NATIONAL INSTITUTES OF HEALTH

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

NATIONAL RECREATION AND PARK ASSOCIATION

NHLBI Obesity Education Initiative

COMMUNITY

MOBILIZATION

GUIDE
A CKNOWLEDGEMENTS

The NHLBI and the NRPA wish to acknowledge the efforts

of Dr. Ellen O’ Sullivan, Southern Connecticut State University,

and Ruth Bielobocky, Ion Design, in the preparation of the 

Hearts N’ Parks Community Mobilization Guide.
1

A project of the

National Heart, Lung,

and Blood Institute

and the

National Recreation 

and Park Association

NIH Publication 

Number 01-1655

June 2001

COMMUNITY

MOBILIZATION

GUIDE
i

T ABLE OF CONTENTS

Hearts N’ Parks—Community Mobilization Guide Introduction..........................................1

The Partnership ......................................................................................................................................1

The Beginning of Hearts N’ Parks ..........................................................................................................2

Hearts N’ Parks Is Special ......................................................................................................................3

The Bad News: Cardiovascular Disease ................................................................................................4

Why Heart-Healthy Behavior? ..........................................................................................................4

The Good News: Physical Activity and Healthy Eating............................................................................8

Physical Activity ................................................................................................................................8

Heart-Healthy Eating ........................................................................................................................9

How to Use This Guide..........................................................................................................................13

How To Sign Up for Hearts N’ Parks......................................................................................................14

Frequently Asked Questions..................................................................................................................17

Hearts N’ Parks: 1st P—People ......................................................................................................19

Support Systems for Hearts N’ Parks....................................................................................................19

Department Staff....................................................................................................................................19

Other Sources of Support......................................................................................................................20

Participants as Target Groups................................................................................................................20

Definition of Target Groups on Basis of Participation and Relationship ........................................................21

Stages of Change for Heart-Healthy Behavior ......................................................................................22

Stage(s) of Change................................................................................................................................22

At-Risk Groups ......................................................................................................................................22

Countdown Checklist: 1st P—People ....................................................................................................25

Outline of Staff Training & Meetings......................................................................................................26

Frequently Asked Questions..................................................................................................................27

Hearts N’ Parks: 2nd P—Programs and Practices..................................................................29

Program Varieties ..................................................................................................................................29

Strategies and Techniques ....................................................................................................................30

Information and Knowledge Infusion ..............................................................................................30

Raising the Potential ......................................................................................................................32

Hands-On Activity ..........................................................................................................................32

❅❅❅
ii

Adapt Traditional Activities ..............................................................................................................32

Program Progression ............................................................................................................................32

Offer Opportunities ........................................................................................................................34

Breaking Barriers ............................................................................................................................34

Lifestyle Behavior Support..............................................................................................................35

From Programs to Practices ..................................................................................................................36

Countdown Checklist: 2nd P—Programs ..............................................................................................39

Staff Training/Meeting Outlines ..............................................................................................................40

Hearts N’ Parks Program Worksheet ....................................................................................................42

Frequently Asked Questions..................................................................................................................43

Hearts N’ Parks: 3rd P—Public Visibility ....................................................................................45

Who Needs To Know? ..........................................................................................................................45

Writing Hearts N’ Parks Messages........................................................................................................45

Modifying the Messages ........................................................................................................................47

Moving the Messages............................................................................................................................48

Internal Opportunities ............................................................................................................................51

Extending Your Reach............................................................................................................................51

Holding Special Events..........................................................................................................................52

Working With the Media ........................................................................................................................53

Media Contact Is Ongoing ....................................................................................................................58

News Releases......................................................................................................................................59

Countdown Checklist: 3rd P—Public Visibility ......................................................................................62

Frequently Asked Questions..................................................................................................................63

Hearts N’ Parks: 4th P—Partnering ..............................................................................................65

The Partnership Advantage ..................................................................................................................65

Partnership Possibilities ........................................................................................................................65

Getting Started ......................................................................................................................................67

Types of Partnering Opportunities ........................................................................................................67

Moving Forward ....................................................................................................................................68

Program/Service Assessment ........................................................................................................68

❅❅❅❅❅❅❅❅❅❅❅❅❅❅❅❅❅❅❅❅
Performance

Indicators

iii

Celebrating

& Sharing

Moving to Action ....................................................................................................................................72

Partnership Project Plan ................................................................................................................72

Tracking ..........................................................................................................................................75

Countdown Checklist: 4th P—Partnering ..............................................................................................77

Frequently Asked Questions..................................................................................................................79

Hearts N’ Parks: 5th P—Performance Indicators ....................................................................81

Types of Indicators ................................................................................................................................81

Getting Started ......................................................................................................................................83

Conducting the Assessment ..................................................................................................................84

Selecting and Using Assessment Tools..........................................................................................84

Analyzing and Reporting Results ..........................................................................................................86

Displaying the Results ..........................................................................................................................87

Countdown Checklist: 5th P—Performance Indicators ..........................................................................88

Outline of Staff Training for Performance Measurement........................................................................89

Recommendations for Administering Hearts N’ Parks Pretests and Posttests ....................................91

Frequently Asked Questions..................................................................................................................93

Hearts N’ Parks: Celebrating and Sharing ................................................................................95

Celebrating ............................................................................................................................................95

Sharing ..................................................................................................................................................95

Sustaining ..............................................................................................................................................96

Appendices..............................................................................................................................................99

10 A. Program Design and Development: Tracking and Log Sheets, Consent Forms, 

and Performance Questionnaires ..................................................................................................A–1

B. Answer Keys and Scoring Sheets ..................................................................................................B–1

C. Media Materials and Miscellaneous Forms ....................................................................................C–1

D. Additional Resources ......................................................................................................................D–1

E. Health Statistics ..............................................................................................................................E–1

F. Background Sheets..........................................................................................................................F–1

Reproducibles
Hearts N’ Parks is a national, community-based

program supported by the National Heart, Lung,

and Blood Institute (NHLBI) and the National

Recreation and Park Association (NRPA). It is

designed to help local agencies promote hearthealthy lifestyle changes among their residents.

The objectives of Hearts N’ Parks are to increase

the number of children and adults who engage in

heart-healthy behavior and to demonstrate the impact that community park and recreation

programs can have on

behavior. The long-term

goal is to decrease the number of people with heart disease.

Hearts N’ Parks seeks to bring about

these changes in the following ways:

■ Identifying target groups

■ Creating heart-healthy activities and techniques 

■ Raising the level of awareness of Hearts N’

Parks and its messages

■ Making the most of existing community

resources to extend the reach and 

effectiveness of Hearts N’ Parks

■ Conducting an evaluation to document the

results of Hearts N’ Parks’ efforts.

Hearts N’ Parks is meant to be fun and

flexible. And it’s for everybody—young and

old, active and nonactive. This Hearts N’ Parks

Community Mobilization Guide provides the

background and resources needed to implement

the program. But each community can adapt

the material to its own design, resources,

and needs. 

THE PARTNERSHIP

The National Heart, Lung, and Blood Institute is

one of the Institutes of the National Institutes of

Health (NIH). The mission of the NHLBI is to

provide leadership for a national program in

diseases of the heart, blood vessels, lungs, and

blood; sleep disorders; and blood resources 

management. The NHLBI supports Hearts N’

Parks with a wealth of resources, including

current and reliable scientific information as well as an extensive 

catalog of printed educational

materials. The NHLBI 

Web site offers lots of

information about adopting a

heart-healthy lifestyle, plus a

special Hearts N’ Parks site

(http://www.nhlbi.nih.gov/health/

prof/heart/obesity/hrt_n_pk) that

is updated regularly to provide 

participating agencies with 

current program information.

The National Recreation and

Park Association (NRPA), a

nonprofit organization, is dedicated to advancing parks,

recreation, and environmental conservation

efforts that enhance the

quality of life for all

people. Health and

wellness issues are

also core to the 

NRPA mission

INTRODUCTION

1
(http://www.activeparks.org). Information 

about Hearts N’ Parks can be found at

http://www.heartsnparks.org.

Local park and recreation departments and other

community agencies that foster Hearts N’ Parks

efforts are part of the partnership. While national

agencies, such as the NHLBI and the NRPA,

provide basic resources, information, and support,

those who work in community programs come

face to face with local residents on a daily basis,

and are thus better positioned to provide information and services, as well as raising awareness

to support and sustain healthy lifestyles.

Accordingly, they are able to involve and keep

people involved in heart-healthy programs, thus

ensuring long-term adoption of heart-healthy

behavior.

THE BEGINNING OF HEARTS N’ PARKS

Hearts N’ Parks began in the summer of 1999 as

a pilot initiative in North Carolina called Hearts

N’ Parks Y2K. Parks and recreation agencies in

12 communities throughout the State utilized

training and resources from the NHLBI and the

NRPA to incorporate heart-healthy lifestyle 

messages in programs for children, adolescents,

and adults. More than 2,000 participants, ranging

in age from 4 to 74, took part in a number of

unique programs. Some of the agencies were

very small, with less than 30 people in the Hearts

N’ Parks program, while one agency, Mecklenburg

County Park and Recreation Department in

Charlotte, operated a number of Hearts N’ Parks

programs for more than 1,500 participants. 

An important element of the pilot was an attempt

to consider changes in attitudes, knowledge, and

behaviors of the participants related to hearthealthy eating and physical activity. Despite

some limitations in data collection, pre- and

posttests administered by the sites provided 

2

N ORTH C AROLINA , 1999

The Roanoke Rapids Park and Recreation

Department conducted a program for children

that taught the basics of nutrition to 4 to 6 yearolds in its FLIP (Fun for Little Interested People) camp. One

of the activities was an arts and craft program that helped the children learn

about different kinds of foods and which ones were healthy for them.

The Garner Parks and Recreation Department sponsored both senior-citizen and youth programs.

The senior fitness program, “Keep the Beat...Circle Yourself in Health,” lasted 5 weeks and 

included 12 participants. Participants kept a journal of their involvement and received credit 

for prizes as an incentive to “keep the beat” toward a healthier lifestyle. Blood pressure

screenings were also offered to senior participants.

In Wilson, the Parks and Recreation Department offered a drop-in weightlifting program for adults,

and participants were given a journal to track their progress. The department also partnered with

local trainers and nutrition specialists to discuss the importance of proper use of weights, the role

nutrition plays in building muscle, and the benefits of increasing muscle mass.
3

valuable insights to the program in a variety of

ways. A comparison between pre- and posttests

showed that the children participating in Hearts

N’ Parks appeared to improve their knowledge

of healthy eating and expressed greater intentions to eat healthier. The children also reported, on average, learning four new physical

activities and getting better at six physical

activities. Senior participants reported some

improvements in nearly all the variables considered, as well as feeling healthier at the end of

the program.

In the spring of 2000, the Arlington County

Department of Parks, Recreation and

Community Resources, a large, multifaceted

agency in Northern Virginia, kicked off a 

second pilot initiative of Hearts N’ Parks.

Arlington County was selected as the second

pilot site for Hearts N’ Parks because of the 

variety of recreational programs at its two 

flagship sites: Thomas Jefferson Community

Center and Barcroft Sport and Fitness Center. 

Arlington’s promotion of Hearts N’ Parks

included programs focused on both adults and

children. It featured activities such as blood 

pressure screenings and a seated exercise class

for adults, jumping rope and tennis for kids,

and a biking program for all age groups called

“Cycle Reebok.” The Hearts N’ Parks logo was

printed on trail maps, mile markers, and other

promotional materials for programs and 

facilities that offer heart-healthy activities. 

The “Recreation and Leisure” class catalog

promoted a series of heart-healthy classes in

the fall of 2000.

HEARTS N’ PARKS IS SPECIAL

Hearts N’ Parks is a unique approach to 

promoting healthy hearts in the United States.

Cardiovascular disease is the number one killer

in this country, and lifestyle change is the 

primary and most important step toward 

There is no one size of agency or

one type of staff person that

works best for participation in

Hearts N’ Parks. In fact, the pilot

sites differed from one another on

the basis of size, organizational

structure, population density and, most of

all, the individual who headed up the Hearts

N’ Parks effort. For example:

Some of the agencies were large, 

countywide departments where “large”

refers to either size of population or size of

geographic area. Moderate to large cities as

well as small and medium-sized communities

have also been successful at delivering

Hearts N’ Parks.

Many differences existed among staff 

people, who either elected or were “selected”

to coordinate Hearts N’ Parks. Successful

Hearts N’ Parks coordinators ranged from

people who had little or no prior experience

in heart-healthy behavior or were actually

new to the community service field, to individuals who had extensive backgrounds in

health and wellness, experience in community service, or human services.

Congratulations to those people behind the

success stories of our pilot sites in North

Carolina, who included a summer intern, a

newly hired college graduate, a long-time

program supervisor, a department manager,

a wellness coordinator, and a director of

education.

That’s right. There is no one specific type of

community, agency, or person needed to

move forward with Hearts N’ Parks. Big or

small, experienced or novice, you can

become the coordinator of a successful

Hearts N’ Parks project, and we’d like to

help you with that endeavor.
prevention. However, getting the message 

out to those who most need to hear it is often

difficult and confusing.

Hearts N’ Parks provides all the tools...

■ Hearts N’ Parks provides community 

agencies with the resources to communicate

lifestyle changes in a clear and concise way

to all kinds of people.

■ Hearts N’ Parks can be part of health-related

programs, such as aerobic or wellness classes,

but can also be part of nonhealth-related

programs, such as senior center drop-in 

programs or day camps. It is easily integrated

into existing programs, so it doesn’t require

the effort involved in starting a new program.

■ Hearts N’ Parks provides the information

and tools to spread the word through media

support and partnerships. 

– Media support can be advertising your event

on radio or television or in the newspaper,

and even having the media cover a special

event or a day in your program.

– Partnerships can be of any kind...Some

examples are local hospitals providing health

screenings at your community center or during

a special hospital event, health professionals

giving lectures, neighborhood grocery stores

or restaurants donating heart-healthy snacks,

or a more focused effort with one of your

current partners.

■ Hearts N’ Parks programs have increased 

credibility and visibility because they are 

supported by two highly respected national

organizations, the NHLBI and the NRPA.

■ Hearts N’ Parks is self-sustaining because it is

developed by a community agency that must

operate within the means of the community.

■ Hearts N’ Parks provides the tools to 

measure what your participants have learned

and done. This information helps motivate

participants as well as engage partners and

senior management.

■ Hearts N’ Parks is meant for everyone.

Information and materials are available for

children, adolescents, adults, and seniors. 

THE BAD NEWS:

CARDIOVASCULAR DISEASE

The goal of Hearts N’ Parks is to increase the

number of children and adults who engage in

heart-healthy behavior. 

Why Heart-Healthy Behavior?

Heart-healthy behavior can prevent the 

development of cardiovascular disease

(CVD) and reduce its severity among those

who already have it. CVD includes such 

diseases as high blood pressure, coronary heart

disease (myocardial infarction and angina 

pectoris), stroke, rheumatic fever/rheumatic

heart disease, and congestive heart failure. 

The risk factors for cardiovascular disease

include high blood cholesterol, high blood

pressure, overweight, obesity, diabetes, smoking,

and physical inactivity. These factors do not

4

■ Cardiovascular disease is

the leading cause of death for

all people in the United States.

■ 60.8 million Americans had one

or more types of cardiovascular disease

in 1998.

■ Cardiovascular disease claimed 949,000

lives in the United States in 1998.

■ 41 percent of all deaths in 1998 were 

attributable to cardiovascular disease.

Source: NHLBI FY 2000 Fact Book
5

R ISK FACT ORS F O R H EART D ISEASE

High Blood Cholesterol

High blood cholesterol plays an important part in deciding a person’s chance or risk of getting coronary

heart disease.The higher your blood cholesterol, the greater your risk.When you have too much 

cholesterol in your blood, the excess builds up on the walls of the arteries that carry blood to the heart.

This buildup is called “atherosclerosis,” or “hardening of the arteries.” It narrows the arteries and can

slow down or block blood flow to the heart.With less blood, the heart gets less oxygen.Without enough

oxygen to the heart, there may be chest pain (“angina” or “angina pectoris”), heart attack (“myocardial

infarction”), or death. Cholesterol buildup is the most common cause of heart disease, but it happens 

so slowly that people are not aware of it. Blood cholesterol level is influenced by many factors.

These include:

■ Diet ■ Level of physical activity ■ Age

■ Weight ■ Heredity ■ Gender

High Blood Pressure

High blood pressure, also called hypertension, is a risk factor for heart and kidney diseases and stroke.

Blood is carried from the heart to all of the body’s tissues and organs in vessels called arteries. Blood 

pressure is the force of the blood pushing against the walls of arteries. Each time the heart beats (about 

60–70 times a minute at rest), it pumps blood into the arteries. Some people have blood pressure that

stays high all or most of the time.Their blood pushes against the walls of their arteries with higher-thannormal force. If untreated, this can lead to serious medical problems like atherosclerosis, heart attack,

enlarged heart, kidney damage, and stroke. High blood pressure is influenced by several 

factors. These include:

■ Diet ■ Physical activity ■ Family history

■ Weight ■ Alcohol consumption ■ Ethnicity

Diabetes

Diabetes is a disorder of metabolism—the way our bodies use digested food for growth and energy.

Most of the food we eat is broken down into a simple sugar called glucose, which is the main source

of fuel for the body. For the glucose to get into the body’s cells, insulin must be present. In people with

diabetes the body produces little or no insulin, or the cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the

body. Thus, the body loses its main source of fuel, even though the blood contains large amounts of

glucose.

Diabetes is widely recognized as one of the leading causes of death and disability in the

United States. Diabetes is associated with long-term complications that affect almost every

major organ of the body. It contributes to blindness, heart disease, strokes, kidney failure,

amputations, and nerve damage. Diabetes is not contagious. People cannot catch it from each

other. However, certain factors can increase one’s risk of developing diabetes. People at risk for

diabetes include:

■ Those with family members who have diabetes (especially type 2 diabetes)

■ Those who are overweight

■ Those who are African American, Hispanic, or Native American

Overweight and Obesity

Over the past four decades, the number of overweight children, adolescents, and adults has

risen. In 1998, a little over one-half of all American adults (about 97 million) and one in five children

over the age of 6 were considered overweight or obese, levels unmatched in our nation’s 

history. In 1995, the costs attributed to obesity alone amounted to an estimated $99 billion.
6

R ISK FACT ORS F O R H EART D ISEASE ( CONTINUED )

Being overweight or obese puts someone at risk for developing many problems, such as

heart disease, stroke, diabetes, cancer, gallbladder disease, arthritis, sleep apnea, and

breathing problems. Losing weight helps to prevent and control these diseases and

conditions. Obesity is a complex, chronic disease that develops from an interaction of

genetics and the environment. Our understanding of how and why obesity develops is

incomplete, but involves the integration of social, behavioral, cultural, physiological,

metabolic, and genetic factors. Assessment and classification of overweight and obesity

uses three key measures:

■ Body mass index (BMI) 

■ Waist circumference

■ Risk factors for diseases and conditions associated with obesity.

Smoking

Smoking is a major risk factor in four of the five leading causes of death, including heart

disease, stroke, cancer, and lung diseases like emphysema and bronchitis. For adults 60 and

over, smoking is a major risk factor for 6 of the top 14 causes of death. The good news is that

stopping smoking reduces these risks and improves outcomes for people who have suffered

a heart attack. In some cases, ex-smokers can cut their risk of another heart attack by half 

or more.

Physical Inactivity

Physical inactivity increases the risk of heart disease. It contributes directly to heart-related 

problems and increases the chances of developing other conditions that raise heart disease

risk, such as high blood pressure and diabetes. Unfortunately, too few Americans are active

enough. Consider:

■ About 40 percent of Americans age 18 or older reported no leisure-time physical 

activity in 1997.

■ About 23 percent of U.S. adults engaged in regular vigorous physical activity

3 times a week for at least 20 minutes in 1997.

■ Less-active, less-fit persons have a 30–50 percent greater risk of developing high 

blood pressure.

But the good news is that regular physical activity can help reduce the risk of coronary heart

disease. Staying active helps take off extra pounds, helps to control blood pressure, boosts

the level of “good” HDL-cholesterol, helps to prevent diabetes, and helps to prevent heart

attacks. For those who have heart disease, regular, moderate physical activity lowers the risk

of death from heart-related causes. Physical activity has many other benefits. It strengthens

the lungs, tones the muscles, keep the joints in good condition, maintains bone density,

improves balance, and helps prevent and treat depression. Many people find that physical

activity helps them cope better with stress and anxiety.

To reap benefits from physical activity, you don’t need to train for a marathon. You need to

engage in only about 30 minutes of moderate-level activity on most—and preferably all—

days. A moderate-level activity is one that’s about as demanding as brisk walking.
7

R ISK FACT ORS F O R H EART D ISEASE ( CONTINUED )

Children and Heart Disease

The evidence shows that the atherosclerotic process begins in childhood and that many

American children have risk factors for coronary heart disease. A report card on the state of

the cardiovascular health of America’s children revealed:

Health factor Status

High Blood Cholesterol Average blood cholesterol levels in American children and 

adolescents are too high. Children and adolescents with elevated 

blood cholesterol levels are more likely to have elevated levels as

adults. Research shows that atherosclerosis develops in the late 

teenage years, and cholesterol levels in young adults predict the 

risk of coronary disease over the next 40 years.

Overweight Nearly 14 percent of children and 11.5 percent of adolescents 

are overweight (NHANES III), more than double the percentage 

of a decade ago. Up to 20 percent of overweight children 

is considered overweight, and overweight or obesity acquired

during childhood or adolescence may persist into adulthood and

increase the risk for some chronic diseases later in life.

Physical Activity Most children accumulate at least 1 hour of activity daily, but a 

sizable percentage do not get frequent, vigorous, continuous 

activity. Of high school students, about 70 percent of boys and 

55 percent of girls do a vigorous physical activity three or more 

times per week. Activity levels of girls are below those of boys 

and tend to decline with age.

remain so throughout life. One in five children over the age of 6 
8

just add up in a simple manner. Instead, each one

multiplies the effects of the other risk factors. For

example, if you smoke and have high blood

pressure and high blood cholesterol, you’re

eight times more likely to develop coronary

heart disease than someone with no risk 

factors. The good news is that all of these risk

factors, except for smoking, can be prevented

or controlled by two important behaviors:

heart-healthy eating and physical activity. 

Hearts N’ Parks incorporates both of these behaviors

and strives to make them attainable and fun.

THE GOOD NEWS:

PHYSICAL ACTIVITY AND HEALTHY

EATING

As you can see from the discussion about 

cardiovascular risks, the good news is that the

likelihood of developing heart disease can be

reduced by focusing on physical activity and

heart-healthy eating. It’s simple, and it’s easy.

Physical Activity

Although physical activity is fundamental to

cardiovascular fitness, it is important to 

understand that it doesn’t have to be vigorous

in order to be beneficial to your health. Any

moderate physical activity, if engaged in often

enough, can improve and maintain cardiovascular health. This is not to say that vigorous

activity such as jogging is unnecessary, but

only to say that at a minimum, everyone

should engage in at least 30 minutes of 

moderate physical activity on most, preferably

all, days of the week for adequate fitness. The

U.S. Surgeon General, in his 1996 “Exercise

Lite” message, endorsed this recommendation,

which cited the conclusions outlined in a pivotal

1995 report in the Journal of the American

Medical Association.*

So what constitutes moderate physical activity

in “Exercise Lite”? The most common example

is brisk walking, typically at a pace of about

15 minutes per mile. Thus, walking about 2

miles (for 30 minutes) would provide a day’s

worth of moderate activity. 

■ Consider measuring 2 miles from your home

(or wherever you might walk from) using

the odometer in your car. That way, you

don’t have to keep track of time or distance

when you walk, and you’ll know just how

far you need to go to get your day’s worth

of activity. 

Other kinds of moderate activity might include

walking your dog, playing golf, or tossing a

Frisbee. Count vacuuming, but not washing

dishes. Mowing your lawn with a power

mower is moderate activity, but a push mower is

vigorous activity. You can ride your bike to the

store, play table tennis, go square dancing, or do

some serious yard work, and it adds up to 30

minutes before you know it.

The idea is to have an active lifestyle: don’t

ride in a car when you can walk, don’t take the

elevator when you can climb the stairs, don’t fax

something you can deliver by hand, and don’t

use automated or electronic devices just

because they exist. 

Seniors and Physical Activity

Moderate physical activity is important for

older adults because it can help reduce the

chances of developing high blood pressure,

The “Guide to Physical Activity” in the

reproducible section of this guide gives

examples of moderate amounts of

physical activity and ideas for fitting

physical activity into your schedule. * Centers for Disease Control and Prevention (CDC) and

The American College of Sports Medicine (ACSM),

Journal of American Medical Association, Feb. 1, 1995.
9

obesity, and other ailments. It may also help

prevent problems related to mobility. It is

never too late for seniors to start being

physically active. Moreover, studies have

shown that when seniors visit community

parks for recreation and activity they acquire a

feeling of renewal and social fulfillment, which

provides further incentive to continue being

physically active. Walking and playing with

grandchildren are activities seniors can enjoy

for moderate activity. Swimming, jogging,

 or biking are more intense and should only be

undertaken by seniors who have checked with

a doctor first.

Kids and Physical Activity

Keep in mind that kids, especially 6- to 10-yearolds, are usually different from adults in the

way they engage in physical activity. Most kids

tend to have quick bursts of energy that come

between longer periods of rest, which is perfectly

normal and should be encouraged. However, if

the children you work with are in the 11- to 

14-year-old range, they may be active for longer

periods of time. It is a good idea to try to get a

sense of your kids’ physical limitations early on 

and remain aware of how active they are during

the program. This will help ensure that their

level of intensity does not compromise the 

quality of the activity or lead to injuries.

Heart-Healthy Eating

Adopting a heart-healthy eating plan provides

individuals with health benefits without the

necessity of giving up favorite foods. Such an

eating plan balances calorie intake with 

physical activity and is low in saturated fat,

cholesterol, and sodium, and rich in fruits and

vegetables, low-fat dairy foods, and whole

grains. A heart-healthy eating plan can help

protect against high blood pressure, high blood

cholesterol, and overweight. It may also protect

against cancer and other health problems. 

The earlier individuals take action to adopt a

heart-healthy eating plan, the better. Research

shows that heart disease begins early in life

and that, once learned, bad habits are difficult

to break. 

What is A Heart-Healthy Eating Plan?

To follow a heart-healthy eating plan means 

basically eating some foods more often and

P HYSICAL ACTIVITY T IPS

As a Hearts N’ Parks coordinator, you have a unique and remarkable opportunity to positively

impact your participants’ lives by exposing them to the fulfilling and fun rewards of physical activity. Below are a few tips to ensure that your physical activity-based programs are effective for participants of all ages:

■ Encourage activities that can be done easily throughout life.

■ Focus instructional feedback on process, not product.

■ Offer a diverse range of competitive and noncompetitive activities appropriate for different 

ages and abilities.

■ Provide participants with the skills and confidence they need to be physically active.

■ Individualize activities.

■ Make sure activities are inclusive and get everyone off the sidelines.

■ Be an active role model. Get out there and join in the fun.
10

other foods less often. Foods that can be eaten

more often include those that are lower in calories, fat, saturated fat, cholesterol, and sodium.

Examples of these foods include

low-fat dairy products, lean meat, fish, and

poultry, as well as high-fiber foods and 

complex carbohydrates, such as whole grains,

starches, fruit, and vegetables. Saturated fat

raises blood cholesterol levels and should be

avoided. It is found mainly in fresh and

processed meats; high-fat dairy products 

(like cheese, whole milk, cream, butter, and 

ice cream); lard; and in the coconut and 

palm oils found in many processed foods.

Cholesterol is found in eggs, organ meats,

and dairy fats.

Calories are the energy from carbohydrates,

fats, and protein contained in foods. Fat 

contains more calories than these other 

components, so eating high-fat foods can make

it difficult to avoid excess calories. Low-fat,

however, doesn’t necessarily mean low calorie.

Sometimes extra sugar is added to low-fat

muffins or desserts, and they may be just as

high in calories. Limit portion sizes of foods

high in calories, such as cookies, cakes, other

sweets, french fries, and fats, oils, and spreads.

These tips are consistent with the latest version

of Nutrition and Your Health: Dietary

Guidelines for Americans released in May

2000 by the Department of Health and 

Human Services and the U.S. Department of

Agriculture. These guidelines provide the basis

for Federal nutrition policies, education, and

dietary guidance for healthy Americans ages 2

and up. The 10 Dietary Guidelines emphasize

the following ABCs for building a healthy diet

and lifestyle:

H ERE ARE A FEW SUGGESTIONS TO HELP FOLLOW A

HEART- HEALTHY EATING PLAN :

■ Practice balance, variety, and moderation in your eating habits.

■ Eat fewer high fat meats and eggs. Choose lean meats, chicken or turkey without skin, or fish.

■ Eat lower fat dairy items—fat-free or 1 percent milk, low-fat yogurt, and cheese.

■ Choose bread, rice, pasta, and other starches that are made of whole grains.

■ Choose whole grain and high fiber cereals that are also low in sugar.

■ Avoid high fat, high sugar snacks and desserts.

■ Eat a variety of fruits and vegetables daily.

■ Limit processed foods that have a lot of salt or fat, such as regular luncheon meats, prepared

food, fast food, and canned soups and sauces.

■ Substitute corn, safflower, sunflower, peanut, canola, and olive oils for butter, shortening, and

stick margarine.

■ Avoid foods made with coconut and palm oils.

■ Choose and prepare foods with less salt.

■ For greater variety, include healthy cultural traditions when planning meals.
11

Aim for Fitness:

1. Aim for a healthy weight.

2. Be physically active each day.

Build a Healthy Base:

1. Let the Pyramid guide your food choices.

2. Choose a variety of grains daily,

especially whole grains.

3. Choose a variety of fruits and vegetables

daily.

4. Keep foods safe to eat.

Choose Sensibly:

1. Choose a diet that is low in saturated fat 

and cholesterol and moderate in total fat.

2. Choose beverages and foods to moderate 

your intake of sugars.

3. Choose and prepare foods with less salt.

4. If you drink alcoholic beverages, do so in 

moderation.

The Dietary Guidelines include the Food

Guide Pyramid to help with healthy food

choices and daily servings or portion sizes.

Weight Control on a Heart-Healthy Eating Plan

Balancing calorie intake with regular physical

activity can help individuals achieve or 

maintain a healthy weight. For individuals 

who are overweight, even modest amounts of

weight loss of approximately 10 percent of 

initial body weight can have health benefits.

Weight loss can lower high blood pressure,

high blood cholesterol levels, and high blood

sugar levels. Reducing these risk factors helps

to prevent cardiovascular disease and/or decrease

its severity in those with existing disease.

To maintain or lose weight, it is important 

to watch the types and amounts of food 

consumed. In general:

■ Begin the day with a hearty breakfast to

provide energy and nutrients, and to

jump-start metabolism.

■ Control calories by eating smaller meals

spaced throughout the day rather than eating

one or two large meals.

Fats, Oils, & Sweets

Use Sparingly

Milk, Yogurt & 

Cheese Group

2–3 Servings

Vegetable Group

3–5 Servings

Meat, Poultry, Fish, Dry Beans,

Eggs & Nuts Group

2–3 Servings

Fruit Group

2–4 Servings

Bread, Cereal,

Rice & Pasta

Group

6–11

Servings

KEY

Fat (naturally occurring and added)

Sugars (added)

These symbols show fats and added sugars in foods
12

■ Read food labels and choose foods lower in

calories, total fat, and saturated fat.

■ Keep simple sugars, such as desserts and

sweetened beverages, to a minimum.

■ Be familiar with portion sizes and avoid 

eating second portions. 

■ Balance food intake with physical activity. 

Special Tips for Kids

One in five children over the age of 6 is 

considered overweight. Overweight and 

obesity acquired in childhood may persist 

into adulthood and increase the risk of disease

later in life. Children today are consuming 

excessive amounts of saturated fat, total fat,

and calories from fast foods and snacks and

are not getting enough physical activity.

Additional heart-healthy advice for parents 

and kids includes:

■ Cut back on high-fat foods by offering more

fruits or vegetables as snacks. 

■ Offer low-fat milk and juice instead of soft

drinks.

■ Add finely chopped vegetables to favorite

recipes.

■ Choose whole grain bread for sandwiches.

■ Offer alternative desserts, such as fruit bars,

ginger snaps, graham crackers, low-fat 

pudding, and yogurt. 

■ At fast food restaurants, order a small, plain

hamburger (no cheese), grilled chicken or

lean roast beef sandwich, and baked potato

instead of french fries.

Special Tips for Seniors

It is important for seniors to follow a hearthealthy eating plan because the risk of heart 

disease increases with age. A heart-healthy 

eating plan, along with medications if needed,

can help control risk factors like high blood

pressure and high blood cholesterol.

Maintaining a healthy body weight by 

consuming nutritious foods and being 

physically active is also important for older

individuals. 

The National Heart, Lung, and Blood Institute (NHLBI) publishes a variety of educational materials for

adults, children, and adolescents on ways to follow a heart-healthy eating plan and help control high 

blood cholesterol, high blood pressure, and overweight. Check out materials available from the NHLBI 

catalog, and in particular the Web page “Aim For A Healthy Weight” at www.nhlbi.nih.gov. The Web page

provides information for patients and the public, and guides individuals to determine their weight and risk

status and to choose lifestyle changes for losing weight. It includes a chart on diseases associated 

with obesity, menus and recipes, shopping lists and ideas, an interactive menu planner, and a guide to

physical activity.

Nutrition and Your Health: Dietary Guidelines for Americans, May 2000, Department of Health

and Human Services and the U.S. Department of Agriculture. The Dietary Guidelines include the Food

Guide Pyramid to help with healthy food choices and daily servings or portion sizes. Further information

can be found at the U.S. Department of Agriculture’s nutrition Web site, www.usda.gov/cnpp. Also, check

out the USDA’s Web site for kids, www.usda.gov/news/usdakids/index.html.
13

Within each section you will 

find subsections that can 

assist you as you implement

Hearts N’ Parks. They include:

SOS: Signs of Success—Examples

of successful programs or strategies related

to implementation of Hearts N’ Parks projects

or related activities.

Do You Know?—

Additional information or

insight into a particular

topic or area.

Resources—Refers you to specific

resources at the end of the section or within

the guide.

Rx: Resource

Examples—Excerpts from

some of the resources available

either within the guide or by

ordering, or accessing the Web

sites of the NHLBI and the NRPA.

Focused Facts—Facts or statistics

that you may wish to refer.

FAQs (Frequently

Asked Questions)—

At the end of each section.

HOW TO USE THIS GUIDE

This Community Mobilization Guide is 

organized according to the 5Ps that make up

the Hearts N’ Parks project. Each section 

contains basic information, as well as

suggested steps and actions to be taken. 

■ 1st P—People: Identification of targeted groups

for participation in Hearts N’ Parks

■ 2nd P—Programs: Techniques for creating and

delivering heart-healthy activities and alternatives to

participants

■ 3rd P—Public Visibility: Techniques to raise

the level of awareness of Hearts N’ Parks and its

messages, as well as tools and strategies for reaching

targeted groups and working with the media

■ 4th P—Partnering: Methods to make the most

of existing community resources to extend the reach

of Hearts N’ Parks

■ 5th P—Performance Measures: Tracking

sheets, surveys, and directions for data analysis to

document the results of your Hearts N’ Parks efforts.

At the end of each of the five P sections you 

will find a Countdown Checklist to help you

implement your Hearts N’ Parks effort. The

activities and actions are:

■ Getting Started—Things you need to do initially.

■ Moving Forward—Actions to take as you 

proceed.

■ Keeping the Beat—Ways to extend Hearts N’

Parks programs and practices.

The final section, Celebrating and Sharing,

provides postprogram guidance. 

If you find that you have specific questions

about Hearts N’ Parks that are not addressed 

in this guide, you may contact the NRPA by

telephone at (800) 649-3042, or by e-mail at

programs@nrpa.org. You may also contact

NHLBI at (301) 592-8573, or by e-mail at

NHLBIinfo@rover.nhlbi.nih.gov.
14

HOW TO SIGN UP FOR

HEARTS N’ PARKS

Please complete and send in the registration

form on the following page.

Also, consider using the Hearts N’ Parks

pledge on page 16, or the slogan from

Arlington County, VA as a promotional item to

spark interest. Make it into a large poster for

display or reproduce it on colorful paper and

pass it out as a flyer to potential Hearts N’

Parks participants.

A RLINGTON C OUNTY S LOGAN

Hearts N’ Parks—Mobilizing the Vision

“Your Community, USA, Is the Healthiest and

Happiest Place to Live, Work, Learn, and Play.”

(See pages 57,60, and 61 for details)
15

The NHLBI and the NRPA are pleased that you have 

decided to become a Hearts N’ Parks community. 

To become officially designated as a Hearts N’ Parks 

community, please complete and mail, fax, or e-mail this form to:

National Recreation and Park Association

22377 Belmont Ridge Road, Ashburn, VA 20148

Fax: (703) 729-4753; E-mail: programs@nrpa.org

Name of City/Town/County: ______________________________________________________

Name of Agency/Organization: ____________________________________________________

Name of Contact Person: ________________________________________________________

Address: ______________________________________________________________________

Telephone:________________________________Fax: ________________________________

E-mail: ________________________________________________________________________

Population of Community:________________________________________________________

Please identify those aspects of Hearts N’ Parks that you would like to consider pursuing. 

Feel free to check all.

❍ Yes, we’d like to consider all 5Ps of Hearts N’ Parks.

❍ People—Yes, we would like to extend our impact upon people’s health and well-being.

❍ Programs—Yes, we would like to incorporate heart-healthy information and activities

into our existing programs.

❍ Public Visibility—Yes, we would like to share information about the benefits of physical

activity and heart-healthy behavior with our residents and the media.

❍ Partnering—Yes, we would like to use community contacts to pull together resources to

enhance health.

❍ Performance Indicators—Yes, we would be interested in demonstrating the impact of

our programs and services on health.

T O HEARTS N’ PARKS
16

❍ Lunch lightly! Pack or

buy a low-saturated-fat,

low-cholesterol lunch.

Try a veggie sandwich

with low-fat cheese,

hummus, or a fresh

green salad. 

❍ Take a commercial

break! Work on your 

flexibility during television

commercials three times a

week. Hold each stretch for at

least 10 seconds, working up

to 30 seconds in a slow,

controlled manner—

no bouncing!

❍ Stock the snack 

cupboard! Buy hearthealthy snacks, such as 

pretzels, graham crackers,

mini carrots, whole wheat

crackers, fresh fruit, and

low-fat or fat-free dairy

products. 

❍ Jump to it! Improve

your muscular endurance

by jumping rope three

times a week. How long

can you go? 

❍ Shop savvy! Read labels

before buying food to make

healthy choices at the 

grocery store. Watch the

calorie, fat, saturated fat,

and sodium content.

❍ Tip the scale! Test your

muscular strength

by getting into

a push-up

position

and pressing your

hands down on a bathroom scale to see how

high you can make it go.

❍ Go green! Try a new

green vegetable. Eat a green

vegetable every day!

❍ Get your heart

pumping! Take a

family walk, go dancing,

rake leaves, or work in 

the garden.

❍ Be on the alert for

mega-portions. 

Learn what one serving

or portion of each type 

of food looks like.

❍ Pass on the salt!

Try a new spice or 

seasoning when cooking

and leave the salt in 

the shaker.

❍ Have fun! Have a hearthealthy cookout and invite

your friends.

T AKE THE

Visit the NHLBI Web site at

www.nhlbi.nih.gov

✔I/We pledge to adopt at least three of the following 

heart-healthy habits during the Hearts N’ Parks Program:

❍ ❍

❍❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍ ❍

❍

❍

❍

❍ ❍❍ ❍ ❍

❍ ❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

Please complete and place in a visible area,

such as a bulletin board for all to see!
? ?

?

?

?

?

?

?

?

1 What qualifications do I need to be

a Hearts N’ Parks Coordinator?

If you are enthusiastic, motivated,

resourceful, and a good role model,

you are qualified to do the job. You don’t

need a special degree or certificate,

and you don’t need to be a nutrition or

fitness expert. Successful Hearts N’ Parks 

coordinators have ranged from people 

who had little or no prior experience in

heart-healthy behavior or were new to 

the community service field to individuals

who have extensive backgrounds in 

health and wellness or experience in 

community service. 

2 What are risk factors and how do

they fit together with respect to

cardiovascular disease?

Risk factors are the conditions or behavior

that increase the risk of developing 

cardiovascular disease. They include 

high blood cholesterol, high blood pressure,

overweight, obesity, diabetes, smoking, and

physical inactivity. However, these factors

do not exist exclusive of one another. In

fact, each factor poses a greater risk when

it exists alongside the others. For example,

if you smoke and have high blood pressure

and high blood cholesterol, you’re eight

times more likely to develop coronary

heart disease than someone with no risk

factors. Moreover, having one of the risk

factors can make you more likely to have

others. Physical inactivity, for example,

can contribute to overweight or obesity,

which in turn may lead to diabetes. 

❍

17

19

The common element of every human service

agency, and the starting point for all services

developed for the public, is people. Because

Hearts N’ Parks is about making life better for

people and helping them to make better decisions about their health, it is an absolute necessity that the first P of Hearts N’ Parks is people.

Every member of the community has the potential for playing a role and being involved with

Hearts N’ Parks. It is important to target a variety of people who can help support the overall

goals of Hearts N’ Parks and help make hearthealthy behavior a way of life in your community. There are essentially two groups of people important to this project. Some individuals

and groups will serve as part of the support

and delivery system for Hearts N’ Parks. Other

people will be participants of the program.

SUPPORT SYSTEMS FOR HEARTS N’

PARKS

To start your Hearts N’ Parks initiative, you

will need the help of many people. 

Groups of people whose support you will find

helpful include:

Decision-Makers Agency managers 

Board members 

Elected officials

Staff Full- and part-time

Support- and front-line

Volunteers

Media Those employed by 

local media outlets

Partners Individuals and other 

community organizations

Participants Individuals involved in 

your programs and 

activities

General Public Everyone else in the 

community 

In order to gain community support, we need

to let all of these groups know:

■ Why Hearts N’ Parks is important for the

community

■ The relationship of park, recreation, and

leisure activities to a healthier lifestyle

■ How these groups can help and/or become

involved.

You need to start internally, moving from decision-makers to staff whose help you will need

in providing the services. Then you can work

on getting external support for the project.

DEPARTMENT STAFF

High on the list is the staff of your department.

There are many ways you can help staff

become engaged in this community-wide initiative:

HEARTS N’ PARKS: 1ST P—PEOPLE

Internal Manager/Supervisor

Staff

External Media

Partners

Participants and the general public

→ → →

→
20

■ Orienting staff to Hearts N’ Parks so they

know the specific facts about CVD and 

heart-healthy behavior, as well as details

about the 5Ps of Hearts N’ Parks

■ Brainstorming and program planning 

sessions where staff identify ways in 

which they can bring Hearts N’ Parks to 

participants and the general public

■ Training staff in methods to incorporate 

heart-healthy activities into their programs

■ Involving staff in the selection of resources,

such as those available from NHLBI and

NRPA, to assist them in achieving program

goals

■ Assisting staff in selecting programs to be

used in outcomes assessment efforts

■ Training staff about the guidelines and 

procedures for assessment activities

■ Enabling staff to take part in various 

heart-healthy activities that your department

sponsors.

The involvement of department staff in this 

project is essential. There is a direct link

between the needs of targeted groups and the

programs and services designed to address

these needs.

OTHER SOURCES OF SUPPORT

There are many others who can and will 

provide support for this program. Two of those

groups are the media and community partners.

More extensive information about how to

involve those two groups is provided later in

this guide.

