Short-term results of community-based interventions for improving physical activity: Isfahan Healthy Heart Programme

Three Growth Spurts in Global Physical Activity Policies between 2000 and 2019: A Policy Document Analysis

Non-communicable diseases (NCDs) contribute significantly to global mortality and are of particular concern in growing urban populations of low- and-middle income countries (LMICs). Physical inactivity is a key NCD determinant and requires urgent addressing. Laudable global and regional efforts to promote physical activity are being made, but the links between physical activity (PA), NCD reduction, and integrated intersectoral approaches to reducing obesogenic environments are not consistently made. This study applied a document analysis approach to global PA and NCD policies to better understand the current global policy environment and how this may facilitate integrated PA promotion. A total of 34 global policies related to PA, from different sectors, were analyzed. PA policy in mitigation of NCDs has evolved exponentially, with a progression towards addressing structural determinants alongside individual behavior change. The global PA agenda is primarily driven by the World Health Organization. Intersectoral collaboration is importantly regarded, but the contributions of other sectors, outside of health, education, transport, and urban planning, are less clear. Improving PA among key sub-populations-women, girls, and adolescents-requires greater policy consideration. It is imperative for PA-relevant sectors at all levels to recognize the links with NCDs and work towards integrated policy and practice in mitigation of the rising NCD pandemic.

Community-Based Interventions for Cardiovascular Disease Prevention in Low-and Middle-Income Countries: A Systematic Review

Objectives: To synthesize evidence on the effectiveness of community-based interventions for cardiovascular disease (CVD) prevention in low- and middle-income countries (LMICs) to inform design of effective strategies for CVD prevention. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane register of controlled studies and PSYCINFO databases for studies published between January 2000 and June 2019. Other studies were identified from gray literature sources and review of reference lists of included studies. The primary outcomes for the review were those aimed at primary prevention of CVD targeting physical activity, diet, smoking and alcohol consumption. Results: Database searches yielded 15,885 articles and 94 articles were identified through snowball searching. After screening, the articles from LMICs were 32 emanating from 27 studies: 9 cluster randomized trials, eight randomized controlled trials and 10 controlled before and after studies. Community-based interventions successfully improved population knowledge on CVD and risk factors and influenced physical activity and dietary practices. Evidence of interventions on smoking cessation and reduced alcohol consumption was inconsistent. Conclusion: This evidence should inform policy makers in decision-making and prioritizing evidence-based interventions.

Prevalence of eczema among older persons: A population-based cross-sectional study

BACKGROUND

There are very few population-based studies on the prevalence of eczema among older persons Aims: To estimate the prevalence and types of eczema in those aged 65 years or more in the community and to evaluate the effectiveness of community-based interventions for case finding.

METHODS

In the first stage of this cross-sectional survey, trained health workers of a non-governmental organization surveyed the eligible population and identified persons likely to have eczema. In the second stage, dermatologists examined such persons to ascertain the diagnosis. Statistical analysis was done using Epi Info software version 7. Prevalence of eczema was expressed in percentages. Chi-square test was used for comparing the difference in prevalence of eczema in various age groups and sex.

RESULTS

Health workers identified 98 persons as possible cases of eczema after interviewing 385 older persons in the community. Among them 95 persons were examined by dermatologists and 44 were confirmed to have eczema (diagnostic accuracy of health workers = 46.3%).Point prevalence of eczema was 11.4% (44/385). Prevalence was similar in males and females. It was greater (18.2 %) among persons aged 81 years or more. Asteatotic eczema, gravitational eczema and lichen simplex chronicus were the more common types of eczema.

LIMITATIONS

Possible underestimation of the prevalence rates due to limited medical knowledge of health workers; limited facilities for examination and investigations at the medical camps and home visits.

CONCLUSION

There appears to be a considerable burden of eczema among older persons in the community. A community-based approach involving non-governmental organizations has the potential to identify cases and offer care close to their homes.

Mental health benefits from lifestyle physical activity interventions: A systematic review

Lifestyle physical activity (LPA) interventions are a promising alternative to structured exercise interventions for addressing mental health problems. The authors conducted a systematic review of the literature on LPA interventions in any population in order to determine (a) the extent to which mental health outcomes were examined and (b) whether benefits in mental health outcomes were observed. Mental health outcomes were defined as depression, anxiety, perceived stress, health-related quality of life, and psychological well-being. A total of 73 articles were identified as LPA intervention, of which 24.7% (n = 18) reported the effect of LPA intervention on mental health outcomes. The most commonly evaluated mental health outcome was depression, and to a lesser extent anxiety and perceived stress. Overall, findings point to promising effects of LPA interventions across common mental health problems. Key areas for future research are discussed in light of emergent limitations in existing published studies.

