OBJECTIVE -The aim was to assess the net effects on risk factors for type 2 diabetes and cardiovascular disease of a community-based 3-year intervention to increase physical activity. RESEARCH DESIGN AND METHODS-A pseudo-experimental cohort design was used to compare changes in risk factors from an intervention and a control district with similar socioeconomic status in Oslo, Norway, using a baseline investigation of 2,950 30-to 67-year-old participants and a follow-up investigation of 1,776 (67% of those eligible, 56% women, 18% non-Western immigrants) participants. A set of theory-based activities to promote physical activity were implemented and tailored toward groups with different psychosocial readiness for change. All results reported are net changes (the difference between changes in the intervention and control districts). At both surveys, the nonfasting serum levels of lipids and glucose were adjusted for time since last meal.RESULTS -The increase in physical activity measured by two self-reported questionnaires was 9.5% (P ϭ 0.008) and 8.1% (P ϭ 0.02), respectively. The proportion who increased their body mass was 14.2% lower in the intervention district (P Ͻ 0.001), implying a 50% relative reduction compared with the control district, and was lower across subgroups. Beneficial effects were seen for triglyceride levels (0.16 mmol/l [95% CI 0.06 -0.25], P ϭ 0.002), cholesterolto-HDL cholesterol ratio (0.12 [0.03-0.20], P ϭ 0.007), systolic blood pressure (3.6 mmHg [2.2-4.8], P Ͻ 0.001), and for men also in glucose levels (0.35 mmol/l [0.03-0.67], P ϭ 0.03). The net proportion who were quitting smoking was 2.9% (0.1-5.7, P ϭ 0.043).CONCLUSIONS -Through a theory-driven, low-cost, population-based intervention program, we observed an increase in physical activity levels, reduced weight gain, and beneficial changes in other risk factors for type 2 diabetes and cardiovascular disease. Diabetes Care 29:1605-1612, 2006P hysical inactivity is an important risk factor for type 2 diabetes (1,2). Clinical trials (3,4) in high-risk individuals have demonstrated the importance of healthy lifestyle programs to prevent diabetes but are rather expensive and not likely to have much impact on the total burden of disease (5,6). Therefore, community-based strategies are urgently needed to stem the worldwide epidemic of obesity and type 2 diabetes, especially in low-income communities (6). Such strategies have a considerable potential effect on public health if they manage to reduce modifiable risk factors even to a small degree in a large proportion of the population.Disappointing results in previous community-based research on cardiovascular risk factors may be due to methodological weaknesses in the theoretical framework, the intervention itself, the assessment of outcomes, and beneficial secular trends for the risk factors addressed (7-10). The development of theories and models has enhanced our understanding of the processes underlying behavioral changes. A broad set of factors influencing behavior has been identified ...

The prevalence of self-reported diabetes is remarkably higher than reported from other studies in Norway. The proportion of undiagnosed diabetes was higher than anticipated, and constituted 39% of all those categorized as diabetics.

Two important public health challenges are to influence sedentary people to become physically active, and to influence active people to maintain their level of activity. Psychosocial factors might have important influencing properties in this regard. The aims of this study were threefold: (1) to examine the relationships between selected psychosocial factors and physical activity stages of change; (2) to examine moderating influences of socio-demographic and anthropometric factors in these relationships; and (3) to identify possible interactions between psychosocial factors in their relation to stages of change.Altogether, 2336 men and women aged 31 Á67 (mean 48, s 010) years completed self-administered questionnaires that assessed stages of change in physical activity, self-efficacy, social support, perceived behavioural control, attitude, and identity. The psychosocial factors were measured by instruments derived or modified from instruments that have previously been shown to have acceptable validity and reliability. The statistical tests employed were descriptive and frequency analyses, Pearson's correlations, multiple regressions, multivariate analyses of variance, analyses of variance, and Tukey post-hoc comparison tests.Analyses revealed that self-efficacy in the face of psychological barriers, support from family and from friends, perceived behavioural control, and identity explained 42% of the variance in stages of physical activity behaviour change. Results further showed that all measured psychosocial variables differed significantly by stages of change, with almost every stage having significantly different psychosocial variable scores than every other stage. Although we found no moderating effects of socio-demographic or anthropometric variables on these relationships, social support from family and social support from friends, identity and social support from family, as well as perceived behavioural control and self-efficacy faced with psychological barriers were found to interact with respect to their relationships with stages of change.The study identified a strong set of psychosocial correlates of physical activity stages of change as well as significant interactions between particular correlates in these relationships. The findings might provide guidance in the design of stage-matched interventions to promote physical activity among adults. Further work is needed to confirm these findings as well as to provide evidence of the causality in the observed relationships.

