University of North Carolina at Chapel Hill

Part 1: Statement of NeedHypertension is the number one attributable risk factor for mortality worldwide.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/HJH.0b013e3283544669", "ISSN" : "0263-6352", "author" : [ { "dropping-particle" : "", "family" : "Rossi", "given" : "Amanda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dikareva", "given" : "Anastasia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bacon", "given" : "Simon L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daskalopoulou", "given" : "Stella S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Hypertension", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1277-1288", "title" : "The impact of physical activity on mortality in patients with high blood pressure", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 Globally, the statistics show that hypertension effects more than a quarter of the world’s population, which is roughly 1 billion people, and is estimated to be responsible for 6% of all deaths.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/14651858.CD008822", "author" : [ { "dropping-particle" : "", "family" : "Chandrasekaran", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arumugam", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kumaran, D S Chandrasharma, B Khundrakpam", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chanam", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Philipraj", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sanathombi Devi", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cochrane Database of Systematic Reviews", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "title" : "Resistance exercise training for hypertension (Protocol)", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1161/CIR.0000000000000152", "ISBN" : "0000000000000", "ISSN" : "0009-7322", "author" : [ { "dropping-particle" : "", "family" : "Mozaffarian", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benjamin", "given" : "E. 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J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Howard", "given" : "V. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Huffman", "given" : "M. D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Judd", "given" : "S. E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kissela", "given" : "B. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lackland", "given" : "D. T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lichtman", "given" : "J. H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lisabeth", "given" : "L. D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mackey", "given" : "R. H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matchar", "given" : "D. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McGuire", "given" : "D. K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mohler", "given" : "E. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moy", "given" : "C. S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Muntner", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mussolino", "given" : "M. E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nasir", "given" : "K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Neumar", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Nichol", "given" : "G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Palaniappan", "given" : "L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pandey", "given" : "D. K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reeves", "given" : "M. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodriguez", "given" : "C. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "P. D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stein", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Towfighi", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turan", "given" : "T. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Virani", "given" : "S. S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Willey", "given" : "J. Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Woo", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yeh", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turner", "given" : "M. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2015" ] ] }, "number-of-pages" : "e29-e322", "title" : "Heart Disease and Stroke Statistics--2015 Update: A Report From the American Heart Association", "type" : "book", "volume" : "131" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "2,3", "plainTextFormattedCitation" : "2,3", "previouslyFormattedCitation" : "2,3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2,3 According to data from 2009-2012, nearly one third of adults over the age of 19 in the U.S. are hypertensive.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIR.0000000000000152", "ISBN" : "0000000000000", "ISSN" : "0009-7322", "author" : [ { "dropping-particle" : "", "family" : "Mozaffarian", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benjamin", "given" : "E. 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D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mackey", "given" : "R. H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Matchar", "given" : "D. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McGuire", "given" : "D. K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Mohler", "given" : "E. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moy", "given" : "C. 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K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reeves", "given" : "M. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodriguez", "given" : "C. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "P. D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stein", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Towfighi", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turan", "given" : "T. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Virani", "given" : "S. S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Willey", "given" : "J. Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Woo", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yeh", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turner", "given" : "M. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2015" ] ] }, "number-of-pages" : "e29-e322", "title" : "Heart Disease and Stroke Statistics--2015 Update: A Report From the American Heart Association", "type" : "book", "volume" : "131" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3 Inactivity has surpassed smoking as the greatest risk factor leading to hypertension.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0140-6736(12)60954-4", "ISBN" : "01406736 (ISSN)", "ISSN" : "01406736", "PMID" : "22818933", "abstract" : "Exercise has been called a miracle drug1 that can benefit every part of the body2 and substantially extend lifespan.3 Yet it receives little respect from doctors or society.4 Socially, being inactive is perceived as normal, and in fact doctors order patients to remain on bed rest far more often than they encourage exercise.5 This passive attitude towards inactivity, where exercise is viewed as a personal choice, is anachronistic, and is reminiscent of the battles still being fought over smoking.\\nPhysical inactivity burdens society through the hidden and growing cost of medical care and loss of productivity. Getting the public to exercise is a public health priority because inactive people are contributing to a mortality burden as large as tobacco smoking. To individuals, the failure to spend 15\u201430 min a day in brisk walking increases the risk of cancer, heart disease, stroke, and diabetes by 20\u201430%,3, 5 and shortens lifespan by 3\u20145 years.3 Although the benefits of exercise and the harms of inactivity might seem like two sides of a coin, the benefits message emphasised so far has not worked well for most of the population. In tobacco control, doctors did not emphasise the benefits of non-smoking, but the harms of smoking. Similarly, armed with credible global and national data, we should emphasise the harms of inactivity and not merely the benefits of exercise.\\nSmoking and physical inactivity are the two major risk factors for non-communicable diseases around the globe. Of the 36 million deaths each year from non-communicable diseases,6 physical inactivity5 and smoking each contribute about 5 million.7 Physical inactivity and smoking have similar population attributable risks, although their relative risks8, 9 and prevalence are somewhat different (figure). For smoking, intensive and coordinated tobacco control efforts have been organised through WHO's Framework Convention on Tobacco Control (FCTC), a treaty already ratified by 175 countries.10 By contrast, we have few organised efforts to combat physical inactivity. Governmental programmes to move people from sedentary living to meeting recommended levels of exercise are very limited, in both developed and developing countries. Where available, these programmes are viewed as useful but not as essential as, say, anti-smoking programmes, partly owing to a failure to emphasise the colossal harms of inactivity. Furthermore, treatment of physical inactivity is not a reimbursable item under most health insu\u2026", "author" : [ { "dropping-particle" : "", "family" : "Wen", "given" : "Chi Pang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wu", "given" : "Xifeng", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Lancet", "id" : "ITEM-1", "issue" : "9838", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "192-193", "publisher" : "Elsevier Ltd", "title" : "Stressing harms of physical inactivity to promote exercise", "type" : "article-journal", "volume" : "380" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "4" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 Despite these statistics, little effort has been focused on interventions to increase activity by governments when compared to anti-smoking campaigns.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0140-6736(12)60954-4", "ISBN" : "01406736 (ISSN)", "ISSN" : "01406736", "PMID" : "22818933", "abstract" : "Exercise has been called a miracle drug1 that can benefit every part of the body2 and substantially extend lifespan.3 Yet it receives little respect from doctors or society.4 Socially, being inactive is perceived as normal, and in fact doctors order patients to remain on bed rest far more often than they encourage exercise.5 This passive attitude towards inactivity, where exercise is viewed as a personal choice, is anachronistic, and is reminiscent of the battles still being fought over smoking.\\nPhysical inactivity burdens society through the hidden and growing cost of medical care and loss of productivity. Getting the public to exercise is a public health priority because inactive people are contributing to a mortality burden as large as tobacco smoking. To individuals, the failure to spend 15\u201430 min a day in brisk walking increases the risk of cancer, heart disease, stroke, and diabetes by 20\u201430%,3, 5 and shortens lifespan by 3\u20145 years.3 Although the benefits of exercise and the harms of inactivity might seem like two sides of a coin, the benefits message emphasised so far has not worked well for most of the population. In tobacco control, doctors did not emphasise the benefits of non-smoking, but the harms of smoking. Similarly, armed with credible global and national data, we should emphasise the harms of inactivity and not merely the benefits of exercise.\\nSmoking and physical inactivity are the two major risk factors for non-communicable diseases around the globe. Of the 36 million deaths each year from non-communicable diseases,6 physical inactivity5 and smoking each contribute about 5 million.7 Physical inactivity and smoking have similar population attributable risks, although their relative risks8, 9 and prevalence are somewhat different (figure). For smoking, intensive and coordinated tobacco control efforts have been organised through WHO's Framework Convention on Tobacco Control (FCTC), a treaty already ratified by 175 countries.10 By contrast, we have few organised efforts to combat physical inactivity. Governmental programmes to move people from sedentary living to meeting recommended levels of exercise are very limited, in both developed and developing countries. Where available, these programmes are viewed as useful but not as essential as, say, anti-smoking programmes, partly owing to a failure to emphasise the colossal harms of inactivity. Furthermore, treatment of physical inactivity is not a reimbursable item under most health insu\u2026", "author" : [ { "dropping-particle" : "", "family" : "Wen", "given" : "Chi Pang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wu", "given" : "Xifeng", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Lancet", "id" : "ITEM-1", "issue" : "9838", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "192-193", "publisher" : "Elsevier Ltd", "title" : "Stressing harms of physical inactivity to promote exercise", "type" : "article-journal", "volume" : "380" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "4", "plainTextFormattedCitation" : "4", "previouslyFormattedCitation" : "4" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }4 It is well documented that aerobic and resistance training can lead to reductions in blood pressure.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/HJH.0b013e3283544669", "ISSN" : "0263-6352", "author" : [ { "dropping-particle" : "", "family" : "Rossi", "given" : "Amanda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dikareva", "given" : "Anastasia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bacon", "given" : "Simon L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daskalopoulou", "given" : "Stella S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Hypertension", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1277-1288", "title" : "The impact of physical activity on mortality in patients with high blood pressure", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 However, the U.S. health care reimbursement system currently does not reimburse for preventative programs, which have been proven to reduce costs.