A Public Health Approach to the Planning and Implementation of an Exercise Support Group for Veterans

Background: Poor musculoskeletal health is a public health issue disproportionately affecting the veteran population. VA Strong, a health initiative developed from the partnership of the Muscle Morphology, Mechanics, and Performance Laboratory (3MAP Lab) at the Washington DC VA Medical Center (DC VAMC) and the Catch-A-Lift Fund (CAL), targets veteran DC VAMC employees interested in both maintaining a fitness regimen and contributing to the well-being of fellow veterans within the local community. 3MAP Lab has the core mission of improving the musculoskeletal health of veterans through exercise-based rehabilitation, and CAL has the primary goal enhancing the well-being of returning veterans through strength training and peer-to-peer support. Therefore, the founding principles of the VA Strong program are: self-efficacy, volunteerism, and community engagement. Methods: Application of public health theory will allow the VA Strong program to identify program components that align well with its central activities. Logic models will be applied to determine the program’s inputs, activities, and outputs, and their relationship to one another: 1) The Health Belief Model best explains the fitness component of the program and will serve to best identify how veteran perceptions of musculoskeletal health will affect their participation and adherence to an exercise regimen. 2) Social Learning Theory will provide a framework for the peer-to-peer volunteerism aspect of the program. This element of VA Strong will be used to engender the participation of DC VAMC employees in CAL-sponsored community activities to support subsidized community fitness center memberships for returning veterans. 3) Grounded Theory will be utilized to better understand how veterans perceive common research outcomes concerning musculoskeletal health, functional performance, and caregiver burden. Feedback from veterans will inform the use of patient-centered outcomes and shape future research endeavors at the DC VAMC. Results: The use of integrated logic models will provide a conceptual framework for the VA Strong program and its component activities. Moreover, this approach will provide the opportunity for DC VAMC stakeholders to evaluate the program’s effectiveness in attaining its targeted outcomes concerning self-efficacy, volunteerism, and community engagement. Conclusion: Overall, this conceptual framework is informed by previous research on community engagement, and the barriers to physical fitness among the veteran population. The application of public health theory to the implementation and evaluation of the VA Strong program will maximize veteran adherence to the exercise regimen, foster participation in veteran volunteer programs associated with CAL, and identify patient-centered outcomes for exercise-based rehabilitation research