CLINICAL APPLICATIONS

Using a Health Promotion Program

Planning Model to Promote Physical
Activity and Exercise
by Kristi M. King, Ph.D., CHES and Kimberly Rapp Hartson, Ph.D., R.N.
hysical activity and exercise are priorities for health and 2. Access relevant existing national or local information

P fitness professionals. It behooves professionals to use a

program planning model to clearly outline the program’s
mission, goals, and objectives. Throughout the scientific litera-
ture, program planning models have been used as a foundation
and data related to health and fitness (e.g., percentage
of population physically inactive).
3. Collect individual data from members of the population
(e.g., fitness testing a small sample of women in a poten-
to test the efficacy of physical activity and exercise programs. tial intervention).
Program planning models guide health and fitness professionals 4. Analyze relationships among behaviors (e.g., physical in-
through a process of strategically assessing the needs of the prior- activity), environment (e.g., lack of sidewalks), and other
ity population, carefully planning appropriate interventions, exe- factors that influence health (e.g., family support).
cuting the planned interventions, modifying the plan if necessary, 5. Examine factors that influence the learning process of
and evaluating the immediate, short-term, and long-term effi- the priority population (e.g., college students may prefer
cacy of the program. In addition, using such a clear, organized technology-based programs, and older adults may prefer
framework for reference during the planning and implementa- in-person or group programs).
tion of an intervention ensures tangible products/outcomes for 6. Examine the factors that enhance or impede engagement
presentation to key stakeholders. Therefore, the purposes of in physical activity/exercise by the priority population
this Clinical Applications column are to describe the steps in a (e.g., what resources such as gyms or access to personal
Generalized Program Planning Model (GPPM) as explained by trainers are available and affordable).
McKenzie et al. (1), to give examples of how to operationalize 7. Determine the needs of the priority population, based
these steps and to incorporate best evidence in the promotion on the findings of the needs assessment (e.g., because
of physical activity and exercise interventions. of the prevalence of hypertension among low-income
women in the specified zip code and limited access to
GENERALIZED PROGRAM PLANNING MODEL exercise facilities, a free family-based dance program
Using the GPPM for health promotion programming (see Figure 1) with childcare will be offered in the mornings at the
(1), a health and fitness professional can organize interventions local library).
to promote physical activity and exercise. The program planning
steps include assessing the needs, setting goals and objectives,
developing an intervention, implementing the intervention, and
evaluating the results.

STEP 1: ASSESSING THE NEEDS

Health and fitness professionals must understand the actual (or
perceived) needs of their priority population (e.g., sedentary
women, older men, etc.) that affect their health directly or indi-
rectly. The following steps and examples for conducting a needs
assessment have been adapted for use for health and fitness
professionals from the responsibilities and competencies for
Health Education Specialists (2):

1. Develop a simple plan outlining the types of information to

gather about the priority population’s needs (e.g., weight
loss, increased strength, type 2 diabetes prevention).
Volume 24 | Number 2 www.acsm-healthfitness.org 43

Copyright © 2020 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
CLINICAL APPLICATIONS

Figure 1. Generalized program planning model for health promotion programming (1).