Prevalence and correlates of low physical activity in the Iranian population: National survey on non-communicable diseases in 2011

To assess the prevalence and correlates of low physical activity among Iranian population aged 15-64 years. We used the data collected in National Surveillance of Risk Factors of Non-Communicable Diseases in Iran, 2011. Physical activity was categorized in 3 levels of low, moderate, and high based on a Persian version of Global Physical Activity Questionnaire. The multistage cluster sampling design was accounted for using complex survey analysis method. The sample included 10016 individuals; 41.7% (n = 4178) were men and 58.3% (n = 5837) were women. The mean (SD) age of participants was 38.8 (14.9) years also, and 69.8% (n = 6991) of the participants were from urban areas. The prevalence of low physical activity in the whole population was estimated to be 44.8% (95% CI: 41.7, 48.1). The odds of lower physical activity in the women were 3 times greater than men (OR = 3.14; 95% CI: 2.64, 3.57); in the wealthiest people was 25% lower than the poorest people (OR = 0.75; 95% CI: 0.60, 0.94). The odds of lower physical activity in the age groups 55-64 years were 44% greater than the youngest age groups 15-24 years (OR = 1.44; 95% CI: 1.23, 1.68). The odds of lower physical activity in the obese participants were 18% greater than normal-weight people (OR = 1.18; 95% CI: 1.01, 1.38).). The odds of lower physical activity in diabetic patients were 30% greater than healthy people (OR: 1.30; 95% CI: 1.07, 1.57). The prevalence of low physical activity in Iran, 2011 was high. The correlates of low physical activity in Iran are different to those of Western populations. The main associated factors with low physical activity were female gender, urban area, low socioeconomic status, obesity, diabetes, and older age. Public health policies should target the groups at highest risk of low physical activity.

Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study

BACKGROUND

Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD) and respiratory diseases (ResD) (CAPACITY) to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran.

METHODS

Hourly levels of air pollutants including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE), Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study.

RESULTS

The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar.

CONCLUSION

The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups.

Progress in physical activity over the Olympic quadrennium

On the eve of the 2012 summer Olympic Games, the first Lancet Series on physical activity established that physical inactivity was a global pandemic, and global public health action was urgently needed. The present paper summarises progress on the topics covered in the first Series. In the past 4 years, more countries have been monitoring the prevalence of physical inactivity, although evidence of any improvements in prevalence is still scarce. According to emerging evidence on brain health, physical inactivity accounts for about 3·8% of cases of dementia worldwide. An increase in research on the correlates of physical activity in low-income and middle-income countries (LMICs) is providing a better evidence base for development of context-relevant interventions. A finding specific to LMICs was that physical inactivity was higher in urban (vs rural) residents, which is a cause for concern because of the global trends toward urbanisation. A small but increasing number of intervention studies from LMICs provide initial evidence that community-based interventions can be effective. Although about 80% of countries reported having national physical activity policies or plans, such policies were operational in only about 56% of countries. There are important barriers to policy implementation that must be overcome before progress in increasing physical activity can be expected. Despite signs of progress, efforts to improve physical activity surveillance, research, capacity for intervention, and policy implementation are needed, especially among LMICs.

Multiple Risk Factor Interventions for Primary Prevention of CVD in LMIC: A Cochrane Review

This study sought to determine the effectiveness of multiple risk factor interventions aimed at modifying major cardiovascular risk factors for the primary prevention of cardiovascular disease in low- and middle-income countries (LMIC). We searched electronic databases for randomized controlled trials of health promotion interventions to achieve behavior change. The pooled effect indicated a reduction in systolic blood pressure (-6.72 mm Hg; 95% confidence interval [CI]: -9.82 to -3.61; I² = 91%), diastolic blood pressure (-4.40 mm Hg; 95% CI: -6.47 to -2.34; I² = 92%), body mass index (-0.76 kg/m²; 95% CI: -1.29 to -0.22; I² = 80%), and waist circumference (-3.31 cm; 95% CI: -4.77 to -1.86; I² = 55%) in favor of multiple risk factor interventions. There is some evidence that multiple risk factor interventions may lower blood pressure levels and anthropometrics in populations in LMIC settings at high risk of hypertension and diabetes.

Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries

BACKGROUND

In many low- and middle-income countries (LMICs) morbidity and mortality associated with cardiovascular diseases (CVDs) have grown exponentially over recent years. It is estimated that about 80% of CVD deaths occur in LMICs. People in LMICs are more exposed to cardiovascular risk factors such as tobacco, and often do not have access to effective and equitable healthcare services (including early detection services). Evidence from high-income countries indicates that multiple risk factor intervention programmes do not result in reductions in CVD events. Given the increasing incidence of CVDs and lower CVD health awareness in LMICs it is possible that such programmes may have beneficial effects.

