Primary care-based program helps overweight, middle-aged women increase physical activity

Getting help from the family doctor may be a better way for overweight, middle-aged women to increase their physical activity, rather than trying to go it alone, according to a trial led by researchers at the University of Pittsburgh School of Medicine and funded by the National Institutes of Health (NIH). Obesity and physical inactivity are significant risk factors for cardiovascular disease in middle-aged women.

The results, available online in the February issue of the Journal of General Internal Medicine, show that obese, middle-aged women who participated in an exercise program based at their primary care doctor’s office were more likely to continue to exercise over several months compared with those who were self-guided.

“Women who participated in programs in their doctor’s office had a structured environment allowing them to focus on their lifestyle habits like eating and exercising, and make changes,” said Molly Conroy, M.D., M.P.H., associate professor of medicine, epidemiology, and clinical and translational science at Pitt.

The Healthy Bodies Healthy Hearts investigators enrolled 99 inactive, overweight women ages 45 through 65 at three UPMC primary care offices at UPMC Montefiore, UPMC Shadyside and Magee-Womens Hospital of UPMC. The women were randomly separated into two groups: one in which they participated in 12 weekly sessions at their primary care physician’s office consisting of 30 minutes of discussion and 30 minutes of moderate-intensity exercise; and a self-guided group that received a manual for independent use.

After three months, assessments showed that the women in the interventionist-led group had significantly higher levels of physical activity, such as walking at a moderate pace, with improvements equal to about 90 minutes per week, compared to the self-guided women who improved by only about 30 minutes per week.

After a year, both groups reduced their level of activity. The self-guided participants returned to pre-intervention activity levels; however, the interventionist-led women were still more active than they had been before participation by about 60 minutes of exercise per week.

Women are less likely than men to reach recommended levels of physical activity and have unequal access to active leisure time. Studies in Australia have consistently found that women are only half as likely as men to be adequately active. A community-based multi-strategic health promotion intervention, ‘Concord, A Great Place to be Active’, was implemented from 1997 to 1999. It aimed to increase the physical activity levels of women aged 20–50 years living in the Concord Local Government Area (LGA), an inner-western region of Sydney, Australia. A key feature of this intervention was a partnership between Concord Council (the local government) and the Central Sydney Health Promotion Unit (CSHPU). The project was evaluated using qualitative and quantitative methods. Key informant interviews and focus groups were conducted to inform the development of the intervention and to assess the impact of the project on Concord Council. Pre- and post-intervention telephone surveys of the target group were also conducted. Following the intervention, there was a statistically significant (6.4%) reduction in the proportion of sedentary women. Further, there were a number of positive enhancements in the Council’s capacity to promote physical activity in the community. These findings demonstrate that a community-based intervention targeting a specific population can achieve positive changes in physical activity and that a local government has the capacity to be involved in and sustain physical activity interventions.

Primary care-based program helps overweight, middle-aged women increase physical activity “These outcomes imply that primary care-based interventions can be very beneficial to keep sedentary women motivated for several months. Many indicated their confidence was higher and that they felt more comfortable exercising with support. Follow-up sessions could help women over the long-term,” said Dr. Conroy. “Future efforts should focus on finding the best way to sustain that activity, using resources available in the primary care setting.”


Co-authors of the study include Kathleen L. Sward, Ph.D., M.P.H., of Heartchange; Kathleen Spadaro, Ph.D., of Chatham University; and Dana Tudorascu, Ph.D., Irna Karpov, M.S., Bobby L. Jones, Ph.D., Andrea M. Kriska, Ph.D., and Wishwa N. Kapoor, M.D., M.P.H., all of Pitt.

The study was sponsored by NIH National Heart, Lung and Blood Institute grant K23 HL 085405.

Lowering cancer risk with exercise

It is important to remember that there is no proven way to completely prevent cancer, but there may be steps you can take to lower your risk. Research shows that physical activity may lower the risk of the following cancers:

Colon cancer. According to the National Cancer Institute, people who exercise regularly have a 40% to 50% lower risk of colon cancer, compared with those who don’t exercise regularly. There is some evidence that suggests people who maintain active lifestyles throughout their lives have the lowest risk of colon cancer.

Breast cancer. Research shows that women who exercise at moderate-to-vigorous levels for more than three hours per week have a 30% to 40% lower risk of breast cancer. This result held true for all women, regardless of their family history or risk level of breast cancer.

Most studies show that the higher the level of activity, the lower the risk, although it is not clear whether there is a specific level of activity that must be met. Although activity throughout a person’s life is important, activity at any age may help lower breast cancer risk.

Uterine cancer. Some research has found a 38% to 46% reduced risk of this type of cancer in active women. Exercise can help lower obesity and decrease estrogen levels, both of which are factors that may be related to uterine cancer development.

Lung cancer. Studies show that people who are regularly active are less likely to develop lung cancer. However, it isn’t clear why this link exists, although one reason may be that people who exercise are less likely to use tobacco.

How physical activity can lower cancer risk

Being physically active can help you avoid the following factors that contribute to the development of cancer.

Obesity. Being obese (substantially or extremely overweight) is defined as having a body mass index (BMI; the ratio of a person’s weight and height) of 30 or higher. Obesity increases a person’s risk of developing and dying from certain types of cancer, including postmenopausal breast cancer, colorectal cancer, uterine cancer, kidney cancer, pancreatic cancer, gallbladder cancer, thyroid cancer, and esophageal cancer.  Other cancers that may be linked to obesity include prostate cancer, liver cancer, ovarian cancer, cervical cancer, multiple myeloma, and non-Hodgkin lymphoma.

Several studies have shown that regular aerobic exercise combined with a low-calorie diet can help people lose weight and keep it off. Even when a person doesn’t eat less, aerobic exercise results in small amounts of weight loss and lowers intra-abdominal fat (the dangerous fat that forms deep in the center part of the body and is linked with a higher risk of several diseases). Talk with your doctor about an exercise and eating plan that is appropriate for your medical history and goals.

About the University of Pittsburgh Schools of the Health Sciences

The University of Pittsburgh Schools of the Health Sciences include the schools of Medicine, Nursing, Dental Medicine, Pharmacy, Health and Rehabilitation Sciences and the Graduate School of Public Health. The schools serve as the academic partner to the UPMC (University of Pittsburgh Medical Center). Together, their combined mission is to train tomorrow’s health care specialists and biomedical scientists, engage in groundbreaking research that will advance understanding of the causes and treatments of disease and participate in the delivery of outstanding patient care. Since 1998, Pitt and its affiliated university faculty have ranked among the top 10 educational institutions in grant support from the National Institutes of Health.


Rick Pietzak

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University of Pittsburgh Schools of the Health Sciences

  Journal of General Internal Medicine

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