PARTICIPANTS AS TARGET GROUPS

Participants are an important target group to

involve early. Participants differ from one

another on a number of factors. These factors

include:

■ Relationship with department

■ Participation in heart-healthy activities

■ Stage of change status for heart-healthy

behavior.

These factors indicate various target groups.

On the basis of the relationship with your 

department, some people can be considered

casual participants not having a formal or 

regular relationship with your department while

others may be current or regular participants.

People not involved with your department are

viewed as potential participants.

People can also be categorized on the basis of

the programs they choose. Some people may

gravitate towards programs such as aerobics,

yoga, or healthy cooking classes that have a

strong emphasis on heart-healthy behavior.

Other people may primarily participate in 

activities that do not have a specific heart-healthy

focus. So participants, casual or current, can be

categorized as involved either in heart-healthy or

nonheart-healthy programs.

It is also important to begin to visualize people

based upon their personal or individual understanding of, and relationship to, heart-healthy

behavior. This can range from people with almost

complete lack of knowledge or interest to people

who lead very heart-healthy lifestyles. The stages

of change framework will help you envision 

various target groups on this basis. There are a

number of stages of change, including people

who resist change all the way up to people who

have made lifestyle changes.

Traditional program models have a tendency to

focus on people who are currently enrolled or

involved in existing programs and services.

Since they are right there in front of you, it is

easy to assume they are the only targets for

programs or services. Since just about everybody has the potential to become involved in

leisure or community activities, you can

expand your target groups to include those
21

people who are either not involved or don’t

appear to be involved in any way with your

department. Gear up for your potential 

participants.

DEFINITION OF TARGET GROUPS ON

BASIS OF PARTICIPATION AND

RELATIONSHIP

There are plenty of opportunities to increase the

range of participants by expanding your view of

target groups to include those people who are casual

or secondary participants. For instance, people who

run in your parks or stop by your community 

center to attend a civic meeting may be considered

casual participants. You also have a large number

of secondary participants. Just think of all those

parents who come in and out of your center or

drive by your facilities either dropping off or 

picking up their children.

Many adults, among them working parents, are

often unable to find or make the time for hearthealthy behavior. This provides you with a

unique opportunity to reach these parents who

are secondary participants in your programs.

Don’t overlook this parent-child connection as 

a way to distribute information, raise awareness, and even as a way to encourage family

participation in physical activity and healthy

eating. 

People who have some contact with your facility

still must pass by bulletin boards or signboards

that can include heart-healthy information.

There are three different types of participant

groups based upon their relationship with your

department: casual, current, and potential.

When you look at those three groups on the

basis of whether or not they participate in 

programs that have a heart-healthy focus or not,

you create a number of target groups as follows:

■ Casual Participants. People not formally

involved in any specific programs.

■ Non-Involved. Informal or infrequent

users; may be secondary participants

who know of your programs through

participation of children or friends.

■ Heart-Healthy Independents. Frequent

users of parks or facilities for regular

physical activity but usually on a drop-in

or informal basis.

About 20 percent of the people enrolled in your programs probably account for 80

percent of your total participation? This 20/80 rule applies to almost everything,

including heart-healthy behavior. For instance:

About 22 percent of American adults report regular, sustained physical activity of any intensity lasting 

30 minutes or more 5 times per week. These people are the 20 percent that account for 80 percent of 

sustained physical activity.

About 25 percent report no leisure-time physical activity.

Sixty percent or more don’t achieve the recommended amount of physical activity (30 minutes or more of

moderate physical activity at least 3 or 4 days a week).

These are the 80 percent who are not getting adequate physical activity.

Grow your market share. Don’t be fooled by the level of heart-healthy behavior you see in front of you.

You may have waiting lists for your gymnastics classes and long lines during the late afternoon or early

evening hours in your fitness center, but that doesn’t mean that you’ve reached everybody who needs

information, support, or assistance. Be sure to target and go after the 80 percent not involved.
22

■ Current Participants. People currently 

participating in programs.

■ Non-Heart-Healthy Focus. Involved in a 

program that doesn’t target physical

activity or healthy eating.

■ Heart-Healthy Focus. Involved in a

program that focuses on heart-healthy

behavior.

■ Potential Participants. People not currently

involved or possibly not even aware of your

programs and services. They may become 

target groups for information, communication,

or programs.

S TAGE ( S ) O F C HANGE C HARACTERISTICS

Precontemplation (resisting change) Don’t engage in physical activity or eat heart-healthy and 

have little or no intention of doing so

Contemplation (change on the horizon) Intend to make change in behavior; length of time in this 

stage can vary considerably

Preparation (getting ready) Planning to incorporate physical activity and hearthealthy eating into lifestyle

Action (making change) Engage in heart-healthy behavior on a regular basis 

but have been doing so for less than 6 months

Maintenance (staying there) Continuous engagement in heart-healthy behavior for 6 

months or more

Termination (end of change cycle) Physical activity and healthy eating as a way of life

STAGES OF CHANGE FOR HEART- HEALTHY BEHAVIOR

People have varying levels of information

about and involvement in heart-healthy behavior.

There may be a writer for the local newspaper

who always makes time for physical activity in

her day or a board member with a family member who has had a stroke. These people have

higher levels of awareness and involvement

with heart-healthy issues and behavior than

many others do. Other people may not be

aware of, or interested in, making lifestyle

changes. One way of defining those differences

is to use the “stages of change” model.

STAGE(S) OF CHANGE

Not everyone is ready to hear the same 

messages or to receive them in the same way.

Naturally, people differ from one another and

there can be a variety of reasons for these 

variations in motivation or lack of motivation.

The Stage(s) of Change model identifies six 

different stages as people make changes in

their behavior (See Box). 

AT-RISK GROUPS

Individuals who are either unaware of hearthealthy behavior or are not interested in

involvement in such behavior are at higher risk

for CVD. Though essentially everyone is at

some risk for CVD, it’s important to make sure

that these high-risk people are targets for your

information and programs.

People who tend to fall into the at-risk group

tend to have higher than average levels of 

overweight or obesity and lower than average

levels of physical activity, as well as high

blood cholesterol levels, high blood pressure,

and high rates of smoking. Lifestyle changes

can have a positive impact on all risk factors.
23

Women in general are less active than men.

People with lower incomes and less education are typically not as physically active as

those are with higher incomes and education.

African Americans and Hispanics are generally less physically active than whites.

Adults in the northeastern and southern states tend to be less active than adults in north central and 

western states.

People with disabilities are less physically active than people without disabilities.

By age 75, one in three men and one in two women engage in no regular physical activity.

The proportion of adolescents from poor households who are overweight is almost twice that of 

adolescents from middle-and high-income households.

Overweight is especially prevalent among women with lower incomes and less education.

Obesity is more common among African American and Hispanic women than among white women.

Among African Americans, the proportion of women who are obese is 80 percent higher than the 

proportion of men who are obese; this difference is also seen among Hispanic women and men.

NHLBI resources designed to reach groups more at risk for CVD include:

For Participants:

Preventing Heart Disease—Eight easy-to-read bilingual booklets (in Spanish and English).

Improving Cardiovascular Health in African Americans—Package of seven easy-to-read booklets.

Controlling High Blood Pressure: A Women’s Guide.

Package of four easy-to-read booklets for Native Americans and Alaska Natives from 

three tribes: Bristol Bay Area, Ponco Tribe, and Pueblo of Laguna

For Your Agency’s Use:

Heart-Healthy Home Cooking: African American Style.

Delicious Heart-Healthy Latino Recipes.

Working with Religious Congregations: A Guide for Health Professionals.

From Heart to Heart: A Bilingual Group Discussion Guide.
24

Take a look at some excerpts as presented in From Heart to Heart: A Bilingual

Group Discussion Guide.

How To Start a Group Discussion

And Now for the Show! Follow This Outline:

Welcome and Introduction ..........................................5 minutes

Video Presentation ......................................................25 minutes

Discussion Series With

Questions and Answers ..............................................30 minutes

Review ........................................................................10 minutes

Evaluation ....................................................................15 minutes

Screenings ..................................................................Optional

H IGHLIGHTS FROM “ F OR THE L OVE OF YOUR H EART ” V IDEOTAPE

The video portrays the Gomez family as its members make changes in their eating and physical 

activity habits after the father, Pablo Gomez, suffers a heart attack. It is intended to show 

participants that making some changes in habits is possible. An off-camera narrator offers

suggestions on adopting healthy lifestyles. Dr. Elmer Huerta appears on camera to explain

other steps people can take to lower their risk of heart disease.

Key Messages From “For the Love of Your Heart”

More Latinos in the United States die of heart disease than from any other cause.

Many Latinos believe that heart attacks happen suddenly because of bad news or strong emotions.

The truth is that a heart attack is the result of disease that has developed over many years.

The disease often starts in childhood or adolescence. Taking steps to prevent heart disease is

important.
✔

25

GETTING STARTED

____Put together a Hearts N’ Parks overview packet consisting of FAQs and other general 

information to share with potential supporters of the process. Review talking points for your 

conversations with them.

____Orient your organization’s decision-makers to Hearts N’ Parks. Secure their input and get their 

approval.

____Make a list of current partners who might be interested in Hearts N’ Parks.

____Brainstorm some partnering possibilities from less traditional organizations.

____Hold a Hearts N’ Parks orientation for staff. Recruit volunteers interested in working on the project.

____Set up a joint meeting for potential partners. Send out invitations, Hearts N’ Parks information 

sheets, and the agenda for the first meeting.

MOVING FORWARD

____Meet with program staff to describe the various groups of participants and to identify specific 

targets. Be sure to discuss the 20/80 rule, at-risk groups, and casual participants.

____Hold a brainstorm meeting for staff to identify ways to move Hearts N’ Parks forward.

____Ask staff to select resources for Hearts N’ Parks efforts.

____Hold a potential partnering meeting (see 4th P for more specifics in this area).

____Tell staff about Tracking Sheet for Activities (page 82).

KEEPING THE BEAT

____Notify the people in your department about current initiatives and activities of Hearts N’ Parks:

■ Give management a written report and verbal update on the project.

■ Make a report at a board or council meeting.

____Don’t forget to go back and check out your participant groups and ask yourself if you are 

targeting the following groups:

■ People in various stages of change.

■ At-risk groups.

■ The 80 percent not involved in heart-healthy behaviors.

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔
OUTLINE OF STAFF

1. Orientation to Hearts N’ Parks

People Involved: Management, supervisors,

support, front-line staff, part-time staff, and

volunteers not necessarily at the same 

session, due to size and time constraints. 

Time Allotted: 50 minutes.

Goal(s): Expose department members to this

new initiative and solicit their support and

involvement, as appropriate.

Materials and Resources: Overheads, FAQ

handouts, Hearts N’ Parks videotape.

Suggested Agenda:

■ Welcome and Expression of Support for

Hearts N’ Parks: the Department Director 

(5 minutes).

■ Warm-up and Mixer: Ask staff to find

someone else in the room who practices the

same type of heart-healthy physical activity 

(10 minutes).

■ Overview of Hearts N’ Parks: Brief 

explanation of elements of the initiative,

including FAQ handout (7 minutes).

■ Show Hearts N’ Parks videotape

(10 minutes).

■ Questions and Comments (7 minutes).

■ Volunteer Sign-up (7 minutes).

■ Closing: Provide attendees with a fun 

heart-healthy tip (2 minutes).

2. Creating Focus on Hearts N’ Parks 

People Involved: Program and front-line staff

who deliver the programs and services.

Time Allotted: 75 minutes.

Goals:

1. Acquire greater depth of understanding of 

Hearts N’ Parks.

2. Identify ways in which the department can 

involve participants in Hearts N’ Parks.

3. Create staff understanding of differences 

among participants.

4. Provide staff with programming information

for Hearts N’ Parks.

Materials and Resources:

■ Reproduce “Stages of Change Characteristics”

on page 22, as handout or overhead.

■ Reproduce program variations, focus, and

strategies and techniques from handout or

overhead.

■ Reproduce Check Your Weight and Heart

Disease I.Q. and Check Your Physical

Activity and Heart Disease I.Q. (see

Reproducible Section).

■ Optional: Complete packets of copies of

reproducibles.

Suggested Topics and Activities:

Hearts N’ Parks (30 minutes)

■ Overview of 5Ps.

■ Individual activity: Complete Check Your

Weight and Heart Disease I.Q. and Check

Your Physical Activity and Heart Disease

I.Q.

■ Explain importance of heart-healthy behavior.

■ Questions and answers.

People and Programs (30 minutes)

■ Review different types and levels of participants.

■ Update on “Stages of Change” model.

■ Overview program considerations.

Wrap-Up (15 minutes)

■ Questions, comments, etc.

■ Review of today’s outcomes.

■ Set stage for next meeting.

■ Announce date and time if possible.

■ Ask staff to review programming information

and come ready to share ideas.

■ Pass out reproducibles (optional).

26
? ?

?

?

?

?

?

?

?

27

What kind of training does my

staff require?

First and foremost, make sure that your

members are motivated to work with

Hearts N’ Parks by emphasizing the significant role they can play in improving the

lives of those they will be working with.

A training session for staff that provides an

overview of basic CVD, physical activity,

and nutrition information that will be taught to 

program participants will be helpful. 

A training session in Arlington, Virginia,

was carried out as follows:

■ Staff members attended three training 

sessions. The first, led by representatives

from the NHLBI and the NRPA, covered 

the nuts and bolts of the Hearts N’ Parks

program. The second, about 2 months

later and led by representatives of the

Arlington Department of Parks,

Recreation and Community Resources

(PRCR), focused on cardiovascular 

disease and the importance of promoting

heart-healthy behavior within a recreation

setting. PRCR staff had an opportunity 

to brainstorm activities specific to 

cardiovascular disease that they could 

do with their kids. 

■ During a third session at camp, materials

from the Arlington County Parks and

Recreation Wellness Lending Library 

(the WELL) were introduced to all 

summer day camp staff. The materials

contained information and activities for

different age groups on many different

health topics, including nutrition and

physical activity to be used in summer

camp.

Should I only target people who are

at high risk for CVD?

No. Everyone can benefit from learning

about heart-healthy behavior, physical

activity, and nutrition. Every adult, no 

matter how apparently healthy, is at some

level of risk for CVD. People who are at

greater risk will benefit more from Hearts

N’ Parks than those who are low-risk,

but you don’t want to exclude potential 

participants simply because they are low-risk.

1 2

HEARTS N’ PARKS: 2ND P—PROGRAMS AND PRACTICES

New to You Innovations Heart-Healthy Non-Heart-Healthy

New Focus

Programs & Practices

Local programs are the lifeblood of Hearts N’

Parks. It is through the connection of local

programs with participants that heart-healthy

information can be shared and lead to hearthealthy behavior. Programs come in many

shapes and sizes. Through Hearts N’ Parks,

you can either create new programs or put new

information and activities into existing ones.

You can move people from knowledge to

action by starting from where they are and supporting them as they move to a heart-healthy

lifestyle. 

PROGRAM VARIETIES

There can be a number of variations within 

program offerings. Two of those relate to

whether programs are new or existing, and

whether or not the focus of a program is 

specifically upon heart-healthy behavior. 

This results in a framework for program 

possibilities:

New to You. If you cosponsor a healthy 

cooking program for the first time with the

Cooperative Extension Service, it may not be

new to your area but will certainly be new to

your department and possibly new to your 

target groups. If your department has never

offered programs or activities on healthy eating

or managing weight and diet, that would be

another example.

Innovations. The only limit here is imagination.

The Albemarle (North Carolina) Parks and

Recreation Department partnered with a local

hospital to create a series of evening strolls in

various locations in the county. Residents 

visited places they hadn’t been recently while

engaging in a physical activity, meeting old or

making new friends, and being screened for high

blood pressure.

Heart-Healthy. Programs with a major emphasis

on physical activity or learning about healthful

eating. Examples: aerobics, volleyball, low-fat

cooking class.

Non-Heart-Healthy. Programs that do not focus

on physical activity skills or participation or

nutrition or weight loss. Examples: arts and

crafts, day camp, bridge club, etc.

29
30

Three science-based health/recreation resources include the curriculum from the Child and Adolescent Trial

for Cardiovascular Health (CATCH), JumpSTART, and JumpSTART Afterschool.

CATCH was a multisite study that demonstrated the effectiveness of school health education for motivating

heart-healthy behavior in elementary school age children. CATCH’s field tested materials include:

1) a physical education curriculum with lesson plans and a set of more than 350, 5x8" cards showing fun,

easy-to-teach activities; 2) heart-healthy classroom curriculum with family components for grades 3, 4, and

5; and 3) an eat smart school cafeteria program guide. The CATCH physical education component offers a

blend of moderate to vigorous physical activities, sports adaptations, and suggestions for hula hoops, jump

ropes, and parachutes. The CATCH program offers a successful blend of physical education, classroom

curriculum, nutrition awareness, student-directed activities, and P.E. equipment designed to promote and

maintain cardiovascular health in children, grades K–5.

CATCH Recreation is an adaptation of the original curriculum developed specifically for park and

recreation personnel and provides hundreds of youth activities promoting physical activity. A special recreation

leaders guide complements the program material and supports the Hearts N’ Parks program. All of the

CATCH materials can be obtained from Flaghouse at http://www.flaghouse.com or at (800) 793-7900.

JumpSTART is a school-based program adapted from CATCH developed by NHLBI and NRPA in

collaboration with Scholastic magazine that provides teachers with a variety of ways to include physical activity

and healthy eating components into their language arts, social studies, math, and science classes. Another

component to JumpSTART is the back-pack stuffers on heart-healthy behaviors for children to bring home

to their parents. The target age group is third through sixth grade. JumpSTART is available from NHLBI at

http://www.nhlbi.nih.gov/health/prof/heart/other/jumpstrt.htm.

JumpSTART Afterschool is a program also developed by NHLBI and NRPA with assistance from the

National Recreation Foundation to help children and youth get active, have fun, and be healthy. The

booklet (also available in Spanish) includes a series of activities selected to augment current after-school

programming. The activities encourage physical activity and recreation as well as heart-healthy eating

habits by using creative discovery techniques that are applicable to indoor and outdoor environments.

The target age group is third through sixth grade. Information on JumpSTART Afterschool is available

on the NRPA Web site www.activeparks.org under programs and partners.

STRATEGIES AND TECHNIQUES

Whether your department decides to create new

programs or continue existing ones, there are a

number of techniques that can be used to make all

department programs a part of Hearts N’ Parks.

Information and Knowledge Infusion

One approach that the North Carolina pilot 

sites found particularly effective was to infuse

knowledge and activity into existing programs.

The pilot sites did this both with programs that

had a heart-healthy focus and those that did

not. Some of the ways you can infuse

information and build knowledge within 

programs include:

Existing Programs (heart-healthy focus)

■ Have participants in exercise classes monitor

their pulse periodically.

■ Suggest that participants in summer day

camps substitute healthier foods for high-fat

snacks.
31

To give you an idea of the wealth of information available within JumpSTART

and CATCH Recreation:

Snack-vertising (JumpSTART Afterschool)

Objective: To use persuasive writing techniques to spread nutrition information.

Benefits: Reinforces participants’ knowledge of heart-healthy food choices.

Equipment: Construction paper, posterboard, markers and other art supplies, tape recorder, and 

video camera.

Directions: Have groups of kids think of interesting and fun ways (e.g., billboard, magazine, or TV 

advertisement) to ‘advertise’ their snacks, and convince others of their heart-healthy 

properties.

The Great Alphabet Hunt (JumpSTART Afterschool)

Objective: Reinforce language arts and spelling.

Benefit: Environmental appreciation.

Directions: As you walk or jog, look for objects whose first letters spell out the alphabet in 

order (i.e., acorn, bird, cloud). See how far you can get in a given time or distance.

Go Fitness Fast Games 2 (CATCH Recreation)

Activity: Elbow Tag Grade Level: 3–5 

Equipment: Four cones, scarves, or objects to identify children that are “it.”

Skills Emphasized: Fleeing, dodging, chasing, running.

Organization: Designate boundaries and reentry task zone; designate one of five kids

to be “it”; kids scatter.

Description: On signal, children that are “it” try to tag the others. At any time the other children 

may find a partner and link elbows. For 10 seconds, while elbows are linked, 

kids are safe from the person chasing them (count out loud). While linked, pairs 

should continue to walk. When participants are tagged, they go to the reentry task 

zone and complete the designated reentry task (e.g., 10 jumping jacks or 10 sit-ups).

Go Activity Aerobic Games 5 (CATCH Recreation)

Activity: Circulation Grade Level: 3–4

Equipment: Bean bag or similar safe object.

Skills Emphasized: Various locomotor movements.

Organization: Children form large circle in an open space with bean bag in the center.

Divide the class into two teams: half are Team A, the other Team B.

Players on each team are numbered 1–15.

Description: On signal, all kids walk in the same direction around the circle. Call out a number.

The player with the same number on each team runs out and tries to take the bean 

bag back to their group on the perimeter of the circle. If a player succeeds, that 

team gets 2 points. If the player that took the bean bag is tagged by an opposing 

player before getting back to the circle, the other team gets one point. All other 

players continue to walk in a circle.
32

PROGRAM PROGRESSION

Information ➞ Knowledge ➞ Intention ➞ Activity ➞ Lifestyle

■ Expose program participants to myths about

exercise, such as the need to engage in vigorous activity to have cardiovascular benefit.

Existing Programs (non-heart-healthy focus) 

■ Have participants complete health quizzes,

such as Check Your High Blood Pressure

Prevention I.Q. or Check Your Healthy

Heart I.Q., (in reproducible section), so they

can transform information into knowledge

about their own health. 

■ Have instructors begin or end class sessions

with a heart-healthy tip from such resources

as “Nutrition Tip Sheets” or Exercise and

Your Heart.

■ Teach participants a new skill, such as how

to read a food label for fat and sugar content,

or how to determine a “moderate” level of

physical activity.

Raising the Potential

Another strategy for infusing Hearts N’ Parks

into local programs, particularly existing ones,

is to raise the potential of programs for helping

the project reach its goals. There are a couple

of ways to do this. Programs with a captive

audience over an extended period of time, such

as afterschool, daycare, or latchkey programs,

summer camps or playgrounds, adaptive or

therapeutic recreation, and senior citizen meal

programs and clubs provide opportunities for

providing heart-healthy information.

And take advantage of commemorations, such

as American Heart Month, National Nutrition

Month, or National Cookout Month. These can

be used to help people boost their activity 

levels or learn to prepare healthier meals.

Some of the national organizations on the

NHLBI partner’s list sponsor such annual

events. These events include:

■ February is American Heart Month.

■ March is National Nutrition Month.

■ May is National High Blood Pressure

Education Month.

■ September is National Cholesterol Education

Month.

■ November is National Diabetes Month.

The NRPA also has a number of national

program partners that sponsor events that could

work well for you.

■ May is USA Tennis Month and National

Physical Fitness and Sports Month.

■ July is Recreation and Parks Month and

National Cookout Month.

Hands-On Activity

Emphasize “doing.” The value of a healthy eating tip is enhanced with a copy of a related

heart-healthy recipe. 

Adapt Traditional Activities 

Substitute soccer for softball to get more 

participants actively involved in the game.

Frozen tag involves more physical activity than

Red Light, Green Light. Serve bite-sized

snacks at camp or social meetings. Encourage

concessionaires to provide a wider range of

heart-healthy snacks, meals, and beverages.

PROGRAM PROGRESSION

Being exposed to a fact sheet about a healthy

diet is not the same as knowing how to shop

for one. Knowing how to shop for healthier

foods is not the same as choosing to eat those

foods. People pass through a number of stages

from learning about the importance of CVD

until they attain a heart-healthy lifestyle. We

can help them move along that continuum:
33

S IGNS OF S UCCESS

Many of the North Carolina communities utilized existing programs

that involved participants over a period of time.

Day Camps and Playgrounds

■ Mecklenburg County incorporated healthy snacks into its programs.

■ Garner Parks and Recreation focused on fitness and reading food labels during one week at

Camp Geko.

■ Roanoke Rapids taught nutrition basics to children ages 4 through 6 at the FLIP (Fun for

Little Interested People) Camp.

Senior Programs

■ Garner Parks and Recreation revamped an existing program, calling it

"Keep the Beat-Circle Yourself in Health" and had seniors keep a journal

and receive credit for prizes as an incentive.

■ Roanoke Rapids incorporated heart-healthy information into its

"Aquacise" program for seniors.

■ The mall-walking program in Mecklenburg County provided hearthealthy information and activities.

Other Programs

■ The Summer Youth Basketball League, a joint venture of the

Raleigh Police Department and the Parks and Recreation

Department, incorporated physical activity testing and offered the

youths fruit and a sports drink.

■ Hickory included information

and activities at Kindergym, a

preschool physical activity 

program.

■ Winston-Salem featured

heart-healthy activities as part

of its Weed and Seed

Summer Youth Academy,

with healthy snacks, 

educational sessions, 

and instruction in 

physical activity.

■ Wilson Parks and Recreation incorporated

information and instruction in both their summer

sports day camp and its weightlifting program for adults.
Providing people with information about the

value of dietary changes and physical activity

may not be enough to persuade them to make

changes in how they live. People know that

they should be more active or eat healthier

meals, but they don’t always act on this 

knowledge.

Offer Opportunities

The goal of Hearts N’ Parks is to move people

along from having information to acting upon

it. Three ways to accomplish this progression

are as follows: The first is to provide people

with more opportunities to become involved in

programs. Think of these as introductory 

versions of your programs that are designed to

attract people who may lack the time, money,

confidence, or level of commitment needed to

adopt a healthier lifestyle. Possibilities

include:

■ Offer A Taste of one or more of your

programs. That is, offer “miniclasses” in the

heart-healthy programs currently offered by

your department.

■ Offer invitations that are Good for One

Free Session. That is, invite people to

attend a heart-healthy class at no charge. 

■ Hold a Get Started series of programs. These

could include “getting started” on shopping

for healthier food, “getting started” on healthier

ways to eat fast foods, or “getting started” on

reducing fat eaten during meals.

■ Hold a Special Event. For example, sponsor

a “Get Ready for Summer Fun” event

where people can try out the various physical

activities offered by your department.

■ Hold an Open House. At one of your 

facilities, include sessions on heart-healthy

behavior as part of an open house.

■ Reach Out. Sometimes the people who are

most in need of involvement in heart-healthy

34

programs are those who are most difficult

to reach by traditional methods. Don’t wait

for them to come to you, find a way to go

to them where they are most comfortable

and accessible.

Breaking Barriers

The second way to help people progress from

knowledge to action is to help people break

down their personal barriers to adopting hearthealthy behavior. These barriers may include a

long list of “don’ts,” as in:

There are various ways

to infuse information,

knowledge, and activity

into existing efforts,

such as:

Information

Low-fat foods should be included in your

daily diet.

Reduce amount of fat and sugar in snacks.

It is important to warm up before physical

activity.

Activity

Cooking demonstration and sampling from

4–6 p.m., when parents pick up children.

Serve a healthy snack at camp with a “mini”

reminder about why it’s good for you.

Ministretching and warm-up lesson at drop-in

volleyball.

Skill/Knowledge

Low-fat food tastes good and is easy to

prepare.

Can recognize a snack that tastes good and

is good for you.

Practice appropriate warm-up techniques.
35

Some North Carolina communities created new programs as part of the Hearts N’ Parks projects:

■ Albemarle Parks and Recreation teamed with a local hospital to create 

“walk about” programs that transported residents to different parts of Albermarle

County and provided opportunities for health education and free screening of

blood pressure and blood glucose as part of the evening out.

■ Staff from the Madison-Mayodan Recreation Department created a special

version of Hearts N’ Parks for sixth to eighth graders. The program included

fun, lifetime physical activity skill opportunities as well as games, such as

“design your personal pizza.”

■ The Smithfield Parks Department collaborated with

the county health department and a fitness center to 

create a 6-week senior physical activity program that

offered screening for blood pressure, cholesterol, 

and body fat.

Don’t have the... time

... money

... ability

Don’t know ... how

... if I can

... if I’ll like it

Don’t want to ... look/feel silly or stupid

... invest too much time, money,

or effort in something I may 

not like or be able to do

Lifestyle Behavior Support

The third way to help people progress from

knowledge to action is to help them maintain

their new lifestyle. There are ways to do that,

such as:

■ Special events that reinforce social support

for people with similar interests and goals.

■ Programs that help reinforce their

progress. 

■ Recognition of milestones achieved or 

continued participation.

■ Prizes as incentives. Offer people some

kind of small gift or giveaway. 

■ Suggest Alternatives. People sometimes 

tire of the same activities and the same

heart-healthy recipes. Suggest to treadmill

fans that they might enjoy cycling or hiking.

Distribute new heart-healthy recipes and

meal ideas. Fight against boredom and

repetitiveness as a reason for sliding back

into old habits.

■ “Welcome Back-We Missed You.” There

are always people who slip out of newly

acquired patterns. Often they feel bad about

it but think they can’t start anew. Make sure

you try to get them back.
36

■ Goal Attainment. You can help people

understand that behavior change isn’t the 

easiest thing to do but that setting measurable

goals that are reasonable can help them 

maintain new behavior.

■ Barrier Bashing. Continue to provide 

information and program alternatives to

assist in breaking through barriers to 

physical activity and healthy eating. 

■ Social Support Alternatives. Facilitate the

organization of walking clubs, cooking

clubs, dining-out clubs, or any other way

that people can help one another.

FROM PROGRAMS TO PRACTICES

It is likely that your department has provided

information and oriented decision-makers and

staff. You’ve adapted existing programs and 

created new ones. But organizations must also

adopt Hearts N’ Parks into their lifestyle. 

Some possibilities include:

■ Mission Statement. Include the health and

well-being of department employees as part 

of the department’s mission statement.

■ Vision Statement. Make a heart-healthy,

active community a mainstay of your 

department’s vision for the future.

■ Planning. Be sure that issues related to 

heart-healthy behavior are discussed in your

department’s strategic plan.

■ Communication. Include statistics, information, and awareness-building messages

about community health and physical fitness

in annual reports, newsletters, brochures,

press releases, and other forms of communication.

■ Personnel. Staff orientation and staff 

training should emphasize the importance 

of heart-healthy behavior.

■ Resources. Link budget requests, grant 

proposals, and fundraising efforts to the role

of your programs and services in promoting

community health.

The following excerpt from The Practical Guide to the Identification, Evaluation

and Treatment of Overweight and Obesity in Adults suggests ways to respond to

some of the standard reasons why people don’t engage in physical activity.

I don’t have time to exercise.

Physical activity does take time, but only about 1 hour per week of vigorous activity can greatly benefit your

heart, lungs, muscles, and weight. Consider the amount of time you spend watching TV. Many forms of 

physical activity can be done while watching TV, such as riding an exercise bike or using handweights.

I don’t like to exercise.

You have bad memories of doing situps or running in high school, sweating, puffing, and panting.

Now we know that you can get plenty of gain without pain. Activities you already do, such as gardening 

and walking, can improve your health, so just do more of the activities you like.

I don’t have the energy to be more active.

Once you become a little more active, you should have more energy. As you progress, daily tasks will 

seem easier.

Source: The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Pub. No. 00-4084
37

Fitting Activity Into Your Schedule

Try walking before going to work or school. Or maybe you prefer evenings. Even a

few minutes of walking counts. Try to build up to 30 minutes a day. You can walk

whenever it is convenient for you, or you can take an aerobics class instead. Whatever works for

you is fine. There is no one right time of day to exercise. The important thing is that you try to be

more active.

Try to think about the little things that you can do to add more activity to your daily life. For

instance, take the stairs instead of the elevator at work, park farther away from the entrance to the

mall, or walk instead of driving to work or shopping. These little things add up and are easy to fit

into your schedule.

Source: The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. NIH Pub. No. 00-4084

■ Policy and Procedures. Review, and modify

if necessary, policies and procedures to

ensure safe, convenient, and equitable access

to areas, facilities, programs, and 

services that contribute to individual and

community health.

■ Advocate. Assume the role of advocate for

physical activity facilities, such as bike

paths, walking or jogging paths, lighted

facilities for evening use, and indoor

facilities for exercise during bad weather.
Arlington County Vision

Statement

The Department of Parks,

Recreation and Community

Resources is vital to the 

enrichment of Arlington as 

a vibrant and enjoyable 

community.

Arlington County Mission

Statement

We work to make Arlington the happiest, healthiest

place to live, work, and play through dynamic

programs, public spaces, and collaborations that:

■ Provide healthy and fun recreation, sport, and leisure

choices.

■ Cultivate, maintain, and protect natural and cultural

resources.

■ Provide opportunities for creative expression.

38
✔

39

GETTING STARTED

____Involve staff in the identification of heart-healthy and non-heart-healthy programs that might 

lend themselves to heart-healthy activities.

____Have staff identify resources within those programs that could be used for a Hearts N’ Parks 

focus.

____Identify ways in which program activities could become more “hands-on” heart-healthy or 

adapted to support more heart-healthy behavior. 

____Create a plan adding Hearts N’ Parks information and activities to those programs.

____Make plans for staff training and program modifications.

MOVING FORWARD

____Identify high-potential programs, such as after-school, day camp, or senior meals,

where Hearts N’ Parks might be incorporated.

____Plan specific activities and techniques for these high-potential programs.

____Identify possibilities for incorporating national observances in your program schedule.

____Create a schedule for implementing these programs.

KEEP THE BEAT

____Offer special events/opportunities to introduce people to heart-healthy behavior and programs.

____Ask staff to identify possible barriers to participation in programs and suggest ways to break 

down those barriers.

____Identify reproducible materials that could be used to encourage people to move from knowledge

to action.

____Create recognition or incentive programs to sustain the involvement of participants.

____Offer programs or activities to attract people who lapse from a heart-healthy lifestyle.

____Provide decision-makers in your department with ways in which they can help to make that 

happen. Share with them the suggestions in “From Programs to Practices.”

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔
40

People Involved: Program and front-line staff

Time Allotted: 2 hours

Goals:

1. Identify existing programs where heart-healthy information and activity can be added.

2. Identify resources that can be used for this purpose.

3. Create a schedule and system for doing so.

4. Identify high potential programs for heart-healthy behavior.

5. Brainstorm ways to incorporate heart-healthy activities into these programs.

Materials and Resources:

■ List of current programs (Program Worksheet, page 42)

■ Program plan form (Program Worksheet, page 42)

■ Copy of reproducible materials

Suggested Topics and Activities:

■ Review differences between new and existing programs and heart-healthy and non-heart-healthy programs.

■ Overview of ways to move knowledge about heart health to existing programs.

■ Individual or small group: identify existing programs where heart-healthy information and activity

could be added.

■ Share list of programs identified.

■ Individual or small group: create a plan and schedule for integrating heart-healthy information and

activity.

■ Group brainstorming: possible high potential programs to be incorporated into Hearts N’ Parks.

■ Wrap-up: questions and comments. 

STAFF TRAINING/MEETING OUTLINES
41

People Involved: Program supervisors and programmers

Time Allotted: 2 hours

Goals:

1. Identify high-potential programs for involvement with Hearts N’ Parks.

2. Identify possible national programs or celebrations for incorporation into the department’s 

offerings.

3. Develop plans and activities for both high potential and national programs.

4. Create a schedule for implementation of these programs.

Materials and Resources: Information from this section

Suggested Topics and Activities:

■ Share progress and challenges on incorporation of heart-healthy information into programs.

■ Make adjustments and make plans for continuation.

High Potential and Profile Programs

■ Group brainstorming: List potential programs for both high potential and profile; refer to 

information in this section on those two areas, if needed.

■ Group decision: On the basis of department criteria—that is, resources, number of people reached,

ease of access to target group, etc., decide to place greater-than-average emphasis on heart-healthy

behavior in several existing programs.

■ Program plans: Identify one or more national programs or celebrations which the department

plans to incorporate into its offerings. Develop an action plan.

Wrap-up

■ Questions and comments.

■ Set a date and time to reconvene to finalize plans for incorporation.

STAFF TRAINING/MEETING OUTLINES
42

Overall Goal: If more than one, indicate priority by designating the first goal as #1 and also check 

secondary goals.

____Add heart-healthy information and activities to existing programs 

____Target high potential or national programs 

____Move people from information to action

____Reach potential participants

____Support heart-healthy lifestyle 

____Identify possibilities for partnerships

____Utilize opportunities for building public visibility

Program List:

List each of the major programs or services under your supervision.

Mark as follows under the heading Designation:

• strong possibility to reach goal(s)

X possible alternative for goal(s) attainment

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

✍

List suggestions for possible information, activities, or modifications.

Program Designation Possible Activities

Designate programs selected for Hearts N’ Parks, along with major goal or focus and types of activities.

Program Major Goal/Focus Activities 

Designate actions that need to be taken to implement the Hearts N’ Parks program. Include due date and

person responsible.

Action By When By Whom
? ?

?

?

?

?

?

?

?

43

1 We have a tight budget. How can we 

implement Heart N’ Parks without

going over budget?

Work to achieve some flexibility in your 

program so that costly rearranging or

replanning is minimized; try to be creative.

For example, as part of its Hearts N’ Parks

program, the Winston-Salem (North

Carolina) Parks and Recreation Department

partnered with the Wake Forest University

Baptist Medical Center to provide blood

pressure and cholesterol checks for adults

in a “Healthy Strider” mall-walking 

program. The medical center used a 

storefront in the mall as a place to 

provide walkers with healthy snacks 

and information. This joining of resources

and facilities enabled both groups to keep

costs down while reaching out to a larger

segment of the community.

Obtain educational materials and program

ideas from the Web and see the 4th P

starting on page 65 for information about

forming partnerships.

2 How many participants can 

participate?

There is no set number, but it is better for 

evaluation purposes to start off with a small

group (15–30) and allow the program to

grow.

HEARTS N’ PARKS: 3RD P—PUBLIC VISIBILITY

“If a tree falls in the forest and there’s nobody

there to hear it, does it still make a sound?”

That old question highlights the challenge for

Hearts N’ Parks. This project doesn’t exist

unless people hear about it. The relationship

between CVD and heart-healthy programs is

worthy of great visibility.

Take up the challenge of raising awareness of

cardiovascular disease and the role individuals

can play in reducing their disease risk. Now is

the best time to raise the visibility of Hearts N’

Parks and to show people in your community

how you are working to improve their health.

WHO NEEDS TO KNOW?

Who needs to know about Hearts N’ Parks?

Somewhere between lots of people and 

everybody.

Given the large audience, you need to use

many different strategies for getting the word

out. Hearts N’ Parks offers five approaches to

greater program visibility:

■ Defining Hearts N’ Parks messages

■ Modifying the messages

■ Moving the messages

■ Holding special events

■ Working with the media.

Elaboration of these approaches is provided in

the following sections.

WRITING HEARTS N’ PARKS MESSAGES

Some people who know a great deal about the

causes of CVD will live in your community

along with people who are unaware that CVD

is a serious health threat or that people can

reduce their risk. Other people may be aware

of ways they can reduce their risk for CVD

who aren’t interested in making any changes in

their behavior. The “stages of change” in the

“1st P—People” come into play here.

Although the program’s overall message is the

value of adopting heart-healthy behavior, the

program uses various levels of the message to

move people from awareness to action.

At the broadest level, the goal is to raise

awareness of the seriousness of cardiovascular

disease. The hope is that a progression of 

messages will result in people participating in

activities that support heart-healthy behaviors.

45
46

Heart disease is the leading cause of death in the United States.

Risk factors for heart disease are:

High Blood Cholesterol

High Blood Pressure

Smoking

Diabetes

Being Overweight

and

Lack of Physical Activity.

Fortunately, there are steps you can take 

to reduce your risk of heart disease.

Two of those actions you can take 

involve increased leisure-time physical activity 

and heart-healthy eating.

Your community is involved in a National program,

Hearts N’ Parks, that addresses heart-healthy 

eating and physical activity.

There are individuals or community groups 

who can play a part in the Hearts N’ Parks 

program and its success.

People can learn more and become involved 

in physical activity and heart-healthy 

eating activities at your department.

Types of activities and programs offered 

along with dates, times and locations.

The table on page 47 shows each stage of change and the corresponding message goal and suggestions.

→

→

→

→

→

→

→
47

Stages of Change Message Goals and Suggestions

Precontemplation To raise awareness of CVD. “Heart disease is the leading cause of death in

the United States.”

Contemplation To raise awareness of the important role of the individual in relation to the 

risk factors. “You can make a positive change.”

Preparation To encourage involvement in heart-healthy behavior and encourage 

individuals to participate in your programs. “These programs are accessible, 

and activities are easy to start—no experience or skill required.”

Action To tell individuals how to get started and help them stay involved. Introduce 

other activities and options for them as well as ways to break barriers, etc.

Maintenance To focus on sustained, continued activity. “Keep up the good work.”

Termination To offer continued access and availability. “We’re your partners in healthy 

lifestyles.”

Another stage of change is quite common: relapse. For a variety of reasons, people with the best of

intentions stop their involvement. It’s important that we don’t overlook this natural, human progression.

Relapse To give options for restarting healthy habits and behavior. “Don’t let periodic

lapses become a reason to give up.”

MODIFYING THE MESSAGES

Initially, the messages are intended to provide

information and create awareness, but over

time you want to influence people to move

through the stages of change. Strategies for

modifying the messages:

Program Titles—Change the names of your 

programs. Rather than just listing the name of

the program—Walking, Ethnic Cooking, etc.—

consider adding some of the following phrases:

■ Getting Started...(Walking, Aerobics, etc.)

■ Time To Try...(Hiking, Biking, etc.)

■ How About...(Healthy Food Shopping, etc.).

Program titles for those who have already

adopted heart-healthy behavior might focus on

words of encouragement:

■ Keeping at It (Walking, Aerobics, etc.)

■ Moving from Walking to Hiking

■ Now On to Healthy Cooking

■ Learning More About (Biking, Low-Fat

Cooking, etc.).

Program descriptions—These too can be modified.

To reach people who are thinking about getting

started, the description could address:

■ Assistance in overcoming reluctance to

change behavior

■ Techniques for learning skills

■ Methods of making the behavior doable.

Example

“Have you thought about becoming more

physically active? How about walking as a way

to improve your health and well-being? Join us

in an easy walking plan.”
48

To influence people to sustain a heart-healthy

behavior, program descriptions could incorporate

language on:

■ Reinforcing skills

■ Making the new behavior manageable

■ Keeping activities enjoyable

■ Encouraging mutual support.

Example

“Looking for ways to continue your venture

into physical activity? How about learning

more about biking OR taking the next step in

aerobics OR looking for more tasty, low-fat

meal ideas.”

MOVING THE MESSAGES

There are a number of ways available to help

you reach the intended audiences for Hearts N’

Parks messages:

■ Existing resources

■ Internal opportunities

■ Extension strategies.

The Practical Guide on Overweight and Obesity in Adults offers information that

can be used to help people change their behavior.

Set the Right Goals

Setting the right goals is an important first step. Most people trying to lose weight focus on just that one

goal: weight loss. The most productive areas to focus on, however, are the dietary and physical activity

changes that will lead to that long-term weight change. Successful weight managers select two or three

goals at a time that meet the following criteria of useful goals:

Effective goals are (1) specific; (2) attainable; and (3) forgiving (less than perfect). “Exercise more” is a

commendable ideal, but it’s not specific. “Walk 5 miles everyday” is specific and measurable, but is it

attainable if you ’re just starting out? “Walk 30 minutes every day” is more attainable, but what happens if

you’re held up at work one day and there’s a thunderstorm during your walking time another day? “Walk 30

minutes, 5 days each week” is specific, attainable, and forgiving. In short, a great goal!

The NHLBI has prepared a substantial number of fact and information sheets on heart-healthy

activities and heart-healthy eating. You can order these from NHLBI or reproduce many of

the sheets in the reproducible section in this guide and distribute them. The NRPA also has

materials that can be helpful to your audience.
• Eat Right for a Healthy Heart

• Snacks Like These Are 

Okay

• Find the Foods

• Get Moving Fast

• Stay Young at Heart Menu 

• Dining Out—How to Choose

• Foods in the Fast Lane

• Putting Heart Healthy Eating 

Habits Into Play

• Physical Activity and Heart 

Disease I.Q.

