Q&A: CVD risk reduction intervention helps rural women improve diet-related behaviors
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Key takeaways:
- Strong Hearts Healthy Communities 2.0 led to sustainable positive behavior change linked to improved cardiovascular health.
- The behavior change included consuming fewer calories and healthy eating attitudes.
An intervention consisting of experiential nutrition education and group-based physical activity classes led by local health educators created sustainable positive behavior change, according to an expert.
The prevalence of CVD has risen disproportionately among midlife and older women in rural communities, Rebecca A. Seguin-Fowler, PhD, RDN, LD, CSCS, codirector of the Texas A&M Institute for Advancing Health Through Agriculture, and colleagues wrote in the American Journal of Clinical Nutrition. This is partially due to psychosocial factors that impede healthy eating and poor diet or diet-related behaviors.
The researchers conducted a community-randomized controlled trial in rural, medically underserved communities to evaluate the impact that the intervention Strong Hearts Healthy Communities 2.0 might have on CVD risk in this population. They ultimately found that the intervention “has strong potential to improve diet patterns and diet-related psychosocial well-being consistent with improved cardiovascular health.”
Healio spoke with Seguin-Fowler, who is also a professor of nutrition and founder of the StrongPeople program, to learn more about the study and what primary care physicians should know about their findings.
Healio: Why did you decide to research this subject?
Seguin-Fowler: This current research builds upon a foundation of nearly 3 decades of research focusing on improving the health of midlife and older women. That very early research showed that strength training could help midlife and older women gain bone mass, muscular strength and muscle mass, which was innovative and new knowledge at that time. Studies later expanded to include men and to examine a range of outcomes including arthritis, diabetes, functional fitness and many others.
In the early 2000s, we translated these findings into a book, Growing Stronger: Strength Training for Older Adults, in partnership with colleagues at the CDC. Thereafter, we created a community-based strength training program with a training workshop and toolkit (now called StrongPeople Strong Bodies) with Cooperative Extension partners in Kansas and Alaska. That program has been disseminated via the national extension network to nearly every state in the U.S. as well as Canada, Mexico and Australia. Because of the enormous dissemination and implementation success of StrongPeople Strong Bodies, combined with input from our community-based extension partners as well as civic engagement, we went on to develop and test an aerobic exercise and nutrition program (now called StrongPeople Living Well), and a civic engagement program that guides residents through a step-wise approach to help make their community-level food and physical activity environments healthier (StrongPeople Change Club).
Strong Hearts Healthy Communities was the natural outgrowth of those initial three initiatives because it combined key aspects of each: experiential classes with strength training, aerobic exercise, nutrition skill-building and civic engagement. That program’s effectiveness has now been established through two community-based randomized trials with approximately 400 participants across more than 20 locations.
The second trial, which was refined with feedback from participants and program leaders in the first trial, is known as Strong Hearts Healthy Communities [version] 2.0 to differentiate the study findings from the first trial’s results.
Healio: What was the intervention?
Seguin-Fowler: A community-randomized controlled trial was conducted in rural, medically underserved communities. Five communities were randomly assigned to the intervention and six were randomly assigned to the control condition, which was a delayed intervention. Participants were women aged 40 years or older who either had obesity or were sedentary and overweight. Participants attended 24 weeks of twice-weekly experiential nutrition education and group-based physical activity classes led by local health educators. We measured a large range of health outcomes and behaviors; this article focuses on diet and diet-related psychosocial measures.
At the end of the program (24 weeks), intervention participants compared with control participants consumed fewer calories, improved their overall eating patterns and improved psychosocial measures, which included healthy eating attitudes, uncontrolled eating, cognitive restraint and emotional eating.
Healio: What is the importance and clinical implications of your findings?
Seguin-Fowler: Achieving positive behavior change and related health outcomes is absolutely attainable and feasible among at-risk midlife and older women using the now-named StrongPeople Strong Hearts curriculum with implementation by local health educators. Other related, published research also shows that even after the program ended, women maintained their positive health effects and even improved further in areas such as blood pressure and hemoglobin A1c. StrongPeople Strong Hearts could be done by an individual or in a group setting, which is how it was evaluated in these studies; we believe the social setting offered through the group environment helps individuals build cohesion and support.
Healio: What is the take-home message for PCPs?
Seguin-Fowler: A large majority of U.S. adults have at least one risk factor for chronic disease. PCPs and other health care practitioners can be encouraged by these findings and support implementation of and attendance at evidence-based programs like StrongPeople Strong Hearts within an outpatient program offerings. Key to this message is that participants not only achieve initial positive health outcomes and behavior change, but sustainable and clinically meaningful change. This means those patients are more likely to live healthier lives and live independently longer. Additional published research and a new forthcoming publication also demonstrate the cost effectiveness of the StrongPeople Strong Hearts program.
Healio: Is there anything else you would like to add?
Seguin-Fowler: We welcome connections with new organization partners, both for new research projects, as well as for training and program dissemination opportunities. It is critical that we support implementation and dissemination of evidence-based programs such as StrongPeople Strong Hearts (which was renamed to align with the others within the suite of programs). These are self-sustaining programs that can be implemented in virtually any location with a large space and very basic equipment and led by a variety of allied health professionals or community health educators.