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Preps, Reps and Steps - African American women rev up their physical activity to prevent obesity
Janet Riddick says, "I always felt like I didn't have the time to take care of myself. PRISE showed me how to take care of myself in the little time that I do have. And that has made a world of difference."
spacer Janet Riddick knew she should exercise, but when? Between managing admissions and Medicaid at Grady Memorial Hospital, working as a real estate broker in the evenings and on weekends, helping her 12-year-old daughter with homework, and cooking, cleaning, and shopping for a household that includes her husband and father-in-law, Riddick was lucky if she could carve out five minutes for herself. By her own account, the extent of her daily physical activity was walking from her car to her desk.
     Then last fall, Riddick enrolled in a worksite fitness program at Grady. She was weighed, measured, given a host of tests, and then handed a pedometer and a set of two-pound weights. She met regularly with a behavioral counselor to evaluate her progress and set new goals. Soon, Riddick found herself parking her car farther from entrances, taking the stairs instead of the elevator, and walking in place during TV commercials in the evening.
     Six months after enrolling, Riddick repeated the tests and found that all those extra steps paid off, and her results were impressive. Her total cholesterol fell from 244 to 199, and her LDL (the “bad cholesterol”) fell from borderline high at 142 to near optimal at 107. Her triglyceride and blood glucose levels also improved.
     “I really didn’t lose a whole lot of weight, but I feel so much better,” says Riddick, 49. “I’ve kept up with my walking, and now I don’t get as winded as my daughter! I even picked up tennis. I play two to three times a week in our subdivision. I can’t remember the last time I felt this good.”
     Riddick was a participant in PRISE, a six-month workplace intervention and scientific study aimed at increasing physical activity among employed African American women. The brainchild of RSPH collaborator Cheryl Franklin, PRISE stands for Preps, Reps, Increased Steps, and Encouragement. A gynecologist with a large African American patient base, Franklin had become increasingly alarmed at the growing rates of obesity and inactivity she saw among her
  Janet Riddick and daughter, Jamila now take time to exercise together.
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  Janet Riddick (right) now makes time to cook healthier meals and exercise regularly with her daughter Jamilah at their Atlanta-area home.
patients and her staff. And she knew the problem was not unique to her Atlanta practice.
     Indeed, rates of obesity in this country have reached epidemic proportions, with nearly 65% of American adults weighing in as either overweight or obese. African American women suffer obesity rates even higher than the rest of the population. And that means they also endure more than their fair share of the devastating complications of obesity—heart disease, diabetes, and hypertension, to name a few.
     Franklin saw increasing physical activity levels as the key to reversing the obesity rates of African American woman, and she decided the workplace was the best place to try it.
     “When I asked the women in my practice why they didn’t get more physical activity, they said they didn’t have the time or the energy,” says Franklin. “By the time they get home from work, feed their families, and do whatever else needs doing, they are too tired to think about exercising. So I decided we needed to develop a sustainable approach to incorporating physical activity into the workplace.”
     To make such a program happen, Franklin turned to Carol Hogue, director of the Women’s and Children’s Center at the RSPH. Hogue assembled a multidisciplinary team of researchers from the RSPH, the School of Medicine, and Emory College, and together they devised a work-site fitness program with funding from the CDC.
     Grady was chosen as the test site thanks to its large number of African American female employees. PRISE researchers recruited 150 African American women ages 18 and 35 who were not physically active. Participants complete a comprehensive physical exam and a psychological survey.
Cheryl Franklin says, "We hope to learn how factors like stress, anger, gendered racism correlate to the ability to exercise."
spacer Changing behavior
Recognizing that change is made in steps, not leaps, the PRISE intervention was designed to walk participants through the various phases involved in altering behavior, based on the Transtheoretical Model. According to this model, “Behavioral change is accomplished by going through a recognized series of stages, from pre-contemplation through maintenance,” notes Nancy Thompson, PRISE team member and associate professor of behavioral sciences and health education.
     Discovering which stage a participant is in falls under the “Preps” umbrella. A counselor talks with the participant to find out where she is on her own personal motivational scale and helps prepare her to start the intervention.
     In the “Reps” phase, each woman is given a set of weights and taught how to use them safely to increase strength and flexibility. The “Increased Steps” portion of the program helps participants
PRISE team members, Carol Hogue, Sameer Nagamia, Laura Gaydos and Usha Ramakrishnan
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Cheryl Franklin came up with the idea for PRISE to increase physical activity for African American women. PRISE team members, including Carol Hogue (front), Sameer Nagamia (L-R), Laura Gaydos, and Usha Ramakrishnan, then developed the intervention.  
strive to take 10,000 steps a day—an approximation of the Surgeon General’s recommended 30 minutes of activity on most days of the week.
     “Each walking program is tailored for that woman, says Laura Gaydos, a senior research associate in the Women’s and Children’s Center. “We find out how she spends her day and where we can add steps in.”
     For the final component of the program, “Encouragement,” participants meet with a behavioral and motivational counselor every couple of weeks while they are enrolled in the study. The counselor, armed with a motivational manual developed by Thompson, walks the woman through each phase of the program.
     “By asking a series of questions outlined in the manual, the counselor can determine which behavioral phase the woman is in and then decide appropriate ways to motivate her,” explains Thompson.
     For example, many working mothers say they are so busy taking care of others that they don’t have time to take care of themselves. The manual offers some guided visualization exercises to help the women imagine what would happen to their loved ones if they could not care for them. “It helps them understand that taking care of themselves is taking care of others,” says Thompson.
spacer The POWER of nutrition
The PRISE researchers launched a companion intervention called POWER lunches to address the nutritional component of physical health. POWER (Preparing Our Women to Eat Right) is a 12-week lunchtime program in which participants have a healthy meal prepared for them and they receive a lesson on various nutritional topics. A weekly newsletter reinforces these lessons, with information ranging from how to read food labels to basic nutrition facts. At the last session, participants enjoy a celebratory luncheon, each bringing in a favorite recipe that they have modified to improve nutrition content.
     All PRISE participants are invited to attend the POWER lunches, some while enrolled in PRISE and some afterward. Consequently, researchers can compare outcomes and determine if the nutritional component improved results.
     Once participants complete the six-month PRISE intervention, they undergo the same tests they did at the outset. The researchers then will compare the before and after data to determine the
A POWER lunch at Grady
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  A POWER lunch at Grady Hospital.
effectiveness of the intervention in improving cardiovascular disease risk factors.
     “We hope to learn how factors like stress, anger, and gendered racism correlate to the ability to exercise,” says Franklin. “We may find that some of these factors are positively influenced by physical activity.”
     The next step will be to replicate the study in another location to see if the results are the same in different populations. Meharry Medical College in Nashville, one of the nation’s first predominantly African-American medical schools, will partner with RSPH to roll out the PRISE intervention to its employees.
     Ultimately, the PRISE team hopes to create a program that employers could offer as part of their benefits packages. “Employers lose an extraordinary amount of money on employees with chronic diseases that are really lifestyle diseases, such as obesity, diabetes, and high blood pressure,” says Franklin. “They lose money in insurance costs, lost productivity, and absenteeism. And the cost is only going to go up. So we think employers would be very interested in a proven physical activity intervention such as PRISE.”
     Then perhaps more employees will follow in Janet Riddick’s footsteps. “I always felt like I didn’t have the time to take care of myself,” says Riddick. “PRISE showed me how to take care of myself in the little time that I do have. And that has made a world of difference.”
spacer Martha Nolan McKenzie is an Atlanta freelance writer.  


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