• Get Physical

• Guide to Physical Activity

• Check Your Weight and 

Heart Disease I.Q.

• Healthy Heart I.Q.

• High Blood Pressure 

Prevention I.Q.

• Healthy Heart I.Q.

• Cholesterol and Heart 

Disease I.Q.

• Heart Healthy Eating Plan

• Help Your Family to Better 

Heart Health

• Cooking the Heart-Healthy Way

• Shop to Your Heart’s Content

• Dining Out—How to Choose

• Stay Young at Heart Menu

• Help Your Family to Better 

Heart Health

• Physical Activity and Heart 

Disease I.Q.

• Guide to Physical Activity

• Guidelines on Overweight and 

Obesity

• Check Your Weight and Heart 

Disease I.Q.

• Heart Healthy Eating Plan

• Healthy Heart I.Q.

• High Blood Pressure 

Prevention I.Q.

• Tips to Help Older Americans 

Control Cholesterol

• Healthy Heart I.Q.

• Cholesterol and

High Blood

Heart Disease I.Q.

High Blood Obesity & Physical Healthy

Cholesterol Pressure Overweight Activity Eating

Children Adolescents Adults

I NFORMATION S HEETS

49
50

C ONSUMER F RIENDLY M ESSAGE

The message below is in the Surgeon General’s report on physical activity. It attempts to make people

aware that even a small amount of time spent in physical activity is worth the effort. It also reminds people

that moderate physical activity can be enjoyable. Consider using this language for a display item targeting

current, casual, and potential participants in your program.

Life is short. So is 30 minutes. 30 minutes of “moderate” physical activity a day. A brisk

walk. A romp with the kids. A dance break. Hard to believe that so much fun can dramatically

reduce your risk of serious disease and early death. Even if it’s done 10 minutes at a time.

And considering that it decreases stress and increases your energy, you may not only live

longer, you’ll probably enjoy it more. Physical Activity. A little goes a long way.

Source: Physical Activity and Health: A Report of the Surgeon General; DHHS 1996.

Grant Park—Sign Board from Setting the Course

Bene-E-Fit Bear, Mascot 

Incline Village, Nevada Parks and Recreation Department,

from Setting the Course

Exercise boosts 

our immune system,

releases endorphins

and serotonin which all

help elevate our feeling

of well-being and 

energy level.

Neenah Parks & Recreation from Setting the Course
51

The NHLBI Web site is a good source of information. You can use this excerpt from the site

as a model for turning information into heart-healthy activity. (The information included here

is not presented in its entirety. You can find it at the NHLBI Web site as part of a set of

booklets for Improving the Cardiovascular Health of African Americans.)

INTERNAL OPPORTUNITIES

Use the resources in this guide to reinforce the

Hearts N’ Parks message inside your agency.

Try to have the message incorporated into

departmental vehicles, such as:

■ Flyers, brochures, bulletin boards, sign

boards, newsletters, etc.

■ Printed forms, such as fax cover sheets,

meeting agendas, and registration forms.

■ High-tech messages—voice mail, recorded

updates, e-mail messages.

■ Personal contact—continue to meet face to

face with decision-makers, partners, and

staff involved in the project.

EXTENDING YOUR REACH

Hundreds of people enroll in your programs—

hundreds more pass by your parks and 

facilities. Extend your reach by placing 

messages in places where they can be seen,

such as:

■ Posters and information near rest rooms and

refreshment facilities.

■ Fact and tip sheets in high traffic locations.

■ Brochures at special events and community

occasions.

■ Hearts N’ Parks video as part of a display or

part of a talk to a local civic or service club.

(See “Holding Special Events” for more

information.)

■ In the mail, accompanying local utility bills,

paychecks, and brochures and the newsletters

of other human services agencies.

Move Your Body!

Change your habits by adding activity to

your daily routine. Any movement burns

calories. The more you move, the better.

Try some of these simple activities to get

you started today.

Perk up:

Get up 15 minutes earlier in the morning 

and stretch.

Jog in place.

Ride your stationary bike while watching TV.

Work out along with an exercise video.

Do a quick workout:

Use the stairs instead of the elevator.

Walk to the bus or train stop.

Walk to each end of the mall when you go 

shopping.

Park your car a few blocks away from your 

destination and walk.

Have fun:

Play your favorite dance music. Do the old 

steps you love—add some new moves.

Jump rope or play tag with your kids or 

grandkids.

Use handheld arm weights during a phone 

conversation with a friend.

Source: Energize Yourself! Stay Physically Active, NHLBI, and NIH Office of Research on Minority Health
52

Remember to vary the message to reach people with different degrees of knowledge and readiness.

By identifying places frequented by at-risk groups, casual participants, or nonparticipants, you can

extend your reach even further. Some possibilities might include:

TARGET G R OUP P LACE OF C ONTACT

Teens Area or center where they drop in to play pool, etc.

Park where they “hang out” afternoons or evenings.

Parents dropping Sign boards outside building.

off children Message in take-home flyers or forms.

Families Distribute information at youth sports games.

Signs at family picnic spots or child play areas.

Senior citizens Announcements at social gatherings.

Fact sheets at meal programs.

Contact individuals or agencies that may have

contact with at-risk individuals and nonparticipants. This may involve providing materials for

distribution by a social club, a self-help club,

or a church.

HOLDING SPECIAL EVENTS

You can tap into the popularity of existing special events or create some new ones for Hearts

N’ Parks. Special events:

■ Attract larger than usual numbers of people

■ Attract the interest of the media

■ May reach people at higher than average

risk for CVD

■ Can attract volunteers who learn more about

CVD and heart-healthy behavior through

their involvement

■ Are opportunities to bring many community

resources together.

Just remember that you don’t necessarily have

to create something new. Almost any existing

special event can be transformed into a Hearts

N’ Parks opportunity.

What is a special event? A special event can

last an hour, a day, or a week. 

Here are some examples:

■ A health and wellness fair

■ An awards ceremony

■ A ribbon-cutting event for new equipment or

building(s)

■ A news conference 

■ A Fourth of July festival.

In addition to each of these being an event by

itself, each can be a part of a larger event. For

example, at Arlington County, Virginia’s,

Hearts N’ Parks launch, a news conference

kicked off a full day of heart-healthy activities,

including a health and wellness fair where people

from local hospitals and other organizations

performed blood pressure screenings and 

provided heart-healthy educational materials.

Remember, combining your activity with

another event can be a win-win situation.

Perhaps there’s a community awareness day in

your town—why not ask to participate in the

same way as part of a health and wellness fair?

Or, hold your awards ceremony for participants

in your Hearts N’ Parks programs during halftime at the local high school sporting event.
53

Regardless of which activities comprise the event, there are common steps that must be taken to

make it successful:

S TEPS FOR A S UCCESSFUL E VENT

1. Identify your goals, target audiences(s), key messages, and activities. An event takes a lot of 

time and other resources, and it should be a tool to reach goals, not an end in and of itself.

2. Identify and contact potential partners, cosponsors, and presenters, if appropriate.

3. Assemble a task force or committee for your event. Recruit from within your department 

or organization, potential partnering organizations, representatives from groups that are 

connected to your target audiences, community volunteers, etc.

4. Choose a date and location. Find out what else is going on around the time you want to hold 

your event and plan accordingly. You might be able to turn what would otherwise be a 

competing event into a partnership! (If you plan to have a legislator, local sports figure, or other 

celebrity participate, you may need to choose a date and location that best meets his 

or her needs.)

5. Promote your event to encourage attendance and media coverage.

6. Coordinate logistics.

7. Promote your event afterwards.

Documenting the event with photographs or

videotape may be useful for future promotions.

So you need to factor in the logistics for doing

so, such as hiring a photographer. Keep in

mind that you should obtain signed consent

forms from individuals whose image or voice

are recorded. Parents or guardians must provide

consent forms for minors. This guide contains

a sample consent and waiver form, as well as a

sample cover letter in appendix C.

Thinking at least one step ahead is key. 

Use the Prototype Plan for Launching Your

Program in appendix C, especially the timeline

and check list to help stay on track.

Using Baltimore’s SOS program as a model,

the Medical University of South Carolina

Blood Pressure Pilot Project conducted a 

similar program during a football game at a

small, relatively rural, high school with a 

significant percentage of African American

students. Because the school’s football games

typically draw people from the entire community,

the program was able to reach a sizable 

percentage of the population. 

WORKING WITH THE MEDIA

Media coverage of Hearts N’ Parks raises the 

visibility of your agency and helps to set the

stage for recruiting partners or sponsors.

Successful media outreach is a multifaceted

effort. First, identify your target audience and

tailor your message accordingly. Remember

that the audience is not the news media but

their readers, listeners, and viewers. Reporters,

editors, and producers are your messengers,

but you must show them why your message is

important. To do so, you must tailor your 

messages to key audiences and use an appropriate

“hook” or angle to interest the media.
54

Here’s a media strategy checklist:

✔ Define your goal. Are you trying to recruit

participants to programs, draw attendance 

at an event, inform potential partners or

sponsors?

✔ Think about which audiences you want to 

target. If your goal is to recruit program 

participants, do you want to reach children

or adults? Do you want to reach individuals

of certain ethnic or cultural backgrounds or

from a specific socioeconomic class or 

neighborhood?

✔ Develop an appropriate message. Try to 

identify ONE key message and ONE call

to action. The key here is to not try to

communicate several concepts at

once—that approach can backfire.

For example:

Key message: “Hearts N’

Parks is an innovative,

nationwide initiative that

aims to reduce the growth

in the number of obese

people and the risk of

coronary heart disease.”

Call to action: “Help us

launch this exciting and

prestigious program in

our community by

attending [YOUR

ORGANIZATION’S 

SPECIAL EVENT,

ETC.].”

Key message: “Two

ways to reduce

your risk of heart

disease are to

participate in

regular physical

activity and to eat

heart-healthy

foods.”

Call to action: “Register now to discover easy

ways to be more active and eat 

healthfully by calling or visiting

[YOUR ORGANIZATION].”

✔ Create a targeted media list. Be sure that

your list is up-to-date and covers all media

you are interested in contacting.
55

Strike Out Stroke (SOS) Week in Baltimore, Maryland, was a collaborative project involving the Baltimore

Orioles, Community Health Assessment and Monitoring Programs, Bon Secours Hospital, the University of

Maryland Medical School, and the NHLBI. This program targeted high-risk individuals through community events 

at barbershops, libraries, farmers’ markets, community basketball courts, pharmacies, and grocery stores, and 

culminated at a Baltimore Orioles baseball game. The events were advertised through TV and radio PSAs, 

banners at the ballpark, and video screen announcements. Events included blood pressure screening, risk

assessment quizzes on stroke and heart disease, and educational material hand-outs on a variety of health 

topics. In addition, young adults and adolescents from the community were taught CVD risk reduction and how to

measure blood pressure.

Another resource for incorporating special events is The Sports Guide: NHLBI Planning

Guide for Cardiovascular Risk Reduction Projects at Sporting Events found in the NHLBI

Educational Materials Catalog. NHLBI materials are available by contacting the NHLBI

Information Center at (301) 592-8573 or online at http://emall.nhlbihin.net. The catalog provides ideas related to various sports.

Baseball/Softball Strike Out Stroke

Foul Out Far

Home Run for Heart Health

Basketball Slam Dunk Stroke

Hoops for Healthy Hearts

Soccer Kick Out Stroke

Score a Goal for Physical Activity

Football Touchdown on Fat

Down on Stroke

Boxing Knock Out Stroke

Weigh-In Light

Car Racing Watch Your Pressure

Finish First in the Health Lane

Bowling Strike Out Stroke

Strikes and Spares for a Healthy Heart

Wrestling Take Down Stroke

Demolition Derby Demolish Stroke

Tennis Love Physical Activity

Net a Healthy Heart

Swimming Dive into a Healthy Lifestyle

Track Run for Life
56

✔ Prepare the tools you need to inform the

media effectively. These include news

releases, fact sheets, brochures, or other

background information. If you’re planning

an event, you might also need a media advisory (a “save the date” announcement), as

well as a press kit with the above-mentioned

tools plus an agenda, short bios of speakers,

and copies of their speeches. Don’t forget to

include the five “W”s—what, when, where,

who, and why—in the new release. Also,

you’ll need to identify the people in your 

department or agency who are best able to

serve as media contact or spokesperson.

✔ Construct a timetable of outreach events

and activities. See sample Checklist and

Timeline for Special Events and Prototype

Plan for Launching Your Program in 

appendix C.

✔ Decide how you will measure the success of

your outreach efforts. How many people 

participated in your program or event? How

many newspapers, TV stations, etc., reported

on your program as a result of your outreach?

Materials for working with the media are found

in this chapter and in the appendix

At the end of the chapter:

Proclamation by community officials—

Arlington’s promotional flyer 

In the appendix:

Sample Pitch Letter for Media (appendix C)

Story Ideas and Media Tips (appendix C)

Encouraging Media to Cover Your Event

(appendix C)

Sample Media Advisory for Hearts N’ Parks

Launch at Local Site (appendix C)

Sample News Release (appendix C)

Background sheet—Hearts N’ Parks (appendix F)

Background sheet—Get Moving for a Healthy

Heart (appendix F)

Background sheet—Eat Right for a Healthy

Heart (appendix F)

Consider the following questions and suggestions when forming your media strategy:

1. What are the best ways to reach your target audiences? 

2. What newspapers do they read? What radio stations do they listen to? 

3. Check the list of media contacts used by your agency, as well as any related agencies, 

partners, etc., to determine if you are missing any media outlets.

4. If you are holding a special event, don’t forget to notify calendar editors, including those on 

community Web sites.

5. How will you distribute your materials—by fax, by mail, by e-mail? 

6. Make sure your list includes all the information you need to reach your targeted media.

7. Whenever possible, note media deadlines for submitting information.
Excerpt of newspaper article from Roanoke Rapids:

By Robert DeAngelo, Herald Staff Writer

ROANOKE RAPIDS-What’s better for you, an apple or a bowl of

deep-fried pork rinds? Carrot sticks or a triple-scoop, marshmallowladen hot fudge sundae? Walking a mile or getting a thumb cramp

from channel surfing?

Those were pretty easy, but the Roanoke Rapids Parks and Recreation Department

is hoping to increase awareness of heart-healthy habits in children and adults this

week during their Hearts N’ Parks/Keep the Beat campaign.

Roanoke Rapids is one of 11 communities in the state selected as a test site for

the program, which seeks to educate both young and old on healthy eating

plans along with moderate physical activity programs.

“We’re trying to promote heart-healthy behavior,” said Allen

Overby, who is helping coordinate the program locally.

“We want to emphasize that a plan of physical activity and

nutrition is important throughout someone’s entire life.”

Arlington County Hearts N’ Parks “Kickoff”:

In the summer of 2000, the Arlington

County Department of Parks, Recreation

and Community Resources in 

Arlington, Virginia, kicked off the second

year of Hearts N’ Parks in the Washington,

DC, metropolitan area. A special launch

event held on July 18 featured

the Surgeon General, Dr. David

Satcher, Olympic Figure Skating

Champion Michael Weiss,

NHLBI Director Dr. Claude

Lenfant, and others at a press

conference. Activities included healthy

food demonstrations; physical activity

demonstrations including

tennis, volleyball, and

jumping rope; sidewalk

chalk art; and a performance

by the “Merry Makers,” a senior

citizen music and dance troupe.

57
58

Here’s a way to keep up with the latest in heart-health research and NHLBI activities:

Bookmark the NHLBI Web site, www.nhlbi.nih.gov, and check the site regularly. (See especially

the “What’s New” and “News & Press Releases” sections.) You can also subscribe to the

NHLBI Health Information Network which provides members with information and educational opportunities

applicable to everyday activities. For example, let’s say NHLBI posts a news release about a new study

showing that teens as a group are becoming increasingly overweight. You might send out a news release

or a letter to the editor that summarizes the research (because NHLBI is a Federal agency, you can copy

an excerpt verbatim)—be sure to cite your source—and explain how your program offers opportunities to

help teens lose weight (or better yet, how effective your program is in helping them lose weight).

MEDIA CONTACT IS ONGOING

It’s important to capture media attention when

launching a new project such as Hearts N’

Parks. It is equally important to try to keep the

message and activities of Hearts N’ Parks in

the public eye. How do you go about doing

that? Some things you can do:

■ Provide the media with information on new

heart-healthy programs or services that you

are offering. Announce new partnerships

with other organizations. Keep your media

contact and spokesperson informed about

any new developments in your program. 

■ Ask local officials to proclaim your city,

town, or county a Hearts N’ Parks community and invite the media to cover it. Include a

copy of the proclamation with your news

release.

■ Include Hearts N’ Parks materials at every

appropriate public event. Try to keep your

materials recognizable with a standard

design or logo.

■ Stay on top of medical research related to

Hearts N’ Parks and tell the media about it.

Use only reputable sources of information,

such as the NHLBI. 

■ Pitch ideas for a feature article to select

media. The focus of the feature could be a

program participant who has been exceptionally successful or who has overcome

unique challenges, a volunteer who has 

contributed significantly, a corporate sponsor

that has generously contributed to the 

community’s well-being, or the history or

evolution of park and recreation programs 

in your area. 

■ Expand your contacts with the media so

information about Hearts N’ Parks and

heart-healthy behavior is featured in various

sections of the newspaper—e.g., sports,

lifestyle, weekend, or activity section—as

well as radio stations that attract different

groups of listeners. Take note of reporters—

including freelancers—who cover related 

stories and add their names to your list of

media contacts. 

■ Try to find media that appeal to at-risk 

individuals or nonparticipants you want to

reach. Identify new media possibilities by

reading neighborhood or small weekly

newspapers and listening to different radio

stations.

■ Invite members of the media to become

partners with the Hearts N’ Parks effort in

your community. Local TV and radio 

stations as well as newspapers often adopt

special causes to show their support for the

community. 
59

Ways to make your activities newsworthy:

Provide a local angle on this national story; editors use local stories far more often than

out-of-town stories.

Provide details on the impact of your agency’s activities on local people, businesses, or

quality of life.

Ensure visual appeal. Visuals include photos (preferably “action” shots of a key individual in action),

maps, graphs or charts, and visual identifiers (e.g., logos) of your agency.

Timely distribution of up-to-date information that is respectful of media deadlines.

Keep in mind, however, that more does not

always equal better. Reporters constantly

receive story ideas, and repeated attempts to

gain media coverage can backfire. When you

contact reporters, be sure you have an idea

they might be interested in—and make their

job easier by providing them with all the 

information they need.

NEWS RELEASES

Much of the news that is printed or broadcast

is from news releases. Your release may be the

first—and perhaps only—information a

reporter receives about your program. It

should be written as if a reporter wrote it,

because it may be printed or broadcast verbatim. Or a reporter may use only portions of the

release or supplement it with additional information from you, your program partners, interviews with key people, or their own sources.

Here are some hints for writing a news release:

■ Write a headline that sells the story.

■ Prepare a lead paragraph with the five Ws—

who, what, when, where, and why (or how).

■ Incorporate accurate information from 

reputable sources, with the most important

details in the first few paragraphs.

■ Use quotations that bring the story to life

from influential people in the community as

well as participants. You might compose

draft quotes that are approved by the people

for whom the quotes are written. This is a

fairly common procedure and may be 

preferred by the people being quoted.

In addition, prepare a professional-looking

news release by:

■ Keeping it to no more than two pages. You

can provide additional material through fact

sheets, interviews, etc.

■ Presenting it on a letterhead with the name

and phone number of your agency’s contact

person.

■ Proofing it to ensure that it is error-free.
60

SAMPLE: A RLINGTON , V IRGINIA ’ S , H EARTS N’ PARKS

This text from the Arlington, Virginia, program is an example of the kind of information you could use for

your program’s flyer. Consider adding a logo or clip art to make your program’s flyer more colorful.

What is Hearts N’ Parks?

Hearts N’ Parks is an exciting new national program sponsored by the

National Heart, Lung, and Blood Institute (NHLBI) and the National

Recreation and Park Association (NRPA). The goal of the program is to 

create model community-based programs to increase the number of 

children and adults who engage in heart-healthy behaviors.

Why Arlington?

Arlington County’s Department of Parks, Recreation and Community

Resources is honored to be hand-selected as a pilot site. Arlington was

selected because the NHLBI and the Surgeon General’s Office recognize

the many ways that community parks and recreation programs positively

affect the well-being of people. We are proud to offer programs that

demonstrate Arlington as A Hearts N’ Parks Community! 

What is the Arlington

Department of Parks,

Recreation and Community

Resources doing to 

promote Hearts N’ Parks?

Kids in the elementary after

school and playground

camp programs, as 

well as mature adults in the

senior adult programs, 

are participating in more 

physical activities while 

learning about the importance

of a heart healthy diet.

The Hearts N’ Parks logo will be

found on trail maps, mile markers,

and other promotional materials

for programs and facilities that offer

heart-healthy activities.

The Recreation and Leisure class catalog will promote

a series of heart-healthy classes in the fall of 2000.
61

SAMPLE: (C ONTINUED )

Thomas Jefferson Community Center and Barcroft Sport

and Fitness Center will be flagship sites for Hearts N’ Parks,

offering a safe and affordable place to be active.

What can Arlingtonians do to promote heart-healthy

behaviors?

These simple tips will help control body weight, prevent/control

obesity, high blood pressure, and high cholesterol, which are

major risk factors for cardiovascular disease:

■ Get regular physical activity—You need to engage in only

about 30 minutes of moderate-level activity, preferably,

all days of the week.

■ Choose a diet that is low in saturated and

total fat and cholesterol.

■ Follow an eating plan that balances caloric intake 

with your level of physical activity. This is the 

key to maintaining a healthy body weight, or 

even losing weight if you are overweight.

Where can I find more information about the

Hearts N’ Parks program in Arlington?

Please call ___________________________ 

at __________________________________.

Where can I find more information about the

Arlington County Department of Parks,

Recreation and Community Resources?

For information about the Arlington County

Department of Parks, Recreation and

Community Resources, please visit our

Web site at http://www.co.arlington.va.us.

Pick up a copy of the latest Recreation

and Leisure catalog at your local library or

community center. Call 703-228-5920

to request information to be mailed.
✔

GETTING STARTED

Messages

____At a staff meeting, expose people to the Hearts N’ Parks message and encourage them to take 

action according to their roles within the department.

Media

____Create or revise a list of media contact names and numbers.

____Identify media tools you’ll need—such as a media advisory, news releases, background sheets. 

Create a schedule, then draft and distribute these items.

____Set up a date and time for community officials to proclaim your community a Hearts N’ Parks 

Community, then arrange for media coverage.

MOVING FORWARD

Messages

____Change your messages by modifying program titles and descriptions.

____Form a small group of staff who are willing to identify internal opportunities for spreading the 

message and then do so.

Media

____Extend your reach by partnering with local organizations or businesses and promoting 

Hearts N’ Parks to their constituents.

____Think of different story ideas with a local angle or human interest approach and forward them 

to your media contacts. These should be targeted; do not send the same pitch letter to several 

media outlets.

____Expand your reach by contacting the people who write for the sports or lifestyle sections of 

local newspapers.

KEEPING THE BEAT

Messages

____Continue to tell your message; don’t assume that everyone has received it.

____Begin a new round of distributing information about the risks for CVD.

____Change your message to support people who have taken action and need to maintain this way of life.

Media

____Create a new special event or infuse a Hearts N’ Parks emphasis into an existing special event. 

Invite the media to cover the event and become involved.

____Check the NHLBI Web site and alert local media contacts to new findings. Provide them with a 

local angle if you can.

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

62
?

?

?

?

?

?

?

?

?

63

1 Why do we need to

involve the media?

Media support is crucial because it 

provides a way to reach the people of 

your community. Good media coverage

can assist your program by attracting 

participants and outside partners. 

2 What’s a good first step to 

getting media exposure?

Using the example in the resource guide,

write a news release that highlights the

major details of your program (date,

time, place, purpose, who’s involved) and

submit it to local newspapers and radio

stations. When you submit the release,

invite the paper or radio station to send a

reporter to your program’s launch.

3 What if our efforts to generate 

publicity don’t result in a good

turnout for the program?

If you’ve tried all possible ways to inform

your community (radio spots, news releases,

contacting media, putting up posters,

handing out flyers, etc.), try encouraging

participants to tell their friends and 

families about the program. Simple wordof-mouth tends to link people with shared 

interests. Also, find out how those

involved became aware of the program.

That should help you understand which

communication methods are effective.

Whatever you do, don’t give up. Change

your approach if you have to—create a

new slogan, make new posters, or hold a

special event at a time when no other

major events are happening.

HEARTS N’ PARKS: 4TH P—PARTNERING

Consider pursuing partnerships. One of the

powerful aspects of Hearts N’ Parks is its

potential to make the most of existing 

community resources AND to extend the reach

of important information to your community.

Partnering goes a long way toward making

that a reality.

THE PARTNERSHIP ADVANTAGE

Partnering is powerful because it holds the

potential for making things happen that:

■ Could not have happened with one agency

acting on its own

■ Would not have happened as efficiently or

successfully if partners had not joined

together.

It’s never too soon to start thinking about 

partnering. Partners can be a big help to moving

a project forward because they can provide:

■ Access to a target audience you might not

currently reach

■ Greater credibility for your message or 

program

■ Additional resources, either tangible or

intangible

■ Added expertise

■ Potential cosponsorship of programs and

events.

PARTNERSHIP POSSIBILITIES

Every community possesses a unique richness

of resources. Explore the resources that might

serve as possible partners in Hearts N’ Parks. 

They might include:

■ Public departments and agencies, such as

health departments, school districts, police

departments, fire departments, etc.

■ Health-related agencies, hospitals, visiting

nurses, emergency services

■ Nonprofit agencies, YMCAs, Boys and Girls

Clubs, local chapters of AARP

■ Churches and religious groups 

■ Affiliates of national organizations—

American Heart Association, American

Cancer Society, etc.

■ Private sector—grocery stores, sporting

goods stores, fitness centers

■ Neighborhood and community groups 

■ Service clubs, such as Rotary, Lions, etc.

The best prospective partners are those who

share a common interest in your mission.

Partners are those who can bring something to

the process that you or other partners are not

capable of providing.

Take a moment to:

■ Brainstorm the names of individuals and

agencies that might be interested in being a

part of this effort.

■ Think of organizations or groups you might

not have been involved with previously,

such as hospitals, grocery stores, the health

department, or police and fire departments. 

■ Ask other staff or your current partners for

additions to your potential partner list.

65
66

Most of the partnerships in North Carolina involved hospitals, healthcare and fitness centers,

and health departments. There were also partnerships with local restaurants and businesses,

police departments, a mayor’s council for substance abuse, and USA Tennis. A few examples:

■ The Mecklenburg County Park and Recreation Department in Charlotte, operated many adult and youth

programs, ranging in duration from 8 to 10 weeks. The “Walk for Life” senior walking program culminated with

a walk in which participants tested their endurance by walking several miles from Charlotte to the local outlet mall. For the 1,800 youths involved in summer day camp programs, the department partnered with USA

Tennis to focus on the health benefits of participating in lifelong sports like tennis. The youths 

participated in a healthy lunch program that challenged them to “go around the world in 80 days by 

sampling various cuisines.” Winners were awarded prizes and given coupons for active places to visit,

such as bowling alleys and skating rinks. Sponsorship with local Subway sandwich shops was part of the

Hearts N’ Parks partnering mix.

■ The Winston-Salem Parks and Recreation Department partnered with the Wake

Forest University Baptist Medical Center to provide blood pressure and cholesterol

checks for adults in the “Healthy Strider” mall-walking program. The hospital used 

a storefront in the mall to provide walkers with healthy snacks and information.

This program was 4 weeks long and had about 40 participants.

■ The Smithfield Parks and Recreation Department established a partnership with the Johnston County Health Department and the Looking

Good Fitness Center to provide a 6-week senior exercise program.

The Health Department conducted blood pressure, cholesterol, and

body fat screenings for participants. Participants were also given information

about health, fitness, and nutrition as part of the Hearts N’ Parks program.

■ In Raleigh, the summer Youth Basketball League, a joint venture

of the Raleigh Police Department and the Raleigh Parks and

Recreation Department, gave approximately 25 teens the

opportunity to learn about health and fitness while having fun.

Hearts N’ Parks provided an opportunity to include good nutrition

and physical activity as part of the program with guest speakers,

such as a personal trainer and a football player. The Parks and

Recreation Department arranged for fruit and a healthy beverage

to be served after basketball games through a partnership with

the local bottling company.

■ Lindsey Dunevant, Director of the Albemarle Parks and Recreation

Department, called Karen Brown at the Stanley Memorial

Hospital and received an enthusiastic “yes” to partnering

before he attended the first Hearts N’ Parks meeting. These

partners went on to develop a 1-month “Walk About” program for adults. The program 

included walks with health education professionals, screenings for blood pressure and blood 

glucose, stress management seminars, healthy eating classes, and strength training.
67

■ The Town of Fletcher Parks and Recreation Department

partnered with a variety of community organizations to give

day camp participants the opportunity to hear from experts

in nutrition and exercise. Partners included a local fitness

club, the Henderson County Partnership for Health, the

American Red Cross, the Cooperative

Extension Service, and the Henderson County

Health Department. Partners and staff gave talks, conducted demonstrations, and led

games, activities, and exercises that emphasized the importance of a heart-healthy lifestyle.

■ The Madison-Mayodan Recreation Department teamed with a local restaurant that 

provided nutritional information about items on its menu to children in the Hearts N’ Parks

program. The children ate at the restaurant, and staff used the nutritional information to talk

about making healthy food choices when eating out.

S IGNS OF S UCCESS ( CONTINUED )

GETTING STARTED

Creating new relationships or reinforcing existing partnerships can generate strong interest in

Hearts N’ Parks. But you can’t build upon this

interest until you ask people to join you.

Be the change agent for healthy behavior in

your community and call a meeting to recruit

the many valuable assets from within your

community.

Be the one to:

■ Mail a letter to potential partners explaining

the program and asking about their interest.

Be sure to include the Hearts N’ Parks

information and fact sheets.

■ Schedule a meeting with potential partners.

Be sure to make use of the Hearts N’ Parks

video and suggested agenda for that first

meeting.

TYPES OF PARTNERING OPPORTUNITIES

There are lots of partnering opportunities,

including:

Communication: Information and insight

sharing conducted formally at a monthly

or annual meeting or informally through

networking and phone trees.

Coordination: Programs and services offered

to either address an important community issue

or avoid replication of services and resources.

Cooperation: Exchange of resources of some

kind—building, staff, publicity, equipment, or

access to different target groups.

Resources to help you get started include:

■ Additional Resources for Your Hearts N’ Parks Program (appendix D)

■ Sample Invitation Letter with suggested enclosures (at the end of the chapter)

■ Sample Agenda for Initial Meeting (at the end of the chapter)
68

Collaboration: Usually a combination of

some or all of the above. The partners share

information, communicate between themselves, coordinate programs and efforts, and

share resources and responsibility for addressing

the common purpose that brought them together.

Now is a good time to decide who your partners

in Hearts N’ Parks may be and to determine

what types of partnering alternatives you will

jointly pursue.

MOVING FORWARD

A twofold approach to making the most of

existing resources includes a Program/Service

Assessment and an Outcomes/Opportunity

Action Framework.

Program/Service Assessment

Before your agency and your partners decide to

create new programs, you need to look at those

currently being offered. Conduct a quick 

assessment of heart-healthy related offerings or

programs that could incorporate such activities.

Determine whether all aspects of heart-healthy

behavior are being addressed and that all 

members of the community have access to such

programs. You should look at your programs to

find out if they have the following characteristics:

■ All age groups

■ Provide for men, women, and children

■ Are offered at various locations

■ Are offered at different days and times

■ Are affordable 

■ Provide ease of access to all

■ Take account of the need for personal safety.

The following checklist, Program/Service

Assessment of Basic Elements and Offerings,

can be completed by your agency and your partners. It will give you an initial picture of what is

happening or not happening in terms of hearthealthy behavior in your community. It will also

serve as a good starting point for the next phase,

when you identify desirable outcomes.

Remember that elements such as affordability,

ease of access, and perceived comfort and safety levels need to be discussed. They cannot be

addressed easily through a checklist.

There are steps and suggestions for creating and working with partners as follows:

■ Involve representatives of partnering organizations as early as possible in

the planning process.

■ Provide them with the Hearts N’ Parks mission, strategies, and materials in a readily 

usable format.

■ Give partners advance notice so they can rework their program schedules around the new initiatives.

■ Determine what types of resources or assistance they might need; aside from just money, 

consider training, information, or other forms of assistance.

■ Provide them with contacts and linkages to the NHLBI and the NRPA so they realize the potential

value of Hearts N’ Parks for their organizations.

■ Keep initial efforts manageable; don’t take on too much too soon.

■ Create a way to gently remind people of their responsibilities.

■ Develop a feedback mechanism so activities can stay on track and adjustments can be made quickly.
69

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

69

Step 1: Current Programs and Services Offered (number programs for easy reference below)

1. 6. 11.

2. 7. 12.

3. 8. 13.

4. 9. 14.

5. 10. 15.

Step 2: Review Programs on the basis of which target groups and community locations are

addressed by the programs listed in Step 1. Be sure to classify the programs according to whether

they focus on providing a heart-healthy activity or only have some elements related to heart-healthy

behavior. This chart allows you to see what elements you are including or missing. Some programs

may be entered in more than one category.

Place an asterisk (*) by program name to indicate occasional programs. 

Program Name Focus Elements of

or Number Physical Heart-Healthy Physical Heart-Healthy

__________________ Activity Eating Activity Eating

Children: Male

Female

Teens: Male

Female

Adults: Male

Female

Seniors: Male

Female

At-Risk Groups (specify)

__________________

__________________

Non-Participants (specify)

__________________

__________________

Location (specify areas 

or neighborhoods)

__________________

__________________
70

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

The completion of this assessment is intended to identify desirable outcomes and opportunities for

Hearts N’ Park initiatives. The Outcomes/Opportunity Action Framework form does just that. It

serves as a framework to move forward.

Review the results of your assessment with your staff and your partners to identify gaps and duplications. By not replicating similar programs, you can save time, energy, and money. By offering programs

at different times and locations for different groups of people, you may break through a number of other

barriers as well.

People:

Groups who do NOT have regular, ongoing opportunities for physical activity:

1. 4.

2. 5.

3. 6.

Groups who do NOT have regular, ongoing opportunities to learn about heart-healthy nutrition:

1. 4.

2. 5.

3. 6.

Groups who are at high risk for CVD and are not participating in current programs:

1. 4.

2. 5.

3. 6.

Programs:

Successful programs with a heart-healthy focus that could be expanded to reach more people:

1. 4.

2. 5.

3. 6.

Programs with potential for adding or enhancing heart-healthy elements for current participants:

1. 4.

2. 5.

3. 6.

❉

70
71 71

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

71

Programs without a heart-healthy focus that could be expanded to include heart-healthy physical

activity or information about a heart-healthy diet:

1. 4.

2. 5.

3. 6.

Heart-healthy information and strategies that are NOT sufficiently targeted and could be expanded:

(check as many as apply)

Information: Importance of CVD

Risk factors for CVD

Personal role in reducing risk

Activity: Physical activity

Heart-healthy eating

Opportunity/Action Areas:

Identify programs or services, existing or new, that present either an opportunity for motivating

heart-healthy behavior or areas where new programs should be created.

Target Group Expansion of Existing Program Creation of New 

Program Program
72

As in any human interaction, misunderstandings can arise in partnerships.

These may include:

Participation

■ Participation dominated by one group or person

■ Participation by partner(s) is unenthusiastic 

■ Attendance and involvement are sporadic

Personal 

■ Personality clashes or ideological differences among partners

■ Inability to compromise

■ Unrealistic expectations 

■ Real or perceived loss of authority by one or more partners

Philosophy

■ Disagreements over values, methods, or actions

■ Past history of differences

■ Organizational policies do not lend themselves to cooperative efforts

Practicalities

■ Activities or resources put too large a burden on one agency 

If you acknowledge these challenges and address them, chances of long-lasting

partnering are increased.

MOVING TO ACTION

Two techniques for keeping partnership 

projects on track include a Partnership Plan

and a Tracking Mechanism.

A partnership plan enables all participants 

to agree on the specifics of the project; a 

tracking mechanism provides a way to monitor 

achievement of goals.

Partnership Project Plan

How formal and official you choose to be may

relate to the size of the cooperative effort or

the needs of the various partners. Use the 

following guidelines and information to create

this plan.
73

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

73

Overall Purpose of Hearts N’ Parks Partnering:

To bring together existing community resources and assets to improve the overall health and quality

of life for residents of the community through increased information and access to physical activity

and healthy eating.

Brief Description of Cooperative Program or Project:

Participating Partners (list names of all involved):

Desired Outcome(s) of the Program/Project (can include a focus on a particular group or set of

information or behavior):

1.

2.

3.

Major Activities/Action Needed for Program/Project:

1.

2.

3.

4.

5.

6.
❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

74

Needed Resources: Partner(s) Providing the Resource:

Access to People

Training

Communication

Expertise

Facility

Funding

Staff

Actions for Implementation:

Action/Step By Whom By When How Tracked

1.

2.

3.

4.

5.

6.
75

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

75

Name of Project:

Proposed Action Steps (include proposed completion date):

1. 4.

2. 5.

3. 6.

Please take a few moments and reflect as to how these specific activities or actions related to your

Hearts N’ Parks project are progressing. Consider the categories below in describing the progress of

these activities:

Once you select the appropriate visual category, see if you can detect the underlying reason or cause

for either the challenge or success of this part of the project. On the basis of that identification,

please describe a suggested action.

1. Needed Action Step #1 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

2. Needed Action Step #2 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

3. Needed Action Step #3 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

4. Needed Action Step #4 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

5. Needed Action Step #5 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

6. Needed Action Step #6 (specify):

Category Designation:

Reason/Cause:

Suggested Action:

Tow Truck-

“Stalled, no

movement”

Snail-

“Moving at

a very slow pace”

Car in Motion-

“Moving right along”

Rocket Ship-

“Really taking off”
76

Partnering is truly a group venture and the unofficial guidelines for group dynamics suggest

that there are four phases of group behavior as follows:

■ Forming—coming together

■ Norming—establishing a framework

■ Storming—encountering difficulties and disagreements, and

■ Performing—making the project come to life.

It is likely that your partnership experience will move through most, if not all, of these phases.

Some suggestions for each of the phases include:

Forming

Make the most of your opportunity to be a community change agent. Make a list of all those who might be

interested in the goals of Hearts N’ Parks and invite them to an initial meeting.

Helpful Hints:

■ Try to include all potential partners at the first meeting.

■ Send out information on Hearts N’ Parks before the first meeting.

■ Have a written agenda and a list of desired outcomes for the first meeting.

Norming

Allow time for the individuals representing the various partners time to get to know one another.

The more everyone understands the mission and strengths and different approaches of members of the

group, the better.

Helpful Hints:

■ Move the location of the meetings around to each of the partners to provide a sense of ownership 

and inclusion.

■ Try to involve all members of the group so as to not overshadow or leave out those who are less 

vocal or direct than others.

■ Take the time to work out the ways in which the group wants to communicate with one 

another and function as a group.

Storming

This is potentially the most important phase. Disagreements are bound to arise. If addressed, working

through this phase can improve the final outcome.

Helpful Hints:

■ Refer partners to the original plan and see if changes or adjustments are in order; don’t blame 

when you can reframe.

■ Have a concise agenda and planned outcomes for each meeting so members don’t get sidetracked.

■ Use a tracking mechanism to address problems and offer suggested alternatives.

Performing

When moving from planning to action, be sure that all partners are clear about the goals of the project and

the role they will play. Since you are likely to have media coverage at this point, be sure to recognize the

roles, involvement, and impact of your partners.
✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

77

GETTING STARTED

____Review list of current and past partners for possible involvement with Hearts N’ Parks.

____Ask staff and current partners to suggest names of possible partners.

____Set a date for initial meeting and invite potential partners to attend. 

____Hold initial meeting and determine level of interest and possible involvement.

MOVING FORWARD

____At second meeting, expand the number of partners and garner a more definite level of support; 

suggest conducting an assessment to determine areas of possible cooperation. 

____At the third meeting, review the assessment to determine program or service opportunities.

____Decide upon one or more specific partnering ventures, such as joint staff training, cosponsoring 

a special event, etc.

____Agree on partnership plan.

KEEP THE BEAT

____Plan methods of communication and networking.

____Update the tracking mechanism regularly.

____Remind yourself and your partners to acknowledge challenges or difficulties right away so that 

they can be addressed.

____Make a strong effort to thank and give recognition to Hearts N’ Parks partners.

____Review the success of initial partnerships and plan additional partnerships.
78

Date

Name of Contact Person

Organization

Address

Dear __________:

Our department is involved in a Hearts N’ Parks program sponsored by the

National Heart, Lung, and Blood Institute of the National Institutes of Health and

the National Recreation and Park Association. The purpose of the program is to

improve the overall health and quality of life of our community by promoting

heart-healthy eating and physical activity.

A major component of the program is effective and efficient use of community

resources. Recognizing your organization’s involvement in the community, we

would like to invite you to learn more about this program and to explore the possibility of collaborating with us to achieve these goals. 

A number of organizations and agencies within our community are being invited to

attend a meeting on

Date and Time

Location

We hope that you or a representative from your organization can attend. 

Enclosed is a fact sheet about “Hearts N’ Parks” as well as “Health Statistics

About Cardiovascular Disease.” If you have any questions, please give me a call at

(fill in your phone number). We look forward to seeing you at the meeting.

Sincerely,
? ?

?

1. Call to order (department head, if possible or appropriate)

2. Self Introductions of Participants and Organizations Represented

3. Overview of Hearts N’ Parks (program coordinator)

■ Expanded purpose of program

■ Examples of activities from North Carolina and Arlington pilot sites

■ Use of new and existing programs and services

4. Roles in Partnership

■ Communication

■ Coordination

■ Cooperation

■ Collaboration

5. Where do we go from here? (group participation)

■ Determine level of interest.

■ Identify other potential partner suggestions.

■ Arrange next meeting date and time; invite potential partner to host.

■ Identify information to be prepared for next meeting.

6. “On time” adjournment

79

1 Does a partnership have to be

approved by Hearts N’ Parks?

No, but keep the NRPA and the NHLBI

informed about who your partners are and

how your program develops. 

2 Can we enter into a partnership with

an organization whose purposes

are not of a heart-healthy nature?

Yes, but the reason for having a partnership is that partners will share resources

and work together to promote each other’s

programs. You don’t want to be in a partnership if it doesn’t benefit your program

or sends the wrong message. Don’t run the

risk of getting your message confused with

that of a partner.

HEARTS N’ PARKS: 5TH P—PERFORMANCE INDICATORS

Performance Indicators

Performance indicators are the hidden treasure

of Hearts N’ Parks. At the end of the first 

season, the North Carolina professionals

involved with Hearts N’ Parks said it was one

of the biggest draws for their involvement with

the project. Everything you need to gather 

performance indicators is included in the 

Community Mobilization Guide. This chapter

and appendices A and B contain performance

measures for children (less than 10 years old),

adolescents (11–17 years old), and adults

(more than 18 years old) that assess their

knowledge, attitudes, and behaviors about

physical activity, heart-healthy eating, and the

risk factors related to coronary heart disease.

We’ve also included directions for administering

and scoring the measures. 

Your ability to demonstrate the impact of your

programs on the health of your community is 

a big plus. The Hearts N’ Parks program 

provides directions, model surveys, and plenty 

of suggestions to help you measure that impact.

Performance indicators enable you to:

■ Document the factual results of your 

programs.

■ Determine if your programs and services are

making a difference to your community.