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2519/jospt.2005.2085", "ISBN" : "0190-6011", "ISSN" : "0190-6011", "PMID" : "16294983", "abstract" : "As a part of the American Physical Therapy Association's (APTA) vision statement, by the year 2020, physical therapists \"will hold all privileges of autonomous practice.\" This vision statement and the ideals held within it are elemental to the direction of our continued growth as a profession. Many members and nonmembers, however, appear confused and perhaps even intimidated by the concept of autonomous practice. This paper will review and discuss the processes used by other health care professions to gain autonomy within the US health care system. In particular, the processes used by physicians, which were extremely effective and have been used as a template by many other health professions, including physical therapy. Further discussion will focus on the physical therapy profession, emphasizing the parallels with medicine and considering many issues relevant to the goal of autonomous practice. 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Just as it has been proven through evidenced based research that exercise can reverse coronary artery disease, so too can exercise be used to reverse hypertension and reduce premature death in the U.S. and around the world.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0002-9149(98)00744-9", "ISBN" : "0002-9149 (Print) 0002-9149 (Linking)", "ISSN" : "00029149", "PMID" : "9860380", "abstract" : "The Multicenter Lifestyle Demonstration Project was designed to determine if comprehensive lifestyle changes can be a direct alternative to revascularization for selected patients without increasing cardiac events. A total of 333 patients completed this demonstration project (194 in the experimental group and 139 in the control group). We found that experimental group patients were able to avoid revascularization for at least 3 years by making comprehensive lifestyle changes at substantially lower cost without increasing cardiac morbidity and mortality. 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OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-2", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1097/HJH.0b013e3283544669", "ISSN" : "0263-6352", "author" : [ { "dropping-particle" : "", "family" : "Rossi", "given" : "Amanda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dikareva", "given" : "Anastasia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bacon", "given" : "Simon L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daskalopoulou", "given" : "Stella S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Hypertension", "id" : "ITEM-3", "issue" : "7", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1277-1288", "title" : "The impact of physical activity on mortality in patients with high blood pressure", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1,7,8", "plainTextFormattedCitation" : "1,7,8", "previouslyFormattedCitation" : "1,7,8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1,7,8Hypertension is a chronic condition in which the pressure in the blood vessels remains elevated for long periods of time.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "10", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Staff", "given" : "Mayo Clinic", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "title" : "High blood pressure (hypertension) - Mayo Clinic", "type" : "webpage" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1002/14651858.CD008822", "author" : [ { "dropping-particle" : "", "family" : "Chandrasekaran", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arumugam", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kumaran, D S Chandrasharma, B Khundrakpam", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chanam", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Philipraj", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sanathombi Devi", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cochrane Database of Systematic Reviews", "id" : "ITEM-2", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "title" : "Resistance exercise training for hypertension (Protocol)", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "2,9", "plainTextFormattedCitation" : "2,9", "previouslyFormattedCitation" : "2,9" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2,9 Sustained time periods of elevated blood pressure leads to an increased risk for cardiovascular diseases such as coronary artery disease, atherosclerosis, cardiovascular disease, and peripheral vascular disease, as well as myocardial infarction (heart attack), heart failure, kidney disease, and stroke.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/14651858.CD003075.pub2", "ISBN" : "1469-493X (Electronic)\\r1361-6137 (Linking)", "PMID" : "19821300", "abstract" : "BACKGROUND: Peripheral arterial disease (PAD) causes considerable morbidity and mortality. Hypertension is a risk factor for PAD. Treatment for hypertension must be compatible with the symptoms of PAD. Controversy regarding the effects of beta-blockade for hypertension in patients with PAD has led many physicians to stop prescribing beta-blockers. Little is known about the effects of other classes of anti-hypertensive drugs in the presence of PAD. This is an update of a Cochrane review first published in 2003. OBJECTIVES: To determine the effects of anti-hypertensive drugs on cardiovascular events and death, symptoms of claudication, critical leg ischaemia, progression of PAD and revascularisation or amputation in people with hypertension and PAD SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched May 2009) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2). The authors studied abstracts of cardiology meetings. SELECTION CRITERIA: Randomised controlled trials of at least one anti-hypertensive treatment against placebo, or two anti-hypertensive medications against each other, with interventions lasting at least one month. Trials had to include patients with symptomatic PAD. DATA COLLECTION AND ANALYSIS: Data were extracted by one author (DAL) and checked by the other (GYHL). Eligible studies were excluded when results presentation prevented adequate extraction of data and enquiries to authors did not yield raw data. MAIN RESULTS: Four studies were included. Two compared ACE inhibitors against placebo. In the HOPE study there was a significant reduction in the number of cardiovascular events in 168 patients receiving ramipril (OR 0.72, 95% confidence interval 0.58 to 0.91). In the second trial using perindopril in a small numbers of patients, there was a marginal increase in claudication distance but no change in ankle brachial pressure index (ABPI) and a reduction in maximum walking distance.The third trial in patients undergoing angioplasty suggested that the calcium antagonist verapamil reduced restenosis, although this was not reflected in the maintenance of a high ABPI. Another small study demonstrated no significant difference in arterial intima-media thickness with men receiving the thiazide diuretic hydrochlorathiazide compared to those receiving the alpha-adrenoreceptor blocker doxazosin. AUTHORS' CONCLUSIONS: Evidence on various anti-hyperten\u2026", "author" : [ { "dropping-particle" : "", "family" : "Lane", "given" : "D a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lip", "given" : "G Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cochrane Database Syst Rev", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "CD003075", "title" : "Treatment of hypertension in peripheral arterial disease", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "10", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Staff", "given" : "Mayo Clinic", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "title" : "High blood pressure (hypertension) - Mayo Clinic", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "9,10", "plainTextFormattedCitation" : "9,10", "previouslyFormattedCitation" : "9,10" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }9,10 Hypertension is often referred to as the “silent killer” because there are usually no signs or symptoms present while these underlying damaging changes are occurring.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/14651858.CD008822", "author" : [ { "dropping-particle" : "", "family" : "Chandrasekaran", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arumugam", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Davis", "given" : "F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kumaran, D S Chandrasharma, B Khundrakpam", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chanam", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Philipraj", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sanathombi Devi", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cochrane Database of Systematic Reviews", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010" ] ] }, "title" : "Resistance exercise training for hypertension (Protocol)", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "2", "plainTextFormattedCitation" : "2", "previouslyFormattedCitation" : "2" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2 Economically, hypertension is one of the largest burdens to health care, worldwide and in the U.S.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/HJH.0b013e3283544669", "ISSN" : "0263-6352", "author" : [ { "dropping-particle" : "", "family" : "Rossi", "given" : "Amanda", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dikareva", "given" : "Anastasia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bacon", "given" : "Simon L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daskalopoulou", "given" : "Stella S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Hypertension", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "1277-1288", "title" : "The impact of physical activity on mortality in patients with high blood pressure", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 According to 2011 statistics presented in the 2015 Heart Disease and Stroke Statistics from the American Heart Association, heart disease represents the largest cost to the U.S. healthcare system and hypertension is number eight in terms of cost expenditure categorized by disease (See Appendix part A for details).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIR.0000000000000152", "ISBN" : "0000000000000", "ISSN" : "0009-7322", "author" : [ { "dropping-particle" : "", "family" : "Mozaffarian", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benjamin", "given" : "E. 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For example, individuals with hypertension may be able to take medications to lower their blood pressure, however, this is not preventative and will not target the original reason hypertension may have occurred. Activity level is a modifiable risk factor that has been found to have a significant impact on preventing, and even reversing cardiovascular disease.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00008483-199905000-00016", "ISBN" : "0098-7484", "ISSN" : "0883-9212", "PMID" : "9863851", "abstract" : "CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-1", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "8", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }8 The Health Promotion Program will target 45-60 year olds that currently have hypertension or are at high risk for developing hypertension and are not meeting the current CDC exercise recommendations in order to increase quality of life, vitality, and longevity (see Appendix part C). The implementation of this Health Promotion Program will be rolled out in Winston-Salem, NC and will reduce health care costs, help people discover the tools to lead healthier lives, and reduce premature deaths. Winston-Salem was chosen because it is representative of the larger demographic of the Southeast, which has a higher rate of hypertension compared to other regions in the United States.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pmed.0030260", "ISBN" : "1549-1277", "ISSN" : "15491277", "PMID" : "16968116", "abstract" : "BACKGROUND: The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the \"eight Americas,\" to explore the causes of the disparities that can inform specific public health intervention policies and programs. METHODS AND FINDINGS: The eight Americas were defined based on race, location of the county of residence, population density, race-specific county-level per capita income, and cumulative homicide rate. Data sources for population and mortality figures were the Bureau of the Census and the National Center for Health Statistics. We estimated life expectancy, the risk of mortality from specific diseases, health insurance, and health-care utilization for the eight Americas. The life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001. Within the sexes, the life expectancy gap between the best-off and the worst-off groups was 15.4 y for males (Asians versus high-risk urban blacks) and 12.8 y for females (Asians versus low-income southern rural blacks). Mortality disparities among the eight Americas were largest for young (15-44 y) and middle-aged (45-59 y) adults, especially for men. The disparities were caused primarily by a number of chronic diseases and injuries with well-established risk factors. Between 1982 and 2001, the ordering of life expectancy among the eight Americas and the absolute difference between the advantaged and disadvantaged groups remained largely unchanged. Self-reported health plan coverage was lowest for western Native Americans and low-income southern rural blacks. Crude self-reported health-care utilization, however, was slightly higher for the more disadvantaged populations. CONCLUSIONS: Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.", "author" : [ { "dropping-particle" : "", "family" : "Murray", "given" : "Christopher J L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kulkarni", "given" : "Sandeep C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Michaud", "given" : "Catherine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tomijima", "given" : "Niels", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bulzacchelli", "given" : "Maria T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Iandiorio", "given" : "Terrell J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ezzati", "given" : "Majid", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PLoS Medicine", "id" : "ITEM-1", "issue" : "9", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "1513-1524", "title" : "Eight Americas: Investigating mortality disparities across races, counties, and race-counties in the United States", "type" : "article-journal", "volume" : "3" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "11", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "11" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }11 Winston-Salem’s population consists of approximately 35% Black or African Americans and 15% Hispanics (representing approximately 50% of the overall population), both have higher rates of hypertension and physical activity compared with Caucasian.