OBJECTIVES

To determine the effectiveness of multiple risk factor interventions (with or without pharmacological treatment) aimed at modifying major cardiovascular risk factors for the primary prevention of CVD in LMICs.

SEARCH METHODS

We searched (from inception to 27 June 2014) the Cochrane Library (CENTRAL, HTA, DARE, EED), MEDLINE, EMBASE, Global Health and three other databases on 27 June 2014. We also searched two clinical trial registers and conducted reference checking to identify additional studies. We applied no language limits.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of health promotion interventions to achieve behaviour change (i.e. smoking cessation, dietary advice, increasing activity levels) with or without pharmacological treatments, which aim to alter more than one cardiovascular risk factor (i.e. diet, reduce blood pressure, smoking, total blood cholesterol or increase physical activity) of at least six months duration of follow-up conducted in LMICs.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial eligibility and risk of bias, and extracted data. We combined dichotomous data using risk ratios (RRs) and continuous data using mean differences (MDs), and presented all results with a 95% confidence interval (CI). The primary outcome was combined fatal and non-fatal cardiovascular disease events.

MAIN RESULTS

Thirteen trials met the inclusion criteria and are included in the review. All studies had at least one domain with unclear risk of bias. Some studies were at high risk of bias for random sequence generation (two trials), allocation concealment (two trials), blinding of outcome assessors (one trial) and incomplete outcome data (one trial). Duration and content of multiple risk factor interventions varied across the trials. Two trials recruited healthy participants and the other 11 trials recruited people with varying risks of CVD, such as participants with known hypertension and type 2 diabetes. Only one study reported CVD outcomes and multiple risk factor interventions did not reduce the incidence of cardiovascular events (RR 0.57, 95% CI 0.11 to 3.07, 232 participants, low-quality evidence); the result is imprecise (a wide confidence interval and small sample size) and makes it difficult to draw a reliable conclusion. None of the included trials reported all-cause mortality. The pooled effect indicated a reduction in systolic blood pressure (MD -6.72 mmHg, 95% CI -9.82 to -3.61, I² = 91%, 4868 participants, low-quality evidence), diastolic blood pressure (MD -4.40 mmHg, 95% CI -6.47 to -2.34, I² = 92%, 4701 participants, low-quality evidence), body mass index (MD -0.76 kg/m², 95% CI -1.29 to -0.22, I² = 80%, 2984 participants, low-quality evidence) and waist circumference (MD -3.31, 95% CI -4.77 to -1.86, I² = 55%, 393 participants, moderate-quality evidence) in favour of multiple risk factor interventions, but there was substantial heterogeneity. There was insufficient evidence to determine the effect of these interventions on consumption of fruit or vegetables, smoking cessation, glycated haemoglobin, fasting blood sugar, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and total cholesterol. None of the included trials reported on adverse events.

AUTHORS' CONCLUSIONS

Due to the limited evidence currently available, we can draw no conclusions as to the effectiveness of multiple risk factor interventions on combined CVD events and mortality. There is some evidence that multiple risk factor interventions may lower blood pressure levels, body mass index and waist circumference in populations in LMIC settings at high risk of hypertension and diabetes. There was considerable heterogeneity between the trials, the trials were small, and at some risk of bias. Larger studies with longer follow-up periods are required to confirm whether multiple risk factor interventions lead to reduced CVD events and mortality in LMIC settings.

A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project)

BACKGROUND

This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.

METHODS

Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.

RESULTS

Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.

CONCLUSIONS

Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.

The sustainability of interventions of a community-based trial on children and adolescents' healthy lifestyle

BACKGROUND

Sustainability is the core of a successful health-related intervention program. This study was conducted to evaluate the sustainability of interventions of the Heart Health Promotion from Childhood (HHPC) project, one of the 10 interventional projects of the Isfahan Healthy Heart Program.

METHODS

The evaluation of HHPC included administrating surveys to 500 elementary and middle, and 500 high school students. The study participants were randomly selected from all schools in Isfahan. The questionnaires were administered by interviews to evaluate the sustainability of interventions.

RESULTS

The results of interviews showed that interventions were sustainable in 100% of elementary school, 99% of middle school, and 87% of high school students. Training of healthy lifestyle behaviors was significantly higher in all-girls middle schools (P < 0.001). Daily morning exercise was more frequent in girls high schools (P < 0.001), while selling unhealthy food was more frequent in boys high schools (P < 0.001). The participants attributed the success of the program mostly to students' agreement and cooperation.

CONCLUSION

Even though 5 years have passed since the end of the HHPC project, many of the interventions have been continued at the schools, often because healthy behaviors have become institutionalized in the target population. However, now all schools have the same level of sustainability, especially the middle and high schools, and all-boys schools. Therefore, it is important for future projects to place additional emphasis on these institutions for future school-based interventions.