■ Provide information for decision-makers,

funding sources, and the public.

■ Suggest how to improve your programs.

■ Reinforce the efforts of staff.

TYPES OF INDICATORS

The Hearts N’ Parks program utilizes two

types of performance measurements. The first

type is the activity indicators that measure

what has been done by the program: numbers

of brochures distributed, programs sponsored,

participants served. These are often tracked by

age group, gender, and ethnicity. This involves 

tracking, for example, the number of people

who received a fact sheet on how physical

activity reduces the risk of CVD, sampled food

at a healthy cooking demonstration, or attended

the “How To Start a Walking Program” clinic.

Tracking of activity could also include other 

elements of Hearts N’ Parks, such as the 

number of community organizations attending

an initial Hearts N’ Parks partners meeting 

or the number of news articles about Hearts 

N’ Parks in local newspapers.

81
82

Tracking Sheet for Activities

Number of Number of 

Number of M/F Age Number Number of Materials Number Articles/

Activity Participants Ratio Group of Events Screenings Distributed of PSAs Interviews

Source: The Sports Guide: NHLBI Planning Guide for Cardiovascular Risk Reduction Projects at Sporting Events.

Outcome indicators are the second type of

measurement used in the Hearts N’ Parks 

program. These data demonstrate a program’s

success in achieving important outcomes.

While activity indicators keep track of “how

many,” outcome indicators give us an 

understanding of “what happened.” Outcomes

are the participant benefits that may be

acquired during or after their involvement 

with a Hearts N’ Parks program.

As informative as activity indicators can be,

they are not as meaningful as outcome indicators.

There is a difference between a person who

picks up the “Achieving Your Healthy Weight

Tip Sheet” and the person who actually loses

weight.

Outcome indicators may include:

■ The number of people who improved their

knowledge about heart-healthy behavior.

■ The percentage of people who changed their

attitudes toward a healthy diet.

■ The increase in the number of people who

engage in the recommended amount of

physical activity per week.
83

According to data collected at the North Carolina Hearts N’ Parks sites in Summer 1999, youth participants

showed significant improvements in their knowledge about healthy eating and their intention to eat a

healthier diet (7 percent and 9 percent improvements, respectively). Scores for healthy eating improved

slightly.

Youth participants also indicated that, on average, they learned four new kinds of physical activity and got

better at six different activities.

In the adult program, the biggest improvement occurred in healthy-eating habits, which improved by 6 percent.

Improvement was also made in participants’ desire to follow dietary guidelines (a 5 percent increase). Adult

participants also reported that, on average, they felt that they were in better health by the end of the program.

Collecting, tracking, and sharing these statistics as part of your Hearts N’ Parks initiative helps

the NHLBI discover the effectiveness of park, recreation, and leisure-related community 

service agencies’ efforts in reaching people and building awareness for heart-healthy behavior.

Organizations such as yours benefit from:

■ Enhanced recognition!

■ Added credibility!

■ The potential for new partnerships, sponsorships, and funding!

GETTING STARTED

There are a number of things to think about 

and choices to be made in planning to conduct

performance measurements. Consider selecting

one youth program and one adult program for

purposes of measurement until your department

becomes more comfortable with the process. 

Decisions about the programs to be measured

can be based on a number of factors.

Program Considerations:

A natural starting point might be to select a 

program that lends itself to both the incorporation

of heart-healthy activities and suitability for

conducting pretests and posttests.

People Considerations:

You might decide to measure whether the 

program changed the attitudes and behavior of,

say, overweight males between the ages of 20

and 50. You might decide to use a group for

whom you can easily secure permission for

involvement in measurement or whose involvement lends itself to the pretest and posttest

measurement schedule.
84

Appendix A contains the Program Design

and Development Tracking Sheet. The following information moves through the decisions

that need to be made.

CONDUCTING THE ASSESSMENT

You know at this point which programs are

going to be measured. Make sure program staff

incorporated heart-healthy elements into their

scheduled program activities. Just take a few

minutes to check these activities necessary to

ensure the value of this process.

Selecting and Using Assessment Tools

Be sure to select assessment tools that are

appropriate for the specific group whose 

outcomes are being measured. See the 

measures included in appendix A for guidance.

Example: Giving children a survey that they

are unable to comprehend would influence the

results OR giving people an instrument measuring

knowledge of blood pressure when you want to

measure food shopping habits would be useless.

Pretests and Posttests. To measure changes in

knowledge, skills, attitudes, or behavior, it is 

necessary to measure them before the program

starts and after the program ends. A second 

followup 6 months or after completion of the

program, is of even greater value to see if

changes continue over time.

Example: Youth enrolled in a summer camp 

program complete the Physical Activity pretest

on the first day of camp and then the posttest

on the last day of camp. OR participants in a

senior exercise program complete the Food and

Eating Habits survey during the first week of

class and then again at the end of the 10

weeks.

Size of Sample. It is not necessary to survey all

participants in a program. Select a manageable

number to be surveyed who are representative

of the program population. Suppose your 

community has six after-school programs.

Rather than survey all children in each 

program, survey 20 percent of the participants

in each program or all participants in two of

the six programs.

The Need for Consistency. The approaches and

timing of the pretests and posttests should be

as consistent as possible. Things you should

try to keep the same include instructions to 

participants about completing surveys as well

as the time and day if tests are administered to

more than one group with similar members. If

staff at one day camp helped children complete

their food forms and staff at other day camps

did not, the results may differ. If two groups of

senior citizens are not given the test on the

same day and the second group takes the test

after a news story on heart disease, that too

could change the results.

Tracking Participants. The tests track changes

in knowledge, attitudes, and behaviors. Assign

each individual a number to help ensure privacy;

use the same number on both pretest and

posttest.

Informed Consent. You must obtain the

informed consent of participants in the tests. 

If your participants are under 18, you must

seek informed consent from their parents. 

Example: As part of the day camp registration

parents were sent a letter indicating that their

child would be part of this program, asked to

sign a consent form and given a phone number

to contact the department if they had any 

questions or objections. Adults are asked to

sign a form indicating their understanding of

what they will be asked to do as part of this

process and their agreement.
85

In appendices A and B are several items to help you conduct assessments.

They include:

■ Survey instruments: “What’s Your Food, Physical Activity and Heart Health I.Q.” for children,

adolescents, and adults 

■ Answer keys for the surveys

■ Score sheets for the surveys

■ Log sheets to record participant identification numbers

■ Tracking sheets

■ Sample permission letter

■ Sample permission form

The following are activities and resources that you might use as part of the 

programming aspect to help people better understand heart-healthy behavior.

Possible Outcomes:

■ Increase their knowledge of leisure-time physical activity

■ Increase their skill levels in leisure-time physical activity

■ Improve their attitude towards physical activity

■ Increase their level of physical activity

■ Increase their knowledge of healthy eating

■ Increase their skill level related to healthy eating

■ Improve their attitude towards healthy eating

■ Increase their level of healthy eating

Appropriate Reproducibles:

■ See Resources chart, Information Sheets on page 49. These materials are found in the 

reproducible section of this guide.
86

Your department can take various steps to increase the accuracy of outcome measurements:

Program Group and Comparison Group. Outcomes measurement in community

recreation programs usually involves one group—for example, all adults who attend a swimming program.

To improve the accuracy of your assessment results, create a comparison group and involve one of those

program groups in the heart-healthy information and activities. The other program group called the comparison group is not exposed to the healthy information and activities.

Example: Your department sponsors after-school programs at several local elementary schools. Some of

the programs receive the special heart-healthy activities and some of them do not, but both groups take

pretests and posttests.

Self-Selected Groups. Most participants in recreation programs are self-selected, meaning that they

themselves made the decision to become involved or, in the case of children, have parents who made that

decision for them. This means that your measurements cannot necessarily be generalized to a larger population, such as all senior citizens or all Hispanic women.

Example: Teens who regularly show up at your department’s midnight basketball program may be different

from other teens in the neighborhood who choose not to be a part of this program.

Random Selection. You can also improve the generalizability of your assessment by randomly selecting

the participants whose outcomes will be measured. In this way, participation in the program is determined

by chance, ensuring that those tested are more representative of the larger population.

Example: Slips of paper with the names of 50 adults in a senior lunch program are placed in a bowl; the

first 20 names randomly selected are invited to participate in a fitness program. If you can’t select participants randomly, you may be able to systematically select program sites. That will allow you to avoid selecting sites whose outcomes might bias the results because these sites are more conveniently located for

participants or because more program staff members have a greater interest in operating the program.

Multiple Measures. Another way to boost the rigor of your assessment is to use all of the measures in

the sample surveys.

ANALYZING AND REPORTING RESULTS

Instructions for administering and scoring your

participants’ performance assessments are 

provided on pages 91 and 92. Answer keys and

scoring sheets are found in appendix B.

■ Be sure that you’ve selected the right

instruments—children, for example, should

take tests designed for children in their age

bracket.

■ Be sure that you’ve selected the right 

scoring sheets.

After you’ve scored each individual test, add

up the scores of all participants and divide by

the number of participants. This will give you

the average score for the group. It may help

you to write all the scores on one page, total

them, then divide by the number of scores.
87

DISPLAYING THE RESULTS

The scoring sections have been grouped

according to knowledge, attitudes, and 

behaviors regarding healthy eating and 

physical activity. Why not create related

posters or trifold bulletin boards? 

■ After you’ve scored the pretests, display 

the group scores on a bulletin board and

challenge participants to improve their

scores when they take the posttest. 

■ After you’ve scored the posttests, display

the scores next to the pretest scores.

■ Congratulate participants and site personnel

on a job well done if scores improve, even if

the improvement is small. 

■ If you don’t see improvement at posttest,

check your scoring. Maybe you’ve made a

simple error. If not, encourage participants

to do better next time. 

Utilize graphic resources in the guide or 

download clip art from the Web to highlight

the scores. 
✔Performance

Indicators

88

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

GETTING STARTED

____Ask program staff to use tracking sheets to record distribution of program information to 

participants and of activities engaged in by participants.

____During training, identify programs that will be involved in the performance measurement process.

____Hold training for staff who will be involved in performance measurement.

____Determine the elements to be measured in each program so the programs can be planned accordingly.

MOVING FORWARD

____Develop program schedules that include adequate time for pretests and posttests.

____Coordinate the program schedule and the pretest and posttest dates with the presentation of 

information and activities that are being measured.

____Appoint someone to make sure that program activities and testing schedule stay on target.

____Hold an orientation meeting for staff who will deliver the program and administer the pretest 

and posttest.

____Appoint someone to be responsible for analysis of the tests.

____Ask that information on program implementation be forwarded to the program coordinator so it 

can be shared with staff, partners, and the NHLBI.

KEEP THE BEAT

____Use the information from measurement indicators to create greater visibility for your efforts 

and to make program modifications.

____Identify other programs or services whose outcomes will be measured.

____Share results of measurement indicators with staff, partners, decision-makers, the media, and 

the public.
89

People Involved: Program supervisors and other staff whose programs have been selected for 

outcomes measurement.

Time Allotted: 2 hours

Goals:

1. Create an understanding of the performance measurement process and its elements.

2. Review the measurement instruments.

3. Identify informational materials and program activities that support program goals and desired outcomes.

4. Address questions and concerns.

Materials and Resources (Appendix A):

■ Pretest and posttests (appendix A)

■ Permission letters/forms (appendix A)

■ Program Design and Development Tracking Sheet (appendix A)

■ Directions (“Recommendations for Administering the Pretests and Posttests” is a good resource for

staff training.) (pages 91 and 92)

Overheads or Handouts:

■ FAQ—activity and outcome indicators (at the end of this chapter, page 93)

■ Program Design and Development Tracking Sheet (appendix A)

■ “Conducting the Assessment” (this chapter, page 84)

■ “Do You Know?” information boxes (this chapter, page 86)

Suggested Topics and Activities:

Overview of Outcomes Measurement Process (45 minutes):

■ Why outcomes

■ Difference between activity measures and outcomes measures

■ Measurement requirements

■ Improving the accuracy of the results

OUTLINE OF STAFF TRAINING FOR
OUTLINE OF STAFF TRAINING FOR

90

Staff Tasks (45 minutes):

■ Permission letters and forms

■ Tracking sheets

■ Timing of pretest and posttest

■ Directions for conducting tests

■ Identify or reinforce the program activities that relate to the outcomes being measured

Break (10 minutes):

Creating a program and schedule (40 minutes):

■ Selecting appropriate information

■ Designing and delivery of activities and exercises

■ Coordinating activities and testing

Role play test administration (10 minutes):

■ Read instructions

■ Pass out materials

■ Take the tests

Questions, Comments, Suggestions (10 minutes)
91

1. It is important to administer pretests before

the program begins.

You should allow about 45 minutes for a 

group to complete the questionnaire. It is also

important that adult participants not consult

one another, and that children not share

answers. Try to find a place for the assessment

that is quiet and allows a reasonable amount of

space between participants.

If you do not want to conduct a single 

45-minute assessment, administer sections of

the questionnaire at separate times for, say,

20 minutes each (for example, nutrition section

one day, physical activity the next). If you do so,

make sure that all sections are completed within

a few days. Don’t let the time between the start

and finish of a test span more than a week.

2. Emphasize to participants that the purpose

of questionnaires is not to evaluate them

personally.

Explain that their identities and answers will

remain confidential and that the results will be

displayed only as group results. Try not to

refer to them as “tests.”

3. Use a log sheet to keep track of every person

who completes a pretest and posttest.

It is important to evaluate participants by

matching pretest and posttest results. 

Assign IDs that are consistent in format and

anonymous for each test-taker. A Hearts N’

Parks log sheet is provided to keep track of

participants’ names and IDs (so that you can be

sure to match up names and numbers for

pretest and posttest). Keep this log sheet private.

4. If administering a questionnaire becomes

unmanageable because of the number of

participants, you may be better off using 

a small sample.

If possible, let the sample consist of 40 to 50

test-takers per age group.

If you decide to select a sample, you have a

few choices:

If you administer multiple programs, select one

with a sufficient number of participants (more

than 20) to take part in the pretest and posttest.

You can create a random sample by having 

all participants pick numbers out of a hat to

determine which ones will complete the 

instruments. Make sure that the same people

selected for the pretest are the ones who take

the program posttest. (Don’t do a separate hat

drawing for the posttest.)

If your program is small (less than 30 in an

age group), it is important to have every 

participant complete a pretest and posttest.

5. Note the ID blanks on the first page of the

tests and make sure cover sheets are

attached to questionnaires.

The cover sheet indicates whether the test is to

be taken before the program begins or after it

ends. Participants’ IDs are to be written on

these sheets so that pretests and posttests can

be matched up. 

The pretest and posttest formats for the adult

and adolescent tests are identical, but different

cover sheets are provided (to distinguish the

adults’ and adolescents’ questionnaires as

pretests or posttests). Attach the appropriate

cover sheet.

Children’s pretests and posttests are slightly

different in format so the pretests and posttests

have a different cover sheet. 

Using different colors of paper for the pretest

and posttest can help prevent mix-ups.

6. If you conducted a program that did not

discuss the causes of high blood pressure

or how to control high cholesterol, participants need not complete those sections of

the pretest and posttest.

RECOMMENDATIONS FOR ADMINISTERING HEARTS N’ PARKS
92

7. Scoring and Displaying Group Scores.

Score sheets and answer keys are provided for

each type of questionnaire. Follow the directions on the score sheets and use the answer

keys to record test scores. Add the scores

together for everyone in the same group, and

then divide by the number of test-takers to

determine the group’s mean score on each 

section. You may break down scores by section

to focus on knowledge, attitude, behavior, etc.,

or to look specifically at heart-healthy eating

or physical activity.

Example: Adolescent Questionnaires—Participants’ Scores

Nutrition knowledge scores:

7+7+6+10+11+9+9+8+12+9= 88 ÷ 10=8.8

Mean score for the group (n=10 participants) is 8.8 out of 12.

Overweight/obesity knowledge scores:

5+9+6+9+9+8+7+6+8+5=72 ÷ 10=7.2

Mean score for the group (n=10) is 7.2 out of 9.

Attitude toward healthy eating scores:

24+32+30+22+29+36+35+21+25+27=281 ÷ 10=28.1

Mean score for the group (n=10) is 28.1 out of 40.

Overweight/obesity attitude scores:

22+26+25+30+29+24+23+23+20+22=244 ÷ 10=24.4

Mean score for the group (n=10) is 24.4 out of 32.

Healthy eating behavior scores:

4+5+4+7+5+5+6+5+7+4=52 ÷ 10=5.2

Mean score for the group (n=10) is 5.2 out of 8.

Healthy eating intentions scores:

4+3+2+5+3+6+4+3+3+5=38 ÷ 10=3.8

Mean score for the group (n=10) is 3.8 out of 7.

RECOMMENDATIONS FOR ADMINISTERING HEARTS N’ PARKS

Consider creating a display of group scores on

a poster or bulletin board to highlight improvements made by participants in the program.

Highlighting group improvements could serve

to motivate participants toward continued good

health.

Do not display or discuss individual scores

openly. However, if an individual asks about

his/her scores, you should discuss them with

him/her in private.
?

?

?

?

?

?

?

?

?

93

1 What is the purpose of using the

performance measures and how

would I use the information once I

got it?

Performance measures are the best way of

tracking the progress of participants. A

record of progress can be a good motivator

for further progression and an indicator of

program success to be shared with the 

program’s management and partners,

as well as with the media. Likewise,

quantitative performance measurements

can be used as evidence of improvement to

be displayed on fact sheets and posters that

generate excitement about progress gained

by participants in the community. 

The success of the Hearts N’ Parks program,

as well as your own specific program,

relies heavily on the ability of the NRPA

and the NHLBI to evaluate participants’

development. These questionnaires help to

show not only how participants’ knowledge

and habits have progressed, but also what

specific parts of the program are in need of

modification, and where some programs

may need help relative to others.

2 What if I don’t have time to have my

participants fill out questionnaires?

The central purpose of the program is to

help people learn how to live more hearthealthy lives, not to take questionnaires.

Program coordinators should schedule time

for filling out questionnaires so that 

valuable learning and activity times are 

not missed for the sake of completing the

questionnaires. 

3 How are activity indicators different

from outcome indicators?

An activity indicator refers to Hearts 

N’ Parks activities conducted by your

department.

An outcome indicator measures the impact

of these activities on participants.

HEARTS N’ PARKS: CELEBRATING AND SHARING

Celebrating & Sharing95

We urge you to take advantage of the guidance,

recommendations, and examples in this guide. It

will be a valuable tool for both establishing and

maintaining a successful Hearts N’ Parks program.

Refer to it often and make copies of it for your staff.

This chapter provides recommendations for 

celebrating the completion of your first Hearts N’

Parks program, ways of sharing the program’s

accomplishments with partners and the community,

and suggestions for sustaining the program in the

future.

CELEBRATING

Completing the Hearts N’ Parks program at your

agency deserves recognition. Enjoy a job well

done! Take the time to celebrate everyone’s 

contributions, progress, and successes (including

your own). Also, remember to celebrate what

you’ve learned and the challenges you’ve met

during the program. Participants, program staff,

and partners all deserve recognition.

■ A closing get-together or wrap-up event is 

a great way to celebrate and applaud the efforts

and accomplishments of your three principal

groups: participants, program staff, and partners.

– Participants: Encourage invitees to bring

along family members and friends. Have a

heart-healthy potluck feast. Pass out 

honorary stars or ribbons to kids, and pins

to adults, as a way of praising the efforts of

all participants. 

– Personnel: Let them know that their 

contributions were valuable. Award 

certificates of appreciation. Consider 

creating an entertaining video diary of

Hearts N’Parks Behind the Scenes to 

show at the wrap-up event. 

– Partners: Express your appreciation to your

partners. Thank them personally and in 

writing for their support. Encourage them to

stay involved so that the program can grow

and improve over time. 

■ Throughout the program, take photos of your

participants, program staff, and partners in

action. Then post the photos to provide recognition of their commitment and service. This

type of postprogram promotion can help sustain

interest in and awareness of the program and

its lessons before the next program begins.

SHARING

Sharing the program’s achievements is an 

important way of forming and sustaining a 

positive perception of the program, enabling it to

flourish in the long term.

■ Media: Sharing program achievements with

the media is a very important task. Contact

media outlets to let them know the program

has been completed. If they provided any news

about your program when it began, they will 

probably be interested in doing a followup

piece. Discuss with them the highlights of your

program, how many participants you had, and

what types of achievements were made.

Consider telling them about some aspect of the

program or providing an anecdote that would

make an interesting news story.

■ Focus Groups: Conduct an informal “focus

group” of participants, partners, and staff to

share thoughts about the program. Encourage

everyone to tell about their experiences with

the program. Keep the mood upbeat, but don’t

be shy about discussing challenges that came

up. Solicit suggestions about how the program

can be improved.
96

■ Displays: Create a display piece that chronicles

the program with photos and highlights along

with information about when it will take place

again. Place the display where members of the

community will see it, such as your community

center’s entrance or on a community bulletin

board at a store, college, or public library.

■ Followup: Update interested parties on 

program activities and participant progress.

Remember to highlight their contributions to

the program.

– Contact the families of participants to let

them know how much you appreciated 

getting to know their family member and

to share the program’s activities. Express

the hope that they will continue to 

be involved in the program and will 

encourage others to join.

– If you had a partner organization or 

program, send a letter of appreciation to its

president or chairperson. If the recent 

partnership was successful, express 

willingness to work together in the future.

Make a few suggestions about possibilities

and let them know that you’re willing to

help out.

– Acknowledge the contribution of your

agency’s director or senior management.

Their support and interest are necessary to

maintain the program. Share the results of

performance assessments with partners,

program staff, participants, and the 

community, if you can. Changes measured

by these tests will help everyone feel proud

of the program. It will also raise the 

visibility of your agency.

■ Refer to 3rd P—Public Visibility for 

suggestions about “moving the messages.”

See how you can employ these ideas to

share the Hearts N’ Parks message with

community members who are not yet

involved with the program.

Celebrating and sharing are important 

conclusions to your Hearts N’ Parks program.

Afterward, take a breather. Enjoy your success,

but remember that Hearts N’ Parks is an 

ongoing pursuit for your agency as well as

your community.

SUSTAINING

Sustaining is the final piece of Hearts N’ Parks.

Because you’ve designed the program based on

your community’s needs and your agency’s

abilities, continuing it will be easy. To keep

participants, program staff, and partners interested,

use the suggested tools to change, expand, and

improve the program.

■ Use performance assessments as a tool for

evaluating and improving your program.

They provide the means by which Hearts 

N’ Parks officials at both local and national 

levels can identify shortcomings and 

overcome them, as well as bring successes

to light. This kind of evidence allows you to

promote Hearts N’ Parks as an effective

long-term program for making your 

community more heart-healthy.

■ Solicit feedback from everyone involved

about continuing the program. How would

they do it? What would they change? What

new activities could be incorporated into the

program? Do they have ideas about reaching

a new audience? Once you’ve solicited feedback, ask them for help to enact their ideas

and suggestions.

■ Be visible in your community. March in

community parades. Offer to speak about

the program at schools and club meetings.

■ Take on the challenge of a new program.

Once you’ve finished your first Hearts N’

Parks program, consider making changes to

it. Not only will this help you reach a new

group of participants, it will also keep your

current participants, program staff, and 

partners motivated.
97

Remember that the goal of Hearts N’ Parks is to increase the number of children and adults who

engage in heart-healthy behavior. Cardiovascular disease is the #1 killer in the United States, and

lifestyle changes incorporating heart-healthy behavior are the most important step toward prevention.

Heart-healthy behavior can prevent the development of cardiovascular disease and reduce its

severity for those who already have it. Heart-healthy behavior includes a diet low in calories, saturated fat, cholesterol, and sodium, and rich in fruits and vegetables, low-fat dairy foods, and whole

grains in combination with regular physical activity.

Hearts N’ Parks provides the tools to get the heart-healthy message out to those want to hear it

and those who need to hear it. The program’s ideas and suggestions are designed to be easy to

implement and fun to do. Use these tools and share them with your colleagues.


a

Program Design and Development: Tracking Sheet...to record information about

each of your Hearts N’ Parks programs.

Log Sheet...to assign and track participants’

identification numbers.

Consent Forms...to inform parents and other

participants of the program’s intent. Performance Questionnaires...to assess

changes in knowledge, attitudes, and practices

regarding heart-healthy eating and physical activity 

of children, adolescents, and adults.

• Prequestionnaires are used to measure baseline

information of participants before the program begins.

• Postquestionnaires are used to measure any

changes possibly due to the program’s content.

(See directions on reverse side.)
Child A-21

What kinds of things do you like to do or would like to learn how to do? 

For each of the activities below, please put check marks ( √ ) to let us know if: 

This is something you LIKE to do.

This is something YOU’VE DONE in the past week.

This is something you would like to LEARN how to do.

Games (tag, hopscotch, 4-square, dodgeball, 

kickball, etc.)

Exercises (jumping jacks, running, etc.)

Jump Rope

Basketball

Football

Soccer

Softball/ Baseball

Volleyball

Swimming

Tennis

Biking

Bowling

Dancing

Roller-skating, Roller-blading, Skateboarding

I like to

do this

I’ve done

this in the

past week

I would like to

learn how to

do this

.

.

.

Things I likeand things Ido

Child A-33

What kinds of things have you been doing with parks and recreation?

For each of the activities below, please put check marks (✔) to let us know if: 

.This is something NEW you LEARNED here at parks and recreation.

.This is something you GOT BETTER at during your time with parks and recreation.

.This is something you’d like to PLAY AGAIN after your parks and recreation time is over.

Games (tag, hopscotch, 4-square, dodgeball, 

kickball, etc.)

Exercises (jumping jacks, running, etc.)

Jump Rope

Basketball

Football

Soccer

Softball/ Baseball

Volleyball

Swimming

Tennis

Biking

Bowling

Dancing

Roller-skating, Roller-blading, Skateboarding

Something

new I learned

I got better

at this

I would like

to play this

again

I learnedanddidthis summer

Things

A-2

The questionnaires are grouped by age first,

then by whether they are pre- or postquestionnaires.

How to use the

Performance Questionnaires

For example:

2

1

1. Give one copy of the prequestionnaire

to each participant prior to beginning the

program.

2. Give one copy of the postquestionnaire

after completing the program.

Child

Adolescent and Adult

Please refer to the Community Mobilization Guide: 5th P

for more information on how to administer Performance

Indicator Instruments.

For adolescents and adults, the pre- and postquestionnaires are identical. Therefore, only

one set of questions is provided along with the 

appropriate pre- and postquestionnaire cover sheets.

At the beginning of your program, assess the 

performance of adolescents and adults by doing

the following:

1. Reproduce the questionnaire and use the

prequestionnaire cover sheet.

2. Give one copy of the prequestionnaire to

each participant.

At the end of your program, assess changes by

doing the following:

1. Reproduce the same questionnaire and use the

postquestionnaire cover sheet.

2.Give one copy of the postquestionnaire to each

participant completing the program

Child A-13

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

ID__________ DATE__________

heart health

WHAT’S YOUR

physical activity,

&

food,

Child PREQUESTIONNAIRE

Child A-25

ID__________ DATE__________

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

Child POSTQUESTIONNAIRE

ID__________ DATE__________

heart health, 

WHAT’S YOUR

physical activity,

&

food,

Adolescent A-37

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

ID__________ DATE__________

heart health

WHAT’S YOUR

physical activity,

&

food,

Adolescent PREQUESTIONNAIRE

Adolescent A-39

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

✲

✲

Adolescent POSTQUESTIONNAIRE

ID__________ DATE__________

heart health

WHAT’S YOUR

physical activity,

&

food,

HEARTS N’ PARKS

Adolescent A-41

Heart-healthyeating

Please answer each of the following questions by circling your answer. 

Mark only one answer for each question.

3. Joe ate cereal with milk and a banana and drank orange juice for breakfast. 

How many different food groups did Joe eat from? 

1 2 3 4 Don’t Know

4. What is a “balanced diet”? 

a. Eating lots of fruit and vegetables

b. Eating the same foods every day

c. Eating the exact same amount of food from each food group

d. Eating different foods from all the food groups

5. If you want to eat more fruit, which of the following would you choose?

a. Orange soda

b. Grape jelly

c. A banana

d. Strawberry ice cream

6. From which food group should you eat the most servings a day? 

a. Bread, cereal, rice, and pasta

b. Meat, poultry, fish, eggs, dry beans, and nuts

c. Vegetable

d. Fruit
A-3

Use this tracking sheet to record information about each one of the Hearts N’ Parks programs

that uses performance indicators.

Site Name 

and Location: _______________________________________________________________________

Program

Name: _____________________________________________________________________________

If you are running multiple programs under a common name, please specify which one this is:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

1. Number of participants at start of program: ____________ Start Date: _______________

2. Number of participants at completion: ____________ Completion Date: _____________

3. Total length of program (in weeks and days): ____________

Names and Date(s) of Pretest:__________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Names and Date(s) of Posttest:_________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

4. How many days per week did your program run? ____________

5. How many hours per day did it run on average? ____________

A-1

PROGRAM DESIGN & DEVELOPMENT

Tracking Sheet
A-4

6. People Served: (check all that apply)

____ Children ____ Adolescents

____ Young Adults ____ Adults

____ Older Adults ____ At-Risk Group (specify): ______________________

____ Special Population (specify):___________________________________________________

Approximate Numbers: Male ____ Female ____

7. Permission Secured:

Parental information letter________________________________________________________

Participant release form _________________________________________________________

Other: _______________________________________________________________________

8. Recreational Objectives: (based upon your department or program goals)

a.________________________________________________________________________________

b.________________________________________________________________________________

c.________________________________________________________________________________

9. Target Areas:

____ Physical Activity ____ Nutrition ____ Both

10. Change Level: (please check all that apply)

____ Knowledge ____ Skill ____ Attitude ____ Behavior

11. Outcomes - On the basis of the decisions made above, please select the appropriate outcomes:

____ Increase participants’ knowledge of leisure-time physical activity

____ Increase participants’ skill levels in leisure-time physical activity

____ Improve participants’ attitudes towards physical activity

____ Increase participants’ levels of physical activity

____ Increase participants’ knowledge of healthy eating

____ Increase participants’ skill levels related to healthy eating

____ Improve participants’ attitudes towards healthy eating

____ Increase participants’ level of healthy eating

✐
A-5

12. Specific Program Activities Designed to Support the Outcomes:

a._______________________________________________ Date:_______________________

b._______________________________________________ Date:_______________________

c._______________________________________________ Date:_______________________

d._______________________________________________ Date:_______________________

e._______________________________________________ Date:_______________________

f. _______________________________________________ Date:_______________________

g._______________________________________________ Date:_______________________

h._______________________________________________ Date:_______________________

13. How many coordinators helped run the program? ______

14. Program/Testing Coordination:

Staff Orientation & Training for Program Activities

Date(s): _________________________ By whom: _________________________

Staff Orientation & Training for Pre- and Posttesting

Date(s): _________________________ By whom: _________________________

15. Please list the different types of materials (i.e., educational, instructional, and activity-based

materials) used in your program or distributed to participants:

a.___________________________________________________________________________

b.___________________________________________________________________________

c.___________________________________________________________________________

d.___________________________________________________________________________

e.___________________________________________________________________________

f. ___________________________________________________________________________

g.___________________________________________________________________________

h.___________________________________________________________________________
A-6
A-7

Use this sheet to assign and track participants’ identification numbers.

Using identification numbers rather than names will ensure participant confidentiality.

Site: ______________________________________________________________________________

Date:__________________ Group:________________ Leader:_____________________________

ID Name ID Name

PA R TICIPANT

Log Sheet
A-8
A-9

Introductory Letter

Send this letter home to parents of the children in your Hearts N’ Parks program. It will introduce Hearts N’

Parks and obtain both their support of the program as well as their permission for their child to participate.

[On Agency Letterhead]

DEAR PARENT,

SINCERELY,

[NAME]

[TITLE]

[OFFICE]

Dear Parent,

Did you know that the prevalence of overweight and the trends in overweight for 

children and adolescents in the U.S. population is on the rise and is the highest it has

ever been? Did you know that recent data shows a decline in vigorous amounts of 

physical activity in the nation’s youth? 

Participation in leisure time physical activity and changes in heart-healthy eating have

the potential for improving the health and well-being of our children. To better meet this 

potential, the __________ [fill in the name of the department] has joined with the

National Recreation and Park Association (NRPA) in cooperation with the National

Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health to

implement a Hearts N’ Parks program in our community.

As part of this process, your child will be asked to complete short quizzes from the

NRPA with questions about heart-healthy behaviors and new physical activities they have

learned during their recreation program with us. We welcome your cooperation with 

this project. If you have any questions or would like to learn more information about 

this project, please feel free to contact us at the Park and Recreation Department. 

Our project coordinator is ______________ [insert name] and can be reached at

___________ [insert phone number]. 

We have enclosed a permission slip for you to sign and return, allowing your child to 

participate in the Hearts N’ Parks program. 

Thanks so much, and we look forward to providing your child with a safe, healthy,

and fun experience.

Sincerely,

[Name]

[Title]

[Office]
A-10

Consent Form for Parents

Thank you for joining us in the Hearts N’ Parks program being conducted by the

_______________ (name of site) in cooperation with the National Heart, Lung, and

Blood Institute (NHLBI) and the National Recreation and Park Association (NRPA).

I, [your name] , understand that my child will be asked to answer questions related

to his/her knowledge, attitudes, and behaviors regarding heart-healthy eating

and physical activity. All of his/her answers will be kept confidential and his/her

individual scores will not be reported to anyone. Only group scores will be used to

gain some understanding of whether the Hearts N’ Parks program impacted the

group’s knowledge, attitudes, or behaviors in regard to heart-healthy eating and physical activity. In addition, my child’s name will not appear on any of the tests that

he/she completes. 

I also understand that if my child is uncomfortable answering any of the questions,

he/she is free to not answer them. Refusing to answer any questions will in no way

affect my child’s participation in any of the programs. 

______________________ ___________________

Signature Date
A-11

Consent Form for Adults

Thank you for joining us in the Hearts N’ Parks program being conducted

by the _____________(name of site) in cooperation with the National

Heart, Lung, and Blood Institute (NHLBI) and the National Recreation

and Park Association (NRPA). 

I, [your name] , understand that I will be asked to answer questions

related to my knowledge, attitudes, and behaviors regarding heart-healthy

habits of nutrition and physical activity. All of my answers will be kept

confidential and my individual scores will not be reported to anyone. 

Only group scores will be used to gain some understanding of whether the

Hearts N’ Parks program impacted my group’s knowledge, attitudes,

or behaviors in regard to heart-healthy eating and physical activity. 

In addition, my name will not appear on any of the tests that I complete. 

I also understand that if I am uncomfortable answering any of the

questions, I am free to not answer them. Refusing to answer any 

questions will in no way affect my participation in any of the programs. 

______________________ ___________________

Signature Date
A-12
Child A-13

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

ID__________ DATE__________

heart health

WHAT’S YOUR

physical activity,

&

food,

Child PREQUESTIONNAIRE
A-14 Child

1. Are you a...

❑ Boy or ❑ Girl ?

2. Your age is...

❑ a. under 6 years old

❑ b. 6 or 7 years old

❑ c. 8 or 9 years old

❑ d. 10 or 11 years old

Check the correct box!

✔
Child A-15

Instructions: Circle one of the two foods that you think is better for your health.

1. Doughnut Toast

2. Orange Cookies

3. Whole Wheat Bread White Bread

Which food 

is better for your health?
A-16 Child

4. Cold Cereal Eggs and Bacon

5. Regular Milk Low-fat or Fat-free Milk

6. Green Salad French Fries

7. Grapes Candy Bar 
Child A-17

1. Baked Potato French Fries

2. Fruit Juice Soda

3. Cookies Apple

Instructions: Circle one of the two foods that you eat most often.

do you eat 

most of the time?

What foods
A-18 Child

4. Hot Dog Sandwich with Lettuce & Tomato

5. Chocolate Cake Orange

6. Ice Cream Fresh Fruit Popsicle

7. Regular Milk Low-fat or Fat-free Milk
Child A-19

Instructions: Answer each question by choosing one of the two foods.

1. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

2. If you were going to eat your lunch, which would you do?

Eat the food without adding salt Shake salt on the food before eating

3. Which food would you put on your hamburger?

Ketchup Tomato

What would you do?
A-20 Child

4. Which would you pick to drink?

Regular Milk Low-fat or Fat-free Milk

5. Which food would you eat for a snack?

Candy Bar Fresh Fruit

6. Which food would you choose for dinner?

Baked Potato French Fries

7. Which would you order if you were going to eat at a fast food restaurant?

Hamburger Green Salad
Child A-21

What kinds of things do you like to do or would like to learn how to do? 

For each of the activities below, please put check marks ( √ ) to let us know if:

This is something you LIKE to do.

This is something YOU’VE DONE in the past week.

This is something you would like to LEARN how to do.

Games (tag, hopscotch, 4-square, dodgeball, 

kickball, etc.)

Exercises (jumping jacks, running, etc.)

Jump Rope

Basketball

Football

Soccer

Softball/Baseball

Volleyball

Swimming

Tennis

Biking

Bowling

Dancing

Rollerskating, Rollerblading, Skateboarding

I like to

do this

I’ve done

this in the

past week

I would like to

learn how to

do this

.

.

.

Things I likeand things Ido
A-22 Child
Child A-23

Please circle your answers.

Remember there are no right or wrong answers.

1. I would rather watch TV than play sports or be active.

Yes No Sometimes

2. People who play sports or are active seem to have a lot 

of fun doing it.

Yes No Sometimes

3. How do you feel about your ability to kick a ball hard and hit 

a target, like soccer?

☺ Great . Okay / Not Good

4. How do you feel about your ability to run a long way without 

stopping?

☺ Great . Okay / Not Good

5. How do you feel about your ability to hit a ball with a bat,

like softball?

☺ Great . Okay / Not Good

6. How do you feel about your ability to play many different 

games and sports?

☺ Great . Okay / Not Good

☺

Physical

Activity and 

You!
A-24 Child
ID__________ DATE__________

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

Child POSTQUESTIONNAIRE

ID__________ DATE__________

heart health 

WHAT’S YOUR

physical activity,

&

food,

Child A-25
A-26 Child

Check the correct box!

✔

1. Are you a... ❑ Boy or ❑ Girl ?

2. Your age is... ❑ a. Under 6 years old

❑ b. 6 or 7 years old

❑ c. 8 or 9 years old

❑ d. 10 or 11 years old
Child A-27

Which food 

is better for your health?

Instructions: Circle one of the two foods that you think is better for your health.

1. Doughnut Toast

2. Orange Cookies

3. Whole Wheat Bread White Bread
A-28 Child

4. Cold Cereal Eggs and Bacon

5. Regular Milk Low-fat or Fat-free Milk

6. Green Salad French Fries

7. Grapes Candy Bar 
Child A-29

1. Baked Potato French Fries

2. Fruit Juice Soda

3. Cookies Apple

Instructions: Circle one of the two foods that you eat most often.

do you eat 

most of the time?

What foods
A-30 Child

4. Hot Dog Sandwich with Lettuce & Tomato

5. Chocolate Cake Orange

6. Ice Cream Fresh Fruit Popsicle

7. Regular Milk Low-fat or Fat-free Milk
Child A-31

Instructions: Answer each question by choosing one of the two foods.

1. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

2. If you were going to eat your lunch, which would you do?

Eat the food without adding salt Shake salt on the food before eating

3. Which food would you put on your hamburger?

Ketchup Tomato

What would you do?
A-32 Child

4. Which would you pick to drink?

Regular Milk Low-fat or Fat-free Milk

5. Which food would you eat for a snack?

Candy Bar Fresh Fruit

6. Which food would you choose for dinner?

Baked Potato French Fries

7. Which would you order if you were going to eat at a fast food restaurant?

Hamburger Green Salad
Child A-33

What kinds of things have you been doing with parks and recreation?

For each of the activities below, please put check marks (✔) to let us know if:

.This is something NEW you LEARNED here at parks and recreation.

.This is something you GOT BETTER at during your time with parks and recreation.

.This is something you’d like to PLAY AGAIN after your parks and recreation time is over.

Games (tag, hopscotch, 4-square, dodgeball, 

kickball, etc.)

Exercises (jumping jacks, running, etc.)

Jump Rope

Basketball

Football

Soccer

Softball/Baseball

Volleyball

Swimming

Tennis

Biking

Bowling

Dancing

Rollerskating, Rollerblading, Skateboarding

Something

new I learned

I got better

at this

I would like to

play this

again

I learnedanddidthis summer

Things
A-34 Child
Child A-35

Please circle your answers.

Remember there are no right or wrong answers.

1. I would rather watch TV than play sports or be active.

Yes No Sometimes

2. People who play sports or are active seem to have a lot of fun doing it.

Yes No Sometimes

3. How do you feel about your ability to kick a ball hard and hit a target, like soccer?

☺ Great . Okay / Not Good

4. How do you feel about your ability to run a long way without stopping?

☺ Great . Okay / Not Good

5. How do you feel about your ability to hit a ball with a bat, like softball?

☺ Great . Okay / Not Good

6. How do you feel about your ability to play many different games and sports?

☺ Great . Okay / Not Good

☺

Physical

Y

Activity and 

ou! ☺
A-36 Child
Adolescent A-37

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

ID__________ DATE__________

heart health

WHAT’S YOUR

physical activity,

&

food,

Adolescent PREQUESTIONNAIRE
A-38 Adolescent
Adolescent A-39

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

✲

✲

Adolescent POSTQUESTIONNAIRE

ID__________ DATE__________

heart health

WHAT’S YOUR

physical activity,

&

food,
A-40 Adolescent

1. Are you a...

❑ Boy or ❑ Girl ?

2. Your age is...

❑ a.12 or 13

❑ b.14 or 15

❑ c.16 or 17

❑ d.18 or over

Check the correct box!

✔
Adolescent A-41

Heart-healthyeating

Please answer each of the following questions by circling your answer.

Mark only one answer for each question.

3. Joe ate cereal with milk and a banana and drank orange juice for breakfast.

How many different food groups did Joe eat from? 

1234 Don’t Know

4. What is a “balanced diet”? 

a. Eating lots of fruit and vegetables

b. Eating the same foods every day

c. Eating the exact same amount of food from each food group

d. Eating different foods from all the food groups

5. If you want to eat more fruit, which of the following would you choose?

a. Orange soda

b. Grape jelly

c. A banana

d. Strawberry ice cream

6. From which food group should you eat the most servings a day? 

a. Bread, cereal, rice, and pasta

b. Meat, poultry, fish, eggs, dry beans, and nuts

c. Vegetable

d. Fruit
A-42 Adolescent

7. Which food is better for your health?

For each question, cIrcle which one of the two foods is better for your health.

a. Doughnut Toast

b. Orange Cookies

c. Whole Wheat Bread White Bread

d. Cold Cereal Eggs and Bacon

e. Regular Milk Low-Fat or Fat-free Milk

f. Green Salad French Fries

g. Grapes Candy Bar

h. French Fries Baked Potato

8. Please indicate whether you think the following statements are true or false by circling T or F

after each one.

True False

a. Polyunsaturated fat has the same number of calories as saturated fat.

b. The single most important change most people can make to lose 

weight is to avoid sugar.

c. Being overweight puts you at risk for heart disease.

d. Lowering sodium or salt in the diet does not always lower high blood

pressure to normal.

e. If you are overweight, losing weight helps lower your high blood

cholesterol and high blood pressure.

f. The best way to lose weight is to eat fewer calories and be physically active.

g. Overweight children are very likely to become overweight adults.

h. Skipping meals is a good way to cut down on calories.

i. Foods high in complex carbohydrates (starch and fiber) are good choices

when you are trying to lose weight.

