calling or visiting participants to programs, draw attendance [YOUR ORGANIZATION].” at an event, inform potential partners or sponsors? Create a targeted media list. Be sure that your list is up-to-date and covers all media

Think about which audiences you want to

you are interested in contacting. target. If your goal is to recruit program participants, do you want to reach children or adults? Do you want to reach individuals of certain ethnic or cultural backgrounds or from a specific socioeconomic class or neighborhood?

Develop an appropriate message. Try to identify ONE key message and ONE call to action. The key here is to not try to communicate several concepts at once—that approach can backfire. For example:

Key message: “Hearts N’ Parks is an innovative, nationwide initiative that aims to reduce the growth in the number of obese people and the risk of coronary heart disease.”

Call to action: “Help us launch this exciting and prestigious program in our community by attending [YOUR ORGANIZATION’S SPECIAL EVENT, ETC.].”

Key message: “Two ways to reduce your risk of heart disease are to participate in regular physical activity and to eat heart-healthy foods.”

Baseball/Softball Strike Out Stroke Foul Out Far Home Run for Heart Health

Basketball Slam Dunk Stroke Hoops for Healthy Hearts

Soccer Kick Out Stroke Score a Goal for Physical Activity

Football Touchdown on Fat Down on Stroke

Boxing Knock Out Stroke Weigh-In Light

Car Racing Watch Your Pressure Finish First in the Health Lane

Bowling Strike Out Stroke Strikes and Spares for a Healthy Heart

Wrestling

Demolition Derby

Tennis

Take Down Stroke

Demolish Stroke

Love Physical Activity Net a Healthy Heart

Swimming Dive into a Healthy Lifestyle

Track Run for Life

Strike Out Stroke (SOS) Week in Baltimore, Maryland, was a collaborative project involving the Baltimore Orioles, Community Health Assessment and Monitoring Programs, Bon Secours Hospital, the University of Maryland Medical School, and the NHLBI. This program targeted high-risk individuals through community events at barbershops, libraries, farmers’ markets, community basketball courts, pharmacies, and grocery stores, and culminated at a Baltimore Orioles baseball game. The events were advertised through TV and radio PSAs, banners at the ballpark, and video screen announcements. Events included blood pressure screening, risk assessment quizzes on stroke and heart disease, and educational material hand-outs on a variety of health topics. In addition, young adults and adolescents from the community were taught CVD risk reduction and how to measure blood pressure.

Consider the following questions and suggestions when forming your media strategy:

1. What are the best ways to reach your target audiences?
2. What newspapers do they read? What radio stations do they listen to?
3. Check the list of media contacts used by your agency, as well as any related agencies, partners, etc., to determine if you are missing any media outlets.
4. If you are holding a special event, don’t forget to notify calendar editors, including those on community Web sites.
5. How will you distribute your materials—by fax, by mail, by e-mail?
6. Make sure your list includes all the information you need to reach your targeted media.
7. Whenever possible, note media deadlines for submitting information.

Prepare the tools you need to inform the department or agency who are best able to media effectively. These include news serve as media contact or spokesperson. releases, fact sheets, brochures, or other Construct a timetable of outreach events background information. If you’re planning and activities. See sample Checklist and an event, you might also need a media advi- Timeline for Special Events and Prototype sory (a “save the date” announcement), as Plan for Launching Your Program in well as a press kit with the above-mentioned appendix C. tools plus an agenda, short bios of speakers,

and copies of their speeches. Don’t forget to include the five “W”s—what, when, where, who, and why—in the new release. Also, you’ll need to identify the people in your

Decide how you will measure the success of your outreach efforts. How many people participated in your program or event? How many newspapers, TV stations, etc., reported on your program as a result of your outreach?

Materials for working with the media are found in this chapter and in the appendix At the end of the chapter:

Encouraging Media to Cover Your Event (appendix C) Sample Media Advisory for Hearts N’ Parks

Launch at Local Site (appendix C) Proclamation by community officials— Arlington’s promotional flyer Sample News Release (appendix C)

Background sheet—Hearts N’ Parks (appendix F) In the appendix: Background sheet—Get Moving for a Healthy Sample Pitch Letter for Media (appendix C) Heart (appendix F) Story Ideas and Media Tips (appendix C) Background sheet—Eat Right for a Healthy Heart (appendix F)

Excerpt of newspaper article from Roanoke Rapids:

By Robert DeAngelo, Herald Staff Writer

ROANOKE RAPIDS-What’s better for you, an apple or a bowl of deep-fried pork rinds? Carrot sticks or a triple-scoop, marshmallowladen hot fudge sundae? Walking a mile or getting a thumb cramp from channel surfing?

Those were pretty easy, but the Roanoke Rapids Parks and Recreation Department is hoping to increase awareness of heart-healthy habits in children and adults this week during their Hearts N’ Parks/Keep the Beat campaign.

Roanoke Rapids is one of 11 communities in the state selected as a test site for the program, which seeks to educate both young and old on healthy eating plans along with moderate physical activity programs.

“We’re trying to promote heart-healthy behavior,” said Allen Overby, who is helping coordinate the program locally. “We want to emphasize that a plan of physical activity and nutrition is important throughout someone’s entire life.”

Arlington County Hearts N’ Parks “Kickoff”:

In the summer of 2000, the Arlington County Department of Parks, Recreation and Community Resources in Arlington, Virginia, kicked off the second year of Hearts N’ Parks in the Washington, DC, metropolitan area. A special launch event held on July 18 featured the Surgeon General, Dr. David Satcher, Olympic Figure Skating Champion Michael Weiss, NHLBI Director Dr. Claude Lenfant, and others at a press conference. Activities included healthy food demonstrations; physical activity demonstrations including tennis, volleyball, and jumping rope; sidewalk chalk art; and a performance by the “Merry Makers,” a senior citizen music and dance troupe.

Here’s a way to keep up with the latest in heart-health research and NHLBI activities:

Bookmark the NHLBI Web site, www.nhlbi.nih.gov, and check the site regularly. (See especially the “What’s New” and “News & Press Releases” sections.) You can also subscribe to the NHLBI Health Information Network which provides members with information and educational opportunities applicable to everyday activities. For example, let’s say NHLBI posts a news release about a new study showing that teens as a group are becoming increasingly overweight. You might send out a news release or a letter to the editor that summarizes the research (because NHLBI is a Federal agency, you can copy an excerpt verbatim)—be sure to cite your source—and explain how your program offers opportunities to help teens lose weight (or better yet, how effective your program is in helping them lose weight).

MEDIA CONTACT IS ONGOING It’s important to capture media attention when launching a new project such as Hearts N’ Parks. It is equally important to try to keep the message and activities of Hearts N’ Parks in the public eye. How do you go about doing that? Some things you can do: ■ Provide the media with information on new heart-healthy programs or services that you are offering. Announce new partnerships with other organizations. Keep your media contact and spokesperson informed about any new developments in your program.

tionally successful or who has overcome unique challenges, a volunteer who has contributed significantly, a corporate sponsor that has generously contributed to the community’s well-being, or the history or evolution of park and recreation programs in your area. ■ Expand your contacts with the media so information about Hearts N’ Parks and heart-healthy behavior is featured in various sections of the newspaper—e.g., sports, lifestyle, weekend, or activity section—as well as radio stations that attract different

groups of listeners. Take note of reporters—

• Ask local officials to proclaim your city, including freelancers—who cover related town, or county a Hearts N’ Parks communistories and add their names to your list of ty and invite the media to cover it. Include a media contacts. copy of the proclamation with your news release. ■ Try to find media that appeal to at-risk individuals or nonparticipants you want to
• Include Hearts N’ Parks materials at every reach. Identify new media possibilities by appropriate public event. Try to keep your reading neighborhood or small weekly materials recognizable with a standard newspapers and listening to different radio design or logo. stations.
• Stay on top of medical research related to
• Invite members of the media to become Hearts N’ Parks and tell the media about it. partners with the Hearts N’ Parks effort in Use only reputable sources of information, your community. Local TV and radio such as the NHLBI. stations as well as newspapers often adopt
• Pitch ideas for a feature article to select special causes to show their support for the media. The focus of the feature could be a community. program participant who has been excep-

Ways to make your activities newsworthy:

Provide a local angle on this national story; editors use local stories far more often than out-of-town stories.

Provide details on the impact of your agency’s activities on local people, businesses, or quality of life.

Ensure visual appeal. Visuals include photos (preferably “action” shots of a key individual in action), maps, graphs or charts, and visual identifiers (e.g., logos) of your agency.

Timely distribution of up-to-date information that is respectful of media deadlines.

Keep in mind, however, that more does not always equal better. Reporters constantly receive story ideas, and repeated attempts to gain media coverage can backfire. When you contact reporters, be sure you have an idea they might be interested in—and make their job easier by providing them with all the information they need.

NEWS RELEASES

Much of the news that is printed or broadcast is from news releases. Your release may be the first—and perhaps only—information a reporter receives about your program. It should be written as if a reporter wrote it, because it may be printed or broadcast verbatim. Or a reporter may use only portions of the release or supplement it with additional information from you, your program partners, interviews with key people, or their own sources.

Here are some hints for writing a news release:

• Write a headline that sells the story.
• Prepare a lead paragraph with the five Ws— who, what, when, where, and why (or how).
• Incorporate accurate information from reputable sources, with the most important details in the first few paragraphs.
• Use quotations that bring the story to life from influential people in the community as well as participants. You might compose draft quotes that are approved by the people for whom the quotes are written. This is a fairly common procedure and may be preferred by the people being quoted.

In addition, prepare a professional-looking news release by:

• Keeping it to no more than two pages. You can provide additional material through fact sheets, interviews, etc.
• Presenting it on a letterhead with the name and phone number of your agency’s contact person.
• Proofing it to ensure that it is error-free.

SAMPLE:A RLINGTON , V IRGINIA ’S , H EARTS N’PARKS

This text from the Arlington, Virginia, program is an example of the kind of information you could use for your program’s flyer. Consider adding a logo or clip art to make your program’s flyer more colorful.

What is Hearts N’ Parks?

Hearts N’ Parks is an exciting new national program sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and the National Recreation and Park Association (NRPA). The goal of the program is to create model community-based programs to increase the number of children and adults who engage in heart-healthy behaviors.

Why Arlington?

Arlington County’s Department of Parks, Recreation and Community Resources is honored to be hand-selected as a pilot site. Arlington was selected because the NHLBI and the Surgeon General’s Office recognize the many ways that community parks and recreation programs positively affect the well-being of people. We are proud to offer programs that demonstrate Arlington as A Hearts N’ Parks Community!

What is the Arlington Department of Parks, Recreation and Community Resources doing to promote Hearts N’ Parks?

Kids in the elementary after school and playground camp programs, as

well as mature adults in the

senior adult programs,

are participating in more physical activities while learning about the importance of a heart healthy diet.

The Hearts N’ Parks logo will be found on trail maps, mile markers, and other promotional materials for programs and facilities that offer heart-healthy activities.

The Recreation and Leisure class catalog will promote

a series of heart-healthy classes in the fall of 2000.

SAMPLE:(C ONTINUED )

Thomas Jefferson Community Center and Barcroft Sport and Fitness Center will be flagship sites for Hearts N’ Parks,

offering a safe and affordable place to be active.

What can Arlingtonians do to promote heart-healthy behaviors?

These simple tips will help control body weight, prevent/control obesity, high blood pressure, and high cholesterol, which are major risk factors for cardiovascular disease:

• Get regular physical activity—You need to engage in only about 30 minutes of moderate-level activity, preferably, all days of the week.
• Choose a diet that is low in saturated and total fat and cholesterol.
• Follow an eating plan that balances caloric intake with your level of physical activity. This is the key to maintaining a healthy body weight, or even losing weight if you are overweight.

Where can I find more information about the Hearts N’ Parks program in Arlington?

Please call ___________________________ at __________________________________.

Where can I find more information about the Arlington County Department of Parks, Recreation and Community Resources?

For information about the Arlington County Department of Parks, Recreation and Community Resources, please visit our Web site at http://www.co.arlington.va.us. Pick up a copy of the latest Recreation and Leisure catalog at your local library or community center. Call 703-228-5920 to request information to be mailed.

GETTING STARTED

Messages

____At a staff meeting, expose people to the Hearts N’ Parks message and encourage them to take action according to their roles within the department.

Media

____Create or revise a list of media contact names and numbers.

____Identify media tools you’ll need—such as a media advisory, news releases, background sheets. Create a schedule, then draft and distribute these items.

____Set up a date and time for community officials to proclaim your community a Hearts N’ Parks Community, then arrange for media coverage.

MOVING FORWARD

Messages

____Change your messages by modifying program titles and descriptions.

____Form a small group of staff who are willing to identify internal opportunities for spreading the message and then do so.

Media

____Extend your reach by partnering with local organizations or businesses and promoting Hearts N’ Parks to their constituents.

____Think of different story ideas with a local angle or human interest approach and forward them to your media contacts. These should be targeted; do not send the same pitch letter to several media outlets.

____Expand your reach by contacting the people who write for the sports or lifestyle sections of local newspapers.

KEEPING THE BEAT

Messages

____Continue to tell your message; don’t assume that everyone has received it.

____Begin a new round of distributing information about the risks for CVD.

____Change your message to support people who have taken action and need to maintain this way of life.

Media

____Create a new special event or infuse a Hearts N’ Parks emphasis into an existing special event. Invite the media to cover the event and become involved.

____Check the NHLBI Web site and alert local media contacts to new findings. Provide them with a local angle if you can.

?

1 Why do we need to

involve the media? Media support is crucial because it provides a way to reach the people of

your community. Good media coverage?

can assist your program by attracting participants and outside partners.

2 What’s a good first step to

getting media exposure? Using the example in the resource guide, write a news release that highlights the major details of your program (date, time, place, purpose, who’s involved) and submit it to local newspapers and radio stations. When you submit the release,

invite the paper or radio station to send a?

reporter to your program’s launch.

3 ?

What if our efforts to generate publicity don’t result in a good turnout for the program? If you’ve tried all possible ways to inform your community (radio spots, news releases,

? contacting media, putting up posters,

handing out flyers, etc.), try encouraging participants to tell their friends and families about the program. Simple wordof-mouth tends to link people with shared interests. Also, find out how those

involved became aware of the program. ?

That should help you understand which communication methods are effective.

Whatever you do, don’t give up. Change

?

your approach if you have to—create a new slogan, make new posters, or hold a special event at a time when no other major events are happening.

?

?

P—P

Consider pursuing partnerships. One of the powerful aspects of Hearts N’ Parks is its potential to make the most of existing community resources AND to extend the reach of important information to your community. Partnering goes a long way toward making that a reality.

THE PARTNERSHIP ADVANTAGE

Partnering is powerful because it holds the potential for making things happen that:

• Could not have happened with one agency acting on its own
• Would not have happened as efficiently or successfully if partners had not joined together.

It’s never too soon to start thinking about partnering. Partners can be a big help to moving a project forward because they can provide:

• Access to a target audience you might not currently reach
• Greater credibility for your message or program
• Additional resources, either tangible or intangible
• Added expertise
• Potential cosponsorship of programs and events.

PARTNERSHIP POSSIBILITIES

Every community possesses a unique richness of resources. Explore the resources that might serve as possible partners in Hearts N’ Parks.

They might include:

• Public departments and agencies, such as health departments, school districts, police departments, fire departments, etc.
• Health-related agencies, hospitals, visiting nurses, emergency services
• Nonprofit agencies, YMCAs, Boys and Girls Clubs, local chapters of AARP
• Churches and religious groups
• Affiliates of national organizations— American Heart Association, American Cancer Society, etc.
• Private sector—grocery stores, sporting goods stores, fitness centers
• Neighborhood and community groups
• Service clubs, such as Rotary, Lions, etc.

The best prospective partners are those who share a common interest in your mission. Partners are those who can bring something to the process that you or other partners are not capable of providing.

Take a moment to:

• Brainstorm the names of individuals and agencies that might be interested in being a part of this effort.
• Think of organizations or groups you might not have been involved with previously, such as hospitals, grocery stores, the health department, or police and fire departments.
• Ask other staff or your current partners for additions to your potential partner list.

Most of the partnerships in North Carolina involved hospitals, healthcare and fitness centers, and health departments. There were also partnerships with local restaurants and businesses, police departments, a mayor’s council for substance abuse, and USA Tennis. A few examples:

• The Mecklenburg County Park and Recreation Department in Charlotte, operated many adult and youth programs, ranging in duration from 8 to 10 weeks. The “Walk for Life” senior walking program culminated with a walk in which participants tested their endurance by walking several miles from Charlotte to the local outlet mall. For the 1,800 youths involved in summer day camp programs, the department partnered with USA Tennis to focus on the health benefits of participating in lifelong sports like tennis. The youths participated in a healthy lunch program that challenged them to “go around the world in 80 days by sampling various cuisines.” Winners were awarded prizes and given coupons for active places to visit, such as bowling alleys and skating rinks. Sponsorship with local Subway sandwich shops was part of the Hearts N’ Parks partnering mix.
• The Winston-Salem Parks and Recreation Department partnered with the Wake Forest University Baptist Medical Center to provide blood pressure and cholesterol checks for adults in the “Healthy Strider” mall-walking program. The hospital used a storefront in the mall to provide walkers with healthy snacks and information. This program was 4 weeks long and had about 40 participants.
• The Smithfield Parks and Recreation Department established a partnership with the Johnston County Health Department and the Looking Good Fitness Center to provide a 6-week senior exercise program. The Health Department conducted blood pressure, cholesterol, and body fat screenings for participants. Participants were also given information about health, fitness, and nutrition as part of the Hearts N’ Parks program.
• In Raleigh, the summer Youth Basketball League, a joint venture of the Raleigh Police Department and the Raleigh Parks and Recreation Department, gave approximately 25 teens the opportunity to learn about health and fitness while having fun. Hearts N’ Parks provided an opportunity to include good nutrition and physical activity as part of the program with guest speakers, such as a personal trainer and a football player. The Parks and Recreation Department arranged for fruit and a healthy beverage to be served after basketball games through a partnership with the local bottling company.
• Lindsey Dunevant, Director of the Albemarle Parks and Recreation Department, called Karen Brown at the Stanley Memorial Hospital and received an enthusiastic “yes” to partnering before he attended the first Hearts N’ Parks meeting. These partners went on to develop a 1-month “Walk About” program for adults. The program included walks with health education professionals, screenings for blood pressure and blood glucose, stress management seminars, healthy eating classes, and strength training.

S IGNS OF S UCCESS ( CONTINUED )

• The Town of Fletcher Parks and Recreation Department partnered with a variety of community organizations to give day camp participants the opportunity to hear from experts in nutrition and exercise. Partners included a local fitness club, the Henderson County Partnership for Health, the American Red Cross, the Cooperative Extension Service, and the Henderson County Health Department. Partners and staff gave talks, conducted demonstrations, and led games, activities, and exercises that emphasized the importance of a heart-healthy lifestyle.
• The Madison-Mayodan Recreation Department teamed with a local restaurant that provided nutritional information about items on its menu to children in the Hearts N’ Parks program. The children ate at the restaurant, and staff used the nutritional information to talk about making healthy food choices when eating out.

GETTING STARTED video and suggested agenda for that first

Creating new relationships or reinforcing exist- meeting. ing partnerships can generate strong interest in

Hearts N’ Parks. But you can’t build upon this T

YPES OF PARTNERING OPPORTUNITIES

interest until you ask people to join you. There are lots of partnering opportunities, including: Be the change agent for healthy behavior in

your community and call a meeting to recruit the many valuable assets from within your community.

Communication: Information and insight sharing conducted formally at a monthly or annual meeting or informally through networking and phone trees. Be the one to: Coordination: Programs and services offered

• Mail a letter to potential partners explaining to either address an important community issue the program and asking about their interest. or avoid replication of services and resources. Be sure to include the Hearts N’ Parks information and fact sheets. Cooperation: Exchange of resources of some kind—building, staff, publicity, equipment, or
• Schedule a meeting with potential partners. access to different target groups. Be sure to make use of the Hearts N’ Parks

Resources to help you get started include:

• Additional Resources for Your Hearts N’ Parks Program (appendix D)
• Sample Invitation Letter with suggested enclosures (at the end of the chapter)
• Sample Agenda for Initial Meeting (at the end of the chapter)

There are steps and suggestions for creating and working with partners as follows:

• Involve representatives of partnering organizations as early as possible in the planning process.
• Provide them with the Hearts N’ Parks mission, strategies, and materials in a readily usable format.
• Give partners advance notice so they can rework their program schedules around the new initiatives.
• Determine what types of resources or assistance they might need; aside from just money, consider training, information, or other forms of assistance.
• Provide them with contacts and linkages to the NHLBI and the NRPA so they realize the potential value of Hearts N’ Parks for their organizations.
• Keep initial efforts manageable; don’t take on too much too soon.
• Create a way to gently remind people of their responsibilities.
• Develop a feedback mechanism so activities can stay on track and adjustments can be made quickly.

Collaboration: Usually a combination of programs. You should look at your programs to some or all of the above. The partners share find out if they have the following characteristics: information, communicate between them-

• All age groups selves, coordinate programs and efforts, and share resources and responsibility for addressing ■ Provide for men, women, and children the common purpose that brought them together.
• Are offered at various locations Now is a good time to decide who your partners
• Are offered at different days and times in Hearts N’ Parks may be and to determine
• Are affordable what types of partnering alternatives you will jointly pursue. ■ Provide ease of access to all
• Take account of the need for personal safety.

MOVING FORWARD

A twofold approach to making the most of existing resources includes a Program/Service Assessment and an Outcomes/Opportunity Action Framework.

The following checklist, Program/Service Assessment of Basic Elements and Offerings, can be completed by your agency and your partners. It will give you an initial picture of what is

happening or not happening in terms of heart-

Program/Service Assessment Before your agency and your partners decide to create new programs, you need to look at those

healthy behavior in your community. It will also serve as a good starting point for the next phase, when you identify desirable outcomes. currently being offered. Conduct a quick Remember that elements such as affordability, assessment of heart-healthy related offerings or ease of access, and perceived comfort and safeprograms that could incorporate such activities. ty levels need to be discussed. They cannot be Determine whether all aspects of heart-healthy addressed easily through a checklist. behavior are being addressed and that all members of the community have access to such

Step 1: Current Programs and Services Offered

11.

12.

13.

14.

15.

on the basis of which target groups and community locations are addressed by the programs listed in Step 1.

Be sure to classify the programs according to whether they focus on providing a heart-healthy activity or only have behavior. This chart allows you to see what elements you are including or missing. Some programs may be entered in more than one category.

Place an asterisk (*) by program name to indicate occasional programs.

Focus or Number Physical __________________ Activity

Children: Male Female

Teens: Male Female

Adults: Male Female

Seniors: Male Female

At-Risk Groups (specify)

_________

_________

Non-Participants (specify)

_________

_________

Location (specify areas or neighborhoods)

_________

_________

Heart-Healthy Physical Heart-Healthy Eating Activity Eating

The completion of this assessment is intended to identify desirable outcomes and opportunities for Hearts N’ Park initiatives. The Outcomes/Opportunity Action Framework form does just that. It serves as a framework to move forward.

Review the results of your assessment with your staff and your partners to identify gaps and duplications. By not replicating similar programs, you can save time, energy, and money. By offering programs at different times and locations for different groups of people, you may break through a number of other barriers as well.

People: Groups who do NOT have regular, ongoing opportunities for physical activity:

Groups who do NOT have regular, ongoing opportunities to learn about heart-healthy nutrition:

Groups who are at high risk for CVD and are not participating in current programs:

Programs: Successful programs with a heart-healthy focus that could be expanded to reach more people:

Programs with potential for adding or enhancing heart-healthy elements for current participants:

7070

Programs without a heart-healthy focus that could be expanded to include heart-healthy physical activity or information about a heart-healthy diet:

Heart-healthy information and strategies that are NOT sufficiently targeted and could be expanded: (check as many as apply)

Information: Importance of CVD Risk factors for CVD Personal role in reducing risk

Activity: Physical activity Heart-healthy eating

Opportunity/Action Areas:

Identify programs or services, existing or new, that present either an opportunity for motivating heart-healthy behavior or areas where new programs should be created.

Target Group Expansion of Existing Program Creation of New Program Program

71 71

As in any human interaction, misunderstandings can arise in partnerships. These may include:

Participation

• Participation dominated by one group or person
• Participation by partner(s) is unenthusiastic
• Attendance and involvement are sporadic

Personal

• Personality clashes or ideological differences among partners
• Inability to compromise
• Unrealistic expectations
• Real or perceived loss of authority by one or more partners

Philosophy

• Disagreements over values, methods, or actions
• Past history of differences
• Organizational policies do not lend themselves to cooperative efforts

Practicalities

• Activities or resources put too large a burden on one agency

If you acknowledge these challenges and address them, chances of long-lasting partnering are increased.

MOVING TO ACTION Two techniques for keeping partnership projects on track include a Partnership Plan and a Tracking Mechanism.

Partnership Project Plan How formal and official you choose to be may relate to the size of the cooperative effort or the needs of the various partners. Use the

following guidelines and information to create A partnership plan enables all participants this plan. to agree on the specifics of the project; a tracking mechanism provides a way to monitor achievement of goals.

Overall Purpose of Hearts N’ Parks Partnering:

To bring together existing community resources and assets to improve the overall health and quality of life for residents of the community through increased information and access to physical activity and healthy eating.

Brief Description of Cooperative Program or Project:

Participating Partners (list names of all involved):

Desired Outcome(s) of the Program/Project (can include a focus on a particular group or set of information or behavior):

1.

2.

3.

Major Activities/Action Needed for Program/Project:

1.

2.

3.

4.

5.

6.

73 73

Needed Resources: Partner(s) Providing the Resource:

Access to People

Training

Communication

Expertise

Facility

Funding

Staff

Actions for Implementation:

Action/Step By Whom By When How Tracked

1.

2.

3.

4.

5.

6.

Name of Project:

Proposed Action Steps (include proposed completion date):

1.

2.

3.

4.

5.

6.

Please take a few moments and reflect as to how these specific activities or actions related to your Hearts N’ Parks project are progressing. Consider the categories below in describing the progress of these activities:

Tow Truck- “Stalled, no movement”

Snail- “Moving at a very slow pace”

Car in Motion- Rocket Ship- “Moving right along” “Really taking off”

Once you select the appropriate visual category, see if you can detect the underlying reason or cause for either the challenge or success of this part of the project. On the basis of that identification, please describe a suggested action.

1. Needed Action Step #1 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

1. Needed Action Step #2 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

1. Needed Action Step #3 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

1. Needed Action Step #4 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

1. Needed Action Step #5 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

1. Needed Action Step #6 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

Partnering is truly a group venture and the unofficial guidelines for group dynamics suggest that there are four phases of group behavior as follows:

• Forming—coming together
• Norming—establishing a framework
• Storming—encountering difficulties and disagreements, and
• Performing—making the project come to life.

It is likely that your partnership experience will move through most, if not all, of these phases. Some suggestions for each of the phases include:

Forming

Make the most of your opportunity to be a community change agent. Make a list of all those who might be interested in the goals of Hearts N’ Parks and invite them to an initial meeting.

Helpful Hints:

• Try to include all potential partners at the first meeting.
• Send out information on Hearts N’ Parks before the first meeting.
• Have a written agenda and a list of desired outcomes for the first meeting.

Norming

Allow time for the individuals representing the various partners time to get to know one another. The more everyone understands the mission and strengths and different approaches of members of the group, the better.

Helpful Hints:

• Move the location of the meetings around to each of the partners to provide a sense of ownership and inclusion.
• Try to involve all members of the group so as to not overshadow or leave out those who are less vocal or direct than others.
• Take the time to work out the ways in which the group wants to communicate with one another and function as a group.

Storming

This is potentially the most important phase. Disagreements are bound to arise. If addressed, working through this phase can improve the final outcome.

Helpful Hints:

• Refer partners to the original plan and see if changes or adjustments are in order; don’t blame when you can reframe.
• Have a concise agenda and planned outcomes for each meeting so members don’t get sidetracked.
• Use a tracking mechanism to address problems and offer suggested alternatives.

Performing

When moving from planning to action, be sure that all partners are clear about the goals of the project and the role they will play. Since you are likely to have media coverage at this point, be sure to recognize the roles, involvement, and impact of your partners.

GETTING STARTED

____Review list of current and past partners for possible involvement with Hearts N’ Parks.

____Ask staff and current partners to suggest names of possible partners.

____Set a date for initial meeting and invite potential partners to attend.

____Hold initial meeting and determine level of interest and possible involvement.

MOVING FORWARD

____At second meeting, expand the number of partners and garner a more definite level of support; suggest conducting an assessment to determine areas of possible cooperation.

____At the third meeting, review the assessment to determine program or service opportunities.

____Decide upon one or more specific partnering ventures, such as joint staff training, cosponsoring a special event, etc.

