Sarcopenia, the loss of skeletal muscle mass and strength, is a major problem as people age, and sometimes leads to disability, osteoporosis, falls, hospital stays, and even death. By their mid-forties, women begin to lose one-quarter to one-third pound of muscle mass with each passing year. Two major preventable factors contributing to sarcopenia are lack of exercise and poor nutrition. Many older adults spend much of their time in sedentary activities, which speeds muscle breakdown, dysfunction, and inefficient repair. This can lead to a vicious cycle of muscle loss, injury, and reduced functional ability resulting in even greater sedentary behaviors. A report of the Surgeon General notes that 25% of U.S. women are not active at all, and women are less active than men.
Almost half (46%) of U.S. adults do not get sufficient physical activity in spite of the American College of Sports Medicine recommendation to engage in strength training exercises at least twice a week. Poor muscle tone and reduced strength complicate the activities of daily living, affecting balance and increasing the risk of falls. Additional debilitating effects of osteoporosis and osteopenia loom, as half of all Americans over 50 will have weak bones within the decade unless significant changes in diet and lifestyle take place. Osteoporosis prevention is especially important for middle-aged and older women, as currently one-third of women over age 40 suffer from this condition. Half of women and up to a quarter of men will suffer a fracture of the hip, spine, or wrist in their lifetime.
Pennsylvania ranks fourth in the nation for percentage of older adults, at 15.5%, placing a burden on our state’s medical resources. The good news is that weight bearing exercise, strength training and improved nutrition can positively impact frailty by reducing the risk of sarcopenia and bone loss. The StrongWomen/Growing Stronger program can help support the Centers for Disease Control and Prevention’s Healthy People 2020 objectives to reduce the portion of adults with osteoporosis, promote health and reduce chronic disease risk through the encouragement of healthful diets and achievement or maintenance of healthy body weight. In addition, the program supports the 2008 Physical Activity Guidelines. Education and prevention strategies can reduce the burden of chronic disease on Pennsylvania’s citizens.
The StrongWomen/Growing Stronger program is an evidence-based strength training and nutrition program for women and men ages 40 and older, designed to reduce the risk of osteoporosis and other chronic disease, improve bone density and muscle mass, as well as increase flexibility and balance. The program includes a series of nutrition lessons and 8-12 strength training, balance and flexibility exercises, using hand and ankle weights, to be done in classes held twice per week. It is one of few programs geared to the mature person who is a first-time exerciser, and is held in a non-threatening community setting, rather than in a gym or health club. The return rate for the participants attests to the popularity of this setting – 20% of survey respondents have taken SW for 5 or more years, while 80% have taken the course for 1-5 years. Instructors receive training and supportive services, including training on additional exercise modules, refresher training, nutrition and health handouts and occasional continuing education opportunities. Participants complete a fitness test assessment when beginning classes, and at intervals, to measure progress.
The universal experience of StrongWomen/Growing Stronger participants seems to be the myriad changes that occur as they begin the major step of implementing a program of strength training and nutrition. The program awakens interest in self-care behaviors in many areas of their lives. Feedback mechanisms directly measure increases in strength and flexibility, as well as the perceptions of participants on their improvement in a number of areas related to healthy nutrition and general health. In addition, the ripple effect on social support and relationships has been measured by a group cohesion survey; a 2014 statewide conference for StrongWomen/Growing Stronger participants and leaders also showed excellent engagement. Public value has been shown by impact narratives offered via evaluations. Continued participation is also an indicator of the value of this program for the public. In the U.S., osteoporosis causes approximately 2 million fractures annually. For those who suffer a hip fracture as a result of osteoporotic bones, 20% will die as a result of complications. Yearly estimates of associated medical costs are about $19 billion, and are expected to climb to $25.3 billion by 2025. For those women in the StrongWomen program who reported having a repeat bone density scan (45%), the scores were stable and remained the same for 52% and actually increased for 39%, resulting in 91% of women maintaining or increasing their bone density scores. This is an extremely encouraging finding that is important for overall health and in preventing falls, fractures and osteoporosis.
StrongWomen/Growing Stronger aims to improve upper/lower body strength, fitness, flexibility, balance and general health of participants while encouraging participants to increase intake of fruits, vegetables, whole grains, fiber, calcium and Vitamin D. These behaviors reduce the risk of osteoporosis, sarcopenia, and cardiovascular disease.
Since the program’s inception at Penn State Extension in 2005, program impact has been measured using pre-/post-fitness assessments, and a post-survey. In 2010, the basic program was modified based on findings from post-breast cancer research, and the StrongWomen: New STEPS to Breast Health program was created to help breast cancer survivors incorporate safe strength training exercises into their daily routine. In 2012, a grant of $10,000 from PA Dept. of Health, Chronic Disease Prevention and Education, supported the expansion of the Strong-Women/Growing Stronger program into 6 additional PA counties. Recognizing the need for physical activity education for mid-life and older women in Pennsylvania, Dr. Miriam Nelson’s team at Tufts University developed the StrongWomen – Healthy Hearts program. The program was implemented in 2011 as a community-based program combining aerobic physical activity and heart-healthy nutrition in a 9-12-week program. A Group Cohesion Survey of StrongWomen/Growing Stronger participants was conducted in 2014-2015 to assess characteristics of social support and interaction as an unintentional outcome of the group classes, with findings that participants form a camaraderie, reinforcing healthy lifestyle change, and promoting program engagement. Since its inception in 2005, StrongWomen/Growing Stronger leaders in PA have conducted sessions reaching more than 17,000 participants!
This program year, over 150 StrongWomen/Growing Stronger classes were offered in 23 counties with 2,091 participants, for participants ranging from 40-86 years (average age 67). Effectiveness was measured by the Senior Fitness Test assessment at the beginning and end of the program, and a post-class evaluation. Participants improved their results from pre- to post-test in five testing areas with an average increase of 18% in strength and stamina across test areas. As a result, participants have improved their general health, increased intake of fruits and vegetables (45%), fiber (38%), whole grains (35%), calcium (27%) and vitamin D (30%). They increased upper and lower body strength and 82% moderately or considerably improved their ability to perform activities of daily living, such as lifting, carrying groceries, and rising from a chair: 86% improved balance, 81% flexibility and 85% upper body strength.
Comments from first-time and continuing participants:
- “I have had a definite increase in my ability to lift weight and the program has helped me resolve problems with leg/hip pain. StrongWomen is a great motivator to improve my health.”
- “I never had good upper body strength, but this class has improved my strength and I am able to lift things that I had difficulty with before.”
- “My legs are stronger . I was using a walker, and now I am walking on my own.” “Bone density scores improved, body pain has decreased and I am more motivated for regular exercise and to watch my weight and intake of healthy food.”