T F

T F

T F

T F

T F

T F

T F

T F

T F
Adolescent A-43

a. I like the taste of new foods. 4 3 2 1

b. I like having fruits around for snacks. 4 3 2 1

c. I like the taste of foods that are good for me. 4 3 2 1

d. I like to choose snacks lower in fat. 4 3 2 1

4 3 2 1

4 3 2 1

4 3 2 1

4 3 2 1

4 3 2 1

4 3 2 1

a. My friends will like me.

b. My family will be proud of me.

c. My friends will want to eat over

at my house.

d. My friends will start eating

a healthy diet too.

e. I will enjoy eating as much as before.

f. I will have more energy than I do now.

9. For this question, circle the answer that best describes your opinion of each 

of the following statements:

10. If I eat healthy every day...

Strongly

Agree Agree Disagree Strongly

Disagree

Strongly

Agree Agree Disagree Strongly

Disagree
A-44 Adolescent

12. What foods do you eat most of the time? 

Circle which one of the two foods you eat most often.

a. Baked Potato French Fries

b. Fruit Juice Soda

c. Cookies Apple

d. Hot Dog Sandwich with Lettuce and Tomato

e. Chocolate Cake Orange

f. Ice Cream Fresh Fruit Popsicle

g. Sweet Roll Whole Wheat Roll

h. Regular Milk Low-fat or Fat-free Milk

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

Strongly

Agree Agree Disagree Strongly

Disagree

1 2 3 4

1 2 3 4

a. With my schedule, it’s impossible to eat right.

b. There’s too much stress in my life for me to 

handle managing my weight.

c. I just can’t let food go to waste.

d. I eat more when I’m alone than when I eat

around others.

e. When I’ve done something good, I reward

myself with food.

f. I eat more on the weekends.

g. If I’m craving food, my body must need it.

h. Some people are meant to be fat.

11. For the following statements about food and eating, please indicate whether you are in 

agreement or disagreement by circling your response in the appropriate box.
Adolescent A-45

13. What would you do? 

Answer each question by circling one of the two food choices.

a. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

b. If you were going to have lunch right now, which would you do?

Eat food without adding salt Shake salt on your food

c. Which food would you put on your hamburger?

Ketchup Tomato

d. Which would you pick to drink?

Regular Milk Low-fat or Fat-free Milk

e. Which food would you eat for a snack?

Candy Bar Fresh Fruit

f. Which food would you choose for dinner?

Baked potato French Fries

g. Which would you order if you were going to eat at a fast food restaurant?

Hamburger Salad
A-46 Adolescent
Adolescent A-47

1. In the past week, how many days were you active for at least 20 minutes in sports activities

that made you sweat and breathe hard, such as basketball, jogging, swimming laps, tennis,

fast bicycling, or similar aerobic activities?

Record the number of days per week (0–7) in the space below.

____ days

2. In the past week, how many days did you do exercises to strengthen 

or tone your muscles, such as pushups, situps, or weight lifting? 

Record the number of days per week (0–7) in the space below.

____ days

3. Which one of the following activities do you do the most 

from the time school gets out until you eat dinner?

Be sure to check only one.

___ Watch television ___ Play a sport or exercise

___ Play outside ___ Do homework

___ Talk on the phone to friends ___ Play video or computer games

___ Read, but not for school ___ Baby-sit children

___ Work at a job ___ Practice a musical instrument

___ Cook ___ None of the above

4. During the past 12 months, how many sports teams were you on 

(like a soccer or basketball team, but not including physical education or gym classes)?

____ teams

5. In general, do you think you get too much physical activity, not enough physical activity, or

about the right amount of physical activity?

__ Too much ___ About right ___ Not enough

Physical

Activity
A-48 Adolescent
Adult A-49 ✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

ID__________ DATE__________

heart health 

WHAT’S YOUR

physical activity,

&

food,

Adult PREQUESTIONNAIRE
A-50 Adult
Adult

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

ID__________ DATE__________

A-51

heart health

WHAT’S YOUR

physical activity,

&

food,

Adult POSTQUESTIONNAIRE
A-52 Adult

Please tell us a little

about yourself.

Check the correct box!

1. Your gender: ❑ 1 - Male ❑ 2 - Female 

2. What is your age group?

❑ 1 - Under 21

❑ 2 - 21 – 30 

❑ 3 - 31 – 40

❑ 4 - 41 – 50

❑ 5 - 51 – 60

❑ 6 - 61 – 70

❑ 7 - Over 70

3. Are you...

❑ 1 - White

❑ 2 - African American or Black

❑ 3 - Hispanic

❑ 4 - Asian or Pacific Islander

❑ 5 - American Indian or Alaska Native

❑ 6 - Other (specify: _______________ )?

4. What is your highest level of education?

❑ 1 - Less than High School

❑ 2 - High School Graduate

❑ 3 - Some College

❑ 4 - College Degree

❑ 5 - Some Graduate School

❑ 6 - Graduate Degree 

✔
Adult A-53

Heart-healthyeating

5. For each of the foods below, indicate if the item would count as a serving of a 

fruit or vegetable.

a. Half cup of orange juice? Yes No Don’t Know

b. Half cup of lettuce? Yes No Don’t Know

c. Half cup of steamed broccoli? Yes No Don’t Know

6. From which food group should you eat the most servings a day?

1 – Bread, cereal, rice, and pasta

2 – Vegetable

3 – Fruit

4 – Meat, poultry, fish, eggs, dry beans, and nuts

5 – Milk, yogurt, and cheese

0 – Don’t know

7. Which of these is the best choice for a low-fat diet? (circle just one)

1 – Whole milk

2 – Low-fat yogurt

3 – Cheese

4 – Fat-free milk

0 – Don’t know

8. Which is the best snack choice for a low-fat diet? (circle just one)

1 – Cookies

2 – Fruit roll-ups

3 – Pie

4 – Ice cream

0 – Don’t know
A-54 Adult

True False

a. Polyunsaturated fat has the same number of calories 

as saturated fat. T F

b. The single most important change most people can make to

lose weight is to avoid sugar. T F

c. Being overweight puts you at risk for heart disease. T F

d. A reduced intake of sodium or salt does not always 

lower high blood pressure to normal. T F

e. If you are overweight, losing weight helps lower your

high blood cholesterol and high blood pressure. T F

f. The best way to lose weight is to eat fewer calories and 

be physically active. T F

g. Overweight children are likely to become overweight adults. T F

h. Skipping meals is a good way to cut down on calories. T F

i. Foods high in complex carbohydrates (starch and fiber) 

are good choices when you are trying to lose weight. T F

10. To you personally, how important is each of the following choices? 

(Circle one on each line.) 

9. Please indicate whether you think the following statements are true or false

by circling T or F after each one.

Very Somewhat Not Too Not at all 

Important Important Important Important

a. Choosing a diet with plenty of fruits and vegetables. 4 3 2 1

b. Eating a variety of foods. 4 3 2 1

c. Maintaining a healthy weight. 4 3 2 1

d. Choosing a diet low in fat. 4 3 2 1

e. Choosing a diet with plenty of breads, 

cereals, rice, and pasta. 4 3 2 1

f. Eating at least two servings of dairy products daily. 4 3 2 1
Adult A-55

11. Please indicate how much you tend to agree or disagree with each statement.

a.With my schedule, it’s impossible to eat right.

b.There’s too much stress in my life for me 

to handle managing my weight.

c. I just can’t let food go to waste.

d. I eat more when I’m alone than

when I eat around others.

e.When I’ve done something good,

I reward myself with food.

f. I eat more on the weekends.

g. If I’m craving food, my body must need it.

h. Some people are meant to be fat.

Strongly Strongly

Agree Agree Disagree Disagree

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

a. Eat turkey bologna instead

of regular bologna?

b. Use fat-free milk or 1% milk

instead of 2% or whole milk

c. Eat low-fat cheeses when

you eat cheese?

d. Eat ice milk, frozen yogurt, or sherbet

instead of ice cream?

e. Use low-calorie instead

of regular dressing?

f. Have fruit for dessert?

g. Eat fish or poultry instead of meat

(e.g., beef, pork, or lamb)?

12. Please indicate the term that most closely describes your habits when you eat the 

following foods.

(Circle one on each line. If you do not eat any of the foods listed in an item circle “X”.) 

Almost SomeAlways Often times Rarely Never N/A

4 3 2 1 0 X

4 3 2 1 0 X

4 3 2 1 0 X

4 3 2 1 0 X

4 3 2 1 0 X

4 3 2 1 0 X

4 3 2 1 0 X
A-56 Adult
Adult A-57

6. During the past 7 days, how many times did you engage in physical activity to 

try to lose weight or keep from gaining weight?

0 – I have never done this 2 – 1 to 2 times

1 – I have done this but not 3 – 3 to 6 times

in the last 7 days 4 – 7 or more times

7. On how many of the past 7 days did you do any kind of physical activity in a 

place such as a “Y”, sports league, dance class, recreational center, or any

other community center?

0 – None

1 – 1 – 2 days

2 – 3 – 4 days

3 – 5 – 7 days

Physical

Activity

Moderate physical activity includes activities such as walking, gardening, and heavy house cleaning. For moderate activity to be regular, it must add up to a total of 30 or more minutes per day

and be done at least 5 days per week. For example, you could take a 30-minute walk or take a 10-

minute walk, rake leaves for 10 minutes, and climb up stairs for 10 minutes—adding up to a total of

30 minutes of time.

Please circle Yes if the statement applies to you, or No if it doesn’t.

1. I currently participate in moderate physical activity. Yes No

2. I intend to increase my participation in moderate 

physical activity in the next 6 months. Yes No

3. I currently engage in regular moderate physical activity. Yes No

4. I have been participating in moderate physical activity 

regularly for the past 6 months. Yes No

5. In the past, I have been regularly physically active in 

moderate activities for a period of at least 3 months. Yes No

For the following two statements, circle the number that corresponds to your answer.
A-58 Adult

a. I’m just too tired after work to engage

in physical activity.

b. I’ve been thinking about being more physically

active, but I just can’t seem to get started.

c. I’m getting older so physical activity can

be risky.

d. I’m not physically active because I have never

learned the skills for any sport.

e. I don’t have access to jogging trails, swimming

pools, bike paths, etc.

f. Physical activity takes too much away from my

other commitments – like work, family, etc.

g. I’m embarrassed about how I will look when

I engage in physical activity with others.

h. It’s easier for me to find excuses not to 

be physically active than to go out and 

do something.

i. I really can’t see learning a new sport

at my age.

j. My free time during the day is too short

to include physical activity.

k. My usual social activities with family or friends

do not include physical activity.

l. I’m too tired during the week and I need the

weekend to catch up on my rest.

m. I’m afraid I might injure myself or have

a heart attack.

n. If we had exercise facilities and showers at

work, then I would be more likely to engage

in physical activity.

Very Somewhat Somewhat Very

Likely Likely Unlikely Unlikely 

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

8. How likely are you to say each of the following statements? (Circle one answer on each line)
Adult A-59

9. The following statements are either true or false. Please choose your response by circling T or F.

True False

a. Regular physical activity can reduce

your chances of getting heart disease.

b. It doesn’t take a lot of money or 

expensive equipment to become 

physically fit.

c. Exercise programs do not require 

a lot of time to be very effective.

d. You should always consult a doctor 

before starting a physical activity program.

e. There are many risks and injuries that 

can occur with exercise.

f. Most people get enough physical 

activity from their daily routine.

g. You don’t have to train like a 

marathon runner to become 

more physically fit.

h. People who need to lose some weight 

are the only ones who will benefit 

from regular physical activity.

i. The older you are, the less active 

you need to be.

j. People who have had a heart attack 

should not start any physical activity program.

k. All exercises give you the same benefits.

l. To help you stay physically active, 

include a variety of activities.

T F

T F

T F

T F

T F

T F

T F

T F

T F

T F

T F

T F
A-60 Adult

Activity Mon. Tues. Wed. Thurs. Fri. Sat. Sun.

Organized or Team Sports (e.g., basketball, 

tennis, racquetball, softball, etc.)

Bicycling

Dancing / Aerobics

Walking / Hiking

Golf

Heavy Household Chores

Pushups / Situps

Rollerskating / Blading

Jogging / Stairs / Treadmill

Snow Skiing (winter sports)

Swimming (water sports)

Bowling

Weightlifting

Other Physical Activities;

Specify:_________________

DAILY TOTALS

FIT SCORE GRAND TOTAL: __________

10. Fit Score

In the past 7 days, how much time did you spend on each of the following activities?

Write in the number of hours for each one, rounding to the nearest half-hour 

(1/2, 1, 11/2). Add your totals for each day in the last row.

11. Sit Score

In the past 7 days, how much inactive time did you spend at work, reading, watching

TV programs, using a home computer, or watching videotapes and movies on TV or in

a theater? In each space, write the number of hours for each activity, rounding to the

nearest half-hour. Add your totals at the bottom.

Mon. Tues. Wed. Thurs. Fri. Sat. Sun.

At work (nonmanual labor)

Reading

Watching TV 

Using the computer

Watching movies

DAILY TOTALS

SIT SCORE GRAND TOTAL: ___________
Adult A-61

Listed below are some things that have been said are possible causes of high blood

pressure (HBP). For each of those listed, please check whether you think it is a

Cause or Not a Cause, or else check Not Sure.

Cause of HBP Not a Cause of HBP Not Sure

1. Being overweight

2. Heredity—it runs in the family

3. Eating too much salt

4. Race or ethnic group

5. Worrying, tension, strain

6. Eating fatty foods

7. Smoking

8. Drinking too much alcohol

9. Regular hard exercise

10. Being underweight

11. Being pregnant

12. Not getting enough exercise

13. Old age

14. Stress

Possible causes of

high blood pressure
A-62 Adult

Listed below are some actions that people might take to control high blood cholesterol.

For each of these actions, please check whether it is an action that Would or 

Would Not Help control high blood cholesterol, or else check Not Sure.

Would Help Would Not Help Not Sure

1. Getting regular exercise

2. Eating less salt 

3. Eating less sugar

4. Eating more soluble fiber

5. Using fat-free milk or 

low-fat dairy products

6. Eating less cheese

7. Eating fewer eggs

8. Eating more fish

9. Eating less sausage, bacon,

and luncheon meats 

10. Eating less saturated fat 

11. Losing weight if you are overweight

12. Using soft or liquid margarine 

instead of butter

to control high

blood cholesterol

Actions 
bB-1

Answer Keys...to illustrate the correct answers,

shaded in gray, to the child, adolescent, and adult

questionnaires

Scoring Sheets...to add up the total score

for the pre- and postquestionnaires of each child, 

adolescent, and adult participant. One sheet is 

used to score the participant’s prequestionnaire 

and another copy of the same sheet is used to 

score the postquestionnaire
B-2
Child B-3

✲

✲

Answer Key (PRE & POST)

Child QUESTIONNAIRE

✲

✲ ✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

heart health

WHAT’S YOUR

physical activity,

&

food,
B-4 Child
Child B-5

**Correct and positive answers are shaded in gray**

Which food is better for your health? (KNOWLEDGE)

1. Doughnut Toast

2. Orange Cookies

3. Whole Wheat Bread White Bread

4. Cold Cereal Eggs and Bacon

5. Regular Milk Low-fat or Fat-free Milk

6. Green Salad French Fries

7. Grapes Candy Bar

What foods do you eat most of the time? (BEHAVIOR)

1. Baked Potato French Fries

2. Fruit Juice Soda

3. Cookies Apple

4. Hot Dog Sandwich with Lettuce and Tomato

5. Chocolate Cake Orange

6. Ice Cream Fresh Fruit Popsicle

7. Regular Milk Low-fat or Fat-free Milk

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

✲ ✲

✲

✲

✲
B-6 Child

What would you do? (INTENTION)

1. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

2. If you were going to eat your lunch, which would you do?

Eat the food without adding salt Shake salt on the food before eating

3. Which food would you put on your hamburger?

Ketchup Tomato

4. Which would you pick to drink?

Regular Milk Low-fat or fat-free milk

5. Which food would you eat for a snack?

Candy Bar Fresh Fruit

6. Which food would you choose for dinner?

Baked Potato French Fries

7. Which would you order if you were going to eat at a fast-food restaurant?

Hamburger Salad

✲

✲ ✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲ ✲

✲

✲

✲
Child B-7

Things I like and things I do (PRETEST)

**Record total check marks for each column in the score sheet. There are no right or

wrong answers here.

Things I learned and did this summer (POSTTEST)

**Record total check marks for each column in the score sheet. There are no right or

wrong answers here.

Physical activity and you (ATTITUDE)

1. I would rather watch TV than play sports or be active.

Yes - 0 points No - 2 points Sometimes - 1 point

2. People who play sports or are active seem to have a lot of fun doing it.

Yes - 2 points No - 0 points Sometimes - 1 point

3. How do you feel about your ability to kick a ball hard and hit a target, like soccer?

Great - 2 points Okay - 1 point Not Good - 0 points

4. How do you feel about your ability to run a long way without stopping?

Great - 2 points Okay - 1 point Not Good - 0 points

5. How do you feel about your ability to hit a ball with a bat, like softball?

Great - 2 points Okay - 1 point Not Good - 0 points 

6. How do you feel about your ability to play many different games and sports?

Great - 2 points Okay - 1 point Not Good - 0 points

✲

✲

✲

✲

✲

✲

✲
B-8 Child

ID#__________ DATE________

Children Pre Score Sheet

Personal: 1. Gender:_____ 2. Age Group:_____

Use one score sheet for each participant.

Give one point for each correct answer; and one or two points (as specified in Answer Key) for

each ‘positive’ answer, i.e., an answer demonstrating healthy nutrition or physical activity.

Consult answer key to complete this score sheet.

Knowledge

(Which Food Is Better

For Your Health?)

Behavior

(What Foods Do You

Eat Most of the Time?)

Intention

(What Would You Do?)

1. 5. 1. 5. 1. 5.

2. 6. 2. 6. 2. 6.

3. 7. 3. 7. 3. 7.

4. 4. 4.

Knowledge

Total: __________

Out of 7 possible points

Behavior

Total: __________

Out of 7 possible points

Intention

Total: __________

Out of 7 possible points

Things I Like and Things I Do Attitude

(Physical Activity and You)

1. 4.

2. 5.

3. 6.

I like to

do this

I’ve done

this in the

past week

I would like

to learn

how to do

this

Out of 14 Out of 14 Out of 14

Attitude Total: _________

Out of 12 possible points

✲ ✲

✲

✲

✲

✲

✲
Child B-9

ID#__________ DATE________

Children Post Score Sheet

Personal: 1. Gender:_____ 2. Age Group:_____

Use one score sheet for each participant.

Give one point for each correct answer; and one or two points (as specified in Answer Key) for

each ‘positive’ answer, i.e., an answer demonstrating healthy nutrition or physical activity.

Consult answer key to complete this score sheet.

Knowledge

(Which Food Is Better

For Your Health?)

Behavior

(What Foods Do You

Eat Most of the Time?)

Intention

(What Would You Do?)

1. 5. 1. 5. 1. 5.

2. 6. 2. 6. 2. 6.

3. 7. 3. 7. 3. 7.

4. 4. 4.

Knowledge

Total: __________

Out of 7 possible points

Behavior

Total: __________

Out of 7 possible points

Intention

Total: __________

Out of 7 possible points

Things I Learned and 

Did This Summer

Attitude

(Physical Activity and You)

1. 4.

2. 5.

3. 6.

Something

new I learned I got better

at this

I would like

to play this

again

Out of 14 Out of 14 Out of 14

Attitude Total: _________

Out of 12 possible points

✲ ✲

✲

✲ ✲

✲

✲

✲
B-10 Child
Adolescent B-11

Answer Key (PRE & POST)

Adolescent QUESTIONNAIRE

✲ ✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

heart health

WHAT’S YOUR

physical activity,

&

food,
B-12 Adolescent

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

**Correct and positive answers are shaded in gray**

Heart-healthy eating

3. Joe ate cereal with milk and a banana and drank orange juice for breakfast.

How many different food groups did Joe eat from? 

1 2 3 4 Don’t Know

4. What is a “balanced diet”? 

a. Eating lots of fruit and vegetables

b. Eating the same foods every day

c. Eating the exact same amount of food from each food group

d. Eating different foods from all the food groups

5. If you want to eat more fruit, which of the following would you choose?

a. Orange soda

b. Grape jelly

c. A banana

d. Strawberry ice cream

6. From which food group should you eat the most servings a day? 

a. Bread, cereal, rice, and pasta

b. Meat, poultry, fish, eggs, dry beans, and nuts

c. Vegetable

d. Fruit

7. Which food is better for your health?

a. Doughnut Toast

b. Orange Cookies

c. Whole Wheat Bread White Bread

d. Cold Cereal Eggs and Bacon

e. Regular Milk Low-fat or Fat-free Milk

f. Green Salad French Fries

g. Grapes Candy Bar

h. French Fries Baked Potato
Adolescent B-13

For 9–11 below, use the number that is circled on the questionnaire to represent the

number of points on the score sheet. Add up points of all answers in each section.

9. Attitude Toward Healthy Eating - Four Agree/Disagree Questions 

10. Attitude Toward Healthy Eating: “If I eat a healthy diet every day...”—

Six Agree/Disagree Questions

11. Overweight/Obesity Attitude - Eight Agree/Disagree Questions

12. What Foods Do You Eat Most Of The Time? (Eating Behavior)

a. Baked Potato French Fries

b. Fruit Juice Soda

c. Cookies Apple

d. Hot Dog Sandwich with Lettuce and Tomato

e. Chocolate Cake Orange

f. Ice Cream Fresh Fruit Popsicle

g. Sweet Roll Whole Wheat Roll

h. Regular Milk Low-fat or Fat-free Milk

True False

a. Polyunsaturated fat has the same number of calories as saturated fat.

b. The single most important change most people can make to lose 

weight is to avoid sugar.

c. Being overweight puts you at risk for heart disease.

d. Lowering sodium or salt in the diet does not always lower high blood

pressure to normal.

e. If you are overweight, losing weight helps lower your high blood

cholesterol and high blood pressure.

f. The best way to lose weight is to eat fewer calories and be physically active.

g. Overweight children are very likely to become overweight adults.

h. Skipping meals is a good way to cut down on calories.

i. Foods high in complex carbohydrates (starch and fiber) are good choices

when you are trying to lose weight.

T F

T F

T F

T F

T F

T F

T F

T F

T F

8. Overweight/Obesity Knowledge

✲

✲

✲
B-14 Adolescent

13. What Would You Do? (Eating/Intention)

a. If you were at the movies, which one would you pick?

Popcorn with salt and butter Popcorn without salt and butter

b. If you were going to have lunch right now, which would you do?

Eat food without adding salt Shake salt on your food

c. Which food would you put on your hamburger?

Ketchup Tomato

d. Which would you pick to drink?

Regular Milk Low-fat or Fat-free Milk

e. Which food would you eat for a snack?

Candy Bar Fresh Fruit

f. Which food would you choose for dinner?

Baked Potato French Fries

g. Which would you order if you were going to eat at a fast food restaurant?

Hamburger Salad

✲

✲

✲

✲

✲ ✲

✲

✲

✲

✲

✲

✲

✲

✲
Adolescent B-15

Physical Activity

1. In the past week, how many days were you active for at least 20 minutes in 

sports activities...? (Between 0 - 7)

Give one point for an answer of 4 or more days

2. In the past week, how many days did you do exercises to strengthen or tone

your muscles, such as pushups, situps, or weight-lifting?

Give one point for an answer of 4 or more days

3. Which of the following activities do you do the most from the time school gets

out until you eat dinner?

One point for either answer: Play a sport or exercise Play outside

4. During the past 12 months, how many sports teams were you on?

0 teams - 0 points 1 team - 1 point 2 or more teams - 2 points

5. In general, do you think you get too much physical activity, not enough 

physical activity, or about the right amount of physical activity?

Too much - 0 points About right - 1 point Not enough - 0 points

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

✲

✲

✲
B-16 Adolescent

Personal: 1. Gender:_____ 2. Age Group:_____

Use one score sheet for each participant. Using the answer key as a guide, complete the score

sheet by giving points for correct or ‘positive’ answers.

Heart-Healthy Eating

Nutrition Overweight/ Attitude Toward Overweight/ Healthy Healthy 

Knowledge Obesity Healthy Eating Obesity Eating Eating

(1pt each) Knowledge (1-4 pts each) Attitude Behavior Intentions

(1 pt each) (1-4 pts each) (1 pt each ) (1 pt each )

3. 7c. 8a. 8f. 9a. 10b. 11a. 12a. 13a.

4. 7d. 8b. 8g. 9b. 10c. 11b.

7a. 7g. 8e. 10a. 10f. 11e. 12e.

POINT POINT POINT POINT POINT POINT 

TOTAL: TOTAL: TOTAL: TOTAL: TOTAL: TOTAL:

12 possible 9 possible 40 possible 32 possible 8 possible 7 possible

Physical Activity

Level of Physical Activity

1.

2.

3.

4.

5.

POINT 

TOTAL:

6 possible

Adolescent Pre and Post Score Sheet

ID__________ DATE__________

12b. 13b.

5. 7e. 8c. 8h. 9c. 10d. 11c. 12c. 13c.

7b. 7h. 11f. 12f. 13f.

11g. 12g. 13g.

11h. 12h.

6. 7f. 8d. 8i. 9d. 10e. 11d. 12d. 13d.

 13e.
Adult B-17

✲

✲

Answer Key (PRE & POST)

Adult QUESTIONNAIRE

✲

✲ ✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲

✲ ✲

✲

heart health

WHAT’S YOUR

physical activity,

&

food,
B-18 Adult

**Correct and positive answers are shaded in gray**

Heart-healthy eating

5. Serving of a fruit or vegetable?

a. Half cup of orange juice? Yes No Don’t Know

b. Half cup of lettuce? Yes No Don’t Know

c. Half cup of steamed broccoli? Yes No Don’t Know

6. From which food group should you eat the most servings a day?

1 - Bread, cereal, rice, and pasta

2 - Vegetable

3 - Fruit

4 - Meat, poultry, fish, eggs, dry beans, and nuts

5 - Milk, yogurt, and cheese

0 - Don’t know

7. Which of these is the best choice for a low-fat diet? (circle just one)

1 - Whole milk

2 - Low-fat yogurt

3 - Cheese

4 - Fat-free milk

0 - Don’t Know

8. Which is the best snack choice for a low-fat diet? (circle just one)

1 - Cookies

2 - Fruit roll-ups

3 - Pie

4 - Ice cream

0 - Don’t Know

9. Overweight/Obesity Knowledge - T/F

a. Polyunsaturated fat has the same number of calories as saturated fat.

b. The single most important change most people can make to lose

weight is to avoid sugar.

c. Being overweight puts you at risk for heart disease.

T F

T F

T F

True False

✲

✲

✲

✲

✲

✲

✲

✲

✲
Adult B-19

d. A reduced intake of sodium or salt does not always 

lower high blood pressure to normal.

e. If you are overweight, losing weight helps lower your

high blood cholesterol and high blood pressure.

f. The best way to lose weight is to eat fewer calories and 

be physically active.

g. Overweight children are likely to become overweight adults.

h. Skipping meals is a good way to cut down on calories.

i. Foods high in complex carbohydrates (starch and fiber) 

are good choices when you are trying to lose weight.

10. Attitude Toward Healthy Eating - “To you personally, how important is each of

the following choices?” Record all answers on the score sheet.

11. Overweight/Obesity Attitude - “Please indicate how much you tend to agree or 

disagree with each statement.” Record all answers on the score sheet.

12. Eating Behavior/Habits - Record all answers on the score sheet.

Physical Activity

Give one point for each Yes answer.

1. I currently participate in moderate physical activity.

2. I intend to increase my participation in moderate 

physical activity in the next 6 months.

3. I currently engage in regular moderate physical activity.

4. I have been participating in moderate physical activity 

regularly for the past 6 months.

5. In the past, I have been regularly physically active in 

moderate activities for a period of at least 3 months.

6. During the past 7 days, how many times did you engage in physical activity to try

to lose weight or keep from gaining weight?

Use the number that is circled (0-4) to represent the number of points on the score sheet.

T F

T F

T F

T F

T F

T F

Yes No

Yes No

Yes No

Yes No

Yes No

✲ ✲

✲

✲

✲
B-20 Adult

9. Physical Activity Knowledge – T/F

True False 

a. Regular physical activity can reduce

your chances of getting heart disease.

b. It doesn’t take a lot of money or 

expensive equipment to become 

physically fit.

c. Exercise programs do not require 

a lot of time to be very effective.

d. You should always consult a doctor 

before starting a physical activity program.

e. There are many risks and injuries that 

can occur with exercise.

f. Most people get enough physical 

activity from their daily routine.

g. You don’t have to train like a 

marathon runner to become 

more physically fit.

h. People who need to lose some weight 

are the only ones who will benefit 

from regular physical activity.

i. The older you are, the less active 

you need to be.

j. People who have had a heart attack 

should not start any physical activity program.

k. All exercises give you the same benefits.

l. To help you stay physically active, 

include a variety of activities.

7. On how many of the past 7 days did you do any kind of physical activity in a 

place such as a “Y”, sports league, dance class, recreational center, or any 

other community center?

Use the number that is circled to represent the number of points on the score sheet.

8. Attitude Toward Physical Activity - Likely/Unlikely

Record all answers on the score sheet.

T F

T F

T F

T F

T F

T F

T F

T F

T F

T F

T F

T F

10. and 11. Fit/Sit Scores – Totals are already on the questionnaire.

✲ ✲

✲

✲

✲
Adult B-21

For the next two sections, give one point for each correct answer as listed below.

Give 0 points for wrong answers or “Not Sure” answers.

Possible causes of high blood pressure

1. Being overweight Cause

3. Eating too much salt

4. Race or ethnic group Cause

5. Worrying, tension, strain Not a Cause

6. Eating fatty foods Not a Cause

7. Smoking Cause

8. Drinking too much alcohol Cause

9. Regular hard exercise Not a Cause

10. Being underweight Not a Cause

11. Being pregnant Cause

12. Not getting enough exercise Cause

13. Old age Cause

14. Stress Not a Cause

Actions to control high blood cholesterol

1. Getting regular exercise Would Help

2. Eating less salt Would Not Help

3. Eating less sugar Would Not Help

4. Eating more soluble fiber Would Help

5. Using fat-free milk or low-fat dairy products Would Help

6. Eating less cheese Would Help

7. Eating fewer eggs Would Help

8. Eating more fish Would Help

9. Eating less sausage, bacon, and luncheon meats Would Help

10.Eating less saturated fat Would Help

11. Losing weight if you are overweight Would Help

12.Using soft or liquid margarine instead of butter Would Help

✲ ✲

✲

✲

✲ ✲

✲

✲

✲

✲

Cause

2. Heredity--it runs in the family Cause
B-22 Adult
Adult B-23

Personal: 1. Gender:___ 2. Age Group:___ 3. Race:___ 4. Education:___

Use one score sheet for each participant.

Give one point for each correct answer; and 1-4 points (as specified in Answer 

Key) for each ‘positive’ answer, i.e., an answer demonstrating healthy nutrition 

or physical activity. Consult answer key to complete this score sheet.

Heart-Healthy Eating

Nutrition

Knowledge

(1 pt each)

Overweight/

Obesity Knowledge

(1 pt each)

Attitude

Toward

Healthy Eating

(1-4 pts each)

Overweight/

Obesity

Attitude

(1-4 pts each)

Eating

Behavior

(0-4 pts each)

5a. 9a. 9f. 10a. 11a. 11e. 12a.

5b. 9b. 9g. 10b. 11b. 11f. 12b.

5c. 9c. 9h. 10c. 11c. 11g. 12c.

5d. 9d. 9i. 10d. 11d. 11h. 12d.

6. 9e. 10e. 12e.

7. 10f. 12f.

8. 12g.

POINT

TOTAL:

POINT

TOTAL:

POINT

TOTAL:

POINT

TOTAL:

POINT

TOTAL:

6 possible 9 possible 24 possible 32 possible 28 possible

see note below

Adult Pre and Post Score Sheet

ID#__________ DATE__________ 

✲

✲

✲

✲

✲ ✲

✲

Note: For every part of question 12 on Eating Behavior that the respondent answered

“x” (for not applicable”), subtract 4 from the total possible number of points.
B-24 Adult

Physical Activity

Level of

Physical

Activity

(0-4 pts each)

Attitude Toward 

Physical Activity

(1-4 pts each)

Physical

Activity

Knowledge

(1 pt each)

Knowledge:

Causes of 

High Blood 

Pressure

(1 pt each)

Knowledge:

Actions to

Control 

High Blood

Cholesterol

(1 pt each)

1. 8a. 8h. 9a. 9g. 1. 8. 1. 7.

2. 8b. 8i. 9b. 9h. 2. 9. 2. 8.

3. 8c. 8j. 9c. 9i. 3. 10. 3. 9.

4. 8d. 8k. 9d. 9j. 4. 11. 4. 10.

5. 8e. 8l. 9e. 9k. 5. 12. 5. 11.

6. 8f. 8m. 9f. 9l. 6. 13. 6. 12.

7. 8g. 8n. 7. 14.

POINT

TOTAL:

POINT

TOTAL:

POINT

TOTAL:

POINT

TOTAL:

POINT

TOTAL:

12 possible 28 possible 12 possible 14 possible 12 possible

FIT SCORE: ___________ SIT SCORE: ___________

✲

✲

✲ ✲
cC-1

Media Materials and Miscellaneous

Forms...to assist in planning for media involvement

in your Hearts N’ Parks program. Includes a prototype

plan for launching the program to the media, timelines

and checklists, tips on how to encourage the media to

participate in the event, pitch letter to the media, story

ideas, sample news advisory and press release, and

consent waiver forms.
C-2
C-3

GOALS

1. To announce the launch of Hearts N’ Parks in

Healthy County.

2. To inform community members about upcoming

Hearts N’ Parks activities.

3. To inform local policymakers about participation in

Hearts N’ Parks.

4. To encourage partnerships with other community

organizations and potential sponsors.

5. To increase the number of children participating in

recreational programs.

TARGET AUDIENCES

1. Local newspapers, radio and TV stations,

corporations, and organizations that have 

approved private communication vehicles.

2. Local media, clubs and other organized groups,

community calendar editors.

3. Local policymakers.

4. Community organizations and businesses.

5. Schools, day care centers, parenting groups, and

businesses that are geared toward children in the

community. Media that reach these groups.

KEY MESSAGES

1. Healthy County is becoming a Hearts N’ Parks

community.

2. Planned activities as part of Healthy County’s

Hearts N' Parks initiative will include [LIST].

3. Hearts N’ Parks is an innovative, nationwide

initiative that aims to reduce the growing trend

of obesity and the risk of coronary heart disease

in the United States.

4. By becoming a Hearts N’ Parks partner, local 

organizations and businesses can demonstrate

their commitment to the well-being of citizens of

Healthy County, share resources for implementing

worthwhile programs, and gain exposure for their

own programs and services.

5. The sooner we can teach our children how to

prevent heart disease, the faster we can reduce

their risk.

SPECIAL EVENT

1. Hold special event to launch Hearts N’ Parks.

Agenda to include a news conference featuring

prominent community leaders and policymakers

including a representative of the community, activities for children, exhibits or screenings by local

organizations and businesses, sponsorship opportunities (such as paying for T-shirts).

2. To maximize coverage by the media, request 

official proclamation by policymakers, and hold

event during National Recreation and Park Month

or relevant “health holiday.”

3. Invite local hospitals, day care centers, pharmacies,

and radio or TV stations to join your task force

and/or participate in the event.

Prototype plan

for launching your program

Situation: Healthy County Department of Parks and Recreation is taking steps to become a

Hearts N’ Parks community. Staff members are developing a plan to launch this initiative.
C-4
C-5

6to8 weeks prior to the event

• Request permit and reserve park area by town square. Weather contingency plan to include ordering 

canopy for space. Work with adjacent city offices to identify available space for individual interviews with 

the media if needed.

• Invite speakers.

• Request proclamation from local government officials.

• Order brochures on heart disease, information on risk factors, banners, and T-shirts.

4to 6 weeks prior to the event

• Prepare and send calendar announcement.

• Assign responsibilities to staff and volunteers. Hire photographer, contractor to provide staging area,

sound system, etc.

• Invite guests, including policymakers, county agencies, wellness directors at area health-care facilities,

prominent business people, leaders in the community.

2to4 weeks prior to the event

• Prepare the following media tools: media advisory, news release, backgrounders on the Healthy 

County Hearts N’ Parks program, speakers list for news conference. Copy backgrounders included in 

Resource Guide on Eat Right and Get Moving.

• Discuss media list with county communications office, and review and update for special event. Target 

local media that reach community-at-large, policymakers (newsletters, etc.), parents and caregivers of 

children, local businesses.

1to2 weeks prior to the event

• Send media advisory.

• Update Web site.

• Send event schedule, list of responsibilities, and directions to the site to staff and volunteers. Also provide

copies of all materials to county communications staff, administrative staff, and others who might receive

inquiries about the event.

• Gather biographic information from speakers for media and for the moderator’s introductions.

Provide information to help speakers with their remarks.

• Supplies you will need on-site: pens, sign in sheets (for media), business cards, brochures on 

Healthy County Park and Recreation programs.

Timeline and Checklist
C-6

1 week prior to the event

• Confirm space, volunteers, and equipment.

• Distribute letter and consent form to parents of children who will be participating through their 

regular programs.

• Call key media to encourage them to attend.

• Collate media kits.

1to2 days prior to the event

• Resend media advisory to entire media list.

• Keep calling media targets.

• Gather and pack supplies.

• Arrange for designated staff person to field calls on the day of the event;

update outgoing voice mail message.

At the event

• Greet media when they arrive. Ask them to sign in, so you can track who attended.

• Give every media person who attends a press kit to take back to their office. It will help them round

out the story.

• Introduce media representatives to your spokespersons for interviews.

Afterthe event

• Follow up on any special requests made during the event by the media, speakers, etc.;

for example, reporters might ask for a bio or “head shot” photo of a specific speaker, or they might

have asked for data or other information that was not readily accessible. (To expedite your response,

call your office and have someone else process the request while the event is still happening.)

• Send press kits to reporters who expressed interest but did not attend, because it may still result in

coverage, or they may come to your next event.

• Check for coverage in newspapers, on TV and radio, and on the Internet.

• Obtain contact sheets or prints from the photographer and order photos for your internal

publications, as well as to send to partners or sponsors, speakers, special guests, etc.

• Write article about the event for your organization, and encourage partners and sponsors to do the same.

• Send thank-you notes to the reporters who attended. Tell them that you enjoyed working with them and that

you hope to continue to serve as a resource for their reporting.

• Send a letter to the editor of your daily newspaper to publicly thank your volunteers for making the event a

success and ask the editor to consider it for publication.

• And, of course, thank your sponsors, partners, and volunteers directly.
C-7

Timeline and Checklist for

Special Events

As soon as possible

• Identify your goals, target audience(s), and key messages.

• Develop an agenda for the event, identify potential speakers, and prepare a budget and timeline to

include promotion of the event and logistics (e.g. renting space or equipment).

• Identify and contact potential partners and cosponsors.

• Assemble a task force or committee for building your event.

6to8 weeks prior to the event

• Reserve space. If your event is likely to draw media, be sure to identify a quiet space

for individual interviews.

• Invite speakers.

• Request proclamation from local government officials.

• Order educational materials, signs or banners, awards, and T-shirts or other give-away

items you will need.

4to6 weeks prior to the event

• Identify community calendar contacts and their deadlines, and distribute your media advisory or

calendar announcement.

• Recruit event volunteers, staff, and contractors (such as audiovisual technicians if needed,

photographer, caterer, etc.), and assign specific responsibilities.

• Arrange for equipment (if not provided by the site). Equipment might include, for example, tables

(with draping) for health screenings or exhibits, easels for signs, a podium, a stage or “riser,” microphone(s), and a sound system. For a news conference or event with a celebrity, you might also

need a “mult box” - a device that allows broadcast media to record directly from the sound system.

• Create guest list and invite guests.

2to4 weeks prior to the event

• Determine what media tools you will need and prepare them. These include, for example, 

media advisory, news release, backgrounders or fact sheets, agenda, etc.

• Update or develop your media list (see “Working with the Media”).
1to 2 weeks prior to the event

• Send media advisory.

• Update your Web site.

• Send event schedule, list of responsibilities, and directions to the site to staff and 

volunteers. Also provide copies of all materials to anyone who will be responding to

inquiries before, during, or after the event.

• Assist speakers with their remarks; be sure to gather brief biographical information for the

moderator to use to introduce speakers.

• Check on the status of the materials you’ve ordered and make checklist of supplies you’ll

need on-site. Examples: pens, sign-in sheets, business cards, brochures, or other infomation

about your program or department.

1 week prior to the event

• Confirm space, volunteers and equipment.

• If you will be photographing, videotaping, or otherwise recording the event, then distribute

consent forms. If children will be participating, signatures from their parents or guardians

will be needed. (Note: No consent forms are required for news coverage.)

• Make follow-up calls to key media to confirm their receipt of the advisory and to 

encourage them to attend.

• Collate media kits.

1to 2 days prior to the event

• Resend the advisory to your entire list.

• Keep calling your media targets.

• Gather and pack supplies.

• Make any necessary arrangements for responding to calls while you are at the event.

Brief office staff, update your outgoing voice mail message, distribute your cell phone

number, and/or inform office staff as to whether you will be calling in to check messages.

C-8
C-9

At the event

• Greet media when they arrive. Ask them to sign in, so you can track who attended.

• Give every media person who attends a press kit to take back to their office. It will help them

round out the story.

• Introduce media representatives to your spokespersons for interviews.

Afterthe event

• Follow up on any special requests made during the event by the media, speakers, etc.;

for example, reporters might ask for a bio or “head shot” photo of a specific speaker, or they

might have asked for data or other information that was not readily accessible. (To expedite 

your response, call your office and have someone else process the request while the event is

still happening.)

• Send press kits to reporters who expressed interest but did not attend, because it

may still result in coverage, or they may come to your next event.

• Check for coverage in newspapers, on TV and radio, and on the Internet.

• Obtain contact sheets or prints from the photographer and order photos for your internal

publications, as well as to send to partners or sponsors, speakers, special guests, etc.

• Write article about the event for your organization, and encourage partners and sponsors to 

do the same.

• Send thank-you notes to the reporters who attended. Tell them that you enjoyed working with them

and that you hope to continue to serve as a resource for their reporting.

• Send a letter to the editor of your daily newspaper to publicly thank your volunteers for making the

event a success and ask the editor to consider it for publication.

• And, of course, thank your sponsors, partners, and volunteers directly.

on a job well done.

Now on to the next event...
C-10
C-11

Here are tips on encouraging the media

to participate:

1. Prioritize your calls; review your media

list and identify the reporters who are

most important to you. Call them first.

2. Try to speak directly to a reporter. Don’t

be shy. Keep calling, even if you leave a

voice mail message.

3. Be prepared to resend the news 

advisory to individuals several times;

they will likely say they 

didn’t receive the information,

even if they did.

4. If you are asking staff or

volunteers to assist in follow-up calls, prepare a

script and a list of possible

questions and answers.

To reporters who say...

Yes: Work with them to arrange an 

interview with your spokesperson. Ask if

there’s anything special they might need

from you — for example, a camera crew

may need access to an electrical source

or to a “mult box” that will provide them

with sound directly from any microphones

you might be using. Record them on a log

of expected media attendance with notes

on when they will be there, whom they are

sending, and whether they will

want interviews or other 

special assistance.

Maybe: Put them on your 

callback list and call again in

the final days before the event

to encourage them to attend.

You might want to add a 

section to your media log for

possible attendees.

No: Ask if they can suggest

someone else on the staff 

who might be interested in the

story. Tell them you’d like to send them a

press kit after the event, in case they

become interested in the program or topic.

to cover your event

Encouraging Media 

In many cases, sending a news advisory is not enough to get a reporter to attend

your event. Following up with key media beforehand may mean the difference

between coverage and no publicity.

