Hip Hip Hooray for Bone Health

Target Audience: New Brunswick Meals on Wheels seniors aged 65 years and older

Summary of audience characteristics; justification for the nutrition education

needs and the teaching strategies:

Population estimates provided by the 2017 American Community Survey showed

that approximately despite attending high school, 15.1% of the senior population in New
Brunswick did not obtain a diploma (Census American Fact Finder, 2017). Low levels of
calcium and vitamin D have been associated with increased fracture risk due to
compromised bone health. In 2008, the Food and Drug Administration amended the label
health claim regulations concerning calcium and osteoporosis so that they could also
include vitamin D because of increasing recognition that vitamin D plays a pivotal role in
calcium uptake and therefore bone homeostasis (FDA, 2008).
Vitamin D deficiency affects about 42% of adults in the US. Vitamin D deficiency
has been more common among those with poor health status, obesity and not consuming
milk daily (Forrest and Stuhldreher, 2011).NHANES 2009-2010 indicated that 42% of
Americans did not meet their Estimated Average Requirements for calcium as
recommended by the Institute of Medicine (Hoy and Goldman, 2014).
The International Osteoporosis Foundation mentions that “with age, the body is
less able to absorb and retain calcium” (International Osteoporosis Foundation, 2015),
and the NIH states that “national nutrition surveys have shown that most people are not
getting the calcium they need to grow and maintain healthy bones” (NIH, 2018). Only
36% of Americans 65 years of age or older meet the requirements for physical activity
(National Prevention Council, 2016). There is strong evidence that physical activity
improves physical function outcomes such as walking, balance, and overall strength.
Exercise, which combines aerobics, strength training, and balance is most effective in
reducing fall-related injuries such as fractures (Physical Activity Guidelines Advisory
Committee, 2018, F9-37/38).
Older adults benefit from education styles that focus on “self-management” where
they participate in goal setting and in identifying problem-solving strategies designed to
address barriers to managing their treatment regimens. (Holli and Beto, 2018). The
strategies include defining goals and SMART objectives. The participants will first be
assessed to determine what they already know. Then, based on the results of the
assessment, the information presented to them will be tailored towards the individual
participants.
Providing them with basic knowledge of nutrient sources allows participants to
associate foods they already eat or learn about foods they can possibly consume to
increase their intake. The incorporation of simple exercises allows participants to
determine how engaged they wish to be based on physical ability. The post-assessment
is used as a marker to determine how much information was retained. Lastly, the
handouts given to the participant will allow them to have the information should they wish
to “self-manage” the steps they wish to take towards bone health.
Lesson Definition and Goal: This nutrition lesson aims to educate the seniors in New
Brunswick Meals on Wheels about the importance of Vitamin D, calcium, and weight-bearing
exercise for bone mineral density. Participants will be able to identify food sources and
benefits of calcium and Vitamin D and understand how to incorporate exercise into their daily
routine

Objectives
Objective 1: At the end of this lesson, 60% or more of participants will identify one food
source of Calcium or one food source of Vitamin D.

Objective 2: At the end of this lesson, 60% or more of participants will believe that either
Calcium, Vitamin D, or exercise is important for bone health

Objective 3: At the end of this lesson, 60% or more of participants will plan to incorporate
15 minutes of light physical activity into their daily routine within the next month.

Lesson Time:
Total Lesson Time: 50 minutes
Set-up: 5 minutes
Pre Test: 10 minutes
Nutrition Intervention: 20 minutes
Post Test: 10 minutes
Clean-up: 5 minutes

Materials
Supplies to be transported to the location
- Projector (& HDMI cable)
- Laptop
- Hip Hip Hooray for Bone Health [PowerPoint presentation]
- 25 copies of pre-test
- 25 copies of post-test
- Markers to fill out pre/post-test
Supplies provided at the location
- Table for handout display
- Blank wall for PowerPoint presentation
Handouts
- 5 Steps to Healthy Bones and a Fracture-Free Future
- Vitamin D Handout: Pages 6 and 7 of Serve Up Bone Strength Throughout Life
(an informative PDF from the International Osteoporosis Foundation)
- Calcium Handout: Pages 4 and 5 of Serve Up Bone Strength Throughout Life (an
informative PDF from the International Osteoporosis Foundation)
- Exercise handout: Modified Slides 23 and 24 of Healthy Bones for Life (a
PowerPoint presentation from American Bone Health)