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "11", "7" ] ] }, "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "QuickFacts", "type" : "webpage" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1161/CIR.0000000000000152", "ISBN" : "0000000000000", "ISSN" : "0009-7322", "author" : [ { "dropping-particle" : "", "family" : "Mozaffarian", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benjamin", "given" : "E. 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B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2015" ] ] }, "number-of-pages" : "e29-e322", "title" : "Heart Disease and Stroke Statistics--2015 Update: A Report From the American Heart Association", "type" : "book", "volume" : "131" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3,12", "plainTextFormattedCitation" : "3,12", "previouslyFormattedCitation" : "3,12" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,12 If successful, this model can serve as a basis for other Southeast communities with similar demographics. The program will begin by primarily targeting churches in Winston-Salem, NC, starting with Green Street Methodist, due to its proximity to diverse neighborhoods and because it is actively engaged in the community through a free medical clinic and food pantry.Physical therapists are well situated to help with the implementation of this Health Promotion Program. The American Physical Therapy Association’s vision statement is “transforming society by optimizing movement to improve the human experience.”ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Bellamy", "given" : "Jason", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "language" : "en", "title" : "Vision Statement for the Physical Therapy Profession and Guiding Principles to Achieve the Vision", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "13", "plainTextFormattedCitation" : "13", "previouslyFormattedCitation" : "13" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }13 As health professionals, physical therapists are trusted, respected, and regarded as credible sources for health behavior change.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/09593980902835344", "ISBN" : "0959398090", "ISSN" : "1532-5040", "PMID" : "19842866", "abstract" : "Client adherence to exercises prescribed by a physical therapist is very important to successful treatment outcomes. Unfortunately, many clients struggle with adherence and thus efficient and effective motivational interventions are desirable. The purpose of this article was to review the available evidence for: 1) the modifiable factors associated with adherence to physical therapy recommended exercise and 2) the efficacy of exercise intervention efforts to make conclusions and suggestions toward practice. Articles were limited to English peer-reviewed journals and published from 1993 to 2008. Major findings from 13 studies were summarized based on common subtopics of: outcome expectations, self-efficacy expectations, cognitive-behavioural and educational interventions, and intervention medium. The review provided evidence for the importance of self-efficacy in exercise adherence to physical therapy, but it showed that current cognitive-behavioural interventions have had limited effectiveness. It was recommended that future research broaden the scope of predictor variables with social ecological designs, increase the length of prospective follow-up in assessments, include larger and more diverse samples, and focus on innovative aesthetic and affective-based intervention strategies.", "author" : [ { "dropping-particle" : "", "family" : "Rhodes", "given" : "Ryan E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiala", "given" : "Bonnie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physiotherapy theory and practice", "id" : "ITEM-1", "issue" : "5-6", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "424-441", "title" : "Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence.", "type" : "article-journal", "volume" : "25" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "14", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "14" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }14 Physical therapists are already skilled at the treatment level with helping patients modify behavior through modification of activity, strength training, and developing movement strategies.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/09593980902835344", "ISBN" : "0959398090", "ISSN" : "1532-5040", "PMID" : "19842866", "abstract" : "Client adherence to exercises prescribed by a physical therapist is very important to successful treatment outcomes. Unfortunately, many clients struggle with adherence and thus efficient and effective motivational interventions are desirable. The purpose of this article was to review the available evidence for: 1) the modifiable factors associated with adherence to physical therapy recommended exercise and 2) the efficacy of exercise intervention efforts to make conclusions and suggestions toward practice. Articles were limited to English peer-reviewed journals and published from 1993 to 2008. Major findings from 13 studies were summarized based on common subtopics of: outcome expectations, self-efficacy expectations, cognitive-behavioural and educational interventions, and intervention medium. The review provided evidence for the importance of self-efficacy in exercise adherence to physical therapy, but it showed that current cognitive-behavioural interventions have had limited effectiveness. It was recommended that future research broaden the scope of predictor variables with social ecological designs, increase the length of prospective follow-up in assessments, include larger and more diverse samples, and focus on innovative aesthetic and affective-based intervention strategies.", "author" : [ { "dropping-particle" : "", "family" : "Rhodes", "given" : "Ryan E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fiala", "given" : "Bonnie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physiotherapy theory and practice", "id" : "ITEM-1", "issue" : "5-6", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "424-441", "title" : "Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence.", "type" : "article-journal", "volume" : "25" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "14", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "14" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }14 Physical therapists are well situated to provide these health preventative services and help reduce the prevalence and incidence of hypertension through the implementation of this Health Promotion Program through education and leading group exercises. There is evidence supporting the positive effects of prevention through exercise on reducing cardiovascular disease as well as improving quality of life.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S1470-2045(09)70175-5", "ISSN" : "14702045", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "Dean", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Lancet Oncology", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "638-639", "publisher" : "Elsevier Ltd", "title" : "Intensive lifestyle changes and health reform", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1097/00008483-199905000-00016", "ISBN" : "0098-7484", "ISSN" : "0883-9212", "PMID" : "9863851", "abstract" : "CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-2", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/S0002-9149(98)00744-9", "ISBN" : "0002-9149 (Print) 0002-9149 (Linking)", "ISSN" : "00029149", "PMID" : "9860380", "abstract" : "The Multicenter Lifestyle Demonstration Project was designed to determine if comprehensive lifestyle changes can be a direct alternative to revascularization for selected patients without increasing cardiac events. A total of 333 patients completed this demonstration project (194 in the experimental group and 139 in the control group). We found that experimental group patients were able to avoid revascularization for at least 3 years by making comprehensive lifestyle changes at substantially lower cost without increasing cardiac morbidity and mortality. These patients reported reductions in angina comparable with what can be achieved with revascularization.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of cardiology", "id" : "ITEM-3", "issue" : "10B", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "72T-76T", "title" : "Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project.", "type" : "article-journal", "volume" : "82" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "6\u20138", "plainTextFormattedCitation" : "6\u20138", "previouslyFormattedCitation" : "6\u20138" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6–8 The “Lifestyle Heart Trial” and the “Multicenter Lifestyle Demonstration Project” demonstrated successful outcomes through lifestyle changes, such as eating healthy, stress management, group support, and smoking cessation.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00008483-199905000-00016", "ISBN" : "0098-7484", "ISSN" : "0883-9212", "PMID" : "9863851", "abstract" : "CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-1", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/S0002-9149(98)00744-9", "ISBN" : "0002-9149 (Print) 0002-9149 (Linking)", "ISSN" : "00029149", "PMID" : "9860380", "abstract" : "The Multicenter Lifestyle Demonstration Project was designed to determine if comprehensive lifestyle changes can be a direct alternative to revascularization for selected patients without increasing cardiac events. A total of 333 patients completed this demonstration project (194 in the experimental group and 139 in the control group). We found that experimental group patients were able to avoid revascularization for at least 3 years by making comprehensive lifestyle changes at substantially lower cost without increasing cardiac morbidity and mortality. These patients reported reductions in angina comparable with what can be achieved with revascularization.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The American journal of cardiology", "id" : "ITEM-2", "issue" : "10B", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "72T-76T", "title" : "Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project.", "type" : "article-journal", "volume" : "82" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "7,8", "plainTextFormattedCitation" : "7,8", "previouslyFormattedCitation" : "7,8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }7,8 The “Lifestyle” intervention also included moderate aerobic exercise as part of their routines with no use of lipid lowering drugs which ultimately led, not only to a decrease, but a reversal of cardiovascular disease and events.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00008483-199905000-00016", "ISBN" : "0098-7484", "ISSN" : "0883-9212", "PMID" : "9863851", "abstract" : "CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-1", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "8", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }8 Moderate exercise was mostly walking with a target of 50-80% of their maximum heart rate (adjusted based on conditioning level) for at least 30 consecutive minutes for a minimum of 3 hours per week.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/0140-6736(90)91656-U", "ISSN" : "01406736", "PMID" : "1973470", "abstract" : "In a prospective, randomised, controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year, 28 patients were assigned to an experimental group (low-fat vegetarian diet, stopping smoking, stress management training, and moderate exercise) and 20 to a usual-care control group. 195 coronary artery lesions were analysed by quantitative coronary angiography. The average percentage diameter stenosis regressed from 40\u00b70 (SD 16\u00b79)% to 37\u00b78 (16\u00b75)% in the experimental group yet progressed from 42\u00b77 (15\u00b75)% to 46\u00b71 (18\u00b75)% in the control group. When only lesions greater than 50% stenosed were analysed, the average percentage diameter stenosis regressed from 61\u00b71 (8\u00b78)% to 55\u00b78 (11\u00b70)% in the experimental group and progressed from 61\u00b77 (9\u00b75)% to 64\u00b74 (16\u00b73)% in the control group. Overall, 82% of experimental-group patients had an average change towards regression. Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S.E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J.H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L.W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W.T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T.a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McLanahan", "given" : "S.M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R.L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K.L.