STEP 2: SETTING GOALS AND OBJECTIVES to set challenging yet realistic objectives. For example, although
To effectively plan, implement, and evaluate physical activity a health and fitness professional may wish for clients to improve
and exercise programs, health and fitness professionals must all fitness outcomes, a realistic ideal may be to improve in three
strategically develop a mission statement, goals, and objectives of five outcomes (e.g., cardiovascular, muscular strength, muscu-
(1). A mission statement describes the purpose and breadth of lar endurance, flexibility, or body composition). There are three
the program. For example, a mission statement for a worksite- main types of objectives: process, impact, and outcome. Process
based fitness program may be as follows: objectives refer to the tasks and activities that are required on a
daily basis to achieve the impact and outcome objectives. Impact
The purpose of the Work-well Fitness Program is to engage, support, objectives are focused on the immediate effects of a program and
and inspire employees in the care of their health. We strive to provide a variety also may include learning, behavioral, and environmental ob-
of educational, supportive, and easily accessible wellness and fitness program- jectives. Lastly, outcome objectives are focused on the final
ming to meet your needs. health and fitness outcomes (1). Although health and fitness
outcomes are the main purposes of the program, including
Once an inclusive mission statement is agreed upon by key learning, behavioral, and environmental objectives may facil-
stakeholders (e.g., managers, employees, individuals, and teams itate the achievement of health and fitness outcomes in the fu-
who offer or support programs), determining goals and objec- ture. For example, a client learning about health and fitness
tives must ensue. Goals are broad statements that describe the (learning objective) and engaging in healthy behaviors may pur-
desired results, including the expected direction of change in chase a park access pass (environmental objective) and go hiking
the outcomes of interest. Examples of goals for new clients at a on an outdoor trail. Although gaining access to parks and hik-
gym may be as follows: ing trails will not elicit immediate improvement in cardiore-
spiratory fitness (outcome objective), achieving this impact
To improve fitness outcomes objective may set up the client for potential success in the future,
To increase physical activity if continued (see Table 1).
To decrease percent body fat
STEP 3: DEVELOPING AN INTERVENTION
Typically, only one or two goals are necessary because they The intervention should follow from the assessed needs, mission
are generally encompassing of multiple positive health out- statement, goals, and objectives. When planning the intervention,
comes. Next, corresponding objectives should be developed remember to regularly revisit the goals and objectives to ensure
for each goal. These objectives will help determine if each goal that the program stays true and focused on the original purpose.
is met or not. The objectives must be specific, measurable, attain- Although this process is presented in a linear fashion, planning the
able, realistic, and time sensitive (SMART). It is very important intervention often unveils logistical problems and new ideas arise.
It may be necessary to revise the mission statement, goals, and
objectives to ensure that they all flow together as one large strategic
plan to address the assessed needs.
When developing an intervention, it can be helpful to con-
sider how an individual’s health behavior is influenced by the
surrounding context and environment (3). A variety of personal,
peer, family, social, sociocultural, organizational, community,
policy, and physical environmental factors can positively or
negatively influence a person’s engagement in physical activ-
ity (4,5). These factors can be organized as a framework called
an ecological model. In fact, the 2018 Physical Activity Guidelines
Advisory Committee recently conducted a systematic review
of physical activity interventions and concluded that the most
effective interventions addressed multiple social ecological levels
(i.e., individual, community, communications environment, and
44 ACSM’s Health & Fitness Journal ® March/April 2020

Copyright © 2020 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
TABLE 1: Types of Objectives, Targeted Outcomes, and SMART Objectives
Objectives Targeted Outcomes SMART Objectives

Process Activities and tasks necessary for achieving The health and fitness specialist will host 20 group exercise classes. Specifically,
objectives other objectives one class per week from August to December in the local community center.
Specific: identified who, what, when, where
Measurable: 20 classes total; 1 per week
Attainable: 1 per week
Realistic: feasible given personnel constraints
Time sensitive: August to December
Impact Immediate outcomes
objectives
Learning: outcomes related to awareness, Learning Objective:
knowledge, attitudes, or skills After participation in the 5K event, parents or community members will list one benefit
of living a physically active lifestyle on the exit survey.
Specific: identified who, what, when, how
Measurable: 1 benefit to be listed
Attainable: 1 benefit
Realistic: adds only 1 question to the exit survey
Time sensitive: After completing run, before exiting
Behavioral: behavioral outcomes Behavioral objective:
The employee benefits department will provide all employees with 45 minutes of flex
time to participate in any fitness activity throughout the workday for 1 month.
Specific: identified who, what, when
Measurable: all employees get 45 minutes
Attainable: access and authority of the benefits dept
Realistic: if it is within budget
Time sensitive: flex time provided for one month

Environmental: modification of environment Environmental Objective:

During participation in the 4-week fitness walking program, 80% of the participants
will use the online platform to report engaging in walking at least five times per week.
Specific: identified who, what, where, when, how
Measurable: 80% of participants
Attainable: 5 times per week
Realistic: within recommended PA guidelines
Time sensitive: 4-week fitness walking program
Outcome Fitness, health status outcomes The percentage of employees with hypertension will decrease from 50% to 40%
objectives by the year 2022.
Specific: identified who, what, when
Measurable: rate of hypertension among employees
Attainable: if proper process objectives are in place
Realistic: if proper process objectives are in place
Time sensitive: before 2022
Adapted from McKenzie et al. (1).

