StrongPeople™ Program

Evidence-level

Evidence-Based (About evidence-level criteria)

Description

StrongPeople™ first began as a program called StrongWomen™, designed by Dr. Miriam Nelson after her research study examining the effects of strength training on bone density and other risk factors for osteoporosis. She found that midlife and older women could safely improve bone density and muscle mass through progressive strength training. The results were published in the Journal of the American Medical Association in 1994, and Dr. Nelson began the StrongWomen book series, focusing on innovative research related to nutrition, fitness, chronic disease, and community health.

In 2002, prompted by two Extension educators in Alaska and Kansas, Dr. Nelson partnered with Dr. Seguin-Fowler, and together they developed the StrongWomen Program Tool Kit, which translated the 1994 research findings into a formalized community-based program for implementation by Extension educators and other allied health professionals. In 2003, the curriculum was released and the first programs were launched.

Because of their community-based nature, these programs are often offered in rural areas where other opportunities may be lacking and barriers to healthy living may be unique. The programs include strength training, aerobic exercise, dietary skills training, and/or civic engagement. They provide an opportunity for participants to build skills, confidence, and socialize.

Services offered

StrongPeople Strong Bodies

The Strong Bodies Program is a nationally disseminated evidence-based community strength training program. It is disseminated through a strong nationwide partnership with Extension educators as well as several healthcare systems. Strong Bodies has over 4,000 community health educators trained to implement the program, with regional Ambassadors in New York, Oregon, Texas, and Wisconsin who conduct trainings in their state and for other states as needed. In research studies, participants improved muscle mass, muscle strength, bone density, body fat, balance, physical activity, blood sugar, blood pressure, physical function, pain, depression, and self-confidence.

StrongPeople Living Well

Living Well is an evidence-based healthy living curriculum that includes aerobic exercise and dietary skills training. It has demonstrated effectiveness at improving diet, physical activity behaviors, and body weight among midlife and older women. National dissemination research was supported by a Centers for Disease Control and Prevention grant, in which over 30 states and 90 communities participated.

StrongPeople Change Clubs

StrongPeople developed the Change Clubs, also known as HEART Clubs, curriculum in 2011. The goal of the Change Club process is to harness the collective power of local residents to advocate for community-level change targeting chronic disease prevention through improved access to healthier food and physical activity environments and related policies.

StrongPeople Strong Hearts

In 2013, Dr. Seguin-Fowler was awarded a National Institutes of Health (NIH) grant to integrate the three core programs into a multilevel, multicomponent intervention aiming to reduce cardiovascular disease risk factors in medically underserved rural communities: StrongPeople Strong Hearts, previously known as Strong Hearts, Healthy Communities.

Results

• StrongPeople Strong Bodies has over 4,000 community health educators trained to implement the program.
• Approximately 1,500 StrongPeople Living Well educators have been trained. The program was originally tested with Extension partners in a randomized control trial in Kansas and Arkansas in 2007.
• StrongPeople Strong Hearts participants demonstrated significant, clinically meaningful improvements in body weight, diet, physical activity, and strength. Their overall cardiovascular health profile also improved, as measured by the American Heart Association's "Simple 7" score. Intervention participants' friends and family members also improved their own body weight and health. The trial was implemented in two phases across a total of 27 towns in Montana and New York in collaboration with Extension and local healthcare partners. Many of the improvements were maintained or further improved six months after the program ended.
• StrongPeople Change Clubs are being evaluated by a National Institutes of Health funded (R01) study, in which 12 rural towns across New York and Texas were randomly assigned to implement (or delayed to implement) evidence-based policy, system, and environmental (PSE) interventions using the Change Club curriculum. The study includes rigorous evaluation among the Extension educator facilitators, Change Club members (those who lead implementation in the towns), and their social networks, and with town residents in each community, including population-wide health outcome assessments. This is the first study of its kind with a randomized design evaluating real-world, resident-led PSE intervention effects on population health.
• StrongPeople programs have been shown to improve weight, diet, physical activity, strength, cardiovascular health profile, physical function, pain, depression, and/or self-confidence in midlife and older adults.

Programs and program results:

StrongPeople Strong Bodies

• Seguin-Fowler, R. A., Grocke, M., Graham, M.L., Tarabochia, D., Sriram, U., Eldridge, G.D. (2021). Effects of StrongPeople Strong Bodies on functional fitness: a community-based randomized trial. Translational Journal of the American College of Sports Medicine, 6(4).
• Seguin, R. A., Eldridge, G., Lynch, W., Paul, L. C. (2013). Strength training improves body image and physical activity behaviors among midlife and older rural women. Journal of Extension, 51(4).

