Introduction
Disease prevention is directly related to a healthy active
lifestyle, yet only 54.2% of adults in the United States are sufficiently
physically active, as defined by engaging in at least 150 minutes of moderate
intensity physical activity per week (Centers for Disease Control and
Prevention [CDC], n.d.). Only 27.6% of adults meet the recommended two days of
strength-related exercise per week (CDC, n.d.). Opportunities to engage in
regular physical activity, however, are not equally distributed in the
population. Lower income populations, for example, engage in less physical
activity than higher income groups (Sturm & Cohen, 2019). Hispanic,
non-Hispanic Black and American Indian adults are less active compared with
white adults (King et al., 2000). Physical inactivity also increases with age
(Watson et al., 2016). In a study of adults 50 years and older, rates of
physical inactivity were higher among women, Non-Hispanic Blacks, Hispanics,
and people with only a high school education or less (Watson et al., 2016).
Community parks represent an important resource for promoting
physical activity (Han et al., 2014; Harnik & Welle, 2011; Hunter et al.,
2015; Müller-Riemenschneider et al., 2018; Zarr et al., 2017). First, local
parks are accessible to most people because they are free and located within
close proximity to residential areas. A large study of 50 community parks
across Los Angeles found that the average distance to a local park for local
residents was 1.2 miles (Cohen et al., 2012). Second, people already use parks
to engage in moderate-to-vigorous physical activity. A review of 23
observational studies of parks by Joseph and Maddock (2016) found that 31.0 to
85.4% of park users engaged in moderate-to-vigorous physical activity. Third,
parks provide opportunities for social interaction and social support (Fan et
al., 2011). Social support can enable physical activity among adults because
social support promotes self-efficacy or confidence in one’s ability to engage
in regular physical activity, positive beliefs about the benefits of physical
activity, and self-regulatory behaviors such as goal setting and problem
solving (Ayotte et al., 2010).
Physical activity increases with park-based programming (Han
et al., 2015). Research has shown that park-based exercise programs enable
adults to be more physically active and improve their fitness, mobility, and
strength (Han et al., 2015; Joseph & Maddock, 2016; Kling et al., 2018).
Park-based programs involve a range of structured exercise activities such as
moderate intensity aerobic activities, strength-building exercises, and balance
exercises. Exercise physiologists or kinesiology
professionals lead the sessions, which are commonly one-hour in length and
take place one-to-three times a week. Exercise sessions take place either
outside on park grounds or indoors in the recreation center buildings. In
addition to supervised exercises in parks, interventions may also include
educational workshops to build knowledge and skills and one-on-one brief
counseling sessions to offer behavior modification assistance such as goal
setting and problem solving (Barclay et al., 2018; Kling et al., 2018;
Müller-Riemenschneider et al., 2018).
While the evidence suggests that structured programming in parks
promotes physical activity among adults, it is not clear whether the benefits
of park-based interventions extend to a range of populations defined by age,
gender, income, and race/ethnicity. Joseph and Maddock (2016) found that park
users were more likely to be male and younger adults. In Los Angeles, Derose et
al. (2018) found that women and non-White men and women were less likely to
frequent parks in Los Angeles and engage in physical activity while at the
parks. Information on the use of parks among racial/ethnic minorities is scant
because many observational park studies do not report on the racial/ethnic
backgrounds of park users (Joseph & Maddock, 2016). Reaching diverse
populations with park-based physical activity interventions requires community
partnerships to help with outreach and recruitment.
3 WINS Fitness (“3 WINS”) is an innovative
park-based health promotion program that is delivered by undergraduate and
graduate kinesiology students and provided for free for the public (Han et al.,
2015; Loy, 2017; Loy et al., 2012). 3 WINS (formerly 100 Citizens)
was developed in 2011 as a partnership between a university kinesiology
department and one neighborhood park in a predominately Latinx community (Loy
et al., 2012). 3 WINS was designed to increase opportunities for
physical activity among adults in low-income communities through
university-community partnerships. Current Physical Activity Guidelines (PAG)
recommend that adults aged 18 and over engage in a minimum of 150 minutes of
moderate-intensity physical activity (PA), 75 minutes of vigorous-intensity PA,
or an equivalent combination of moderate-to-vigorous PA (MVPA) each week. These
recommendations should be supplemented with two or more days of strength
training activities per week. The objective of 3 WINS is to provide a
program offered three days per week to enable adults to meet both the aerobic
and strength training minimum guidelines. As the name suggests, 3 WINS
has three central aims: to improve participant fitness, to improve community
health, and to offer professional development opportunities for kinesiology
students (http://3winsfitness.com).
3 WINS capitalizes on the skills of kinesiology
students who are being trained in exercise physiology, biomechanics, and motor
behavior to create appropriate exercise prescriptions to improve health and
fitness. The program provides a practical academic internship or volunteer
experience where students deliver free exercise classes in local parks under
the supervision of faculty. Students apply classroom knowledge in a community
setting, develop interpersonal communication skills, and acquire leadership and
team building experience.