physical environmental and policy), were based on behavior change among the resources they have to operate a program, the ac-
theories, and were implemented in different settings throughout the tivities they plan to implement, and the outcomes they expect
community (6) (Table 2). Research indicates that interventions (1). For example, the implementation of an effective physical
are most effective when they operate on multiple levels and ac- activity and exercise intervention requires organization among
count for the four domains of physical activity that contribute to appropriate allocation of human, curriculum, fiscal, technical,
“active living,” including active recreation, household activities, location, equipment, supplies, and time resources; securing
occupational activities, and active transportation (7). external funding through community grants or businesses; gaining
approval/support from key stakeholders and/or decision makers;
STEP 4: IMPLEMENTING THE INTERVENTION AND and training staff members or volunteers. In addition to using a
ORGANIZING RESOURCES logic model as a road map to keep the intervention organized
When implementing an intervention, developing and adher- and “on track,” a visual chart of the projected timeline for plan-
ing to a logic model is a systematic and visual way for planners ners to know what to do and when is also useful (Table 3). The
to share and present their understanding of the relationship following logic model and projected timeline not only help the
Volume 24 | Number 2 www.acsm-healthfitness.org 45

Copyright © 2020 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
CLINICAL APPLICATIONS
TABLE 2: Socioecological Level and Physical Activity Intervention Strategies and Approaches (6)
Socioecological Level Strategies and Approaches

Individual level • Application of behavioral theories and models to inform interventions

• Interventions specific to youth and older adults
• Peer-led interventions
• Self-monitoring of behavior and intention formation
Community level Community-wide interventions
• Door-to-door distribution of instruction and information
• Identification and support of community members at increased chronic disease risk
• Health counselor advising
School interventions
• Well-structured physical education classes
• Environmental changes in school settings
Communication environment level • Wearable activity monitors
• Telephone-assisted interventions
• Web-based or Internet-delivered interventions
• Computer-tailored print interventions
• Mobile phone interventions
• Goal setting
Physical environment and policy level Community design and characteristics that support recreational physical activity
• Point-of-decision prompts promoting stair use
• Built environment characteristics that support active transport to destinations
• Street connectivity
• A mix of commercial, residential, and public land uses and similar types of built environment characteristics
Policy-specific approaches to physical activity promotion
• Access to indoor and/or outdoor recreation facilities or outlets
• Safe Routes to School program

program team stay organized, they also can be presented when The evaluation consists of calculating the percentage of par-
pitching the project to potential supporters, collaborators, and ticipants of the fitness program who used the online platform
key stakeholders (Figure 2). For example, it may be useful when to report engaging in walking at least five times per week during
attempting to gain support from health care organizations in the 4-week fitness walking program, and then determining if the
agreeing to allow an ACSM Certified Exercise Physiologist® percentage is more or less than the 80% target. A health and
(ACSM-EP) to present the Exercise is Medicine® initiative to fitness professional can definitively report to key stakeholders
medical offices. In addition to these options, there are also several whether each of the program objectives were met. Further, if
commercially available project trackers created for the business objectives were not met, the health and fitness professional has
industry that can be helpful in tracking and visually representing a clear foundation from which to make data-driven, strategic
progress of the program. recommendations for future interventions. It is often helpful to
key stakeholders to see visual representations of the results and
STEP 5: EVALUATING THE RESULTS key findings for each objective, for example, providing a table,
Evaluation of the program once again takes us back to the goals a chart, or a graph that shows the percentage of participants
and objectives set for the program. Data and information to in the fitness program who reported walking at least five times
evaluate the objectives are collected on an on-going basis and per week compared with the percentage of participants who
at the completion of the program, depending on the objective. did not report walking at least five times per week (see Figure 3).
Sometimes it is necessary to make adaptations to the plan and Lastly, once the results have been tallied and analyzed, a well-
program when challenges arise. To determine if program goals written narrative summarizing the findings should be written.
were met, evaluate each of the processes, impacts (learning, be- Below is an excerpt from the results of a school-based interven-
havioral, and environmental), and outcome objectives. If each tion that was implemented in rural, public elementary schools:
objective is written in SMART terms, program evaluation can
be simple. For example, the following behavioral objective can “A total of 999 kindergarten to third grade children participated in data
be evaluated: collection consisting of 4-day pedometer tracking and previous-day fruits and
vegetables consumption recall from baseline in January 2011 through 12
During participation in the 4-week fitness walking program, 80% of follow-up assessments ending May 2013 … Children’s nutrition and phys-
the participants will use the online platform to report engaging in walking ical activity behaviors significantly improved over the 3-year intervention …
at least five times per week. The percentages of children who met the nutrition recommendation increased
46 ACSM’s Health & Fitness Journal ® March/April 2020

Copyright © 2020 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Figure 2. Logic model.