Procedures and Activities

Preparation List what needs to be done in preparation for the lesson such as printing
certain handouts, setting up tables/displays in a particular way, etc.
● Print 25 copies of each handout
● Print 25 copies of Pre/Post-test
● Arrange chairs to face the presentation wall, and space them appropriately for
exercise demonstration
● Set up PowerPoint with the projector
● Writing utensils (clipboards if needed)
● Four-minute warm-up video:
○ https://go4life.nia.nih.gov/sample_workout/exercise-warm-up-older-adults/

Lesson Activities
● Opening Line
o “Hello everyone! Thank you for coming here today to learn about ways to
improve your bone health, can we get a Hip Hip Hooray?” (Lead a “hip hip
hooray” chant).
o Introductions:
▪ All instructors introduce yourselves to the participants before starting
the lesson
▪ “Taking care of our bones is important as we age, and there are a
few things you can do now to keep feeling your best.”
o Distribute the pre-test to all participants.
▪ Distribute markers and the pre-test to each participant, explain how
to complete the pre-test and state that you will collect them after 10
minutes.
▪ After allowing 10 minutes to complete the pre-test, collect the
completed forms from participants.
o Present the calcium slides from the PowerPoint
▪ Take 2 minutes to ask participants if they can identify any foods with
calcium before presenting the slides.
▪ Go over which foods have calcium
▪ Explain why calcium is important for bone health.
o Present the Vitamin D nutrition education slides from the PowerPoint
▪ Ask participants to identify food items with Vitamin D.
▪ Go over which foods have Vitamin D
▪ Explain why Vitamin D is important for bone health.
o Present the exercise education slides for bone health
▪ Explain what weight-bearing exercise is and why it is beneficial for
bone health.
o Play the exercise education video
▪ Act out the video exercises with participants
 o Distribute Post-Test to participants
▪ Distribute writing utensils and clipboards if needed
▪ After allowing 10 minutes to complete the post-test, collect the
completed forms from participants
o Pass out handouts for all participants to take home
▪ 5 Steps to Healthy Bones and a Fracture-Free Future
▪ Vitamin D Handout: Pages 6 and 7 of Serve Up Bone Strength
Throughout Life (an informative PDF from the International
Osteoporosis Foundation)
▪ Calcium Handout: Pages 4 and 5 of Serve Up Bone Strength
Throughout Life (an informative PDF from the International
Osteoporosis Foundation)
▪ Exercise handout: Modified Slides 23 and 24 of Healthy Bones for
Life (a PowerPoint presentation from American Bone Health)

Take Home Material:

- 5 Steps to Healthy Bones and a Fracture-Free Future

- Vitamin D Handout: Pages 6 and 7 of Serve Up Bone Strength Throughout Life
(an informative PDF from the International Osteoporosis Foundation)
- Calcium Handout: Pages 4 and 5 of Serve Up Bone Strength Throughout Life (an
informative PDF from the International Osteoporosis Foundation)
- Exercise handout: Modified Slides 23 and 24 of Healthy Bones for Life (a
PowerPoint presentation from American Bone Health)

These take-home handouts will help the audience remember a few key steps to
maintaining healthy bones. The nutrient handouts can remind why calcium and vitamin D
are important for bone health and include sources of these nutrients. The exercise
handout presents some simple exercises the participants can engage in.

Pamphlets are helpful reminders for the target population because visual aids can be
helpful. Also, if they forget some of the information presented, this informative and colorful
handouts can be great refreshers.

Modifications What can the educator do if the lesson is not engaging or appropriate for
the audience? Is there a complimentary extra activity if the audience is highly engaged?
● Begin by mentioning that the participants are free to stop the presenters or ask
questions at any point during the presentation
○ Ask the participants periodically for verbal confirmation that they are
following the presentation and that the material is easy for them to grasp
● Modify exercises based on the target population’s abilities
● Modify exercises based on individual ability within the target population
○ If participants cannot stand - they can remain seated
○ If participants’ range of motion is limited - they will only move their arms or
legs to comfortable levels to avoid strain
● Modify nutrition education content based on the target population’s literacy levels
 ○ Use simpler words and language
○ Translate the content into the most comfortable language for the participant
(i.e., Spanish)
● Ask participants questions to actively participate with the exercises or with verbal
responses rather than passively listen to the lesson
● Complementary activities can include:
○ Play music with the exercise routine video and make up a dance routine to
go along with the exercise
○ Add pop quizzes throughout the lesson to test participant’s knowledge and
understanding of the material being presented