____Agree on partnership plan.

KEEP THE BEAT

____Plan methods of communication and networking.

____Update the tracking mechanism regularly.

____Remind yourself and your partners to acknowledge challenges or difficulties right away so that they can be addressed.

____Make a strong effort to thank and give recognition to Hearts N’ Parks partners.

____Review the success of initial partnerships and plan additional partnerships.

Date

Name of Contact Person

Organization

Address

Dear __________:

Our department is involved in a Hearts N’ Parks program sponsored by the National Heart, Lung, and Blood Institute of the National Institutes of Health and the National Recreation and Park Association. The purpose of the program is to improve the overall health and quality of life of our community by promoting heart-healthy eating and physical activity.

A major component of the program is effective and efficient use of community resources. Recognizing your organization’s involvement in the community, we would like to invite you to learn more about this program and to explore the possibility of collaborating with us to achieve these goals.

A number of organizations and agencies within our community are being invited to attend a meeting on Date and Time Location

We hope that you or a representative from your organization can attend.

Enclosed is a fact sheet about “Hearts N’ Parks” as well as “Health Statistics About Cardiovascular Disease.” If you have any questions, please give me a call at (fill in your phone number). We look forward to seeing you at the meeting.

Sincerely,

(department head, if possible or appropriate)

1. Self Introductions of Participants and Organizations Represented

(program coordinator)

• Expanded purpose of program

Examples of activities from North Carolina and Arlington pilot sites

• Use of new and existing programs and services

1. Roles in Partnership

• Communication
• Coordination
• Cooperation
• Collaboration

1. Where do we go from here? (group participation)

• Determine level of interest.
• Identify other potential partner suggestions.

Arrange next meeting date and time; invite potential partner to host.

• Identify information to be prepared for next meeting.

1. “On time” adjournment

1 Does a partnership have to be

approved by Hearts N’ Parks? No, but keep the NRPA and the NHLBI informed about who your partners are and

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how your program develops.

2 Can we enter into a partnership with

an organization whose purposes are not of a heart-healthy nature?

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Yes, but the reason for having a partnership is that partners will share resources and work together to promote each other’s programs. You don’t want to be in a partnership if it doesn’t benefit your program or sends the wrong message. Don’t run the risk of getting your message confused with that of a partner.

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Performance Indicators

P—P

Performance indicators are the hidden treasure of Hearts N’ Parks. At the end of the first season, the North Carolina professionals involved with Hearts N’ Parks said it was one of the biggest draws for their involvement with the project. Everything you need to gather performance indicators is included in the Community Mobilization Guide. This chapter and appendices A and B contain performance measures for children (less than 10 years old), adolescents (11–17 years old), and adults (more than 18 years old) that assess their knowledge, attitudes, and behaviors about physical activity, heart-healthy eating, and the risk factors related to coronary heart disease. We’ve also included directions for administering and scoring the measures.

Your ability to demonstrate the impact of your programs on the health of your community is a big plus. The Hearts N’ Parks program provides directions, model surveys, and plenty of suggestions to help you measure that impact.

Performance indicators enable you to:

• Document the factual results of your programs.
• Determine if your programs and services are making a difference to your community.
• Provide information for decision-makers, funding sources, and the public.
• Suggest how to improve your programs.
• Reinforce the efforts of staff.

TYPES OF INDICATORS

The Hearts N’ Parks program utilizes two types of performance measurements. The first type is the activity indicators that measure what has been done by the program: numbers of brochures distributed, programs sponsored, participants served. These are often tracked by age group, gender, and ethnicity. This involves tracking, for example, the number of people who received a fact sheet on how physical activity reduces the risk of CVD, sampled food at a healthy cooking demonstration, or attended the “How To Start a Walking Program” clinic.

Tracking of activity could also include other elements of Hearts N’ Parks, such as the number of community organizations attending an initial Hearts N’ Parks partners meeting or the number of news articles about Hearts N’ Parks in local newspapers.

Tracking Sheet for Activities

Number of M/F Age Number Activity Participants Ratio Group of Events

Number of Number of Number of Materials Number Articles/ Screenings Distributed of PSAs Interviews

The Sports Guide: NHLBI Planning Guide for Cardiovascular Risk Reduction Projects at Sporting Events.

Outcome indicators are the second type of measurement used in the Hearts N’ Parks program. These data demonstrate a program’s success in achieving important outcomes. While activity indicators keep track of “how many,” outcome indicators give us an understanding of “what happened.” Outcomes are the participant benefits that may be acquired during or after their involvement with a Hearts N’ Parks program.

As informative as activity indicators can be, they are not as meaningful as outcome indicators. There is a difference between a person who

picks up the “Achieving Your Healthy Weight Tip Sheet” and the person who actually loses weight.

Outcome indicators may include:

• The number of people who improved their knowledge about heart-healthy behavior.
• The percentage of people who changed their attitudes toward a healthy diet.
• The increase in the number of people who engage in the recommended amount of physical activity per week.

According to data collected at the North Carolina Hearts N’ Parks sites in Summer 1999, youth participants showed significant improvements in their knowledge about healthy eating and their intention to eat a healthier diet (7 percent and 9 percent improvements, respectively). Scores for healthy eating improved slightly.

Youth participants also indicated that, on average, they learned four new kinds of physical activity and got better at six different activities.

In the adult program, the biggest improvement occurred in healthy-eating habits, which improved by 6 percent. Improvement was also made in participants’ desire to follow dietary guidelines (a 5 percent increase). Adult participants also reported that, on average, they felt that they were in better health by the end of the program.

Collecting, tracking, and sharing these statistics as part of your Hearts N’ Parks initiative helps the NHLBI discover the effectiveness of park, recreation, and leisure-related community service agencies’ efforts in reaching people and building awareness for heart-healthy behavior.

Organizations such as yours benefit from:

• Enhanced recognition!
• Added credibility!
• The potential for new partnerships, sponsorships, and funding!

GETTING STARTED There are a number of things to think about and choices to be made in planning to conduct

program that lends itself to both the incorporation of heart-healthy activities and suitability for conducting pretests and posttests.

performance measurements. Consider selecting

People Considerations:

one youth program and one adult program for You might decide to measure whether the purposes of measurement until your department program changed the attitudes and behavior of, becomes more comfortable with the process. say, overweight males between the ages of 20 Decisions about the programs to be measured and 50. You might decide to use a group for can be based on a number of factors. whom you can easily secure permission for involvement in measurement or whose involve-

Program Considerations:

ment lends itself to the pretest and posttest A natural starting point might be to select a measurement schedule.

Appendix A contains the Program Design and Development Tracking Sheet. The following information moves through the decisions that need to be made.

CONDUCTING THE ASSESSMENT

You know at this point which programs are going to be measured. Make sure program staff incorporated heart-healthy elements into their scheduled program activities. Just take a few minutes to check these activities necessary to ensure the value of this process.

Selecting and Using Assessment Tools

Be sure to select assessment tools that are appropriate for the specific group whose outcomes are being measured. See the measures included in appendix A for guidance.

Example: Giving children a survey that they are unable to comprehend would influence the results OR giving people an instrument measuring knowledge of blood pressure when you want to measure food shopping habits would be useless.

Pretests and Posttests. To measure changes in knowledge, skills, attitudes, or behavior, it is necessary to measure them before the program starts and after the program ends. A second followup 6 months or after completion of the program, is of even greater value to see if changes continue over time.

Example: Youth enrolled in a summer camp program complete the Physical Activity pretest on the first day of camp and then the posttest on the last day of camp. OR participants in a senior exercise program complete the Food and Eating Habits survey during the first week of class and then again at the end of the 10 weeks.

Size of Sample. It is not necessary to survey all participants in a program. Select a manageable number to be surveyed who are representative of the program population. Suppose your

community has six after-school programs. Rather than survey all children in each program, survey 20 percent of the participants in each program or all participants in two of the six programs.

The Need for Consistency. The approaches and timing of the pretests and posttests should be as consistent as possible. Things you should try to keep the same include instructions to participants about completing surveys as well as the time and day if tests are administered to more than one group with similar members. If staff at one day camp helped children complete their food forms and staff at other day camps did not, the results may differ. If two groups of senior citizens are not given the test on the same day and the second group takes the test after a news story on heart disease, that too could change the results.

Tracking Participants. The tests track changes in knowledge, attitudes, and behaviors. Assign each individual a number to help ensure privacy; use the same number on both pretest and posttest.

Informed Consent. You must obtain the informed consent of participants in the tests. If your participants are under 18, you must seek informed consent from their parents.

Example: As part of the day camp registration parents were sent a letter indicating that their child would be part of this program, asked to sign a consent form and given a phone number to contact the department if they had any questions or objections. Adults are asked to sign a form indicating their understanding of what they will be asked to do as part of this process and their agreement.

In appendices A and B are several items to help you conduct assessments.

They include:

• Survey instruments: “What’s Your Food, Physical Activity and Heart Health I.Q.” for children, adolescents, and adults
• Answer keys for the surveys
• Score sheets for the surveys
• Log sheets to record participant identification numbers
• Tracking sheets
• Sample permission letter
• Sample permission form

The following are activities and resources that you might use as part of the programming aspect to help people better understand heart-healthy behavior.

Possible Outcomes:

• Increase their knowledge of leisure-time physical activity
• Increase their skill levels in leisure-time physical activity
• Improve their attitude towards physical activity
• Increase their level of physical activity
• Increase their knowledge of healthy eating
• Increase their skill level related to healthy eating
• Improve their attitude towards healthy eating
• Increase their level of healthy eating

Appropriate Reproducibles:

• See Resources chart, Information Sheets on page 49. These materials are found in the reproducible section of this guide.

Your department can take various steps to increase the accuracy of outcome measurements:

Program Group and Comparison Group. Outcomes measurement in community

recreation programs usually involves one group—for example, all adults who attend a swimming program.

To improve the accuracy of your assessment results, create a comparison group and involve one of those program groups in the heart-healthy information and activities. The other program group called the comparison group is not exposed to the healthy information and activities.

Example: Your department sponsors after-school programs at several local elementary schools. Some of the programs receive the special heart-healthy activities and some of them do not, but both groups take pretests and posttests.

Self-Selected Groups. Most participants in recreation programs are self-selected, meaning that they

themselves made the decision to become involved or, in the case of children, have parents who made that decision for them. This means that your measurements cannot necessarily be generalized to a larger population, such as all senior citizens or all Hispanic women.

Example: Teens who regularly show up at your department’s midnight basketball program may be different from other teens in the neighborhood who choose not to be a part of this program.

Random Selection. You can also improve the generalizability of your assessment by randomly selecting

the participants whose outcomes will be measured. In this way, participation in the program is determined by chance, ensuring that those tested are more representative of the larger population.

Example: Slips of paper with the names of 50 adults in a senior lunch program are placed in a bowl; the first 20 names randomly selected are invited to participate in a fitness program. If you can’t select participants randomly, you may be able to systematically select program sites. That will allow you to avoid selecting sites whose outcomes might bias the results because these sites are more conveniently located for participants or because more program staff members have a greater interest in operating the program.

Multiple Measures. Another way to boost the rigor of your assessment is to use all of the measures in

the sample surveys.

ANALYZING AND REPORTING RESULTS Instructions for administering and scoring your participants’ performance assessments are provided on pages 91 and 92. Answer keys and scoring sheets are found in appendix B.

After you’ve scored each individual test, add up the scores of all participants and divide by the number of participants. This will give you the average score for the group. It may help you to write all the scores on one page, total

them, then divide by the number of scores.

• Be sure that you’ve selected the right instruments—children, for example, should take tests designed for children in their age bracket.
• Be sure that you’ve selected the right scoring sheets.

DISPLAYING THE RESULTS

The scoring sections have been grouped according to knowledge, attitudes, and behaviors regarding healthy eating and physical activity. Why not create related posters or trifold bulletin boards?

• After you’ve scored the pretests, display the group scores on a bulletin board and challenge participants to improve their scores when they take the posttest.
• After you’ve scored the posttests, display the scores next to the pretest scores.
• Congratulate participants and site personnel on a job well done if scores improve, even if the improvement is small.
• If you don’t see improvement at posttest, check your scoring. Maybe you’ve made a simple error. If not, encourage participants to do better next time.

Utilize graphic resources in the guide or download clip art from the Web to highlight the scores.

Performance

Indicators

GETTING STARTED

____Ask program staff to use tracking sheets to record distribution of program information to participants and of activities engaged in by participants.

____During training, identify programs that will be involved in the performance measurement process.

____Hold training for staff who will be involved in performance measurement.

____Determine the elements to be measured in each program so the programs can be planned accordingly.

MOVING FORWARD

____Develop program schedules that include adequate time for pretests and posttests.

____Coordinate the program schedule and the pretest and posttest dates with the presentation of information and activities that are being measured.

____Appoint someone to make sure that program activities and testing schedule stay on target.

____Hold an orientation meeting for staff who will deliver the program and administer the pretest and posttest.

____Appoint someone to be responsible for analysis of the tests.

____Ask that information on program implementation be forwarded to the program coordinator so it can be shared with staff, partners, and the NHLBI.

KEEP THE BEAT

____Use the information from measurement indicators to create greater visibility for your efforts and to make program modifications.

____Identify other programs or services whose outcomes will be measured.

____Share results of measurement indicators with staff, partners, decision-makers, the media, and the public.

OUTLINE OF STAFF TRAINING FOR

People Involved: Program supervisors and other staff whose programs have been selected for outcomes measurement.

Time Allotted: 2 hours

Goals:

1. Create an understanding of the performance measurement process and its elements.
2. Review the measurement instruments.
3. Identify informational materials and program activities that support program goals and desired outcomes.
4. Address questions and concerns.

Materials and Resources (Appendix A):

• Pretest and posttests (appendix A)
• Permission letters/forms (appendix A)
• Program Design and Development Tracking Sheet (appendix A)
• Directions (“Recommendations for Administering the Pretests and Posttests” is a good resource for staff training.) (pages 91 and 92)

Overheads or Handouts:

• FAQ—activity and outcome indicators (at the end of this chapter, page 93)
• Program Design and Development Tracking Sheet (appendix A)
• “Conducting the Assessment” (this chapter, page 84)
• “Do You Know?” information boxes (this chapter, page 86)

Suggested Topics and Activities:

Overview of Outcomes Measurement Process (45 minutes):

• Why outcomes
• Difference between activity measures and outcomes measures
• Measurement requirements
• Improving the accuracy of the results

OUTLINE OF STAFF TRAINING FOR

Staff Tasks (45 minutes):

• Permission letters and forms
• Tracking sheets
• Timing of pretest and posttest
• Directions for conducting tests
• Identify or reinforce the program activities that relate to the outcomes being measured

Break (10 minutes):

Creating a program and schedule (40 minutes):

• Selecting appropriate information
• Designing and delivery of activities and exercises
• Coordinating activities and testing

Role play test administration (10 minutes):

• Read instructions
• Pass out materials
• Take the tests

Questions, Comments, Suggestions (10 minutes)

DMINISTERING

1. It is important to administer pretests before the program begins.

You should allow about 45 minutes for a group to complete the questionnaire. It is also important that adult participants not consult one another, and that children not share answers. Try to find a place for the assessment that is quiet and allows a reasonable amount of space between participants.

If you do not want to conduct a single 45-minute assessment, administer sections of the questionnaire at separate times for, say, 20 minutes each (for example, nutrition section one day, physical activity the next). If you do so, make sure that all sections are completed within a few days. Don’t let the time between the start and finish of a test span more than a week.

1. Emphasize to participants that the purpose of questionnaires is not to evaluate them personally.

Explain that their identities and answers will remain confidential and that the results will be displayed only as group results. Try not to refer to them as “tests.”

1. Use a log sheet to keep track of every person who completes a pretest and posttest.

It is important to evaluate participants by matching pretest and posttest results. Assign IDs that are consistent in format and anonymous for each test-taker. A Hearts N’ Parks log sheet is provided to keep track of participants’ names and IDs (so that you can be sure to match up names and numbers for pretest and posttest). Keep this log sheet private.

1. If administering a questionnaire becomes unmanageable because of the number of participants, you may be better off using a small sample.

If possible, let the sample consist of 40 to 50 test-takers per age group.

If you decide to select a sample, you have a few choices:

If you administer multiple programs, select one with a sufficient number of participants (more than 20) to take part in the pretest and posttest.

You can create a random sample by having all participants pick numbers out of a hat to determine which ones will complete the instruments. Make sure that the same people selected for the pretest are the ones who take the program posttest. (Don’t do a separate hat drawing for the posttest.)

If your program is small (less than 30 in an age group), it is important to have every participant complete a pretest and posttest.

1. Note the ID blanks on the first page of the tests and make sure cover sheets are attached to questionnaires.

The cover sheet indicates whether the test is to be taken before the program begins or after it ends. Participants’ IDs are to be written on these sheets so that pretests and posttests can be matched up.

The pretest and posttest formats for the adult and adolescent tests are identical, but different cover sheets are provided (to distinguish the adults’ and adolescents’ questionnaires as pretests or posttests). Attach the appropriate cover sheet.

Children’s pretests and posttests are slightly different in format so the pretests and posttests have a different cover sheet.

Using different colors of paper for the pretest and posttest can help prevent mix-ups.

1. If you conducted a program that did not discuss the causes of high blood pressure or how to control high cholesterol, participants need not complete those sections of the pretest and posttest.

RECOMMENDATIONS FOR ADMINISTERING HEARTS N’ PARKS

7. Scoring and Displaying Group Scores. Score sheets and answer keys are provided for each type of questionnaire. Follow the directions on the score sheets and use the answer keys to record test scores. Add the scores together for everyone in the same group, and

then divide by the number of test-takers to determine the group’s mean score on each section. You may break down scores by section to focus on knowledge, attitude, behavior, etc., or to look specifically at heart-healthy eating or physical activity.

Example: Adolescent Questionnaires—Participants’ Scores

Nutrition knowledge scores: 7+7+6+10+11+9+9+8+12+9= 88 ÷ 10=8.8 Mean score for the group (n=10 participants) is 8.8 out of 12.

Overweight/obesity knowledge scores: 5+9+6+9+9+8+7+6+8+5=72 ÷ 10=7.2 Mean score for the group (n=10) is 7.2 out of 9.

Attitude toward healthy eating scores: 24+32+30+22+29+36+35+21+25+27=281 ÷ 10=28.1 Mean score for the group (n=10) is 28.1 out of 40.

Overweight/obesity attitude scores: 22+26+25+30+29+24+23+23+20+22=244 ÷ 10=24.4 Mean score for the group (n=10) is 24.4 out of 32.

Healthy eating behavior scores: 4+5+4+7+5+5+6+5+7+4=52 ÷ 10=5.2 Mean score for the group (n=10) is 5.2 out of 8.

Healthy eating intentions scores: 4+3+2+5+3+6+4+3+3+5=38 ÷ 10=3.8 Mean score for the group (n=10) is 3.8 out of 7.

Consider creating a display of group scores on a poster or bulletin board to highlight improvements made by participants in the program. Highlighting group improvements could serve

Do not display or discuss individual scores openly. However, if an individual asks about his/her scores, you should discuss them with him/her in private. to motivate participants toward continued good health.

1 What is the purpose of using the

performance measures and how would I use the information once I

got it? ?

Performance measures are the best way of tracking the progress of participants. A record of progress can be a good motivator for further progression and an indicator of program success to be shared with the program’s management and partners, as well as with the media. Likewise,

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quantitative performance measurements can be used as evidence of improvement to be displayed on fact sheets and posters that generate excitement about progress gained by participants in the community.

The success of the Hearts N’ Parks program, as well as your own specific program, relies heavily on the ability of the NRPA and the NHLBI to evaluate participants’

? development. These questionnaires help to

show not only how participants’ knowledge and habits have progressed, but also what specific parts of the program are in need of modification, and where some programs may need help relative to others.

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2 What if I don’t have time to have my

participants fill out questionnaires?

The central purpose of the program is to help people learn how to live more hearthealthy lives, not to take questionnaires. Program coordinators should schedule time for filling out questionnaires so that valuable learning and activity times are not missed for the sake of completing the questionnaires.

3 How are activity indicators different

from outcome indicators?

An activity indicator refers to Hearts N’ Parks activities conducted by your department.

An outcome indicator measures the impact of these activities on participants.

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Celebrating & Sharing

ELEBRATING AND

We urge you to take advantage of the guidance, recommendations, and examples in this guide. It will be a valuable tool for both establishing and maintaining a successful Hearts N’ Parks program. Refer to it often and make copies of it for your staff.

This chapter provides recommendations for celebrating the completion of your first Hearts N’ Parks program, ways of sharing the program’s accomplishments with partners and the community, and suggestions for sustaining the program in the future.

CELEBRATING

Completing the Hearts N’ Parks program at your agency deserves recognition. Enjoy a job well done! Take the time to celebrate everyone’s contributions, progress, and successes (including your own). Also, remember to celebrate what you’ve learned and the challenges you’ve met during the program. Participants, program staff, and partners all deserve recognition.

• A closing get-together or wrap-up event is a great way to celebrate and applaud the efforts and accomplishments of your three principal groups: participants, program staff, and partners.
• Participants: Encourage invitees to bring along family members and friends. Have a heart-healthy potluck feast. Pass out honorary stars or ribbons to kids, and pins to adults, as a way of praising the efforts of all participants.
• Personnel: Let them know that their contributions were valuable. Award certificates of appreciation. Consider creating an entertaining video diary of Hearts N’ Parks Behind the Scenes to show at the wrap-up event.
• Partners: Express your appreciation to your partners. Thank them personally and in writing for their support. Encourage them to stay involved so that the program can grow and improve over time.
• Throughout the program, take photos of your participants, program staff, and partners in action. Then post the photos to provide recognition of their commitment and service. This type of postprogram promotion can help sustain interest in and awareness of the program and its lessons before the next program begins.

SHARING

Sharing the program’s achievements is an important way of forming and sustaining a positive perception of the program, enabling it to flourish in the long term.

• Media: Sharing program achievements with the media is a very important task. Contact media outlets to let them know the program has been completed. If they provided any news about your program when it began, they will probably be interested in doing a followup piece. Discuss with them the highlights of your program, how many participants you had, and what types of achievements were made. Consider telling them about some aspect of the program or providing an anecdote that would make an interesting news story.
• Focus Groups: Conduct an informal “focus group” of participants, partners, and staff to share thoughts about the program. Encourage everyone to tell about their experiences with the program. Keep the mood upbeat, but don’t be shy about discussing challenges that came up. Solicit suggestions about how the program can be improved.
• Displays: Create a display piece that chronicles the program with photos and highlights along with information about when it will take place again. Place the display where members of the community will see it, such as your community center’s entrance or on a community bulletin board at a store, college, or public library.
• Followup: Update interested parties on program activities and participant progress. Remember to highlight their contributions to the program.
• Contact the families of participants to let them know how much you appreciated getting to know their family member and to share the program’s activities. Express the hope that they will continue to be involved in the program and will encourage others to join.
• If you had a partner organization or program, send a letter of appreciation to its president or chairperson. If the recent partnership was successful, express willingness to work together in the future. Make a few suggestions about possibilities and let them know that you’re willing to help out.
• Acknowledge the contribution of your agency’s director or senior management. Their support and interest are necessary to maintain the program. Share the results of performance assessments with partners, program staff, participants, and the community, if you can. Changes measured by these tests will help everyone feel proud of the program. It will also raise the visibility of your agency.
• Refer to 3rd P—Public Visibility for suggestions about “moving the messages.” See how you can employ these ideas to share the Hearts N’ Parks message with community members who are not yet involved with the program.

Celebrating and sharing are important conclusions to your Hearts N’ Parks program. Afterward, take a breather. Enjoy your success, but remember that Hearts N’ Parks is an ongoing pursuit for your agency as well as your community.

SUSTAINING

Sustaining is the final piece of Hearts N’ Parks. Because you’ve designed the program based on your community’s needs and your agency’s abilities, continuing it will be easy. To keep participants, program staff, and partners interested, use the suggested tools to change, expand, and improve the program.

• Use performance assessments as a tool for evaluating and improving your program. They provide the means by which Hearts N’ Parks officials at both local and national levels can identify shortcomings and overcome them, as well as bring successes to light. This kind of evidence allows you to promote Hearts N’ Parks as an effective long-term program for making your community more heart-healthy.
• Solicit feedback from everyone involved about continuing the program. How would they do it? What would they change? What new activities could be incorporated into the program? Do they have ideas about reaching a new audience? Once you’ve solicited feedback, ask them for help to enact their ideas and suggestions.
• Be visible in your community. March in community parades. Offer to speak about the program at schools and club meetings.
• Take on the challenge of a new program. Once you’ve finished your first Hearts N’ Parks program, consider making changes to it. Not only will this help you reach a new group of participants, it will also keep your current participants, program staff, and partners motivated.

Remember that the goal of Hearts N’ Parks is to increase the number of children and adults who engage in heart-healthy behavior. Cardiovascular disease is the #1 killer in the United States, and lifestyle changes incorporating heart-healthy behavior are the most important step toward prevention.

Heart-healthy behavior can prevent the development of cardiovascular disease and reduce its severity for those who already have it. Heart-healthy behavior includes a diet low in calories, saturated fat, cholesterol, and sodium, and rich in fruits and vegetables, low-fat dairy foods, and whole grains in combination with regular physical activity.

Hearts N’ Parks provides the tools to get the heart-healthy message out to those want to hear it and those who need to hear it. The program’s ideas and suggestions are designed to be easy to implement and fun to do. Use these tools and share them with your colleagues.

Program Design and Development: Tracking Sheet...to record information about

each of your Hearts N’ Parks programs.

Log Sheet...to assign and track participants’

identification numbers.

Consent Forms...to inform parents and other

participants of the program’s intent.

Performance Questionnaires...to assess

changes in knowledge, attitudes, and practices regarding heart-healthy eating and physical activity of children, adolescents, and adults.

• Prequestionnaires are used to measure baseline information of participants before the program begins.
• Postquestionnaires are used to measure any changes possibly due to the program’s content.

(See directions on reverse side.)

a

How to use the

Performance Questionnaires

The questionnaires are grouped by age first, postquestionnaires.

For example:

ID__________ DATE__________

Child PREQUESTIONNAIRE

W H AT ’ S YOUR

food, physical activity,

1 Child &heart health

Things I like and thingsI do

1. Give one copy of the prequestionnaire What kinds of things do you like to do or would like to learn how to do?For each of the activities below, please put check marks (√) to let us know if:

. This is something you LIKE to do.This is something YOU’VE DONE in the past week. . This is something you would like to LEARN how to do.

to each participant prior to beginning the I like todo this I’ve donethis in thepast week I would like tolearn how todo this

Games (tag, hopscotch, 4-square, dodgeball,kickball, etc.)

Exercises (jumping jacks, running, etc.) Child A-13

program. Jump Rope

Basketball

Football

Soccer

1. Give one copy of the postquestionnaire Softball/ Baseball

Volleyball

Swimming

after completing the program. Tennis

Biking

Bowling

Dancing

Roller-skating, Roller-blading, Skateboarding

Child A-21

2 Adolescent and Adult

For adolescents and adults, the pre- and postquestionnaires are identical. Therefore, only ID__________ DATE__________

ID__________ DATE__________

Child POSTID__________QUESTIONNAIREDATE__________

W H AT ’ S YOUR

food, physical activity,

&heart health,

Things

I learnedanddid this summer

What kinds of things have you been doing with parks and recreation?For each of the activities below, please put check marks () to let us know if:

.This is something NEW you LEARNED here at parks and recreation.This is something you GOT BETTER at during your time with parks and recreation. .This is something you’d like to PLAY AGAIN after your parks and recreation time is over.

new I learnedSomething I got betterat this I would liketo play this again

Games (tag, hopscotch, 4-square, dodgeball,kickball, etc.) Child A-25

Exercises (jumping jacks, running, etc.)

Jump Rope

Basketball

Football

Soccer

Softball/ Baseball

Volleyball

Swimming

Tennis

Biking

Bowling

Dancing

Roller-skating, Roller-blading, Skateboarding

Child A-33

ID__________ DATE__________

QUESTIONNAIRE

appropriate pre- and postquestionnaire cover sheets. W H AT ’ S YOUR

food, physical activity,

&heart health

At the beginning of your program, assess the performance of adolescents and adults by doing the following:

1. Reproduce the questionnaire and use the prequestionnaire cover sheet.
2. Give one copy of the prequestionnaire to each participant.

At the end of your program, assess changes by doing the following:

1. Reproduce the same questionnaire and use the postquestionnaire cover sheet.

2.Give one copy of the postquestionnaire to each participant completing the program

Please refer to the Community Mobilization Guide: 5th P for more information on how to administer Performance Indicator Instruments.