Prior research documented an increase in moderate-to-vigorous
physical activity in a park where 3 WINS personnel implemented the
program (Han et al., 2015). The present study builds upon prior research on 3
WINS by testing its impact on participants through a reduction in body mass
index (BMI). For the present study, we pilot-tested 3 WINS in one park
located in a low income, predominately Latino community in the northeastern
valley of Los Angeles County.
METHODS
Intervention Description
3 WINS offered one-hour exercise sessions three days
per week for 10 weeks in fall 2019. Each day, students assign participants to
one of three groups based on their movement capacity, ranging from beginner to
advanced. In the lowest level of fitness, where participants have poor movement
skills or balance, focus is on engaging in movement patterns that mimic
activities of daily living, such as pushing, pulling, squatting, standing,
single-leg movements, and rotation. As participants progress, they are
encouraged to move to the next level fitness group where students introduce
them to more complex movement patterns, such as combining a squat with an
overhead press, increasing resistance, and shorter rest intervals.
Regardless of which group a
participant is in, each 60-minute session follows the same structure. The
exercise sessions begin with a 5 - 10-minute dynamic warm-up, transitioning
into 25 minutes of resistance training exercises that targets each major muscle
group using body weight and equipment such as resistance bands, battle ropes,
kettlebells, and dumbbells. Students use a circuit training format. After the
strength training component, participants engage in 25 minutes of aerobic
exercise. Throughout the duration of the session, participants are constantly
moving, allowing them to maintain an elevated heart rate (HR) and engage in
moderate-to-vigorous physical activity (MVPA). Water consumption was encouraged
as needed. See Table 1 for an overview of 3 WINS sessions.
Recruitment and Study Site
Requirements for participation included 1) age 18 years and
older, 2) signing the informed consent form, and 3) no contraindications to
physical activity. At enrollment, students screened participants for
eligibility using the Physical Activity Readiness Questionnaire (Warburton et
al., 2010).
The location for the program was a large urban park (11
acres) in a predominately Hispanic city in the northeastern valley of Los
Angeles County. As part of an effort to build community relationships,
kinesiology faculty met with park administrators. In exchange for use of
facilities and program promotion, 3 WINS offered the city an opportunity
to host a free exercise program for the community. In order to promote 3
WINS and recruit participants, students distributed informational flyers to
businesses within a mile radius of the park and recruited participants from
local farmers markets and health fairs. Students also made announcements at
nearby elementary schools during “back to school nights” and at local churches.
To facilitate forming relationships between instructors and
participants, the program required participants to wear nametags. Students
organized meetings with participants to discuss their personal physical
activity goals and hosted an end-of-semester potluck and one holiday
celebration at the park. On average, ten students led the implementation of the
3 WINS program each day. The total number of students involved in the 3
WINS program during the semester-long implementation was between 15-20.
Evaluation Design, Measures and Data Collection
We used a single group pre-post design for the evaluation of
the pilot study. The outcome for this study was participant BMI (kg/m2).
Students measured participants’ height and weight during the initial week of
the program at the park and weekly for 10 weeks. At enrollment, students
collected self-reported demographic data including age, gender, race/ethnicity,
marital status, and educational attainment. Students recorded attendance at
every exercise session over the 10-week period.
Data analysis
We calculated descriptive statistics for demographic
characteristics, BMI, and program attendance. Due to participants missing some
of the weekly sessions, we calculated baseline (i.e., pre-test) BMI using
participants average weight from weeks 1-3 and the follow up (i.e., post-test)
BMI using the average of weeks 8-10. We used repeated measure analysis of
variance (ANOVA) to test for a change in BMI over time for the entire sample
and to examine if changes in BMI differed between normal weight, overweight,
and obese participants, as defined by BMI scores at pre-test. For group
comparisons, a Bonferroni test was used to adjust for the family-wise error
rate. For all analyses, statistical significance was set at α = 0.05. We used Stata
15.0 MP for the analyses.
RESULTS
A total of 169 people participated in the program; however,
pre- and post-test BMI data were collected on 66 participants (39%). Table 2
displays the demographic characteristics and baseline weight status of the total
sample and the pre- and post-test sample. Much like the total sample,
participants in the pre- and post-test sample were primarily female (92.4%),
Hispanic (93.1%), married (66.7%), had high school or lower education (68.5%),
and an average age of 58.6 years. With regards to weight, we observed that
slightly more than half of participant were overweight (53.0%), 33.3% were
obese, and 13.6% fell into the normal weight range.
Of the participants in the pre- and post-test sample, most
(78.8%) attended 50% of sessions or more. This contrasts with 51.5% of the
total sample attending 50% or more sessions. Approximately one fifth (21.2%) of
participants in the pre- and post-test sample attended fewer than 50% of
classes. See Table 3 for a summary of participant attendance.