If you are 

asking staff

or volunteers

to assist in 

follow-up calls,

prepare a

script and a

list of possible

questions 

and answers.
Sample Pitch Letter for Media 

Dear [NAME of Editor],

A growing number of Healthy County residents—from children to seniors—are overweight

and physically inactive. As a result, these individuals are at increased risk for heart 

disease, stroke, diabetes, cancer, and other serious conditions.

Healthy County Department of Parks and Recreation (HCDPR) is taking steps to counteract this serious problem by becoming a Hearts N’ Parks community. Hearts N’ Parks is an

innovative program developed jointly by the National Heart, Lung, and Blood Institute

(NHLBI) of the National Institutes of Health, and by the National Recreation and Park

Association (NRPA) to reduce the growing trend of obesity in the United States and to

lower Americans’ risk of coronary heart disease. The program encourages Americans of

all ages to aim for a healthy weight, follow a heart-healthy eating plan, and engage in 

regular physical activity. HCDPR is the first Hearts N’ Parks community in our State,

and one of XX across the United States. 

Joining with such prestigious partners as the NHLBI and NRPA enables Healthy County

to bring quality, measurable public health programs to our community with minimal

resources. For example, Healthy County now offers heart-healthy cooking and snack

preparation classes for seniors and singles, and our existing programs have been augmented

with special activities on eating well and being active. In addition, we’re working with

Healthy County Mall to display weight-loss materials and to publicize free consultations

with our staff for creating and following a personalized eating and exercise plan. 

Heart disease is the leading killer among all Americans; it affects XXXX percent of

Healthy County residents. As a Hearts N’ Parks community, Healthy County Department

of Parks and Recreation hopes to make a significant and long-lasting contribution to

Healthy County. For story ideas on the HCDPR Hearts N’ Parks programs, please see the

attached sheet, or contact [NAME] at (XXX) XXX-XXXX.

Sincerely,

[NAME]

C-12
C-13

Help us spread the word that Healthy County is a Hearts N’ Parks community! 

Story Ideas

and Media Tips

Hearts N’ Parks and the

Healthy County Parks and Recreation

Here are a few story ideas to consider:

● With the fast pace of today’s society, more and

more people are eating away from home – at

greater cost to their wallet and their waistline.

Through Healthy County Parks and Recreation’s

Hearts N’ Parks program, singles are learning quick

and easy ways to prepare heart-healthy meals

at home.

● Ask 5-year-olds why they jump rope, and they’ll

probably say because it’s fun. Ask Caroline Jones,

and she’ll tell you how jumping rope will help her

avoid having a heart attack when she’s older.

Caroline is building lifelong skills to help her prevent

heart disease...just one example of how Healthy

County Parks and Recreation is bringing important

heart-healthy information and activities to the community through the Hearts N’ Parks program.

● Forget expensive diet programs. Healthy County

Parks and Recreation offers personalized weight-loss

programs that put you on the right track to a healthy

weight. Participants receive journals to help track

their progress, and they consult with local trainers

and nutrition specialists. (Let us know if you’d like to

profile one of our participants’ ongoing success.)

● It’s family pizza night, and your seventh-grader

requests broccoli on his pizza. What’s up? If your

child is enrolled in the Healthy County Parks and

Recreation after-school program, he’s learning how

to make good nutritional choices when ordering or

making meals. Nutritionists from Healthy County

Health Department recently spoke to participants,

who were then asked to design their personal pizza.

Future activities include a trip to the grocery store

following a learning session on nutrition labels. It’s

all part of the Parks and Recreation Department’s

commitment to making Healthy County a Hearts N’

Parks community.

● New rewards for mall walkers. Seniors in the

Healthy County Parks and Recreation mall-walking

program now have additional incentives for meeting

their fitness goals. As part of the Hearts N’ Parks

initiative, Community Hospital has partnered with

the Parks and Recreation Department to provide

screenings and information on topics such as high

blood pressure, diabetes, and cholesterol—a new

topic is highlighted each week. In addition, area

stores have donated gift certificates as rewards for

those who meet program goals.

For more information on Healthy County Parks

and Recreation and the Hearts N’ Parks program,

please call [NAME] at (XXX) XXX-XXXX.

You can also find general information about Hearts N’

Parks at these Web sites:

National Heart, Lung, and Blood Institute

(http://www.nhlbi.nih.gov/health/prof/heart/obesity/hrt_n

_pk/index.htm) and 

National Recreation and Park Association

(http://heartsnparks.org).
C-14

Sample Media Advisory

for Hearts N’ Parks Launch at local site

NEWS ADVISORY

FOR [IMMEDIATE] RELEASE CONTACT: [NAME OF ORGANIZATION

[DATE] OR DEPARTMENT]

[PHONE]

[NAME OF ORGANIZATION AND/OR KEY PRESENTER]

To Launch Innovative

Heart Disease Prevention Program

WHAT: Special event to launch the [NAME OF ORGANIZATION OR COMMUNITY] 

Hearts N’ Parks Program, an innovative, community-based initiative that teaches 

people of all ages how to incorporate heart-healthy eating and physical activity into 

their lives. Activities will include a news conference and heart-healthy activities,

including [SUMMARIZE EVENT ACTIVITIES]. A list of activities is attached 

[OPTIONAL]. 

WHO: Hearts N’ Parks is a national program cosponsored by the National Heart,

Lung, and Blood Institute (NHLBI) of the National Institutes of Health, and 

the National Recreation and Park Association (NRPA). The [NAME OF 

ORGANIZATION OR COMMUNITY] is the first to offer the program in the 

[CITY/TOWN/REGION] area.

Speakers: [LIST NAMES AND TITLES]

WHEN: [DATE AND TIME] 

WHERE: [NAME, ADDRESS, AND PHONE NUMBER FOR EVENT; DIRECTIONS IF 

SITE IS NOT LIKELY TO BE EASILY RECOGNIZED BY MEDIA] 

OTHER: [ADDITIONAL DETAILS, SUCH AS SPECIAL PHOTO OR INTERVIEW 

OPPORTUNITIES, REQUEST FOR MEDIA TO REGISTER, ETC] 

[Note: Advisory Should Never Be More Than One Page]
C-15

FOR [IMMEDIATE] RELEASE Contact: [ORGANIZATION NAME] 

[DATE] [PHONE NUMBER]

[NAME OF ORGANIZATION/AGENCY] 

Launches Hearts N’ Parks

[COMMUNITY] Becomes First in Area to

Participate in Innovative and Nationwide Obesity and

Heart Disease Prevention Effort

[CITY, STATE]-The [NAME OF ORGANIZATION OR AGENCY] launched Hearts N’ Parks at

a special event in [CITY, STATE] on [DATE]. A national, community-based program developed

by the National Heart, Lung, and Blood Institute of the National Institutes of Health and by the

National Recreation and Park Association, Hearts N’ Parks is an innovative initiative that aims to

reduce the growing trend of obesity and the risk of coronary heart disease in the United States. 

The event began with a news conference featuring [NAME AND TITLES OF SPEAKERS,

LISTING MOST PRESTIGIOUS FIRST]. 

[ADD OTHER DETAILS ABOUT THE EVENT, INCLUDING PARTNERING/COSPONSORING ORGANIZATIONS, OTHER PARTICIPATING ORGANIZATIONS, etc.] 

Heart disease is the leading killer among all Americans. Through Hearts N’ Parks, science-based

information about lifestyle choices that can reduce one’s risk of heart disease and skills for

incorporating heart-healthy behaviors into one’s life—such as engaging in regular physical 

activity, following a heart-healthy eating plan, and maintaining a healthy weight—are taught as

part of regular activities offered by park and recreation departments and other community-based

agencies. Maintaining a healthy weight is stressed because overweight and obese individuals are

at increased risk of heart disease, stroke, diabetes, cancer, and other serious conditions. Hearts

N’ Parks provides tools for measuring the impact of these activities, which are intended for 

people of all ages.

“This is a very important and exciting public health effort and NAME OF PARK/REC CENTER

is proud to be a part of it,” said NAME AND TITLE OF CENTER DIRECTOR OR OTHER

LOCAL AUTHORITY. “Heart disease and obesity are major health problems, and we are

pleased to play a role in helping members of our community learn how to prevent and control

these and related conditions.”

Sample News Release
C-16

[IF POSSIBLE, ADD QUOTE OR DATA THAT ADDRESSES THE SIGNIFICANCE OF

THE ABOVE ISSUES TO THE LOCAL COMMUNITY.] 

The [NAME OF ORGANIZATION OR AGENCY] Hearts N’ Parks program will include

[PROVIDE HIGHLIGHTS OF HEARTS N’ PARKS RELATED ACTIVITIES]. “We feel

confident that the residents of AREA will learn a lot while having a great time in our 

facility,” added NAME. 

Hearts N’ Parks was launched nationally in July 2000 at a special event featuring U.S.

Surgeon General David Satcher, M.D., Ph.D., and hosted by the Arlington County (Virginia)

Department of Parks, Recreation, and Community Resources. 

The initiative was first piloted in 1999 by more than 2,000 participants in 33 North

Carolina sites. An evaluation of the North Carolina pilot program showed that 

participants retained information about heart-healthy behaviors and intended to eat

healthier. In addition, children reported learning new physical activities and improving

their performance in others; seniors reported feeling healthier and experiencing less

pain in their daily lives by the end of the program. To date, nearly 350 recreation and

parks agencies in more than 35 States have expressed interest in becoming Hearts N’

Parks communities. [UPDATE INFO ACCORDING TO INFORMATION ON THE

HEARTS N’ PARKS WEBSITE OR FROM NRPA.] 

For more information about Hearts N’ Parks activities 

provided by [NAME OF ORGANIZATION OR AGENCY],

please contact [PROGRAM INFORMATION STAFF

OR REGISTRAR] or visit the [NAME OF 

ORGANIZATION OR AGENCY] Web site at [URL].

The National Heart, Lung, and Blood Institute

(NHLBI) has been helping Americans and people

worldwide stay healthier since 1948. The Federal

institute undertakes a wide range of activities to

improve the understanding, prevention, diagnosis

and treatment of heart, lung, and blood disorders.

The National Recreation and Park Association

(NRPA) supports the delivery of quality park

and recreation resources through a nationwide

network of recreation and park professionals

and citizen advocates. The primary areas for

national program focus are on health, youth

development, and the environment.

Additional information about Hearts N’

Parks is available through NRPA at 

1-800-649-3042 or www.heartsnparks.org,

or through NHLBI at www.nhlbi.nih.gov. 

AdditionalNotes [IN RELEASE EMPHASIZING EVENT FOR

KIDS, INSERT BRIEF DESCRIPTION OF

CHILDREN-ORIENTED ACTIVITIES AND

FOLLOWING QUOTE: Children as well as adults

can develop high blood pressure and high blood 

cholesterol. Research shows that the buildup of

plaque in the arteries (atherosclerosis), which causes

coronary heart disease, begins in adolescence. Thus,

it is important to start heart-healthy behaviors early

in childhood.]

[IN RELEASE EMPHASIZING EVENT FOR

SENIORS, INSERT BRIEF DESCRIPTION OF

EVENT AND FOLLOWING AFTER LOCAL

REPRESENTATIVE’S QUOTE: Seniors need to 

stay physically active not only to help prevent heart 

disease but also to help slow bone loss and prevent

fractures from osteoporosis. Activities that build 

balance and strength are particularly important for 

senior citizens.]
C-17

I hereby grant permission to [OFFICIAL NAME(S) OF ORGANIZATION(S)] to

use, reproduce, publish, distribute, and exhibit my picture, portrait, likeness, or

voice, or any or all of them (or those of a child under my guardianship), in or in

connection with the production of a photograph, videotape, audiotape, CD-ROM,

or in any manner and for any purpose as stated below, and...

I hereby waive all rights of privacy or compensation (or those of a child under my

guardianship) which I have in connection with the use of my picture, portrait,

likeness or voice, or any or all of them, in or in connection with said photograph,

videotape, audiotape, CD-ROM, or Web site, and any use to which the same 

or any material therein may be put, applied, or adapted by the organizations 

designated above.

It is understood and agreed that the above waiver is limited to the use by the 

organizations listed above, or by any of their agencies, departments, or distributors

for educational purposes only and not for profit or trade. 

It is also understood and agreed that this consent and waiver will not be made the

basis of a future claim of any kind against the organizations as noted above or their

affiliates.

Participant’s Name: _______________________________

Address: _______________________________

_______________________________

_______________________________

*Signature:____________________________ Date:_____________

*If above is signature of parent or guardian (required if individual is a minor),

please print name here: _______________________________

Consent and Waiver
C-18

Dear Parent:

On [DATE AND TIME], the [NAME OF ORGANIZATION] will host an event

to launch Hearts N’ Parks, an innovative program that promotes the adoption of

heart-healthy behaviors by people of all ages. Hearts N’ Parks was developed and

is supported by the National Heart, Lung, and Blood Institute (NHLBI) of the

National Institutes of Health and by the National Recreation and Park Association

(NRPA). 

We invite you and your child to join us for this exciting event, which includes a

news conference featuring [LIST PROMINENT SPEAKERS AND TITLES].

Heart-healthy activities to be held during the event include [ADD DETAILS]. 

We will have photographers [ADD “and videographers” IF APPROPRIATE] 

documenting the event. We would appreciate your signing the attached consent

form to grant permission for your child to participate in this exciting event,

including being photographed or videotaped. Please return it to [SPECIFY]

by [PROVIDE DEADLINE]. 

If you have any questions, please contact [PROVIDE NAME AND PHONE NUMBER]. 

Thank you for your cooperation.

Sincerely,

[NAME, TITLE, ETC.]

Sample Cover Letter

to Parents of Children

for Consent Form
dD-1

Additional Resources...to assist 

programmers in locating resources and 

information that help plan and implement 

Hearts N’ Parks programs.
D-2
D-3

The list below is intended to help you locate resources and information that may assist you with

planning and implementing your Hearts N’ Parks program. References to any nongovernmental 

entity, product, service, or source of information that may be contained in this list should not be 

considered an endorsement, either direct or implied, by the National Heart, Lung, and Blood Institute

(NHLBI). NHLBI is not responsible for the content of any non-Federal Web pages referenced in this

list. Furthermore, contact information listed is subject to change. 

General and Heart Health Information Type of information provided 

American Health Foundation • Cancer prevention

1 Dina Road • Healthy eating

Valhalla, NY 10595 • High fiber, low-fat diet

Telephone: (212) 953-1900 • Cholesterol lowering

Web: www.ahf.org

American Heart Association** • A-Z Guide for Heart and Stroke

7272 Greenville Avenue Information

Dallas, TX 75231-4596 • Stroke prevention

Telephone: (214) 373-6300 • Nutrition education, recipes, and meal

1-800-AHA-USA or (800) 242-8721 - locate regional affiliate ideas

(800) 553-6321 (Stroke Connection) • Exercise ( children and older adults)

Fax: (214) 706-2139 • Fundraising events

E-mail: inquire@amhrt.org

Web: www.amhrt.org

American Lung Association** • Asthma, smoking, occupational health

1740 Broadway, 14th Floor • School-based education program

New York, NY 10019-4374 • Referral to local allergists and free 

Telephone: (212) 315-8700 patient education

(800) LUNGUSA or (800) 586-4872 - referral to local chapters • Teen smoking

Fax: (212) 265-5642

E-mail: info@lungusa.org

Web: www.lungusa.org

Association of Worksite Health Promotion • Best-practices, methods, processes,

60 Revere Drive and technologies

Suite 500 • Publications

Northbrook, IL 60062

Telephone: (847) 480-9574

Fax: (847) 480-9282

E-mail: awhp@awhp.org 

Web: www.awhp.org

Additional

Resources

for your Hearts N’ Parks program

** Local or State Chapters exist 
D-4

General and Heart Health Information Type of information provided

The American Academy of Pediatrics • Children’s health

141 Northwest Point Boulevard • You and Your Family health and 

Elk Grove Village, IL 60007-1098 nutrition brochures

Telephone: (847) 228-5005 • Guide to organizing a health fair

Fax: (847) 228-5097 

Web: www.aap.org

Centers for Disease Control and Prevention • Health topics A–Z

1600 Clifton Road • School-based nutrition and physical

Atlanta, GA 30333 activity programs

Telephone: (800) 311-3435 • Health statistics

Web: www.cdc.gov • Health topics in the news

Health Resources and Services Administration (HRSA) • Access to healthcare, quality of care, 

Public Health Services and healthcare policy

5600 Fishers Lane, Room 14-05 • Spanish material

Rockville, MD 20857

(301) 443-3376

Web: www.hrsa.gov

Heart Information Service • 800-number for questions relating to 

Texas Heart Institute heart disease

Houston, TX 77225-0345 • Heart-health quiz

Telephone: (713) 794-6630 or (800) 292-2221

Fax: (713) 794-3714

E-mail: his@biostl.thi.tmc.edu

Web: www.tmc.edu/thi

National Heart, Lung, and Blood Institute • Health information from trained

Bethesda, MD 20824 • Asthma, sleep disorders, overweight,

Telephone: (301) 592-8573 obesity, physical activity, cholesterol,

Fax: (301) 592-8563 heart disease, high blood pressure, 

Web: www.nhlbi.nih.gov and other heart, lung, and blood

E-mail requests: NHLBIinfo@rover.nhlbi.nih.gov disorders

National Institutes of Health (NIH) • A–Z subject guide including all the

9000 Rockville Pike Institutes at NIH

Bethesda, Maryland 20892

Web: www.nih.gov/index.html

Wellness Council of America** • Workplace and employee wellness

7101 Newport Avenue, Suite 311 programs

Omaha, NE 68152 • Local chapter in some States

Telephone: (402) 572-3590

Fax: (402) 572-3594

Web: www.welcoa.org

** Local or State Chapters exist 

P.O. Box 20345, MCI-194 • Cardiovascular health

P.O. Box 30105 information specialists
D-5

Nutrition and Weight Loss Type of Information Provided

American Dietetic Association** • Nutrition information for various age

216 West Jackson Boulevard, Suite 800 groups, diseases, and circumstances

Chicago, IL 60606-6995 • Nutrition education

Telephone: (312) 899-0040, (800) 877-1600 • Nutrition hotline for nutrition information and 

Web: www.eatright.org to find a local dietitian

Consumer Nutrition Hotline

(800) 366-1655

Center for Science in the Public Interest • Food safety

Suite 300 • Nutrition

1875 Connecticut Avenue, NW • Kids nutrition Web site

Washington, DC 20009-5728 • Nutrition quizzes

Telephone: (202) 418-2312

Fax: (202) 208-2321

E-mail: cspi@cspinet.org

Web: www.cspinet.org

USDA Center for Nutrition Policy • “Nutrition Insights” newsletter on 

and Promotion nutrition-related topics

U.S. Department of Agriculture • Nutrition and Your Health: Dietary Guidelines for Americans

North Lobby, Suite 200 • Food Guide Pyramid

1120 20th Street, NW • Information on nutrition policy

Washington, DC 20036

Telephone: (202) 418-2312

Web: www.usda.gov/cnpp

Cooperative State Research, Education, • Research and education, including food

and Extension Service** and nutrition

Web: www.reeusda.gov • State partners

• Find an expert (such as home economists or food

and nutrition specialists)

Overeaters Anonymous** • Support for compulsive overeaters

P.O. Box 44020

Rio Rancho, NM 87174-4020

Telephone: (505) 891-2664

Web: www.overeatersanonymous.org

TOPS Club, Inc.** • Weight loss support groups

Take Off Pounds Sensibly

4577 South 5th Street

Milwaukee, WI 53207

Telephone: (414) 482-4620

(800) 932-8677 (chapter location)

Web: www.tops.org/html/information.html

Weight-control Information • Eating disorders

Network (WIN) • Weight loss programs

1 WIN Way • Nutrition tips

Bethesda, MD 20892-3665

Telephone: (800) WIN-8098

Web: www.niddk.nih.gov/health/nutrit/win.htm

** Local or State Chapters exist
D-6

Nutrition and Weight Loss Type of Information provided

Tufts University Nutrition Navigator • A rating guide to nutrition Web sites

Web: www.navigator.tufts.edu • General nutrition, parents, women, kids, 

special dietary needs, journalists, health

professionals, educators

Physical Activity and Sports Type of Information Provided

Alliance for Health, Physical Education, • Physical fitness programs for youth and

Recreation and Dance adults

1900 Association Drive • Physical Best Activity Guides (elementary

Reston, VA 20191 and secondary levels) 

Telephone: (703) 476-3400 or (800) 213-7193 • Public advocacy to expand physical

Web: www.aahperd.org/index.html education programs for students

Publications catalog (800) 321-0789

American College of Sports Medicine • Nutrition and sports information

P.O. Box 1440 (to order, free, not available online )

Indianapolis, IN 46206-1440

Telephone: (317) 637-9200 or (800) 486-5643

Fax: (317) 634-7817

E-mail: pipascm@acsm.org

Web: www.acsm.org/sportsmed

Cooper Institute of Aerobic Research • Fitness and aerobic health

Web: www.cooperinst.org • Physical fitness assessments

Health and nutrition tips: • Worksite health promotion

Web: www.cooperaerobics.com/index.htm

National Association for Health and Fitness • Activity planning kits

201 S. Capitol Ave., Suite 560 • Resource and product guide

Indianapolis, IN 46225 • 8-week program for adults to establish a 

Telephone: (317) 237-5630 more healthy and active lifestyle

Fax: (317) 237-5632 • Employee health and fitness

Web: www.physicalfitness.org

National Association for Sport and • Sport and physical activity programs that 

Physical Education promote healthy behaviors and individual

1900 Association Drive well-being

• Physical activity guidelines for pre-adolescent

Telephone: (703) 476-3410 children and national standards for

Fax: (703) 476-8316 physical education curriculum

Web: www.aapherd.org/naspe/naspe-main.html

Online Store: www.aapherd.org

** Local or State Chapters exist 

Reston, VA 20191
D-7

Physical Activity and Sports

National Recreation and Park Association**

Belmont Ridge Road

Ashburn, VA 20148

Telephone: (703) 858-0784

Fax: (703) 858-0794

E-mail: programs@nrpa.org

Web: www.activeparks.org

President’s Council on Physical Fitness

and Sports

200 Independence Avenue, SW

Room 738H

Washington, DC 20201

Telephone: (202) 690-9000

Web: www.surgeongeneral.gov/ophs/ pcpfs.htm

** Local or state chapters exist

Information on the Internet

Centers for Disease Control and Prevention

Web: www.cdc.gov/other.htm 

Food and Nutrition Information Center

U.S. Department of Agriculture

National Agricultural Library

10301 Baltimore Boulevard, Room 304

Beltsville, MD 20705-2351

Telephone: (301) 504-5719

Web: www.nal.usda.gov/fnic

Healthfinder®

U.S. Department of Health and Human Services

Web: www.healthfinder.gov

National Health Information Center

Office of Disease Prevention and Health

Promotion

U.S. Department of Health and Human Services

P.O. Box 1133

Washington, DC 20013

Telephone: (800) 336-4797

Web: nhic-nt.health.org

Type of Information Provided

• Leisure and lifestyle

• Links to programs focused on

health, youth, and the environment

• Find a park near you

• Online events and calendar contact information 

for State affiliates

• Promotion of physical activity

• Importance of physical activity

• Youth fitness campaign

Type of Information Provided

• Information networks and other information

sources

• State and local health departments, public 

health partners

• Allergies, food safety, food and nutrition for all 

ages, pregnancy and breastfeeding, diabetes,

body weight, cardiovascular disease, and 

• Food Guide Pyramid

for Americans

• Healthfinder is a free gateway to reliable 

consumer health and human services

information developed by the U.S. Department

of Health and Human Services

• Health Information Resource Database:

1,100 organizations and government offices 

that provide health information upon request

Gateways/Clearinghouses for Health

nutritional and herbal supplements

• Nutrition and Your Health: Dietary Guidelines 
D-8

Gateways/Clearinghouses for Health

Information on the Internet Type of Information Provided

The National Women’s Health • Gateway to health information and

Information Center referral center for women

Office on Women’s Health • Heart health assessment

Department of Health and Human Services • Media information

Telephone: (800) 994-WOMAN (9662) • Women’s health statistics

Web: www.4woman.gov 

Local Professionals Ask for the:

American Diabetes Association Diabetes educator

Web: www.diabetes.org

American Dietetic Association Registered dietitian (800) 366-1655

Web: www.eatright.org Local chapter (800) 877-1600

Cooperative State Research, Education, Home economist or food and nutrition 

Nutrition and Extension Service specialist

Web: www.reeusda.gov

American Nurses Association Registered nurse

Web: www.nursingworld.org/index.htm State nurses association

Telephone: (800) 274-4ANA (4262)

County Health Department Health education consultant

Department of Public Health, Health Promotion Division Public health nutritionist

Office of Health Education Health educator

Media and Local Associations Type of Information Provided

The National Association of Counties • Contact information for 

440 First Street, NW State association

Washington, DC 20001

Telephone: (202) 393-6226

Fax: (202) 393-2630

Web: www.naco.org

National League of Cities • Contacts for State municipal leagues

1301 Pennsylvania Avenue, NW • Links to State, local, and Federal 

Washington, DC 20004-1763 government resources on the World 

Telephone: (202) 626-3000 Wide Web

Fax: (202) 626-3043

Web: www.nlc.org

Suite 800
D-9

Media and Local Associations Type of Information Provided

ABC

Web: www.abc.go.com • Contact information for local networks

NBC

Web: www.nbc.com • Contact information for local networks

CBS

Web: www.cbs.com • Contact information for local networks

Fox Network

Web: www.foxnetwork.com • Contact information for local networks

Other helpful

contacts

and ideas

• Local grocery stores or

restaurants will often donate

heart-healthy food for events.

• Hospitals will sometimes

donate staff time and/or

supplies for screenings,

health fairs, etc. Call your

State hospital association or

search for it on the Web by

searching for “[your State]

hospital association”

• Contact local newspapers 

and local TV stations for 

coverage of special events.
D-10
e

Health Statistics...to provide programmers

with background health information on the burden

of heart disease and associated risk factors within

the community.
E-2
E-3

Cardiovascular Disease (CVD)

• Approximately 60.8 million people in the United

States had some form of CVD in 1998.

• CVD includes such diseases as high blood 

pressure (hypertension), coronary heart disease

(CHD), stroke, congestive heart failure, and

rheumatic heart disease.

• Approximately 50 million people had hypertension

and about 12 million people had CHD in 1998.

• CVD is the leading cause of death in the United

States, contributing to 949,000 deaths in 1998.

The estimated total economic cost of CVD is

expected to be $298 billion in 2001;

$182 billion is expected to be in

direct health expenditures.

Source: NHLBI FY 2000 Fact Book

Hypertension (High Blood

Pressure)

• Approximately 50 million adults in

the United States had hypertension

in 1997.

• Hypertension is a major risk factor

for heart disease.

• High blood pressure is known as

the “silent killer” since a large

number of people are unaware

that they have it and may not have

symptoms.

• High blood pressure is more common in older 

persons, in African Americans, overweight persons,

and those with a family history of high blood 

pressure.

• Lifestyle changes, such as engaging in physical

activity, maintaining a healthy weight, limiting

alcohol, and following a heart-healthy diet can help

prevent or control hypertension.

Source: Healthy People 2010: Understanding and

Improving Health

Cholesterol

• High blood cholesterol is a major

risk for CVD.

• More than 90 million adults in the United

States have blood cholesterol levels that

are higher than desirable.

• More than 50 million adults in the United

States have blood cholesterol levels that 

require medical intervention.

• Lifestyle changes, such as increasing 

physical activity, reducing excess 

weight, and following a heart-healthy

eating diet low in saturated fat and 

cholesterol can prevent or lower high 

blood cholesterol.

Source: Healthy People 2010:

Understanding and Improving Health

%Health

Statistics

about Cardiovascular Disease
E-4

Overweight and Obesity

• Approximately 97 million people (55 percent of the

American adult population) are overweight 

or obese.

• One in five children over the age of 6 is considered overweight or obese.

• Overweight and obesity are risk factors for CVD

and other diseases, such as type 2 diabetes,

osteoarthritis, gall bladder disease, sleep apnea,

as well as some types of cancer.

• Obesity acquired during childhood or adolescence

may persist into adulthood and increase the risk

for CVD and other diseases later in life.

• Lifestyle changes, such as increasing physical

activity, behavior modification, and following a

heart-healthy eating plan can help with weight

loss and maintenance.

Source: Healthy People 2010: Understanding and

Improving Health

Physical Activity

• Physically inactivity increases the risk of heart 

disease.

• Moderate, regular physical activity for 30 minutes

on most days of the week can reduce the risk for

many diseases, including heart disease.

• Regular physical activity enhances the quality of

life for people of all ages and helps to maintain the

functional independence of older adults.

• Currently, 23 percent of adults report regular, 

vigorous physical activity for 20 minutes or longer

3 or more days per week.

• Approximately 15 percent of adults report moderate

physical activity for 5 or more days per week for

30 minutes or longer.

• Approximately 27 percent of adolescents in

grades 9 through 12 engage in moderate physical

activity for at least 30 minutes for 5 or more days.

Source: Healthy People 2010: Understanding and

Improving Health

Smoking

• Cigarette smoking causes heart disease as well

as several types of cancer, and chronic lung disease.

• Secondhand smoke exposure causes heart 

disease in adults.

• Tobacco is responsible for more than 430,000

adult deaths per year in the United States.

• Tobacco use and addiction usually begin in 

adolescence, and have increased in the 1990s.

Source: Healthy People 2010: Understanding 

and Improving Health

Approximately

27 percent of

adolescents in grades

9 through 12 engage

in moderate

physical activity

for at least

30 minutes for

5 or more days.
f

Background Sheets...to provide programmers

with reproducible background sheets on what Hearts

N’ Parks is all about, as well as one on Eat Right for a Healthy Heart and one on Get Moving for a

Healthy Heart.
F-2
F-3

Why are these goals important? 

• Heart disease is the leading cause of death in

the United States. Overweight and obesity

increase one’s risk of developing heart disease. 

• The numbers of overweight children and 

adolescents, as well as obese adults, in the

United States have doubled over the past 2

decades. Approximately 97 million American

adults—or 55 percent—are currently overweight

or obese. In addition, one in five children

over the age of 6 is considered overweight,

and overweight and obesity acquired during

childhood or adolescence may persist into

adulthood and increase the risk for some

chronic diseases later in life. In addition to

being more likely to develop heart disease

and stroke than individuals with healthy

weights, overweight and obese individuals are

at increased risk for diabetes, cancer,

gallbladder disease, sleep apnea and other

respiratory problems, osteoarthritis, and

other conditions. 

• Adopting heart-healthy behaviors, such as

following a healthy eating plan and participating in regular physical activity, can help

individuals achieve or maintain a healthy

weight. Even modest amounts of weight loss

of approximately 10 percent of initial body

weight can reduce high blood pressure, high

blood cholesterol levels, and high blood 

glucose levels in overweight or obese 

About Hearts N’ Parks

Hearts N’ Parks is a national, community-based program supported by the National Heart, Lung, and

Blood Institute (NHLBI) of the National Institutes of Health and the National Recreation and Park

Association (NRPA). This innovative program aims to reduce the growing trend of obesity and the

risk of coronary heart disease in the United States by encouraging Americans of all ages to aim for a

healthy weight, follow a heart-healthy eating plan, and engage in regular physical activity. 
F-4

individuals with high levels.

Reducing these risk factors

helps to prevent cardiovascular disease and/or reduce

its severity in those with 

existing disease. 

Through Hearts N’ Parks,

science-based information

about lifestyle choices that can

reduce an individual’s risk of

heart disease and skills for

incorporating heart healthy behaviors into one’s

life are taught as part of the regular activities

offered by park and recreation departments and

other community-based agencies. The program

also provides tools for measuring the impact of

these activities. 

Hearts N’ Parks also demonstrates the impact

that community park and recreation programs

can have on helping people improve and 

maintain their health. According to NRPA,

75 percent of Americans live within a 2-mile 

walking distance of a public park. These 

facilities are widely accessible to individuals

from culturally and socioeconomically diverse

populations, as well as to individuals with 

disabilities. 

Key elements and benefits of 

Hearts N’ Parks include:

• Hearts N’ Parks activities can be incorporated

into a variety of programs - nutrition and 

fitness activities, stress reduction or family

life programs, etc. Activities can

be adapted for children, youth,

adults and seniors. 

• Recreation and park departments and other community

organizations receive staff 

training and resources to 

integrate heart-healthy activities

into existing activities or to

develop new activities. 

• Consumeroriented materials

are available to communicate

heart-healthy messages related

to weight management, physical

activity, high blood pressure,

cholesterol, and heart disease.

In addition, materials targeted

to specific populations, such

as African Americans and

Hispanics, are also available. 

• Evaluation materials to measure the program’s

impact are included. 

• Hearts N’ Parks provides opportunities for

community organizations to gain public 

recognition of their commitment to encouraging

healthy behaviors, as well as to develop 

partnerships to further enrich their activities. 

Hearts N’ Parks was piloted during the summer

of 1999 in 33 sites in 12 North Carolina 

communities involving more than 2,000 

participants. An evaluation showed that 

participants retained information about 

heart-healthy behaviors and intended to eat

healthier. In addition, children reported learning

new physical activities and improving their 

performance in others; seniors reported feeling

healthier and experiencing less pain in their

daily lives by the end of the program. 

Hearts N’ Parks is fun and flexible. Each 

community agency can adapt the program 

material to its own design,

abilities, and needs. And it’s for

everybody—participants can be

young or old, active or non-active.

Community organizations interested

in signing up to become a Hearts

N’ Parks community should contact

the National Recreation and Park

Association at programs@nrpa.org

or 1-800-649-3042. 

Hearts N’ Parks is

fun and flexible.

Each community

agency can adapt

the program 

material to its

own design,

abilities, and

needs.
F-5

Heart disease is the leading

cause of death in the United

States. Fortunately, though,

there are things you can do to protect

yourself and your family against heart disease.

For example, following an eating plan that 

balances calorie intake with your level of physical

activity and is low in saturated and total fat, and

cholesterol, and rich in fruits and vegetables,

lowfat dairy foods, and whole grains, can help

protect you against high blood pressure, high

blood cholesterol, and overweight—factors that,

along with physical inactivity and smoking,

increase the risk of heart disease.

This eating plan may also help

prevent cancer and other

health problems.

The earlier you take action, the better. Research

shows that heart disease begins early in life and

that, once learned, bad habits are hard to break.

So you and your family should adopt a hearthealthy eating plan now.

Here’s some advice about heart-healthy eating

from the National Heart, Lung, and Blood

Institute (NHLBI) and the National Recreation

and Park Association (NRPA):

• Balancing the calories in the foods you eat

with the calories your body uses in physical

activity is key to maintaining a healthy body

weight, or even to losing weight if you are 

overweight. Being overweight increases your

risk of developing high blood pressure, high

blood cholesterol, diabetes, and other serious

diseases or conditions. 

• The kinds and amounts of foods you eat can

affect your ability to maintain weight. Highfat foods contain more calories per serving

than other foods and increase the likelihood of

weight gain. However, even when people eat

less high-fat food, they still can gain weight

from eating too much of foods high in starch,

sugars, or proteins. 

• Healthy people over age 2 should consume

less than 10 percent of the day’s total calories

from saturated fat; no more than 30 percent of

total calories from fat; and less than 300 

milligrams of dietary cholesterol per day. 

• Saturated fat raises cholesterol in the blood

more than anything else eaten. Saturated fat is

found mainly in animal foods. One way to cut

down is to switch to lower-fat foods, including

Eat Right

for a Healthy Heart
F-6

low-fat or fat-free dairy products and to

remove skin from poultry. 

• Cholesterol in the diet also can raise blood

cholesterol. It is found only in foods from

animals. Meat and poultry have similar

amounts. Since eggs are especially high in

cholesterol, limit intake to four eggs per week. 

• Unsaturated fat does not raise blood cholesterol

but can add calories. Be careful of extra

calories when trying to lose weight. 

• Another key to healthy eating is choosing

foods lower in salt and sodium, which can

affect blood pressure. Have no more than

2,400 mg of sodium a day—equal to about

one teaspoon of table salt. This includes salt

used in cooking. Instead, season food with

herbs and spices. Also, snack on unsalted

pretzels, popcorn without salt or butter,

and crackers or fruits.

• Having an adequate intake of vitamins and 

minerals, especially potassium, calcium, and

magnesium, also is important for lowering

blood pressure. 

• Limit alcohol, since it supplies calories but

few or no nutrients—for example, no more

than two 12-ounce beers in a day for men 

and one for women. 

• To help you follow a heart-healthy eating

plan, read food labels to choose foods that 

are lower in calories, total fat, saturated fat,

and sodium. 

American children 

are gaining weight.

They are eating too

many calories from 

high-calorie fast- and

snack foods and not

getting enough physical

activity. Try cutting 

back on high-fat foods

for your children by

offering more fruits as

snacks. Vegetables can

be chopped into small

pieces and added to favorite recipes without

kids noticing. Combine rice with vegetables.

Whole wheat or bran breads add fiber to

sandwiches. For desserts, offer fig bars,

ginger snaps, graham crackers, or frozen 

fatfree dairy desserts.

Children often eat many meals away from

home, making it harder to maintain good 

eating habits. To improve fast-food meals,

order a small plain hamburger—it has less fat

than fried or battered items—and hold the

cheese or special sauce. Or, try lean roast

beef and grilled or broiled chicken sandwiches

or pita pockets with small pieces of meat and

vegetables.

Seniors need to be diet-smart too.

Maintaining a healthy body weight is important for older people, since we begin to lose

weight as we age. Some weight may be lost

from muscle, so be sure that your diet is rich

in protein and carbohydrates while watching

out for too many saturated fats.

Special Tips for

Kids and

Seniors
F-7

Heart disease is the leading cause of death

in the United States. Fortunately, though,

you can take steps to reduce your risk of

heart disease. For example, getting regular 

physical activity can help protect you and

your family against high blood pressure and 

overweight and obesity—factors that, along with

high blood cholesterol and smoking, increase 

the risk of heart disease.

Staying active also helps keep off extra pounds,

control blood pressure, boost the level of “good”

HDL-cholesterol, and prevent diabetes and heart

attacks. It also strengthens the lungs, tones the

muscles, keeps the joints in good condition,

improves balance, helps prevent and treat 

depression, and helps many people cope better

with stress and anxiety.

If you already have heart disease, regular, moderate

physical activity lowers your risk of death from

heart-related causes. (However, if you have heart

disease, check with your doctor first to find out

what kinds of activities are best for you.)

The earlier you start, the better. The best time to

start learning heart-healthy habits is in childhood,

because heart disease risk factors start developing

then too. Still, it’s never too late to begin living

heart-healthy. This is true even for people in their

‘80s and ‘90s.

Here’s some advice about physical activity from

the National Heart, Lung, and Blood Institute

(NHLBI) and the National Recreation and Park

Association (NRPA):

• To reap benefits from physical activity, you

don’t need to train for a marathon. You need 

to engage in only about 30 minutes

of moderate-level activity on most—

and preferably all—days of the week. 

A moderate-level activity is one that’s 

about as demanding as brisk walking. 

• Other examples of moderate physical activity

that can improve heart health are bicycling,

conditioning or general calisthenics, racquet

sports (such as table tennis), jogging, swimming, dancing, housework, gardening, or lawn

mowing. 

• You can engage in any of these activities for 30

minutes at one time, or you can do them in

shorter periods of at least 10 minutes each, as

long as you total approximately 30 minutes

each day. 

• If you are already engaging in this level of

physical activity, you will receive extra health

and fitness benefits by doing these activities for

a longer period each day or becoming involved

in more vigorous activity. 

Special Tips for Kids, Adults, and Seniors:

Young people should be physically active—

both in and out of school. Instead of television,

video games and the computer, kids need to be

engaged in “active play,” such as tag, jump rope,

hide and seek, or bicycling, or team activities like

soccer, basketball, and softball.

Another way to increase children’s activity levels

is to get them involved in everyday activities, like

household chores, walking the dog, or helping

with the groceries.

Get moving 

for a healthy heart
Take the time to be physically active as

a family. This not only provides health

benefits for the entire family but can be

an important time to get to know each

other better. Young kids particularly

enjoy being involved in family fun,

such as shooting hoops with dad or

playing tennis with mom.

Adults who have not been active for a

while should start slowly, gradually building up to

the recommended 30 minutes per day of moderatelevel activity. For example, if you want to begin

walking regularly, you might begin with a 10–15-

minute walk three times a week. As you become

more fit, you can increase the sessions to every

day and gradually lengthen each walking session

or increase your pace. Some adults should get

medical advice before starting a program of 

physical activity. Consult your doctor first if you:

• Have heart trouble or have had a heart attack; 

• Are taking medicine for high blood pressure or

a heart condition; 

• Are over 50 years old and not used

to moderately energetic activity; 

• Have someone in your family who

developed heart disease at an 

early age. 

Seniors also need regular physical

activity. Regular physical activity is

good for your heart, mood, muscles,

and arteries, and improves your bones

and ability to sleep well. It builds strength,

promotes coordination and balance, and helps slow

bone loss and prevent fractures from osteoporosis.

Many older people think they are too old or too

frail to exercise. Nothing could be further from

the truth. Physical activity of any kind—from

heavy-duty exercise, such as jogging or bicycling,

to easier efforts like walking—is good for you.

Older people who become more active—including

those with medical problems—may feel better

and have more energy. Being active is also an

easy way to share some time with friends or family,

as well as to meet new friends.

Keys to Success

• Go slow. If you have not been physically active until now, gradually build up to the

recommended 30 minutes per day of moderate-level activity. 

• Begin each workout slowly. Allow a 5-minute period of stretching and slow movement to 

“warm up” and 5 minutes at the end to “cool down” at a slower pace. 

• Listen to your body. A certain amount of stiffness is normal at first. But if you hurt a joint or 

pull a muscle or tendon, stop the activity for several days to avoid more serious injury. 

• Pay attention to warning signals. Some types of physical activity may worsen heart problems.

Warning signals include sudden dizziness, cold sweat, paleness, fainting, or pain or pressure in

your upper body or chest during—or just after—physical activity. If you notice any of these

signs, stop and call your doctor immediately. 

• Check the weather. Dress appropriately for hot, humid days and for cold days, and drink lots of

water before, during, and after activity. 

• Keep at it. Unless you have to stop your activity for a health reason, stay with it. Set small,

short-term goals for yourself. If you find yourself becoming bored, try doing the activity with 

a friend or family member. Or switch to another activity. 

F-8
❉

❉

❉

❉ ❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❍

❍

❍

❍

❍

❍

❍

❍ ❍

❍❂ ❍

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

✻

❂

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✫

✫

✫

✫

✫

✫

✫

✫

Healthy Eating 3

• Eat Right for a Healthy Heart

• Snacks Like These Are 

Okay

• Find the Foods

• Get Moving Fast

• Stay Young at Heart Menu 

• Dining Out—How to Choose

• Foods in the Fast Lane

• Putting Heart Healthy Eating 

Habits Into Play

• Physical Activity and Heart 

Disease IQ

• Get Physical

• Guide to Physical Activity

• Check Your Weight and 

Heart Disease IQ

• Healthy Heart IQ

• High Blood Pressure 

Prevention IQ

• Healthy Heart IQ

• Cholesterol and Heart 

Disease IQ

• Heart Healthy Eating Plan

• Help Your Family to Better 

Heart Health

• Cooking the Heart-Healthy Way

• Shop to Your Heart’s Content

• Dining Out—How to Choose

• Stay Young at Heart Menu

• Help Your Family to Better 

Heart Health

• Physical Activity and Heart 

Disease IQ

• Guide to Physical Activity

• Guidelines on Overweight and 

Obesity

• Check Your Weight and Heart 

Disease IQ

• Heart Healthy Eating Plan

• Healthy Heart IQ

• High Blood Pressure 

Prevention IQ

• Tips to Help Older Americans 

Control Cholesterol

• Healthy Heart IQ

• Cholesterol and Heart Disease IQ

High Blood High Blood Obesity & Physical Healthy

Cholesterol Pressure Overweight Activity Eating

3

Children Adolescents Adults

Healthy Eating ............................7

Physical Activity ......................41

Obesity & Overweight ..............55

High Blood Pressure................63

High Blood Cholesterol............73

Contents

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

❉

Healthy Eating 7
8 Healthy Eating
Healthy Eating 9

FOODS HIGH IN SATURATED FAT

/ Fatty cuts of beef, pork, and lamb, 

like hamburger and ribs

/ Butter

/ Whole milk and cream

/ Most cheeses

/ Ice cream

/ Many cakes, cookies, and pies

FOODS HIGH IN CHOLESTEROL

/ Egg yolks

/ Liver

For a Healthy Heart:

❤ You can eat right.

