Bringing workforce development into public health: An upstream intervention
focused on the social determinants of health
Technical Appendix
September 2014
This technical appendix serves to bring a more detailed look at how Train4Change
structured the program components of their intervention.
Appendix A
Program Structure
Participants’ involvement continued over two years. The program revolved around a
required 1.5 hour meeting and training session held twice a week at SJPHC. Once participants
began teaching GroupX classes (through the provision of paid internships), participants met
once per week for the duration of the program. T4C was administered by the project coordinator
(PC), who had a background in both public health and education. The PC facilitated the
meetings/training sessions, was the contact person for participants, supervised participants’
progress through the training program, taught the content material, developed slides for training
sessions, assigned and graded take-home assignments, administered practice tests, identified
internship placements and sites for classes, organized classes, managed scheduling issues,
resolved logistical issues, and dealt with all project related operations. Whew! (Slides and other
materials for the training sessions were posted to the T4C program Wiki page.)
Appendix B
Program Components
The core training program consisted of six components:
(1) community health worker (CHW) training,
(2) the Aerobic and Fitness Association of America (AFAA) curriculum for GroupX
instructors
(3) preparation for the AFAA GroupX certification exam, which included a written and
practical exam
(4) practical training,
(5) externships
(6) paid internships.
T4C also included the curriculum for the American Council on Exercise (ACE) personal trainer
certification exam, but the use of curriculum was minimized at the point of implementation
In addition to the training, a fitness video was produced with the T4C program participants, and
a career workshop was held.
A descriptive timeline of the T4C intervention is presented in Figure 3.
Figure 3
Train4Change Program Timeline
9
2011
10 11
Recruitment
12
1
2
3
4
5
2012
6
7
8
9
10
11
12
1
2
3
4
2013
5
6
7
8
9
Content instruction & written exam prep
AFAA Exam
Practical instruction & practical exam prep
Externships
AFAA Results
Exam Refresh
Retake AFAA
AFAA Results 2
T4C Video
Internships
Career Workshop
CHW curriculum
The first 4 weeks of the training was focused on the Road to Health Toolkit provided by
the Massachusetts Department of Public Health. The toolkit was modified for the
purposes of the T4C program, and the topics covered included health disparities, chronic
disease causes and prevalence; prevention of chronic disease and communication
strategies.
CPR Certification
Participants completed the American Heart Association CPR and AED course. CPR
certification is required for the AFAA exam and for work in a fitness setting.
AFAA/written exam preparation
The majority of the didactic component of the training consisted of 12 weeks instruction
on fitness and exercise using the AFAA packaged curriculum and study guide, the
Primary Group Exercise Instructor Deluxe Study Package, in order to prepare
participants to take the AFAA GroupX instructor certification exam. Topics covered
included essentials of exercise, anatomy and physiology, nutrition, safety guidelines and
basics on how to teach group fitness classes. Participants were administered practice
tests, and the group had to demonstrate sufficient proficiency before the group was
registered for the exam. This training component culminated with participants taking the
AFAA exam.
AFAA/practical exam preparation
As part of participants’ training and preparation for the AFAA exam, an experienced
GroupX instructor (Consultant) with expertise in women’s health and fitness was brought
in. The Consultant trained participants in the practical application of exercise science in
a GroupX setting, in order to solidify participants’ understanding of essential steps in a
GroupX class (e.g.: warm up, cool down, low/high impact cardiovascular, low/high
intensity strengthening), as well as basic movements and exercises in a GroupX class
(compound and isolation exercises for upper and lower body), to prepare participants to
demonstrate individual exercises and movements during the practical component of the
AFAA exam.
AFAA Certification Exam
After taking the exam, participants who did not pass the test and did not earn
certification were required to attend review sessions of the AFAA material with an
emphasis on their weakest sections according to the test results. Participants were
required to take and pass practice tests before registering to re-take the exam.
