Volume 5: No.
2, April 2008
Pilot Study of a Faith-Based Physical Activity Program Among
Melicia C. Whitt-Glover, PhD, Patricia E. Hogan, MS, Wei Lang,
PhD, Daniel P. Heil, PhD
Suggested citation for this article: Whitt-Glover MC,
Hogan PE, Lang W, Heil DP. Pilot study of a faith-based physical activity
program among sedentary blacks. Prev
Chronic Dis 2008;5(2).
Physical activity participation is low among blacks, and
strategies are needed to successfully create immediate and
sustained behavior change related to physical activity. Churches
can play an important role in health promotion efforts among
blacks because of their central role in spiritual guidance,
communication, social support, and networking. This pilot study
evaluated the feasibility and acceptability of implementing a
physical activity program for sedentary black adults in
We used a preintervention/postintervention single-group design to evaluate the effect of a 3-month faith-based physical
activity intervention on daily walking and moderate- and
vigorous-intensity physical activity among sedentary blacks.
Eighty-seven black adults participated in eight group sessions
that included discussion of physical activity-related topics, an
instructor-led physical activity session, and weekly incentives
to promote physical activity. We used a questionnaire to assess moderate and vigorous physical
activity in minutes per week at
baseline and after 3 months. Walking was assessed weekly in steps
per day by using a pedometer.
Participants (mean age, 52 yrs; mean body mass index, 35
kg/m2) reported 27 ± 54 and 10 ± 25 minutes
per week in moderate-intensity and vigorous-intensity physical
activity, respectively, and walked 4822 ± 2351 steps per
day at baseline. After 12 weeks, moderate- and vigorous-intensity physical
activity increased by 67 ± 78 and 44 ± 66 minutes per
week, respectively (P ≤ .01), and daily walking
increased by 1373 ± 728 steps per day (P <
These data suggest that a faith-based physical activity
intervention may be an appropriate strategy for increasing
physical activity among sedentary black adults. Future research
will determine the impact of this program in a randomized, controlled design.
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The benefits of increased physical activity (PA) have been
well documented (1-4), yet national data show that only 24% to
36% of black adults (aged 18 years or older) reported
participating in regular physical activity (5). Churches may be an ideal setting
for health promotion efforts in black communities because of
their central role in spiritual guidance, communication, social
support, and networking (6-9). Faith-based interventions among
blacks have been successful for smoking cessation (10), reducing
cardiovascular disease risk factors (11-13), and increasing fruit
and vegetable consumption (14-16). Several faith-based studies
among blacks have included PA within programs focusing on other
outcomes (6,17-21). These studies showed increases in PA levels,
but most showed no significant differences between intervention
and control participants. One limitation of previous faith-based
studies may have been limited attention to incorporating tenets
of the faith-based organization (e.g., religious beliefs,
scriptural references) into intervention strategies and limited
involvement of the faith-based organization in intervention
development. These factors may play an important role in
determining intervention success, but additional research is
needed to develop interventions that address these factors.
The purpose of this study was to develop and test a
faith-based PA program to increase participation in daily walking
and moderate- and vigorous-intensity physical activity (MPA and
VPA, respectively), particularly in bouts lasting 10 minutes or
longer, among sedentary black adults. This study was funded as a
part of a career development grant. Data collected during this
study were intended to serve as pilot data for a proposal for a
larger randomized, controlled trial to test the faith-based PA
program compared with a control group.
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We conducted this study in a suburban community in North
Carolina from March through October 2005. In September and October 2004, nine local church pastors participated in in-depth
interviews and provided input on the design, development, and
implementation strategies for health promotion programs in
churches in general and a faith-based PA program specifically.