❤ You can get plenty of exercise.

❤ Do not start smoking.

for a Healthy Heart

Build a Balanced Diet

Eat Right

The foods you eat play a big part in keeping your blood cholesterol level low or high. It depends on

the choices you make. Foods low in fat and cholesterol are good choices.

A type of fat, called saturated (SACH-uh-rate-id) fat, can really make your blood cholesterol go up. So

can the cholesterol you eat. Cholesterol is not the same as saturated fat. A food can be low in cholesterol

but high in saturated fat. Choosing foods low in saturated fat and cholesterol is important. This will help

you lower your blood cholesterol level. And, this may help prevent heart problems when you get older.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563

“Diet” means the foods you eat most often.

A healthful diet is a balanced diet which is low in saturated fat and 

cholesterol. A balanced diet has the right amount of calories (KAL-uhreez) and nutrients (NEW-tree-unts) your body needs. Calories provide

you with energy to grow and move around. Fat of any kind provides

more calories than any other nutrient. So you have to be careful not to eat

too much. Other nutrients found in food are protein, carbohydrate (starch

and sugars), vitamins, and minerals.
10 Healthy Eating
Healthy Eating 11

Do you know 

what a balanced diet

looks like?

The foods in A, B, and C below are low in saturated fat and cholesterol.

Which of these do you think provide all the nutrients you need in one day?

A. Toast and fat-free milk

B. A baked potato and baked chicken leg

C. Lots of spinach

D. None of the above

The answer is D. No one food can give you all the nutrients your body needs. Even

two foods, like those in A and B, do not give a balance. You need to eat a variety of

foods every day.

Foods can be put in groups. Each group provides different kinds of nutrients.

❤ Meat, poultry, and fish

❤ Milk and dairy products

❤ Breads, cereals, pasta, rice, dry peas, and beans

❤Vegetables

❤ Fruits

To build a balanced diet:

Eat a variety of foods from 

each food group.

Choose those foods lower 

in saturated fat and cholesterol.

Eat Right for a Healthy Heart

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
12 Healthy Eating
13 Healthy Eating

☺ Fruit juices, drinks, punches

☺ Fat-free or 1% milk

☺ Frozen desserts like sherbet, sorbet, fruit ice, popsicles, 

ice milk, frozen yogurt

☺ Flavored low-fat yogurt, plain or with fruit

☺ Animal crackers, graham crackers

☺ Homemade cookies, cake, muffins, pudding made 

with less saturated fat and cholesterol

☺ Gingersnaps, fig bar cookies

☺ Angel food cake

☺ Candy like candy corn, gumdrops, hard candy

☺ Gelatin

☺ Canned, fresh, or dried fruit

☺ Vegetable sticks

☺ Air-popped popcorn

☺ Pretzels

☺ Peanut butter in celery sticks

Snacks Like

These Are 

Okay!

Healthy Eating 13

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563

FATFREE
14 Healthy Eating
Look at the snacks in the list. Can you find these

11 snack foods in the picture? They are low in

saturated fat and cholesterol. Color them after

you find them.

Find The Foods!

Healthy Eating 15

1 Cold cereal with fat-free milk

2 Toast with jam or jelly

3 Popcorn

4 Popsicles or fruit slush

5 A bowl of fresh fruit

6 Flavored low-fat yogurt

7 Celery stalk filled with 

peanut butter

8 Peanuts in a shell

9 Fruit juice

10 Homemade muffin

11Peanut butter spread 

on crackers

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
16 Healthy Eating
CHOOSE:

Salad (with dressing on the side)

Regular-sized hamburger (hold the mayo)

Turkey, chicken, lean ham, or roast beef 

sandwich (hold the mayo)

Broth-based soups

Low fat or nonfat cottage cheese or yogurt

with fresh fruit

DECREASE:

Deluxe sandwiches

Hot dogs or sausage

Breaded and fried chicken or fish

Cream-based soups

French fries, onion rings, or chips

Stay Young at Heart

CHOOSE:

Egg substitute 

Hot or cold cereal

Toast with margarine and jam

English muffin or bagel with nonfat 

cream cheese

Fruit or juice

Fat-free or 1 percent milk

Canadian bacon

DECREASE:

Egg yolks, any style

Fried potatoes

Bacon or sausage

Biscuit, croissant, or sweet roll

Whole milk

BREAKFAST

LUNCH

CHOOSE:

Pasta with low-fat sauce, such as marinara

Grilled or broiled fish or skinless chicken

Lean steak, trimmed of fat

Vegetarian entree (little or no cheese)

Baked potato with a little margarine or nonfat

yogurt

Vegetables, plain

Low-fat desserts like fresh fruit, sorbet,

sherbet, ice milk, or nonfat frozen yogurt

DECREASE:

Prime rib or untrimmed steaks or chops

Fried chicken

Cream sauces or gravies

Rich desserts, such 

as cake, cheesecake,

or tortes

DINNER

HERE ARE SOME MENU ITEMS TO CHOOSE AND SOME TO DECREASE FOR EACH MEAL.

Healthy Eating 17

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
18 Healthy Eating
Healthy Eating 19

GENERAL TIPS FOR HEALTHY DINING OUT

Whether or not you’re trying to lose weight, you

can eat healthfully when dining out or bringing

in food, if you know how. The following tips

will help you move toward healthier eating as

you limit your calories, as well as fat, saturated

fat, cholesterol, and sodium when eating out. 

YOU ARE THE CUSTOMER

• Ask for what you want. Most

restaurants will honor your

requests.

• Ask questions. Don’t be

intimidated by the menu—

your server will be able to

tell you how foods are prepared

or suggest substitutions on the menu.

• If you wish to reduce portion sizes, try

ordering appetizers as your main meal.

• General tips: Limiting your calories and fat

can be easy as long as you know what to

order. Try asking these questions when you

call ahead or before you order. Ask the

restaurant, whether they would, on request, do

the following:

– Serve nonfat (fat-free)

milk rather than whole

milk or cream.

– Reveal the type of cooking

oil used.

– Trim visible fat off poultry

or meat.

– Leave all butter, gravy, or sauces off a side

dish or entree.

– Serve salad dressing on the side.

– Accommodate special requests if made in

advance by telephone or in person.

Above all, don’t get discouraged. There are

usually several healthy choices to choose from at

most restaurants.

READING THE MENU

• Choose lower calorie, low-fat cooking

methods. Look for terms such as, “steamed in 

its own juice” (au jus), “garden fresh,”

“broiled,” “baked,” “roasted,” “poached,”

“tomato juice,” “dry boiled” (in wine or lemon

juice), or “lightly sautéed.”

• Be aware of foods high in calories, fat, and

saturated fat. Watch out for terms such as

“butter sauce,” “fried,” “crispy,” “creamed,”

“in cream or cheese sauce,” “au gratin,”

“au fromage,” “escalloped,” “parmesan,”

“hollandaise,” “bearnaise,” “marinated (in

oil),” “stewed,” “basted,” “sautéed,” “stirfried,” “casserole,” “hash,” “prime,” “pot pie,”

and “pastry crust.”

SPECIFIC TIPS FOR HEALTHY CHOICES

BREAKFAST

• Fresh fruit or small glass of citrus juice

• Whole grain bread, bagel, or English muffin

with jelly or honey

• Whole grain cereal with 

low-fat (1%) or nonfat milk

• Oatmeal with nonfat milk topped with fruit

• Omelet made with egg whites or egg substitute

• Multigrain pancakes without butter on top

• Nonfat yogurt (try adding cereal or fresh fruit)

BEVERAGES

• Water with lemon

• Flavored sparkling water (noncaloric)

• Juice spritzer (half fruit juice and

half sparkling water)

• Iced tea

• Tomato juice (reduced sodium)

BREAD

Most bread and bread sticks are low in calories

and low in fat. The calories add up when you

add butter, margarine, or olive oil to the bread. 

Dining Out—How to Choose
Also, eating a lot of bread in

addition to your meal will fill

you up with extra unwanted

calories and not leave enough

room for fruits and vegetables.

APPETIZERS

• Steamed seafood

• Shrimp* cocktail (limit cocktail

sauce—it’s high in sodium)

• Melons or fresh fruit

• Bean soups

• Salad with reduced-fat dressing (or add lemon

juice or vinegar)

*If you are on a cholesterol-lowering diet, eat

shrimp and other shellfish in moderation.

ENTREE

• Poultry, fish, shellfish, and vegetable dishes

are healthy choices.

• Pasta with red sauce or

with vegetables

(primavera).

• Look for terms such as “baked,” “broiled,”

“steamed,” “poached,” “lightly sauteed,” or

“stir-fried.”

• Ask for sauces and dressings on the side.

• Limit the amount of butter, margarine, and salt

you use at the table.

SALADS/SALAD BARS

• Fresh greens, lettuce, and spinach

• Fresh vegetables—tomato,

mushroom, carrots, cucumber,

peppers, onion, radishes, and broccoli

• Beans, chickpeas, and kidney beans

• Skip the nonvegetable choices: deli meats,

bacon, egg, cheese, and croutons. 

• Choose lower calorie, reduced fat or fat free

dressing, lemon juice, or vinegar.

SIDE DISH

• Vegetables and starches

(rice, potato, noodles)

make good additions to

meals and can also be

combined for a lower calorie alternative to

higher calorie entrees.

• Ask for side dishes without butter or

margarine.

• Ask for mustard, salsa, or low-fat yogurt

instead of sour cream or butter.

DESSERT/COFFEE

• Fresh fruit

• Nonfat frozen yogurt

• Sherbet or fruit sorbet

(these are usually fat free,

but check the calorie

content)

• Try sharing a dessert.

• Ask for lowfat milk for your coffee (instead of

cream or half-and-half).

20 Healthy Eating 

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
Healthy Eating 21

■ Order a small hamburger instead of

a larger one. Try the lower-fat

hamburger. Hold the extra

sauce.

■ Order roast beef for a leaner

choice than most burgers.

■ Order a baked potato instead of

French fries. Be careful of high-fat 

toppings like sour cream, butter, or

cheese.

■ Order grilled, broiled, or baked fish and

chicken.

■ Order fat-free or 1 percent milk instead of a

milkshake. Try the low-fat frozen yogurt or

low-fat milkshake.

■ Order a salad. Use vinegar and oil or 

low-calorie dressing more often than 

creamy salad dressing.

■ Create a salad at the salad bar.

Choose any raw vegetables, fruits,

or beans. Limit high saturated fat

toppings of cheese, fried noodles,

and bacon bits as well as some

salads made with mayonnaise. Also limit salad

dressings high in saturated

fat and cholesterol.

■ For sandwich toppings,

try lettuce, tomato, onion, mustard, and

ketchup instead of high saturated fat

toppings such as cheese, bacon, special

sauces, or butter. 

■ Order pizza with vegetable toppings such as

peppers, mushrooms, or onions instead of

extra cheese, pepperoni, or sausage.

Typical Meal Lower-Fat Choice

Cheeseburger Hamburger

Large French fries 1/2 small French fries

12-ounce cola 12-ounce cola

Vanilla ice milk cone Low-fat frozen yogurt cone

Saturated Fat(g) ..................................16 ................................................................6

Dietary Cholesterol(mg) ......................78 ..............................................................38

Total Fat(g) ..........................................40 ..............................................................19

Total Calories ....................................990 ............................................................649

Foods

In The Fast Lane

When you eat in a heart-healthy way, you don’t have to give up eating fast foods completely. You

can eat right and still eat fast foods if you select carefully. Here are some tips on fast foods to choose:

Let’s see how small changes can add up to big changes 

with the following sample fast-food meals.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
22 Healthy Eating
This is a Who’s Who of foods. Use it to learn about food groups and their nutrients. It lists foods in

choose and decrease columns. It also gives recommended serving numbers and sizes. Some 

serving numbers differ for guys and girls. That’s because guys often need more calories. The 

amount of a single serving is given in parentheses beside the food.

Do:

Choose foods from each food group every day.

Select food group items more often from the “choose” column than the “decrease” column.

MEAT, POULTRY, FISH, & SHELLFISH

Nutrients: Protein, minerals (especially iron), vitamins, saturated fat, and cholesterol.

Servings/day: Up to 6 ounces cooked (3 ounces of cooked meat is about the size of a deck of cards).

CHOOSE

Lean cuts of meat with fat trimmed, like:

Beef—round, sirloin, chuck, loin, extra lean

hamburger

Lamb—leg, arm, loin, rib

Pork—tenderloin, leg, shoulder

(arm or 

picnic)

Veal—all

trimmed

cuts except

ground

Poultry without skin

Fish

Shellfish like crabs, clams, and scallops

Lean luncheon meat like turkey ham, turkey,

lean ham, or lean roast beef. Chicken hot dogs—

these are lower in saturated fat than beef or pork

hot dogs. But “lower” doesn’t equal “low.” So

make them a once-in-a-while choice.

DECREASE

Cuts of meat, like:

Beef—regular hamburger,

short ribs, corned beef brisket

Pork—spareribs, blade roll

Bacon, sausage

Poultry with skin, fried chicken

Fried fish and fried shellfish

Organ meats like liver, kidney, sweetbread, brain

Regular luncheon meat like bologna, salami,

sausage, beef or pork hot dogs

Putting Heart Healthy Eating Habits Into PlayFoods to choose

and foods to lose

Healthy Eating 23
”

CHOOSE

Milk (1 cup)—fat-free milk, 1% milk (fluid,

powdered, evaporated); buttermilk

Yogurt (1 cup)—nonfat or low-fat yogurt;

yogurt beverages

Cottage cheese (1/2 cup)—low-fat or non-fat

Cheese (1 oz.)—low-fat cheeses labeled no

more than 3 grams of fat per ounce

Frozen dairy dessert (1/2 cup)—ice milk, lowfat frozen yogurt

Sour cream—low-fat and fat-free

DECREASE

Whole milk (fluid, evaporated,

condensed); 2% low-fat milk;

imitation milk

Whole-milk yogurt; custard-style

yogurt; whole-milk yogurt beverages

Cottage cheese (4% fat)

High-fat cheese like American, blue,

Brie, cheddar, Colby, Edam, Monterey 

Jack, Parmesan, Swiss; cream cheese

Ice cream

Cream like half and half, whipping 

cream, sour cream

DAIRY PRODUCTS

Nutrients: Protein, vitamins, minerals (especially calcium), saturated fat, and cholesterol.

Servings/day: 4

Note: The numbers in parentheses below are equal to 1 serving.

One of the easiest things to change is drinking

1% milk instead of whole milk. And now

there are lots of substitutes for ice cream. 

Maria, 15

DON’T HAVE A COW

Dairy foods are a great source of calcium and protein. Eating foods high 

in calcium helps bones grow and stay strong. As a teen, your bones are 

growing quickly. So now is the best time in your life to eat foods rich in

calcium. Girls, especially, need to eat foods high in calcium. A very good

choice is low-fat dairy products, which are not only rich in calcium but

also low in saturated fat and cholesterol.

“

Foods to choose and foods to lose...

24 Healthy Eating
CHOOSE

Vegetables (1/2 cup)—

fresh, frozen, or 

canned

DECREASE

Vegetables prepared with 

butter, cheese, or cream sauce

Fried vegetables like French fries

CHOOSE

Bread (1 slice)—whole-grain bread; hamburger

and hot-dog buns (1/2 a bun); bagels (1/2); 

tortilla (1)

Cereal (1 cup ready-to-eat, 1/3 cup bran or 

1/2 cup cooked)—oat, wheat, corn, multigrain

Pasta (1/2 cup cooked)—plain noodles,

spaghetti, macaroni

Rice (1/2 cup cooked)

Low-fat crackers—animal crackers (8); 

graham (3); saltine-type (6)

Homemade baked goods using unsaturated oil,

fat-free or 1% milk, and egg substitutes—

quick bread (1 slice); 2" biscuit (1); cornbread 

muffin (1); bran muffin (1); 4" pancake (1); 

9" diameter waffle (1/4)

Dry beans, peas and legumes (1/2 cup

cooked)—split peas, black-eyed peas, chick

peas, kidney beans, navy beans, lentils,

soybeans, soybean curd (tofu)

Soup like chicken or beef noodle, tomato,

vegetable

DECREASE

Bread in which eggs are a major ingredient;

croissants, butter rolls, cheese bread

Granola-type cereals

Egg noodles and pasta containing egg yolk

Pasta and rice prepared with cream, butter,

or cheese sauces

High-fat crackers—cheese crackers, butter

crackers, or others made with saturated fats

Commercial baked pastries, muffins, biscuits,

doughnuts, sweet rolls, Danish pastry using

high saturated fat and 

cholesterol ingredients

Dry beans, peas and legumes 

prepared with butter, cheese,

or cream sauce

Potato or corn chips

Soups made with 

cream or 

whole milk

BREADS, CEREALS, PASTA, RICE, DRY PEAS, & BEANS

Nutrients: Carbohydrates, protein, vitamins, minerals, and fiber.

Servings/day: 12 for guys and 8 for girls.

Note: The numbers in parentheses below are equal to 1 serving.

VEGETABLES

Nutrients: Carbohydrates, fiber, vitamins, and minerals.

Servings/day: 4 for guys and 3 for girls. 

Note: The numbers in parentheses below are equal to 1 serving.

Foods to choose and foods to lose...

Healthy Eating 25
CHOOSE

Unsaturated oils (1 tsp.)—sunflower, safflower,

sesame, soybean, corn, olive, canola oil

Margarine or shortening (1 tsp.)—made from

unsaturated oils listed above; light or diet 

margarine (2 tsp.) 

Salad dressings (1 tbsp.)—dressings made 

with unsaturated oils listed above; low-fat or

oil-free dressings (serving size depends on

amount of oil)

Seeds and nuts (1 tbsp.)—peanut butter, other

nut butters*

Cocoa powder (as desired)

Olives (5 small) and avocado (1/8 of whole)*

DECREASE

Saturated oils—coconut oil, palm kernel oil,

palm oil

Butter, lard, bacon fat

Shortening

Dressings made with egg yolk, cheese, sour

cream, whole milk

Coconut

Chocolate

CHOOSE

Fruit (1/2 cup or medium-size piece)—fresh,

frozen, canned, or dried

Fruit juice (1/2 cup)—fresh, frozen, or canned

DECREASE

Fried fruit like banana chips or 

fruit served with butter,

cream sauce, or ice 

cream

FRUITS

Nutrients: Carbohydrates, fiber, and vitamins.

Servings/day: 5 for guys and 3 for girls.

Note: The numbers in parentheses below are equal to 1 serving.

FATS & OILS

Nutrients: saturated and unsaturated fats, cholesterol, and very small amounts of vitamins and minerals.

Servings/day: 10 for guys and 5 for girls.

Note: The numbers in parentheses below are equal to 1 serving.

Foods to choose and foods to lose...

* These are listed because they are high in unsaturated fat.

26 Healthy Eating
Healthy Eating 27

SWEETS & SNACKS

Nutrients: Saturated fat, cholesterol, and carbohydrates.

Servings/day: 4 for guys and 3 for girls.

Note: The numbers in parentheses below are equal to 1 serving.

CHOOSE

Beverages (6 fl. oz.)—fruit-flavored drinks; lemonade, fruit punch

Sweets (1-1/2 tbsp.)—sugar, syrup, honey, jam, preserves; candy (3/4 oz.) made primarily

with sugar (candy corn, gumdrops, hard candy); fruit-flavored gelatin (1/2 cup)

Low-fat frozen desserts (1/3 cup)—sherbet, sorbet, fruit ice, popsicles, low-fat frozen yogurt

Cookies (2), cake (1 slice), pie (1 slice), pudding (1/2 cup)—all prepared with egg whites,

egg substitute, fat-free or 1% milk, and unsaturated oil or margarine; plain popcorn (3 cups); 

gingersnaps (2); fig bar cookies (1); angel food cake (1 slice)

DECREASE

Candy made with chocolate, butter, cream, coconut oil, palm oil, palm kernel oil

Ice cream and frozen treats made with ice cream or whole milk

Commercial baked high-fat cookies,

cakes, cream pies, doughnuts

Foods to choose and foods to lose...

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
28 Healthy Eating
Healthy Eating 29

The foods you eat

play a big part in

keeping your heart

healthy. But, what

exactly is a hearthealthy eating plan?

And is a heart-healthy

eating plan important for 

everyone? All healthy Americans,

2 years of age or older, should

eat in a way that is lower in

total fat, saturated fat, cholesterol, sodium, and extra calories.

Heart disease is still the number one killer of

both men and women in the United States.

High blood cholesterol, high blood pressure,

smoking, overweight, and physical inactivity

increase your risk of getting heart disease. The

good news is that you can change these risk

factors and reduce your risk of heart disease.

In order to help your family eat in a hearthealthy way, follow these recommendations.

1 Choose foods low in saturated fat.

All foods that contain fat are made up of a 

mixture of saturated and unsaturated fats.

Saturated fat raises your blood cholesterol

level more than anything else you eat. The

best way to reduce blood cholesterol is to

choose foods lower in saturated fat. Less

than 10 percent of the calories in your diet

should come from saturated fat. One way to

help your family do this is by choosing

foods such as fruits, vegetables, and whole

grains—foods naturally low in total fat and

high in starch and fiber.

2 Choose foods low in total fat.

Since many foods high in total fat are also

high in saturated fat, eating foods low in

total fat will help your family

eat less saturated fat. No more

than 30 percent of the calories

in your diet should come from

fat. When you do eat fat,

substitute unsaturated fat—

either polyunsaturated or

monounsaturated—for 

saturated fat. But, watch the

amount. Fat is a rich source of 

calories, so eating foods low in fat 

will also help you eat fewer calories.

Eating fewer calories can help you

lose weight and, if you are overweight, losing

weight is an important part of lowering your

blood cholesterol.

3 Choose foods high in starch and fiber.

Foods high in starch and fiber are excellent

substitutes for foods high in saturated fat.

These foods—breads, cereals, pasta, grains,

fruits, and vegetables—are low in saturated

fat and cholesterol. They are also lower in

calories than foods that are high in fat. But

limit fatty toppings and spreads like butter

and sauces made with cream and whole

milk dairy products. Foods high in starch

and fiber are also good sources of vitamins

and minerals. 

When eaten as part of a diet low in saturated

fat and cholesterol, foods with soluble

fiber—like oat and barley bran and dry 

peas and beans—may help to lower blood

cholesterol.

4 Choose foods low in cholesterol.

Remember, dietary cholesterol can raise

blood cholesterol, although usually not as

much as saturated fat. So it’s important for

your family to choose foods low in dietary

The Heart-Healthy

Eating Plan
cholesterol. Strive for less than 300 

milligrams of cholesterol a day. Dietary 

cholesterol is found only in foods that come

from animals. And even if an animal food 

is low in saturated fat, it may be high in 

cholesterol; for instance, organ meats (like

liver) and egg yolks are low in saturated fat

but high in cholesterol. Egg whites and

foods from plant sources do not have 

cholesterol. 

5 Choose foods lower in salt and sodium.

Americans eat more salt (sodium chloride)

and other forms of sodium than they need.

Often, when people with high blood 

pressure cut back on salt and sodium, their

blood pressure falls. Cutting back on salt

and sodium also prevents blood pressure

from rising. African Americans, the elderly,

and persons with certain illnesses are more

affected by sodium than others. Since

there’s really no practical way to predict

exactly who will be affected by sodium, it

makes sense to limit intake of salt and 

sodium to help prevent high blood pressure.

Americans, especially people with high

blood pressure, should eat no more than

about 6 grams of salt a day, which equals

about 2,400 milligrams of sodium (the daily

reference value you see on the new food

label). That’s about 1 teaspoon of table salt.

But remember to keep track of ALL salt

eaten—including that in processed foods

and added during cooking or at the table.

6 Maintain a healthy weight, and lose

weight if you are overweight.

People who are overweight tend to have

higher blood cholesterol levels. And, as

body weight increases, blood pressure

increases. Overweight adults with an “apple

shape— bigger (pot) belly—tend to have a

higher risk for heart disease than those with

a “pear” shape—bigger hips and thighs.

Whatever your body shape, when you cut

the fat in your diet, you cut down on the

richest source of calories. However, even

some low-fat foods are high in calories. So

it is not only what you eat but how much

you eat. An eating pattern of foods high in

starch and fiber, instead of fat and calories,

in moderation is a good way to help

control weight. 

7 Be more physically active.

Being physically active helps

improve blood cholesterol levels.

Being more active also can help

you lose weight, lower your

blood pressure, improve the

fitness of your heart and

blood vessels, and reduce

stress. And being active

together is great for the

entire family.

30 Healthy Eating

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
It is good to tell children and teenagers to eat

right and be physically active; it is even better

to show them. Encourage children to eat for the

health of their heart, and teach them that what

they eat makes a difference in how their body

looks, feels, and grows. Here are some tips to help

your family develop healthful habits.

KNOW THE GUIDELINES TO HEART-HEALTHY

EATING.

Choosing foods lower in saturated fat, total fat,

cholesterol, and sodium is important to your

success in heart-healthy eating. Here are the

basic guidelines:

■ Less than 10 percent of calories from 

saturated fat

■ An average of no more than 30 percent of 

calories from fat

■ Less than 300 milligrams of dietary 

cholesterol a day

■ Enough calories to support growth and to

reach or maintain a healthy weight

■ No more than 2,400 milligrams of sodium 

a day.

BE A GOOD ROLE MODEL.

Set a good example. Adults, particularly 

parents, are a major influence on children’s

behavior. Children also are influenced by 

television, radio, magazines, advertisements,

friends, brothers and sisters, and others who

may not follow your ways. If you follow a

heart-healthy lifestyle, your children will be

more likely to do the same. Being physically

active with your child also sets a good example.

LEARN TO CHOOSE HEART-HEALTHY FOODS.

Learn to choose foods lower in saturated fat,

cholesterol, and sodium within each of the 

different groups. This will help you buy and

provide such foods and snacks at home. 

Choose heart-healthy foods from:

■ Meat, poultry, fish, and shellfish

■ Dairy products

■ Eggs and egg substitutes

■ Fruits and vegetables

■ Breads, cereals, pasta, rice, and dry peas and

beans 

■ Sweets and snacks.

STOCK THE KITCHEN.

Stock the kitchen with foods that are lower in

saturated fat, cholesterol, and sodium from

each of the food groups. Prepare these foods in

large quantities to be frozen for quick use later.

Foods such as casseroles, soups, and breads

can be frozen in individual servings for a quick

meal. The whole family will then have hearthealthy meals on hand. Have healthy snacks

such as fruit, English muffin mini-pizzas,

cereal mixes, lower fat microwave popcorn,

or frozen fruit bars easily available.

TEACH BASIC FOOD PREPARATION SKILLS.

Teach children how to clean vegetables, make

salads, and use the stove, oven, microwave,

and toaster safely. Children who have basic

cooking skills appreciate food more and are

more inclined to try new foods. Teach your

children to read the food labels.

Help Your Family 

To Better Heart Health

Healthy Eating and Physical Activity 31
PLAN FAMILY MEALS.

Eating meals as a family can encourage hearthealthy eating habits in children. The more you

create a family setting where everyone shares

the same nutritious meals, the more likely 

children will accept healthful eating as a way

of life. Try to maintain regular family meals as

often as you can. This way, the whole family

can learn about healthful eating and build good

eating habits.

ENCOURAGE PHYSICAL ACTIVITY.

Make time for physical activity. Encourage

children to get some exercise throughout the

day and especially on weekends. Take trips

that involve activities like hiking, swimming,

and skiing. Join in the fun. Ride bikes, run,

skate, or walk to places close by. Give your

child a splash or dance party. Use your backyard or local park for basketball, baseball,

football, badminton, or volleyball.

To be really heart-healthy, physical activity for

children needs to raise their heart and breathing rates, last 15 to 30 minutes without stopping, and be repeated at least three times a

week.

Children can participate in these 

activities on their own to help keep

their hearts strong.

Bicycling

Dancing

Jumping rope

Running

Brisk walking

Jogging

Roller blading

Skating

Here are some heart-healthy group

activities.

Baseball and softball

Basketball

Cross-country skiing

Football

Frisbee 

Gymnastics

Hiking and backpacking

Ice and field hockey

Racquetball

Rowing

Soccer

Swimming

Tennis

32 Healthy Eating and Physical Activity

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
Healthy Eating 33

MEAT, POULTRY, AND FISH

Before cooking meat, poultry, or fish:

■ Trim fat from meat; remove the skin and fat

from poultry.

■ If you buy tuna or other canned fish packed in

oil, rinse it in a strainer before cooking. Better

yet, buy canned fish packed in water. If you

are watching your sodium to help lower blood

pressure, be sure to rinse the fish whether it is

packed in oil or water.

Changes in your cooking style also can help

to lower fat.

■ Bake, broil, microwave, poach, or roast

instead of frying.

■ When you do fry, use a nonstick pan and a

nonstick cooking spray or a very small

amount of oil or margarine.

■ When you roast meat or make meatloaf, place

the meat on a rack so the fat can drip away.

■ When a recipe calls for ground meat, brown

the meat and drain well before adding to

other ingredients.

■ If you baste meats and poultry, use fat-free

ingredients like wine, tomato juice, lemon

juice, or defatted beef or chicken broth

instead of the fatty drippings.

SAUCES, SOUPS, AND CASSEROLES

■ After making sauces or soups, cool them in the

refrigerator and skim the fat from the top.

Treat canned broth-style soups the same way.

Try low-sodium or reduced-sodium soups.

■ When making casseroles with cheese, try lowerfat cheese. Or use less regular cheese than what

the recipe calls for. If you use a sharp-flavored

cheese, you won’t taste the difference.

■ When you make creamed soup or white

sauces, use fat-free, 1 percent, or evaporated 

fat-free milk instead of 2 percent milk, whole

milk, or cream.

■ To make a low-fat sauce, thicken it with

cornstarch or flour.

■ Make main dishes with pasta, rice, or dry peas

and beans. If you add meat, use small pieces just

for flavoring instead of the main ingredient.

SEASONING AND CONDIMENTS

■ Use small amounts of lean meats instead of

salt pork or fat back to flavor vegetables

while cooking.

■ Flavor cooked vegetables with herbs or butterflavored seasoning instead of butter or margarine.

■ Use herbs, spices, and no salt seasoning

blends to bring out the flavor of foods. Try

using garlic, garlic powder, onion, or onion

powder instead of garlic salt and onion salt.

■ Use salt sparingly in cooking, and use less

salt at the table. Reduce the amount a little

each day until no salt is used.

■ Limit salty condiments like olives and pickles.

CONVENIENCE FOODS

And for those times when you don’t feel like

cooking:

■ Use your own convenience foods—low-fat

casseroles and soups that you have cooked

ahead and then frozen in small batches.

■ Check the nutrition labels to choose frozen

dinners and pizzas that are lower in saturated

fat, cholesterol, and sodium. Make sure the

dinners have vegetables, fruits, and grains—

or add them on the side.

■ Use fewer sauces, mixes, and “instant”

products, including flavored rices, pastas, and

cereal, which usually have added salt.

■ Use vegetables that are fresh, frozen without

sauce, or canned with no salt added.

Cooking

The Heart-Healthy Way

Now it’s time to learn about some easy cooking tips to cut down

on calories, saturated fat, cholesterol, and sodium.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563 
34 Healthy Eating
Use this handy guide to shop for a variety of heart-healthy

foods. By eating a variety of foods each day, you will get 

the nutrients you need. Remember to use the food labels.

Look for the words low-fat, lean, and light. The Federal 

Government has defined these words to help consumers

find heart-healthy foods that contain less saturated fat, 

cholesterol, and sodium.

MEAT, POULTRY, FISH, AND SHELLFISH

CHOOSE MORE OFTEN

Lean cuts of meat with fat trimmed before

cooking:

Beef—round, top loin, sirloin, chuck arm pot

roast, lean ground beef (< 7% fat)

Lamb—leg shank, fore shank, whole leg,

loin, sirloin

Pork—tenderloin, sirloin, top loin

Veal—cutlets, ground, shoulder, sirloin, rib roast

Turkey and chicken, skinless

Most seafood~

Low-fat lunchmeat and hotdogs*

CHOOSE LESS OFTEN

Fatty cuts of meat:

Beef—ribs, brisket, chuck blade roast, ground

(regular)

Lamb—chops and rib

Pork—spareribs, blade, centerloin

Goose, duck

Liver, kidney

Sausage, bacon

Turkey and chicken, with skin

Eel, pompano, and mackerel

Regular lunchmeat and hotdogs

DAIRY PRODUCTS

CHOOSE MORE OFTEN

Fat-free or 1 percent milk

Nonfat or low-fat yogurt

Cheese with 3 grams of fat or less per ounce*

Low-fat or nonfat sour cream

CHOOSE LESS OFTEN

Whole or 2 percent milk

Cream, most nondairy creamers

Whipped cream or nondairy topping 

Whole milk yogurt

Cheese with more than 3 grams of fat per ounce

~ Shrimp, abalone, and squid are low in fat but high in sodium. Sour cream

* Choices may be higher in sodium.

S

To Your Heart’s Content

hop

Healthy Eating 35
FRUITS

CHOOSE MORE OFTEN

Fresh, frozen, canned, dried fruit, and fruit in

its own juice

CHOOSE LESS OFTEN

Fried fruit such as fried apples

CHOOSE MORE OFTEN

Breads, white or whole grain, such as pita, bagel,

English muffin, sandwich buns, dinner rolls

Rice cake

Corn tortilla

Low-fat crackers like matzo, bread sticks, rye

crackers, saltines*

Pancakes, waffles

Lower-fat biscuits, muffins, hot cereals, most

cold cereals*

Rice, barley, bulgur

Dry peas and beans

Pasta

CHOOSE LESS OFTEN

Croissants, pastry, doughnuts, coffee cake,

butter rolls

Snack crackers like cheese and butter crackers

Pasta, grain, and potato dishes made with

cream, butter, or cheese

Egg noodles

Chow mein noodles, canned

Regular granola cereals

VEGETABLES

CHOOSE MORE OFTEN

Fresh, frozen, or canned* vegetables

CHOOSE LESS OFTEN

Vegetables prepared in butter, cream, sauce, or fried

BREADS, CEREALS, PASTA, RICE AND GRAINS, DRY PEAS AND BEANS

EGGS

CHOOSE MORE OFTEN

Egg whites 

Cholesterol-free or cholesterol-reduced egg

substitutes*

CHOOSE LESS OFTEN

Egg yolks

FATS AND OILS

CHOOSE MORE OFTEN

Unsaturated vegetable oils: corn, olive, canola,

sesame, soybean, sunflower, safflower

Soft margarine made with unsaturated fats listed above as first ingredient

Low-fat or nonfat salad dressings

Reduced or nonfat mayonnaise

CHOOSE LESS OFTEN

Lard, butter, palm kernel oil, palm oil, beef

tallow, cocoa butter, coconut oil

Hydrogenated fats and oils

Margarine or shortening made with fats listed

above

Dressing made with egg yolk

Fried foods

* Choices may be higher in sodium.

36 Healthy Eating
Healthy Eating 37

Do You Know How Much You Are Serving?

Learning about portion sizes is an important part of being in control of 

what you eat. Here are some tips to help you know just how much you’re getting.

■ Jar Lid: A piece of meat the size of a pint or quart mayonnaise jar lid is about 3 ounces.

■ Deck of cards: A standard deck of cards is about the same size as 3 ounces of meat,

poultry, or fish.

■ Measuring cups: To find out how much you’re serving your family at meals, try dishing it up

with measuring cups. After a few tries, it should be easy to judge how big the portions are.

How Much Sodium Is in Your Food?

■ Most canned vegetables, vegetable juices, and frozen vegetables with sauce are higher in sodium

than fresh or frozen ones cooked without added salt.

■ Sodium content of milk products varies. Lowest are milk and yogurt. Natural cheese contains 

a bit more, followed by cottage cheese, then processed cheeses, cheese foods, and cheese spreads.

■ Most fresh meats, poultry, and fish are low in sodium. 

Most cured and processed meats such as hotdogs, sausage,

and lunchmeats are higher in sodium because sodium is used

as a preservative.

■ “Convenience” foods such as frozen dinners and combination

dishes, canned soups, and dehydrated mixes for soups,

sauces, and salad dressings often 

contain a lot of sodium.

SWEETS AND SNACKS

CHOOSE MORE OFTEN

Nonfat and low-fat frozen desserts like 

sherbet, sorbet, Italian ice, frozen yogurt,

frozen fruit juice bars

Low-fat or nonfat baked goods like brownies,

cakes, cupcakes, pastries, fig and other fruit

bars, vanilla or lemon wafers, graham 

crackers, gingersnaps

Jelly beans, hard candy, fruit leather

Plain popcorn, pretzels, no-oil baked chips*

(Remember that baked goods and frozen

desserts are high in sugar and may be high in

calories.)

CHOOSE LESS OFTEN

High-fat frozen desserts, like ice cream,

frozen tofu, whole-milk frozen yogurt

High-fat baked goods, like most store-bought

pound and frosted cakes, pies, cookies

Milk chocolate

Fried chips and buttered popcorn

*Choices may be higher in sodium.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
38 Healthy Eating
Healthy Eating 39

Lots of special cookbooks and recipe booklets can help you lower the fat, saturated fat, cholesterol,

and sodium when you cook. But you don’t have to throw out your favorite cookbook or recipes that

you’ve been using for years. Just cut down on the high-fat, high-sodium ingredients, and substitute

ingredients that are lower in saturated fat, cholesterol, and sodium as much as possible. Some recipes

may change in texture and consistency when you use these substitutions.

Recipe Substitutions

Instead of Use

Whole milk ......................................Fat-free or 1 percent milk

Evaporated milk ..............................Evaporated fat-free milk

Light cream......................................Equal amounts of 1 percent milk and evaporated fat-free milk

Heavy cream ....................................Evaporated fat-free milk

1 cup butter ......................................1 cup soft margarine or 2/3 cup vegetable oil*

Shortening or lard ............................Soft margarine*

Mayonnaise or salad dressing..............Nonfat or light mayonnaise or salad dressing; Mustard in sandwiches

1 whole egg......................................1/4 cup egg substitute or 2 egg whites

Cheese..............................................Lower fat cheese+

Cream cheese ..................................Nonfat or light cream cheese

Sour cream ......................................Nonfat or low-fat sour cream or yogurt

Fat for greasing pan ........................Nonstick cooking spray

1 ounce baking chocolate ................3 tablespoons cocoa powder plus 1 tablespoon vegetable oil

Regular bouillon or broth ................Low sodium bouillon and broth

Fatback, neck bone, or ham hocks......Skinless chicken thighs

Pork bacon ......................................Turkey bacon, lean ham, or Canadian bacon (omit if on low 

sodium diet)

Pork sausage ....................................Ground skinless turkey breast

Ground beef and pork......................Ground skinless turkey breast

* The texture of baked goods may be different when you use these substitutions.

“Light” margarine is not recommended for baking. Experiment to find out what works best for you.

+ Some salad dressings, processed cheeses, and cottage cheese are very high in sodium. 

Omit if on a low-sodium diet or substitute a product that is low in sodium and fat.

New Ways To Use Favorite Recipes

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
40 Healthy Eating
❍

Physical Activity 41

❍

❍

❍

❍ ❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍

❍
42 Physical Activity
Physical Activity 43

Can you run for a bus without huffing and puffing?

Physical activity is good for you and your heart. 

Your heart, like every other muscle, gets stronger with

exercise. The right kind of exercise will help you and

your heart become more fit. The more fit your heart is,

the better it works. The more fit you are, the longer you

can exercise without getting tired. You will be able to run

for the bus without huffing and puffing.

Physical activity is fun for everyone. There are all kinds of

activities you can do. You can enjoy exercise by yourself, with

a friend, or your family. Find what is right for you.

Exercise is good for you and your heart.

Fast walking

Soccer

Swimming

Dancing

Skating

Frisbee®

Hockey

Hiking

Tennis

Running

Basketball

Jumping rope

Skipping

Kickball

Skiing

Rowing

Bicycling

Handball

These

Activities

Are Good for

Your Heart

mniwgims ____________________________

creocs ________________________________

gpsnpkii ______________________________

cdainng ______________________________

sfta likngaw ____________________________

pmjungi proe __________________________

kistnga ________________________________

nugnnri________________________________

ksabtelbal______________________________

Fast Get Moving

• Your heart gets strong because it

gets a good workout.

• Your muscles look and feel firm

and work better.

• You can breathe easier.

• You burn off calories which will

help keep you from getting fat.

• You have more energy.

The good things 

physical activity 

does for you

The letters in some of the activities listed above are now all mixed up.

Can you write the word the way it should be?

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
44 Physical Activity
Physical Activity 45

1 Regular physical activity can reduce

your chances of getting heart disease.

❑ T ❑ F

2 Most people get enough physical 

activity from their normal daily routine.

❑ T ❑ F

3 You don’t have to train like a marathon

runner to become more physically fit.

❑ T ❑ F

4 Exercise programs do not require a lot

of time to be very effective.

❑ T ❑ F

5 People who need to lose some weight

are the only ones who will benefit from

regular physical activity.

❑ T ❑ F

6 All exercises give you the same 

benefits.

❑ T ❑ F

7 The older you are, the less active you 

need to be.

❑ T ❑ F

8 It doesn’t take a lot of money or 

expensive equipment to become 

physically fit.

❑ T ❑ F

9 There are many risks and injuries that 

can occur with exercise.

❑ T ❑ F

10 You should always consult a doctor 

before starting a physical activity 

program.

❑ T ❑ F

11 People who have had a heart attack 

should not start any physical activity 

program.

❑ T ❑ F

12 To help stay physically active, 

include a variety of activities.

❑ T ❑ F

Test how much you know about how

physical activity affects your heart.

Mark each question true or false.

See how you did by checking the

answers on the back of this sheet.

Check Your

Physical Activity

and Heart Disease
46 Physical Activity

1 True. Heart disease is almost twice as 

likely to develop in inactive people. Being

physically inactive is a risk factor for heart

disease along with cigarette smoking, high

blood pressure, high blood cholesterol, and

being overweight. The more

risk factors you have, the

greater your chance for

heart disease. Regular

physical activity (even mild

to moderate exercise) can reduce

this risk.

2 False. Most Americans are very busy but

not very active. Every American adult

should make a habit of getting 30 minutes

of low-to-moderate levels of physical

activity daily. This includes walking,

gardening, and walking up stairs. If you

are inactive now, begin by doing a few

minutes of activity each day. If you only

do some activity every once in a while,

try to work something into your routine

every day.

3 True. Low- to moderate-intensity activities,

such as pleasure walking, stair climbing,

yard work, moderate-to-heavy housework,

dancing, and home exercises can have both

short- and long-term benefits. If you are

inactive, the key is to get started. One

great way is to take a walk for 10 to 15

minutes during your lunch break, or take

your dog for a walk every day. At least 30

minutes of physical activity every day can

help improve your heart health and lower

your risk of heart disease.

