Changes in diet and physical activity resulting from the Strong Hearts, Healthy Communities randomized cardiovascular disease risk reduction multilevel intervention trial

Abstract

BackgroundWomen living in rural areas face unique challenges in achieving a heart-healthy lifestyle that are related to multiple levels of the social-ecological framework. The purpose of this study was to evaluate changes in diet and physical activity, which are secondary outcomes of a community-based, multilevel cardiovascular disease risk reduction intervention designed for women in rural communities.MethodsStrong Hearts, Healthy Communities was a six-month, community-randomized trial conducted in 16 rural towns in Montana and New York, USA. Sedentary women aged 40 and older with overweight and obesity were recruited. Intervention participants (eight towns) attended twice weekly exercise and nutrition classes for 24 weeks (48 total). Individual-level components included aerobic exercise, progressive strength training, and healthy eating practices; a civic engagement component was designed to address social and built environment factors to support healthy lifestyles. The control group (eight towns) attended didactic healthy lifestyle classes monthly (six total). Dietary and physical activity data were collected at baseline and post-intervention. Dietary data were collected using automated self-administered 24-h dietary recalls, and physical activity data were collected by accelerometry and self-report. Data were analyzed using multilevel linear regression models with town as a random effect.ResultsAt baseline, both groups fell short of meeting many recommendations for cardiovascular health. Compared to the control group, the intervention group realized significant improvements in intake of fruit and vegetables combined (difference: 0.6 cup equivalents per day, 95% CI 0.1 to 1.1, p = .026) and in vegetables alone (difference: 0.3 cup equivalents per day, 95% CI 0.1 to 0.6, p = .016). For physical activity, there were no statistically significant between-group differences based on accelerometry. By self-report, the intervention group experienced a greater increase in walking MET minutes per week (difference: 113.5 MET-minutes per week, 95% CI 12.8 to 214.2, p = .027).ConclusionsBetween-group differences in dietary and physical activity behaviors measured in this study were minimal. Future studies should consider how to bolster behavioral outcomes in rural settings and may also continue to explore the value of components designed to enact social and environmental change.Trial registrationclinicaltrials.gov Identifier: NCT02499731. Registered 16 July 2015.

Ripple Effects of a Community‐Based Randomized Trial for Rural Women: Strong Hearts, Healthy Communities

“…This is similar to the dietary outcomes in the trial participants as well, in whom only a slight increase of the intervention group's combined intake of fruit and vegetables was observed in comparison with the control group (between-group difference [cups daily]: Δ = +0.6; 95% CI = +0.1 to +1.1; P = 0.026) (25). In fact, within-group analyses of the original trial found that the intervention group's combined intake of fruit and vegetables did not change significantly after the intervention (within-group difference [cups daily]: Δ = +0.1; 95% CI = −0.2 to +0.5; P = 0.529) (25). When intervention group participants did not make significant dietary improvements, it was very unlikely to generate a ripple effect on SNMs.…”

“…We found that SNMs’ weight and BMI changes were negatively associated with their weekly walking MET‐minute changes ( P < 0.05). These findings mirror intervention group participants’ improvements in weight, BMI, and self‐reported weekly walking MET‐minutes (24,25). When intervention group participants experienced positive changes, they might have been more likely to share information with their close SNMs, be role models, and provide encouragement for behavior changes.…”

“…Between 2015 and 2016, 194 sedentary midlife and older women with excess weight or obesity participated as SHHC trial participants for 24 weeks in 16 medically underserved rural towns in Montana and New York. Our previous findings showed that in comparison with those in the control group, trial participants in the intervention group (SHHC) had statistically significant weight loss, BMI reduction, increased intake of fruit and vegetables combined, and increased walking metabolic equivalent (MET)-minutes per week (24,25). The study was approved by Cornell University and Bassett Healthcare Network institutional review boards.…”

Cross-sectional associations between the neighborhood built environment and physical activity in a rural setting: the Bogalusa Heart Study

“…Rural populations in the United States are recognized as a health disparity population due to the elevated prevalence of disease and early mortality, both of which are substantially higher in rural populations than among the general adult population of the United States population [ 6 ]. There is a need to improve behaviors to reduce disease risk in rural populations [ 7 ]. Behaviors that contribute to elevated health risk, including smoking, being overweight or obese, and failure to meet PA guidelines are all more prevalent among rural populations in the United States [ 8 , 9 ].…”

Strong Hearts for New York: A multilevel community-based randomized cardiovascular disease risk reduction intervention for rural women

“…SHHC was tested in a 24-week community-based randomized controlled trial with overweight, sedentary midlife and older women in sixteen rural, medically underserved communities in Montana and New York. Compared to participants in a minimal intervention control group, intervention participants improved diet, physical activity, strength, BMI/weight, C-reactive protein, and CVD risk scores [39][40][41]. Outcome and process evaluations from SHHC were used to improve the curriculum [42].…”