Results of repeated measure ANOVA showed that participants’
BMI decreased significantly from baseline (Mpre= 29.34, SD
= 5.36) to follow-up (Mpost= 29.07, SD = 5.37) (F
= 5.520, p = 0.001, h2 =
0.17). The overweight group had the largest decrease in mean BMI (Mpre=
27.51, SD = 1.34 vs. Mpost = 27.08, SD
= 1.27), followed by the obesity group (Mpre= 34.87, SD
= 5.54 vs. Mpost = 34.74, SD = 5.44), and normal
weight group (Mpre= 22.96, SD = 1.07 vs. Mpost
= 27.89, SD = 0.96). However, the overall F-test for group
differences was not statistically significant (F = 2.250, p =
0.114).
DISCUSSION
Approximately 75% of American adults report engaging in no
leisure time physical activity (CDC, n.d.) (. Expanding the use of urban green space
including neighborhood parks to promote physical activity of children and
adults is an important public health strategy (Harnik & Welle, 2011; Kondo
et al., 2018). What 3 WINS offered participants was an opportunity to
meet recommendations for aerobic activity and strengthening, an important
short-term outcome that, over time, may lead to improved fitness, weight loss
and reduced risk of diabetes. After the 10-week program, we observed a
significant decrease in BMI among participants; however, there appeared to be
less improvement for participants who were obese. As such, the 3 WINS
program may consider extending the duration of the intervention and modifying
certain program activities for obese participants to achieve more positive
outcomes. Retention in the 10-week program was very good. A third of
participants attended 75% or more of the sessions and nearly half of
participants attended 50-74%. These results provide preliminary evidence for
the efficacy and feasibility of the 3 WINS program. Future studies
should test the efficacy of 3 WINS in multiple parks using an
experimental research design that includes a follow-up assessment
post-intervention. Additionally, a full trial of 3 WINS should examine
improvements in participants’ fitness levels in addition to BMI and assess the
impact of increased physical activity on mood and quality of life.
The findings of our study must be understood in the context
of several limitations. First, because this was a non-experimental study, we
cannot determine a causal relationship between the program and change in BMI.
Second, given the recruitment strategies students used, our sample was based on
convenience. As such, our sample was not representative of the broader
population in the community where the park is located. While the surrounding
community is 90% Latino, our sample consisted almost entirely of Latinas, many
of whom were over 50 years old. One reason why women comprised the majority of
participants may have to do with the timing of the classes, which were held
from 8:15am-9:15am. Earlier pilot work identified this hour as the most
popular for participation. Many women in the program either did not work
outside the home, had a flexible work schedule, or were retired. The timing of
the classes was also limited by the availability of student interns, with many
having full course loads and jobs outside of school. Third, the sample size for
participants who completed both the pre- and post-test was small, which
precluded a more robust analysis of the change in BMI that includes important
covariates such as age and level of physical activity. While the sample was not
diverse in terms of gender and ethnicity, the ability of 3 WINS to reach
older Latinas is important because this population is generally less physically
active (King et al., 2000) and Latino populations are less likely to exercise
in parks (Han et al., 2014).
Implementation
of 3 WINS at the site of this pilot study has remained active since
2011. The sustainability of 3 WINS is a
result of a few core factors: integration of the program into university
kinesiology programs, creating partnerships with local parks, and reduced
reliance on external funding to implement the program. First, the program
is staffed by undergraduate and graduate kinesiology students who implement 3
WINS as part of their internship, thus creating an ongoing pool of
qualified trainers. By the time of the internship, kinesiology students in
exercise science and applied fitness concentrations have acquired skills to
design and facilitate a range of exercises for people at different fitness
levels. What 3 WINS adds to the internship experience is valuable
“real-world” experience for students. Since the inception of the program, an
average of 50 students have worked with 3 WINS each semester at our
university. Second, park officials who collaborate with 3 WINS have
offered space and equipment for free. While most activities take place outdoors
at the parks, trainers also make use of indoor facilities during inclement
weather. Finally, because of the use of existing resources at the universities
and parks to implement the program, reliance on external funding is reduced and
facilitates sustainability. To date, kinesiology professors at five additional
California State University campuses have adopted the program, which speaks to
the scalability of 3 WINS.
CONCLUSIONS
This pilot study provides preliminary evidence in support of
a park-based program that has successfully engaged low-income populations and,
in particular, older Latinas. Women and non-Whites are less likely to engage in
physical activity at local parks in Los Angeles (Han et al., 2014) and, as
such, represent priority populations for physical activity interventions. 3
WINS used a community partnership approach to gain support for the program
from local officials, operate the program in local parks, gain permission to
use existing equipment at the parks, and market the program in diverse
community settings. As a promising model of university-community partnerships, 3
WINS has the potential to be scalable and sustainable, two important
features of effective population health programs.
Acknowledgements
The authors would like to thank all the Kinesiology students
who have contributed to the growth and sustainability of 3 WINS Fitness over
the last 10 years.
Funding
N/A
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Address correspondence to:
Suzanne E. Spear, Ph.D.
California State University, Northridge
suzanne.spear@csun.edu
This work is licensed
under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0
International License.