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R.J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Lancet", "id" : "ITEM-1", "issue" : "8708", "issued" : { "date-parts" : [ [ "1990" ] ] }, "page" : "129-133", "title" : "Can lifestyle changes reverse coronary heart disease?", "type" : "article-journal", "volume" : "336" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "15", "plainTextFormattedCitation" : "15", "previouslyFormattedCitation" : "15" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }15 Not surprisingly, the participants in the study that were most adherent to the lifestyle changes showed the greatest benefits.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00008483-199905000-00016", "ISBN" : "0098-7484", "ISSN" : "0883-9212", "PMID" : "9863851", "abstract" : "CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-1", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "8", "plainTextFormattedCitation" : "8", "previouslyFormattedCitation" : "8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }8 These two evidence based lifestyle interventions have proven results among participants with severe chronic heart conditions (coronary artery disease) at improving heart health. Another major accomplishment of these two studies is that they were implemented and conducted at a significantly reduced cost (and future cost) to the healthcare system.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S0002-9149(98)00744-9", "ISBN" : "0002-9149 (Print) 0002-9149 (Linking)", "ISSN" : "00029149", "PMID" : "9860380", "abstract" : "The Multicenter Lifestyle Demonstration Project was designed to determine if comprehensive lifestyle changes can be a direct alternative to revascularization for selected patients without increasing cardiac events. A total of 333 patients completed this demonstration project (194 in the experimental group and 139 in the control group). We found that experimental group patients were able to avoid revascularization for at least 3 years by making comprehensive lifestyle changes at substantially lower cost without increasing cardiac morbidity and mortality. 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OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-2", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "7,8", "plainTextFormattedCitation" : "7,8", "previouslyFormattedCitation" : "7,8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }7,8 As mentioned before, our current U.S. ‘health care’ has been described as a being ‘sick-care’ model, which results in expensive surgeries rather than addressing the root cause at a fraction of the cost.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S1470-2045(09)70175-5", "ISSN" : "14702045", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "Dean", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Lancet Oncology", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "638-639", "publisher" : "Elsevier Ltd", "title" : "Intensive lifestyle changes and health reform", "type" : "article-journal", "volume" : "10" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "6", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "6" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6 Another program to serve as a model for this Health Promotion Program is the Eat Smart Move More Weigh Less program (ESMMWL), an evidenced based program helping people to lose weight.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4278/ajhp.120221-QUAN-101", "ISBN" : "0890-1171", "ISSN" : "0890-1171", "PMID" : "23470189", "abstract" : "PURPOSE: To ascertain the effectiveness of a behavior-change weight management program offered to teachers and state employees in North Carolina (NC).\\n\\nDESIGN: Fifteen-week weight management program with premeasures and postmeasures.\\n\\nSETTING: State agencies and public K-12 schools in five NC counties.\\n\\nSUBJECTS: A total of 2574 NC state employees enrolled in 141 classes.\\n\\nINTERVENTION: Eat Smart, Move More, Weigh Less (ESMMWL) is a 15-week weight management program delivered by trained instructors. Lessons inform, empower, and motivate participants to live mindfully as they make choices about eating and physical activity.\\n\\nMEASURES: Height, weight, body mass index (BMI), waist circumference, blood pressure, confidence in ability to eat healthy and be physically active, changes in eating, and physical activity behaviors.\\n\\nANALYSIS: Descriptive statistics, t-tests, \u03c7(2) tests, and analyses of variance.\\n\\nRESULTS: Data are reported for 1341 participants in ESMMWL who completed the program, submitted an evaluation, and had not participated in the program in the past; 89% were female and mean age was 48.8 years. Average BMI and waist circumference decreased significantly. Confidence in eating healthfully and being physically active increased significantly. The percentage of participants with a BMI < 30 kg/m(2) increased from 40% to 45% and those with a normal blood pressure increased from 23% to 32.5%. Participants reported being more mindful of what and how much they ate (92%), being more mindful of how much daily physical activity they got (88%), and eating fewer calories (87.3%).\\n\\nCONCLUSION: This project demonstrated the feasibility of implementing a behavior change-based weight management program at the worksite to achieve positive outcomes related to weight, blood pressure, healthy eating, and physical activity behaviors. Programs such as this have the potential to provide health care cost savings.", "author" : [ { "dropping-particle" : "", "family" : "Dunn", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Whetstone", "given" : "Lauren Mackenzie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolasa", "given" : "Kathryn M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jayaratne", "given" : "K S U Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "Cathy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aggarwal", "given" : "Surabhi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herget", "given" : "Casey", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rogers", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American journal of health promotion : AJHP", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "378-83", "title" : "Delivering a behavior-change weight management program to teachers and state employees in North Carolina.", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "16", "plainTextFormattedCitation" : "16", "previouslyFormattedCitation" : "16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }16 ESMMWL is a 15-week program consisting of group meetings (some online), tracking of weight, food intake, and exercise, and an education component.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "10775315", "abstract" : "Eat Smart, Move More, Weigh Less (ESMMWL) is a 15-week weight-management program that is delivered by local educators. Published research data were used to identify strategies that lead to weight loss and/or weight maintenance. The program uses the Theory of Planned Behavior by informing, empowering, and motivating participants to live mindfully as they make choices about eating and physical activity. The program provides opportunities for participants to keep a journal of healthy behaviors. ESMMWL is offered in worksites, faith communities, and county extension offices. The program was pilot tested and revisions were made. This article updates the earlier description. \u00a9 by Extension Journal, Inc.", "author" : [ { "dropping-particle" : "", "family" : "Dunn", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolasa", "given" : "Kathryn M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vodicka", "given" : "Sheree", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "Lori", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "Cathy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "Christine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lackey", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Extension", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "9-14", "title" : "Eat Smart, Move More, Weigh Less a weight management program for adults-revision of curriculum based on first-year pilot", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "17", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "17" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 Through these components, along with personal goal assessment and motivation, the ESMMWL helps to increase mindfulness about daily choices, which has been shown to lead to a decrease and maintenance of weight loss and a decrease in hypertension.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4278/ajhp.120221-QUAN-101", "ISBN" : "0890-1171", "ISSN" : "0890-1171", "PMID" : "23470189", "abstract" : "PURPOSE: To ascertain the effectiveness of a behavior-change weight management program offered to teachers and state employees in North Carolina (NC).\\n\\nDESIGN: Fifteen-week weight management program with premeasures and postmeasures.\\n\\nSETTING: State agencies and public K-12 schools in five NC counties.\\n\\nSUBJECTS: A total of 2574 NC state employees enrolled in 141 classes.\\n\\nINTERVENTION: Eat Smart, Move More, Weigh Less (ESMMWL) is a 15-week weight management program delivered by trained instructors. Lessons inform, empower, and motivate participants to live mindfully as they make choices about eating and physical activity.\\n\\nMEASURES: Height, weight, body mass index (BMI), waist circumference, blood pressure, confidence in ability to eat healthy and be physically active, changes in eating, and physical activity behaviors.\\n\\nANALYSIS: Descriptive statistics, t-tests, \u03c7(2) tests, and analyses of variance.\\n\\nRESULTS: Data are reported for 1341 participants in ESMMWL who completed the program, submitted an evaluation, and had not participated in the program in the past; 89% were female and mean age was 48.8 years. Average BMI and waist circumference decreased significantly. Confidence in eating healthfully and being physically active increased significantly. The percentage of participants with a BMI < 30 kg/m(2) increased from 40% to 45% and those with a normal blood pressure increased from 23% to 32.5%. Participants reported being more mindful of what and how much they ate (92%), being more mindful of how much daily physical activity they got (88%), and eating fewer calories (87.3%).\\n\\nCONCLUSION: This project demonstrated the feasibility of implementing a behavior change-based weight management program at the worksite to achieve positive outcomes related to weight, blood pressure, healthy eating, and physical activity behaviors. Programs such as this have the potential to provide health care cost savings.", "author" : [ { "dropping-particle" : "", "family" : "Dunn", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Whetstone", "given" : "Lauren Mackenzie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolasa", "given" : "Kathryn M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jayaratne", "given" : "K S U Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "Cathy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aggarwal", "given" : "Surabhi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herget", "given" : "Casey", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rogers", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American journal of health promotion : AJHP", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "378-83", "title" : "Delivering a behavior-change weight management program to teachers and state employees in North Carolina.", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "10775315", "abstract" : "Eat Smart, Move More, Weigh Less (ESMMWL) is a 15-week weight-management program that is delivered by local educators. Published research data were used to identify strategies that lead to weight loss and/or weight maintenance. The program uses the Theory of Planned Behavior by informing, empowering, and motivating participants to live mindfully as they make choices about eating and physical activity. The program provides opportunities for participants to keep a journal of healthy behaviors. ESMMWL is offered in worksites, faith communities, and county extension offices. The program was pilot tested and revisions were made. This article updates the earlier description. \u00a9 by Extension Journal, Inc.", "author" : [ { "dropping-particle" : "", "family" : "Dunn", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolasa", "given" : "Kathryn M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Vodicka", "given" : "Sheree", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schneider", "given" : "Lori", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "Cathy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "Christine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lackey", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Extension", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2011" ] ] }, "page" : "9-14", "title" : "Eat Smart, Move More, Weigh Less a weight management program for adults-revision of curriculum based on first-year pilot", "type" : "article-journal", "volume" : "49" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "16,17", "plainTextFormattedCitation" : "16,17", "previouslyFormattedCitation" : "16,17" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }16,17 The Health Promotion Program utilizes the constructs of the socio-ecological model (SEM). The SEM for health care has been used successfully in other health promotion campaigns. For example, it has been the basis for drug prevention programs, smoking cessation, improving the intake of fruits and vegetables in African Americans, and increasing participation in sports among rural adolescent girls.