A-2

Adolescent POSTQUESTIONNAIRE

W H AT ’ S YOUR

food, physical activity,

&heart health

Adolescent A-37 Adolescent A-39

Heart-healthyeating

Please answer each of the following questions by circling your answer.Mark only one answer for each question.

1. Joe ate cereal with milk and a banana and drank orange juice for breakfast.How many different food groups did Joe eat from?

1 2 3 4 Don’t Know

1. What is a “balanced diet”?
2. Eating lots of fruit and vegetables
3. Eating the same foods every day
4. Eating the exact same amount of food from each food group
5. Eating different foods from all the food groups
6. If you want to eat more fruit, which of the following would you choose?
7. Orange soda
8. Grape jelly
9. A banana
10. Strawberry ice cream
11. From which food group should you eat the most servings a day?
12. Bread, cereal, rice, and pasta
13. Meat, poultry, fish, eggs, dry beans, and nuts
14. Vegetable
15. Fruit

Adolescent A-41

PROGRAM DESIGN & DEVELOPMENT

Tracking Sheet

Use this tracking sheet to record information about each one of the Hearts N’ Parks programs that uses performance indicators.

Site Name and Location: _______________________________________________________________________

Program Name: _____________________________________________________________________________

If you are running multiple programs under a common name, please specify which one this is:

_______________________________________________________________________________________________________

1. Number of participants at start of program: ____________ Start Date: _______________
2. Number of participants at completion: ____________ Completion Date: _____________
3. Total length of program (in weeks and days): ____________

Names and Date(s) of Pretest:__________________________________________________________

_________________________________________

_________________________________________

Names and Date(s) of Posttest:_________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

1. How many days per week did your program run? ____________
2. How many hours per day did it run on average? ____________

A-3

A-1

1. People Served: (check all that apply)

____ Children

____ Young Adults

____ Older Adults

____ Adolescents

____ Adults

____ At-Risk Group (specify): ______________________ ____ Special Population (specify): ___________________________________________________

Approximate Numbers: Male ____ Female ____

1. Permission Secured:

Parental information letter________________________________________________________

Participant release form _________________________________________________________

Other: _______________________________________________________________________

1. Recreational Objectives: (based upon your department or program goals)

a.________________________________________________________________________________ b.________________________________________________________________________________ c.________________________________________________________________________________

1. Target Areas:

____ Physical Activity ____ Nutrition ____ Both

1. Change Level: (please check all that apply)

____ Knowledge ____ Skill ____ Attitude ____ Behavior

1. Outcomes - On the basis of the decisions made above, please select the appropriate outcomes:

____ Increase participants’ knowledge of leisure-time physical activity

____ Increase participants’ skill levels in leisure-time physical activity

____ Improve participants’ attitudes towards physical activity

____ Increase participants’ levels of physical activity

____ Increase participants’ knowledge of healthy eating

____ Increase participants’ skill levels related to healthy eating

____ Improve participants’ attitudes towards healthy eating

____ Increase participants’ level of healthy eating

A-4

1. Specific Program Activities Designed to Support the Outcomes:

a._______________________________________________ Date:_______________________

b._______________________________________________ Date:_______________________

c._______________________________________________ Date:_______________________

d._______________________________________________ Date:_______________________

e._______________________________________________ Date:_______________________

1. _______________________________________________ Date:_______________________

g._______________________________________________ Date:_______________________

h._______________________________________________ Date:_______________________

1. How many coordinators helped run the program? ______
2. Program/Testing Coordination:

Staff Orientation & Training for Program Activities Date(s): _________________________ By whom: _________________________

Staff Orientation & Training for Pre- and Posttesting Date(s): _________________________ By whom: _________________________

1. Please list the different types of materials (i.e., educational, instructional, and activity-based materials) used in your program or distributed to participants:

a.___________________________________________________________________________

b.___________________________________________________________________________

c.___________________________________________________________________________

d.___________________________________________________________________________

e.___________________________________________________________________________

1. ___________________________________________________________________________

g.___________________________________________________________________________

h.___________________________________________________________________________

A-5

A-6

PARTICIPANT

Log Sheet

Use this sheet to assign and track participants’ identification numbers. Using identification numbers rather than names will ensure participant confidentiality.

Site: ______________________________________________________________________________

Date: __________________ Group : ________________ Leader : _____________________________

ID Name ID Name

A-7

A-8

Introductory Letter

Send this letter home to parents of the children in your Hearts N’ Parks program. It will introduce Hearts N’ Parks and obtain both their support of the program as well as their permission for their child to participate.

[On Agency Letterhead]

DEAR PARENT,

Dear Parent,

SINCERELY,

Did you know that the prevalence of overweight and the trends in overweight for children and adolescents in the U.S. population is on the rise and is the highest it has

ever been? Did you know that recent data shows a decline in vigorous amounts of[NAME] physical activity in the nation’s youth? [TITLE] Participation in leisure time physical activity and changes in heart-healthy eating have[OFFICE]

the potential for improving the health and well-being of our children. To better meet this potential, the __________ [fill in the name of the department] has joined with the National Recreation and Park Association (NRPA) in cooperation with the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health to implement a Hearts N’ Parks program in our community.

As part of this process, your child will be asked to complete short quizzes from the NRPA with questions about heart-healthy behaviors and new physical activities they have learned during their recreation program with us. We welcome your cooperation with this project. If you have any questions or would like to learn more information about this project, please feel free to contact us at the Park and Recreation Department. Our project coordinator is ______________ [insert name] and can be reached at ___________ [insert phone number].

We have enclosed a permission slip for you to sign and return, allowing your child to participate in the Hearts N’ Parks program.

Thanks so much, and we look forward to providing your child with a safe, healthy, and fun experience.

Sincerely,

[Name] [Title] [Office]

A-9

Consent Form for Parents

Thank you for joining us in the Hearts N’ Parks program being conducted by the _______________ (name of site) in cooperation with the National Heart, Lung, and Blood Institute (NHLBI) and the National Recreation and Park Association (NRPA).

I, [your name] , understand that my child will be asked to answer questions related to his/her knowledge, attitudes, and behaviors regarding heart-healthy eating and physical activity. All of his/her answers will be kept confidential and his/her individual scores will not be reported to anyone. Only group scores will be used to gain some understanding of whether the Hearts N’ Parks program impacted the group’s knowledge, attitudes, or behaviors in regard to heart-healthy eating and physical activity. In addition, my child’s name will not appear on any of the tests that he/she completes.

I also understand that if my child is uncomfortable answering any of the questions, he/she is free to not answer them. Refusing to answer any questions will in no way affect my child’s participation in any of the programs.

______________________ ___________________

Signature Date

A-10

Consent Form for Adults

Thank you for joining us in the Hearts N’ Parks program being conducted by the _____________(name of site) in cooperation with the National Heart, Lung, and Blood Institute (NHLBI) and the National Recreation and Park Association (NRPA).

I, [your name] , understand that I will be asked to answer questions related to my knowledge, attitudes, and behaviors regarding heart-healthy habits of nutrition and physical activity. All of my answers will be kept confidential and my individual scores will not be reported to anyone. Only group scores will be used to gain some understanding of whether the Hearts N’ Parks program impacted my group’s knowledge, attitudes, or behaviors in regard to heart-healthy eating and physical activity. In addition, my name will not appear on any of the tests that I complete.

I also understand that if I am uncomfortable answering any of the questions, I am free to not answer them. Refusing to answer any questions will in no way affect my participation in any of the programs.

______________________ ___________________

Signature Date

A-11

A-12

ID__________ DATE__________

Child PREQUESTIONNAIRE

food, physical activity, heart health

&

Child A-13

Check the correct box!

1. Are you a...
2. Your age is...

A-14 Child

Boy or Girl ?

1. under 6 years old
2. 6 or 7 years old
3. 8 or 9 years old
4. 10 or 11 years old

Which food

is better for your health?

Instructions: Circle one of the two foods that you think is better for your health.

Child A-15

A-16 Child

Eggs and Bacon

Low-fat or Fat-free Milk

French Fries

Candy Bar

What foods

do you eat

most of the time?

Instructions: Circle one of the two foods that you eat most often.

Child A-17

A-18 Child

Sandwich with Lettuce & Tomato

Orange

Fresh Fruit Popsicle

Low-fat or Fat-free Milk

What would you do?

Instructions: Answer each question by choosing one of the two foods.

1. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

1. If you were going to eat your lunch, which would you do?

Eat the food without adding salt Shake salt on the food before eating

1. Which food would you put on your hamburger?

Ketchup Tomato

Child A-19

1. Which would you pick to drink?

Regular Milk

1. Which food would you eat for a snack?

Candy Bar

1. Which food would you choose for dinner?

Baked Potato

Low-fat or Fat-free Milk

Fresh Fruit

French Fries

1. Which would you order if you were going to eat at a fast food restaurant?

Hamburger

A-20 Child

Green Salad

and things

What kinds of things do you like to do or would like to learn how to do? For each of the activities below, please put check marks (

. This is something you LIKE to do. . This is something YOU’VE DONE in the past week. . This is something you would like to LEARN how to do.

I like to do this

Games (tag, hopscotch, 4-square, dodgeball, kickball, etc.)

Exercises (jumping jacks, running, etc.)

Jump Rope

Basketball

Football

Soccer

Softball/Baseball

Volleyball

Swimming

Tennis

Biking

Bowling

Dancing

Rollerskating, Rollerblading, Skateboarding

I’ve done this in the past week

I would like to learn how to do this

Child A-21

A-22 Child

Physical Activity and

You! ☺

Please circle your answers. Remember there are no right or wrong answers.

1. I would rather watch TV than play sports or be active.

Yes No Sometimes

1. People who play sports or are active seem to have a lot of fun doing it.

Yes No Sometimes

1. How do you feel about your ability to kick a ball hard and hit a target, like soccer?

☺ Great . Okay / Not Good

1. How do you feel about your ability to run a long way without stopping?

☺ Great . Okay / Not Good

1. How do you feel about your ability to hit a ball with a bat, like softball?

☺ Great . Okay / Not Good

1. How do you feel about your ability to play many different games and sports?

☺ Great . Okay / Not Good

Child A-23

A-24 Child

ID__________ DATE__________

ID__________ DATE__________

Child POSTQUESTIONNAIRE

food, physical activity, heart health

&

Child A-25

Check the correct box!

1. Are you a...
2. Your age is...

A-26 Child

Boy or Girl ?

1. Under 6 years old
2. 6 or 7 years old
3. 8 or 9 years old
4. 10 or 11 years old

Which food

is better for your health?

Instructions: Circle one of the two foods that you think is better for your health.

Child A-27

A-28 Child

Eggs and Bacon

Low-fat or Fat-free Milk

French Fries

Candy Bar

What foods

do you eat

most of the time?

Instructions: Circle one of the two foods that you eat most often.

Child A-29

A-30 Child

Sandwich with Lettuce & Tomato

Orange

Fresh Fruit Popsicle

Low-fat or Fat-free Milk

What wouldyou do?

Instructions: Answer each question by choosing one of the two foods.

1. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

1. If you were going to eat your lunch, which would you do?

Eat the food without adding salt Shake salt on the food before eating

1. Which food would you put on your hamburger?

Ketchup Tomato

Child A-31

1. Which would you pick to drink?

Regular Milk

1. Which food would you eat for a snack?

Candy Bar

1. Which food would you choose for dinner?

Baked Potato

Low-fat or Fat-free Milk

Fresh Fruit

French Fries

1. Which would you order if you were going to eat at a fast food restaurant?

Hamburger

A-32 Child

Green Salad

Things

I learnedanddid this summer

What kinds of things have you been doing with parks and recreation? For each of the activities below, please put check marks ( ) to let us know if:

.This is something NEW you LEARNED here at parks and recreation.

This is something you GOT BETTER at during your time with parks and recreation.

.This is something you’d like to PLAY AGAIN after your parks and recreation time is over.

Something I got better I would like to new I learned at this play this again

Games (tag, hopscotch, 4-square, dodgeball, kickball, etc.)

Exercises (jumping jacks, running, etc.)

Jump Rope

Basketball

Football

Soccer

Softball/Baseball

Volleyball

Swimming

Tennis

Biking

Bowling

Dancing

Rollerskating, Rollerblading, Skateboarding

Child A-33

A-34 Child

Physical Activity and

You! ☺☺

Please circle your answers. Remember there are no right or wrong answers.

1. I would rather watch TV than play sports or be active.

Yes No Sometimes

1. People who play sports or are active seem to have a lot of fun doing it.

Yes No Sometimes

1. How do you feel about your ability to kick a ball hard and hit a target, like soccer?

☺ Great . Okay / Not Good

1. How do you feel about your ability to run a long way without stopping?

☺ Great . Okay / Not Good

1. How do you feel about your ability to hit a ball with a bat, like softball?

☺ Great . Okay / Not Good

1. How do you feel about your ability to play many different games and sports?

☺ Great . Okay / Not Good

Child A-35

A-36 Child

ID__________ DATE__________

Adolescent PREQUESTIONNAIRE

food, physical activity, heart health

&

Adolescent A-37

A-38 Adolescent

ID__________ DATE__________

Adolescent POSTQUESTIONNAIRE

food, physical activity, heart health

&

Adolescent A-39

Check the correct box!

1. Are you a...
2. Your age is...

A-40 Adolescent

Boy or Girl ?

a.12 or 13 b.14 or 15 c.16 or 17 d.18 or over

Heart-healthyeating

Please answer each of the following questions by circling your answer. Mark only one answer for each question.

1. Joe ate cereal with milk and a banana and drank orange juice for breakfast. How many different food groups did Joe eat from?

1 2 3 4 Don’t Know

1. What is a “balanced diet”?
2. Eating lots of fruit and vegetables
3. Eating the same foods every day
4. Eating the exact same amount of food from each food group
5. Eating different foods from all the food groups
6. If you want to eat more fruit, which of the following would you choose?
7. Orange soda
8. Grape jelly
9. A banana
10. Strawberry ice cream
11. From which food group should you eat the most servings a day?
12. Bread, cereal, rice, and pasta
13. Meat, poultry, fish, eggs, dry beans, and nuts
14. Vegetable
15. Fruit

Adolescent A-41

1. Which food is better for your health?

For each question, cIrcle which one of the two foods is better for your health.

a. Doughnut b. Orange c. Whole Wheat Bread d. Cold Cereal e. Regular Milk f. Green Salad g. Grapes h. French Fries

Toast Cookies White Bread Eggs and Bacon Low-Fat or Fat-free Milk French Fries Candy Bar Baked Potato

1. Please indicate whether you think the following statements are true or false by circling T or F after each one.
2. Polyunsaturated fat has the same number of calories as saturated fat.
3. The single most important change most people can make to lose weight is to avoid sugar.
4. Being overweight puts you at risk for heart disease.
5. Lowering sodium or salt in the diet does not always lower high blood pressure to normal.
6. If you are overweight, losing weight helps lower your high blood cholesterol and high blood pressure.

True False

T

T

T

T

T

F

F

F

F

F

1. The best way to lose weight is to eat fewer calories and be physically active.
2. Overweight children are very likely to become overweight adults.
3. Skipping meals is a good way to cut down on calories.
4. Foods high in complex carbohydrates (starch and fiber) are good choices when you are trying to lose weight.

A-42 Adolescent

T

T

T

T

F

F

F

F

1. For this question, circle the answer that best describes your opinion of each of the following statements:
2. I like the taste of new foods.
3. I like having fruits around for snacks.
4. I like the taste of foods that are good for me.
5. I like to choose snacks lower in fat.
6. If I eat healthy every day...
7. My friends will like me.
8. My family will be proud of me.
9. My friends will want to eat over at my house.
10. My friends will start eating a healthy diet too.
11. I will enjoy eating as much as before.
12. I will have more energy than I do now.

Strongly Strongly Agree Agree Disagree Disagree

Strongly Strongly Agree Agree Disagree Disagree

Adolescent A-43

1. For the following statements about food and eating, please indicate whether you are in agreement or disagreement by circling your response in the appropriate box.

Strongly Agree Agree

1. With my schedule, it’s impossible to eat right. 1 2
2. There’s too much stress in my life for me to 1 2 handle managing my weight.
3. I just can’t let food go to waste. 1 2
4. I eat more when I’m alone than when I eat 1 2 around others.
5. When I’ve done something good, I reward 1 2 myself with food.

1. What foods do you eat most of the time? Circle which one of the two foods you eat most often.

a. Baked Potato b. Fruit Juice c. Cookies d. Hot Dog e. Chocolate Cake f. Ice Cream g. Sweet Roll h. Regular Milk

French Fries Soda Apple Sandwich with Lettuce and Tomato Orange Fresh Fruit Popsicle Whole Wheat Roll Low-fat or Fat-free Milk

A-44 Adolescent

Strongly Disagree Disagree

1. What would you do?

Answer each question by circling one of the two food choices.

1. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

1. If you were going to have lunch right now, which would you do?

Eat food without adding salt Shake salt on your food

1. Which food would you put on your hamburger?

Ketchup Tomato

1. Which would you pick to drink?

Regular Milk Low-fat or Fat-free Milk

1. Which food would you eat for a snack?

Candy Bar Fresh Fruit

1. Which food would you choose for dinner?

Baked potato French Fries

1. Which would you order if you were going to eat at a fast food restaurant?

Hamburger Salad

Adolescent A-45

A-46 Adolescent

Physical Activity

1. In the past week, how many days were you active for at least 20 minutes in sports activities that made you sweat and breathe hard, such as basketball, jogging, swimming laps, tennis, fast bicycling, or similar aerobic activities?

Record the number of days per week (0–7) in the space below.

____ days

1. In the past week, how many days did you do exercises to strengthen or tone your muscles, such as pushups, situps, or weight lifting?

Record the number of days per week (0–7) in the space below.

____ days

1. Which one of the following activities do you do the most from the time school gets out until you eat dinner?

Be sure to check only one.

___ Watch television

___ Play outside

___ Talk on the phone to friends

___ Read, but not for school

___ Work at a job

___ Cook

___ Play a sport or exercise

___ Do homework

___ Play video or computer games

___ Baby-sit children

___ Practice a musical instrument

___ None of the above

1. During the past 12 months, how many sports teams were you on (like a soccer or basketball team, but not including physical education or gym classes)?

____ teams

1. In general, do you think you get too much physical activity, not enough physical activity, or about the right amount of physical activity?

__ Too much ___ About right ___ Not enough

Adolescent A-47

A-48 Adolescent

ID__________ DATE__________

Adult PREQUESTIONNAIRE

food, physical activity, heart health

&

Adult A-49

A-50 Adult

ID__________ DATE__________

Adult POSTQUESTIONNAIRE

food, physical activity, heart health

&

Adult A-51

Please tell us a little about yourself.

Check the correct box!

1. Your gender: 1 - Male 2 - Female
2. What is your age group?

1 - Under 21 2 - 21 – 30 3 - 31 – 40 4 - 41 – 50 5 - 51 – 60 6 - 61 – 70 7 - Over 70

1. Are you...

1 - White 2 - African American or Black 3 - Hispanic 4 - Asian or Pacific Islander 5 - American Indian or Alaska Native 6 - Other (specify: _______________ )?

1. What is your highest level of education?

1 - Less than High School 2 - High School Graduate 3 - Some College 4 - College Degree 5 - Some Graduate School 6 - Graduate Degree

A-52 Adult

Heart-healthyeating

1. For each of the foods below, indicate if the item would count as a serving of a fruit or vegetable.

1. From which food group should you eat the most servings a day?

1 – Bread, cereal, rice, and pasta 2 – Vegetable 3 – Fruit 4 – Meat, poultry, fish, eggs, dry beans, and nuts 5 – Milk, yogurt, and cheese 0 – Don’t know

1. Which of these is the best choice for a low-fat diet? (circle just one)

1 – Whole milk 2 – Low-fat yogurt 3 – Cheese 4 – Fat-free milk 0 – Don’t know

1. Which is the best snack choice for a low-fat diet? (circle just one)

1 – Cookies 2 – Fruit roll-ups 3 – Pie 4 – Ice cream 0 – Don’t know

Adult A-53

1. Please indicate whether you think the following statements are true or false by circling T or F after each one.
2. Polyunsaturated fat has the same number of calories as saturated fat.
3. The single most important change most people can make to lose weight is to avoid sugar.
4. Being overweight puts you at risk for heart disease.
5. A reduced intake of sodium or salt does not always lower high blood pressure to normal.
6. If you are overweight, losing weight helps lower your high blood cholesterol and high blood pressure.
7. The best way to lose weight is to eat fewer calories and be physically active.
8. Overweight children are likely to become overweight adults.
9. Skipping meals is a good way to cut down on calories.
10. Foods high in complex carbohydrates (starch and fiber) are good choices when you are trying to lose weight.
11. To you personally, how important is each of the following choices? (Circle one on each line.)

Very Somewhat Important Important

1. Choosing a diet with plenty of breads, cereals, rice, and pasta. 4 3
2. Eating at least two servings of dairy products daily. 4 3

A-54 Adult

True

T

T

T

T

T

T

T

T

T

Not Too

False

F

F

F

F

F

F

F

F

F

Not at all

Important Important

1. Please indicate how much you tend to agree or disagree with each statement.
2. With my schedule, it’s impossible to eat right.
3. There’s too much stress in my life for me to handle managing my weight.
4. I just can’t let food go to waste.
5. I eat more when I’m alone than when I eat around others.
6. When I’ve done something good, I reward myself with food.
7. I eat more on the weekends.
8. If I’m craving food, my body must need it.
9. Some people are meant to be fat.

Strongly Strongly Agree Agree Disagree Disagree

1. Please indicate the term that most closely describes your habits when you eat the following foods. (Circle one on each line. If you do not eat any of the foods listed in an item circle “X”.)

Almost Always

1. Eat turkey bologna instead of regular bologna?
2. Use fat-free milk or 1% milk instead of 2% or whole milk
3. Eat low-fat cheeses when you eat cheese?
4. Eat ice milk, frozen yogurt, or sherbet instead of ice cream?
5. Use low-calorie instead of regular dressing?
6. Have fruit for dessert? 4
7. Eat fish or poultry instead of meat (e.g., beef, pork, or lamb)?

Some- Often times Rarely Never N/A

Adult A-55

A-56 Adult

Physical Activity

Moderate physical activity includes activities such as walking, gardening, and heavy house cleaning. For moderate activity to be regular, it must add up to a total of 30 or more minutes per day and be done at least 5 days per week. For example, you could take a 30-minute walk or take a 10- minute walk, rake leaves for 10 minutes, and climb up stairs for 10 minutes—adding up to a total of 30 minutes of time.

Please circle Yes if the statement applies to you, or No if it doesn’t.

1. I currently participate in moderate physical activity. Yes No
2. I intend to increase my participation in moderate physical activity in the next 6 months. Yes No
3. I currently engage in regular moderate physical activity. Yes No
4. I have been participating in moderate physical activity regularly for the past 6 months. Yes No
5. In the past, I have been regularly physically active in moderate activities for a period of at least 3 months. Yes No

For the following two statements, circle the number that corresponds to your answer.

1. During the past 7 days, how many times did you engage in physical activity to try to lose weight or keep from gaining weight?

1. On how many of the past 7 days did you do any kind of physical activity in a place such as a “Y”, sports league, dance class, recreational center, or any other community center?

0 – None

Adult A-57

1. How likely are you to say each of the following statements? (Circle one answer on each line)
2. I’m just too tired after work to engage in physical activity.
3. I’ve been thinking about being more physically active, but I just can’t seem to get started.
4. I’m getting older so physical activity can be risky.
5. I’m not physically active because I have never learned the skills for any sport.
6. I don’t have access to jogging trails, swimming pools, bike paths, etc.
7. Physical activity takes too much away from my other commitments – like work, family, etc.
8. I’m embarrassed about how I will look when I engage in physical activity with others.
9. It’s easier for me to find excuses not to be physically active than to go out and do something.
10. I really can’t see learning a new sport at my age.
11. My free time during the day is too short to include physical activity.
12. My usual social activities with family or friends do not include physical activity.
13. I’m too tired during the week and I need the weekend to catch up on my rest.
14. I’m afraid I might injure myself or have a heart attack.
15. If we had exercise facilities and showers at work, then I would be more likely to engage in physical activity.

A-58 Adult

Very Somewhat Somewhat Very Likely Likely Unlikely Unlikely

1. The following statements are either true or false. Please choose your response by circling T or F.
2. Regular physical activity can reduce your chances of getting heart disease.
3. It doesn’t take a lot of money or expensive equipment to become physically fit.
4. Exercise programs do not require a lot of time to be very effective.
5. You should always consult a doctor before starting a physical activity program.
6. There are many risks and injuries that can occur with exercise.
7. Most people get enough physical activity from their daily routine.
8. You don’t have to train like a marathon runner to become more physically fit.
9. People who need to lose some weight are the only ones who will benefit from regular physical activity.
10. The older you are, the less active you need to be.
11. People who have had a heart attack should not start any physical activity program.
12. All exercises give you the same benefits.
13. To help you stay physically active, include a variety of activities.

True

T

T

T

T

T

T

T

T

T

T

T

T

False

F

F

F

F

F

F

F

F

F

F

F

F

Adult A-59

1. Fit Score In the past 7 days, how much time did you spend on each of the following activities? Write in the number of hours for each one, rounding to the nearest half-hour (1/2, 1, 11/2). Add your totals for each day in the last row.

Activity Mon. Tues. Wed. Thurs. Fri. Sat. Sun.

Organized or Team Sports (e.g., basketball, tennis, racquetball, softball, etc.)

Bicycling

Dancing / Aerobics

Walking / Hiking

Golf

Heavy Household Chores

Pushups / Situps

Rollerskating / Blading

Jogging / Stairs / Treadmill

Snow Skiing (winter sports)

Swimming (water sports)

Bowling

Weightlifting

Other Physical Activities; Specify:_________________

DAILY TOTALS

FIT SCORE GRAND TOTAL: __________

1. Sit Score In the past 7 days, how much inactive time did you spend at work, reading, watching TV programs, using a home computer, or watching videotapes and movies on TV or in a theater? In each space, write the number of hours for each activity, rounding to the nearest half-hour. Add your totals at the bottom.

Mon. Tues. Wed. Thurs. Fri. Sat. Sun. At work (nonmanual labor)

Reading

Watching TV

Using the computer

Watching movies

DAILY TOTALS

SIT SCORE GRAND TOTAL: ___________

A-60 Adult

Possible causes of

high blood pressure

Listed below are some things that have been said are possible causes of high blood pressure (HBP). For each of those listed, please check whether you think it is a Cause or Not a Cause, or else check Not Sure.

Cause of HBP Not a Cause of HBP Not Sure

1. Being overweight
2. Heredity—it runs in the family
3. Eating too much salt
4. Race or ethnic group
5. Worrying, tension, strain
6. Eating fatty foods
7. Smoking
8. Drinking too much alcohol
9. Regular hard exercise
10. Being underweight
11. Being pregnant
12. Not getting enough exercise
13. Old age
14. Stress

Adult A-61

Actions

to control high blood c holesterol

Listed below are some actions that people might take to control high blood cholesterol. For each of these actions, please check whether it is an action that Would or Would Not Help control high blood cholesterol, or else check Not Sure.

Would Help Would Not Help Not Sure

1. Getting regular exercise
2. Eating less salt
3. Eating less sugar
4. Eating more soluble fiber
5. Using fat-free milk or low-fat dairy products
6. Eating less cheese
7. Eating fewer eggs
8. Eating more fish
9. Eating less sausage, bacon, and luncheon meats
10. Eating less saturated fat
11. Losing weight if you are overweight
12. Using soft or liquid margarine instead of butter

A-62 Adult

Answer Keys...to illustrate the correct answers,

shaded in gray, to the child, adolescent, and adult questionnaires

Scoring Sheets...to add up the total score

for the pre- and postquestionnaires of each child, adolescent, and adult participant. One sheet is used to score the participant’s prequestionnaire and another copy of the same sheet is used to score the postquestionnaire

B-1

b

B-2

Answer Key (PRE & POST)

Child QUESTIONNAIRE

food, physical activity, heart health

&

Child B-3

B-4 Child

• *Correct and positive answers are shaded in gray**

Which food is better for your health?

Toast

Cookies

White Bread

Eggs and Bacon

Low-fat or Fat-free Milk

French Fries

Candy Bar

What foods do you eat most of the time?

French Fries

Soda

Apple

Sandwich with Lettuce and Tomato

Orange

Fresh Fruit Popsicle

Low-fat or Fat-free Milk

Child B-5

What would you do? (INTENTION)

1. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

1. If you were going to eat your lunch, which would you do?

Eat the food without adding salt Shake salt on the food before eating

1. Which food would you put on your hamburger?

Ketchup Tomato

1. Which would you pick to drink?

Regular Milk Low-fat or fat-free milk

1. Which food would you eat for a snack?

Candy Bar Fresh Fruit

1. Which food would you choose for dinner?

Baked Potato French Fries

1. Which would you order if you were going to eat at a fast-food restaurant?

Hamburger Salad

B-6 Child

Things I like and things I do (PRETEST)

• *Record total check marks for each column in the score sheet. There are no right or wrong answers here.