StrongPeople Strong Hearts

• Githinji, P., MacMillan Uribe, A.L., Seguin-Fowler, R.A., Ayine, P., On, A., Villarreal, D.L., McNeely, A., Szeszulski, J., Rethorst, C.D. (2024). A qualitative exploration of the health needs and goals of urban women to inform the tailoring and adaptation of Strong Hearts Healthy Communities: a community-based cardiovascular disease prevention intervention. BMC Public Health, 24, 269.
• MacMillan Uribe, A.L., Demment, M., Graham, M.L., Szeszulski, J., Rethorst, C., Githinji, P., Nelson, M.E., Strogatz, D., Folta, S.C., Bailey, R.L., Davis, J.L., Seguin-Fowler, R.A. (2023). Improvements in dietary intake, behaviors, and psychosocial measures in a community-randomized cardiovascular disease risk reduction intervention: Strong Hearts, Healthy Communities 2.0. American Journal of Clinical Nutrition, 118(5), 1055-1066.
• Seguin-Fowler, R.A., Eldridge, G.D., Rethorst, C.D., Graham, M.L., Demment, M., Strogatz, D., Folta, S.C., Maddock, J.E., Nelson, M.E., Ha, S. (2022). Improvements and maintenance of clinical and functional measures among rural women: Strong Hearts, Healthy Communities-2.0 cluster randomized trial. Circulation: Cardiovascular Quality and Outcomes, 15(11), e009333.
• Sriram, U., Graham, M.L., Folta, S., Paul, L., Seguin-Fowler, R.A. (2023). Integrating civic engagement into a lifestyle intervention for rural women – a mixed methods process evaluation. American Journal of Health Promotion, 37(6), 807-820.
• Maddock, J.E., Demment, M., Graham, M., Folta, S., Strogatz, D., Nelson, M., Ha, S.Y., Eldridge, G.D., Seguin-Fowler, R.A. (2022). Changes in physical activity outcomes in the Strong Hearts, Healthy Communities (SHHC-2.0) community-based randomized trial. International Journal of Behavioral Nutrition and Physical Activity, 19(1), 159.
• Seguin-Fowler, R. A., Strogatz, D., Graham, M. L., Eldridge, G. D., Marshall, G. A., Folta, S. C., Pullyblank, K., Nelson, M. E., Paul, L. (2020). The Strong Hearts, Healthy Communities Program 2.0: an RCT examining effects on Simple 7. American Journal of Preventive Medicine, 59(1), 32-40.
• Pullyblank, K., Strogatz, D., Folta, S. C., Paul, L., Nelson, M. E., Graham, M., Marshall, G. A., Eldridge, G., Parry, S. A., Mebust, S., Seguin, R. A. (2020). Effects of the Strong Hearts, Healthy Communities intervention on functional fitness of rural women. The Journal of Rural Health, 36(1), 104-10.
• Lo, B. K., Graham, M. L., Eldridge, G., Donoso, M. R., Folta, S. C., Strogatz, D., Nelson, M. E., Paul, L. C., Parry, S. A., Seguin‐Fowler, R. A. (2020). Ripple effects of a community‐based randomized trial for rural women: Strong Hearts, Healthy Communities. Obesity, 28(7), 1224-34.
• Folta, S. C., Paul, L., Nelson, M. E., Strogatz, D., Graham, M., Eldridge, G. D., Higgins, M., Wing, D., Seguin-Fowler, R. A. (2019). Changes in diet and physical activity resulting from the Strong Hearts, Healthy Communities randomized cardiovascular disease risk reduction multilevel intervention trial. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 91.
• Seguin, R. A., Graham, M. L., Eldridge, G., Nelson, M. E., Strogatz, D., Folta, S. C., Paul, L. (2019). Strong Hearts for New York: a multilevel community-based randomized cardiovascular disease risk reduction intervention for rural women. Contemporary Clinical Trials, 82, 17-24.
• Lo, B. K., Graham, M. L., Folta, S. C., Paul, L. C., Strogatz, D., Nelson, M. E., Parry, S. A., Carfagno, M. E., Wing, D., Higgins, M., Seguin, R. A. (2019). Examining the associations between walk score, perceived built environment, and physical activity behaviors among women participating in a community-randomized lifestyle change intervention trial: Strong Hearts, Healthy Communities. International Journal of Environmental Research and Public Health, 16(5), 849.
• Sriram, U., Sandreuter, K., Graham, M., Folta, S., Pullyblank, K., Paul, L., Seguin, R. (2019). Process evaluation of Strong Hearts, Healthy Communities: a rural community-based cardiovascular disease prevention program. Journal of Nutrition Education and Behavior, 51(2),138-49.
• Seguin, R. A., Paul, L., Folta, S. C., Nelson, M. E., Strogatz, D., Graham, M. L., Diffenderfer, A., Eldridge, G., Parry, S. A. (2018). Strong Hearts, Healthy Communities: a community‐based randomized trial for rural women. Obesity, 26(5), 845-53.
• Seguin, R. A., Eldridge, G., Graham, M. L., Folta, S. C., Nelson, M. E., Strogatz, D. (2015). Strong Hearts, Healthy Communities: a rural community-based cardiovascular disease prevention program. BMC Public Health, 16(1), 1-1.