Pastors were recruited from a list of pastors who attended (or
sent a representative to) at least one of two luncheons held for
ministers in the local community to determine potential
strategies for health promotion and disease prevention among
Data from in-depth interviews suggested that, in general,
health was viewed as a concept that encompassed spiritual,
physical, mental, and emotional health. Pastors indicated that
they play a role in the health of their church congregants by
setting an example for healthy living, imparting the knowledge
that wholeness and health are essential parts of Christian
character that enable one to do God’s bidding and that the
body is God’s temple. They advocate, encourage, and support
efforts to engage in healthy behaviors and to implement
health-related programming within the church. Pastors provided
suggestions for why their congregants were not physically active
(e.g., lack of motivation, knowledge, time, or resources) as well as
feedback on ways to successfully implement a faith-based
intervention (e.g., getting buy-in and support from the pastor,
making sure to offer sessions during times that do not conflict
with other church activities, linking health-promoting activities
to church ministries rather than creating separate programs).
We used information from the in-depth interviews to shape the
study design and session content of the faith-based PA
intervention. Because the pilot study was designed to determine
the feasibility and acceptability of the intervention strategy, a preintervention and postintervention study design with no control
group was used. This design was deemed the most acceptable for
church pastors and is in line with previous research suggesting
that a no- or low-attention control would not be well received by
this population (22). The intervention, which was based on social
cognitive theory (23,24), included eight weekly group sessions
focusing on behavioral strategies to increase daily MPA and VPA.
Weekly sessions included 30 minutes of MPA and a 60-minute
discussion session (Table 1). Sessions opened and closed with prayer,
and session content was presented from a theological perspective
with a focus on personal health care as a method of protecting
God’s temple. Session five focused entirely on
healthful living and negotiating barriers from a Biblical
perspective. Participants discussed scriptural references that
supported the notion of self-care and negotiating barriers, which
were used throughout the remaining sessions. Incentive items were
provided at each session to encourage PA participation. A certified fitness
instructor conducted the
30-minute MPA session and provided an opportunity for participants to
practice using incentive items. Incentives were culturally
relevant items such as faith-based aerobics videos, a gospel
exercise CD, a tote bag, and a T-shirt with a faith-based slogan
that fit the intervention theme.
Participants maintained weekly logs of pedometer step counts,
which were used to self-monitor walking, and received a weekly
summary to track walking progress throughout the study. We used
incentives to encourage participants to increase their daily MPA
to at least 30 minutes by engaging in moderate-intensity walking.
Although participants were not given specific targets to increase
their steps per day, they were advised of the 10,000 steps
recommendation for daily walking (25) and were told that striving
to reach this goal was in line with achieving the recommendation
We hired group leaders to lead the weekly intervention
sessions at churches. The following characteristics were
considered desirable for group leaders: 1) having a working
knowledge of general health and wellness but not being currently
employed as a health educator, 2) being physically active but not
exceptionally athletic, 3) having previous experience working
with blacks and other groups in faith-based settings, 4) being
comfortable speaking in group settings; and 5) not being a member
of a church involved in the intervention. These criteria were
selected to avoid hiring highly trained individuals, which might
hamper the ability to disseminate this type of intervention to a
larger audience, and to avoid potential biases by hiring church
members because all four churches could not be represented in
group leadership. Two black females were recruited as group
leaders. Each group leader was assigned to lead sessions at two
churches, depending on the time the church selected to hold the
sessions and the availability of the group leader.
Each church pastor also selected one church member to serve as
a liaison between the church and the study staff and to attend to
any church-related logistical issues. We paid church liaisons a
modest honorarium for their participation in the study. In
addition, church liaisons received a group leader
training manual and session materials to facilitate continued
implementation of the PA program after completion of the study.
No additional incentives or compensation were provided to churches
We selected a convenience sample of four churches that identified
themselves as predominantly serving blacks and whose pastors
participated in one of the previously mentioned ministers’ luncheons.