Things I learned and did this summer (POSTTEST)

• *Record total check marks for each column in the score sheet. There are no right or wrong answers here.

Physical activity and you (ATTITUDE)

1. I would rather watch TV than play sports or be active.

Yes - 0 points No - 2 points Sometimes - 1 point

1. People who play sports or are active seem to have a lot of fun doing it.

Yes - 2 points No - 0 points Sometimes - 1 point

1. How do you feel about your ability to kick a ball hard and hit a target, like soccer?

Great - 2 points Okay - 1 point Not Good - 0 points

1. How do you feel about your ability to run a long way without stopping?

Great - 2 points Okay - 1 point Not Good - 0 points

1. How do you feel about your ability to hit a ball with a bat, like softball?

Great - 2 points Okay - 1 point Not Good - 0 points

1. How do you feel about your ability to play many different games and sports?

Great - 2 points Okay - 1 point Not Good - 0 points

Child B-7

ID#__________ DATE________

Pre Score

1. Gender:_____

Use one score sheet for each participant.

Give one point for each correct answer; and one or two points (as specified in Answer Key) for each ‘positive’ answer, i.e., an answer demonstrating healthy nutrition or physical activity. Consult answer key to complete this score sheet.

Knowledge

(Which Food Is Better For Your Health?)

4.

Knowledge Total: __________

Out of 7 possible points

Behavior Intention

(What Foods Do You (What Would You Do?) Eat Most of the Time?)

Attitude Things I Like and Things I Do

I like to I’ve done do this this in the past week

Out of 14 Out of 14

B-8 Child

(Physical Activity and You)

1. 4.

I would like to learn

1. 5.

how to do this 3. 6.

Attitude Total: _________

Out of 12 possible points Out of 14

ID#__________

DATE________

Sheet

1. Age Group:_____

Use one score sheet for each participant.

Give one point for each correct answer; and one or two points (as specified in Answer Key) for each ‘positive’ answer, i.e., an answer demonstrating healthy nutrition or physical activity. Consult answer key to complete this score sheet.

Knowledge (Which Food Is Better For Your Health?)

Behavior (What Foods Do You Eat Most of the Time?)

Things I Learned and

Intention

(What Would You Do?)

4.

Intention Total: __________

Out of 7 possible points

Attitude

(Physical Activity and You)

Did This Summer

1.

Something I would like I got better new I learned to play this

2.

at this again

3.

4.

5.

6.

Attitude Total:

Out of 12 possible points Out of 14 Out of 14 Out of 14

Child B-9

B-10 Child

Answer Key (PRE & POST)

Adolescent QUESTIONNAIRE

food, physical activity, heart health

&

Adolescent B-11

• *Correct and positive answers are shaded in gray**

Heart-healthy eating

1. Joe ate cereal with milk and a banana and drank orange juice for breakfast. How many different food groups did Joe eat from?

1 2 3 4 Don’t Know

1. What is a “balanced diet”?
2. Eating lots of fruit and vegetables
3. Eating the same foods every day
4. Eating the exact same amount of food from each food group
5. Eating different foods from all the food groups
6. If you want to eat more fruit, which of the following would you choose?
7. Orange soda
8. Grape jelly
9. A banana
10. Strawberry ice cream
11. From which food group should you eat the most servings a day?
12. Bread, cereal, rice, and pasta
13. Meat, poultry, fish, eggs, dry beans, and nuts
14. Vegetable
15. Fruit
16. Which food is better for your health?

a. Doughnut b. Orange c. Whole Wheat Bread d. Cold Cereal e. Regular Milk f. Green Salad g. Grapes h. French Fries

Toast Cookies White Bread Eggs and Bacon Low-fat or Fat-free Milk French Fries Candy Bar Baked Potato

B-12 Adolescent

1. Overweight/Obesity Knowledge

True False

1. Polyunsaturated fat has the same number of calories as saturated fat. T F
2. The single most important change most people can make to lose

weight is to avoid sugar. T F

1. Being overweight puts you at risk for heart disease. T F
2. Lowering sodium or salt in the diet does not always lower high blood

pressure to normal. T F

1. If you are overweight, losing weight helps lower your high blood

T F

cholesterol and high blood pressure.

1. The best way to lose weight is to eat fewer calories and be physically active. T F
2. Overweight children are very likely to become overweight adults. T F
3. Skipping meals is a good way to cut down on calories. T F
4. Foods high in complex carbohydrates (starch and fiber) are good choices

T F

when you are trying to lose weight.

For 9–11 below, use the number that is circled on the questionnaire to represent the number of points on the score sheet. Add up points of all answers in each section.

1. Attitude Toward Healthy Eating - Four Agree/Disagree Questions
2. Attitude Toward Healthy Eating: “If I eat a healthy diet every day...”— Six Agree/Disagree Questions
3. Overweight/Obesity Attitude - Eight Agree/Disagree Questions
4. What Foods Do You Eat Most Of The Time? (Eating Behavior)

Adolescent B-13

1. What Would You Do? (Eating/Intention)
2. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

1. If you were going to have lunch right now, which would you do?

Eat food without adding salt Shake salt on your food

1. Which food would you put on your hamburger?

Ketchup Tomato

1. Which would you pick to drink?

Regular Milk Low-fat or Fat-free Milk

1. Which food would you eat for a snack?

Candy Bar Fresh Fruit

1. Which food would you choose for dinner?

Baked Potato French Fries

1. Which would you order if you were going to eat at a fast food restaurant?

Hamburger Salad

B-14 Adolescent

Physical Activity

1. In the past week, how many days were you active for at least 20 minutes in sports activities...? (Between 0 - 7)

Give one point for an answer of 4 or more days

1. In the past week, how many days did you do exercises to strengthen or tone your muscles, such as pushups, situps, or weight-lifting?

Give one point for an answer of 4 or more days

1. Which of the following activities do you do the most from the time school gets out until you eat dinner?

One point for either answer: Play a sport or exercise Play outside

1. During the past 12 months, how many sports teams were you on?

0 teams - 0 points 1 team - 1 point 2 or more teams - 2 points

1. In general, do you think you get too much physical activity, not enough physical activity, or about the right amount of physical activity?

Too much - 0 points About right - 1 point Not enough - 0 points

Adolescent B-15

ID__________ DATE__________

Pre and Post Score

Personal: 1. Gender:_____ 2. Age Group:_____

Use one score sheet for each participant. Using the answer key as a guide, complete the score sheet by giving points for correct or ‘positive’ answers.

Heart-Healthy Eating

(1 pt each) (1-4 pts each)

7a. 7g. 8e. 10a. 10f. 11e.

7b. 7h. 11f.

11g.

11h.

Physical Activity

Level of Physical Activity

1. 2. 3. 4. 5.

POINT TOTAL:

6 possible

B-16 Adolescent

Healthy Healthy Eating Eating Behavior Intentions (1 pt each ) (1 pt each )

12h.

POINT

TOTAL:

8 possible

POINT

TOTAL:

7 possible

Answer Key (PRE & POST)

Adult QUESTIONNAIRE

food, physical activity, heart health

&

Adult B-17

• *Correct and positive answers are shaded in gray**

Heart-healthy eating

1. Serving of a fruit or vegetable?

Don’t Know

Don’t Know

Don’t Know

1. From which food group should you eat the most servings a day? 1 - Bread, cereal, rice, and pasta 2 - Vegetable 3 - Fruit 4 - Meat, poultry, fish, eggs, dry beans, and nuts 5 - Milk, yogurt, and cheese 0 - Don’t know

(circle just one) 1 - Whole milk 2 - Low-fat yogurt 3 - Cheese 4 - Fat-free milk 0 - Don’t Know

(circle just one) 1 - Cookies 2 - Fruit roll-ups 3 - Pie 4 - Ice cream 0 - Don’t Know

1. Overweight/Obesity Knowledge - T/F
2. Polyunsaturated fat has the same number of calories as saturated fat.
3. The single most important change most people can make to lose weight is to avoid sugar.
4. Being overweight puts you at risk for heart disease.

B-18 Adult

True False

T

T

T

F

F

F

1. A reduced intake of sodium or salt does not always

T F

lower high blood pressure to normal.

1. If you are overweight, losing weight helps lower your

T F

high blood cholesterol and high blood pressure.

1. The best way to lose weight is to eat fewer calories and

T F

be physically active.

1. Overweight children are likely to become overweight adults. T F
2. Skipping meals is a good way to cut down on calories. T F
3. Foods high in complex carbohydrates (starch and fiber)

T F

are good choices when you are trying to lose weight.

1. Attitude Toward Healthy Eating - “To you personally, how important is each of the following choices?” Record all answers on the score sheet.
2. Overweight/Obesity Attitude - “Please indicate how much you tend to agree or disagree with each statement.” Record all answers on the score sheet.
3. Eating Behavior/Habits - Record all answers on the score sheet.

Physical Activity

Give one point for each Yes answer.

1. I currently participate in moderate physical activity. Yes No
2. I intend to increase my participation in moderate Yes No physical activity in the next 6 months.
3. I currently engage in regular moderate physical activity. Yes No
4. I have been participating in moderate physical activity Yes No regularly for the past 6 months.
5. In the past, I have been regularly physically active in Yes No moderate activities for a period of at least 3 months.
6. During the past 7 days, how many times did you engage in physical activity to try to lose weight or keep from gaining weight?

Use the number that is circled (0-4) to represent the number of points on the score sheet.

Adult B-19

1. On how many of the past 7 days did you do any kind of physical activity in a place such as a “Y”, sports league, dance class, recreational center, or any other community center? Use the number that is circled to represent the number of points on the score sheet.
2. Attitude Toward Physical Activity - Likely/Unlikely Record all answers on the score sheet.
3. Physical Activity Knowledge – T/F

True

1. Regular physical activity can reduce

T

your chances of getting heart disease.

1. It doesn’t take a lot of money or

expensive equipment to become T

physically fit.

1. Exercise programs do not require

T

a lot of time to be very effective.

1. You should always consult a doctor

T

before starting a physical activity program.

1. There are many risks and injuries that

T

can occur with exercise.

1. Most people get enough physical

T

activity from their daily routine.

1. You don’t have to train like a

marathon runner to become T

more physically fit.

1. People who need to lose some weight

are the only ones who will benefit T

from regular physical activity.

1. The older you are, the less active

T

you need to be.

1. People who have had a heart attack

T

should not start any physical activity program.

1. All exercises give you the same benefits. T
2. To help you stay physically active,

T

include a variety of activities.

False

F

F

F

F

F

F

F

F

F

F

F

F

1. and 11. Fit/Sit Scores – Totals are already on the questionnaire.

B-20 Adult

For the next two sections, give one point for each correct answer as listed below. Give 0 points for wrong answers or “Not Sure” answers.

Possible causes of high blood pressure

1. Being overweight
2. Heredity--it runs in the family
3. Eating too much salt
4. Race or ethnic group
5. Worrying, tension, strain
6. Eating fatty foods
7. Smoking
8. Drinking too much alcohol
9. Regular hard exercise
10. Being underweight
11. Being pregnant
12. Not getting enough exercise
13. Old age
14. Stress

Cause

Cause

Cause

Cause

Not a Cause

Not a Cause

Cause

Cause

Not a Cause

Not a Cause

Cause

Cause

Cause

Not a Cause

Actions to control high blood cholesterol

1. Getting regular exercise
2. Eating less salt
3. Eating less sugar
4. Eating more soluble fiber
5. Using fat-free milk or low-fat dairy products
6. Eating less cheese
7. Eating fewer eggs
8. Eating more fish
9. Eating less sausage, bacon, and luncheon meats

10.Eating less saturated fat

1. Losing weight if you are overweight
2. Using soft or liquid margarine instead of butter

Would Help

Would Not Help

Would Not Help

Would Help

Would Help

Would Help

Would Help

Would Help

Would Help

Would Help

Would Help

Would Help

Adult B-21

B-22 Adult

ID#__________ DATE__________

Pre and Post Score

Personal: 1. Gender:___

1. Age Group:___ 3. Race:___ 4. Education:___

Use one score sheet for each participant.

Give one point for each correct answer; and 1-4 points (as specified in Answer Key) for each ‘positive’ answer, i.e., an answer demonstrating healthy nutrition or physical activity. Consult answer key to complete this score sheet.

Nutrition Overweight/

Heart-Healthy Eating

Attitude Overweight/ Toward Eating Obesity Obesity Knowledge Knowledge

(1 pt each) (1 pt each)

1. 9e.

7.

8.

POINT POINT TOTAL: TOTAL:

6 possible 9 possible

Healthy Eating Behavior Attitude

(1-4 pts each) (0-4 pts each) (1-4 pts each)

10e. 12e.

10f. 12f.

12g.

POINT POINT POINT TOTAL: TOTAL: TOTAL:

28 possible 24 possible 32 possible see note below

Note: For every part of question 12 on Eating Behavior that the respondent answered “x” (for not applicable”), subtract 4 from the total possible number of points.

Adult B-23

Physical Activity

(0-4 pts each) (1 pt each)

1. 8g. 8n.

POINT POINT POINT TOTAL: TOTAL: TOTAL:

12 possible 28 possible 12 possible

FIT SCORE: ___________ SIT SCORE: ___________

B-24 Adult

Knowledge:

Causes of

High Blood

Pressure

(1 pt each)

Knowledge:

Actions to

Control

High Blood

Cholesterol

(1 pt each)

1. 14.

POINT

TOTAL:

14 possible

POINT

TOTAL:

12 possible

Media Materials and Miscellaneous Forms...to assist in planning for media involvement

in your Hearts N’ Parks program. Includes a prototype plan for launching the program to the media, timelines and checklists, tips on how to encourage the media to participate in the event, pitch letter to the media, story ideas, sample news advisory and press release, and consent waiver forms.

C-1

c

C-2

Prototype plan

for launching your program

Healthy County Department of Parks and Recreation Hearts N’ Parks community. Staff members are developing a plan to launch this initiative.

GOALS

1. To announce the launch of Hearts N’ Parks in Healthy County.
2. To inform community members about upcoming Hearts N’ Parks activities.
3. To inform local policymakers about participation in Hearts N’ Parks.
4. To encourage partnerships with other community organizations and potential sponsors.
5. To increase the number of children participating in recreational programs.

TARGET AUDIENCES

1. Local newspapers, radio and TV stations, corporations, and organizations that have approved private communication vehicles.
2. Local media, clubs and other organized groups, community calendar editors.
3. Local policymakers.
4. Community organizations and businesses.
5. Schools, day care centers, parenting groups, and businesses that are geared toward children in the community. Media that reach these groups.

KEY MESSAGES

1. Healthy County is becoming a Hearts N’ Parks community.
2. Planned activities as part of Healthy County’s Hearts N' Parks initiative will include [LIST].
3. Hearts N’ Parks is an innovative, nationwide initiative that aims to reduce the growing trend of obesity and the risk of coronary heart disease in the United States.
4. By becoming a Hearts N’ Parks partner, local organizations and businesses can demonstrate their commitment to the well-being of citizens of Healthy County, share resources for implementing worthwhile programs, and gain exposure for their own programs and services.
5. The sooner we can teach our children how to prevent heart disease, the faster we can reduce their risk.

SPECIAL EVENT

1. Hold special event to launch Hearts N’ Parks. Agenda to include a news conference featuring prominent community leaders and policymakers including a representative of the community, activities for children, exhibits or screenings by local organizations and businesses, sponsorship opportunities (such as paying for T-shirts).
2. To maximize coverage by the media, request official proclamation by policymakers, and hold event during National Recreation and Park Month or relevant “health holiday.”
3. Invite local hospitals, day care centers, pharmacies, and radio or TV stations to join your task force and/or participate in the event.

C-3

C-4

Timeline and Checklist

6to8 weeks prior to the event

• Request permit and reserve park area by town square. Weather contingency plan to include ordering canopy for space. Work with adjacent city offices to identify available space for individual interviews with the media if needed.
• Invite speakers.
• Request proclamation from local government officials.
• Order brochures on heart disease, information on risk factors, banners, and T-shirts.

4to6 weeks prior to the event

• Prepare and send calendar announcement.
• Assign responsibilities to staff and volunteers. Hire photographer, contractor to provide staging area, sound system, etc.
• Invite guests, including policymakers, county agencies, wellness directors at area health-care facilities, prominent business people, leaders in the community.

2to4 weeks prior to the event

• Prepare the following media tools: media advisory, news release, backgrounders on the Healthy County Hearts N’ Parks program, speakers list for news conference. Copy backgrounders included in Resource Guide on Eat Right and Get Moving.
• Discuss media list with county communications office, and review and update for special event. Target local media that reach community-at-large, policymakers (newsletters, etc.), parents and caregivers of children, local businesses.

1to2 weeks prior to the event

• Send media advisory.
• Update Web site.
• Send event schedule, list of responsibilities, and directions to the site to staff and volunteers. Also provide copies of all materials to county communications staff, administrative staff, and others who might receive inquiries about the event.
• Gather biographic information from speakers for media and for the moderator’s introductions. Provide information to help speakers with their remarks.
• Supplies you will need on-site: pens, sign in sheets (for media), business cards, brochures on Healthy County Park and Recreation programs.

C-5

1 week prior to the event

• Confirm space, volunteers, and equipment.
• Distribute letter and consent form to parents of children who will be participating through their regular programs.
• Call key media to encourage them to attend.
• Collate media kits.

1to2 days prior to the event

• Resend media advisory to entire media list.
• Keep calling media targets.
• Gather and pack supplies.
• Arrange for designated staff person to field calls on the day of the event; update outgoing voice mail message.

At the event

• Greet media when they arrive. Ask them to sign in, so you can track who attended.
• Give every media person who attends a press kit to take back to their office. It will help them round out the story.
• Introduce media representatives to your spokespersons for interviews.

After the event

• Follow up on any special requests made during the event by the media, speakers, etc.; for example, reporters might ask for a bio or “head shot” photo of a specific speaker, or they might have asked for data or other information that was not readily accessible. (To expedite your response, call your office and have someone else process the request while the event is still happening.)
• Send press kits to reporters who expressed interest but did not attend, because it may still result in coverage, or they may come to your next event.
• Check for coverage in newspapers, on TV and radio, and on the Internet.
• Obtain contact sheets or prints from the photographer and order photos for your internal publications, as well as to send to partners or sponsors, speakers, special guests, etc.
• Write article about the event for your organization, and encourage partners and sponsors to do the same.
• Send thank-you notes to the reporters who attended. Tell them that you enjoyed working with them and that you hope to continue to serve as a resource for their reporting.
• Send a letter to the editor of your daily newspaper to publicly thank your volunteers for making the event a success and ask the editor to consider it for publication.
• And, of course, thank your sponsors, partners, and volunteers directly.

C-6

Timeline and Checklist for

Special Events

As soon as possible

• Identify your goals, target audience(s), and key messages.
• Develop an agenda for the event, identify potential speakers, and prepare a budget and timeline to include promotion of the event and logistics (e.g. renting space or equipment).
• Identify and contact potential partners and cosponsors.
• Assemble a task force or committee for building your event.

6to8 weeks prior to the event

• Reserve space. If your event is likely to draw media, be sure to identify a quiet space for individual interviews.
• Invite speakers.
• Request proclamation from local government officials.
• Order educational materials, signs or banners, awards, and T-shirts or other give-away items you will need.

4to6 weeks prior to the event

• Identify community calendar contacts and their deadlines, and distribute your media advisory or calendar announcement.
• Recruit event volunteers, staff, and contractors (such as audiovisual technicians if needed, photographer, caterer, etc.), and assign specific responsibilities.
• Arrange for equipment (if not provided by the site). Equipment might include, for example, tables (with draping) for health screenings or exhibits, easels for signs, a podium, a stage or “riser,” microphone(s), and a sound system. For a news conference or event with a celebrity, you might also need a “mult box” - a device that allows broadcast media to record directly from the sound system.
• Create guest list and invite guests.

2to4 weeks prior to the event

• Determine what media tools you will need and prepare them. These include, for example, media advisory, news release, backgrounders or fact sheets, agenda, etc.
• Update or develop your media list (see “Working with the Media”).

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1to2 weeks prior to the event

• Send media advisory.
• Update your Web site.
• Send event schedule, list of responsibilities, and directions to the site to staff and volunteers. Also provide copies of all materials to anyone who will be responding to inquiries before, during, or after the event.
• Assist speakers with their remarks; be sure to gather brief biographical information for the moderator to use to introduce speakers.
• Check on the status of the materials you’ve ordered and make checklist of supplies you’ll need on-site. Examples: pens, sign-in sheets, business cards, brochures, or other infomation about your program or department.

1 week prior to the event

• Confirm space, volunteers and equipment.
• If you will be photographing, videotaping, or otherwise recording the event, then distribute consent forms. If children will be participating, signatures from their parents or guardians will be needed. (Note: No consent forms are required for news coverage.)
• Make follow-up calls to key media to confirm their receipt of the advisory and to encourage them to attend.
• Collate media kits.

1to2 days prior to the event

• Resend the advisory to your entire list.
• Keep calling your media targets.
• Gather and pack supplies.
• Make any necessary arrangements for responding to calls while you are at the event. Brief office staff, update your outgoing voice mail message, distribute your cell phone number, and/or inform office staff as to whether you will be calling in to check messages.

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At the event

• Greet media when they arrive. Ask them to sign in, so you can track who attended.
• Give every media person who attends a press kit to take back to their office. It will help them round out the story.
• Introduce media representatives to your spokespersons for interviews.

After the event

• Follow up on any special requests made during the event by the media, speakers, etc.; for example, reporters might ask for a bio or “head shot” photo of a specific speaker, or they might have asked for data or other information that was not readily accessible. (To expedite your response, call your office and have someone else process the request while the event is still happening.)
• Send press kits to reporters who expressed interest but did not attend, because it may still result in coverage, or they may come to your next event.
• Check for coverage in newspapers, on TV and radio, and on the Internet.
• Obtain contact sheets or prints from the photographer and order photos for your internal publications, as well as to send to partners or sponsors, speakers, special guests, etc.
• Write article about the event for your organization, and encourage partners and sponsors to do the same.
• Send thank-you notes to the reporters who attended. Tell them that you enjoyed working with them and that you hope to continue to serve as a resource for their reporting.
• Send a letter to the editor of your daily newspaper to publicly thank your volunteers for making the event a success and ask the editor to consider it for publication.
• And, of course, thank your sponsors, partners, and volunteers directly.

on a job well done.

Now on to the next event...

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Encouraging Media

to cover your event

In many cases, sending a news advisory is not enough to get a reporter to attend your event. Following up with key media beforehand may mean the difference between coverage and no publicity.

Here are tips on encouraging the media To reporters who say... to participate: Yes: Work with them to arrange an

1. Prioritize your calls; review your media list and identify the reporters who are most important to you. Call them first.

interview with your spokesperson. Ask if there’s anything special they might need from you — for example, a camera crew may need access to an electrical source

1. Try to speak directly to a reporter. Don’t or to a “mult box” that will provide them be shy. Keep calling, even if you leave a with sound directly from any microphones voice mail message. you might be using. Record them on a log
2. Be prepared to resend the news of expected media attendance with notes advisory to individuals several times; on when they will be there, whom they are they will likely say they sending, and whether they will didn’t receive the information, want interviews or other

If you are

even if they did. special assistance.

asking staff

1. If you are asking staff or

or volunteers

volunteers to assist in fol- Maybe: Put them on your

low-up calls, prepare a to assist in callback list and call again in

script and a list of possible the final days before the event

follow-up calls,

questions and answers. to encourage them to attend.

prepare a

You might want to add a

script and a section to your media log for list of possible possible attendees. questions and answers. No: Ask if they can suggest

someone else on the staff who might be interested in the story. Tell them you’d like to send them a press kit after the event, in case they become interested in the program or topic.

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Sample Pitch Letter for Media

Dear [NAME of Editor],

A growing number of Healthy County residents—from children to seniors—are overweight and physically inactive. As a result, these individuals are at increased risk for heart disease, stroke, diabetes, cancer, and other serious conditions.

Healthy County Department of Parks and Recreation (HCDPR) is taking steps to counteract this serious problem by becoming a Hearts N’ Parks community. Hearts N’ Parks is an innovative program developed jointly by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, and by the National Recreation and Park Association (NRPA) to reduce the growing trend of obesity in the United States and to lower Americans’ risk of coronary heart disease. The program encourages Americans of all ages to aim for a healthy weight, follow a heart-healthy eating plan, and engage in regular physical activity. HCDPR is the first Hearts N’ Parks community in our State, and one of XX across the United States.

Joining with such prestigious partners as the NHLBI and NRPA enables Healthy County to bring quality, measurable public health programs to our community with minimal resources. For example, Healthy County now offers heart-healthy cooking and snack preparation classes for seniors and singles, and our existing programs have been augmented with special activities on eating well and being active. In addition, we’re working with Healthy County Mall to display weight-loss materials and to publicize free consultations with our staff for creating and following a personalized eating and exercise plan.

Heart disease is the leading killer among all Americans; it affects XXXX percent of Healthy County residents. As a Hearts N’ Parks community, Healthy County Department of Parks and Recreation hopes to make a significant and long-lasting contribution to Healthy County. For story ideas on the HCDPR Hearts N’ Parks programs, please see the attached sheet, or contact [NAME] at (XXX) XXX-XXXX.

Sincerely,

[NAME]

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Hearts N’ Parks and the Healthy County Parks and Recreation

Story Ideas and Media Tips

Help us spread the word that Healthy County is a Hearts N’ Parks community!

Here are a few story ideas to consider:

• With the fast pace of today’s society, more and more people are eating away from home – at greater cost to their wallet and their waistline. Through Healthy County Parks and Recreation’s Hearts N’ Parks program, singles are learning quick and easy ways to prepare heart-healthy meals at home.
• Ask 5-year-olds why they jump rope, and they’ll probably say because it’s fun. Ask Caroline Jones, and she’ll tell you how jumping rope will help her avoid having a heart attack when she’s older. Caroline is building lifelong skills to help her prevent heart disease...just one example of how Healthy County Parks and Recreation is bringing important heart-healthy information and activities to the community through the Hearts N’ Parks program.
• Forget expensive diet programs. Healthy County Parks and Recreation offers personalized weight-loss programs that put you on the right track to a healthy weight. Participants receive journals to help track their progress, and they consult with local trainers and nutrition specialists. (Let us know if you’d like to profile one of our participants’ ongoing success.)
• It’s family pizza night, and your seventh-grader requests broccoli on his pizza. What’s up? If your child is enrolled in the Healthy County Parks and Recreation after-school program, he’s learning how to make good nutritional choices when ordering or making meals. Nutritionists from Healthy County Health Department recently spoke to participants,

who were then asked to design their personal pizza. Future activities include a trip to the grocery store following a learning session on nutrition labels. It’s all part of the Parks and Recreation Department’s commitment to making Healthy County a Hearts N’ Parks community.

• New rewards for mall walkers. Seniors in the Healthy County Parks and Recreation mall-walking program now have additional incentives for meeting their fitness goals. As part of the Hearts N’ Parks initiative, Community Hospital has partnered with the Parks and Recreation Department to provide screenings and information on topics such as high blood pressure, diabetes, and cholesterol—a new topic is highlighted each week. In addition, area stores have donated gift certificates as rewards for those who meet program goals.

For more information on Healthy County Parks and Recreation and the Hearts N’ Parks program, please call [NAME] at (XXX) XXX-XXXX.

You can also find general information about Hearts N’ Parks at these Web sites:

National Heart, Lung, and Blood Institute (http://www.nhlbi.nih.gov/health/prof/heart/obesity/hrt_n _pk/index.htm) and

National Recreation and Park Association (http://heartsnparks.org).

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Sample Media Advisory

for Hearts N’ Parks Launch at local site

[Note: Advisory Should Never Be More Than One Page]

NEWS ADVISORY

FOR [IMMEDIATE] RELEASE CONTACT: [NAME OF ORGANIZATION [DATE] OR DEPARTMENT] [PHONE]

[NAME OF ORGANIZATION AND/OR KEY PRESENTER]

To Launch Innovative Heart Disease Prevention Program

WHAT: Special event to launch the [NAME OF ORGANIZATION OR COMMUNITY] Hearts N’ Parks Program, an innovative, community-based initiative that teaches people of all ages how to incorporate heart-healthy eating and physical activity into their lives. Activities will include a news conference and heart-healthy activities, including [SUMMARIZE EVENT ACTIVITIES]. A list of activities is attached [OPTIONAL].

WHO: Hearts N’ Parks is a national program cosponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, and the National Recreation and Park Association (NRPA). The [NAME OF ORGANIZATION OR COMMUNITY] is the first to offer the program in the [CITY/TOWN/REGION] area.

