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.