The CardioVision 2020 baseline community report card

A cross-sectional survey of the relationship between walking, biking, and the built environment for adults aged over 70 years

Purpose

Determine the relationship between walkability scores (using the Walk Score^®) and activity levels (both bicycle and walking) in adults aged between 70 and 85 years in Rochester, Minnesota.

Patients and methods

This was a self-reported cross-sectional survey in adults aged over 70 years living in Rochester, Minnesota. Analysis used t-tests or chi-square analysis as appropriate. The primary endpoint was bicycle use or walking. The predictor variables were the Walk Score^® as determined by their address, Charlson index, Duke Activity Status Index (DASI), and a 12-item short-form survey (SF-12) scores. Secondary analysis used an outcome of functional status (using the DASI) and walkability scores.

Results

Fifty-three individuals completed the surveys (48% return rate). The average age in the overall cohort was 77.02 years. Eighty-nine percent of individuals could walk at least a block and 15.1% rode their bicycles. The Walk Scores^® did not differ between those who walked (38.9 ± 27.4) and those that did not (40.0 ± 36.08; P = 0.93). In a similar fashion, the Walk Scores^® were not different for those who biked (36.38 ± 27.68) and those that did not (39.44 ± 28.49; P = 0.78). There was no relationship between Walk Scores^® and DASI; however, a decreased DASI score was associated with increased age and comorbid illness (Charlson Score).

Conclusion

In this small pilot survey, there was no difference in Walk Scores^® between those older adults who walked or biked, compared to those that did not. The Walk Scores^® were low in both groups, which may indicate the lack of accessibility for all older adults living in Rochester, Minnesota. The functional status seemed to be more related to age or comorbid conditions than the built environment.

Optimizing practice through research: a new perspective to solve an old problem

Policy makers, researchers, clinicians, and the public are frustrated that research in the health sciences has not resulted in a greater improvement in patient outcomes. Our experience as clinicians and researchers suggests that this frustration could be reduced if health sciences research were directed by 5 broad principles: (1) the needs of patients and populations determine the research agenda; (2) the research agenda addresses contextual and implementation issues, including the development of delivery and accountability systems; (3) the research agenda determines the research methods rather than methods determines the research agenda; (4) researchers and clinicians collaborate to define the research agenda, allocate resources, and implement findings; and (5) the level of funding for implementation research is commensurate with and proportional to the magnitude of the task. To keep the research agenda focused on the task of improving health and to acknowledge that the effort must be seen as more comprehensive than translating or transferring research into practice (TRIP), we suggest that the task be reframed, using the term optimizing practice through research.

Position of the American Dietetic Association: individual-, family-, school-, and community-based interventions for pediatric overweight

The American Dietetic Association (ADA), recognizing that overweight is a significant problem for children and adolescents in the United States, takes the position that pediatric overweight intervention requires a combination of family-based and school-based multi-component programs that include the promotion of physical activity, parent training/modeling, behavioral counseling, and nutrition education. Furthermore, although not yet evidence-based, community-based and environmental interventions are recommended as among the most feasible ways to support healthful lifestyles for the greatest numbers of children and their families. ADA supports the commitment of resources for programs, policy development, and research for the efficacious promotion of healthful eating habits and increased physical activity in all children and adolescents, regardless of weight status. This is the first position paper of ADA to be based on a rigorous systematic evidence-based analysis of the pediatric overweight literature on intervention programs. The research showed positive effects of two specific kinds of overweight interventions: a) multicomponent, family-based programs for children between the ages of 5 and 12 years, and b) multicomponent, school-based programs for adolescents. Multicomponent programs include behavioral counseling, promotion of physical activity, parent training/modeling, dietary counseling, and nutrition education. Analysis of the literature to date points to the need for further investigation of promising strategies not yet adequately evaluated. Furthermore, this review highlights the need for research to develop effective and innovative overweight prevention programs for various sectors of the population, including those of varying ethnicities, young children, and adolescents. To support and enhance the efficacy of family- and school-based weight interventions, community-wide interventions should be undertaken; few such interventions have been conducted and even fewer evaluated.

CardioVision 2020: program acceptance and progress after 4 years

OBJECTIVE

To report program acceptance and progress after 4 years of a heart disease prevention program.

SUBJECTS

All Olmsted County, Minnesota residents aged >/=20 years.

METHODS

The analysis is based on independent population-based interview samples from 1999, 2000, 2001, and 2003; a dietary questionnaire mailed to interviewees; and blood pressure and cholesterol data from medical records of consenting Olmsted County residents. National, Minnesota, and Olmsted County Behavioral Risk Factor Surveillance System trends for fruit and vegetable consumption, body mass index, participation in physical activity, and smoking are compared. The data were analyzed in 2005.