Speakers: [LIST NAMES AND TITLES]

WHEN: [DATE AND TIME]

WHERE: [NAME, ADDRESS, AND PHONE NUMBER FOR EVENT; DIRECTIONS IF SITE IS NOT LIKELY TO BE EASILY RECOGNIZED BY MEDIA]

OTHER: [ADDITIONAL DETAILS, SUCH AS SPECIAL PHOTO OR INTERVIEW OPPORTUNITIES, REQUEST FOR MEDIA TO REGISTER, ETC]

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Sample News Release

FOR [IMMEDIATE] RELEASE Contact: [ORGANIZATION NAME] [DATE] [PHONE NUMBER]

[NAME OF ORGANIZATION/AGENCY]

Launches Hearts N’ Parks

[COMMUNITY] Becomes First in Area to Participate in Innovative and Nationwide Obesity and Heart Disease Prevention Effort

[CITY, STATE]-The [NAME OF ORGANIZATION OR AGENCY] launched Hearts N’ Parks at a special event in [CITY, STATE] on [DATE]. A national, community-based program developed by the National Heart, Lung, and Blood Institute of the National Institutes of Health and by the National Recreation and Park Association, Hearts N’ Parks is an innovative initiative that aims to reduce the growing trend of obesity and the risk of coronary heart disease in the United States.

The event began with a news conference featuring [NAME AND TITLES OF SPEAKERS, LISTING MOST PRESTIGIOUS FIRST].

[ADD OTHER DETAILS ABOUT THE EVENT, INCLUDING PARTNERING/CO- SPONSORING ORGANIZATIONS, OTHER PARTICIPATING ORGANIZATIONS, etc.]

Heart disease is the leading killer among all Americans. Through Hearts N’ Parks, science-based information about lifestyle choices that can reduce one’s risk of heart disease and skills for incorporating heart-healthy behaviors into one’s life—such as engaging in regular physical activity, following a heart-healthy eating plan, and maintaining a healthy weight—are taught as part of regular activities offered by park and recreation departments and other community-based agencies. Maintaining a healthy weight is stressed because overweight and obese individuals are at increased risk of heart disease, stroke, diabetes, cancer, and other serious conditions. Hearts N’ Parks provides tools for measuring the impact of these activities, which are intended for people of all ages.

“This is a very important and exciting public health effort and NAME OF PARK/REC CENTER is proud to be a part of it,” said NAME AND TITLE OF CENTER DIRECTOR OR OTHER LOCAL AUTHORITY. “Heart disease and obesity are major health problems, and we are pleased to play a role in helping members of our community learn how to prevent and control these and related conditions.”

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[IF POSSIBLE, ADD QUOTE OR DATA THAT ADDRESSES THE SIGNIFICANCE OF THE ABOVE ISSUES TO THE LOCAL COMMUNITY.]

The [NAME OF ORGANIZATION OR AGENCY] Hearts N’ Parks program will include [PROVIDE HIGHLIGHTS OF HEARTS N’ PARKS RELATED ACTIVITIES]. “We feel confident that the residents of AREA will learn a lot while having a great time in our facility,” added NAME.

Hearts N’ Parks was launched nationally in July 2000 at a special event featuring U.S. Surgeon General David Satcher, M.D., Ph.D., and hosted by the Arlington County (Virginia) Department of Parks, Recreation, and Community Resources.

The initiative was first piloted in 1999 by more than 2,000 participants in 33 North Carolina sites. An evaluation of the North Carolina pilot program showed that participants retained information about heart-healthy behaviors and intended to eat healthier. In addition, children reported learning new physical activities and improving their performance in others; seniors reported feeling healthier and experiencing less pain in their daily lives by the end of the program. To date, nearly 350 recreation and parks agencies in more than 35 States have expressed interest in becoming Hearts N’ Parks communities. [UPDATE INFO ACCORDING TO INFORMATION ON THE HEARTS N’ PARKS WEBSITE OR FROM NRPA.]

For more information about Hearts N’ Parks activities provided by [NAME OF ORGANIZATION OR AGENCY], please contact [PROGRAM INFORMATION STAFF OR REGISTRAR] or visit the [NAME OF

ORGANIZATION OR AGENCY] Web site at [URL]. Additional

Notes

The National Heart, Lung, and Blood Institute

[IN RELEASE EMPHASIZING EVENT FOR

(NHLBI) has been helping Americans and people KIDS

, INSERT BRIEF DESCRIPTION OF

worldwide stay healthier since 1948. The Federal CHILDREN-ORIENTED ACTIVITIES AND institute undertakes a wide range of activities to FOLLOWING QUOTE: Children as well as adults

can develop high blood pressure and high blood

improve the understanding, prevention, diagnosis

cholesterol. Research shows that the buildup of

and treatment of heart, lung, and blood disorders.

plaque in the arteries (atherosclerosis), which causes coronary heart disease, begins in adolescence. Thus,

The National Recreation and Park Association

it is important to start heart-healthy behaviors early

(NRPA) supports the delivery of quality park

in childhood.]

and recreation resources through a nationwide network of recreation and park professionals [IN RELEASE EMPHASIZING EVENT FOR and citizen advocates. The primary areas for SENIORS,

INSERT BRIEF DESCRIPTION OF EVENT AND FOLLOWING AFTER LOCAL

national program focus are on health, youth

REPRESENTATIVE’S QUOTE: Seniors need to

development, and the environment.

stay physically active not only to help prevent heart disease but also to help slow bone loss and prevent

Additional information about Hearts N’

fractures from osteoporosis. Activities that build

Parks is available through NRPA at

balance and strength are particularly important for

1-800-649-3042 or www.heartsnparks.org, senior citizens.] or through NHLBI at www.nhlbi.nih.gov.

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Consent and Waiver

I hereby grant permission to [OFFICIAL NAME(S) OF ORGANIZATION(S)] to use, reproduce, publish, distribute, and exhibit my picture, portrait, likeness, or voice, or any or all of them (or those of a child under my guardianship), in or in connection with the production of a photograph, videotape, audiotape, CD-ROM, or in any manner and for any purpose as stated below, and...

I hereby waive all rights of privacy or compensation (or those of a child under my guardianship) which I have in connection with the use of my picture, portrait, likeness or voice, or any or all of them, in or in connection with said photograph, videotape, audiotape, CD-ROM, or Web site, and any use to which the same or any material therein may be put, applied, or adapted by the organizations designated above.

It is understood and agreed that the above waiver is limited to the use by the organizations listed above, or by any of their agencies, departments, or distributors for educational purposes only and not for profit or trade.

It is also understood and agreed that this consent and waiver will not be made the basis of a future claim of any kind against the organizations as noted above or their affiliates.

Participant’s Name: _______________________________

Address: _______________________________

_______________________________

_______________________________

• Signature:____________________________ Date:_____________
• If above is signature of parent or guardian (required if individual is a minor), please print name here: _______________________________

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Sample Cover Letter to Parents of Children for Consent Form

Dear Parent:

On [DATE AND TIME], the [NAME OF ORGANIZATION] will host an event to launch Hearts N’ Parks, an innovative program that promotes the adoption of heart-healthy behaviors by people of all ages. Hearts N’ Parks was developed and is supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and by the National Recreation and Park Association (NRPA).

We invite you and your child to join us for this exciting event, which includes a news conference featuring [LIST PROMINENT SPEAKERS AND TITLES].

Heart-healthy activities to be held during the event include [ADD DETAILS].

We will have photographers [ADD “and videographers” IF APPROPRIATE] documenting the event. We would appreciate your signing the attached consent form to grant permission for your child to participate in this exciting event, including being photographed or videotaped. Please return it to [SPECIFY] by [PROVIDE DEADLINE].

If you have any questions, please contact [PROVIDE NAME AND PHONE NUM- BER].

Thank you for your cooperation.

Sincerely,

[NAME, TITLE, ETC.]

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Additional Resources...to assist

programmers in locating resources and information that help plan and implement Hearts N’ Parks programs.

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d

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Additional Resources

for your Hearts N’ Parks program

The list below is intended to help you locate resources and information that may assist you with planning and implementing your Hearts N’ Parks program. References to any nongovernmental entity, product, service, or source of information that may be contained in this list should not be considered an endorsement, either direct or implied, by the National Heart, Lung, and Blood Institute (NHLBI). NHLBI is not responsible for the content of any non-Federal Web pages referenced in this list. Furthermore, contact information listed is subject to change.

Web: www.ahf.org

E-mail: inquire@amhrt.org Web: www.amhrt.org

(800) LUNGUSA or (800) 586-4872 - referral to local chapters • Teen smoking Fax: (212) 265-5642 E-mail: info@lungusa.org Web: www.lungusa.org

Northbrook, IL 60062 Telephone: (847) 480-9574 Fax: (847) 480-9282 E-mail: awhp@awhp.org Web: www.awhp.org

• * Local or State Chapters exist

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General and Heart Health Information

The American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village, IL 60007-1098 Telephone: (847) 228-5005 Fax: (847) 228-5097 Web: www.aap.org

Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 Telephone: (800) 311-3435 Web: www.cdc.gov

Health Resources and Services Administration (HRSA) Public Health Services 5600 Fishers Lane, Room 14-05 Rockville, MD 20857 (301) 443-3376 Web: www.hrsa.gov

Heart Information Service Texas Heart Institute P.O. Box 20345, MCI-194 Houston, TX 77225-0345 Telephone: (713) 794-6630 or (800) 292-2221 Fax: (713) 794-3714 E-mail: his@biostl.thi.tmc.edu Web: www.tmc.edu/thi

National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892 Web: www.nih.gov/index.html

Wellness Council of America** 7101 Newport Avenue, Suite 311 Omaha, NE 68152 Telephone: (402) 572-3590 Fax: (402) 572-3594 Web: www.welcoa.org

• * Local or State Chapters exist

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Type of information provided

• Children’s health
• You and Your Family health and nutrition brochures
• Guide to organizing a health fair
• Health topics A–Z
• School-based nutrition and physical activity programs
• Health statistics
• Health topics in the news
• Access to healthcare, quality of care, and healthcare policy
• Spanish material
• 800-number for questions relating to heart disease
• Cardiovascular health
• Heart-health quiz
• Health information from trained information specialists
• Asthma, sleep disorders, overweight, obesity, physical activity, cholesterol, heart disease, high blood pressure, and other heart, lung, and blood disorders
• A–Z subject guide including all the Institutes at NIH
• Workplace and employee wellness programs
• Local chapter in some States

Nutrition and Weight Loss

American Dietetic Association** 216 West Jackson Boulevard, Suite 800 Chicago, IL 60606-6995 Telephone: (312) 899-0040, (800) 877-1600 Web: www.eatright.org Consumer Nutrition Hotline (800) 366-1655

Center for Science in the Public Interest Suite 300 1875 Connecticut Avenue, NW Washington, DC 20009-5728 Telephone: (202) 418-2312 Fax: (202) 208-2321 E-mail: cspi@cspinet.org Web: www.cspinet.org

USDA Center for Nutrition Policy and Promotion U.S. Department of Agriculture North Lobby, Suite 200 1120 20th Street, NW Washington, DC 20036 Telephone: (202) 418-2312 Web: www.usda.gov/cnpp

Cooperative State Research, Education, and Extension Service** Web: www.reeusda.gov

Overeaters Anonymous** P.O. Box 44020 Rio Rancho, NM 87174-4020 Telephone: (505) 891-2664 Web: www.overeatersanonymous.org

TOPS Club, Inc.** Take Off Pounds Sensibly 4577 South 5th Street Milwaukee, WI 53207 Telephone: (414) 482-4620 (800) 932-8677 (chapter location) Web: www.tops.org/html/information.html

Weight-control Information Network (WIN) 1 WIN Way Bethesda, MD 20892-3665 Telephone: (800) WIN-8098 Web: www.niddk.nih.gov/health/nutrit/win.htm

• * Local or State Chapters exist

Type of Information Provided

• Nutrition information for various age groups, diseases, and circumstances
• Nutrition education
• Nutrition hotline for nutrition information and to find a local dietitian
• Food safety
• Nutrition
• Kids nutrition Web site
• Nutrition quizzes
• “Nutrition Insights” newsletter on nutrition-related topics
• Nutrition and Your Health: Dietary Guidelines for Americans
• Food Guide Pyramid
• Information on nutrition policy
• Research and education, including food and nutrition
• State partners
• Find an expert (such as home economists or food and nutrition specialists)
• Support for compulsive overeaters
• Weight loss support groups
• Eating disorders
• Weight loss programs
• Nutrition tips

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Nutrition and Weight Loss

Tufts University Nutrition Navigator Web: www.navigator.tufts.edu

Physical Activity and Sports

Alliance for Health, Physical Education, Recreation and Dance 1900 Association Drive Reston, VA 20191 Telephone: (703) 476-3400 or (800) 213-7193 Web: www.aahperd.org/index.html Publications catalog (800) 321-0789

American College of Sports Medicine P.O. Box 1440 Indianapolis, IN 46206-1440 Telephone: (317) 637-9200 or (800) 486-5643 Fax: (317) 634-7817 E-mail: pipascm@acsm.org Web: www.acsm.org/sportsmed

Cooper Institute of Aerobic Research Web: www.cooperinst.org Health and nutrition tips: Web: www.cooperaerobics.com/index.htm

National Association for Health and Fitness 201 S. Capitol Ave., Suite 560 Indianapolis, IN 46225 Telephone: (317) 237-5630 Fax: (317) 237-5632 Web: www.physicalfitness.org

National Association for Sport and Physical Education 1900 Association Drive Reston, VA 20191 Telephone: (703) 476-3410 Fax: (703) 476-8316 Web: www.aapherd.org/naspe/naspe-main.html Online Store: www.aapherd.org

• * Local or State Chapters exist

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Type of Information provided

• A rating guide to nutrition Web sites
• General nutrition, parents, women, kids, special dietary needs, journalists, health professionals, educators

Type of Information Provided

• Physical fitness programs for youth and adults
• Physical Best Activity Guides (elementary and secondary levels)
• Public advocacy to expand physical education programs for students
• Nutrition and sports information (to order, free, not available online )
• Fitness and aerobic health
• Physical fitness assessments
• Worksite health promotion
• Activity planning kits
• Resource and product guide
• 8-week program for adults to establish a more healthy and active lifestyle
• Employee health and fitness
• Sport and physical activity programs that promote healthy behaviors and individual well-being
• Physical activity guidelines for pre-adolescent children and national standards for physical education curriculum

Physical Activity and Sports

National Recreation and Park Association** Belmont Ridge Road Ashburn, VA 20148 Telephone: (703) 858-0784 Fax: (703) 858-0794 E-mail: programs@nrpa.org Web: www.activeparks.org

President’s Council on Physical Fitness and Sports 200 Independence Avenue, SW Room 738H Washington, DC 20201 Telephone: (202) 690-9000 Web: www.surgeongeneral.gov/ophs/ pcpfs.htm

• * Local or state chapters exist

Gateways/Clearinghouses for Health Information on the Internet

Centers for Disease Control and Prevention Web: www.cdc.gov/other.htm

Food and Nutrition Information Center U.S. Department of Agriculture National Agricultural Library 10301 Baltimore Boulevard, Room 304 Beltsville, MD 20705-2351 Telephone: (301) 504-5719 Web: www.nal.usda.gov/fnic

Healthfinder® U.S. Department of Health and Human Services Web: www.healthfinder.gov

National Health Information Center Office of Disease Prevention and Health Promotion U.S. Department of Health and Human Services P.O. Box 1133 Washington, DC 20013 Telephone: (800) 336-4797 Web: nhic-nt.health.org

Type of Information Provided

• Leisure and lifestyle
• Links to programs focused on health, youth, and the environment
• Find a park near you
• Online events and calendar contact information for State affiliates
• Promotion of physical activity
• Importance of physical activity
• Youth fitness campaign

Type of Information Provided

• Information networks and other information sources
• State and local health departments, public health partners
• Allergies, food safety, food and nutrition for all ages, pregnancy and breastfeeding, diabetes, body weight, cardiovascular disease, and nutritional and herbal supplements
• Food Guide Pyramid
• Nutrition and Your Health: Dietary Guidelines for Americans
• Healthfinder is a free gateway to reliable consumer health and human services information developed by the U.S. Department of Health and Human Services
• Health Information Resource Database: 1,100 organizations and government offices that provide health information upon request

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Gateways/Clearinghouses for Health Information on the Internet

The National Women’s Health Information Center Office on Women’s Health Department of Health and Human Services Telephone: (800) 994-WOMAN (9662) Web: www.4woman.gov

Local Professionals

American Diabetes Association Web: www.diabetes.org

American Dietetic Association Web: www.eatright.org

Cooperative State Research, Education, Nutrition and Extension Service Web: www.reeusda.gov

American Nurses Association Web: www.nursingworld.org/index.htm Telephone: (800) 274-4ANA (4262)

County Health Department

Department of Public Health, Health Promotion Division

Office of Health Education

Media and Local Associations

The National Association of Counties 440 First Street, NW Suite 800 Washington, DC 20001 Telephone: (202) 393-6226 Fax: (202) 393-2630 Web: www.naco.org

National League of Cities 1301 Pennsylvania Avenue, NW Washington, DC 20004-1763 Telephone: (202) 626-3000 Fax: (202) 626-3043 Web: www.nlc.org

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Type of Information Provided

• Gateway to health information and referral center for women
• Heart health assessment
• Media information
• Women’s health statistics

Ask for the:

Diabetes educator

Registered dietitian (800) 366-1655 Local chapter (800) 877-1600

Home economist or food and nutrition specialist

Registered nurse State nurses association

Health education consultant

Public health nutritionist

Health educator

Type of Information Provided

• Contact information for State association
• Contacts for State municipal leagues
• Links to State, local, and Federal government resources on the World Wide Web

Media and Local Associations

ABC Web: www.abc.go.com

NBC Web: www.nbc.com

CBS Web: www.cbs.com

Fox Network Web: www.foxnetwork.com

Type of Information Provided

• Contact information for local networks
• Contact information for local networks
• Contact information for local networks
• Contact information for local networks

Other helpful

contacts and ideas

• Local grocery stores or restaurants will often donate heart-healthy food for events.
• Hospitals will sometimes donate staff time and/or supplies for screenings, health fairs, etc. Call your State hospital association or search for it on the Web by searching for “[your State] hospital association”
• Contact local newspapers and local TV stations for coverage of special events.

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Health Statistics...to provide programmers

with background health information on the burden of heart disease and associated risk factors within the community.

e

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Health Statistics

%about Cardiovascular Disease

Cardiovascular Disease (CVD)

• Approximately 60.8 million people in the United States had some form of CVD in 1998.
• CVD includes such diseases as high blood pressure (hypertension), coronary heart disease (CHD), stroke, congestive heart failure, and rheumatic heart disease.
• Approximately 50 million people had hypertension and about 12 million people had CHD in 1998.
• CVD is the leading cause of death in the United States, contributing to 949,000 deaths in 1998. The estimated total economic cost of CVD is expected to be $298 billion in 2001; $182 billion is expected to be in direct health expenditures.

Source: NHLBI FY 2000 Fact Book

Hypertension (High Blood Pressure)

• Approximately 50 million adults in the United States had hypertension in 1997.
• Hypertension is a major risk factor for heart disease.
• High blood pressure is known as the “silent killer” since a large number of people are unaware that they have it and may not have symptoms.
• High blood pressure is more common in older persons, in African Americans, overweight persons, and those with a family history of high blood pressure.
• Lifestyle changes, such as engaging in physical activity, maintaining a healthy weight, limiting alcohol, and following a heart-healthy diet can help prevent or control hypertension.

Source: Healthy People 2010: Understanding and Improving Health

Cholesterol

• High blood cholesterol is a major risk for CVD.
• More than 90 million adults in the United States have blood cholesterol levels that are higher than desirable.
• More than 50 million adults in the United States have blood cholesterol levels that require medical intervention.
• Lifestyle changes, such as increasing physical activity, reducing excess weight, and following a heart-healthy eating diet low in saturated fat and cholesterol can prevent or lower high blood cholesterol.

Source: Healthy People 2010: Understanding and Improving Health

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Overweight and Obesity

• Approximately 97 million people (55 percent of the American adult population) are overweight or obese.
• One in five children over the age of 6 is considered overweight or obese.
• Overweight and obesity are risk factors for CVD and other diseases, such as type 2 diabetes, osteoarthritis, gall bladder disease, sleep apnea, as well as some types of cancer.
• Obesity acquired during childhood or adolescence may persist into adulthood and increase the risk for CVD and other diseases later in life.
• Lifestyle changes, such as increasing physical activity, behavior modification, and following a heart-healthy eating plan can help with weight loss and maintenance.

Source: Healthy People 2010: Understanding and Improving Health

Physical Activity

• Physically inactivity increases the risk of heart disease.
• Moderate, regular physical activity for 30 minutes on most days of the week can reduce the risk for many diseases, including heart disease.
• Regular physical activity enhances the quality of life for people of all ages and helps to maintain the functional independence of older adults.
• Currently, 23 percent of adults report regular, vigorous physical activity for 20 minutes or longer 3 or more days per week.
• Approximately 15 percent of adults report moderate physical activity for 5 or more days per week for 30 minutes or longer.
• Approximately 27 percent of adolescents in grades 9 through 12 engage in moderate physical activity for at least 30 minutes for 5 or more days.

Source: Healthy People 2010: Understanding and Improving Health

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Smoking

• Cigarette smoking causes heart disease as well as several types of cancer, and chronic lung disease.
• Secondhand smoke exposure causes heart disease in adults.
• Tobacco is responsible for more than 430,000 adult deaths per year in the United States.
• Tobacco use and addiction usually begin in adolescence, and have increased in the 1990s.

Source: Healthy People 2010: Understanding and Improving Health

Approximately 27 percent of adolescents in grades 9 through 12 engage in moderate physical activity for at least 30 minutes for 5 or more days.

Background Sheets...to provide programmers

with reproducible background sheets on what Hearts N’ Parks is all about, as well as one on Eat Right for a Healthy Heart and one on Get Moving for a Healthy Heart.

f

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About Hearts N’ Parks

Hearts N’ Parks is a national, community-based program supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health and the National Recreation and Park Association (NRPA). This innovative program aims to reduce the growing trend of obesity and the risk of coronary heart disease in the United States by encouraging Americans of all ages to aim for a healthy weight, follow a heart-healthy eating plan, and engage in regular physical activity.

Why are these goals important? being more likely to develop heart disease and stroke than individuals with healthy

• Heart disease is the leading cause of death in weights, overweight and obese individuals are the United States. Overweight and obesity at increased risk for diabetes, cancer, increase one’s risk of developing heart disease. gallbladder disease, sleep apnea and other
• The numbers of overweight children and respiratory problems, osteoarthritis, and adolescents, as well as obese adults, in the other conditions. United States have doubled over the past 2
• Adopting heart-healthy behaviors, such as decades. Approximately 97 million American following a healthy eating plan and particiadults—or 55 percent—are currently overweight pating in regular physical activity, can help or obese. In addition, one in five children individuals achieve or maintain a healthy over the age of 6 is considered overweight, weight. Even modest amounts of weight loss and overweight and obesity acquired during of approximately 10 percent of initial body childhood or adolescence may persist into weight can reduce high blood pressure, high adulthood and increase the risk for some blood cholesterol levels, and high blood chronic diseases later in life. In addition to glucose levels in overweight or obese

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Hearts N’ Parks is fun and flexible.

individuals with high levels.

• Consumer-

Each community

Reducing these risk factors

oriented materials

agency can adapt

helps to prevent cardiovas-

are available to communicate

the program

cular disease and/or reduce its severity in those with

heart-healthy messages related to weight management, physical

material to its

existing disease.

activity, high blood pressure,

own design,

Through Hearts N’ Parks,

cholesterol, and heart disease.

abilities, and

science-based information

In addition, materials targeted to specific populations, such

needs.

about lifestyle choices that can reduce an individual’s risk of heart disease and skills for incorporating heart healthy behaviors into one’s life are taught as part of the regular activities offered by park and recreation departments and other community-based agencies. The program also provides tools for measuring the impact of these activities.

Hearts N’ Parks also demonstrates the impact that community park and recreation programs can have on helping people improve and maintain their health. According to NRPA, 75 percent of Americans live within a 2-mile walking distance of a public park. These facilities are widely accessible to individuals from culturally and socioeconomically diverse populations, as well as to individuals with disabilities.

Key elements and benefits of Hearts N’ Parks include:

• Hearts N’ Parks activities can be incorporated into a variety of programs - nutrition and fitness activities, stress reduction or family life programs, etc. Activities can be adapted for children, youth, adults and seniors.
• Recreation and park departments and other community organizations receive staff training and resources to integrate heart-healthy activities into existing activities or to develop new activities.

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as African Americans and Hispanics, are also available.

• Evaluation materials to measure the program’s impact are included.
• Hearts N’ Parks provides opportunities for community organizations to gain public recognition of their commitment to encouraging healthy behaviors, as well as to develop partnerships to further enrich their activities.

Hearts N’ Parks was piloted during the summer of 1999 in 33 sites in 12 North Carolina communities involving more than 2,000 participants. An evaluation showed that participants retained information about heart-healthy behaviors and intended to eat healthier. In addition, children reported learning new physical activities and improving their performance in others; seniors reported feeling healthier and experiencing less pain in their daily lives by the end of the program.

Hearts N’ Parks is fun and flexible. Each community agency can adapt the program material to its own design, abilities, and needs. And it’s for everybody—participants can be young or old, active or non-active. Community organizations interested in signing up to become a Hearts N’ Parks community should contact the National Recreation and Park Association at programs@nrpa.org or 1-800-649-3042.

Eat Right

for a Healthy Heart

Heart disease is the leading cause of death in the United States. Fortunately, though, there are things you can do to protect yourself and your family against heart disease.

For example, following an eating plan that balances calorie intake with your level of physical activity and is low in saturated and total fat, and cholesterol, and rich in fruits and vegetables, lowfat dairy foods, and whole grains, can help protect you against high blood pressure, high blood cholesterol, and overweight—factors that, along with physical inactivity and smoking, increase the risk of heart disease. This eating plan may also help prevent cancer and other health problems.

The earlier you take action, the better. Research shows that heart disease begins early in life and that, once learned, bad habits are hard to break. So you and your family should adopt a hearthealthy eating plan now.

Here’s some advice about heart-healthy eating from the National Heart, Lung, and Blood Institute (NHLBI) and the National Recreation and Park Association (NRPA):

• Balancing the calories in the foods you eat with the calories your body uses in physical activity is key to maintaining a healthy body weight, or even to losing weight if you are overweight. Being overweight increases your risk of developing high blood pressure, high blood cholesterol, diabetes, and other serious diseases or conditions.
• The kinds and amounts of foods you eat can affect your ability to maintain weight. Highfat foods contain more calories per serving than other foods and increase the likelihood of weight gain. However, even when people eat less high-fat food, they still can gain weight from eating too much of foods high in starch, sugars, or proteins.
• Healthy people over age 2 should consume less than 10 percent of the day’s total calories from saturated fat; no more than 30 percent of total calories from fat; and less than 300 milligrams of dietary cholesterol per day.
• Saturated fat raises cholesterol in the blood more than anything else eaten. Saturated fat is found mainly in animal foods. One way to cut down is to switch to lower-fat foods, including

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low-fat or fat-free dairy products and to remove skin from poultry.

• Cholesterol in the diet also can raise blood cholesterol. It is found only in foods from animals. Meat and poultry have similar amounts. Since eggs are especially high in cholesterol, limit intake to four eggs per week.
• Unsaturated fat does not raise blood cholesterol but can add calories. Be careful of extra calories when trying to lose weight.
• Another key to healthy eating is choosing foods lower in salt and sodium, which can affect blood pressure. Have no more than 2,400 mg of sodium a day—equal to about one teaspoon of table salt. This includes salt used in cooking. Instead, season food with herbs and spices. Also, snack on unsalted pretzels, popcorn without salt or butter, and crackers or fruits.
• Having an adequate intake of vitamins and minerals, especially potassium, calcium, and magnesium, also is important for lowering blood pressure.
• Limit alcohol, since it supplies calories but few or no nutrients—for example, no more than two 12-ounce beers in a day for men and one for women.
• To help you follow a heart-healthy eating plan, read food labels to choose foods that are lower in calories, total fat, saturated fat, and sodium.

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Special Tips for

Kids and Seniors

American children are gaining weight. They are eating too many calories from high-calorie fast- and snack foods and not getting enough physical activity. Try cutting back on high-fat foods for your children by offering more fruits as snacks. Vegetables can be chopped into small pieces and added to favorite recipes without kids noticing. Combine rice with vegetables. Whole wheat or bran breads add fiber to sandwiches. For desserts, offer fig bars, ginger snaps, graham crackers, or frozen fatfree dairy desserts.

