标题：The StrongWomen–Healthy Hearts Program: Reducing Cardiovascular Disease Risk Factors in Rural Sedentary, Overweight, and Obese Midlife and Older Women
摘要：Objectives. We tested a community-based intervention designed to reduce cardiovascular disease risk in sedentary midlife and older women who were overweight or obese. Methods . In a randomized controlled trial conducted in 8 counties in Arkansas and Kansas, counties were assigned to the intervention (a 12-week twice-weekly heart health program) group or to the delayed-intervention control group. Ten to fifteen women were selected from each site, and participants' weight, waist circumference, diet, physical activity, and self-efficacy were measured before and after the intervention. Data were analyzed with multiple regressions. Results . Compared with the control group, participants in the intervention group had a significant decrease in body weight (−2.1 kg; 95% confidence interval [CI] = −3.2, −1.0), waist circumference (–2.3 in; 95% CI = −4.2, −0.5), and energy intake (–390 kcal/day; 95% CI = −598, −183); an increase in activity (+1637 steps/day; 95% CI = 712, 2562); and an increase in self-efficacy for dietary and physical activity behaviors. Conclusions . Our results suggest that a community-based program can improve self-efficacy, increase physical activity, and decrease energy intake, resulting in decreased waist circumference and body weight among at-risk women. Cardiovascular disease (CVD) is the leading cause of death and disability for women in the United States, claiming approximately 500 000 women's lives each year. 1 The direct and indirect costs of CVD were estimated at more than $430 billion in 2007. 1 As the American population ages, the burden of CVD will continue to increase. 2 It is important to focus efforts on midlife and older women, because their numbers are increasing in the US population. 2 , 3 Even though CVD develops over decades and early prevention is important, lifestyle modifications can also reduce risk in older adults. 4 Yet few women are leading heart-healthy lifestyles. According to data from the 1999–2000 National Health and Nutrition Examination Survey, half of women aged 51 to 70 years fail to eat at least 5 servings of fruits and vegetables per day. 5 Nearly 40% of women aged 45 to 54 years do not engage in any leisure-time physical activity, and this rate decreases further with age. 6 , 7 Weight control is important for CVD risk reduction, 8 and nearly 70% of midlife and older women are overweight or obese. 9 One strategic prevention approach is the development and evaluation of targeted educational and behavioral programs that can be implemented widely by community organizations that reach many high-risk women. Only a few such programs exist. The Centers for Disease Control and Prevention's WISEWOMAN program focuses on cardiovascular screening for midlife, uninsured women. 10 In addition, it has a lifestyle intervention component that has shown modest improvements in behavioral and clinical outcome measures. 11 – 14 Other community-based projects targeting women and CVD have successfully increased aerobic activity 15 and decreased weight and waist circumference. 16 More community-based programs that improve heart health in midlife and older women are needed. To address this need, we developed the StrongWomen–Healthy Hearts program at Tufts University. We used an existing partnership between the StrongWomen program at Tufts and the Cooperative State Research, Education, and Extension Service (CSREES) of the US Department of Agriculture. 17 CSREES educators have in-depth knowledge of the communities they serve and run health-related programs in their counties; thus, they are well-positioned to deliver interventions related to heart health. Furthermore, CSREES provides an infrastructure for national dissemination. We examined the outcomes of the StrongWomen–Healthy Hearts intervention in Arkansas and Kansas.
