RESUMEN
BACKGROUND: Participant adoption and maintenance is a major challenge in strength training (ST) programs in the community-setting. In adults who were overweight or with type 2 diabetes (T2DM), the aim of this study was to compare the effectiveness of a standard ST program (SST) to an enhanced program (EST) on the adoption and maintenance of ST and cardio-metabolic risk factors and muscle strength. METHODS: A 12-month cluster-randomized controlled trial consisting of a 6-month adoption phase followed by a 6-month maintenance phase. In 2008-2009, men and women aged 40-75 years (n = 318) with T2DM (n = 117) or a BMI >25 (n = 201) who had not participated in ST previously were randomized into either a SST or an EST program (which included additional motivationally-tailored behavioral counselling). Adoption and maintenance were defined as undertaking ≥ 3 weekly gym-based exercise sessions during the first 6-months and from 6-12 months respectively and were assessed using a modified version of the CHAMPS (Community Healthy Activity Models Program for Seniors) instrument. RESULTS: Relative to the SST group, the adjusted odds ratio (OR) of adopting ST for all participants in the EST group was 3.3 (95 % CI 1.2 to 9.4). In stratified analyses including only those with T2DM, relative to the SST group, the adjusted OR of adopting ST in the EST group was 8.2 (95 % CI 1.5-45.5). No significant between-group differences were observed for maintenance of ST in either pooled or stratified analyses. In those with T2DM, there was a significant reduction in HbA1c in the EST compared to SST group during the adoption phase (net difference, -0.13 % [-0.26 to -0.01]), which persisted after 12-months (-0.17 % [-0.3 to -0.05]). CONCLUSIONS: A behaviorally-focused community-based EST intervention was more effective than a SST program for the adoption of ST in adults with excess weight or T2DM and led to greater improvements in glycemic control in those with T2DM. TRIAL REGISTRATION: Registered at ACTRN12611000695909 (Date registered 7/7/2011).
Asunto(s)
Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/sangre , Motivación , Fuerza Muscular , Obesidad , Evaluación de Programas y Proyectos de Salud , Entrenamiento de Fuerza , Terapia Conductista , Glucemia/metabolismo , Enfermedades Cardiovasculares/sangre , Consejo , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Sobrepeso , Características de la Residencia , Factores de RiesgoRESUMEN
Translational or implementation research that assesses the effectiveness of strategies to promote health behaviours among children that have been previously tested under 'ideal' conditions is rarely reported. Switch-2-Activity aimed to examine the effectiveness of an abbreviated programme delivered by teachers targeting children's television viewing, computer use, physical activity and potential mediators of behaviour change. Fifteen schools from disadvantaged areas in Melbourne, Australia agreed to participate in the study (43% school-level response rate). Out of the 1566 Grades 5 and 6 (9-12 year old) children invited to take part in the study, 1048 (67% response rate) provided informed consent. Schools were randomized to either an intervention or wait-list control condition. Teachers delivered six lessons, which included strategies such as self-monitoring, behavioural contracting and budgeting of screen time. Children completed a self-report survey at baseline and post-intervention examining screen-based behaviours, physical activity, self-efficacy and behavioural capability. Teachers reported implementation of and attitudes to the programme. Seventy-one per cent of teachers delivered at least four of the six lessons. Most teachers reported that the materials were easy to follow and deliver; however, many teachers reported modifying the materials in some way. Among boys, there were favourable small intervention effects on weekend screen time [(coefficient = -0.62, 95% 95% confidence interval: -1.15, -0.10, p = 0.020)]. The intervention also had significant positive effects on children's self-efficacy for reducing television viewing and on behavioural capability (television viewing styles). Future studies that assess the translation of efficacious programmes and that test whether such programmes are equally effective in different settings (e.g. in the family setting) are urgently required.
Asunto(s)
Ejercicio Físico , Conductas Relacionadas con la Salud , Promoción de la Salud/organización & administración , Investigación Biomédica Traslacional , Factores de Edad , Australia , Niño , Femenino , Humanos , Masculino , Pobreza , Autoeficacia , Factores Sexuales , Factores SocioeconómicosRESUMEN
This study aimed to examine cross-sectional associations between neighbourhood social environmental factors and physical activity (PA) among Australian primary school children. Baseline data from a large-scale trial among 957 children (48% boys) aged 9-12 years were utilised. Children self-reported their perceptions of the neighbourhood social environment including social networks (e.g. there are lots of other children around to play with), and social capital (e.g. there are lots of people in my area I could go to if I need help). Children also self-reported their weekly walking frequency and PA from which average daily moderate to vigorous PA (MVPA) was calculated. Linear regression analyses examined these associations. Boys performed 17 min/day more MVPA than girls (p<0.01), and girls performed one extra trip/week than boys (p<0.001). Children's perceptions of social capital (p<0.0001) and social networks (p<0.01) were both positively associated with MVPA and social capital was positively associated with walking frequency (p<0.05). These associations were not moderated by the child's sex. These findings suggest that children who had positive perceptions of neighbourhood social capital and social networks in the neighbourhood, tended to be more physically active. Longitudinal and experimental studies are required to further test the influence of these factors among children.