Children often eat many meals away from home, making it harder to maintain good eating habits. To improve fast-food meals, order a small plain hamburger—it has less fat than fried or battered items—and hold the cheese or special sauce. Or, try lean roast beef and grilled or broiled chicken sandwiches or pita pockets with small pieces of meat and vegetables.

Seniors need to be diet-smart too. Maintaining a healthy body weight is important for older people, since we begin to lose weight as we age. Some weight may be lost from muscle, so be sure that your diet is rich in protein and carbohydrates while watching out for too many saturated fats.

Get moving

for a healthy heart

Heart disease is the leading cause of death in the United States. Fortunately, though, you can take steps to reduce your risk of heart disease. For example, getting regular physical activity can help protect you and your family against high blood pressure and overweight and obesity—factors that, along with high blood cholesterol and smoking, increase the risk of heart disease.

Staying active also helps keep off extra pounds, control blood pressure, boost the level of “good” HDL-cholesterol, and prevent diabetes and heart attacks. It also strengthens the lungs, tones the muscles, keeps the joints in good condition, improves balance, helps prevent and treat depression, and helps many people cope better with stress and anxiety.

If you already have heart disease, regular, moderate physical activity lowers your risk of death from heart-related causes. (However, if you have heart disease, check with your doctor first to find out what kinds of activities are best for you.)

The earlier you start, the better. The best time to start learning heart-healthy habits is in childhood, because heart disease risk factors start developing then too. Still, it’s never too late to begin living heart-healthy. This is true even for people in their ‘80s and ‘90s.

Here’s some advice about physical activity from the National Heart, Lung, and Blood Institute (NHLBI) and the National Recreation and Park Association (NRPA):

• To reap benefits from physical activity, you don’t need to train for a marathon. You need

to engage in only about 30 minutes of moderate-level activity on most— and preferably all—days of the week. A moderate-level activity is one that’s about as demanding as brisk walking.

• Other examples of moderate physical activity that can improve heart health are bicycling, conditioning or general calisthenics, racquet sports (such as table tennis), jogging, swimming, dancing, housework, gardening, or lawn mowing.
• You can engage in any of these activities for 30 minutes at one time, or you can do them in shorter periods of at least 10 minutes each, as long as you total approximately 30 minutes each day.
• If you are already engaging in this level of physical activity, you will receive extra health and fitness benefits by doing these activities for a longer period each day or becoming involved in more vigorous activity.

Special Tips for Kids, Adults, and Seniors:

Young people should be physically active— both in and out of school. Instead of television, video games and the computer, kids need to be engaged in “active play,” such as tag, jump rope, hide and seek, or bicycling, or team activities like soccer, basketball, and softball.

Another way to increase children’s activity levels is to get them involved in everyday activities, like household chores, walking the dog, or helping with the groceries.

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Take the time to be physically active as • Are over 50 years old and not used a family. This not only provides health to moderately energetic activity; benefits for the entire family but can be

• Have someone in your family who an important time to get to know each developed heart disease at an other better. Young kids particularly early age. enjoy being involved in family fun, such as shooting hoops with dad or Seniors also need regular physical playing tennis with mom. activity. Regular physical activity is good for your heart, mood, muscles, Adults who have not been active for a and arteries, and improves your bones while should start slowly, gradually building up to and ability to sleep well. It builds strength, the recommended 30 minutes per day of moderatepromotes coordination and balance, and helps slow level activity. For example, if you want to begin bone loss and prevent fractures from osteoporosis. walking regularly, you might begin with a 10–15-

minute walk three times a week. As you become more fit, you can increase the sessions to every day and gradually lengthen each walking session or increase your pace. Some adults should get medical advice before starting a program of physical activity. Consult your doctor first if you: • Have heart trouble or have had a heart attack;

Many older people think they are too old or too frail to exercise. Nothing could be further from the truth. Physical activity of any kind—from heavy-duty exercise, such as jogging or bicycling, to easier efforts like walking—is good for you. Older people who become more active—including those with medical problems—may feel better and have more energy. Being active is also an

• Are taking medicine for high blood pressure or easy way to share some time with friends or family, a heart condition; as well as to meet new friends.

Keys to Success

• Go slow. If you have not been physically active until now, gradually build up to the recommended 30 minutes per day of moderate-level activity.
• Begin each workout slowly. Allow a 5-minute period of stretching and slow movement to “warm up” and 5 minutes at the end to “cool down” at a slower pace.
• Listen to your body. A certain amount of stiffness is normal at first. But if you hurt a joint or pull a muscle or tendon, stop the activity for several days to avoid more serious injury.
• Pay attention to warning signals. Some types of physical activity may worsen heart problems. Warning signals include sudden dizziness, cold sweat, paleness, fainting, or pain or pressure in your upper body or chest during—or just after—physical activity. If you notice any of these signs, stop and call your doctor immediately.
• Check the weather. Dress appropriately for hot, humid days and for cold days, and drink lots of water before, during, and after activity.
• Keep at it. Unless you have to stop your activity for a health reason, stay with it. Set small, short-term goals for yourself. If you find yourself becoming bored, try doing the activity with a friend or family member. Or switch to another activity.

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Children

• Eat Right for a Healthy Heart
• Snacks Like These Are Okay
• Find the Foods HealthyEating
• Get Moving Fast

PhysicalActivity

Obesity & Overweight

High BloodPressure

High BloodCholesterol

Adolescents Adults

• Stay Young at Heart Menu • Heart Healthy Eating Plan
• Dining Out—How to Choose • Help Your Family to Better Heart Health
• Foods in the Fast Lane
• Cooking the Heart-Healthy Way
• Putting Heart Healthy Eating Habits Into Play • Shop to Your Heart’s Content
• Dining Out—How to Choose
• Stay Young at Heart Menu
• Physical Activity and Heart

Disease IQ

• Get Physical
• Help Your Family to Better

Heart Health

• Physical Activity and Heart Disease IQ
• Guide to Physical Activity
• Guide to Physical Activity
• Check Your Weight and • Guidelines on Overweight and Heart Disease IQ Obesity
• Check Your Weight and Heart Disease IQ
• Heart Healthy Eating Plan
• Healthy Heart IQ
• High Blood Pressure

Prevention IQ

• Healthy Heart IQ
• Healthy Heart IQ
• High Blood Pressure

Prevention IQ

• Tips to Help Older Americans Control Cholesterol
• Cholesterol and Heart Disease IQ • Healthy Heart IQ
• Cholesterol and Heart Disease IQ

Healthy Eating 3

Contents

Healthy Eating ............................7

Physical Activity ......................41

Obesity & Overweight ..............55

High Blood Pressure ................63

High Blood Cholesterol............73

Healthy Eating 7

8 Healthy Eating

Eat Right

for a Healthy Heart

The foods you eat play a big part in keeping your blood cholesterol level low or high. It depends on the choices you make. Foods low in fat and cholesterol are good choices.

A type of fat, called saturated (SACH-uh-rate-id) fat, can really make your blood cholesterol go up. So can the cholesterol you eat. Cholesterol is not the same as saturated fat. A food can be low in cholesterol but high in saturated fat. Choosing foods low in saturated fat and cholesterol is important. This will help you lower your blood cholesterol level. And, this may help prevent heart problems when you get older.

FOODS HIGH IN SATURATED FAT FOODS HIGH IN CHOLESTEROL

/ Fatty cuts of beef, pork, and lamb, / Egg yolks

like hamburger and ribs

/ Liver / Butter

For a Healthy Heart:

/ Whole milk and cream

You can eat right.

/ Most cheeses

You can get plenty of exercise.

/ Ice cream

Do not start smoking.

/ Many cakes, cookies, and pies

Build a Balanced Diet

“Diet” means the foods you eat most often.

A healthful diet is a balanced diet which is low in saturated fat and cholesterol. A balanced diet has the right amount of calories (KAL-uhreez) and nutrients (NEW-tree-unts) your body needs. Calories provide you with energy to grow and move around. Fat of any kind provides more calories than any other nutrient. So you have to be careful not to eat too much. Other nutrients found in food are protein, carbohydrate (starch and sugars), vitamins, and minerals.

Healthy Eating 9

10 Healthy Eating

Eat Right for a Healthy Heart

Do you know what a balanced diet

looks like?

The foods in A, B, and C below are low in saturated fat and cholesterol. Which of these do you think provide all the nutrients you need in one day?

A. Toast and fat-free milk B. A baked potato and baked chicken leg C. Lots of spinach D. None of the above

The answer is D. No one food can give you all the nutrients your body needs. Even two foods, like those in A and B, do not give a balance. You need to eat a variety of foods every day.

Foods can be put in groups. Each group provides different kinds of nutrients.

Meat, poultry, and fish

Milk and dairy products

Breads, cereals, pasta, rice, dry peas, and beans

Vegetables

Fruits

To build a balanced diet:

Eat a variety of foods from each food group. Choose those foods lower in saturated fat and cholesterol.

Healthy Eating 11

12 Healthy Eating

Snacks Like These Are

Okay!

☺ Fruit juices, drinks, punches

☺ Fat-free or 1% milk

☺ Frozen desserts like sherbet, sorbet, fruit ice, popsicles, ice milk, frozen yogurt

☺ Flavored low-fat yogurt, plain or with fruit

☺ Animal crackers, graham crackers

FAT- FREE

☺ Homemade cookies, cake, muffins, pudding made with less saturated fat and cholesterol

☺ Gingersnaps, fig bar cookies

☺ Angel food cake

☺ Candy like candy corn, gumdrops, hard candy

☺ Gelatin

☺ Canned, fresh, or dried fruit

☺ Vegetable sticks

☺ Air-popped popcorn

☺ Pretzels

☺ Peanut butter in celery sticks

13 Healthy Eating Healthy Eating 13

14 Healthy Eating

Find The Foods!

Look at the snacks in the list. Can you find these 1 Cold cereal with fat-free milk

11 snack foods in the picture? They are low in

saturated fat and cholesterol. Color them after

2 Toast with jam or jelly

you find them.

3 Popcorn

4 Popsicles or fruit slush

5 A bowl of fresh fruit

6 Flavored low-fat yogurt

7 Celery stalk filled with

peanut butter

8 Peanuts in a shell

9 Fruit juice

10 Homemade muffin

11Peanut butter spread

on crackers

Healthy Eating 15

16 Healthy Eating

Stay Young at Heart

ERE ARE SOME MENU ITEMS TO CHOOSE AND SOME TO DECREASE FOR EACH MEAL

CHOOSE: Egg substitute Hot or cold cereal Toast with margarine and jam English muffin or bagel with nonfat cream cheese Fruit or juice Fat-free or 1 percent milk Canadian bacon

CHOOSE: Salad (with dressing on the side) Regular-sized hamburger (hold the mayo) Turkey, chicken, lean ham, or roast beef sandwich (hold the mayo) Broth-based soups Low fat or nonfat cottage cheese or yogurt with fresh fruit

CHOOSE: Pasta with low-fat sauce, such as marinara Grilled or broiled fish or skinless chicken Lean steak, trimmed of fat Vegetarian entree (little or no cheese)

BREAKFAST DECREASE: Egg yolks, any style Fried potatoes Bacon or sausage Biscuit, croissant, or sweet roll Whole milk

LUNCH DECREASE: Deluxe sandwiches Hot dogs or sausage Breaded and fried chicken or fish Cream-based soups French fries, onion rings, or chips

DINNER

DECREASE: Prime rib or untrimmed steaks or chops Fried chicken Cream sauces or gravies Rich desserts, such as cake, cheesecake, Baked potato with a little margarine or nonfat yogurt Vegetables, plain Low-fat desserts like fresh fruit, sorbet, sherbet, ice milk, or nonfat frozen yogurt

or tortes

Healthy Eating 17

18 Healthy Eating

How to Choose

GENERAL TIPS FOR HEALTHY DINING OUT

Whether or not you’re trying to lose weight, you can eat healthfully when dining out or bringing in food, if you know how. The following tips will help you move toward healthier eating as you limit your calories, as well as fat, saturated fat, cholesterol, and sodium when eating out.

YOU ARE THE CUSTOMER

• Ask for what you want. Most restaurants will honor your requests.
• Ask questions. Don’t be intimidated by the menu— your server will be able to tell you how foods are prepared or suggest substitutions on the menu.
• If you wish to reduce portion sizes, try ordering appetizers as your main meal.
• General tips: Limiting your calories and fat can be easy as long as you know what to order. Try asking these questions when you call ahead or before you order. Ask the restaurant, whether they would, on request, do the following:
• Serve nonfat (fat-free) milk rather than whole milk or cream.
• Reveal the type of cooking oil used.
• Trim visible fat off poultry or meat.
• Leave all butter, gravy, or sauces off a side dish or entree.
• Serve salad dressing on the side.
• Accommodate special requests if made in advance by telephone or in person.

Above all, don’t get discouraged. There are usually several healthy choices to choose from at most restaurants.

READING THE MENU

• Choose lower calorie, low-fat cooking methods. Look for terms such as, “steamed in

its own juice” (au jus), “garden fresh,” “broiled,” “baked,” “roasted,” “poached,” “tomato juice,” “dry boiled” (in wine or lemon juice), or “lightly sautéed.”

• Be aware of foods high in calories, fat, and saturated fat. Watch out for terms such as “butter sauce,” “fried,” “crispy,” “creamed,” “in cream or cheese sauce,” “au gratin,” “au fromage,” “escalloped,” “parmesan,” “hollandaise,” “bearnaise,” “marinated (in oil),” “stewed,” “basted,” “sautéed,” “stirfried,” “casserole,” “hash,” “prime,” “pot pie,” and “pastry crust.”

SPECIFIC TIPS FOR HEALTHY CHOICES

BREAKFAST

• Fresh fruit or small glass of citrus juice
• Whole grain bread, bagel, or English muffin with jelly or honey
• Whole grain cereal with low-fat (1%) or nonfat milk
• Oatmeal with nonfat milk topped with fruit
• Omelet made with egg whites or egg substitute
• Multigrain pancakes without butter on top
• Nonfat yogurt (try adding cereal or fresh fruit)

BEVERAGES

• Water with lemon
• Flavored sparkling water (noncaloric)
• Juice spritzer (half fruit juice and half sparkling water)
• Iced tea
• Tomato juice (reduced sodium)

BREAD

Most bread and bread sticks are low in calories and low in fat. The calories add up when you add butter, margarine, or olive oil to the bread.

Healthy Eating 19

Also, eating a lot of bread in addition to your meal will fill you up with extra unwanted calories and not leave enough room for fruits and vegetables.

APPETIZERS

• Steamed seafood
• Shrimp* cocktail (limit cocktail sauce—it’s high in sodium)
• Melons or fresh fruit
• Bean soups
• Salad with reduced-fat dressing (or add lemon juice or vinegar)
• If you are on a cholesterol-lowering diet, eat shrimp and other shellfish in moderation.

ENTREE

• Poultry, fish, shellfish, and vegetable dishes are healthy choices.
• Pasta with red sauce or with vegetables (primavera).
• Look for terms such as “baked,” “broiled,” “steamed,” “poached,” “lightly sauteed,” or “stir-fried.”
• Ask for sauces and dressings on the side.
• Limit the amount of butter, margarine, and salt you use at the table.

SALADS/SALAD BARS

• Fresh greens, lettuce, and spinach
• Fresh vegetables—tomato, mushroom, carrots, cucumber, peppers, onion, radishes, and broccoli
• Beans, chickpeas, and kidney beans
• Skip the nonvegetable choices: deli meats, bacon, egg, cheese, and croutons.
• Choose lower calorie, reduced fat or fat free dressing, lemon juice, or vinegar.

20 Healthy Eating

SIDE DISH

• Vegetables and starches (rice, potato, noodles) make good additions to meals and can also be combined for a lower calorie alternative to higher calorie entrees.
• Ask for side dishes without butter or margarine.
• Ask for mustard, salsa, or low-fat yogurt instead of sour cream or butter.

DESSERT/COFFEE

• Fresh fruit
• Nonfat frozen yogurt
• Sherbet or fruit sorbet (these are usually fat free, but check the calorie content)
• Try sharing a dessert.
• Ask for lowfat milk for your coffee (instead of cream or half-and-half).

Foods

In The Fast Lane

When you eat in a heart-healthy way, you don’t have to give up eating fast foods completely. You can eat right and still eat fast foods if you select carefully. Here are some tips on fast foods to choose:

■ Order a small hamburger instead of a larger one. Try the lower-fat hamburger. Hold the extra sauce.

■ Create a salad at the salad bar. Choose any raw vegetables, fruits, or beans. Limit high saturated fat toppings of cheese, fried noodles, and bacon bits as well as some

• Order roast beef for a leaner salads made with mayonchoice than most burgers. naise. Also limit salad
• Order a baked potato instead of dressings high in saturated French fries. Be careful of high-fat fat and cholesterol. toppings like sour cream, butter, or
• For sandwich toppings, cheese. try lettuce, tomato, onion, mustard, and
• Order grilled, broiled, or baked fish and ketchup instead of high saturated fat chicken. toppings such as cheese, bacon, special sauces, or butter.
• Order fat-free or 1 percent milk instead of a milkshake. Try the low-fat frozen yogurt or ■ Order pizza with vegetable toppings such as low-fat milkshake. peppers, mushrooms, or onions instead of extra cheese, pepperoni, or sausage.
• Order a salad. Use vinegar and oil or low-calorie dressing more often than creamy salad dressing.

Let’s see how small changes can add up to big changes with the following sample fast-food meals.

Typical Meal

Cheeseburger

Large French fries

12-ounce cola

Vanilla ice milk cone

Lower-Fat Choice

Hamburger

1/2 small French fries

12-ounce cola

Low-fat frozen yogurt cone

Saturated Fat(g) ..................................16 ................................................................6 Dietary Cholesterol(mg) ......................78 ..............................................................38 Total Fat(g) ..........................................40 ..............................................................19 Total Calories ....................................990 ............................................................649

22 Healthy Eating

Putting Heart Healthy Eating Habits Into Play-

Foods to choose and foods to lose

This is a Who’s Who of foods. Use it to learn about food groups and their nutrients. It lists foods in choose and decrease columns. It also gives recommended serving numbers and sizes. Some serving numbers differ for guys and girls. That’s because guys often need more calories. The amount of a single serving is given in parentheses beside the food.

Do:

Choose foods from each food group every day. Select food group items more often from the “choose” column than the “decrease” column.

MEAT, POULTRY, FISH,&SHELLFISH Nutrients: Protein, minerals (especially iron), vitamins, saturated fat, and cholesterol. Servings/day: Up to 6 ounces cooked (3 ounces of cooked meat is about the size of a deck of cards).

CHOOSE

Lean cuts of meat with fat trimmed, like:

Beef—round, sirloin, chuck, loin, extra lean

hamburger

Lamb—leg, arm, loin, rib

Pork—tenderloin, leg, shoulder

DECREASE

Cuts of meat, like:

Beef—regular hamburger,

short ribs, corned beef brisket

Pork—spareribs, blade roll

Bacon, sausage (arm or Poultry with skin, fried chicken picnic) Fried fish and fried shellfish Veal—all

trimmed cuts except ground

Organ meats like liver, kidney, sweetbread, brain Regular luncheon meat like bologna, salami, sausage, beef or pork hot dogs

Poultry without skin

Fish

Shellfish like crabs, clams, and scallops

Lean luncheon meat like turkey ham, turkey, lean ham, or lean roast beef. Chicken hot dogs— these are lower in saturated fat than beef or pork hot dogs. But “lower” doesn’t equal “low.” So make them a once-in-a-while choice.

Healthy Eating 23

Foods to choose and foods to lose...

DAIRY PRODUCTS Nutrients: Protein, vitamins, minerals (especially calcium), saturated fat, and cholesterol. Servings/day: 4 Note: The numbers in parentheses below are equal to 1 serving.

CHOOSE Milk (1 cup)—fat-free milk, 1% milk (fluid, powdered, evaporated); buttermilk

DECREASE Whole milk (fluid, evaporated, condensed); 2% low-fat milk; imitation milk Yogurt (1 cup)—nonfat or low-fat yogurt; yogurt beverages Whole-milk yogurt; custard-style yogurt; whole-milk yogurt beverages Cottage cheese (1/2 cup)—low-fat or non-fat Cottage cheese (4% fat) Cheese (1 oz.)—low-fat cheeses labeled no more than 3 grams of fat per ounce High-fat cheese like American, blue, Brie, cheddar, Colby, Edam, Monterey Frozen dairy dessert (1/2 cup)—ice milk, low- Jack, Parmesan, Swiss; cream cheese fat frozen yogurt Ice cream Sour cream—low-fat and fat-free Cream like half and half, whipping cream, sour cream

DON’T HAVE ACOW

One of the easiest things to change is drinking

“ 1% milk instead of whole milk. And now

there are lots of substitutes for ice cream.

Maria, 15”

Dairy foods are a great source of calcium and protein. Eating foods high in calcium helps bones grow and stay strong. As a teen, your bones are growing quickly. So now is the best time in your life to eat foods rich in calcium. Girls, especially, need to eat foods high in calcium. A very good choice is low-fat dairy products, which are not only rich in calcium but also low in saturated fat and cholesterol.

24 Healthy Eating

Foods to

,&B BREADS, CEREALS, PASTA, RICE, DRY PEAS Carbohydrates, protein, vitamins, minerals, and fiber. Servings/day: 12 for guys and 8 for girls. The numbers in parentheses below are equal to 1 serving.

CHOOSE

Bread (1 slice)—whole-grain bread; hamburger and hot-dog buns (1/2 a bun); bagels (1/2); tortilla (1)

Cereal (1 cup ready-to-eat, 1/3 cup bran or 1/2 cup cooked)—oat, wheat, corn, multigrain

Pasta (1/2 cup cooked)—plain noodles, spaghetti, macaroni

Rice (1/2 cup cooked)

Low-fat crackers—animal crackers (8); graham (3); saltine-type (6)

Homemade baked goods using unsaturated oil, fat-free or 1% milk, and egg substitutes— quick bread (1 slice); 2" biscuit (1); cornbread muffin (1); bran muffin (1); 4" pancake (1); 9" diameter waffle (1/4)

Dry beans, peas and legumes (1/2 cup cooked)—split peas, black-eyed peas, chick peas, kidney beans, navy beans, lentils, soybeans, soybean curd (tofu)

Soup like chicken or beef noodle, tomato, vegetable

VEGETABLES

DECREASE

Bread in which eggs are a major ingredient; croissants, butter rolls, cheese bread

Granola-type cereals

Egg noodles and pasta containing egg yolk

Pasta and rice prepared with cream, butter, or cheese sauces

High-fat crackers—cheese crackers, butter crackers, or others made with saturated fats

Commercial baked pastries, muffins, biscuits, doughnuts, sweet rolls, Danish pastry using high saturated fat and cholesterol ingredients

Dry beans, peas and legumes prepared with butter, cheese, or cream sauce

Potato or corn chips

Soups made with cream or whole milk

Carbohydrates, fiber, vitamins, and minerals. Servings/day: 4 for guys and 3 for girls. The numbers in parentheses below are equal to 1 serving.

CHOOSE

Vegetables (1/2 cup)— fresh, frozen, or canned

DECREASE

Vegetables prepared with butter, cheese, or cream sauce

Fried vegetables like French fries

Healthy Eating 25

lose...

FRUITS Nutrients: Carbohydrates, fiber, and vitamins. Servings/day: 5 for guys and 3 for girls. The numbers in parentheses below are equal to 1 serving.

CHOOSE

Fruit (1/2 cup or medium-size piece)—fresh, frozen, canned, or dried

Fruit juice (1/2 cup)—fresh, frozen, or canned

FATS & OILS

DECREASE

Fried fruit like banana chips or fruit served with butter, cream sauce, or ice cream

saturated and unsaturated fats, cholesterol, and very small amounts of vitamins and minerals. Servings/day: 10 for guys and 5 for girls. The numbers in parentheses below are equal to 1 serving.

CHOOSE

Unsaturated oils (1 tsp.)—sunflower, safflower, sesame, soybean, corn, olive, canola oil

Margarine or shortening (1 tsp.)—made from unsaturated oils listed above; light or diet margarine (2 tsp.)

Salad dressings (1 tbsp.)—dressings made with unsaturated oils listed above; low-fat or oil-free dressings (serving size depends on amount of oil)

Seeds and nuts (1 tbsp.)—peanut butter, other nut butters*

Cocoa powder (as desired)

Olives (5 small) and avocado (1/8 of whole)*

• These are listed because they are high in unsaturated fat.

26 Healthy Eating

DECREASE

Saturated oils—coconut oil, palm kernel oil, palm oil

Butter, lard, bacon fat

Shortening

Dressings made with egg yolk, cheese, sour cream, whole milk

Coconut

Chocolate

Foods to choose and foods to lose...

SWEETS & SNACKS Nutrients: Saturated fat, cholesterol, and carbohydrates. Servings/day: 4 for guys and 3 for girls. Note: The numbers in parentheses below are equal to 1 serving.

CHOOSE

Beverages (6 fl. oz.)—fruit-flavored drinks; lemonade, fruit punch

Sweets (1-1/2 tbsp.)—sugar, syrup, honey, jam, preserves; candy (3/4 oz.) made primarily with sugar (candy corn, gumdrops, hard candy); fruit-flavored gelatin (1/2 cup)

Low-fat frozen desserts (1/3 cup)—sherbet, sorbet, fruit ice, popsicles, low-fat frozen yogurt

Cookies (2), cake (1 slice), pie (1 slice), pudding (1/2 cup)—all prepared with egg whites, egg substitute, fat-free or 1% milk, and unsaturated oil or margarine; plain popcorn (3 cups); gingersnaps (2); fig bar cookies (1); angel food cake (1 slice)

DECREASE

Candy made with chocolate, butter, cream, coconut oil, palm oil, palm kernel oil

Ice cream and frozen treats made with ice cream or whole milk

Commercial baked high-fat cookies, cakes, cream pies, doughnuts

Healthy Eating 27

28 Healthy Eating

The Heart-Healthy

Eating Plan

The foods you eat play a big part in keeping your heart healthy. But, what exactly is a hearthealthy eating plan? And is a heart-healthy eating plan important for everyone? All healthy Americans, 2 years of age or older, should eat in a way that is lower in total fat, saturated fat, cholesterol, sodium, and extra calories. Heart disease is still the number one killer of both men and women in the United States. High blood cholesterol, high blood pressure, smoking, overweight, and physical inactivity increase your risk of getting heart disease. The good news is that you can change these risk factors and reduce your risk of heart disease.

In order to help your family eat in a hearthealthy way, follow these recommendations.

1 Choose foods low in saturated fat.

All foods that contain fat are made up of a mixture of saturated and unsaturated fats. Saturated fat raises your blood cholesterol level more than anything else you eat. The best way to reduce blood cholesterol is to choose foods lower in saturated fat. Less than 10 percent of the calories in your diet should come from saturated fat. One way to help your family do this is by choosing foods such as fruits, vegetables, and whole grains—foods naturally low in total fat and high in starch and fiber.

2 Choose foods low in total fat.

Since many foods high in total fat are also high in saturated fat, eating foods low in

total fat will help your family eat less saturated fat. No more than 30 percent of the calories in your diet should come from fat. When you do eat fat, substitute unsaturated fat— either polyunsaturated or monounsaturated—for saturated fat. But, watch the amount. Fat is a rich source of calories, so eating foods low in fat will also help you eat fewer calories. Eating fewer calories can help you lose weight and, if you are overweight, losing weight is an important part of lowering your blood cholesterol.

3 Choose foods high in starch and fiber.

Foods high in starch and fiber are excellent substitutes for foods high in saturated fat. These foods—breads, cereals, pasta, grains, fruits, and vegetables—are low in saturated fat and cholesterol. They are also lower in calories than foods that are high in fat. But limit fatty toppings and spreads like butter and sauces made with cream and whole milk dairy products. Foods high in starch and fiber are also good sources of vitamins and minerals.

When eaten as part of a diet low in saturated fat and cholesterol, foods with soluble fiber—like oat and barley bran and dry peas and beans—may help to lower blood cholesterol.

4 Choose foods low in cholesterol.

Remember, dietary cholesterol can raise blood cholesterol, although usually not as much as saturated fat. So it’s important for your family to choose foods low in dietary

Healthy Eating 29

cholesterol. Strive for less than 300 milligrams of cholesterol a day. Dietary cholesterol is found only in foods that come from animals. And even if an animal food is low in saturated fat, it may be high in cholesterol; for instance, organ meats (like liver) and egg yolks are low in saturated fat but high in cholesterol. Egg whites and foods from plant sources do not have cholesterol.

5 Choose foods lower in salt and sodium.

Americans eat more salt (sodium chloride) and other forms of sodium than they need. Often, when people with high blood pressure cut back on salt and sodium, their blood pressure falls. Cutting back on salt and sodium also prevents blood pressure from rising. African Americans, the elderly, and persons with certain illnesses are more affected by sodium than others. Since there’s really no practical way to predict exactly who will be affected by sodium, it makes sense to limit intake of salt and sodium to help prevent high blood pressure.