Evaluation: Attached

- Results from the pre and post-lesson assessments will serve as data to evaluate
whether the three objectives lesson objectives were reached
- Pre-assessment will determine
- If participants accurately identify of food sources of vitamin D and calcium
- Participants’ beliefs regarding the importance of vitamin D, calcium, and
exercise for bone health
- Participants’ level of motivation to exercise within the next month
- Post-assessments will determine if:
- Participants increase the accuracy in which they can identify food sources
of Vitamin D and Calcium
- Participants’ belief regarding the importance of vitamin D, calcium, and
exercise for bone health increase
- Participants’ level of motivation to exercise within the next month increase

Evaluation Results
1. Pre Test: n=2
a. Based on pre-test questions, 50% of participants were able to identify one
food source of Calcium or Vitamin D
b. Based on pre-test questions, 100% participants “strongly agreed” Calcium,
Vitamin D, and exercise was important for bone health
c. Based on pre-test questions, 100% of participants “strongly agreed” they
intended to implement 15 minutes of physical activity throughout their day
within the next 6 months
2. Post Test: n=2
a. Based on pre-test questions, 100% of participants were able to identify one
food source of Calcium and Vitamin D
b. Based on pre-test questions, 100% participants “strongly agreed” Calcium,
Vitamin D, and exercise was important for bone health
c. Based on questions, 100% of participants “strongly agreed” they intended
to implement 15 minutes of physical activity throughout their day within the
next 6 months

References
Chien, M. H., & Guo, H. R. (2014). Nutritional status and falls in community-dwelling
older people: a longitudinal study of a population-based random sample. PloS one,
9(3), e91044. doi:10.1371/journal.pone.0091044

Data Access and Dissemination Systems (DADS). “American FactFinder - Results.”

American FactFinder - Results, 5 Oct. 2010,
factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_
17_5YR_S1501&src=pt.

Forrest, Kimberly Y Z, and Wendy L Stuhldreher. “Prevalence and Correlates of Vitamin

D Deficiency in US Adults.” Nutrition Research (New York, N.Y.), U.S. National
Library of Medicine, 31 Jan. 2011, www.ncbi.nlm.nih.gov/pubmed/21310306

Holli B, Beto J. Nutrition Counseling and Education Skills: A Guide for Professionals, 7th
Edition. Philadelphia, PA: Wolters Kluwer Health; 2018: 220-243.

Hoy, Katherine, and Joseph Goldman . “Calcium Intake of the U.S. Population.” Food
Surveys Research Group , NHANES, Sept. 2014,
www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/13_calcium_intake_0910.
pdf

International Osteoporosis Foundation (2015). Save Up Bone Strength Throughout Life

[Brochure]. Retrieved from https://www.bones.nih.gov/health-info/bone/bone-
health/nutrition/calcium-and-vitamin-d-important-every-
agehttp://share.iofbonehealth.org/WOD/2015/patient-brochure/WOD15-
patient_brochure.pdf

Meehan, M., & Penckofer, S. (2014). The Role of Vitamin D in the Aging Adult. Journal
of aging and gerontology, 2(2), 60-71.

National Institute of Health (2018, October). Calcium and Vitamin D: Important at Every
Age Retrieved from https://www.bones.nih.gov/health-info/bone/bone-
health/nutrition/calcium-and-vitamin-d-important-every-age

National Prevention Council. Healthy Aging in Action. Washington, DC: U.S.

Department of Health and Human Services, Office of the Surgeon General; 2016.

New Brunswick, New Jersey Population: Census 2010 and 2000 Interactive Map,
Demographics, Statistics, Quick Facts. (2011). Retrieved April 8, 2019, from
http://censusviewer.com/city/NJ/New Brunswick

Towncharts.com - United States data powerfully illustrated and interactive. (2016,

 December 15). Retrieved April 8, 2019, from https://www.towncharts.com/New-
Jersey/Demographics/New-Brunswick-city-NJ-Demographics-data.html

2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity

Guidelines Advisory Committee Scientific Report. Washington, DC: U.S.
Department of Health and Human Services, 2018.