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "465-482", "ISBN" : "9780787996147", "abstract" : "This chapter describes ecological models of health behavior and their conceptual antecedents. Because ecological models and their terminology may not be familiar to readers, we provide working definitions of key terms in Table 20.1. Also in this chapter, we propose principles that are derived from ecological models. These are intended to guide research efforts and to inform the systematic development and evaluation of more comprehensive health behavior change interventions. Finally, we present examples of applications of ecological models that are drawn from research on nutrition and physical activity", "author" : [ { "dropping-particle" : "", "family" : "Sallis", "given" : "J F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Owen", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fisher", "given" : "E B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Health Behavior and Health Education Theory Research and Practice", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "465-482", "title" : "Ecological models of health behavior", "type" : "article-journal", "volume" : "4" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1177/109019818801500401", "ISBN" : "0195-8402 (Print)", "ISSN" : "0195-8402", "PMID" : "3068205", "abstract" : "During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.", "author" : [ { "dropping-particle" : "", "family" : "McLeroy", "given" : "K R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bibeau", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steckler", "given" : "a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Glanz", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Health education quarterly", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "1988" ] ] }, "page" : "351-377", "title" : "An ecological perspective on health promotion programs.", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1007/s10900-008-9109-5", "ISBN" : "0094-5145", "ISSN" : "00945145", "PMID" : "18594953", "abstract" : "Despite the growing body of literature that provides evidence of the health benefits of a diet high in fruits and vegetables, most Americans eat much less than the recommended amounts of this food group. Among those who are least likely to meet the USDA guidelines for the recommended daily servings of fruits and vegetables are non-Hispanic Blacks and individuals with lower incomes. The purpose of this literature review is to examine the dietary behaviors, focusing on fruit and vegetable intake, of low-income African Americans from a socio-ecological perspective, and to offer rationale for and guidance on integrating socio-ecological concepts into health promoting programs intended to improve dietary behaviors among this population. Based on the 12 descriptive studies retrieved in the review, dietary behaviors and fruit and vegetable intake among African Americans are the result of a complex interplay of personal, cultural, and environmental factors that can be categorized and described using the five levels of influence conceptualized by the socio-ecological model: Intrapersonal level (taste preferences, habits, and nutritional knowledge and skills), Interpersonal level/social environment (processes whereby culture, social traditions, and role expectations impact eating practices; and patterns within peer groups, friends and family), and Organizational, Community, and Public Policy levels/physical environment (environmental factors that affect food access and availability). The socio-ecological model provides a useful framework for achieving a better understanding of the multiple factors and barriers that impact dietary behaviors, and therefore can provide guidance for developing culturally appropriate and sensitive intervention strategies for African Americans. It is an integrative framework that shows great promise in moving the field closer to attaining the goal of improving dietary behaviors and nutritional status among African Americans.", "author" : [ { "dropping-particle" : "", "family" : "Robinson", "given" : "Tanya", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Community Health", "id" : "ITEM-3", "issue" : "6", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "395-406", "title" : "Applying the socio-ecological model to improving fruit and vegetable intake among low-income African Americans", "type" : "article-journal", "volume" : "33" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1177/1049732309338198", "ISBN" : "1049-7323 U6 - ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Using+a+socioecological+approach+to+examine+participation+in+sport+and+physical+activity+among+rural+adolescent+girls&rft.au=Casey%2C+Meghan&rft.au=Eime%2C+Rochelle&rft.au=Payne%2C+Warren&rft.au=Harvey%2C+Jack&rft.date=2009&rft.issn=1049-7323&rft.externalDBID=n%2Fa&rft.externalDocID=oai_arrow_nla_gov_au_1279072307209", "ISSN" : "1049-7323", "PMID" : "19556398", "abstract" : "Adolescence is a critical time for developing lifelong healthy behaviors, including active lifestyles. Participation in sport and physical activity, however, declines during adolescence, and few studies have comprehensively identified why, particularly among rural girls. This article identifies a range of independent and interacting factors that influence sport and physical activity participation of rural adolescent girls. The socioecological model of health was used to guide four focus group discussions with Grade 7 girls (n = 34). The results showed that adolescent girls were positively influenced when sports or physical activities were fun, when they involved being with friends, and when they were supported by families and teachers through role modeling and positive feedback. A range of intrapersonal and organizational factors affected perceived self-competence, particularly the coeducational nature of school physical education classes and peer teasing, which supported social comparisons of skill level. In promoting sport and physical activity to rural adolescent girls, focus must be directed on developmentally appropriate activities that are fun, offering opportunities for single-sex classes, and generating cultural changes that encourage noncompetitive and self-referencing activities.", "author" : [ { "dropping-particle" : "", "family" : "Casey", "given" : "Meghan M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eime", "given" : "Rochelle M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Payne", "given" : "Warren R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harvey", "given" : "Jack T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Qualitative health research", "id" : "ITEM-4", "issue" : "7", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "881-893", "title" : "Using a socioecological approach to examine participation in sport and physical activity among rural adolescent girls.", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "18\u201321", "plainTextFormattedCitation" : "18\u201321", "previouslyFormattedCitation" : "18\u201321" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }18–21 These programs were successful because they identified and recognized the many factors that influence a person’s behavior when planning their health programs. The SEM targets individual and environmental social factors rather than purely at an individual level.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/109019818801500401", "ISBN" : "0195-8402 (Print)", "ISSN" : "0195-8402", "PMID" : "3068205", "abstract" : "During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. 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Also, the education on the risks of inactivity can potentially help participants understand their own susceptibility, seriousness, benefits, barriers, and self efficacy, which are the constructs of the Health Belief Model.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "9780470396292", "author" : [ { "dropping-particle" : "", "family" : "Strecher", "given" : "V. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rosenstock", "given" : "I. 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Barriers to and facilitators of behavioural changes among participants of a Healthy Living Program", "type" : "article-journal", "volume" : "30" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "24", "plainTextFormattedCitation" : "24", "previouslyFormattedCitation" : "24" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }24In terms of community and public policy, one of the targets of the Health Promotion Program will be to increase active transportation among the targeted population. Incentives, in the form of fitness trackers, will be given to participants who utilize active transport such as biking or walking to work, church, or the store. Also, screening and recruitment events will occur throughout the year through the collaboration of churches, health fairs, physicians, and local governments in order to promote the program and educate the community. The church, especially among the African American community, has been shown to have a central role over the influence of lifestyles and behaviors.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10900-008-9109-5", "ISBN" : "0094-5145", "ISSN" : "00945145", "PMID" : "18594953", "abstract" : "Despite the growing body of literature that provides evidence of the health benefits of a diet high in fruits and vegetables, most Americans eat much less than the recommended amounts of this food group. Among those who are least likely to meet the USDA guidelines for the recommended daily servings of fruits and vegetables are non-Hispanic Blacks and individuals with lower incomes. 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B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2015" ] ] }, "number-of-pages" : "e29-e322", "title" : "Heart Disease and Stroke Statistics--2015 Update: A Report From the American Heart Association", "type" : "book", "volume" : "131" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3 The Faith, Activity, and Nutrition Program, implemented in 36 churches throughout South Carolina found a significant reduction in the amount of leisure time spent.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.amepre.2012.09.062", "ISSN" : "07493797", "author" : [ { "dropping-particle" : "", "family" : "Wilcox", "given" : "Sara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Parrott", "given" : "Allen", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baruth", "given" : "Meghan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Laken", "given" : "Marilyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Condrasky", "given" : "Margaret", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Saunders", "given" : "Ruth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dowda", "given" : "Marsha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Evans", "given" : "Rebecca", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Addy", "given" : "Cheryl", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Warren", "given" : "Tatiana Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kinnard", "given" : "Deborah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zimmerman", "given" : "Lakisha", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Preventive Medicine", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "122-131", "publisher" : "Elsevier Inc.", "title" : "The Faith, Activity, and Nutrition Program", "type" : "article-journal", "volume" : "44" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "25", "plainTextFormattedCitation" : "25", "previouslyFormattedCitation" : "25" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }25 The Health Promotion Program plans to educate government leaders, which can impact public policy. Educating the mayor, such as Mike Cornett of Oklahoma City, that have become aware of the pressing issues of inactivity, have made positive impacts in their community by increasing walkability and making the city more bike friendly, which is especially important in areas without access to sidewalks or safe walking spaces, such as Winston-Salem.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "10", "5" ] ] }, "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Mick Cornett: How an obese town lost a million pounds | TED Talk | ", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "26", "plainTextFormattedCitation" : "26", "previouslyFormattedCitation" : "26" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }26 Also, from a national public policy perspective, this health promotion program will promote the 2008 Physical Activity Guidelines for Americans to help influence behavioral change.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "10", "10" ] ] }, "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Needs for Adults | Physical Activity | DNPAO | CDC", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "27", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "27" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27 It will accomplish this by educating the participants and community about these guidelines and will include this as a program and participant goal. This program targets health behavior change through the constructs of the SEM. The Health Promotion Program’s hope is that as changes occur at each of the four individual levels, reciprocal causation will occur. Reciprocal causation between the environment and the individual will transpire which will begin to naturally influence various SEM levels, manifesting the essence of the Health Promotion Program.Part 3: Program Description & Objectives:The Health Promotion Program is an exercise promotion program developed by physical therapists using the constructs of the SEM. This program is aimed at reducing hypertension through increased activity in accordance with the Centers for Disease and Control Prevention (CDC) exercise recommendations and targets adults ages 45-60 in the Winston-Salem area of North Carolina. The SEM recognizes that there are multiple levels of influence, such as individual motivation and the environment, which has served as a guide during the planning and integration of interventions of this Health Promotion Program.