Americans, especially people with high blood pressure, should eat no more than about 6 grams of salt a day, which equals about 2,400 milligrams of sodium (the daily reference value you see on the new food label). That’s about 1 teaspoon of table salt. But remember to keep track of ALL salt eaten—including that in processed foods and added during cooking or at the table.

30 Healthy Eating

6 Maintain a healthy weight, and lose

weight if you are overweight. People who are overweight tend to have higher blood cholesterol levels. And, as body weight increases, blood pressure increases. Overweight adults with an “apple shape— bigger (pot) belly—tend to have a higher risk for heart disease than those with a “pear” shape—bigger hips and thighs. Whatever your body shape, when you cut the fat in your diet, you cut down on the richest source of calories. However, even some low-fat foods are high in calories. So it is not only what you eat but how much you eat. An eating pattern of foods high in starch and fiber, instead of fat and calories, in moderation is a good way to help control weight.

7 Be more physically active.

Being physically active helps improve blood cholesterol levels. Being more active also can help you lose weight, lower your blood pressure, improve the fitness of your heart and blood vessels, and reduce stress. And being active together is great for the entire family.

Help Your Family

To Better Heart Health

It is good to tell children and teenagers to eat right and be physically active; it is even better to show them. Encourage children to eat for the health of their heart, and teach them that what they eat makes a difference in how their body looks, feels, and grows. Here are some tips to help your family develop healthful habits.

KNOW THE GUIDELINES TO HEART-HEALTHY EATING. Choosing foods lower in saturated fat, total fat, cholesterol, and sodium is important to your success in heart-healthy eating. Here are the basic guidelines:

• Less than 10 percent of calories from saturated fat
• An average of no more than 30 percent of calories from fat
• Less than 300 milligrams of dietary cholesterol a day
• Enough calories to support growth and to reach or maintain a healthy weight
• No more than 2,400 milligrams of sodium a day.

BE A GOOD ROLE MODEL. Set a good example. Adults, particularly parents, are a major influence on children’s behavior. Children also are influenced by television, radio, magazines, advertisements, friends, brothers and sisters, and others who may not follow your ways. If you follow a heart-healthy lifestyle, your children will be more likely to do the same. Being physically active with your child also sets a good example.

LEARN TO CHOOSE HEART-HEALTHY FOODS. Learn to choose foods lower in saturated fat, cholesterol, and sodium within each of the different groups. This will help you buy and provide such foods and snacks at home.

Choose heart-healthy foods from:

• Meat, poultry, fish, and shellfish
• Dairy products
• Eggs and egg substitutes
• Fruits and vegetables
• Breads, cereals, pasta, rice, and dry peas and beans
• Sweets and snacks.

STOCK THE KITCHEN. Stock the kitchen with foods that are lower in saturated fat, cholesterol, and sodium from each of the food groups. Prepare these foods in large quantities to be frozen for quick use later. Foods such as casseroles, soups, and breads can be frozen in individual servings for a quick meal. The whole family will then have hearthealthy meals on hand. Have healthy snacks such as fruit, English muffin mini-pizzas, cereal mixes, lower fat microwave popcorn, or frozen fruit bars easily available.

TEACH BASIC FOOD PREPARATION SKILLS. Teach children how to clean vegetables, make salads, and use the stove, oven, microwave, and toaster safely. Children who have basic cooking skills appreciate food more and are more inclined to try new foods. Teach your children to read the food labels.

Healthy Eating and Physical Activity 31

PLAN FAMILY MEALS. Eating meals as a family can encourage hearthealthy eating habits in children. The more you create a family setting where everyone shares the same nutritious meals, the more likely children will accept healthful eating as a way of life. Try to maintain regular family meals as often as you can. This way, the whole family can learn about healthful eating and build good eating habits.

ENCOURAGE PHYSICAL ACTIVITY. Make time for physical activity. Encourage children to get some exercise throughout the day and especially on weekends. Take trips that involve activities like hiking, swimming,

Children can participate in these activities on their own to help keep their hearts strong. Bicycling Dancing Jumping rope Running Brisk walking Jogging Roller blading Skating

32 Healthy Eating and Physical Activity

and skiing. Join in the fun. Ride bikes, run, skate, or walk to places close by. Give your child a splash or dance party. Use your backyard or local park for basketball, baseball, football, badminton, or volleyball.

To be really heart-healthy, physical activity for children needs to raise their heart and breathing rates, last 15 to 30 minutes without stopping, and be repeated at least three times a week.

Here are some heart-healthy group activities. Baseball and softball Basketball Cross-country skiing Football Frisbee Gymnastics Hiking and backpacking Ice and field hockey Racquetball Rowing Soccer Swimming Tennis

Cooking

The Heart-Healthy Way

Now it’s time to learn about some easy cooking tips to cut down on calories, saturated fat, cholesterol, and sodium. MEAT, POULTRY, AND FISH Before cooking meat, poultry, or fish:

• Trim fat from meat; remove the skin and fat from poultry.
• If you buy tuna or other canned fish packed in oil, rinse it in a strainer before cooking. Better yet, buy canned fish packed in water. If you are watching your sodium to help lower blood pressure, be sure to rinse the fish whether it is packed in oil or water.

Changes in your cooking style also can help to lower fat.

• Bake, broil, microwave, poach, or roast instead of frying.
• When you do fry, use a nonstick pan and a nonstick cooking spray or a very small amount of oil or margarine.
• When you roast meat or make meatloaf, place the meat on a rack so the fat can drip away.
• When a recipe calls for ground meat, brown the meat and drain well before adding to other ingredients.
• If you baste meats and poultry, use fat-free ingredients like wine, tomato juice, lemon juice, or defatted beef or chicken broth instead of the fatty drippings.

SAUCES, SOUPS, AND CASSEROLES

• After making sauces or soups, cool them in the refrigerator and skim the fat from the top. Treat canned broth-style soups the same way. Try low-sodium or reduced-sodium soups.
• When making casseroles with cheese, try lowerfat cheese. Or use less regular cheese than what the recipe calls for. If you use a sharp-flavored cheese, you won’t taste the difference.
• When you make creamed soup or white sauces, use fat-free, 1 percent, or evaporated

fat-free milk instead of 2 percent milk, whole milk, or cream.

• To make a low-fat sauce, thicken it with cornstarch or flour.
• Make main dishes with pasta, rice, or dry peas and beans. If you add meat, use small pieces just for flavoring instead of the main ingredient.

SEASONING AND CONDIMENTS

• Use small amounts of lean meats instead of salt pork or fat back to flavor vegetables while cooking.
• Flavor cooked vegetables with herbs or butterflavored seasoning instead of butter or margarine.
• Use herbs, spices, and no salt seasoning blends to bring out the flavor of foods. Try using garlic, garlic powder, onion, or onion powder instead of garlic salt and onion salt.
• Use salt sparingly in cooking, and use less salt at the table. Reduce the amount a little each day until no salt is used.
• Limit salty condiments like olives and pickles.

CONVENIENCE FOODS And for those times when you don’t feel like cooking:

• Use your own convenience foods—low-fat casseroles and soups that you have cooked ahead and then frozen in small batches.
• Check the nutrition labels to choose frozen dinners and pizzas that are lower in saturated fat, cholesterol, and sodium. Make sure the dinners have vegetables, fruits, and grains— or add them on the side.
• Use fewer sauces, mixes, and “instant” products, including flavored rices, pastas, and cereal, which usually have added salt.
• Use vegetables that are fresh, frozen without sauce, or canned with no salt added.

Healthy Eating 33

34 Healthy Eating

Sho p

To Your Heart’s Content

Use this handy guide to shop for a variety of heart-healthy foods. By eating a variety of foods each day, you will get the nutrients you need. Remember to use the food labels. Look for the words low-fat, lean, and light. The Federal Government has defined these words to help consumers find heart-healthy foods that contain less saturated fat, cholesterol, and sodium.

MEAT, POULTRY, FISH, AND SHELLFISH CHOOSE MORE OFTEN

Lean cuts of meat with fat trimmed before cooking: Beef—round, top loin, sirloin, chuck arm pot roast, lean ground beef (< 7% fat) Lamb—leg shank, fore shank, whole leg, loin, sirloin Pork—tenderloin, sirloin, top loin Veal—cutlets, ground, shoulder, sirloin, rib roast Turkey and chicken, skinless Most seafood~

Low-fat lunchmeat and hotdogs*

DAIRY PRODUCTS CHOOSE MORE OFTEN Fat-free or 1 percent milk Nonfat or low-fat yogurt Cheese with 3 grams of fat or less per ounce* Low-fat or nonfat sour cream

~ Shrimp, abalone, and squid are low in fat but high in sodium.

• Choices may be higher in sodium.

CHOOSE LESS OFTEN

Fatty cuts of meat: Beef—ribs, brisket, chuck blade roast, ground (regular) Lamb—chops and rib Pork—spareribs, blade, centerloin Goose, duck Liver, kidney Sausage, bacon Turkey and chicken, with skin Eel, pompano, and mackerel Regular lunchmeat and hotdogs

CHOOSE LESS OFTEN Whole or 2 percent milk Cream, most nondairy creamers Whipped cream or nondairy topping Whole milk yogurt Cheese with more than 3 grams of fat per ounce Sour cream

Healthy Eating 35

EGGS CHOOSE MORE OFTEN Egg whites Cholesterol-free or cholesterol-reduced egg substitutes* FATS AND OILS CHOOSE MORE OFTEN Unsaturated vegetable oils: corn, olive, canola, sesame, soybean, sunflower, safflower Soft margarine made with unsaturated fats listed above as first ingredient Low-fat or nonfat salad dressings Reduced or nonfat mayonnaise

FRUITS CHOOSE MORE OFTEN Fresh, frozen, canned, dried fruit, and fruit in its own juice

VEGETABLES CHOOSE MORE OFTEN Fresh, frozen, or canned* vegetables

CHOOSE LESS OFTEN Egg yolks

CHOOSE LESS OFTEN Lard, butter, palm kernel oil, palm oil, beef tallow, cocoa butter, coconut oil Hydrogenated fats and oils Margarine or shortening made with fats listed above Dressing made with egg yolk Fried foods

CHOOSE LESS OFTEN Fried fruit such as fried apples

CHOOSE LESS OFTEN Vegetables prepared in butter, cream, sauce, or fried

,

CHOOSE MORE OFTEN Breads, white or whole grain, such as pita, bagel, English muffin, sandwich buns, dinner rolls Rice cake Corn tortilla Low-fat crackers like matzo, bread sticks, rye crackers, saltines* Pancakes, waffles Lower-fat biscuits, muffins, hot cereals, most cold cereals* Rice, barley, bulgur Dry peas and beans Pasta

• Choices may be higher in sodium.

36 Healthy Eating

CHOOSE LESS OFTEN Croissants, pastry, doughnuts, coffee cake, butter rolls Snack crackers like cheese and butter crackers Pasta, grain, and potato dishes made with cream, butter, or cheese Egg noodles Chow mein noodles, canned Regular granola cereals

SWEETS AND SNACKS

CHOOSE MORE OFTEN Nonfat and low-fat frozen desserts like sherbet, sorbet, Italian ice, frozen yogurt,

CHOOSE LESS OFTEN High-fat frozen desserts, like ice cream, frozen tofu, whole-milk frozen yogurt frozen fruit juice bars High-fat baked goods, like most store-bought Low-fat or nonfat baked goods like brownies, pound and frosted cakes, pies, cookies cakes, cupcakes, pastries, fig and other fruit Milk chocolate bars, vanilla or lemon wafers, graham crackers, gingersnaps Fried chips and buttered popcorn

Jelly beans, hard candy, fruit leather Plain popcorn, pretzels, no-oil baked chips* (Remember that baked goods and frozen desserts are high in sugar and may be high in calories.)

• Choices may be higher in sodium.

Do You Know How Much You Are Serving?

Learning about portion sizes is an important part of being in control of what you eat. Here are some tips to help you know just how much you’re getting.

• Jar Lid: A piece of meat the size of a pint or quart mayonnaise jar lid is about 3 ounces.
• Deck of cards: A standard deck of cards is about the same size as 3 ounces of meat, poultry, or fish.
• Measuring cups: To find out how much you’re serving your family at meals, try dishing it up with measuring cups. After a few tries, it should be easy to judge how big the portions are.

How Much Sodium Is in Your Food?

• Most canned vegetables, vegetable juices, and frozen vegetables with sauce are higher in sodium than fresh or frozen ones cooked without added salt.
• Sodium content of milk products varies. Lowest are milk and yogurt. Natural cheese contains a bit more, followed by cottage cheese, then processed cheeses, cheese foods, and cheese spreads.
• Most fresh meats, poultry, and fish are low in sodium. Most cured and processed meats such as hotdogs, sausage, and lunchmeats are higher in sodium because sodium is used as a preservative.

Healthy Eating 37

38 Healthy Eating

New Ways To Use Favorite Recipes

Lots of special cookbooks and recipe booklets can help you lower the fat, saturated fat, cholesterol, and sodium when you cook. But you don’t have to throw out your favorite cookbook or recipes that you’ve been using for years. Just cut down on the high-fat, high-sodium ingredients, and substitute ingredients that are lower in saturated fat, cholesterol, and sodium as much as possible. Some recipes may change in texture and consistency when you use these substitutions.

Recipe Substitutions Instead of Use

Whole milk ......................................Fat-free or 1 percent milk

Evaporated milk ..............................Evaporated fat-free milk

Light cream ......................................Equal amounts of 1 percent milk and evaporated fat-free milk

Heavy cream ....................................Evaporated fat-free milk

1 cup butter ......................................1 cup soft margarine or 2/3 cup vegetable oil*

Shortening or lard ............................Soft margarine*

Mayonnaise or salad dressing..............Nonfat or light mayonnaise or salad dressing; Mustard in sandwiches

1 whole egg......................................1/4 cup egg substitute or 2 egg whites Cheese..............................................Lower fat cheese+

Cream cheese ..................................Nonfat or light cream cheese

Sour cream ......................................Nonfat or low-fat sour cream or yogurt

Fat for greasing pan ........................Nonstick cooking spray

1 ounce baking chocolate ................3 tablespoons cocoa powder plus 1 tablespoon vegetable oil

Regular bouillon or broth ................Low sodium bouillon and broth

Fatback, neck bone, or ham hocks ......Skinless chicken thighs

Pork bacon ......................................Turkey bacon, lean ham, or Canadian bacon (omit if on low sodium diet)

Pork sausage ....................................Ground skinless turkey breast

Ground beef and pork ......................Ground skinless turkey breast

• The texture of baked goods may be different when you use these substitutions. “Light” margarine is not recommended for baking. Experiment to find out what works best for you. + Some salad dressings, processed cheeses, and cottage cheese are very high in sodium. Omit if on a low-sodium diet or substitute a product that is low in sodium and fat.

Healthy Eating 39

40 Healthy Eating

Physical Activity 41

42 Physical Activity

Get Moving

Fast

Can you run for a bus without huffing and puffing?

These Physical activity is good for you and your heart. Activities Your heart, like every other muscle, gets stronger with Are Good for exercise. The right kind of exercise will help you and Your Heart

your heart become more fit. The more fit your heart is,

Fast walking

the better it works. The more fit you are, the longer you

Soccer

can exercise without getting tired. You will be able to run

Swimming

for the bus without huffing and puffing.

Dancing

Physical activity is fun for everyone. There are all kinds of

Skating

activities you can do. You can enjoy exercise by yourself, with

Frisbee®

a friend, or your family. Find what is right for you.

Hockey

Exercise is good for you and your heart.

Hiking

Tennis

The good things

Running

physical activity does for you Basketball

Jumping rope

• Your heart gets strong because it

Skipping

gets a good workout.

Kickball

• Your muscles look and feel firm

Skiing

and work better.

Rowing

• You can breathe easier.

Bicycling

• You burn off calories which will

Handball

help keep you from getting fat.

• You have more energy.

The letters in some of the activities listed above are now all mixed up. Can you write the word the way it should be?

mniwgims ____________________________ creocs ________________________________ gpsnpkii ______________________________ cdainng ______________________________ sfta likngaw ____________________________ pmjungi proe __________________________

nugnnri________________________________ ksabtelbal______________________________

Physical Activity 43

44 Physical Activity

Check Your

Physical Activity and Heart Disease

Test how much you know about how physical activity affects your heart. Mark each question true or false. See how you did by checking the answers on the back of this sheet.

1 Regular physical activity can reduce

your chances of getting heart disease. T F

2 Most people get enough physical

activity from their normal daily routine. T F

3 You don’t have to train like a marathon

runner to become more physically fit. T F

4 Exercise programs do not require a lot

of time to be very effective. T F

5 People who need to lose some weight

are the only ones who will benefit from regular physical activity. T F

6 All exercises give you the same

benefits. T F

7 The older you are, the less active you

need to be. T F

8 It doesn’t take a lot of money or

expensive equipment to become physically fit. T F

9 There are many risks and injuries that

can occur with exercise. T F

10 You should always consult a doctor

before starting a physical activity program. T F

11 People who have had a heart attack

should not start any physical activity program. T F

12 To help stay physically active,

include a variety of activities. T F

Physical Activity 45

To the Check Your Physical Activity and Heart Disease I.Q. Quiz

1 True. Heart disease is almost twice as

likely to develop in inactive people. Being physically inactive is a risk factor for heart disease along with cigarette smoking, high blood pressure, high blood cholesterol, and being overweight. The more risk factors you have, the greater your chance for heart disease. Regular physical activity (even mild to moderate exercise) can reduce this risk.

2 False. Most Americans are very busy but

not very active. Every American adult should make a habit of getting 30 minutes of low-to-moderate levels of physical activity daily. This includes walking, gardening, and walking up stairs. If you are inactive now, begin by doing a few minutes of activity each day. If you only do some activity every once in a while, try to work something into your routine every day.

3 True. Low- to moderate-intensity activities,

such as pleasure walking, stair climbing, yard work, moderate-to-heavy housework, dancing, and home exercises can have both short- and long-term benefits. If you are inactive, the key is to get started. One great way is to take a walk for 10 to 15 minutes during your lunch break, or take your dog for a walk every day. At least 30 minutes of physical activity every day can

46 Physical Activity

help improve your heart health and lower your risk of heart disease.

4 True. It takes only a few minutes a day to

become more physically active. If you don’t have 30 minutes in your schedule for an exercise break, try to find two 15-minute periods or even three 10-minute periods. Once you discover how much you enjoy these exercise breaks, they’ll become a habit you can’t live without.

5 False. People who engage in regular

physical activity experience many positive benefits. Regular physical activity gives you more energy, reduces stress, helps you relax, and helps you sleep better. It helps lower high blood pressure and improves blood cholesterol levels. Physical activity helps tone your muscles, burns off calories to help you lose extra pounds or stay at your desirable weight, and helps control your appetite. It can also increase muscle strength, help your heart and lungs work more efficiently, and let you enjoy your life more fully.

6 False. Low-intensity activities—if per-

formed daily—can have some long-term health benefits and can lower your risk of heart disease. Regular, brisk, and sustained exercise for at least 30 minutes—three to four times a week—such as brisk walking, jogging, or swimming—is necessary to improve the efficiency of your heart and

lungs and burn off extra calories. These kinds of activities are called aerobic— meaning the body uses oxygen to produce the energy needed for the activity. Other activities may give you benefits such as increased flexibility or muscle strength, depending on the type of activity.

7 False. Although we tend to become less

active with age, physical activity is still important. In fact, regular physical activity in older persons increases their capacity to do everyday activities. In general, middleaged and older people benefit from regular physical activity just as young people do. What is important, NO matter what your age is tailoring the activity program to your own fitness level.

8 True. Many activities require little or no

equipment. For example, brisk walking only requires a comfortable pair of walking shoes. Also, many communities offer free or inexpensive recreation facilities and physical activity classes. Shopping malls, make ideal walking environments as many of them are open early and late for people who do not wish to walk alone, in the dark, or in bad weather.

9 False. The most common exercise risk is

injury to the muscles and joints. Such injuries are usually caused by exercising too hard for too long, particularly if a person has been inactive for some time. To avoid injuries, try to build up your level of activity gradually; listen to your body for early warning pains; be aware of possible signs of heart problems (such as pain or pressure in the left or mid-chest area, left neck, shoulder, or arm during or just after exercising, or sudden light-headedness, cold sweat, pallor, or fainting); and be prepared for special weather

conditions.

10 True. You should ask your doctor before

you start (or greatly increase) your physical activity if you have a medical condition such as high blood pressure, have pains or pressure in the chest and shoulder area, tend to feel dizzy or faint, get very breathless after mild exertion, are middle-aged or older and have not been physically active, or plan a fairly vigorous activity program. If none of these apply, start slow and get moving.

11 False. Regular, physical activity can help

reduce your risk of having another heart attack. People who include regular physical activity in their lives after a heart attack improve their chances of survival and can improve how they feel and look. If you have had a heart attack, consult your doctor to be sure you are following a safe and effective exercise program that will help prevent heart pain and further damage from overexertion.

12 True. Pick several different activities that

you like doing, because you will be more likely to stay with a regular regimen. Plan short-term as well as long-term goals. Keep a record of your progress, and check it regularly to see the progress you have made. Get your family and friends to join in. They can help keep you going.

Physical Activity 47

48 Physical Activity

Get

Want more energy? Want less stress? Want to fall asleep easily? Firmer muscles sound good? One—count it, one—there’s one way to do it all. What’s the secret? Getting physical, of course.

Turn off your TV and turn on to physical activity! You don’t have to groan for hours every day. A few minutes of some type of activity, even walking, every day will help improve your health— and more vigorous activity such as swimming, running or jumping rope will help condition your heart and lungs if you do them for at least 30 minutes, three to four times a week.

These kinds of activities are often called “aerobic”—which means the body uses oxygen to produce the energy needed for the activity. These exercises are brisk enough to raise your heart and breathing rates. They expand your lung capacity and help to strengthen your heart muscle, warding off heart disease.

Physical activity also can help lower high blood cholesterol and control weight. First, it can decrease “bad” LDL-cholesterol, while increasing “good” HDL-cholesterol. Second, combined with a low-calorie diet, it helps you shed extra weight. You’ll find it decreases your hunger and fine-tunes the metabolism. See the activities on page 51 to see how many calories can be burned up doing different activities.

Sold?

Good, because being physically active is no fad. It’s a lifelong good habit. Try out various activities. Find ones that you enjoy. And don’t hesitate to mix them up—don’t get into a rut. The activities on page 51 give you some ideas. Try one or all!

Physical Activity 49

Get

Body

“

Working out makes you feel and look better. It’s also a good way to meet new people.

Suzanne, 18

”

Key To Health

You hold the key to health and fitness — regular physical activity. Starting

Magic

Start your exercise session by preparing.

Stretch and warm 2

your muscles. Don’t do too much too soon. Begin slowly and intensify carefully.

Ask someone to join you.

do it—but set a schedule

and stick to it.

50 Physical Activity

can be tough, though. So here are some howto’s to rev your motor:

Try an outdoor and an indoor activity. Switch back and forth to prevent boredom. You won’t have to reschedule because of bad weather, either.

If you’re not sure about an activity, ask your gym teacher or coach for advice.

Get

Here are a few activities that just may get you hooked on being physically active.

Listed next to each one is the number of calories a 150-pound person would burn up doing these activities for an hour. Remember: Any activity that gets you moving around is better than nothing at all. To help condition your heart and lungs, move it at least three times a week, for about 30 minutes each time. Do it on your own or with friends.

And don’t forget to have fun!

ACTIVITY CALORIES BURNED UP PER HOUR

Running ..................................................................650-1280

Jogging ....................................................................740-920

Jumping rope ..................................................................750

Racquetball ......................................................................750

Cross-country skiing ........................................................700

Basketball ...................................................................... 564

Ice and field hockey ........................................................546

Football ............................................................................540

Soccer..............................................................................540

Swimming ................................................................275-500

Brisk walking....................................................................440

Dancing............................................................................420

Bicycling....................................................................240-410

Hiking and backpacking ..................................................408

Tennis ..............................................................................400

Skating ............................................................................300

Baseball and softball........................................................282

Gymnastics ......................................................................270

Note: These numbers are for someone who weighs 150 pounds. The amount of calories you burn up depends on how much you weigh. The more you weigh, the more calories you burn. Physical Activity 51

Get

So Figure It Out

For Yourself

To find the number of calories you would burn up in any of the activities noted on the previous chart:

Write down your weight. Since the numbers on the chart are for someone 150 pounds, divide your weight by 150.

Multiply this number by the number of calories burned in an hour of an activity you like to do that is listed on the chart.

This will give you the number of calories YOU burn doing this activity for an hour.

Note: In this example, a 125-pound person burns only 0.83 times the calories of a 150-pound person, and when playing basketball, only 468 calories are burned compared to 564 calories.

Example:

___________ 125 lbs. (Your weight)

÷

150

=

÷

150

=

___________ .83

x x

___________ 564 calories (# of calories) (basketball)

= =

___________ 468 calories

52 Physical Activity

Guide To Physical Activity

To improve your health, set a goal of at least Both healthy eating and physical activity are important in weight control. Most successful weight loss is a combination of eating fewer calories and using more energy through activity. Staying physically active is most helpful in keeping weight off

30 minutes of moderate-intensity physical activity most days of the week. You can do this all at one time or at several times during the day. Initial activities may be to start out walking or swimming at a slow pace. For example, you can start out walking slowly for a total of 30 minutes for life. Plus, physical activity has the benefit of 3 days a week and gradually build to 45 minutes or lowering the risk of certain diseases, such as heart disease and diabetes.

more of faster-paced walking. By doing this, you can use 100 to 200 more calories per day. If you have not been physically active in the past, the key to success is to start slowly. Trying too hard at first can lead to injury. Also, taking the time to find out what you enjoy doing will help to make physical activity a regular part of your lifestyle.

This plan can be used with other types of physical activity, but walking is popular because it is safe and convenient.

Examples of Moderate Amounts of Physical Activity

Common Chores

Washing and waxing a car for 45 to 60 minutes

Washing windows or floors for 45 to 60 minutes

Gardening for 30 to 45 minutes

Wheeling self in wheelchair 30 to 40 minutes

Pushing a stroller 1/2 miles in 30 minutes

Raking leaves for 30 minutes

Walking 2 miles in 30 minutes (15 minutes/mile)

Shoveling snow for 15 minutes

Stair-walking for 15 minutes

Sporting Activities

Playing volleyball for 45 to 60 minutes Less Vigorous, More Time

Playing touch football for 45 minutes

Walking 1/4 miles in 35 minutes (20 minutes/mile)

Basketball (shooting baskets) 30 minutes

Bicycling 5 miles in 30 minutes

Dancing fast (social) for 30 minutes

Water aerobics for 30 minutes

Swimming laps for 20 minutes

Basketball (playing game) for 15 to 20 minutes

Bicycling 4 miles in 15 minutes

Jumping rope for 15 minutes More Vigorous, 1 Less Time Running 1/2 miles in 15 minutes (10 minutes/mile)

Physical Activity 53

Another way to be more active is to do more “everyday” activities, such as taking the stairs instead of the elevator. Also, try spending more time doing lighter activities such as gardening, household chores, and walking to visit neighbors, rather than sedentary activities such as watching television and working on the computer.

Becoming Physically Active

For the beginner, choose very light activities such as an increase in standing activities, special chores like room painting, pushing a stroller or wheelchair, yard work, ironing or cooking, and playing a musical instrument.

The next level would be light activities, such as slow walking, garage work, carpentry, house cleaning, child care, golf, sailing, and recreational table tennis.

Once comfortable with this level, try adding more moderate activities such as faster walking, weeding and hoeing a garden, carrying a load, cycling, skiing, tennis, and dancing.

High intensity activities include very fast walking or walking with a load uphill, tree felling, heavy manual digging, basketball, climbing, or soccer/kickball.

You may also want to try:

• Flexibility exercise to improve joints and muscles
• Strength-building or resistance exercises
• Aerobic conditioning

If structured group activities are what you need to help you stay physically active, try joining community recreation programs, the YMCA, or a health club. You can find a variety of activities for all fitness levels and budgets.

54 Physical Activity

How You Can Fit Activity Into Your Schedule

Many people are completely inactive, and they all have reasons.

I don’t have the time to exercise.

While physical activity does take time, only about 1 hour per week of vigorous activity gives benefits to your heart, lungs, muscles, and weight. Consider the amount of time you spend watching TV. Many forms of physical activity can be done while watching TV, such as riding an exercise bike or using hand weights.

I don’t like to exercise.

You have bad memories of doing situps or running in high school, sweating, puffing, and panting. Nowadays we know that you can get plenty of gain without pain. Activities you already do such as gardening and walking can improve your health, so just do more of the activities you like.