Recruitment for study participants was at the churches’
discretion; it primarily consisted of making announcements during
Sunday morning worship services and weekly activities and
placing flyers throughout the church and in the Sunday
bulletin. Interested individuals were invited to attend a
general-interest session held at each church and led by the study’s
principal investigator (MCW). Interest sessions were held during
the time the church had selected for the weekly intervention
sessions. This limited the number of individuals who would be
unable to attend the sessions regularly. During the interest
session, the principal investigator explained the study
procedures and eligibility criteria and answered participant
questions. At the end of the interest session, participants were
screened for study eligibility using the following criteria: 1)
being self-identified as black; 2) being 18 years of age or
older; 3) not currently meeting recommendations for MPA or VPA
(defined as self-report of 30 minutes or less of MPA on 5 or
fewer days per week; 20 minutes or less of VPA on 3 or fewer days
per week, or obtaining recommended MPA and VPA, but in
bouts lasting less than 10 minutes, as assessed using a modified
version of the International Physical Activity Questionnaire); 4)
responding “no” to all questions on the Physical Activity
Readiness Questionnaire (PAR-Q) or having obtained medical
clearance; 5) having no other physical illnesses or disabilities
limiting PA; and 6) being willing to commit to participating in
weekly intervention sessions and all data collection visits. All
individuals who attended an interest session received a
pedometer, regardless of their eligibility for study
participation. Eighty-seven participants met the eligibility
criteria and were enrolled in the study.
All study procedures were approved by the Institutional Review
Board at Wake Forest University Health Sciences. Eligible
participants provided written informed consent before
participating in data collection or in the study intervention.
Intervention fidelity, which is “the degree to which a program
is implemented as intended by its developers,” (25) was addressed
by several methods. Training materials were developed and used to
standardize program delivery across group leaders. Group leaders
participated in a mandatory half-day training session that
provided an overview of the study goals, objectives, and content.
Before each intervention session, group leaders received a
scripted discussion guide for each session and handouts for study
participants. Group leaders also met for about 2 hours with the
principal investigator before each session to review and discuss
session content and have any questions answered. During the
meetings, the principal investigator modeled delivery of the
session content and provided opportunities for the group leaders
to provide input, ask questions, and practice delivering the
intervention content. Intervention fidelity was also monitored by
anonymous evaluation forms that participants completed at the end
of each session and by examining weekly records of participant
attendance and pedometer logs.
All measurements were collected at baseline and after 3 months
except for records of daily walking, which were collected weekly
throughout the study. All measurements were taken at the church
where participants were recruited unless otherwise requested, and
all measurements were taken by the same trained data
Physical Activity Readiness Questionnaire. The PAR-Q,
which is a valid screening tool for
pre-participation in PA (27-30), was used to screen study
participants. The PAR-Q includes seven questions that assess the
presence or absence of several known risk factors that preclude
participation in MPA or VPA without consent from a medical
professional. Participants who answered “yes” to any question on
the PAR-Q were required to obtain medical clearance from a health
care provider before being enrolled in the study.
Daily walking. Daily walking was measured throughout
the study using an Accusplit Eagle pedometer. Previous studies
have demonstrated the feasibility of the pedometer as an
objective measure of PA and as a potential motivator to increase
PA levels (31,32). All participants received a pedometer and
instructions for wearing the pedometer and recording daily
walking. Group leaders instructed participants to wear the pedometer on
the waistband, in line with the outside of the knee cap, during
all waking hours unless the participant was immersed in water.
Participants were instructed to clear the pedometer count each
morning and to record the total number of steps taken at the end
of each day using a log sheet. The log sheets included space to
record the time the monitor was put on in the morning, the time
it was removed at the end of the day, the day and date of
recording, and the total number of steps taken for the day. Log
sheets were provided each week for recording the number of daily steps, and
participants submitted the log sheets weekly for feedback on
Baseline number of steps per day were based on the average number of steps per day
during week 0. Data for week 4 were based on the average number of steps
per day during weeks 1 to 4, and data for week 12 were based on
the average steps per day during weeks 5 to 12. We performed
separate analyses using only data collected for weeks 4 and 12.