Asunto(s)
Ejercicio Físico , Medio Social , Percepción Social , Caminata , Niño , Estudios Transversales , Recolección de Datos , Femenino , Humanos , Masculino , Factores SexualesRESUMEN
Intervention studies aimed at promoting increased physical activity have been trialled in many different settings including primary care, worksites and the community. Churches are also potential settings for physical activity promotion. However, little is known about the effectiveness of this setting for promoting physical activity, particularly in Australia. The purpose of this study was to evaluate the effectiveness of a mind, body and spiritually based health promotion program in increasing physical activity and promoting mental and spiritual health. Nineteen women completed the 8-week intervention, and 30 women in a non-health related 8-week program at the same church comprised a comparison group. Pre- and post-program surveys assessed outcome measures. Between-group differences over time were examined using one-way MANOVA's. Physical activity was higher in the intervention group than the comparison group. In contrast to the comparison group, both mental health (depression symptoms) and spiritual health improved significantly more among intervention participants. The data highlight the potential for a church-based setting and holistic approach to health promotion as a successful means of increasing physical activity and promoting mental and spiritual health among Australian women.
Asunto(s)
Educación en Salud , Salud Holística , Salud Mental , Actividad Motora/fisiología , Espiritualidad , Salud de la Mujer , Adolescente , Adulto , Anciano , Demografía , Depresión , Femenino , Humanos , Persona de Mediana Edad , Factores de Tiempo , CaminataRESUMEN
BACKGROUND: Weight loss reduces blood pressure, and the Dietary Approaches to Stop Hypertension (DASH) diet has also been shown to lower blood pressure. OBJECTIVE: Our goal was to assess the effect on blood pressure of 2 weight-reduction diets: a low-fat diet (LF diet) and a moderate-sodium, high-potassium, high-calcium, low-fat DASH diet (WELL diet). DESIGN: After baseline measurements, 63 men were randomly assigned to either the WELL or the LF diet for 12 wk, and both diet groups undertook 0.5 h of moderate physical activity on most days of the week. RESULTS: Fifty-four men completed the study. Their mean (+/-SD) age was 47.9 +/- 9.3 y (WELL diet, n = 27; LF diet, n = 27), and their mean baseline home systolic and diastolic blood pressures were 129.4 +/- 11.3 and 80.6 +/- 8.6 mm Hg, respectively. Body weight decreased by 4.9 +/- 0.6 kg (+/-SEM) in the WELL group and by 4.6 +/- 0.6 kg in the LF group (P < 0.001 for both). There was a greater decrease in blood pressure in the WELL group than in the LF group [between-group difference (week 12 -baseline) in both SBP (5.5 +/- 1.9 mm Hg; P = 0.006) and DBP (4.4 +/- 1.2 mm Hg; P = 0.001)]. CONCLUSIONS: For a comparable 5-kg weight loss, a diet high in low-fat dairy products, vegetables, and fruit (the WELL diet) resulted in a greater decrease in blood pressure than did the LF diet. This dietary approach to achieving weight reduction may confer an additional benefit in reducing blood pressure in those who are overweight.
Asunto(s)
Presión Sanguínea/efectos de los fármacos , Dieta Reductora , Grasas de la Dieta/administración & dosificación , Pérdida de Peso , Adulto , Calcio de la Dieta/administración & dosificación , Calcio de la Dieta/farmacología , Grasas de la Dieta/farmacología , Humanos , Masculino , Persona de Mediana Edad , Potasio/administración & dosificación , Potasio/farmacología , Sodio en la Dieta/administración & dosificación , Sodio en la Dieta/farmacología , Pérdida de Peso/efectos de los fármacosRESUMEN
A diet rich in fruits, vegetables, and low-fat dairy foods has been shown to lower blood pressure (BP) when all foods are provided. We compared the effect on BP (measured at home) of 2 different self-selected diets: a low-sodium, high-potassium diet, rich in fruit and vegetables (LNAHK) and a high-calcium diet rich in low-fat dairy foods (HC) with a moderate-sodium, high-potassium, high-calcium DASH-type diet, high in fruits, vegetables and low-fat dairy foods (OD). Subjects were randomly allocated to 2 test diets for 4 wk, the OD and either LNAHK or HC diet, each preceded by a 2 wk control diet (CD). The changes in BP between the preceding CD period and the test diet period (LNAHK or HC) were compared with the change between the CD and the OD periods. Of the 56 men and 38 women that completed the OD period, 43 completed the LNAHK diet period and 48 the HC diet period. The mean age was 55.6 +/- 9.9 (+/-SD) years. There was a fall in systolic pressure between and the CD and OD [-1.8 +/- 0.5 mm Hg (P < 0.001)]. Compared with OD, systolic and diastolic BPs fell during the LNAHK diet period [-3.5 +/- 1.0 (P < 0.001) and -1.9 +/- 0.7 (P < 0.05) mmHg, respectively] and increased during the HC diet period [+3.1 +/- 0.9 (P < 0.01) and +0.8 +/- 0.6 (P = 0.15) mm Hg, respectively]. A self-selected low-sodium, high-potassium diet resulted in a greater fall in BP than a multifaceted OD, confirming the beneficial effect of dietary intervention on BP in a community setting.