Running head: WEIGHT REDUCTION THROUGH RECREATION

New Middletown Plan of Care: Weight Reduction Through Increased Recreation Opportunities in the
Community of New Middletown
Natalee Bommer
Youngstown State Univerversity
December 4th, 2015

Running head: WEIGHT REDUCTION THROUGH RECREATION

Healthy People 2020 Goal:

Under the Nutrition and Weight Status topic area of Healthy People 2020, its goal is to promote
health and reduce chronic disease risk through the consumption of healthful diets and achievement and
maintenance of healthy body weights. According to Healthy People 2020, the new objectives are
supported by strong research emphasizing the health benefits of maintaining a healthy body weight.
Efforts to change weight should address individual behaviors, as well as the policies and environments
that support these behaviors within communities.
In addition, under the Physical Activity topic area, its stated goal is to improve health, fitness,
and quality of life through daily physical activity. Regular physical activity includes participation in
moderate and vigorous physical activities and muscle-strengthening activities. More than 80 percent of
adults do not meet the government guidelines for either aerobic or muscle-strengthening activities.
Physical activity objectives highlight that physical activity levels are positively affected by structural
environments of a community and legislative policies that improve access to facilities that promote
physical activity.
Short Term Goal:
In a windshield survey held by the New Middletown group, it was observed that there is a
serious lack of physical activity-related recreation within the village. There are many social groups for
various activities such as Bible studies, knitting groups, volunteering, and family seminars at the
Springfield Library but very few involve physical activity. In addition, there is Welker Park located
behind the village Municipal building but its exercise-related aspects mostly target children. There are
basketball and tennis courts at the park but that requires the purchase of sports equipment in order to
utilize the park facilities. Within New Middletown, a physical fitness group class will be implemented
either at the Springfield Library or at one of the four churches residing within New Middletown. The
group will involve some physical activity-related health teaching with the rest of the time

Running head: WEIGHT REDUCTION THROUGH RECREATION

encompassing various exercises and dances. It will be lead by a volunteer trained in the exercises to be
performed. Each meeting will be at least one and a half hours in duration and will be held once a week.
This program will not only be accessible and affordable to the residents of New Middletown, but it will
afford residents a new form of recreation within the Village that is targeted toward the entire family but
mainly adults.
Long Term Goal:
Various exercise classes will branch off of the original group in order to appeal to a wider
audience of New Middletown residents. These will be held in an accessible and convenient location on
different days of the week. These classes will teach residents how to perform the exercises or activities
at home. The classes will require some accessory supplies and personal trainers will need to be hired or
skilled volunteers will need to be present in order to lead the classes. By increasing community interest
in physical fitness, the residents of New Middletown will move toward collectively reaching a healthier
BMI and maintaining a healthier weight. These changes will improve the mindset of the community as
a whole and lower the risk of morbidities such as early death, heart disease, high blood pressure, type 2
diabetes, cancer, osteoporosis, etc., greatly improving the community's health in the long term.
Outcome Criteria:
Within three months, a mixed physical fitness class will be established at the Springfield
Library or a church in the community, whichever has a vacant space at a time convenient for a majority
of community residents. This class will be lead by a trained volunteer. The trained volunteer will be
taught how to monitor the blood pressure and heart rate of participants in the class in order to prevent
injury during physical activity. The class will consist of a 10-15 minute educational period held by
volunteer nurses about how to meet government physical activity guidelines followed by a one hour to
one and a half hour exercise period lead by a trained volunteer emphasizing the teachings. The class
will be advertised through fliers in commonly frequented areas such as the Springfield Library, local