Results were comparable with data based on average number of steps per day
across weeks (data not shown); thus, to maximize the sample size
available for data analysis, we used the average number of steps per day across
weeks. In addition, we analyzed steps per day
categorically: less than 5000 steps per day (sedentary); 5000
to 7499 (low active); 7500 to 9999 (somewhat active), 10,000
to 12,499 (active), and 12,500 or more (highly active) (33).
Moderate- and vigorous-intensity physical activity. Self-reported
participation by minutes per week in MPA, VPA, and walking was
assessed using a modified version of the International Physical
Activity Questionnaire (IPAQ) (34). The IPAQ assesses adherence
to national recommendations for MPA and VPA during the previous 7
days. Two questions assess days per week and time per session for
VPA or MPA lasting 10 minutes or more per session. Three
questions assess daily and brisk walking at work, at home, for
transportation, and for recreation, sport, exercise, or leisure
for 10 minutes or more per session. To increase the accuracy of
self-reported data, we modified the questions by changing
open-ended questions related to frequency to closed-ended
questions. Participants selected days per week from a list
ranging from 0 days to 7 days. We also modified the questions on
duration of PA from an open-ended response to categorical
responses to try to reduce overestimation: “I do not do _____
activity for more than 10 minutes in a row”;
“10 to 15 minutes”;
“15 to 30 minutes”;
“30 to 45 minutes”;
“45 to 60 minutes”; and
“Over 60 minutes.” To
calculate a continuous measure of PA participation, 0, 10, 15, 30, 45, and 60 were used
to estimate minutes per day. We modified the question order from
the original version of the IPAQ and asked about daily walking
before asking about other MPA. We modified the timing to ask
about usual PA instead of PA in the past 7 days. Minutes per week
in MPA were calculated as the sum of days per week multiplied by
minutes per day in MPA and brisk walking. Minutes per week in VPA
were calculated as the sum of days per week multiplied by minutes
per day in VPA.
Participant characteristics and anthropometrics. At the
baseline visit, we used a questionnaire to measure self-perceived
general health and well-being and presence of chronic diseases.
Using a digital scale, we weighed each participant twice and
measured a third time if the two measures differed by more than
0.2 kg. Height was also measured twice to the nearest 0.5 cm
using a height stadiometer and measured a third time if the two
measures differed by more than 0.5 cm. The average of the two
closest measures was used for height and weight. Body mass index
(BMI) was calculated as weight (kg) divided by height (m2).
Seated resting blood pressure was measured, in duplicate, using a
digital Omron monitor after participants had been seated with
legs uncrossed for at least 5 minutes. Blood pressure was
measured a third time if the two measures differed by more than 4
mm Hg. The two closest measures were averaged and used for
Statistical analysis. Statistical analyses were performed using SAS version
8.2 (SAS Institute Inc, Cary, North Carolina) and SAS-callable SUDAAN software (RTI
International, Research Triangle Park, North Carolina).
We examined the magnitude of the intra-class correlation
coefficient (ICC) among subjects from the same church, which was
estimated to be 0.06. We used a SUDAAN modeling procedure with two
levels of clustering (both church and individuals specified in the models) to
account for the ICC among church members and temporal
dependence in repeated observations obtained on the same individual. Working independence between participants from the
same church was assumed, along with an exchangeable covariance
structure for repeated measurements on the same individual. Least
square means were obtained from the models along with standard
errors, which were then converted into standard deviations for
the adjusted mean changes.
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At baseline, participants (n = 87) were 52 ± 14 years of
age (range, 20–83 years) with an average BMI in the obese
category (34.7 ± 9.0 kg/m2; range, 16.1 to 63.3
kg/m2; 69% of participants had BMIs ≥30
kg/m2). All participants were black, most were female
(89%), almost half (49%) were married, and most (96%) had a high
school-level education or higher. Eighty-five percent of study
participants reported at least one chronic health condition.
Almost half (43%) of study participants reported using
antihypertensive agents, and the mean systolic/diastolic blood
pressure levels of study participants were in the borderline
hypertension range (137 ± 23 mm Hg systolic and 84 ± 14 mm Hg diastolic). The four
churches included in the intervention were similar across all
baseline characteristics with the exception of education
(P < .01).