I don’t have the energy to be more active.

Once you become a little more active, you should have more energy. As you progress, daily tasks will seem easier.

Benefits Of Regular Activity

• Your weight is much easier to control when you are active.
• Physical activity can be lots of fun.
• You can be with other people when you are active.
• You’ll feel and look better when you’re physically active.
• Physical activity is good for your heart.
• Physical activity is a great way to reduce anxiety and stress, and helps you beat the blues.
• You’ll feel more confident when you are active.
• You’ll have more energy.
• You may sleep better.

55 Healthy Eating Obesity & Overweight 55

56 Obesity & Overweight

Check Your

Weight and Heart Disease

The following statements are either true or false. The statements test your knowledge of overweight and heart disease. The correct answers can be found on the following page.

1 Being overweight puts you at risk for heart

disease. T F

2 If you are overweight, losing weight helps

lower your blood cholesterol and high blood pressure. T F

3 Quitting smoking is healthy, but it

commonly leads to excessive weight gain which increases your risk for heart disease. T F

4 An overweight person with high blood

pressure should pay more attention to a low-sodium diet than to weight reduction. T F

5 A reduced intake of sodium or salt does not

always lower high blood pressure to normal. T F

6 The best way to lose weight is to eat fewer

calories and exercise. T F

7 Skipping meals is a good way to cut down

on calories. T F

8 Foods high in complex carbohydrates (starch

and fiber) are good choices when you are trying to lose weight. T F

9 The single most important change most people

can make to lose weight is to avoid sugar. T F

10 Polyunsaturated fat has the same number of

calories as saturated fat. T F

11 Overweight children are very likely to

become overweight adults. T F

YOUR SCORE: How many correct answers did you make?

10–11 correct=Congratulations! You know a lot about weight and heart disease. Share this information with your family and friends.

8–9 correct=Very good.

Fewer than 8=Go over the answers and try to learn more about weight and heart disease.

NHLBI Obesity Education Initiative

Obesity & Overweight 57

To Your Weight and Heart Disease I.Q. Test

1 True. Being overweight increases your

risk for high blood cholesterol and high blood pressure, two of the major risk factors for coronary heart disease. Even if you do not have high blood cholesterol or high blood pressure, being overweight may increase your risk for heart disease. Where you carry your extra weight may affect your risk too. Weight carried at your waist or above seems to be associated with an increased risk for heart disease in many people. In addition, being overweight increases your risk for diabetes, gallbladder disease, and some types of cancer.

2 True. If you are overweight, even moderate

reductions in weight, such as 5 to 10 percent, can produce substantial reductions in blood pressure. You may also be able to reduce your LDL-cholesterol (“bad” cholesterol) and triglycerides and increase your HDL-cholesterol (“good” cholesterol).

3 False. The average weight gain after

quitting smoking is 5 pounds. The proportion of ex-smokers who gain large amounts of weight (greater than 20 pounds) is relatively small. Even if you gain weight when you stop smoking, change your eating and exercise habits to lose weight rather than starting to smoke again. Smokers who quit smoking decrease their risk for heart disease by about 50 percent compared to those people who do not quit.

58 Obesity & Overweight

4 False. Weight loss, if you are overweight,

may reduce your blood pressure even if you don’t reduce the amount of sodium you eat. Weight loss is recommended for all overweight people who have high blood pressure. Even if weight loss does not reduce your blood pressure to normal, it may help you cut back on your blood pressure medications. Also, losing weight if you are overweight may help you reduce your risk for, or control, other health problems.

5 True. Even though a high sodium or salt

intake plays a key role in maintaining high blood pressure in some people, there is no easy way to determine who will benefit from eating less sodium and salt. Also, a high intake may limit how well certain high blood pressure medications work. Eating a diet with less sodium may help some people reduce their risk of developing high blood pressure. Most Americans eat more salt and other sources of sodium than they need. Therefore, it is prudent for most people to reduce their sodium intake.

6 True. Eating fewer calories and exercising

more is the best way to lose weight and keep it off. Weight control is a question of balance. You get calories from the food you eat. You burn off calories by exercising. Cutting down on calories, especially calories from fat, is key to losing weight. Combining this with a regular physical activity program, like walking, bicycling, jogging, or swimming, can not only help in losing weight but also in maintaining

the weight loss. A steady weight loss of 1 to 2 pounds a week is safe for most adults, and the weight is more likely to stay off over the long run. Losing weight, if you are overweight, may also help reduce your blood pressure and raise your HDL-cholesterol, the “good” cholesterol.

7 False. To cut calories, some people

regularly skip meals and have no snacks or caloric drinks in between. If you do this, your body thinks that it is starving even if your intake of calories is not reduced to a very low amount. Your body will try to save energy by slowing its metabolism—that is, decreasing the rate at which it burns the calories. This makes losing weight even harder and may even add body fat. Try to avoid long periods without eating. Five or six small meals are often preferred to the usual three meals a day for some individuals trying to lose weight.

8 True. Contrary to popular belief, foods

high in complex carbohydrates (like pasta, rice, potatoes, breads, cereals, grains, dried beans and peas) are lower in calories than foods high in fat. In addition, they are good sources of vitamins, minerals, and fiber. What adds calories to these foods is the addition of butter, rich sauces, whole milk, cheese, or cream, which are high in fat.

9 False. Sugar has not been found to cause

obesity; however, many foods high in sugar are also high in fat. Fat has more than twice the calories as the same amount of protein or carbohydrates (sugar and starch). Thus, foods that are high in fat are high in calories. High-sugar foods, like cakes, cookies, candies, and ice cream, are high in fat and calories and low in vitamins, minerals, and protein.

10 True. All fats—polyunsaturated,

monounsaturated, and saturated—have the same number of calories. All calories count, whether they come from saturated or unsaturated fats. Because fats are the richest sources of calories, eating less total fat will help reduce the number of calories you eat every day. It will also help reduce your intake of saturated fat. Particular attention to reducing saturated fat is important in lowering your blood cholesterol level.

11 False. Obesity in childhood does

increase the likelihood of adult obesity, but most overweight children will not become obese. Several factors influence whether or not an overweight child becomes an overweight adult: (1) the age the child becomes overweight; (2) how overweight the child is; (3) the family history of overweight; and (4) dietary and activity habits. Getting to the right weight is desirable, but children’s needs for calories and other nutrients are different from the needs of adults. Dietary plans for weight control must allow for this. Eating habits, like so many other habits, are often formed during childhood, so it is important to develop good ones.

Obesity & Overweight 59

60 Obesity & Overweight

GUIDELINES ON

Overweight and Obesity

With the release of the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: Evidence Report, which is intended for health professionals, many patients have expressed interest in information on how to lose weight and improve their health.

Overweight and Obesity— What Are The Risks?

Over one-half of all American adults (about 97 million) are overweight or obese. If you are overweight or obese, carrying this extra weight puts you at risk for developing many diseases, especially heart disease, stroke, diabetes, and cancer.

Box 1—Consider the Risks

If you are overweight or obese, you are at risk for developing the following diseases:

• High blood pressure
• High blood cholesterol
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Arthritis
• Sleep apnea and breathing problems
• Some cancers
• Endometrial
• Breast
• Prostate
• Colon

Box 2—Calculation Directions and Sample

Here is a shortcut method for calculating BMI (Example: for a person who is 5 feet 5 inches tall weighing 180 lbs.)

1. Multiply weight (in pounds) by 703 180 x 703 = 126,540
2. Divide the answer in step 1 by height (in inches) 126,540/65 = 1,946
3. Divide the answer in step 2 by height (in inches) to get your BMI 1,946/65 = 29.9

BMI = 29.9

What Is Your Risk?

First, let’s gather some information—

1. Check Your Body Mass Index Your body mass index (BMI) is a good indicator of your risk for a variety of diseases since it gives an accurate estimate of your total body fat. There are two ways to check your BMI. One way is to use the chart on the next page to find your weight and height and then go above that column to find your BMI. The other way to check your BMI is to calculate it; one method is shown in Box 2. Another way to do this: Divide your weight in pounds by your height in inches squared and then multiply the total by 703. Once you know your BMI, check Box 3, which shows the BMI ranges for underweight, normal weight, overweight, and obesity.

Obesity & Overweight 61

1. Waist Circumference Measurement Your waist circumference measurement is also important in determining your overall risk. If most of your fat is around your waist, you are at greater chance for developing risk factors for heart disease and diabetes. This risk increases with a waist measurement of greater than 35 inches for women or greater than 40 inches for men.

Are You At Risk?

Talk to your doctor to see if you are at an increased risk and if you should lose weight. Your

?

doctor will evaluate your BMI, waist measurement, and other risk factors for heart disease. These risk factors are shown in Box 4.

If you are overweight, do not have a high waist measurement, and have less then 2 risk factors, it’s important that you not gain any more weight.

If you are overweight (BMI 25 to 29.9) and have?

two or more risk factors, or if you are obese (BMI

30), it is important for you to lose weight. Even a?

small weight loss (just 10 percent of your current weight) will help lower your risk of developing

the diseases listed in Box 1. ?

And remember, if you do need to lose weight there are no quick fixes. Losing as little as 10

percent of your current body weight at a rate of 1?

to 2 pounds per week may take as long as six months, but will make it easier to keep off. And it will give you the time to make new healthy lifestyle changes.

Additional Resources

For additional information on the Clinical Guidelines on Overweight and Obesity, contact the NHLBI Obesity Education Initiative:

62 Obesity & Overweight

Box 3—Classification of Overweight and Obesity by BMI

BMI

Box 4—Risk Factors

Besides being overweight or obese, other risk factors to consider are:

• Cigarette smoking
• High blood pressure (hypertension)
• High LDL-cholesterol (“bad” cholesterol)
• Low HDL-cholesterol (“good” cholesterol)
• High triglycerides
• High blood glucose (sugar)
• Family history of premature heart disease
• Physical inactivity

High Blood Pressure 63

64 High Blood Pressure

Check Your Healthy Heart

Answer “true” or “false” to the following questions to test your knowledge of heart disease and its risk factors. Be sure to check the answers and explanations on the back of this sheet to see how well you do.

1 The risk factors for heart disease that

you can do something about are: high blood pressure, high blood cholesterol, smoking, obesity, and physical inactivity. T F

2 A stroke is often the first symptom of

high blood pressure, and a heart attack is often the first symptom of high blood cholesterol. T F

3 A blood pressure greater than or equal

to 140/90 mm Hg is generally considered to be high. T F

4 High blood pressure affects the same

number of blacks as it does whites. T F

5 The best ways to treat and control high

blood pressure are to control your weight, exercise, eat less salt (sodium), restrict your intake of alcohol, and take your high blood pressure medicine if prescribed by your doctor. T F

6 A blood cholesterol of 240 mg/dL is

desirable for adults. T F

7 The most effective dietary way to lower

the level of your blood cholesterol is to eat foods low in cholesterol. T F

8 Lowering blood cholesterol levels can

help people who have already had a heart attack. T F

9 Only children from families at high risk

for heart disease need to have their blood cholesterol levels checked. T F

10 Smoking is a major risk factor for four

of the five leading causes of death, including heart attack, stroke, cancer, and lung diseases such as emphysema and bronchitis. T F

11 If you have had a heart attack, quitting

smoking can help reduce your chances of having a second attack. T F

12 Someone who has smoked for 30 to

40 years probably will not be able to quit smoking. T F

13 The best way to lose weight is to

increase physical activity and eat fewer calories. T F

14 Heart disease is the leading killer of

men and women in the United States. T F

High Blood Pressure 65

To The Healthy Heart I.Q. Quiz

1 True. High blood pressure, smoking, and

high blood cholesterol are the three most important risk factors for heart disease. On the average, each one doubles your chance of developing heart disease. So, a person who has all three of the risk factors is eight times more likely to develop heart disease than someone who has none. Obesity increases the likelihood of developing high blood cholesterol and high blood pressure, which increase your risk of heart disease. Physical inactivity increases your risk of heart attack. Regular exercise and good nutrition are essential to reducing high blood pressure, high blood cholesterol, and overweight. People who exercise are also more likely to cut down or stop smoking.

2 True. A person with high blood pressure or

high blood cholesterol may feel fine and look great; there are often no signs that anything is wrong until a stroke or heart attack occurs. To find out if you have high blood pressure or high blood cholesterol, you should be tested by a doctor, nurse, or other health professional.

3 True. A blood pressure of 140/90 mm Hg or

greater is generally classified as high blood pressure. However, blood pressures that fall below 140/90 mm Hg can sometimes be a problem. If the diastolic pressure, the second or lower number, is between 85-89, a person is at an increased risk for heart disease or stroke and should have his/her blood pressure checked at least once a year by a health professional. The higher your blood pressure, the greater your risk for developing heart disease or stroke. Controlling high blood pressure reduces your risk.

4 False. High blood pressure is more common

in blacks than whites. It affects 29 out of

66 High Blood Pressure

every 100 black adults compared to 26 out of every 100 white adults. Also, with aging, high blood pressure is generally more severe among blacks than among whites, and therefore causes more strokes, heart disease, and kidney failure.

5 True. Recent studies show that lifestyle

changes can help keep blood pressure levels normal even into advanced age, and are important in treating and preventing high blood pressure. Limit high-salt foods, which include many snack items such as potato chips, salted pretzels, and salted crackers; processed foods such as canned soups; and condiments such as ketchup and soy sauce. Also, it is extremely important to take blood pressure medication if prescribed by your doctor, to make sure your blood pressure stays under control.

6 False. A total blood cholesterol of under 200

mg/dL is desirable and usually puts you at a lower risk for heart disease. A blood cholesterol level of 240 mg/dL or above is high and increases your risk of heart disease. If your cholesterol level is high, your doctor will want to check your levels of LDL-cholesterol (“bad” cholesterol) and HDL-cholesterol (“good” cholesterol). A HIGH level of LDLcholesterol increases your risk for heart disease, as does a LOW level of HDLcholesterol. A cholesterol level of 200-230 mg/dL is considered borderline-high and usually increases your risk for heart disease. If your cholesterol is borderline-high, you should speak to your doctor to see if additional cholesterol tests are needed. All adults 20 years of age or older should have their blood cholesterol level checked at least once every 5 years.

7 False. Reducing the amount of cholesterol

in your diet is important; however, eating

foods low in saturated fat is the most effective dietary way to lower blood cholesterol levels, along with eating less total fat and cholesterol. Choose low-saturated fat foods such as grains, fruits, and vegetables; low-fat or skim milk and milk products; and lean cuts of meat, fish, and chicken. Trim fat from meat before cooking; bake or broil meat rather than fry; use less fat and oil; and take the skin off chicken and turkey. Reducing overweight will also help lower your level of LDL-cholesterol as well as increase your level of HDL-cholesterol.

8 True. People who have had one heart attack

are at much higher risk for a second attack. Reducing blood cholesterol levels can greatly slow down (and, in some people, even reverse) the buildup of cholesterol and fat in the walls of the arteries, and significantly reduce the chances of a second heart attack.

9 True. Children from “high risk” families, in

which a parent has high blood cholesterol (240 mg/dL or above), or in which a parent or grandparent has had heart disease at an early age (at 55 years or younger), should have their cholesterol levels tested. If a child from such a family has a cholesterol level that is high, it should be lowered under medical supervision, primarily with diet, to reduce the risk of developing heart disease as an adult. For most children, who are not from high-risk families, the best way to reduce the risk of adult heart disease is to follow a low-saturated fat, low cholesterol eating pattern. All children over the age of 2 years and all adults should adopt a hearthealthy eating pattern as a principal way of reducing coronary heart disease.

10 True. Heavy smokers are two to four times

more likely to have a heart attack than nonsmokers, and the heart attack death rate among all smokers is 70 percent greater than that of nonsmokers. Older male smokers are also nearly twice as likely to die from stroke than older men who do not smoke, and these odds are nearly as high for older female smokers. Further, the risk of dying from

lung cancer is 22 times higher for male smokers than male nonsmokers and 12 times higher for female smokers than female nonsmokers. Finally, 80 percent of all deaths from emphysema and bronchitis are directly due to smoking.

True. One year after quitting, ex-smokers cut their extra risk for heart attack by about half or more, and eventually the risk will return to normal in healthy ex-smokers. Even if you have already had a heart attack, you can reduce your chances of a second attack if you quit smoking. Ex-smokers can also reduce their risk of stroke and cancer, improve blood flow and lung function, and help prevent diseases like emphysema and bronchitis from getting worse.

False. Older smokers are more likely to succeed at quitting smoking than younger smokers. Quitting helps relieve smokingrelated symptoms like shortness of breath, coughing, and chest pain. Many quit to avoid further health problems and take control of their lives.

True. Weight control is a question of balance. You get calories from the foods you eat. You burn off calories by exercising. Cutting down on calories, especially calories from fat, is key to losing weight. Combining this with a regular physical activity, like walking, cycling, jogging, or swimming, can not only help in losing weight but also in maintaining weight loss. A steady weight loss of 1/2 to 1 pound a week is safe for most adults, and the weight is more likely to stay off over the long run. Losing weight, if you are overweight, may also reduce your blood pressure, lower your LDL-cholesterol, and raise your HDL-cholesterol. Being physically active and eating fewer calories will also help you control your weight if you quit smoking.

True. Coronary heart disease is the number 1 killer in the United States. Approximately 489,000 Americans died of coronary heart disease in 1990, and approximately half of these deaths were women.

68 High Blood Pressure

Check Your

High Blood Pressure Prevention

Test your knowledge of high blood pressure with the following questions. Circle each true or false. The answers are given on the back of this sheet.

1 There is nothing you can do to prevent

high blood pressure. T F

2 If your mother or father has high blood

pressure, you’ll get it. T F

3 Young adults don’t get high blood pressure.

T F

4 High blood pressure has no symptoms.

T F

5 Stress causes high blood pressure.

T F

6 High blood pressure is not life-threatening.

T F

7 Blood pressure is high when it’s at or

over 140/90 mm Hg. T F

8 If you’re overweight, you are two to six

times more likely to develop high blood pressure. T F

9 You have to exercise vigorously every

day to improve your blood pressure and heart health. T F

10 Americans eat two to three times more

salt and sodium than they need. T F

11 Drinking alcohol lowers blood pres-

sure. T F

12 High blood pressure has no cure.

T F

How well did you do?

High Blood Pressure 69

To The High Blood Pressure Prevention I.Q. Quiz

1 False. High blood pressure can be

prevented with four steps: 1) keep a healthy weight; 2) become physically active; 3) limit your salt and sodium use; and, 4) if you drink alcoholic beverages, do so in moderation.

2 False. You are more likely to get high

blood pressure if it runs in your family, but that doesn’t mean you must get it. Your chance of getting high blood pressure is also greater if you’re older or an African American. But high blood pressure is NOT an inevitable part of aging, and everyone can take steps to prevent the disease—the steps are given in answer 1.

3 False. About 15 percent of those ages

18-39 are among the 50 million Americans with high blood pressure. Once you have high blood pressure, you have it for the rest of your life. So start now to prevent it.

4 True. High blood pressure, or “hyperten-

sion,” usually has no symptoms. In fact, it is often called the “silent killer.” You can have high blood pressure and feel fine. That’s why it’s important to have your blood pressure checked—it’s a simple test.

5 False. Stress does make blood pressure

go up, but only temporarily. Ups and downs in blood pressure are normal. Run for a bus and your pressure rises; sleep and it drops. Blood pressure is the force

70 High Blood Pressure

of blood against the walls of arteries. Blood pressure becomes dangerous when it’s always high. That harms your heart and blood vessels. So what does cause high blood pressure? In the vast majority of cases, a single cause is never found.

6 False. High blood pressure is the main

cause of stroke and a factor in the development of heart disease and kidney failure.

7 True. But even blood pressure slightly

under 140/90 mm Hg can increase your risk of heart disease or stroke.

8 True. As weight increases, so does

blood pressure. It’s important to stay at a healthy weight. If you need to reduce, try to lose 1/2 to 1 pound a week. Choose foods low in fat (especially saturated fat), since fat is high in calories. Even if you’re at a good weight, the healthiest way to eat is low fat, low cholesterol.

9 False. Studies show that even a little

physical activity helps prevent high blood pressure and strengthens your heart. Even among the overweight, those who are active have lower blood pressures than those who aren’t. It’s best to do some activity for 30 minutes, most days. Walk, garden, or bowl. If you don’t have a 30-minute period, do something for 15 minutes, twice a day. Every bit helps—so make activity part of your daily routine.

10 True. Americans eat way too much salt

and sodium. And some people, such as many African Americans, are especially sensitive to salt. Salt is made of sodium and chloride, and it’s mostly the sodium that affects blood pressure. Salt is only one form of sodium—there are others. So you need to watch your use of both salt and sodium. That includes what’s added to foods at the table and in cooking, and what’s already in processed foods and snacks. Americans, especially people with high blood pressure, should eat no more than about 6 grams of salt a day, which equals about 2,400 milligrams of sodium.

11 False. Drinking too much alcohol can

raise blood pressure. The “Dietary Guidelines” recommend that for overall health, women should limit their alcohol to no more than one drink a day and men should have no more than two drinks a day. A drink would be 1.5 ounces of 80 proof whiskey, or 5 ounces of wine, or 12 ounces of beer.

For more information on high blood pressure

12 True. But high blood pressure can be

treated and controlled. Treatment usually includes lifestyle changes—losing weight, if overweight; becoming physically active; limiting salt and sodium; and avoiding drinking excess alcohol— and, if needed, medication. But the best way to avoid the dangers of high blood pressure is to prevent the condition.

High Blood Pressure 71

72 High Blood Pressure

High Blood Cholesterol 73

74 High Blood Cholesterol

Check Your

Cholesterol and Heart Disease

Are you cholesterol smart? Test your knowledge about high blood cholesterol with the following questions. Circle each true or false. The answers are given on the back of this sheet.

1 High blood cholesterol is one of the risk 7

factors for heart disease that you can do something about. T F

2 To lower your blood cholesterol level,

you must stop eating meat altogether. T F

3 Any blood cholesterol level below 9

240 mg/dL is desirable for adults. T F

4 Fish oil supplements are recommended to 10

lower blood cholesterol. T F

5 To lower your blood cholesterol level, you 11

should eat less saturated fat, total fat, and cholesterol; and lose weight if you are overweight. T F

6 Saturated fats raise your blood cholesterol

level more than anything else in your diet. T F

National Cholesterol Education Program

All vegetable oils help lower blood cholesterol levels. T F

Lowering blood cholesterol levels can help people who have already had a heart attack. T F

All children need to have their blood cholesterol levels checked. T F

Women don’t need to worry about high blood cholesterol and heart disease. T F

Reading food labels can help you eat the heart-healthy way. T F

High Blood Cholesterol 75

To The Cholesterol and Heart Disease I.Q. Quiz

1 True. High blood cholesterol is one of the

risk factors for heart disease that a person can do something about. High blood pressure, cigarette smoking, diabetes, overweight, and physical inactivity are the others.

2 False. Although some red meat is high

in saturated fat and cholesterol, which can raise your blood cholesterol, you do not need to stop eating it or any other single food. Red meat is an important source of protein, iron, and other vitamins and minerals. You should, however, cut back on the amount of saturated fat and cholesterol that you eat. One way to do this is by choosing lean cuts of meat with the fat trimmed. Another way is to watch your portion sizes and eat no more than 6 ounces of meat a day. Six ounces is about the size of two decks of playing cards.

3 False. A total blood cholesterol level of

under 200 mg/dL is desirable and usually puts you at a lower risk for heart disease. A blood cholesterol level of 240 mg/dL is high and increases your risk of heart disease. If your cholesterol level is high, your doctor will want to check your level of LDL-cholesterol (“bad” cholesterol). A HIGH level of LDL-cholesterol increases your risk of heart disease, as does a LOW level of HDL-cholesterol (“good” cholesterol). An HDL-cholesterol level below 35 mg/dL is considered a risk factor for heart disease. A total cholesterol level of 200- 239 mg/dL is considered borderline–high and usually increases your risk for heart

76 High Blood Cholesterol

disease. All adults 20 years of age or older should have their blood cholesterol level checked at least once every 5 years.

4 False. Fish oils are a source of omega-3

fatty acids, which are a type of polyunsaturated fat. Fish oil supplements generally do not reduce blood cholesterol levels. Also, the effect of the long-term use of fish oil supplements is not known. However, fish is a good food choice because it is low in saturated fat.

5 True. Eating less fat, especially saturated

fat, and cholesterol can lower your blood cholesterol level. Generally, your blood cholesterol level should begin to drop a few weeks after you start on a cholesterollowering diet. How much your level drops depends on the amounts of saturated fat and cholesterol you used to eat, how high your blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your blood cholesterol level by 10-50 mg/dL or even more.

6 True. Saturated fats raise your blood

cholesterol level more than anything else. So, the best way to reduce your cholesterol level is to cut back on the amount of saturated fats that you eat. These fats are found in largest amounts in animal products such as butter, cheese, whole milk, ice cream, cream, and fatty meats. They are also found in some vegetable oils— coconut, palm, and palm kernel oils.

7 False. Most vegetable oils—canola,

corn, olive, safflower, soybean, and sunflower oils—contain mostly monounsaturated and polyunsaturated fats, which help lower blood cholesterol when used in place of saturated fats. However, a few vegetable oils—coconut, palm and palm kernel oils—contain more saturated fat than unsaturated fat. A special kind of fat, called trans fat, is formed when vegetable oil is hardened to become margarine or shortening, through a process called “hydrogenation.” The harder the margarine or shortening, the more likely it is to contain more trans fat. Choose margarine containing liquid vegetable oil as the first ingredient. Just be sure to limit the total amount of any fats or oils, since even those that are unsaturated are rich sources of calories.

8 True. People who have had one heart

attack are at much higher risk for a second attack. Reducing blood cholesterol levels can greatly slow down (and, in some people, even reverse) the buildup of cholesterol and fat in the wall of the coronary arteries and significantly reduce the chances of a second heart attack. If you have had a heart attack or have coronary disease, your LDL level should be around 100 mg/dL, which is even lower than the recommended level of less than 130 mg/dL for the general population.

9 False. Children from “high risk”

families, in which a parent has high blood cholesterol (240 mg/dL or above) or in which a parent or grandparent has had heart disease at an early age (at 55 years or younger), should have their cholesterol levels tested. If a child from such a family has a high cholesterol level, it should be lowered under medical supervision, primarily with diet, to reduce the risk of developing heart

disease as an adult. For most children, who are not from high-risk families, the best way to reduce the risk of adult heart disease is to follow a low saturated fat, low cholesterol eating pattern. All children over the age of 2 years and all adults should adopt a heart–healthy eating pattern as a principal way of reducing coronary heart disease.

10 False. Blood cholesterol levels in both

men and women begin to go up around age 20. Women before menopause have levels that are lower than men of the same age. After menopause, a women’s LDL-cholesterol level goes up—and her risk for heart disease increases. For both men and women, heart disease is the number one cause of death.

11 True. Food labels have been changed.

Claims like “low–fat” or “light” on certain foods are government–regulated. Look on the nutrition label for the amount of saturated fat, total fat, cholesterol, and total calories in a serving of the product. Use this information to compare similar products and find the ones with the smallest amounts. If there is not a nutrition label, look for the list of ingredients. Here, the ingredient in the greatest amount is shown first and the ingredient in the least amount is shown last. So, to choose foods low in saturated fat or total fat, go easy on products that list fats or oil first, or that list many fat and oil ingredients.

High Blood Cholesterol 77

78 High Blood Cholesterol

To Help Older Americans Control Cholesterol

Just because you’re over 65 doesn’t mean you can ignore your cholesterol level. Lowering your cholesterol can help you stay healthy by reducing your risk for heart disease. If you have heart disease, lowering cholesterol can help you live longer and reduce your risk of having a heart attack. So make these cholesterol-lowering habits a part of your life:

Eat foods low in saturated fat, total fat and cholesterol. Good choices include fruits and vegetables, low fat and fat-free dairy products, and whole grains. Choose lean cuts of meat, skinless poultry, and fish.

Be physically active. With your doctor’s okay, try 30 minutes of moderate activity a day. Walking and dancing promote coordination, and light weightlifting strengthens bones. Pressed for time? Divide those 30 minutes into three 10-minute sessions. Maintain a healthy weight.

Being overweight raises your cholesterol and increases your risk of getting heart disease.

Take your medicine if prescribed. If your doctor has prescribed cholesterollowering medication for you, it is important that you take it every day in addition to following heart-healthy habits.

DISCRIMINATION PROHIBITED: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall, on the grounds of race, color, national origin, handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any education program and activity) receiving Federal financial assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and Executive Order 11246 states that no federally funded contractor may discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in compliance with these laws and Executive Orders.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute

NIH Publication No. 01-1655

June 2001

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