Running head: WEIGHT REDUCTION THROUGH RECREATION

churches, the New Middletown Sparkle, the New Middletown Sunoco, and doctor's offices within
Village limits. Signs advertising the class will also be posted in front of the venue to be used for the
class. Volunteer nurses in the community and a trained exercise volunteer will put the class together.
Projected attendance rate for the initial classes will consist of at least 20 residents of New Middletown.
The goal of establishing the exercise class is to gain an increasing amount of attendees with each class
and educate members of the community on how to maintain a healthy weight with an adequate amount
of physical fitness.
By six months, as the number of attendees increases weekly, then two classes will be held
weekly instead of one. This will increase access for a larger number of residents who may not be able
to attend the single class due to work obligations or allow attendees of the single class to attend two
classes per week to further increase their level of physical fitness. Advertising for the assembly will
continue to be perpetuated through fliers and signs throughout the community, however, a facebook
page will be created for those attending or interested in the class. Class hours and the days the class will
be held will be posted on the facebook page for public view.
In order to continue the class in the long term, a proposal will be made to the New Middletown
Village council at one of their Monday council meetings to fund the purchase of simple, portable
exercise equipment and possible payment for one or more personal trainers, including the initial trained
volunteer. The proposal will be made by the initial volunteer and volunteer nurses in the community,
supported by loyal attendees of the class. Data provided during this proposal will include how the class
will improve community health, number of attendees, and the need for recreational activity for adults in
the community.
After eighteen months, funding provided from the community of New Middletown will have
been used to purchase portable exercise equipment suitable for a group class such as jump ropes, small
free weights, yoga mats, etc. The funding will have also been used to pay the trained volunteer to lead

Running head: WEIGHT REDUCTION THROUGH RECREATION

the class as an incentive to continue and grow with the program. With equipment provided, attendance
will continue to increase until the class is able to split into three separate weekly classes, held on three
different days of the week. The additional class will further be able to accommodate more attendees
and the schedules of new attendees.
By twenty-four months, the three classes will be separated into different kinds of physical
fitness activities while continuing to follow government recommendations for exercise. These classes
will continue to consist of a 10-15 discussion on how to meet government exercise guidelines and
fitness goals, with one to one and a half hours of physical activity. Examples of different kinds of
specialized exercise that coincide with government-recommended fitness include: yoga, zumba dance,
obstacle course completion, calisthenics, tai chi, and many more. This will further introduce additional
types of recreation into the community of New Middletown, help to popularize physical fitness in the
community, and improve the health of many residents of the Village.
Nursing Diagnosis:
Risk for activity intolerance among the residents of New Middletown, Ohio, related to
psychosocial factors.
As Evidenced By:

According to the Centers for Disease Control and Prevention (CDC), about one-third of U.S.
adults, 72 million, or 33.8 percent are obese and approximately 17 percent or 12.5 million
children and adolescents aged 2-19 years are obese. No state in the US has an obesity rate less
than 15 percent, the national goal. (cdc.gov)

According to Healthy People 2020, factors associated with reduced adult physical activity
include: advancing age, low income, rural residency, perception of great effort needed for
exercise, and an overweight or obese status, all possible characteristics of the residents of New

Running head: WEIGHT REDUCTION THROUGH RECREATION

Middletown. Environmental influences that improve rates of physical activity include: presence
of sidewalks, having a destination when walking, access to public transportation, and low traffic
density, all of which are not characteristic of New Middletown.

There are no public recreational activities for adults in New Middletown that involve physical
activity other than one set of sidewalks along Main Street, and Welker Park for basketball and
tennis, although personal equipment purchase required. Public transportation is difficult to
access in order to reach other forms of recreation out of town. There is no access to taxi services
and sparse on-demand access to WRTA public transportation in New Middletown, making
residents reluctant to access public transportation in order to attend recreational physical
activities.

In other areas of New Middletown, there are no parks, sidewalks, or safe areas to travel on foot
or by bicycle to other areas of town, requiring vehicular transport. Upon a windshield survey
conducted by nursing students of Youngstown State University, no bicyclists were observed
traveling through town though a few residents were observed walking on the few sidewalks of
Main Street.
Interventions and Rationales:

Intervention: To implement a mixed exercise physical fitness class, introducing a new,

additional form of recreation to the Village of New Middletown.

Rationale: To reduce New Middletown residents' risk of obesity and lack of activity.

Intervention: To provide heart rate and blood pressure monitoring at the implemented physical
fitness classes.

