Promoting Physical Activity in a Low-Income Multiethnic District: Effects of a Community Intervention Study to Reduce Risk Factors for Type 2 Diabetes and Cardiovascular Disease: A community intervention reducing inactivity

Anne Karen Jenum; Sigmund A. Anderssen; Kåre I. Birkeland; Ingar Holme; Sidsel Graff-Iversen; Catherine Lorentzen; Yngvar Ommundsen; Truls Raastad; Ann Kristin Ødegaard; Roald Bahr

doi:10.2337/dc05-1587

Cardiovascular and Metabolic Risk

Promoting Physical Activity in a Low-Income Multiethnic District: Effects of a Community Intervention Study to Reduce Risk Factors for Type 2 Diabetes and Cardiovascular Disease

A community intervention reducing inactivity

Anne Karen Jenum, MD, MPH, PHD1 2,
Sigmund A. Anderssen, PHD3,
Kåre I. Birkeland, MD, PHD1,
Ingar Holme, PHD3,
Sidsel Graff-Iversen, MD, PHD2,
Catherine Lorentzen, MSC4,
Yngvar Ommundsen, PHD4,
Truls Raastad, PHD5,
Ann Kristin Ødegaard, BSC6 and
Roald Bahr, MD, PHD3

¹Diabetes Research Centre, Aker University Hospital, University of Oslo, Oslo, Norway
²Department of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
³Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
⁴Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
⁵Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
⁶City of Oslo, Grorud District, Oslo, Norway

Address correspondence and reprint requests to Anne Karen Jenum, MD, MPh, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, NO-0403 Oslo, Norway. E-mail: anne.karen.jenum{at}fhi.no

Diabetes Care 2006 Jul; 29(7): 1605-1612. https://doi.org/10.2337/dc05-1587

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Figure 1—
Flow chart of participants from baseline to follow-up, showing invited cohort, nonattendees, and study participants.
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Figure 2—
Change in physical activity from baseline to follow-up, showing the intervention versus control district by two ordinal measures. Net differences between districts in change were tested by Mann-Whitney: the heavy physical activity measure (no activity or hours per week, P = 0.008) and stages 1–5 of the change variable (1–2: inactive; 3: active, but not regularly; 4: regularly active, but only recently; 5: regularly active for >6 months, P = 0.024).
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Figure 3—
Net proportion with increase in body mass by districts (A) and net change (difference between changes in the intervention and control district) overall and in subgroups, in cholesterol–to–HDL cholesterol ratio (B), triglycerides (C), and glucose (D). Changes in body mass were assessed in categories gain (>2 kg), stable, or loss (>2 kg), and the proportion with reduction was subtracted from the proportion with increase. The net difference between districts in this ordinal change variable was tested by Mann-Whitney. *P < 0.01. The nonfasting blood samples were adjusted for time since last meal both at baseline and follow-up (ANOVA) and net change by multiple regression analyses. Net changes with 95% CIs are given.

Tables

Figures

Table 1—

Baseline characteristics of the cohort study attendees compared with those reinvited but not attending the follow-up by district

Characteristics	Attending follow-up					Not attending follow-up
Characteristics		Intervention district	Control district	P value (χ²/t test)	Intervention district	Control district	P value (χ²/t test)	Net difference (95% CI)
Background variables
n	890	876		447	431
Age (years)	49.0 ± 10.0	48.9 ± 9.0	0.72	44.6 ± 9.9	46.8 ± 9.7	0.001	2.4 (0.8–3.9)
Women	507 (57.0)	473 (54.0)	0.21	256 (56.6)	249 (57.2)	0.86	3.6 (−4.4 to 11.6)
Non-Western immigrants	147 (16.5)	172 (19.6)	0.09	138 (30.5)	126 (29.0)	0.61	−4.6 (−11.6 to 2.4)
Years of education	11.6 ± 3.9	12.5 ± 3.8	<0.001	11.2 ± 3.7	11.5 ± 3.7	0.39	−0.7 (−1.3 to 0.0)
Full-time work	527 (60.2)	619 (72.7)	<0.001	276 (61.7)	255 (60.7)	0.76	−13.5 (−21.4 to −5.7)
Disability pension*	156 (19.9)	87 (11.5)	<0.001	67 (17.4)	64 (18.8)	0.62	9.8 (3.1–16.5)
Antropometry variables
BMI (kg/m²)	27.1 ± 4.6	26.5 ± 4.3	0.003	27.1 ± 5.2	26.9 ± 4.8	0.52	0.4 (−0.4 to 1.2)
Obesity (BMI >30 kg/m²)	206 (23.2)	150 (17.1)	0.002	114 (25.4)	91 (21.3)	0.15	2.0 (−4.7 to 8.7)
Daily smoking	315 (35.6)	264 (30.6)	0.03	202 (45.4)	173 (40.5)	0.15	0.1 (−7.8 to 8.0)
Physically inactive
No heavy physical activity in leisure time or commuting†	362 (41.9)	282 (37.9)	0.10	200 (45.9)	181 (51.4)	0.12	9.5 (1.0–18.0)
Stages of change‡§	282 (37.3)	224 (30.7)	0.007	125 (37.5)	123 (41.8)	0.26	10.9 (1.9–20.0)
Disease prevalence
Self-reported diabetes	40 (4.6)	24 (2.8)	0.05	21 (4.7)	22 (5.2)	0.75	2.3 (−1.1 to 5.7)
All diabetes	71 (8.0)	45 (5.2)	0.02	28 (6.2)	37 (8.6)	0.18	5.2 (1.0–9.4)

