Promoting Physical Activity in a Low-Income Multiethnic District: Effects of a Community Intervention Study to Reduce Risk Factors for Type 2 Diabetes and Cardiovascular Disease

Abstract

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 ...

Level of physical activity, cardiorespiratory fitness and cardiovascular disease risk factors in a rural adult population in Sogn og Fjordane

“…These findings are consistent with the findings of Jenum et al (40), which show a decrease in TC and smoking habits through thirty years. There is no difference in the prevalence of daily smokers in the present study compared to Kan1.…”

Two short questionnaires on leisure-time physical activity compared with serum lipids, anthropometric measurements and aerobic power in a suburban population from Oslo, Norway

“…The "Romsås in Motion" Study is a population-based three-year pseudo-experimental community intervention programme including Romsås, a low-income, multi-ethnic population in Oslo, and a similar population in a neighbouring district, Furuset [16,17].…”

Sør-Trøndelag Aktivitets-Relaterte Tiltak (START) – Samhandling for bedre helse

“…På samme måte hadde flere av de store kardiovaskulaere populasjonsintervensjonene [8,13,30] problemer med å vise signifikante forskjeller sammenlignet med sekulaere endringer i befolkningen forøvrig, selv om de isolert sett kunne vise til fordelaktige forandringer i de kardiovaskulaere risikofaktorene. Det er likevel holdepunkter for at populasjonsbaserte intervensjoner kan ha en gunstig effekt på risikofaktorer [14,23,24]. Tabell 1 oppsummerer populasjonsbaserte intervensjonsstudier og deres effekt på risikofaktorer og sentrale folkehelseparametere.…”

“…Intervensjoner som har tatt sikte på å øke aktivitetsnivået i befolkningen har hatt vekslende hell. Selv om noen har lykkes i dette [10,24,30,32,40], har de fleste studier ikke kunnet vise til positive resultater [5,11,27,33,37,41,56,62]. Nøye planlagte forebyggingsprogrammer kan vaere et viktig tiltak for å øke aktivitetsnivået og redusere omfanget av kronisk sykdom, og McLaren et al [34] påpeker at man må identifisere de unike kontekstuelle trekkene ved målgruppen (sosiale, fysiske, økonomiske, politiske og kulturelle) for å oppnå suksess med en befolkningsintervensjon.…”