Participants reported 26.6 ± 54.2 minutes per week in MPA
and 10.0 ± 25.3 minutes per week in VPA at baseline.
Consistent with self-reported participation in MPA and VPA,
participants walked 4822 ± 2351 steps per day on average
at baseline and met the definition for sedentary lifestyle (less
than 5000 steps per day ). Most participants (57%) were in
the sedentary category, although almost one-third (30%) were
considered “low active.” Very few participants were considered
“somewhat active” and
“active” (12% and 1%, respectively).
Data on mean changes in study outcome variables are presented
in Table 2. Study participants attended 6.2 ± 1.8 of the
eight intervention sessions. After four intervention sessions,
steps per day increased by 846 ± 2047 steps (an 18%
increase) to an average of 5729 ± 2230 steps per day
(P = .04). The increase in steps per day was 1373 ±
728 steps (a 28% increase) after 12 weeks to an average of 6148
± 2534 steps per day (P < .01). Although our
sample size was not large enough to detect statistically
significant differences, we observed a decrease in the proportion
of participants who were categorized as sedentary (36% after 4
weeks, 32% after 12 weeks), and an increase in the proportion of
participants who were classified as somewhat active (20% after 4
weeks, 28% after 12 weeks). There was an increase from baseline to 4 weeks in the proportion of
participants who were classified as active (from 1% to 4%), but no additional
change was observed after 12 weeks (4% classified as active). Participants also reported increases in self-reported
minutes per week in MPA (66.9 ± 77.6 or 251%, P < .01) and VPA (43.8
± 66.4 or 438%, P < .01). Weight and BMI remained
stable over the 12-week intervention (data not shown). Changes in
systolic and diastolic blood pressure after 3 months were in the
expected direction (−4.3 ± 29.7 mm Hg and
−3.4 ± 20.4
mm Hg, respectively) but were not statistically significant (data not shown).
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We observed statistically significant increases in number of steps per
day after 4 weeks and after 12 weeks, and significant changes in MPA and VPA after
12 weeks. We were encouraged to see that the
proportion of participants who were classified as sedentary on
the basis of previously published criteria for evaluating steps
per day (33) decreased, and the proportion of participants who
were classified as somewhat active and active increased. Although
changes in systolic and diastolic blood pressure were not
statistically significant, changes were in the expected
direction. Weight and BMI remained stable over the 12-week intervention. This study adds to the existing literature on
successful methods for increasing PA levels in black communities and provides preliminary information about the
potential for a faith-based program to increase PA levels over a
3-month period among sedentary black adults.
Findings from our study regarding changes in PA among blacks
are in line with, and in some cases show better results than,
studies with similar time frames and study designs. An
uncontrolled community-based walking program among 24 black
breast-cancer survivors (aged 47 to 66 years) included eight
75-minute weekly sessions held at either a community center or a
local church (35). The study used a curriculum that described the
benefits of and barriers to exercise, the relationship between
exercise and health and cancer risk, and personal
assessment and problem-solving sessions for motivation. Data for
number of steps per day were collected at baseline, 8 weeks, and 12 weeks.
Findings showed significant increases in steps per day from
baseline after 8 weeks, but no further changes after 12 weeks.