4 True. It takes only a few minutes a day to

become more physically active. If you

don’t have 30 minutes in your schedule 

for an exercise break, try to find two

15-minute periods or even three 10-minute

periods. Once you discover how much you

enjoy these exercise breaks, they’ll become

a habit you can’t live without. 

5 False. People who engage in regular

physical activity experience many positive

benefits. Regular physical activity gives

you more energy, reduces stress, helps you

relax, and helps you sleep better. It helps

lower high blood pressure and improves

blood cholesterol levels. Physical activity

helps tone your muscles, burns off calories

to help you lose extra pounds or stay at

your desirable weight, and helps control

your appetite. It can also increase muscle

strength, help your heart and lungs work

more efficiently, and let you enjoy your life

more fully.

6 False. Low-intensity activities—if performed daily—can have some long-term

health benefits and can lower your risk of

heart disease. Regular, brisk, and sustained 

exercise for at least 30 minutes—three to

four times a week—such as brisk walking,

jogging, or swimming—is necessary to

improve the efficiency of your heart and

To the Check Your Physical Activity 

and Heart Disease I.Q. Quiz
Physical Activity 47

lungs and burn off extra calories. These

kinds of activities are called aerobic—

meaning the body uses oxygen to produce

the energy needed for the activity. Other

activities may give you benefits such as

increased flexibility or muscle strength,

depending on the type of activity.

7 False. Although we tend to become less

active with age, physical activity is still

important. In fact, regular physical activity

in older persons increases their capacity to

do everyday activities. In general, middleaged and older people benefit from regular

physical activity just as young people do.

What is important, NO matter what your

age is tailoring the activity program to

your own fitness level.

8 True. Many activities require little or no

equipment. For example, brisk walking

only requires a comfortable pair of walking

shoes. Also, many communities offer free

or inexpensive recreation facilities and

physical activity classes. Shopping malls,

make ideal walking environments as many

of them are open early and late for people

who do not wish to walk alone, in the

dark, or in bad weather.

9 False. The most common exercise risk is

injury to the muscles and joints. Such

injuries are usually caused by exercising

too hard for too long, particularly if a 

person has been inactive for some time. To

avoid injuries, try to build up your level of

activity gradually; listen to your body for

early warning pains; be aware of possible

signs of heart problems (such as pain or

pressure in the left or mid-chest area, left

neck, shoulder, or arm during or just after

exercising, or sudden light-headedness,

cold sweat, pallor, or fainting); and be prepared for special weather 

conditions.

10 True. You should ask your doctor before

you start (or greatly increase) your physical

activity if you have a medical condition

such as high blood pressure, have pains or

pressure in the chest and shoulder area,

tend to feel dizzy or faint, get very breathless

after mild exertion, are middle-aged or

older and have not been physically active,

or plan a fairly vigorous activity program.

If none of these apply, start slow and get

moving.

11 False. Regular, physical activity can help

reduce your risk of having another heart

attack. People who include regular physical

activity in their lives after a heart attack

improve their chances of survival and can

improve how they feel and look. If you

have had a heart attack, consult your

doctor to be sure you are following a safe

and effective exercise program that will

help prevent heart pain and further 

damage from overexertion.

12 True. Pick several different activities that

you like doing, because you will be more

likely to stay with a regular regimen. Plan

short-term as well as long-term goals.

Keep a record of your progress, and check

it regularly to see the progress you have

made. Get your family and friends to join

in. They can help keep you going.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
48 Physical Activity
Physical Activity 49

Turn off your TV and turn on to physical 

activity! You don’t have to groan for hours

every day. A few minutes of some type of

activity, even walking, every day

will help improve your health—

and more vigorous activity 

such as swimming, running or

jumping rope will help condition

your heart and lungs if you do

them for at least 30 minutes, three

to four times a week.

These kinds of activities are often called 

“aerobic”—which means the body uses 

oxygen to produce the energy needed for the

activity. These exercises are brisk enough to

raise your heart and breathing rates. They

expand your lung capacity and help to

strengthen your heart muscle, warding off

heart disease.

Physical activity also can help lower high

blood cholesterol and control weight. First,

it can decrease “bad” LDL-cholesterol,

while increasing “good” HDL-cholesterol.

Second, combined with a low-calorie

diet, it helps you shed extra weight.

You’ll find it decreases your

hunger and fine-tunes the metabolism. See the activities on page 51 to

see how many calories can be burned

up doing different activities.

Sold?

Good, because being physically active is 

no fad. It’s a lifelong good habit. Try out

various activities. Find ones that you enjoy.

And don’t hesitate to mix them up—don’t

get into a rut. The activities on page 51 

give you some ideas. Try one or all!

Want more energy? Want less stress? Want to

fall asleep easily? Firmer muscles sound good?

One—count it, one—there’s one way to do it all.

What’s the secret? Getting physical, of course.

Get
❉

50 Physical Activity

Key To

Health

You hold the

key to health

and fitness —

regular physical

activity. Starting

can be tough, though.

So here are some howMagic

to’s to rev your motor:

Working out 

makes you feel 

and look better. 

It’s also a good 

way to meet 

new people.

Suzanne, 18

“

”

Start your exercise

session by preparing.

Stretch and warm

your muscles. Don’t do too much too

soon. Begin slowly and

intensify carefully.

Try an outdoor and an

indoor activity. Switch

back and forth to prevent

boredom. You won’t have

to reschedule because of

bad weather, either. Ask someone to join you.

Make regular physical

activity part of your life.

Make time for your

workout, whether before,

during, or after school. It

doesn’t matter when you

do it—but set a schedule

and stick to it.

If you’re not sure about

an activity, ask your gym

teacher or coach for

advice.

❉

❉

❉

1 ❉

2 3

4

5

6

❉

Body

Get

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
Physical Activity 51

Here are a few activities that 

just may get you hooked on 

being physically active.

Listed next to each one is the number of calories a 150-pound person would burn 

up doing these activities for an hour.

Remember: Any activity that gets you moving

around is better than nothing at all. To help condition your heart and lungs, move it at least three

times a week, for about 30 minutes each time. Do it

on your own or with friends.

And don’t forget to have fun!

Note: These numbers are for someone who weighs 150 pounds.

The amount of calories you burn up depends on how much you weigh.

The more you weigh, the more calories you burn.

ACTIVITY CALORIES BURNED UP PER HOUR

Running ..................................................................650-1280

Jogging ....................................................................740-920

Jumping rope ..................................................................750

Racquetball......................................................................750

Cross-country skiing ........................................................700

Basketball ...................................................................... 564

Ice and field hockey ........................................................546

Football ............................................................................540

Soccer..............................................................................540

Swimming ................................................................275-500

Brisk walking....................................................................440

Dancing............................................................................420

Bicycling....................................................................240-410

Hiking and backpacking ..................................................408

Tennis ..............................................................................400

Skating ............................................................................300

Baseball and softball........................................................282

Gymnastics ......................................................................270

Get
52 Physical Activity

So Figure It Out

For Yourself

✍

✍

✍

✍

___________ 125 lbs.

(Your weight)

÷ ÷

150 150 

= =

___________ .83

x x

___________ 564 calories

(# of calories) (basketball) 

= =

___________ 468 calories

To find the number of calories you would burn up in any of

the activities noted on the previous chart:

Write down your weight. Since the numbers on the chart are

for someone 150 pounds, divide your weight by 150.

Multiply this number by the number of calories burned in an

hour of an activity you like to do that is listed on the chart.

This will give you the number of calories YOU burn doing this

activity for an hour.

Note: In this example, a 125-pound person burns only 0.83 times the calories of a 150-pound

person, and when playing basketball, only 468 calories are burned compared to 564 calories.

Get

Example:

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
Physical Activity 53

Both healthy eating and physical activity

are important in weight control. Most

successful weight loss is a combination

of eating fewer calories and using more

energy through activity. Staying physically

active is most helpful in keeping weight off

for life. Plus, physical activity has the benefit of

lowering the risk of certain diseases, such as heart

disease and diabetes. 

If you have not been physically active in the past,

the key to success is to start slowly. Trying too

hard at first can lead to injury. Also, taking the

time to find out what you enjoy doing will

help to make physical activity a regular part

of your lifestyle.

To improve your health, set a goal of at least 

30 minutes of moderate-intensity physical activity

most days of the week. You can do this all at one

time or at several times during the day. Initial

activities may be to start out walking or

swimming at a slow pace. For example, you can

start out walking slowly for a total of 30 minutes

3 days a week and gradually build to 45 minutes or

more of faster-paced walking. By doing this, you

can use 100 to 200 more calories per day.

This plan can be used with other

types of physical activity, but

walking is popular because it is

safe and convenient. 

Examples of Moderate Amounts of Physical Activity 

Common Chores Sporting Activities

Washing and waxing a car Playing volleyball for 45 to 60 minutes

for 45 to 60 minutes

Washing windows or floors Playing touch football for 45 minutes

for 45 to 60 minutes

Gardening for 30 to 45 minutes Walking 13

/4 miles in 35 minutes (20 minutes/mile)

Wheeling self in wheelchair 30 to 40 minutes Basketball (shooting baskets) 30 minutes

Pushing a stroller 11

/2 miles in 30 minutes Bicycling 5 miles in 30 minutes

Raking leaves for 30 minutes Dancing fast (social) for 30 minutes

Walking 2 miles in 30 minutes (15 minutes/mile) Water aerobics for 30 minutes

Shoveling snow for 15 minutes Swimming laps for 20 minutes

Stair-walking for 15 minutes Basketball (playing game) for 15 to 20 minutes

Bicycling 4 miles in 15 minutes

Jumping rope for 15 minutes

Running 11

/2 miles in 15 minutes (10 minutes/mile)

Less Vigorous,

More Time

More Vigorous,

Less Time

Guide To Physical Activity
54 Physical Activity

Another way to be more

active is to do more

“everyday” activities, such as

taking the stairs instead of the

elevator. Also, try spending more

time doing lighter activities such as

gardening, household chores, and walking to visit

neighbors, rather than sedentary activities such as

watching television and working on the computer. 

Becoming Physically Active

For the beginner, choose very light activities such

as an increase in standing activities, special chores

like room painting, pushing a stroller or

wheelchair, yard work, ironing or cooking, and

playing a musical instrument. 

The next level would be light activities, such as

slow walking, garage work, carpentry, house

cleaning, child care, golf, sailing, and recreational

table tennis.

Once comfortable with this level, try adding more

moderate activities such as faster walking, weeding

and hoeing a garden, carrying a load, cycling,

skiing, tennis, and dancing.

High intensity activities include very fast walking

or walking with a load uphill, tree felling, heavy

manual digging, basketball, climbing, or

soccer/kickball.

You may also want to try:

• Flexibility exercise to improve joints and muscles

• Strength-building or resistance exercises

• Aerobic conditioning

If structured group activities are what you need to

help you stay physically active, try joining

community recreation programs, the YMCA,

or a health club. You can find a variety of activities

for all fitness levels and budgets.

How You Can Fit Activity 

Into Your Schedule

Many people are completely inactive, and they all

have reasons.

I don’t have the time to exercise.

While physical activity does take time, only about

1 hour per week of vigorous activity gives benefits

to your heart, lungs, muscles, and weight.

Consider the amount of time you spend watching

TV. Many forms of physical activity can be done

while watching TV, such as riding an exercise bike

or using hand weights.

I don’t like to exercise.

You have bad memories of doing situps or running

in high school, sweating, puffing, and panting.

Nowadays we know that you can get plenty of gain

without pain. Activities you already do such as

gardening and walking can improve your health, so

just do more of the activities you like.

I don’t have the energy to be more active.

Once you become a little more active, you should

have more energy. As you progress, daily tasks

will seem easier.

Benefits Of Regular Activity

• Your weight is much easier to control when

you are active.

• Physical activity can be lots of fun.

• You can be with other people when you are

active.

• You’ll feel and look better when you’re

physically active.

• Physical activity is good for your heart.

• Physical activity is a great way to reduce anxiety

and stress, and helps you beat the blues.

• You’ll feel more confident when you are active.

• You’ll have more energy.

• You may sleep better.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
55 Healthy Eating

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

❂

Obesity & Overweight 55
56 Obesity & Overweight
Obesity & Overweight 57

1 Being overweight puts you at risk for heart

disease.

❑ T ❑ F

2 If you are overweight, losing weight helps

lower your blood cholesterol and high blood

pressure.

❑ T ❑ F

3 Quitting smoking is healthy, but it 

commonly leads to excessive weight gain

which increases your risk for heart disease.

❑ T ❑ F

4 An overweight person with high blood 

pressure should pay more attention to a 

low-sodium diet than to weight reduction. 

❑ T ❑ F

5 A reduced intake of sodium or salt does not

always lower high blood pressure to normal. 

❑ T ❑ F

6 The best way to lose weight is to eat fewer

calories and exercise.

❑ T ❑ F

7 Skipping meals is a good way to cut down

on calories. 

❑ T ❑ F

8 Foods high in complex carbohydrates (starch

and fiber) are good choices when you are

trying to lose weight.

❑ T ❑ F

9 The single most important change most people

can make to lose weight is to avoid sugar.

❑ T ❑ F

10 Polyunsaturated fat has the same number of

calories as saturated fat.

❑ T ❑ F

11 Overweight children are very likely to

become overweight adults.

❑ T ❑ F

YOUR SCORE: How many correct answers

did you make?

10–11 correct=Congratulations! You know a

lot about weight and heart disease. Share this

information with your family and friends. 

8–9 correct=Very good. 

Fewer than 8=Go over the answers and try

to learn more about weight and heart disease.

The following statements are either

true or false. The statements test your

knowledge of overweight and heart

disease. The correct answers can be

found on the following page.

NHLBI Obesity Education Initiative

Check Your

Weight and 

Heart Disease
58 Obesity & Overweight

1 True. Being overweight increases your

risk for high blood cholesterol and high

blood pressure, two of the major risk

factors for coronary heart disease. Even if

you do not have high blood cholesterol or

high blood pressure, being overweight

may increase your risk for heart disease.

Where you carry your extra weight may

affect your risk too. Weight carried at your

waist or above seems to be associated with

an increased risk for heart disease in many

people. In addition, being overweight

increases your risk for diabetes, gallbladder disease, and some types of cancer.

2 True. If you are overweight, even moderate

reductions in weight, such as 5 to 10 percent, can produce substantial reductions in

blood pressure. You may also be able to

reduce your LDL-cholesterol (“bad” cholesterol) and triglycerides and increase

your HDL-cholesterol (“good” cholesterol). 

3 False. The average weight gain after 

quitting smoking is 5 pounds. The proportion

of ex-smokers who gain large amounts of

weight (greater than 20 pounds) is relatively

small. Even if you gain weight when you

stop smoking, change your eating and 

exercise habits to lose weight rather than

starting to smoke again. Smokers who quit

smoking decrease their risk for heart 

disease by about 50 percent compared to

those people who do not quit. 

4 False. Weight loss, if you are overweight,

may reduce your blood pressure even if

you don’t reduce the amount of sodium

you eat. Weight loss is recommended for all

overweight people who have high blood

pressure. Even if weight loss does not

reduce your blood pressure to normal, it

may help you cut back on your blood

pressure medications. Also, losing weight

if you are overweight may help you

reduce your risk for, or control, other

health problems.

True. Even though a high sodium or salt

intake plays a key role in maintaining high

blood pressure in some people, there is no

easy way to determine who will benefit

from eating less sodium and salt. Also, a

high intake may limit how well certain

high blood pressure medications work.

Eating a diet with less sodium may help

some people reduce their risk of developing

high blood pressure. Most Americans eat

more salt and other sources of sodium

than they need. Therefore, it is prudent for

most people to reduce their sodium intake.

True. Eating fewer calories and exercising

more is the best way to lose weight and

keep it off. Weight control is a question of

balance. You get calories from the food

you eat. You burn off calories by exercising.

Cutting down on calories, especially 

calories from fat, is key to losing weight.

Combining this with a regular physical

activity program, like walking, bicycling,

jogging, or swimming, can not only help

in losing weight but also in maintaining

To Your Weight and Heart Disease I.Q. Test

5

6
Obesity & Overweight 59

the weight loss. A steady weight loss of 1

to 2 pounds a week is safe for most adults,

and the weight is more likely to stay off

over the long run. Losing weight, if you

are overweight, may also help reduce your

blood pressure and raise your HDL-cholesterol, the “good” cholesterol.

7 False. To cut calories, some people 

regularly skip meals and have no snacks

or caloric drinks in between. If you do

this, your body thinks that it is starving

even if your intake of calories is not

reduced to a very low amount. Your body

will try to save energy by slowing its

metabolism—that is, decreasing the rate at

which it burns the calories. This makes

losing weight even harder and may even

add body fat. Try to avoid long periods

without eating. Five or six small meals are

often preferred to the usual three meals a

day for some individuals trying to lose

weight.

8 True. Contrary to popular belief, foods

high in complex carbohydrates (like pasta,

rice, potatoes, breads, cereals, grains,

dried beans and peas) are lower in calories

than foods high in fat. In addition, they

are good sources of vitamins, minerals,

and fiber. What adds calories to these

foods is the addition of butter, rich sauces,

whole milk, cheese, or cream, which are

high in fat.

9 False. Sugar has not been found to cause

obesity; however, many foods high in

sugar are also high in fat. Fat has more

than twice the calories as the same amount

of protein or carbohydrates (sugar and

starch). Thus, foods that are high in fat are

high in calories. High-sugar foods, like

cakes, cookies, candies, and ice cream, are

high in fat and calories and low in vitamins,

minerals, and protein.

10 True. All fats—polyunsaturated,

monounsaturated, and saturated—have

the same number of calories. All calories

count, whether they come from saturated or unsaturated fats. Because fats are

the richest sources of calories, eating

less total fat will help reduce the number

of calories you eat every day. It will also

help reduce your intake of saturated fat.

Particular attention to reducing saturated

fat is important in lowering your blood

cholesterol level.

11 False. Obesity in childhood does

increase the likelihood of adult obesity,

but most overweight children will not

become obese. Several factors influence

whether or not an overweight child

becomes an overweight adult: (1) the

age the child becomes overweight; (2)

how overweight the child is; (3) the

family history of overweight; and 

(4) dietary and activity habits. Getting to

the right weight is desirable, but children’s

needs for calories and other nutrients are

different from the needs of adults.

Dietary plans for weight control must

allow for this. Eating habits, like so

many other habits, are often formed 

during childhood, so it is important to

develop good ones.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
60 Obesity & Overweight
Obesity & Overweight 61

What Is Your Risk?

First, let’s gather some information—

1. Check Your Body Mass Index

Your body mass index (BMI) is a good

indicator of your risk for a variety of diseases

since it gives an accurate estimate of your total

body fat. There are two ways to check your

BMI. One way is to use the chart on the next

page to find your weight and height and then go

above that column to find your BMI. The other

way to check your BMI is to calculate it; one

method is shown in Box 2. Another way to do

this: Divide your weight in pounds by your

height in inches squared and then multiply the

total by 703. Once you know your BMI, check

Box 3, which shows the BMI ranges for

underweight, normal weight, overweight, and

obesity.

With the release of the Clinical Guidelines on

the Identification, Evaluation, and Treatment

of Overweight and Obesity in Adults:

Evidence Report, which is intended for health

professionals, many patients have expressed

interest in information on how to lose weight

and improve their health.

Overweight and Obesity—

What Are The Risks?

Over one-half of all American adults (about 97

million) are overweight or obese. If you are

overweight or obese, carrying this extra weight

puts you at risk for developing many diseases,

especially heart disease, stroke, diabetes, and

cancer.

Box 1—Consider the Risks

If you are overweight or obese, you are at risk 

for developing the following diseases:

• High blood pressure

• High blood cholesterol

• Type 2 diabetes

• Coronary heart disease

• Stroke

• Gallbladder disease

• Arthritis

• Sleep apnea and breathing problems

• Some cancers

– Endometrial

– Breast

– Prostate

– Colon

Box 2—Calculation 

Directions and Sample

Here is a shortcut method for calculating BMI 

(Example: for a person who is 5 feet 5 inches tall

weighing 180 lbs.)

1. Multiply weight 

(in pounds) by 703 180 x 703 = 126,540

2. Divide the answer 

in step 1 by height

(in inches) 126,540/65 = 1,946

3. Divide the answer 

in step 2 by height

(in inches) to get your BMI 1,946/65 = 29.9

BMI = 29.9

GUIDELINES ON

Overweight and Obesity

1

2
62 Obesity & Overweight

? ?

? ?

?

Box 3—Classification of 

Overweight and Obesity by BMI

BMI

Underweight . . . . . . . . . . . . . . . . . . . .<18.5

Normal . . . . . . . . . . . . . . . . . . . . . . .18.5–24.9

Overweight . . . . . . . . . . . . . . . . . . .25.0–29.9

Obesity . . . . . . . . . . . . . . . . . . . . . . . .>30.0

Box 4—Risk Factors

Besides being overweight or obese, other risk

factors to consider are:

• Cigarette smoking

• High blood pressure (hypertension)

• High LDL-cholesterol (“bad” cholesterol)

• Low HDL-cholesterol (“good” cholesterol)

• High triglycerides

• High blood glucose (sugar)

• Family history of premature heart disease

• Physical inactivity

2. Waist Circumference Measurement

Your waist circumference measurement is also

important in determining your overall risk. If

most of your fat is around your waist, you are

at greater chance for developing risk factors

for heart disease and diabetes. This risk

increases with a waist measurement of greater

than 35 inches for women or greater than 40

inches for men.

Are You At Risk?

Talk to your doctor to see if you are at an

increased risk and if you should lose weight. Your

doctor will evaluate your BMI, waist

measurement, and other risk factors for heart

disease. These risk factors are shown in Box 4.

If you are overweight, do not have a high waist

measurement, and have less then 2 risk factors,

it’s important that you not gain any more weight.

If you are overweight (BMI 25 to 29.9) and have

two or more risk factors, or if you are obese (BMI

30), it is important for you to lose weight. Even a

small weight loss (just 10 percent of your current

weight) will help lower your risk of developing

the diseases listed in Box 1. 

And remember, if you do need to lose weight

there are no quick fixes. Losing as little as 10

percent of your current body weight at a rate of 1

to 2 pounds per week may take as long as six

months, but will make it easier to keep off. And it

will give you the time to make new healthy

lifestyle changes.

Additional Resources

For additional information on the Clinical

Guidelines on Overweight and Obesity,

contact the NHLBI Obesity Education

Initiative:

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 

20824-0105 

301-592-8573, 301-592-8563 (fax);

or visit the NHLBI Web site at 

www.nhlbi.nih.gov

3

4

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
High Blood Pressure 63

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻

✻
64 High Blood Pressure 
High Blood Pressure 65

1 The risk factors for heart disease that

you can do something about are: high

blood pressure, high blood cholesterol,

smoking, obesity, and physical inactivity.

❑ T ❑ F

2 A stroke is often the first symptom of

high blood pressure, and a heart attack

is often the first symptom of high blood

cholesterol.

❑ T ❑ F

3 A blood pressure greater than or equal

to 140/90 mm Hg is generally considered

to be high.

❑ T ❑ F

4 High blood pressure affects the same

number of blacks as it does whites.

❑ T ❑ F

5 The best ways to treat and control high

blood pressure are to control your

weight, exercise, eat less salt (sodium),

restrict your intake of alcohol, and take

your high blood pressure medicine if

prescribed by your doctor.

❑ T ❑ F

6 A blood cholesterol of 240 mg/dL is

desirable for adults.

❑ T ❑ F

7 The most effective dietary way to lower

the level of your blood cholesterol is to

eat foods low in cholesterol.

❑ T ❑ F

8 Lowering blood cholesterol levels can 

help people who have already had a 

heart attack.

❑ T ❑ F

9 Only children from families at high risk 

for heart disease need to have their 

blood cholesterol levels checked.

❑ T ❑ F

10 Smoking is a major risk factor for four 

of the five leading causes of death, 

including heart attack, stroke, cancer, 

and lung diseases such as emphysema

and bronchitis.

❑ T ❑ F

11 If you have had a heart attack, quitting 

smoking can help reduce your chances

of having a second attack.

❑ T ❑ F

12 Someone who has smoked for 30 to 

40 years probably will not be able to 

quit smoking.

❑ T ❑ F

13 The best way to lose weight is to 

increase physical activity and eat 

fewer calories.

❑ T ❑ F

14 Heart disease is the leading killer of 

men and women in the United States.

❑ T ❑ F

Check Your 

Healthy Heart

Answer “true” or “false” to the following

questions to test your knowledge of heart

disease and its risk factors. Be sure to

check the answers and explanations on the

back of this sheet to see how well you do.
66 High Blood Pressure

To The Healthy Heart I.Q. Quiz

1 True. High blood pressure, smoking, and

high blood cholesterol are the three most

important risk factors for heart disease. On

the average, each one doubles your chance of

developing heart disease. So, a person who

has all three of the risk factors is eight times

more likely to develop heart disease than

someone who has none. Obesity increases the

likelihood of developing high blood 

cholesterol and high blood pressure, which

increase your risk of heart disease. Physical

inactivity increases your risk of heart attack.

Regular exercise and good nutrition are

essential to reducing high blood pressure,

high blood cholesterol, and overweight.

People who exercise are also more likely to

cut down or stop smoking.

2 True. A person with high blood pressure or

high blood cholesterol may feel fine and look

great; there are often no signs that anything is

wrong until a stroke or heart attack occurs.

To find out if you have high blood pressure

or high blood cholesterol, you should be

tested by a doctor, nurse, or other health

professional.

3 True. A blood pressure of 140/90 mm Hg or

greater is generally classified as high blood

pressure. However, blood pressures that fall

below 140/90 mm Hg can sometimes be a

problem. If the diastolic pressure, the second

or lower number, is between 85-89, a person

is at an increased risk for heart disease or

stroke and should have his/her blood pressure

checked at least once a year by a health 

professional. The higher your blood pressure,

the greater your risk for developing heart

disease or stroke. Controlling high blood

pressure reduces your risk.

4 False. High blood pressure is more common

in blacks than whites. It affects 29 out of

every 100 black adults compared to 26 out of

every 100 white adults. Also, with aging,

high blood pressure is generally more severe

among blacks than among whites, and therefore causes more strokes, heart disease, and

kidney failure.

5 True. Recent studies show that lifestyle

changes can help keep blood pressure levels

normal even into advanced age, and are

important in treating and preventing high

blood pressure. Limit high-salt foods, which

include many snack items such as potato

chips, salted pretzels, and salted crackers;

processed foods such as canned soups; and

condiments such as ketchup and soy sauce.

Also, it is extremely important to take blood

pressure medication if prescribed by your

doctor, to make sure your blood pressure

stays under control.

6 False. A total blood cholesterol of under 200

mg/dL is desirable and usually puts you at a

lower risk for heart disease. A blood cholesterol

level of 240 mg/dL or above is high and

increases your risk of heart disease. If your

cholesterol level is high, your doctor will

want to check your levels of LDL-cholesterol

(“bad” cholesterol) and HDL-cholesterol

(“good” cholesterol). A HIGH level of LDLcholesterol increases your risk for heart 

disease, as does a LOW level of HDLcholesterol. A cholesterol level of 200-230

mg/dL is considered borderline-high and 

usually increases your risk for heart disease.

If your cholesterol is borderline-high, you

should speak to your doctor to see if additional

cholesterol tests are needed. All adults 20

years of age or older should have their blood

cholesterol level checked at least once every

5 years.

7 False. Reducing the amount of cholesterol

in your diet is important; however, eating
High Blood Pressure 67

foods low in saturated fat is the most effective

dietary way to lower blood cholesterol levels,

along with eating less total fat and cholesterol.

Choose low-saturated fat foods such as

grains, fruits, and vegetables; low-fat or skim

milk and milk products; and lean cuts of

meat, fish, and chicken. Trim fat from meat

before cooking; bake or broil meat rather

than fry; use less fat and oil; and take the

skin off chicken and turkey. Reducing overweight will also help lower your level of

LDL-cholesterol as well as increase your

level of HDL-cholesterol.

8 True. People who have had one heart attack

are at much higher risk for a second attack.

Reducing blood cholesterol levels can greatly

slow down (and, in some people, even

reverse) the buildup of cholesterol and fat in

the walls of the arteries, and significantly

reduce the chances of a second heart attack.

9 True. Children from “high risk” families, in

which a parent has high blood cholesterol

(240 mg/dL or above), or in which a parent

or grandparent has had heart disease at an

early age (at 55 years or younger), should

have their cholesterol levels tested. If a

child from such a family has a cholesterol

level that is high, it should be lowered under

medical supervision, primarily with diet, to

reduce the risk of developing heart disease

as an adult. For most children, who are not

from high-risk families, the best way to

reduce the risk of adult heart disease is to

follow a low-saturated fat, low cholesterol

eating pattern. All children over the age of 2

years and all adults should adopt a hearthealthy eating pattern as a principal way of

reducing coronary heart disease.

10 True. Heavy smokers are two to four times

more likely to have a heart attack than

nonsmokers, and the heart attack death rate

among all smokers is 70 percent greater than

that of nonsmokers. Older male smokers are

also nearly twice as likely to die from stroke

than older men who do not smoke, and these

odds are nearly as high for older female

smokers. Further, the risk of dying from

lung cancer is 22 times higher for male

smokers than male nonsmokers and 12 times

higher for female smokers than female nonsmokers. Finally, 80 percent of all deaths

from emphysema and bronchitis are directly

due to smoking.

11 True. One year after quitting, ex-smokers

cut their extra risk for heart attack by about

half or more, and eventually the risk will

return to normal in healthy ex-smokers.

Even if you have already had a heart attack,

you can reduce your chances of a second

attack if you quit smoking. Ex-smokers can

also reduce their risk of stroke and cancer,

improve blood flow and lung function, and

help prevent diseases like emphysema and

bronchitis from getting worse.

12 False. Older smokers are more likely to

succeed at quitting smoking than younger

smokers. Quitting helps relieve smokingrelated symptoms like shortness of breath,

coughing, and chest pain. Many quit to

avoid further health problems and take 

control of their lives. 

13 True. Weight control is a question of balance.

You get calories from the foods you eat. You

burn off calories by exercising. Cutting

down on calories, especially calories from

fat, is key to losing weight. Combining this

with a regular physical activity, like walking,

cycling, jogging, or swimming, can not only

help in losing weight but also in maintaining

weight loss. A steady weight loss of 1/2 to 1

pound a week is safe for most adults, and the

weight is more likely to stay off over the

long run. Losing weight, if you are overweight, may also reduce your blood pressure,

lower your LDL-cholesterol, and raise your

HDL-cholesterol. Being physically active

and eating fewer calories will also help you

control your weight if you quit smoking.

14 True. Coronary heart disease is the number 1

killer in the United States. Approximately

489,000 Americans died of coronary heart

disease in 1990, and approximately half of

these deaths were women.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563 
68 High Blood Pressure 
High Blood Pressure 69

Test your knowledge of high

blood pressure with the following

questions. Circle each true or

false. The answers are given on

the back of this sheet.

Check Your

High Blood

Pressure

Prevention

1 There is nothing you can do to prevent 

high blood pressure.

❑ T ❑ F

2 If your mother or father has high blood 

pressure, you’ll get it. 

❑ T ❑ F

3 Young adults don’t get high blood pressure.

❑ T ❑ F

4 High blood pressure has no symptoms. 

❑ T ❑ F

5 Stress causes high blood pressure.

❑ T ❑ F

6 High blood pressure is not life-threatening.

❑ T ❑ F

7 Blood pressure is high when it’s at or 

over 140/90 mm Hg.

❑ T ❑ F

8 If you’re overweight, you are two to six 

times more likely to develop high blood 

pressure. 

❑ T ❑ F

9 You have to exercise vigorously every 

day to improve your blood pressure and 

heart health. 

❑ T ❑ F

10 Americans eat two to three times more 

salt and sodium than they need.

❑ T ❑ F

11 Drinking alcohol lowers blood pressure. 

❑ T ❑ F

12 High blood pressure has no cure. 

❑ T ❑ F

How well did you do?
70 High Blood Pressure

To The High Blood Pressure

Prevention I.Q. Quiz

1 False. High blood pressure can be

prevented with four steps: 1) keep a

healthy weight; 2) become physically

active; 3) limit your salt and sodium use;

and, 4) if you drink alcoholic beverages,

do so in moderation.

2 False. You are more likely to get high

blood pressure if it runs in your family,

but that doesn’t mean you must get it.

Your chance of getting high blood

pressure is also greater if you’re older or

an African American. But high blood

pressure is NOT an inevitable part of

aging, and everyone can take steps to

prevent the disease—the steps are given

in answer 1.

3 False. About 15 percent of those ages 

18-39 are among the 50 million

Americans with high blood pressure.

Once you have high blood pressure, you

have it for the rest of your life. So start

now to prevent it.

4 True. High blood pressure, or “hypertension,” usually has no symptoms. In fact,

it is often called the “silent killer.” You

can have high blood pressure and feel

fine. That’s why it’s important to have

your blood pressure checked—it’s a

simple test.

5 False. Stress does make blood pressure

go up, but only temporarily. Ups and

downs in blood pressure are normal. Run

for a bus and your pressure rises; sleep

and it drops. Blood pressure is the force

of blood against the walls of arteries.

Blood pressure becomes dangerous when

it’s always high. That harms your heart

and blood vessels. So what does cause

high blood pressure? In the vast majority

of cases, a single cause is never found.

6 False. High blood pressure is the main

cause of stroke and a factor in the 

development of heart disease and 

kidney failure.

7 True. But even blood pressure slightly

under 140/90 mm Hg can increase your

risk of heart disease or stroke.

8 True. As weight increases, so does 

blood pressure. It’s important to stay at a

healthy weight. If you need to reduce, try

to lose 1/2 to 1 pound a week. Choose

foods low in fat (especially saturated fat),

since fat is high in calories. Even if

you’re at a good weight, the healthiest

way to eat is low fat, low cholesterol.

9 False. Studies show that even a little 

physical activity helps prevent high

blood pressure and strengthens your

heart. Even among the overweight, those

who are active have lower blood pressures

than those who aren’t. It’s best to do

some activity for 30 minutes, most days.

Walk, garden, or bowl. If you don’t have

a 30-minute period, do something for 15

minutes, twice a day. Every bit helps—so

make activity part of your daily routine.
High Blood Pressure 71

10 True. Americans eat way too much salt

and sodium. And some people, such as

many African Americans, are especially 

sensitive to salt. Salt is made of sodium

and chloride, and it’s mostly the sodium

that affects blood pressure. Salt is only

one form of sodium—there are others.

So you need to watch your use of both

salt and sodium. That includes what’s

added to foods at the table and in cooking, and what’s already in processed

foods and snacks. Americans, especially

people with high blood pressure, should

eat no more than about 6 grams of salt a

day, which equals about 2,400 milligrams

of sodium.

11 False. Drinking too much alcohol can

raise blood pressure. The “Dietary

Guidelines” recommend that for overall

health, women should limit their alcohol

to no more than one drink a day and men

should have no more than two drinks a

day. A drink would be 1.5 ounces of 80

proof whiskey, or 5 ounces of wine, or

12 ounces of beer.

12 True. But high blood pressure can be

treated and controlled. Treatment usually

includes lifestyle changes—losing

weight, if overweight; becoming physically active; limiting salt and sodium;

and avoiding drinking excess alcohol—

and, if needed, medication. But the best

way to avoid the dangers of high blood

pressure is to prevent the condition.

For more information

on high blood pressure

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
72 High Blood Pressure 
High Blood Cholesterol 73

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫

✫
74 High Blood Cholesterol 
1 High blood cholesterol is one of the risk

factors for heart disease that you can do

something about. 

❑ T ❑ F

2 To lower your blood cholesterol level,

you must stop eating meat altogether. 

❑ T ❑ F

3 Any blood cholesterol level below 

240 mg/dL is desirable for adults.

❑ T ❑ F

4 Fish oil supplements are recommended to

lower blood cholesterol.

❑ T ❑ F

5 To lower your blood cholesterol level, you

should eat less saturated fat, total fat, and

cholesterol; and lose weight if you are 

overweight.

❑ T ❑ F

6 Saturated fats raise your blood cholesterol

level more than anything else in your diet. 

❑ T ❑ F

7 All vegetable oils help lower blood 

cholesterol levels.

❑ T ❑ F

8 Lowering blood cholesterol levels can 

help people who have already had a

heart attack. 

❑ T ❑ F

9 All children need to have their blood 

cholesterol levels checked.

❑ T ❑ F

10 Women don’t need to worry about high 

blood cholesterol and heart disease.

❑ T ❑ F

11 Reading food labels can help you eat 

the heart-healthy way.

❑ T ❑ F

Check Your

Cholesterol and

Heart Disease

National Cholesterol

Education Program

Are you cholesterol smart? Test your

knowledge about high blood cholesterol

with the following questions. Circle each

true or false. The answers are given on

the back of this sheet.

High Blood Cholesterol 75
76 High Blood Cholesterol

To The Cholesterol and

Heart Disease I.Q. Quiz

1 True. High blood cholesterol is one of the

risk factors for heart disease that a person

can do something about. High blood 

pressure, cigarette smoking, diabetes,

overweight, and physical inactivity are 

the others.

2 False. Although some red meat is high 

in saturated fat and cholesterol, which can

raise your blood cholesterol, you do not

need to stop eating it or any other single

food. Red meat is an important source of

protein, iron, and other vitamins and 

minerals. You should, however, cut back

on the amount of saturated fat and 

cholesterol that you eat. One way to do

this is by choosing lean cuts of meat with

the fat trimmed. Another way is to watch

your portion sizes and eat no more than 6

ounces of meat a day. Six ounces is about

the size of two decks of playing cards.

3 False. A total blood cholesterol level of

under 200 mg/dL is desirable and usually

puts you at a lower risk for heart disease. 

A blood cholesterol level of 240 mg/dL is

high and increases your risk of heart 

disease. If your cholesterol level is high,

your doctor will want to check your level 

of LDL-cholesterol (“bad” cholesterol). A

HIGH level of LDL-cholesterol increases

your risk of heart disease, as does a LOW

level of HDL-cholesterol (“good” cholesterol). An HDL-cholesterol level below 35

mg/dL is considered a risk factor for heart

disease. A total cholesterol level of 200-

239 mg/dL is considered borderline–high

and usually increases your risk for heart

disease. All adults 20 years of age or older

should have their blood cholesterol level

checked at least once every 5 years.

4 False. Fish oils are a source of omega-3

fatty acids, which are a type of polyunsaturated fat. Fish oil supplements generally

do not reduce blood cholesterol levels.

Also, the effect of the long-term use of

fish oil supplements is not known.

However, fish is a good food choice

because it is low in saturated fat.

5 True. Eating less fat, especially saturated

fat, and cholesterol can lower your blood

cholesterol level. Generally, your blood 

cholesterol level should begin to drop a

few weeks after you start on a cholesterollowering diet. How much your level drops

depends on the amounts of saturated fat

and cholesterol you used to eat, how high

your blood cholesterol is, how much

weight you lose if you are overweight, and

how your body responds to the changes

you make. Over time, you may reduce

your blood cholesterol level by 10-50

mg/dL or even more.

6 True. Saturated fats raise your blood 

cholesterol level more than anything else.

So, the best way to reduce your cholesterol level is to cut back on the amount of

saturated fats that you eat. These fats are

found in largest amounts in animal products such as butter, cheese, whole milk,

ice cream, cream, and fatty meats. They

are also found in some vegetable oils—

coconut, palm, and palm kernel oils.
High Blood Cholesterol 77

7 False. Most vegetable oils—canola,

corn, olive, safflower, soybean, and sunflower oils—contain mostly monounsaturated and polyunsaturated fats, which

help lower blood cholesterol when used

in place of saturated fats. However, a few

vegetable oils—coconut, palm and palm

kernel oils—contain more saturated fat

than unsaturated fat. A special kind of

fat, called trans fat, is formed when 

vegetable oil is hardened to become

margarine or shortening, through a

process called “hydrogenation.” The

harder the margarine or shortening, the

more likely it is to contain more trans

fat. Choose margarine containing liquid

vegetable oil as the first ingredient. Just

be sure to limit the total amount of any

fats or oils, since even those that are

unsaturated are rich sources of calories.

8 True. People who have had one heart

attack are at much higher risk for a second

attack. Reducing blood cholesterol levels

can greatly slow down (and, in some

people, even reverse) the buildup of

cholesterol and fat in the wall of the

coronary arteries and significantly reduce

the chances of a second heart attack. If

you have had a heart attack or have coronary disease, your LDL level should be

around 100 mg/dL, which is even lower

than the recommended level of less than

130 mg/dL for the general population.

9 False. Children from “high risk”

families, in which a parent has high

blood cholesterol (240 mg/dL or above)

or in which a parent or grandparent has

had heart disease at an early age (at 55

years or younger), should have their

cholesterol levels tested. If a child from

such a family has a high cholesterol

level, it should be lowered under

medical supervision, primarily with diet,

to reduce the risk of developing heart

disease as an adult. For most children,

who are not from high-risk families, the

best way to reduce the risk of adult heart

disease is to follow a low saturated fat,

low cholesterol eating pattern. All children

over the age of 2 years and all adults

should adopt a heart–healthy eating pattern

as a principal way of reducing coronary

heart disease.

10 False. Blood cholesterol levels in both

men and women begin to go up around

age 20. Women before menopause have

levels that are lower than men of the

same age. After menopause, a women’s

LDL-cholesterol level goes up—and her

risk for heart disease increases. For both

men and women, heart disease is the

number one cause of death.

11 True. Food labels have been changed.

Claims like “low–fat” or “light” on

certain foods are government–regulated.

Look on the nutrition label for the

amount of saturated fat, total fat, cholesterol, and total calories in a serving of

the product. Use this information to

compare similar products and find the

ones with the smallest amounts. If there

is not a nutrition label, look for the list 

of ingredients. Here, the ingredient in the

greatest amount is shown first and the

ingredient in the least amount is shown

last. So, to choose foods low in saturated

fat or total fat, go easy on products that

list fats or oil first, or that list many fat

and oil ingredients.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
78 High Blood Cholesterol 
High Blood Cholesterol 79

To Help Older Americans Control

Cholesterol

Just because you’re over 65 doesn’t mean you can ignore

your cholesterol level. Lowering your cholesterol can help

you stay healthy by reducing your risk for heart disease. If

you have heart disease, lowering cholesterol can help you live

longer and reduce your risk of having a heart attack.

So make these cholesterol-lowering habits a part of your life:

Eat foods low in saturated fat,

total fat and cholesterol. Good choices

include fruits and vegetables, low fat and

fat-free dairy products, and whole grains.

Choose lean cuts of meat, skinless poultry,

and fish.

Maintain a healthy weight.

Being overweight raises your cholesterol

and increases your risk of getting heart 

disease.

Be physically active. With your 

doctor’s okay, try 30 minutes of moderate

activity a day. Walking and dancing 

promote coordination, and light weightlifting strengthens bones. Pressed for time?

Divide those 30 minutes into three 

10-minute sessions.

Take your medicine if prescribed.

If your doctor has prescribed cholesterollowering medication for you, it is important

that you take it every day in addition to 

following heart-healthy habits.

NHLBI Health Information Center

P.O. Box 30105, Bethesda, MD 20824-0105

phone: (301) 592-8573 fax: (301) 592-8563
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 01-1655 

June 2001

DISCRIMINATION PROHIBITED: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall,

on the grounds of race, color, national origin, handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected to 

discrimination under any program or activity (or, on the basis of sex, with respect to any education program and activity) receiving Federal financial

assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in the performance of

Federal contracts, and Executive Order 11246 states that no federally funded contractor may discriminate against any employee or applicant for

employment because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in 

compliance with these laws and Executive Orders.
A project of the

National Heart, Lung, and Blood InstituteNational Recreation and Park Association

COMMUNITY MOBILIZATION GUIDE

A project of theNational Heart, Lung, and Blood InstitutNational Recreation and Park Association