In considering exercise programs for seniors, minimizing the risk of osteoporosis and fractures is a very important element. One in every two women age 50 or older will develop osteoporosis; one in every four men will get this condition. In New Jersey, nearly one million residents have osteoporosis (brittle bone disease) or low bone mass (osteopenia) and about 8,000 individuals over 65 have a hip fracture annually according to the NJDHSS. Each year, more women have osteoporosis-related fractures than have strokes, heart attacks and breast cancer combined. Each year, men suffer one third of all the hip fractures that occur, and one third of these men will not survive more than a year. This is an issue that cannot be ignored.
To combat these risks, Project Healthy Bones is a program through the NJDHSS that includes exercises that target the body’s larger muscle groups to improve strength, balance and flexibility. The 24-week curriculum also has an interactive educational component on the importance of safety, exercise, nutrition, drug therapy and lifestyle factors that relate to osteoporosis. Any person with or at risk of osteoporosis may join. Physician release form and personal waivers are required.
The programs are held at YMCAs, churches, senior centers, community centers and local health departments. Classes are usually held once a week, and participants are encouraged to repeat exercises at home. The classes are broken down into an exercise program that takes about 45 minutes, and an education program which is usually around 15 minutes. Often classes will have a guest speaker on a special topic, so class time may increase.
The only materials required are the participant manual and one 10-lb. ankle weight. Minimal program fees may be charged to cover cost of weights and program manuals. The curriculum includes information on nutrition, medications, prevention, diagnosis, and treatment. Exercises include balance, flexibility, weight-bearing, and resistance (use of ankle and hand weights.) The program was developed by the NJDHSS and the Saint Barnabas Health Care System and is based on research at Tufts University on strength training exercises and improving bone density in older adults. The curriculum is also available in Spanish.
The program is peer-led. Interested volunteer Peer Leaders attend a free two-day training. The Leaders are often Retired Senior Volunteer Program (RSVP) volunteers or local volunteers; RSVP volunteers receive a small stipend for mileage. Lead Coordinators from local health departments, county offices on aging, RSVP and other community-based organizations coordinate the program at the county or local level. They oversee the delivery of Project Healthy Bones classes, recruit and train leaders, enroll participants, and provide oversight to Peer Leaders.
Results
Project Healthy Bones began in 1997 and annually reaches about 1,500 older adults statewide.
The strength, balance and flexibility program is based on extensive research demonstrating the bone-building results of strength training. Program evaluation includes documenting calcium/vitamin D consumption and the amount of free weight and repetitions achieved over the 24-week period. A recent evaluation of the program found more than 90% of participants increased the amount of weight used during the strength-training exercises.
A county survey of Project Healthy Bones participants found:
Although the positive impact of socialization through participation in the 6-month class has not been measured, anecdotal observations underscore the tremendous benefit of long-term/ongoing exercise programs. Many of the classes that began in 1997, as well as those begun in each successive year, still operate because the participants do not want to stop the class.
Physicians and some HMOs are now regularly prescribing Project Healthy Bones for their patients.
Strengths
Lessons Learned
To be most effective, volunteer Peer Leaders need the resources and expertise of health care and fitness/exercise professionals. Hospital-based Program Trainers, together with community-based Lead Coordinators assure that Peer Leaders are given the support, monitoring, technical assistance, in-service training and the recognition they need to continue in their role. The infrastructure also ensures that the curriculum is updated regularly and allows for the addition of new education and new exercise components.
Peer Leader recognition awards are being instituted this year and outstanding Peer Leaders will be recognized during May, which is Osteoporosis Awareness and Prevention Month.
Implementation Guide
Lead Coordinators receive a copy of the Peer Leader Manual, a CD-Rom with the Peer Leader Manual, Participant Manual, and supplemental materials for the 2-day Peer Leader training, as well as marketing resources. Lead Coordinators receive the Peer Leader and Participant Manual, CD-Rom’s and weights at no cost. Individual program costs (printing and participant weights) are covered by class fees or local grants. Some participants are asked to purchase their own weights. Class fees vary, but are usually $1.00 or $2.00 per class.
Lead Coordinators in all NJ counties have the materials to begin new classes, recruit new participants and train new Peer Leaders. Program Trainers train the Peer Leaders that actually lead the classes.
Contact Information
For Bergen, Essex, Hudson, Hunterdon, Morris, Passaic, Somerset, Union, Sussex and Warren Counties Contact:
North Jersey Regional Arthritis Center at Atlantic Health System
877-973-6500
Email:marie.bartello@ahsys.org
Morristown Memorial Hospital Arthritis Center
100 Madison Ave, Box 23
Morristown NJ 07962
For Atlantic, Cape May, Mercer, Middlesex, Monmouth and Ocean Counties Contact:
Community Medical Center, Community Health Services
599 Highway 37 West, Toms River NJ 08755
732-557-3212
For Burlington, Camden, Cumberland, Gloucester and Salem Counties Contact:
Southern New Jersey Regional Arthritis Center at Virtua Health
1 Carnie Blvd., Voorhees NJ 08043
856-325-3517
Email: Rcano@virtua.org