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1186/1479-5868-11-68", "ISSN" : "1479-5868", "author" : [ { "dropping-particle" : "", "family" : "Cleland", "given" : "Claire L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hunter", "given" : "Ruth F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tully", "given" : "Mark a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scott", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kee", "given" : "Frank", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Donnelly", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Prior", "given" : "Lindsay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cupples", "given" : "Margaret E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "International Journal of Behavioral Nutrition and Physical Activity", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "68", "title" : "Identifying solutions to increase participation in physical activity interventions within a socio-economically disadvantaged community: a qualitative study", "type" : "article-journal", "volume" : "11" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "23", "plainTextFormattedCitation" : "23", "previouslyFormattedCitation" : "23" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }23 The Health Promotion Program is designed to influence the intrapersonal, interpersonal, community and public policy constructs of the SEM. The Health Promotion Program consists of weekly classes, which include weekly lessons or group discussion, group exercise classes, and mindfulness training. Health Promotion Program goals:1. Successfully hold 30 recruitment and education events during the first year at the following: churches, physician offices, health fairs, local events, and local governments in order to increase awareness and support. The information about the program will be disseminated through handouts, PowerPoint presentations, and blood pressure screenings. 2. Reduce each participant’s blood pressure by 5% during each of the 8-week sessions through exercise as measured by weekly blood pressure reading “check-ins.” A digital blood pressure machine and a manual blood pressure machine will be available at each event and a booklet will be given to each participant to track blood pressure. Measurements will be taken during each session to increase awareness and to track progress.3. Increase the activity of each participant by program’s end to meet, at a minimum, the exercise component of the current CDC guidelines as evidenced by the completion of the participants’ exercise logs to meet these guidelines consecutively for the last 4 weeks of program. Current CDC guidelines for adults 18-65 years old recommend 150 minutes of moderate intensity aerobic activity per week and 2 days of strength training.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "10", "10" ] ] }, "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Needs for Adults | Physical Activity | DNPAO | CDC", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "27", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "27" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }274. Increase knowledge of the participants understanding of the risks of hypertension and the benefits of exercise - including susceptibility, seriousness, and benefits, which are constructs of the Health Belief Model - as measured by an increased score (minimum increase of 5 points, each question worth 1 point) on the 32 question Health Promotion Program assessment given at the 1st and last session.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "9780470396292", "author" : [ { "dropping-particle" : "", "family" : "Strecher", "given" : "V. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rosenstock", "given" : "I. 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Receive positive confirmation from 80% of the participants that they are engaging in a minimum of 150 minutes of moderate intensity aerobic activity per week at 6 month follow-up.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "10", "10" ] ] }, "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Needs for Adults | Physical Activity | DNPAO | CDC", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "27", "plainTextFormattedCitation" : "27", "previouslyFormattedCitation" : "27" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }27 Long-term success of the program will be demonstrated by sustaining the increased physical activity behavioral change as demonstrated through the maintenance of the CDC guidelines. 6. Successful completion of at least one full program with a minimum of 10 participants during the first year. 7. Establish an additional event center in another part of Winston-Salem within the first year. Methods- Who? - Program/Marketing Director – (full-time) oversees daily operations, in charge of recruitment/education about the program, works directly with PT’s and various organizations, community leaders, and organizers in the community. They will also be responsible for the development and dissemination of printed and online material. 3-5 Physical Therapists – (part-time or paid per event) will be responsible for the following: obtaining blood pressure from participants during screenings/recruitment events and lead weekly exercise/education classes.Methods- What? – Total program length 20 weeks = 2, 8-week sessions, which will meet weekly for 75 minutes with an allotted time of 90 minutes for setup, questions and discussion. A 4-week ‘break’ between sessions will be provided to allow for the participants to adapt the changes into their lives and to have time to identify potential barriers, which will be discussed when the second 8-week session begins. Blood pressure will be taken at the beginning of each session and recorded in the participant’s chart as well as the PT’s chart so that both may have access to this information. Each session will consist of a short, 20-minute discussion with a lesson (every other week) or a group facilitated discussion to provide support and encourage participants. Each week, participants will set individual goals for activity during the week and will be encouraged to be active for a minimum of 2 more days when not in session, recording it in the activity log. Also, participants will be encouraged to exercise with a buddy from the program for increased adherence and motivation. Basic Anatomy of Class (1-1.5 hours)Time (minutes)Each session will obtain at least one component0-15 Obtain blood pressures15-35/45Education sessionGroup discussionGroup supportMotivational speaker35-70Group exerciseBrisk walkingAerobics classDance70-80Mindfulness trainingBody Awareness trainingMental relaxationTitles of the 8 education sessions will be held every other week during the program incorporating the constructs of the SEM:Risks of Hypertension & Learning the Borg (RPE)Beliefs and AttitudesExercise EffectsFamily MattersIdentifying BarriersBreaking Down BarriersKeep Keepin On – How to stay motivated Lifestyle ChangesMethods- When? - Recruitment/education sessions will occur when scheduled according to the availability of the organization. Program intervention will include 3, 20-week sessions held seasonally throughout the year; Spring session: January-June, Fall session: August- January, Summer session: March-August. The sessions will be held on a weekday evening, with the possibility of multiple programs running simultaneously each seasonal session depending on the number on participants based on a max class size of 18. Methods- Where? - The first location, which has been established, is the Green Street Methodist Church. Green Street is located in South East Winston-Salem and is at the center of a diverse community. The Health Promotion Program hopes to collaborate with 2-3 other churches/YMCAs in other parts of Winston-Salem within the first 3 years of the program to effect change in more neighborhoods across the city. Churches and YMCA’s are the target because these are considered community centers and can usually be obtained at low or no cost and typically have large spaces with which to conduct the group exercise classes. Recruitment of participants will be held in Winston-Salem at the following locations: churches, physician offices, health fairs, local events, and local governments.Methods- How? - This Health Promotion Program will decrease hypertension through successfully helping people increase their exercise activity level through program design, which utilizes the constructs of the SEM. Important aspects of this program include (construct of the SEM noted in parentheses): 1) education and goal-setting (intrapersonal) for the purpose of increasing awareness and empowering individuals, 2) group sessions and discussion (interpersonal), which help to foster accountability through peer influence and social support, 3) educating community leaders (community)– to serve as role models to promote change, 4) (public policy) – the promotion of the CDC recommendation.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/fampra/cmt009", "ISSN" : "0263-2136", "author" : [ { "dropping-particle" : "", "family" : "Russell", "given" : "H. a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rufus", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fogarty", "given" : "C. 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The US Army Surgeon General's vision to transition from a health care system to a system of health requires the identification of key health enablers to facilitate the adoption of healthy behaviors. In support of this vision, the US Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled \"Incentives to Create and Sustain Change for Health.\" Members of government and academia participated to identify key health enablers that could ultimately be leveraged by technology. The key health enablers discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior-change intervention, and (5) the role of peer and social networks on change. 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Mindfulness will be promoted through stress reduction techniques, body awareness, and mindfulness training in an effort to empower participants to make healthy choices.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.4278/ajhp.120221-QUAN-101", "ISBN" : "0890-1171", "ISSN" : "0890-1171", "PMID" : "23470189", "abstract" : "PURPOSE: To ascertain the effectiveness of a behavior-change weight management program offered to teachers and state employees in North Carolina (NC).\\n\\nDESIGN: Fifteen-week weight management program with premeasures and postmeasures.\\n\\nSETTING: State agencies and public K-12 schools in five NC counties.\\n\\nSUBJECTS: A total of 2574 NC state employees enrolled in 141 classes.\\n\\nINTERVENTION: Eat Smart, Move More, Weigh Less (ESMMWL) is a 15-week weight management program delivered by trained instructors. Lessons inform, empower, and motivate participants to live mindfully as they make choices about eating and physical activity.\\n\\nMEASURES: Height, weight, body mass index (BMI), waist circumference, blood pressure, confidence in ability to eat healthy and be physically active, changes in eating, and physical activity behaviors.\\n\\nANALYSIS: Descriptive statistics, t-tests, \u03c7(2) tests, and analyses of variance.\\n\\nRESULTS: Data are reported for 1341 participants in ESMMWL who completed the program, submitted an evaluation, and had not participated in the program in the past; 89% were female and mean age was 48.8 years. Average BMI and waist circumference decreased significantly. Confidence in eating healthfully and being physically active increased significantly. The percentage of participants with a BMI < 30 kg/m(2) increased from 40% to 45% and those with a normal blood pressure increased from 23% to 32.5%. Participants reported being more mindful of what and how much they ate (92%), being more mindful of how much daily physical activity they got (88%), and eating fewer calories (87.3%).\\n\\nCONCLUSION: This project demonstrated the feasibility of implementing a behavior change-based weight management program at the worksite to achieve positive outcomes related to weight, blood pressure, healthy eating, and physical activity behaviors. Programs such as this have the potential to provide health care cost savings.", "author" : [ { "dropping-particle" : "", "family" : "Dunn", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Whetstone", "given" : "Lauren Mackenzie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolasa", "given" : "Kathryn M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jayaratne", "given" : "K S U Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "Cathy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aggarwal", "given" : "Surabhi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herget", "given" : "Casey", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rogers", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American journal of health promotion : AJHP", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "378-83", "title" : "Delivering a behavior-change weight management program to teachers and state employees in North Carolina.", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "16", "plainTextFormattedCitation" : "16", "previouslyFormattedCitation" : "16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }16 Another part of the program will be to connect participants to resources if barriers are found. For example, if the participant smokes and is having trouble quitting, the program will refer this participant to a smoking cessation program. If the participant is unable to purchase proper footwear, the program will connect the participant with Fleet Feet on Harvey Street, which has donation programs.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "11", "9" ] ] }, "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Mission: Feet First Fittings & Shoe Donations - Fleet Feet Winston-Salem", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "29", "plainTextFormattedCitation" : "29", "previouslyFormattedCitation" : "29" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }29 Funding for equipment, incentives, employees, and leasing of space will be provided for through a grant, which has been obtained for 3 years with a clause to extend for an additional 5 years if program goals are met. Part 4: Program EvaluationThe Health Promotion Program attempts to counter the trend of increasing inactivity and hypertension, expecting to reverse/reduce hypertension among participants. However, an evaluation naturally needs to be conducted to gain insight into the feasibility of this program and the quality and effectiveness need to be determined and possibly redirected as this program is in its infancy and is getting ready to launch.