Data are n (%) or means ± SD, as appropriate. The net difference between districts with respect to selection is the difference between nonattendees and attendees in the control district versus the intervention district.
*
↵* Disability pension: n = 783/386 and 759/341 for attendees versus nonattendees in intervention and control district, respectively.
†
↵† Heavy physical activity, n = 863/436 and 744/352 in intervention and control district, respectively.
‡
↵‡ Stages of change: n = 755/334 and 730/294 in intervention and control district, respectively. All other numbers are identical with or close to the n reported at the top of each column.
§
↵§ Sum of precontemplative and contemplative stages.

Table 2—

Biological variables at baseline and net change between districts from baseline to follow-up

	Baseline values*					Change during 3 years
		Intervention district (n = 890)	Control district (n = 876)	Group difference P value	Net change intervention versus control district	P value
Resting heart rate (beats/min)
Men	73.9 ± 12.9	71.3 ± 12.1	0.003	−1.70 (−3.31 to −0.10)	0.038
Women	76.6 ± 11.4	74.9 ± 11.4	0.02	−0.27 (−1.51 to 0.98)	0.68
Body mass (kg)†
Men	86.1 ± 15.6	84.8 ± 14.6	0.22	−1.24 (−1.88 to −0.60)	<0.001
aged <50 years	84.8 ± 15.8	82.9 ± 15.3	0.26	−1.11 (−2.01 to −0.21)	0.02
aged >50 years	87.2 ± 15.3	86.5 ± 13.7	0.61	−1.30 (−2.21 to −0.39)	0.005
Women	72.3 ± 13.5	70.0 ± 12.8	0.006	−0.25 (−0.86 to 0.35)	0.41
aged <50 years	71.3 ± 14.0	69.3 ± 13.4	0.11	0.36 (−0.49 to 1.22)	0.41
aged >50 years	73.3 ± 13.0	70.8 ± 11.9	0.03	−0.73 (−1.57 to 0.12)	0.09
BMI (kg/m²)
Men	27.5 ± 4.3	27.0 ± 3.9	0.07	−0.42 (−0.63 to −0.21)	<0.001
Women	26.8 ± 4.8	26.0 ± 4.6	0.01	−0.06 (−0.29 to 0.17)	0.61
Systolic blood pressure (mmHg)†
Men	134.5 ± 17.2	129.4 ± 17.2	<0.001	−3.79 (−5.74 to −1.84)	<0.001
aged <50 years	129.0 ± 13.3	126.8 ± 16.0	0.15	0.22 (−2.27 to 2.70)	0.86
aged >50 years	138.7 ± 18.7	131.7 ± 18.0	<0.001	−7.13 (−10.01 to −4.24)	<0.001
Women	127.3 ± 16.5	119.5 ± 17.7	<0.001	−3.52 (−5.17 to −1.86)	<0.001
aged <50 years	120.8 ± 13.1	114.9 ± 16.6	<0.001	−2.49 (−4.55 to −0.42)	0.02
aged >50 years	133.0 ± 17.1	124.8 ± 17.4	<0.001	−4.45 (−7.06 to −1.85)	0.001
Cholesterol (mmol/l)‡
Men	5.8 ± 1.0	5.8 ± 1.0	0.96	−0.10 (−0.23 to 0.02)	0.11
Women	5.6 ± 1.1	5.6 ± 1.0	0.59	−0.03 (−0.14 to 0.07)	0.53
HDL cholesterol (mmol/l)‡
Men	1.26 ± 0.33	1.30 ± 0.35	0.08	0.024 (−0.005 to 0.053)	0.10
Women	1.54 ± 0.39	1.54 ± 0.40	0.86	0.009 (−0.022 to 0.040)	0.56
Cholesterol-to-HDL cholesterol ratio‡
Men	4.86 ± 1.41	4.73 ± 1.41	0.17	−0.21 (−0.36 to −0.06)	0.006
Women	3.86 ± 1.09	3.87 ± 1.16	0.85	−0.05 (−0.15 to 0.05)	0.30
Triglycerides (mmol/l)‡
Men	2.4 ± 1.5	2.1 ± 1.2	0.005	−0.22 (−0.40 to −0.05)	0.01
Women	1.7 ± 1.1	1.6 ± 1.0	0.04	−0.11 (−0.22 to 0.00)	0.046
Glucose (mmol/l)‡
Men	6.0 ± 2.9	5.7 ± 1.9	0.12	−0.35 (−0.67 to −0.03)	0.03
Women	5.4 ± 1.4	5.4 ± 1.5	0.47	−0.02 (−0.18 to 0.14)	0.82

Data are means ± SD or means (95% CI).
*
↵* All numbers are identical with or close to the n reported at the top of each column.
†
↵† Reported also by age due to interaction.
‡
↵‡ Serum levels of lipids and glucose are adjusted for time since last meal both at baseline and follow-up.