RESULTS

More than 90% of the population considers CardioVision 2020 to be a good, very good, or excellent idea. The program is associated with a 25% reduction in the number of people exposed to environmental tobacco smoke and small but significant increases in consumption of fruits and daily physical activity. The population meeting the serum cholesterol goal increased from 52.0% in 1999 to 57.5% in 2003, and the population meeting the blood pressure goal increased from 53.7% in 1999 to 59.9% in 2003. However, attempts to quit smoking and the amount of time spent in physical activity did not increase. By 2003, nearly 9% of the population reported making a behavior change because of CardioVision 2020. Compared to Minnesota and national trends, fruit and vegetable consumption increased significantly in Olmsted County.

CONCLUSIONS

The population of Olmsted County views CardioVision 2020 in a positive light. Positive changes in several personal behaviors and risk factor levels have occurred.

Dietary intake of fruits, vegetables, and fat in Olmsted County, Minnesota

OBJECTIVE

To assess self-reported dietary intake in the adult population of Olmsted County, Minnesota.

SUBJECTS AND METHODS

We conducted a random-digit-dial telephone survey between March 1 and April 21, 1999, of 1232 adults residing in Olmsted County, Minnesota. We then mailed a structured questionnaire to the survey respondents and achieved a response rate of 732 individuals. Percentages of individuals and predictors of those who meet recommendations for intake of fruits and vegetables and for dietary fats were determined by using chi2 tests of general association and multivariate logistic regression.

RESULTS

Only 16% of the population of Olmsted County reported meeting standard dietary recommendations for consuming both 5 or more servings of fruits and/or vegetables per day and no more than 30% of calories from fat. Fifty-one percent of the population was meeting neither recommendation. Women were more likely than men to report meeting both goals (22% vs 8%, P<.001), but still more women were meeting neither goal than were meeting both goals (40% vs 22%, P<.001). Multivariate logistic regression revealed the following factors to predict adherence to both goals: female sex, lower body mass index, nonsmoker, history of high cholesterol, and daily physical activity.

CONCLUSION

Few individuals in Olmsted County are meeting national recommendations for intake of fruits, vegetables, and dietary fat. More effective interventions are needed to improve dietary habits in all subgroups of this community.

Attempts at changing dietary and exercise habits to reduce risk of cardiovascular disease: who's doing what in the community?

The objective of this study was to characterize adults in Olmsted County, MN who were attempting to change both their dietary and physical activity habits. A random digit-dial telephone survey was taken of 1232 adults, with questions about lifestyle, medical conditions, demographics, and receipt of previous lifestyle advice from a health care professional. Respondents were grouped in four categories: 1) changing neither diet nor exercise habits (22%); 2) changing diet habits only (20%); 3) changing exercise habits only (9%); and 4) changing both diet and exercise habits (49%). Along with several demographic and behavioral factors, receipt of physician advice to change exercise and dietary habits was a strong predictor of attempts to change both lifestyle habits. Only a minority of the population (23%), however, reported having received such advice. These results support the positive impact of health professional advice on dietary and exercise change in the population. Public health campaigns should be aimed at increasing the provision of such advice.

Self-reported weight, weight goals, and weight control strategies of a midwestern population

OBJECTIVE

To elicit from individuals in a population their current weight and height, weight goals, and weight control strategies to aid in design of effective interventions to prevent and treat obesity.

SUBJECTS AND METHODS

By random digit dial telephone survey, 1224 adult residents of Olmsted County, Minnesota, were contacted between February 28 and May 5, 2000. They self-reported weights and weight goals and described physical characteristics associated with their desire to lose weight.

RESULTS

Among the 1224 respondents, 65.6% of men and 47.9% of women reported that they were overweight (body mass index [BMI], 25.0-29.9 kg/m2) or obese (BMI, > or =30.0 kg/m2). Only 0.4% of men and 3.7% of women reported that they were underweight (BMI, <18.5 kg/m2). Of the respondents 72.6% of men and 85.1% of women reported that they were either trying to lose or not gain weight. The average weight loss goal for individuals trying to lose weight was 23.4 pounds for men and 28.0 pounds for women. Only one third of individuals trying to lose weight and one fifth of individuals trying not to gain weight reported using the recommended approach of combining energy restriction with at least 150 minutes of exercise per week.

CONCLUSIONS

The prevalence of overweight and obesity in the population and the underutilization of combining both restricting energy intake and exercising at least 150 minutes per week for weight control is high. Like the majority of people in the United States, the majority of people in Olmsted County desire to control their weight. The community has responded with plans to help residents meet their goals, although efficacy and outcomes remain to be determined.