StrongWomen Program

StrongWomen Program

Presented by:

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Dr. Miriam Nelson, a professor at Tufts University in Boston, Massachusetts, has developed a strength-training program specifically for midlife and older women. The StrongWomen Program will help you increase your strength, bone density, balance, and energy, and you will look and feel better!

Program Objective The objective of the StrongWomen Program is to improve the health and well-being of middleaged and older women throughout the country and abroad by increasing access to structured, safe, and effective strength-training programs. Strength training improves/increases:

? Muscle mass ? Strength & balance ? Bone density ? Arthritis symptoms ? Metabolic rate ? Glucose control & lipid profile In addition to physical benefits, strength training also has tremendous mental and emotional benefits: ? Improves mood & attitude ? Decreases depression ? Allows you to sleep more soundly

Participants Should Wear:

? Comfortable, loose, breathable clothing ? Closed-toe shoes with rubber soles, preferably athletic shoes or

sneakers ? Minimal jewelry ? especially on hands and wrists Participants Should Bring

? At least one full water bottle ? Exercise mat or towel

HOW DO I SIGN UP?

If you are 69 years of age or younger, you need to fill out the

(1) Participant Summary Information Sheet,

(2) Medical History and Current Health Survey Form,

(3) Physical Activity Readiness Questionnaire (PAR-Q), and

(4) Participant Consent Form.

Assuming that none of the yes boxes on the PAR-Q are checked off, you are ready to go.

If you have checked off one or more yes boxes on the PAR-Q form, then you will need authorization from your primary care physician before you can begin the StrongWomen Program. (see number 5 below).

If you are 70 years of age or older, you need to fill out

(1) Participant Summary Information Sheet,

(2) Medical History and Current Health Survey Form,

(3) Physical Activity Readiness Questionnaire (PAR-Q),

(4) Participant Consent Form, and

(5) Physician Authorization Form (completed and approved by your primary care physician) before you begin the StrongWomen Program. There is also a letter to take to your physician with information on the program These forms are provided in the packet for you to complete and return to our office.

The StrongWomen Program A National Fitness Program for Women

Participant Summary Information Sheet

Name: Address: _______________________________________________________________

Phone Number: Email Address: Date of Birth: Program Site: Start Date:

Age: End Date:

In case of emergency, please call:

Name:

Relationship:

Phone Number:

Email address:______________________

The StrongWomen Program A National Fitness Program for Women

Participant Consent

I have voluntarily enrolled in a program of progressive exercise. The program is designed to place a gradually increased workload on the heart, lungs, muscles and bones to help improve their function. I understand that participation in such a program may be associated with some risks. These risks may include but are not limited to: muscle soreness, fainting, disorders of heart beat, abnormal blood pressure, and in very rare instances, heart attack. To the best of my knowledge I do not have any limiting physical conditions or disability that would preclude an exercise program. Effort will be made to minimize any risks to me by a pre-exercise assessment and a medical screening. I release everyone who has designed, promoted, or conducted the StrongWomen Program from all claims or liabilities whatsoever resulting from my participation in this program. I assume all risks and responsibility for any injury, damage, or any other adverse event that may result from my participation in this program.

Before I begin this program I understand that a pre-exercise assessment and physician screening consent form may be required. I understand that each person may react differently to these fitness activities and these reactions cannot be predicted with complete accuracy. I will inform the Program Leader and/or my health care provider if I experience any unusual symptoms.

Signature Printed Name Date _____________________

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