Practical Training
After taking the AFAA exam, and while waiting for the exam results, participants
attended training sessions once a week with the GroupX Consultant. These sessions
provided more in-depth instruction to prepare participants to independently teach a
complete 60 min GroupX classes from start to finish. Training taught participants the
fundamentals of facilitating a GroupX class, and basic teaching techniques for leading a
successful and engaging class. Different types of GroupX classes were covered (e.g.:
cardiovascular, strengthening, combined), as well as strategies for pacing a class,
design of exercise routines, class structure, high/low interval and exercise sequencing,
working with diverse populations, and safety issues. Once participants were engaged in
the internship component of T4C and were teaching their own classes, they continued
with the GroupX Consultant for more specialized training. These more advanced training
sessions included techniques for teaching kickboxing, boxing, and boot camp classes.
Externships
After completing the AFAA certification exam participants were required to finish 18
hours of externships. Externships entailed participants attend different GroupX classes
and complete an assignment with observations from each class taken. To complete this,
participants received a 3-month membership to HCF, as well as 10 one-day passes to
attend classes at Healthworks locations throughout the Boston area (Healthworks is a
for-profit women’s fitness center that is separate from the non-profit HCF). The
externships served to expose participants to different GroupX class types, structures and
teaching techniques, and to give participants an opportunity to participate in similar
classes to those they would be teaching.
Paid Internships/GroupX Classes
After completing the externships, AFAA certified participants started teaching GroupX
classes. Participants without certification lead walking groups. Walking classes were
included in T4C fitness programming to accommodate participants who were not able to
teach GroupX classes due to not having earned the certification. They were also offered
through T4C at the request of community partners. In addition, T4C participants
attended and partook in different community events and health fairs to support the work
of community partners.
ACE Curriculum:
A 4–week training focused solely on anatomy and physiology, the more complex
components of the ACE exam, was developed and taught to participants interested in
taking the ACE personal trainer certification exam. Participants were provided with the
ACE study materials (textbook, study guide, and practice test), and attended a 1.5 hour
session held once a week. Participants interested in taking the exam had to pass a
practice ACE exam in order to be registered for the actual exam.
Exercise Video:
T4C program participants were featured in the exercise film, “An Exercise Video By the
Community, For the Community,” which was produced as part of T4C (Train4Change,
2014). A media firm was contracted to film and produce the video, which was
disseminated throughout the target communities in Boston as a DVD, as well as
electronically through YouTube, professional networks, and through the webpage of the
Boston Moves for Health Campaign, through the Boston Public Health Commission. The
video was developed as an outreach tool to bring exercise into the homes of individuals
who would not attend a GroupX class. The strategic vision behind the video was that it
featured women from the target communities who were women of color that looked and
spoke like the women from the communities. An important motivation driving the video’s
production was to support the T4C participants in their professional development, by
providing them with a product to demonstrate their skills and abilities, which they could
list on their resume and include with a job application. The video was targeted to a not
very physically active audience, and featured an exercise routine by each T4C
participant. The PC and the GroupX Consultant worked closely with each T4C
participant on developing the design and choreography for their exercise routine.
Routines were kept short to ensure they could be done in a short period of time. To be
responsive a diverse populations, the video included a no-impact routine of chair
exercises, as well as low, medium and high impact cardiovascular and muscle
conditioning routines. To be included in the video, participants signed an informed
consent form as well as a video release form. Participants were paid $15 per hour on the
day of the filming of the video.
Career workshop:
At the end of the intervention, a career workshop was organized featuring four experts
from Boston’s fitness industry. Panelists included a representative from HCF, as well as
from the YMCA and a local gym. Panelists presented on the fitness industry in Boston,
hiring practices at their facilities, strategies for obtaining a GroupX class in local gyms,
how to stand out as a GroupX applicant, and recommendations for navigating this
industry. The workshop was interactive, and T4C participants were able to ask
questions.