from 11% to 23% for girls and 12% to 23% for boys, while the percent given that they have the knowledge, attitudes, skills, experience,
who met the physical activity recommendation increased from 1% to 16% and credentials necessary to develop, implement, and evaluate
for girls and 3% to 7% for boys. This school-based intervention could be evidence-based physical activity programs as well as conduct ex-
disseminated to promote healthy behaviors among rural disadvantaged ercise testing and prescription (9,10). Using a program planning
children” (8). model to guide the process of conducting a needs assessment,
setting goals and objectives, developing an intervention, imple-
menting the intervention, and evaluating the program results
CONCLUSION will help keep the program planners organized and on track,
Health and fitness professionals can become integral partners as well as assist in communicating the strategic plan and progress
within a variety of community, clinical, or school-based sectors to gain and maintain support of key stakeholders.

TABLE 3: Projected Timeline

Activity Dec Jan Feb Mar Apr May Jun Jul Aug Sep
CEO approval of program plan X
Train personal trainers on presentation skills X

Recruit medical offices for seminar dates X X

Present seminars X X
Disseminate prescription pads and contact information to medical offices X X
Analyze attendance and personal trainer requests X X X X
Report results to CEO X X
Report results to medical offices X

Volume 24 | Number 2 www.acsm-healthfitness.org 47

Copyright © 2020 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
CLINICAL APPLICATIONS

Figure 3. Pie chart results. 8. King KM, Ling J. Results of a 3-year, nutrition and physical activity intervention for
children in rural, low-socioeconomic status elementary schools. Health Educ Res.
2015;30(4):647–59.
9. King KM, Jaggers JR, Wintergerst K. Strategies for partnering with health care settings
to increase physical activity promotion. ACSMs Health Fit J. 2019;23(4):40–3.
10. McClary King K, Terson de Paleville D. Partnering with schools to implement
physical activity interventions. ACSMs Health Fit J. 2018;22(2):38–41.

Kristi M. King, Ph.D., CHES, is an asso-

ciate professor in the Exercise Physiology
Program in the Department of Health and
Sport Sciences at the University of Louisville
in Kentucky and has a joint appointment in
Pediatric Endocrinology with the Wendy
Novak Diabetes Center. Dr. King is the prin-
cipal investigator on multiyear research studies
that focus on the improvement of health, specifically through phys-
ical activity and nutrition interventions and policies. Dr. King
earned her Ph.D. from Southern Illinois University Carbondale,
completed postdoctorate training in Physical Activity and Public
1. McKenzie JF, Neiger BL, Thackeray R. Planning, Implementing, and Evaluating Health Research with the University of South Carolina’s Arnold
Health Promotion Programs: A Primer. 7th ed. San Francisco (CA): Pearson; 2017.
School of Public Health and Centers for Disease Control and
2. National Commission for Health Education Credentialing, Inc. A
competency-based framework for health education specialists: areas of Prevention, is a Commonwealth Institute of Kentucky Scholar,
responsibilities, competencies, and sub-competencies for health education and is a Certified Health Education Specialist.
specialists—2015. 2015; [cited 2019 October 4]. Available from: https://www.
nchec.org/responsibilities-and-competencies.
3. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health
promotion programs. Health Educ Q. 1988;15(4):351–77. Kimberly Rapp Hartson, Ph.D., R.N., is an
4. National Institutes of Health. Developing interventions for health-enhancing assistant professor at the School of Nursing.
physical activity (R21/R33 — clinical trial optional) — PAR-18-307 research University of Louisville. She is interested in
project Grant. 2017; [cited 2019 Nov 3]. Available from: https://grants.nih.gov/
grants/guide/pa-files/PAR-18-307.html. improving the health behaviors of youth and
5. King KM, Gonzalez GB. Increasing physical activity using an ecological model. young adults to increase well-being and prevent
ACSMs Health Fit J. 2018;22(4):29–32. chronic illness. Her research focuses on physi-
6. King AC, Whitt-Glover MC, Marquez DX, et al. Physical activity promotion: high- cal activity and decreasing the gap between
lights from the 2018 Physical Activity Guidelines Advisory Committee systematic
review. Med Sci Sports Exerc. 2019;51(6):1340–53.
intention and physical activity behavior.
7. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach
Dr. Hartson earned her Ph.D. from the College of Nursing, University
to creating active living communities. Annu Rev Public Health. 2006;27:297–322. of Colorado, with a focus in biobehavioral sciences.

48 ACSM’s Health & Fitness Journal ® March/April 2020

Copyright © 2020 American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.