StrongPeople Change Clubs

• Seguin-Fowler, R.A., Eldridge, G.D., Graham, M., Folta, S.C., Hanson, K.L., Maddock, J.E. (2023). COVID-19 related protocol considerations and modifications within a rural, community-engaged health promotion randomized trial. Methods and Protocols, 6(1), 5.
• Seguin-Fowler, R., Hanson, K.L., Villarreal, D., Rethorst, C.D., Ayine, P., Folta, S.C., Maddock, J.E., Patterson, M.S., Marshall, G.A., Volpe, L.C., Eldridge, G.D., Kershaw, M., Luong, V., Wang, H., Kenkel, D. (2022). Evaluation of a civic engagement approach to catalyze built environment change and promote healthy eating and physical activity among rural residents: a cluster (community) randomized controlled trial. BMC Public Health, 22(1), 1674.
• Seguin-Fowler, R., Graham, M., Sriram, U., Eldridge, G., Kim, J., Tom, M. (2020). Web-based dissemination of a civic engagement curriculum to promote healthy eating and active living in rural towns: the eHEART Study. International Journal of Environmental Research and Public Health, 17(7), 2571.
• Seguin, R. A., Sriram, U., Connor, L. M., Silver, A. E., Niu, B., Bartholomew, A. N. (2018). A civic engagement approach to encourage healthy eating and active living in rural towns: the HEART Club pilot project. American Journal of Health Promotion, 32(7), 1591-601.
• Seguin, R. A., Folta, S. C., Sehlke, M., Nelson, M. E., Heidkamp-Young, E., Fenton, M., Junot, B. (2014). The StrongWomen Change Clubs: engaging residents to catalyze positive change in food and physical activity environments. Journal of Environmental and Public Health.

StrongPeople Living Well

• Seguin, R. A., Perry, C. K., Solanki, E., McCalmont, J. C., Ward, J. P., Jackson, C. (2019). Mujeres Fuertes y Corazones Saludables, a culturally tailored physical activity and nutrition program for rural Latinas: findings from a pilot study. International Journal of Environmental Research and Public Health,16(4):630.
• Perry, C. K., McCalmont, J. C., Ward, J. P., Menelas, H. D., Jackson, C., De Witz, J. R., Solanki, E., Seguin, R. A. (2017). Mujeres Fuertes y Corazones Saludables: adaptation of the StrongWomen—Healthy Hearts program for rural Latinas using an intervention mapping approach. BMC Public Health, 17(1), 982.

For more in-depth information on the programs, see the Research Articles section of the StrongPeople website.

Challenges

Participants have given the programs predominantly positive feedback, often mentioning the camaraderie between group members as a motivating factor to make positive lifestyle changes. Recommendations from the participants include offering programs three days a week, longer exercise sessions, and longer program duration (for 12-week programs). For civic engagement groups, participant-reported challenges include competing priorities and limited finances for projects. At times, trained leaders do not implement the program; a primary reason is changing jobs or retirement.

Replication

For a fee, StrongPeople provides training, a comprehensive toolkit, and other resources for leaders on their website. Trained leaders then offer the programs to the participants, typically done with low cost to the participants.

Contact Information

Rebecca Seguin-Fowler, PhD, RDN, LD, CSCS, Director
StrongPeople Program
info@strongpeopleprogram.org