Objective: To summarize the main results of a community-based study on physical activity promotion -"Romsås in Motion". Methods:We assessed changes in physical activity, body mass and psychosocial mediators of physical activity from a pseudo-experimental cohort study involving two districts with low socio-economic status in Oslo, Norway. In 2000, baseline investigation included 2,950 30-67 year olds -48% of those invited. At follow-up in 2003 we measured 1,776 subjects (67% of those eligible). A set of theoretically informed strategies targeting individuals, groups and the environment were implemented, tailored towards groups with different psychosocial readiness for change. We report net changes (the difference between changes in the intervention and control districts) and results of mediation analyses related to the effect of the intervention. Results:The increase in physical activity measured by two questionnaires was 9.5% (p=0.008) and 8.1% (p=0.02), respectively. The proportion who increased their body mass was reduced by 50% compared with the control district. Participation in walking and aerobic exercise groups, having seen the "Walk the stairs"-poster and used the walk path were particularly effective intervention components. The most promising psychosocial mediators of forward transition in stages of change were physical activity identity, perceived control, support from friends and family, and self-efficacy when facing psychological barriers. Conclusion:Through a theoretically informed, low-cost, population-based intervention program we observed an increase in physical activity levels and a reduced weight gain.Mediation findings regarding forward transition in stages of change enhance our understanding of psychosocial mechanisms of behaviour change, and may prove helpful in guiding implementation and evaluation of future interventions. 3In western societies today low socio-economic status (SES) at the individual, group and regional level represents a risk factor for premature cardiovascular disease (CVD), 1-2 a sedentary lifestyle and is linked to the world-wide increase in obesity and type 2 diabetes. [3][4][5] Although lifestyle interventions may be highly effective in high risk individuals, [6][7] very few community-based interventions have addressed behavioural risk factors for type 2 diabetes, and most study designs are flawed. 8 Even small improvements in one or more risk factors, if achieved in a large proportion of the population, 9 can provide considerable impact on public health. Thus, such interventions are needed, especially in low-income communities. 8 The determinants of physical activity behaviour are multi-factorial. 10-17The most promising theories and models hypothesize that behaviour change is mediated by change in proximal psychological factors such as attitudes, efficacy, control beliefs and identity.Further, influencing also more distal social and physical environmental factors comprising family support and social networks, organizations, communities and societies to reinf...

Background:The level of physical fitness in south Asian immigrants living in Norway is largely unknown, but the level of physical activity seems to be low, possibly in part explaining their high prevalence of diabetes and cardiovascular diseases. However, previous studies have used self-reported measures of physical activity, and it might be questioned whether the previous data reflect the true physical activity level. Aim: To describe objectively measured physical activity level, cardiorespiratory fitness and diabetes risk in a group of Pakistani immigrant men living in Oslo, Norway. Methods: One hundred and fifty Pakistani immigrant men in the age group 25-60 years were included. Physical activity level was assessed with an accelerometer. Cardiorespiratory fitness was measured until exhaustion on a treadmill, and diabetes risk was evaluated with an oral glucose tolerance test. Results: Mean age was 37.3 years (SD=7.7). Total physical activity level was 308 counts/min (SD=131), and peak oxygen uptake was 34.2 ml·kg -1 ·min -1 (SD=5.6). Fifty percent of the participants had the metabolic syndrome, and 76% were obese. Physical activity level and cardiorespiratory fitness level were lower, and prevalence of the metabolic syndrome higher in a subgroup of taxi drivers as compared with those in other occupations (P<0.05). Conclusions: Physical activity and cardiorespiratory fitness levels are low and diabetes risk high among Pakistani immigrant men living in Oslo, especially in taxi drivers.