Rationale: To reduce the risk of injury to those participating in the physical fitness class.

Intervention: To present a proposal to the Village Council of New Middletown at a Monday

Running head: WEIGHT REDUCTION THROUGH RECREATION

village council meeting to fund the purchase of transportable exercise equipment and pay the
wage of a reliable class instructor.

Rationale: To improve the quality of the physical fitness class and increase interest in the class.
Increasing interest in the class will attract more participants, improving New Middletown's
overall health status and the worth of each fitness class implemented. In addition, introducing
more or higher quality equipment at no charge to the residents of New Middletown will allow
residents to get the most out of the exercise class, improving individual fitness.

Intervention: To ensure approval of the proposal made to the Village Council of New
Middletown by supporting the proposal with current attendee numbers and factual information
regarding the benefits of physical fitness to the community.

Rationale: Investing funding into the physical fitness class is a worthwhile investment as it
increases New Middletown's overall fitness and health outcomes, decreasing incidence of
chronic illness.
Evaluation:
Three-Month Evaluation:
A weekly fitness class was organized and held in a vacant room at a church in the community.

The program was advertised using fliers and signs posted outside of the church and along Main Street.
A local resident experienced in personal training volunteered to lead the weekly class and worked with
volunteer nurses to develop a curriculum and carry out the class. The nurses taught during a 10-15
minute period with the volunteer trainer then the trainer carried out the physical activity portion of the
class for a period of over one hour. The volunteer remained with the nurse team throughout the 24
month period and took on a paid position after successful funding from the Village City Council. 14
residents attended the initial class and attendance grew weekly through word of mouth of those already

Running head: WEIGHT REDUCTION THROUGH RECREATION

attending the class.

Six-Month Evaluation:
At the six month period, attendance of the class grew to 36 participants, warranting the need for
an additional weekly class. The class became popular throughout the community and though some
attendees ceased their visits, new participants joined at an even greater rate. Many participants stated
satisfaction with their improving physical fitness, citing weight loss and a better overall feeling of
wellness. Some participants attended both classes while new ones joined as the second class could
better accommodate their schedule.
Announcement of a need for funding was made at the weekly classes and many attendees of the
class agreed to support the proposal made to the village council. A proposal was made at a Village
council meeting by the initial volunteer nurses and the volunteer personal trainer, with several class
participants present to support the cause. Members of the Village council recognized that New
Middletown was lacking in recreational activity, contributing to the village's risk for obesity. As costs
for running the class were economical and reasonable, the proposal was accepted with the knowledge
that the new physical fitness classes were gaining popularity and bringing additional recreation to the
every day of New Middletown residents.
Eighteen-Month Evaluation:
Funding provided by the village of New Middletown was used to purchase various types of
portable group exercise equipment such as jump ropes, medicine balls, yoga mats, small hand weights
and other equipment. The trained volunteer personal trainer was then compensated since she was a
valuable asset in the operation of the weekly classes. Attendance to the classes increased greatly to 83
attendees after introduction of the new equipment, creating a need for a third weekly class.
Twenty-Four Month Evaluation:
After twenty-four months, in order to increase and keep interest for current participants in the

Running head: WEIGHT REDUCTION THROUGH RECREATION

class, the three day-per-week class was split into three separate activities to be held on their own
individual day. The three weekly classes consisted of a yoga class, introduction to exercise dance class,
and a boot camp or calisthenics class for those looking for a more basic exercise class. Attendance
numbers were maintained or increased throughout the study.

Running head: WEIGHT REDUCTION THROUGH RECREATION

References:
Adult Obesity Facts. (2015, September 21). Retrieved December 4, 2015, from
http://www.cdc.gov/obesity/data/adult.html
Chapter 4: Active Adults. (2008). Retrieved December 4, 2015, from
http://health.gov/paguidelines/guidelines/chapter4.aspx
Nutrition and Weight Status. (2010). Retrieved December 4, 2015, from
http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status
Physical Activity. (2010). Retrieved December 4, 2015, from
http://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity

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