Need: Few older adults, particularly women and those in rural areas, participate in healthy living interventions.
Intervention: Health educators lead community-based healthy living classes, which include strength training, aerobic exercise, dietary skill building, and/or civic engagement, depending on the program.
Results: StrongPeople™ programs have been shown to improve weight, diet, physical activity, strength, cardiovascular health profile, physical function, pain, depression, and/or self-confidence in midlife and older adults.
first began as a program called StrongWomen™, designed by
Dr. Miriam Nelson after her research study examining the
effects of strength training on bone density and other
risk factors for osteoporosis. She found that midlife and
older women could safely improve bone density and muscle
mass through progressive strength training. The results
were published in the Journal of the American Medical
Association in 1994, and Dr. Nelson began the
StrongWomen book series, focusing on innovative research
related to nutrition, fitness, chronic disease, and
In 2002, prompted by two Extension educators in Alaska
and Kansas, Dr. Nelson partnered with Dr. Seguin-Fowler,
and together they developed the StrongWomen Program Tool
Kit, which translated the 1994 research findings into a
formalized community-based program for implementation by
Extension educators and other allied health
professionals. In 2003, the curriculum was released and
the first programs were launched.
Because of their community-based nature, these programs
are often offered in rural areas where other
opportunities may be lacking and barriers to healthy
living may be unique. The programs include strength
training, aerobic exercise, dietary skills training,
and/or civic engagement. They provide an opportunity for
participants to build skills, confidence, and socialize.
StrongPeople Strong Bodies
The Strong Bodies Program is a nationally disseminated
evidence-based community strength training program. It is
disseminated through a strong nationwide partnership with
Extension educators as well as several healthcare
systems. Strong Bodies has nearly 4,000 community health
educators trained to implement the program, with regional
Ambassadors in Alaska, New York, Oregon, Texas, and
Wisconsin who conduct trainings in their state and for
other states as needed. In research studies, participants
improved muscle mass, muscle strength, bone density, body
fat, balance, physical activity, blood sugar, blood
pressure, physical function, pain, depression, and
StrongPeople Healthy Weight
Healthy Weight is an evidence-based healthy living
curriculum that includes aerobic exercise and dietary
skills training. It has demonstrated effectiveness at
improving diet, physical activity behaviors, and body
weight among midlife and older women. National
dissemination research was supported by a Centers for
Disease Control and Prevention grant, in which over 30
states and 90 communities participated.
StrongPeople Change Clubs
StrongPeople developed the Change Clubs, also known as
HEART Clubs, curriculum in 2011. The goal of the Change
Club process is to harness the collective power of local
residents to advocate for community-level change
targeting chronic disease prevention through improved
access to healthier food and physical activity
environments and related policies.
StrongPeople Healthy Hearts
In 2013, Dr. Seguin-Fowler was awarded a National
Institutes of Health (NIH) grant to integrate the three
core programs into a multilevel, multicomponent
intervention aiming to reduce cardiovascular disease risk
factors in medically underserved rural communities:
StrongPeople Healthy Hearts, previously known as Strong
Hearts, Healthy Communities.
StrongPeople Strong Bodies has nearly 4,000 community
health educators trained to implement the program.
Approximately 1,500 StrongPeople Healthy Weight
educators have been trained. The program was originally
tested with Extension partners in a randomized control
trial in Kansas and Arkansas in 2007.
StrongPeople Healthy Hearts participants demonstrated
significant, clinically meaningful improvements in body
weight, diet, physical activity, and strength. Their
overall cardiovascular health profile also improved, as
measured by the
American Heart Association's Simple 7 score.
Intervention participants' friends and family members
also improved their own body weight and health. The
trial was implemented in two phases across a total of
27 towns in Montana and New York in collaboration with
Extension and local healthcare partners.
StrongPeople Change Clubs are being evaluated by a
National Institutes of Health funded (R01) study, in
which 12 rural towns across New York and Texas were
randomly assigned to implement (or delayed to implement)
evidence-based policy, system, and environmental (PSE)
interventions using the Change Club curriculum. The study
includes rigorous evaluation among the Extension educator
facilitators, Change Club members (those who lead
implementation in the towns), and their social networks,
and with town residents in each community, including
population-wide health outcome assessments. This is the
first study of its kind with a randomized design
evaluating real-world, resident-led PSE intervention
effects on population health.
StrongPeople programs have been shown to improve
weight, diet, physical activity, strength, cardiovascular
health profile, physical function, pain, depression,
and/or self-confidence in midlife and older adults.
Seguin, R. A., Sriram, U., Connor, L. M., Silver, A.
E., Niu, B., Bartholomew, A. N. (2018). A civic
engagement approach to encourage healthy eating and
active living in rural towns: the HEART Club pilot
project. American Journal of Health Promotion,
32(7), 1591-601. Article
For more in-depth information on the programs, see the
Research Articles section of the StrongPeople
Participants have given the programs predominantly
positive feedback, often mentioning the camaraderie
between group members as a motivating factor to make
positive lifestyle changes. Recommendations from the
participants include offering programs three days a week,
longer exercise sessions, and longer program duration
(for 12-week programs). For civic engagement groups,
participant-reported challenges include competing
priorities and limited finances for projects. At times,
trained leaders do not implement the program; a primary
reason is changing jobs or retirement.
For a fee, StrongPeople provides training, a
comprehensive toolkit, and other resources for leaders on
their website. Trained leaders then offer the programs to
the participants, typically done with low cost to the
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.