Banks-Wallace and Conn conducted an uncontrolled trial evaluating
a 12-month walking intervention with 6-month follow-up in a
sample of 21 sedentary, hypertensive black women (aged 25 to 68
years) (36). The intervention included 3-hour monthly group
meetings and a home-based walking component. For the subset of
women who attended all data collection visits (n = 10),
the number of steps per day increased by 51% after 6 months but decreased by
13% at the end of the 12-month intervention. An 8-week diet and
exercise education program among 10 mothers with children aged 0
to 3 years showed significant decreases in resting heart rate,
which suggested improvements in cardiovascular fitness (37). A
12-week study condicted among urban black middle-school children (n = 56)
and their parents (n = 25) and designed to promote fruit and
vegetable intake and increase exercise showed significant
decreases in walk/run time for parents as well as significant
decreases in BMI, body fat, and resting diastolic blood pressure
Not surprisingly, we did not observe significant changes in
blood pressure in our study. The pilot study had a large enough
sample to test meaningful differences in daily walking as
assessed by a pedometer but was not large enough to be able to
detect small changes in blood pressure. We were encouraged,
however, to see trends in the appropriate direction for these
variables. We were also not surprised that weight did not change
in the current study. Hill et al suggest that small changes in
behavior, such as adding an extra 2000 to 2500 steps per day, may
prevent excess weight gain (39). Changes in steps per day in our
study approached but did not reach Hill’s recommendation.
Data from the National Weight Control Registry (NWCR) suggest
that individuals who successfully maintain weight loss walk an
average of 11,000 to 12,000 steps per day (40). Even though
participants in our study increased daily walking over baseline
levels, the average daily step count after 3 months was about
6100 steps per day, well below estimates from NWCR. To our
knowledge, no studies have articulated the change in steps per
day necessary for significant changes in clinical outcomes, and
additional research is needed in this area.
Our study had a number of limitations. First, because we
were unclear about the feasibility of the proposed study design
and because of the reluctance in some faith-based communities to
be part of a randomized study, particularly to a no-attention control group,
we did not use a randomized, controlled design. We recognize the
lack of a control group as a major limitation of the study.
Second, this study’s sample group was small; additional
participants may have improved our ability to detect differences
in clinical variables. Third, we did not have objective data for
participation in MPA and VPA. We attempted to collect these data
using accelerometers but encountered several issues related to
adherence to the accelerometer data collection protocol and,
thus, were not able to use these data for analyses. Finally, we
are aware that participants who enrolled in our study
might differ from the general population, from individuals who do
not attend church, and from individuals who chose not to
volunteer for the study.
The study also had several strengths. Although we were unable
to obtain an objective measure of MPA and VPA, we were able to
collect this information using a self-reported questionnaire.
Although self-reported PA data tend to be overestimated,
increases in MPA and VPA in our study were in line with
increases in objectively measured PA. We addressed some
limitations of previous studies by incorporating tenets of the
church and by involving the church in intervention development.
Participants reported high satisfaction with the intervention,
suggesting that this strategy might be successful in other black
churches. At least one church used the materials to conduct a
second set of intervention classes with new participants.
Although we did not collect outcome data on the new participants,
anecdotal evidence suggests that the program was well accepted in the
second set of classes. Group leaders were able to implement the
program on their own, suggesting that the program strategy may be
sustainable. Finally, the current pilot study found that participants increased
their number of steps per
day and approached the level suggested to prevent weight gain
These data suggest that a faith-based PA intervention may be
an appropriate strategy for increasing PA among sedentary black
adults. Future research will determine the impact of this program
compared with a control group. We plan to conduct a randomized,
controlled trial to compare the faith-based PA intervention with
a control condition.
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This study was funded under grant #K01 HL070449 from the
National Heart, Lung, and Blood Institute at the National
Institutes of Health. The authors wish to thank the advisory
committee, research team, and participating churches for their
contributions to this study. The authors also wish to thank Ms
Rhonda Blaine for her assistance in preparing the manuscript. The
authors had no professional relationship with any company or
manufacturer that would benefit from the results of this study.
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Corresponding Author: Melicia C. Whitt-Glover, PhD, Assistant
Professor, Department of Epidemiology and Prevention, Division of
Public Health Sciences, Wake Forest University Health Sciences,
Winston-Salem, NC 27157-1063. Telephone: 336-716-9354. E-mail:
Author Affiliations: Patricia E. Hogan, Wei Lang, Department of Biostatistical Sciences, Division of Public Health Sciences, Wake
Forest University School of Medicine, Winston-Salem, North
Carolina; Daniel P. Heil, Department of Health and Human
Development, Montana State University, Bozeman, Montana.
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