Determinants of uncontrolled hypertension in an Iranian population

BACKGROUND

Uncontrolled hypertension, a major concern among hypertensive patients, may be caused by various factors such as inadequate knowledge and inappropriate attitude, unhealthy lifestyle, and ineffective treatment. The present study tried to cast light on factors leading to uncontrolled hypertension.

METHODS

In this cross-sectional study, all hypertensive participants of the third phase of the Isfahan Healthy Heart Program were contacted and invited to take part in the study. A questionnaire including knowledge of and attitude toward hypertension and its control and treatment methods, and practice about lifestyle and pharmacological treatment was completed for all patients who consented to participate. The participants' anthropometric indices and blood pressure were then measured. Chi-square and Student's t-tests were used to compare the groups with controlled and uncontrolled blood pressure. The effect of each factor on uncontrolled blood pressure was assessed by employing stepwise logistic regression.

RESULTS

Of 114 participants, 43 (37.12%) and 71 (62.28%) individuals had controlled and uncontrolled blood pressure, respectively. Stepwise logistic regression revealed body mass index > 25 kg/m2 to have the greatest effects on uncontrolled blood pressure [Odds ratio (OR) = 13.091, Confidence interval of 95% (95% CI): 1.437-116.352, P = 0.021). In addition, male gender increased the risk for uncontrolled blood pressure (OR = 8.475, CI95%: 1.276-56.313, P = 0.027), while inappropriate attitude decreased the mentioned risk (OR = 0.047, CI95%: 0.007-0.318, P = 0.002).

CONCLUSION

According to our findings, obesity is the most important cause of uncontrolled blood pressure. Therefore, weight has to be closely monitored and controlled in hypertensive patients.

Physical activity, sex, and socioeconomic status: A population based study

BACKGROUND

The purpose of the present study was to investigate physical activity by socioeconomic status (SES) and sex in an Iranian adult population.

METHODS

In a cross-sectional study, 6622 adults, who participated in the Isfahan Healthy Heart program (IHHP) surveys in 2004 and 2005 and were living in urban areas, were studied. Daily leisure time, household, occupational, and transportation physical activity, and total physical activity were calculated and compared in 3 socioeconomic status groups classified by the two-step cluster analysis procedure.

RESULTS

Statistically significant variations were found in all physical activity levels, except transportation, by sex. Men were more active than women in all fields, except household physical activity. Leisure time physical activity of men and women were significantly higher in higher SES levels. There was an opposite correlation between SES and total physical activity in men.

CONCLUSION

Considering the importance of physical activity as a component of a healthy lifestyle, differences among varying socioeconomic status and sex must be considered while planning for healthy lifestyle programs. Women with low SES, in particular, may need more attention.

The impact of a community trial on the pharmacological treatment in the individuals with the metabolic syndrome: findings from the Isfahan Healthy Heart Program, 2001-2007

INTRODUCTION

Pharmacological therapy is a crucial step in the management of individuals with the metabolic syndrome, when lifestyle modifications alone cannot achieve the therapeutic goals. The present study aimed to evaluate the efficacy of comprehensive interventions with the pharmacological treatment in individuals with the metabolic syndrome.

MATERIAL AND METHODS

A cross-sectional population-based survey examined a sample of adults before and after conducting a community trial. Physical examination and blood sampling, data regarding the demographic characteristics, medical status and history of medication use were obtained. Pharmacologic treatment related to metabolic syndrome's components was also determined.

RESULTS

The most common pharmacologic agents consumed by individuals with metabolic syndrome were β-blockers (26.1% and 30.4% in 2001 and 2007, respectively), followed by lipid-lowering agents (5.4% and 14% in 2001 and 2007, respectively), with significant differences before and after intervention. The prevalence of metabolic syndrome was higher in women than in men both before (36.4% vs. 14%) and after the community trial (26.1% vs. 16%, respectively) in the intervention areas (p < 0.001).

CONCLUSIONS

We found a significant increase in medication use to control blood pressure and dyslipidemia among the individuals with the metabolic syndrome, notably in the intervention areas. In addition to the population approach, the high-risk approach should be considered in community trials for prevention and control of non-communicable diseases.

Lipids, blood pressure, kidney - what was new in 2011?

The year 2011 was very interesting regarding new studies, trials and guidelines in the field of lipidology, hypertensiology and nephrology. Suffice it to mention the new European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias, American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines on hypertension in the elderly, and many important trials presented among others during the American Society of Nephrology (ASN) Annual Congress in Philadelphia and the AHA Annual Congress in Orlando. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year.