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1057-5987", "PMID" : "10499397", "abstract" : "Effective program evaluation is a systematic way to improve and account for public health actions by involving procedures that are useful, feasible, ethical, and accurate. The framework guides public health professionals in their use of program evaluation. It is a practical, nonprescriptive tool, designed to summarize and organize essential elements of program evaluation. The framework comprises steps in program evaluation practice and standards for effective program evaluation. Adhering to the steps and standards of this framework will allow an understanding of each program's context and will improve how program evaluations are conceived and conducted. Furthermore, the framework encourages an approach to evaluation that is integrated with routine program operations. The emphasis is on practical, ongoing evaluation strategies that involve all program stakeholders, not just evaluation experts. Understanding and applying the elements of this framework can be a driving force for planning effective public health strategies, improving existing programs, and demonstrating the results of resource investments.", "author" : [ { "dropping-particle" : "", "family" : "Centers for Disease Control and Prevention", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control", "id" : "ITEM-1", "issue" : "RR-11", "issued" : { "date-parts" : [ [ "1999" ] ] }, "number-of-pages" : "1-40", "title" : "Framework for program evaluation in public health.", "type" : "report", "volume" : "48" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "30", "plainTextFormattedCitation" : "30", "previouslyFormattedCitation" : "30" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }30 Stakeholders to benefit from this evaluation are those involved with program operations (program director, PTs, funding agencies, collaborating agencies), insurance companies, evaluators, and individual program participants.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1057-5987", "PMID" : "10499397", "abstract" : "Effective program evaluation is a systematic way to improve and account for public health actions by involving procedures that are useful, feasible, ethical, and accurate. The framework guides public health professionals in their use of program evaluation. It is a practical, nonprescriptive tool, designed to summarize and organize essential elements of program evaluation. The framework comprises steps in program evaluation practice and standards for effective program evaluation. Adhering to the steps and standards of this framework will allow an understanding of each program's context and will improve how program evaluations are conceived and conducted. Furthermore, the framework encourages an approach to evaluation that is integrated with routine program operations. The emphasis is on practical, ongoing evaluation strategies that involve all program stakeholders, not just evaluation experts. Understanding and applying the elements of this framework can be a driving force for planning effective public health strategies, improving existing programs, and demonstrating the results of resource investments.", "author" : [ { "dropping-particle" : "", "family" : "Koplan", "given" : "Jeffrey P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Registry", "given" : "Disease", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Milstein", "given" : "Robert L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1999" ] ] }, "page" : "1-40", "title" : "Framework for program evaluation in public health.", "type" : "article-journal", "volume" : "48" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "31", "plainTextFormattedCitation" : "31", "previouslyFormattedCitation" : "31" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }31 Nearly everyone is affected, either directly or indirectly, by hypertension as nearly one third of all adults in the U.S. are hypertensive.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIR.0000000000000152", "ISBN" : "0000000000000", "ISSN" : "0009-7322", "author" : [ { "dropping-particle" : "", "family" : "Mozaffarian", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benjamin", "given" : "E. 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K.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reeves", "given" : "M. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rodriguez", "given" : "C. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "P. D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stein", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Towfighi", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turan", "given" : "T. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Virani", "given" : "S. S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Willey", "given" : "J. Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Woo", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yeh", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turner", "given" : "M. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2015" ] ] }, "number-of-pages" : "e29-e322", "title" : "Heart Disease and Stroke Statistics--2015 Update: A Report From the American Heart Association", "type" : "book", "volume" : "131" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3 The Health Promotion Program is an evidence-based program that uses the constructs of the SEM and Health Belief Model (HBM) to address the public health issue of hypertension.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "9780470396292", "author" : [ { "dropping-particle" : "", "family" : "Strecher", "given" : "V. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rosenstock", "given" : "I. M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cambridge handbook of psychology, health and medicine", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "113\u2013117", "title" : "The health belief model", "type" : "article-journal" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "22", "plainTextFormattedCitation" : "22", "previouslyFormattedCitation" : "22" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }22 The SEM has been used to increase physical activity in populations with positive outcomes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1049732309338198", "ISBN" : "1049-7323 U6 - ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Using+a+socioecological+approach+to+examine+participation+in+sport+and+physical+activity+among+rural+adolescent+girls&rft.au=Casey%2C+Meghan&rft.au=Eime%2C+Rochelle&rft.au=Payne%2C+Warren&rft.au=Harvey%2C+Jack&rft.date=2009&rft.issn=1049-7323&rft.externalDBID=n%2Fa&rft.externalDocID=oai_arrow_nla_gov_au_1279072307209", "ISSN" : "1049-7323", "PMID" : "19556398", "abstract" : "Adolescence is a critical time for developing lifelong healthy behaviors, including active lifestyles. Participation in sport and physical activity, however, declines during adolescence, and few studies have comprehensively identified why, particularly among rural girls. This article identifies a range of independent and interacting factors that influence sport and physical activity participation of rural adolescent girls. The socioecological model of health was used to guide four focus group discussions with Grade 7 girls (n = 34). The results showed that adolescent girls were positively influenced when sports or physical activities were fun, when they involved being with friends, and when they were supported by families and teachers through role modeling and positive feedback. A range of intrapersonal and organizational factors affected perceived self-competence, particularly the coeducational nature of school physical education classes and peer teasing, which supported social comparisons of skill level. In promoting sport and physical activity to rural adolescent girls, focus must be directed on developmentally appropriate activities that are fun, offering opportunities for single-sex classes, and generating cultural changes that encourage noncompetitive and self-referencing activities.", "author" : [ { "dropping-particle" : "", "family" : "Casey", "given" : "Meghan M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Eime", "given" : "Rochelle M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Payne", "given" : "Warren R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harvey", "given" : "Jack T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Qualitative health research", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "881-893", "title" : "Using a socioecological approach to examine participation in sport and physical activity among rural adolescent girls.", "type" : "article-journal", "volume" : "19" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "21", "plainTextFormattedCitation" : "21", "previouslyFormattedCitation" : "21" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }21 The HBM has been successful at increasing perceived benefits of balance to reduce falls in older adults and jogging to reduce blood sugar of people with type II diabetes.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "2074-1812", "PMID" : "22997561", "abstract" : "BACKGROUND: Researchers believe that most of diabetic patients are not necessarily aware of the role of exercises, especially jogging in controlling their disease. The purpose of this study was to evaluate the effect of educational program and jogging based on health belief model (HBM) on sugar control in type 2 diabetic patients.\\n\\nMETHODS: One hundred diabetic (type 2) patients were involved in this prospective quasi-experimental interventional study. Patients were randomly divided into two groups of experimental and control. Data was collected using a questionnaire based on the HBM model, a check list for patient`s practices and a check list for recording the patient`s hemoglobin (HbA1C) and fasting blood sugar (FBS) levels.\\n\\nRESULTS: Our findings indicated that after intervention, there was a significant difference between the mean score of the HBM model variables (susceptibility, severity, benefit and perceived obstacles,) in the experimental group compared to the control group. Additionally, behavioral jogging, level of HbA1C and FBS levels improved significantly among the experimental group when compared to the control group.\\n\\nCONCLUSION: Applying the HBM model was found to be a very effective means for developing an educational program of jogging for diabetics, in order to control their blood sugar.", "author" : [ { "dropping-particle" : "", "family" : "Kashfi", "given" : "S M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Khani Jeihooni", "given" : "a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rezaianzadeh", "given" : "a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Amini", "given" : "Sh", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Iranian Red Crescent medical journal", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "442-6", "title" : "The effect of health belief model educational program and jogging on control of sugar in type 2 diabetic patients.", "type" : "article-journal", "volume" : "14" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.ypmed.2012.07.007", "ISBN" : "0091-7435", "ISSN" : "00917435", "PMID" : "22813920", "abstract" : "Objective: To determine whether adherence to home exercise interventions for the prevention of falls in older adults relates to home exercise program characteristics and intervention efficacy. Methods: In Australia (2011) a systematic literature search of four databases was conducted. Randomized controlled trials were included. Random-effects meta-analysis of participant adherence rates was performed. Meta-regression analyses were used to determine the relationship between intervention program characteristics, intervention efficacy and adherence. Results: Twenty-three studies met the inclusion criteria. The pooled estimate of participants who were fully adherent was 21% (95% Confidence Interval: 15%-29%, range: 0%-68%). Higher levels of full adherence were found in interventions containing balance or walking exercise, moderate home visit support, physiotherapist led delivery and no flexibility training. Higher levels of partial adherence were found in interventions containing home visit or telephone support, a participant health service recruitment approach and no group exercise training. Neither full nor partial adherence to prescribed home exercise program dosages was associated with intervention efficacy. Conclusion: Adherence to home exercise for the prevention of falls in older adults is low and may be affected by home exercise program characteristics. There is an absence of evidence to link adherence to intervention efficacy. ?? 2012 Elsevier Inc.", "author" : [ { "dropping-particle" : "", "family" : "Simek", "given" : "Emily M.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McPhate", "given" : "Lucy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Haines", "given" : "Terry P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Preventive Medicine", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "262-275", "publisher" : "Elsevier Inc.", "title" : "Adherence to and efficacy of home exercise programs to prevent falls: A systematic review and meta-analysis of the impact of exercise program characteristics", "type" : "article-journal", "volume" : "55" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "32,33", "plainTextFormattedCitation" : "32,33", "previouslyFormattedCitation" : "32,33" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }32,33 Another strength is the cost, which is free to participants. A study by Yancey et al. found that a free gym membership was the motivating factor compared to education and social support for participation in an 8-week program targeted toward increasing activity.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1089/jwh.2006.15.412", "ISBN" : "1540-9996", "ISSN" : "1540-9996", "PMID" : "16724889", "abstract" : "OBJECTIVE: This study tested the efficacy of an 8-week culturally targeted nutrition and physical activity intervention on body composition. METHODS: A randomized, attention-controlled, two-group trial was conducted in a blackowned commercial gym with a sample of 366 predominantly healthy, obese African American women. A free 1-year membership to the study site gym was provided to participants in both groups. Data were collected at baseline, 2, 6, and 12 months. RESULTS: Sample retention at 1 year was 71%. Between-group longitudinal analysis including only participants with complete data revealed a trend toward weight stability in the intervention group at 2 months compared with controls (+0.05 kg/m(2), p = 0.75; +0.32 kg/m(2), p = 0.08, respectively), disappearing at 12 months (+1.37 kg/m(2), p = 0.0001; +1.02 kg/m(2), p = 0.001, respectively). Within-group analysis demonstrated that intervention and control participants' fitness (1-mile run-walk) improved by 1.9 minutes (p = 0.0001) and 2.3 minutes (p = 0.0001), respectively, at 12 months. Mixed model regression analyses demonstrated a significant main effect of the intervention on fitness (p = 0.0185) and a marginally significant effect on body mass index (BMI) (p = 0.057), at 2 months, disappearing by 6 months. By 12 months, however, the controls exhibited a significant advantage in waist circumference stability compared with intervention participants (+1.1 cm, p = 0.2763; +2.1 cm, p = 0.0002, respectively). CONCLUSIONS: The intervention produced modest short-term improvements in body composition, but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested. However, longer-term fitness enhancement remains elusive and demands research and policy attention. These findings have policy implications in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change (e.g., physical or social/environmental) to foster sustainable fitness improvements.", "author" : [ { "dropping-particle" : "", "family" : "Yancey", "given" : "Antronette K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McCarthy", "given" : "William J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harrison", "given" : "Gail G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wong", "given" : "Weng Kee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Siegel", "given" : "Judith M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Leslie", "given" : "Joanne", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of women's health (2002)", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2006" ] ] }, "page" : "412-429", "title" : "Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention.", "type" : "article-journal", "volume" : "15" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "34", "plainTextFormattedCitation" : "34", "previouslyFormattedCitation" : "34" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }34 In this same vein, the Health Promotion Program uses incentives, such as activity trackers and individualized PT sessions to motivate participants. Furthermore, the program addresses smoking cessation through referral and stress reduction through mindfulness training.The goals of the Health Promotion Program are measureable. Many short-term program goals (1 year or less) have been accurately described and if met, there is agreement that these would be appropriate program success measures to use. However, the overall goal of the program is prevention, which needs to be addressed in order to accurately measure success. However, it is understood that measuring over the long term is not without its difficulties. It is recommended that a long-term outcome measure be used at 1 year, 5 year, 10 year, and 15 year follow up, measuring if a participant is able to sustain behavioral changes promoted through this program as measured through a verbal or written response and continued ‘normal’ blood pressure readings (Appendix B) at these time periods.The Health Promotion Program has targeted North Carolina’s 4th largest city and recently partnered with Green Street Church in Winston-Salem where sessions will be held one time per week.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "12", "3" ] ] }, "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Populations of North Carolina (NC) Cities - ranked by Population Size", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "35", "plainTextFormattedCitation" : "35", "previouslyFormattedCitation" : "35" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }35 However, it is unknown whether community members in this area will be receptive to this program. As such, an additional evaluation will further assess the needs and desires (feasibility) of the community members through a survey, which is currently being conducted by the evaluators in the 3 areas of Winston-Salem identified for implementation of this program.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1057-5987", "PMID" : "10499397", "abstract" : "Effective program evaluation is a systematic way to improve and account for public health actions by involving procedures that are useful, feasible, ethical, and accurate. The framework guides public health professionals in their use of program evaluation. It is a practical, nonprescriptive tool, designed to summarize and organize essential elements of program evaluation. The framework comprises steps in program evaluation practice and standards for effective program evaluation. Adhering to the steps and standards of this framework will allow an understanding of each program's context and will improve how program evaluations are conceived and conducted. Furthermore, the framework encourages an approach to evaluation that is integrated with routine program operations. The emphasis is on practical, ongoing evaluation strategies that involve all program stakeholders, not just evaluation experts. Understanding and applying the elements of this framework can be a driving force for planning effective public health strategies, improving existing programs, and demonstrating the results of resource investments.", "author" : [ { "dropping-particle" : "", "family" : "Centers for Disease Control and Prevention", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control", "id" : "ITEM-1", "issue" : "RR-11", "issued" : { "date-parts" : [ [ "1999" ] ] }, "number-of-pages" : "1-40", "title" : "Framework for program evaluation in public health.", "type" : "report", "volume" : "48" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "30", "plainTextFormattedCitation" : "30", "previouslyFormattedCitation" : "30" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }30 The number of surveys sent to each of the 3 areas was 1000 (a total of 3000), with a ≥25% interest out of the overall responses received will be considered significant and therefore worthy of implementation. If there is less than a 25% interest based on survey responses, then the revised evaluation report will possibly recommend changes in the areas targeted for implementation or possibly changes to the program according to responses obtained, such as expanding the age limits as indicated below or offering virtual lessons. This programs targets 45-60 year olds, which according to the graph in the appendix C is appropriate, however, it is uncertain whether this targeted lifespan is ideal for a preventative program as it may be harder for these individuals to sustain behavioral changes and it may miss opportunities with younger and older hypertensive individuals that could potentially benefit. The statistics state that almost one out of three individuals over the age of 19 is hypertensive, so, if the basis of this program is prevention, it may benefit recruitment efforts and result in a greater reduction in hypertension if the targeted age is expanded to include individuals with hypertension at any age over 19.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIR.0000000000000152", "ISBN" : "0000000000000", "ISSN" : "0009-7322", "author" : [ { "dropping-particle" : "", "family" : "Mozaffarian", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benjamin", "given" : "E. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Go", "given" : "a. S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arnett", "given" : "D. 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J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sorlie", "given" : "P. D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stein", "given" : "J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Towfighi", "given" : "a.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turan", "given" : "T. N.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Virani", "given" : "S. S.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Willey", "given" : "J. Z.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Woo", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yeh", "given" : "R. W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Turner", "given" : "M. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Circulation", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2015" ] ] }, "number-of-pages" : "e29-e322", "title" : "Heart Disease and Stroke Statistics--2015 Update: A Report From the American Heart Association", "type" : "book", "volume" : "131" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3 LimitationsWhile the Health Promotion Program utilizes the constructs of the SEM model and the HBM in order to elicit sustained behavioral changes among participants, one of the major limitations is that it attempts to do this mainly through only one intervention -increasing activity. However, while increasing activity has been shown to be beneficial, if a participant is not getting the proper nutrition, the effects of the increased activity may be negated. Other successful programs have incorporated multiple factors to reduce hypertension. For example, Dr. Ornish’s program and the Eat Smart Move More Weigh Less, which the Health Promotion Program purports to be based on, use exercise as well as eating healthy, smoking cessation, and stress reduction.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1097/00008483-199905000-00016", "ISBN" : "0098-7484", "ISSN" : "0883-9212", "PMID" : "9863851", "abstract" : "CONTEXT: The Lifestyle Heart Trial demonstrated that intensive lifestyle changes may lead to regression of coronary atherosclerosis after 1 year. OBJECTIVES: To determine the feasibility of patients to sustain intensive lifestyle changes for a total of 5 years and the effects of these lifestyle changes (without lipid-lowering drugs) on coronary heart disease. DESIGN: Randomized controlled trial conducted from 1986 to 1992 using a randomized invitational design. PATIENTS: Forty-eight patients with moderate to severe coronary heart disease were randomized to an intensive lifestyle change group or to a usual-care control group, and 35 completed the 5-year follow-up quantitative coronary arteriography. SETTING: Two tertiary care university medical centers. INTERVENTION: Intensive lifestyle changes (10% fat whole foods vegetarian diet, aerobic exercise, stress management training, smoking cessation, group psychosocial support) for 5 years. MAIN OUTCOME MEASURES: Adherence to intensive lifestyle changes, changes in coronary artery percent diameter stenosis, and cardiac events. RESULTS: Experimental group patients (20 [71%] of 28 patients completed 5-year follow-up) made and maintained comprehensive lifestyle changes for 5 years, whereas control group patients (15 [75%] of 20 patients completed 5-year follow-up) made more moderate changes. In the experimental group, the average percent diameter stenosis at baseline decreased 1.75 absolute percentage points after 1 year (a 4.5% relative improvement) and by 3.1 absolute percentage points after 5 years (a 7.9% relative improvement). In contrast, the average percent diameter stenosis in the control group increased by 2.3 percentage points after 1 year (a 5.4% relative worsening) and by 11.8 percentage points after 5 years (a 27.7% relative worsening) (P=.001 between groups. Twenty-five cardiac events occurred in 28 experimental group patients vs 45 events in 20 control group patients during the 5-year follow-up (risk ratio for any event for the control group, 2.47 [95% confidence interval, 1.48-4.20]). CONCLUSIONS: More regression of coronary atherosclerosis occurred after 5 years than after 1 year in the experimental group. In contrast, in the control group, coronary atherosclerosis continued to progress and more than twice as many cardiac events occurred.", "author" : [ { "dropping-particle" : "", "family" : "Ornish", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Scherwitz", "given" : "L W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Billings", "given" : "J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brown", "given" : "S E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gould", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merritt", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sparler", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Armstrong", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ports", "given" : "T a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kirkeeide", "given" : "R L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hogeboom", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brand", "given" : "R J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "JAMA : the journal of the American Medical Association", "id" : "ITEM-1", "issue" : "23", "issued" : { "date-parts" : [ [ "1998" ] ] }, "page" : "2001-2007", "title" : "Intensive lifestyle changes for reversal of coronary heart disease.", "type" : "article-journal", "volume" : "280" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.4278/ajhp.120221-QUAN-101", "ISBN" : "0890-1171", "ISSN" : "0890-1171", "PMID" : "23470189", "abstract" : "PURPOSE: To ascertain the effectiveness of a behavior-change weight management program offered to teachers and state employees in North Carolina (NC).\\n\\nDESIGN: Fifteen-week weight management program with premeasures and postmeasures.\\n\\nSETTING: State agencies and public K-12 schools in five NC counties.\\n\\nSUBJECTS: A total of 2574 NC state employees enrolled in 141 classes.\\n\\nINTERVENTION: Eat Smart, Move More, Weigh Less (ESMMWL) is a 15-week weight management program delivered by trained instructors. Lessons inform, empower, and motivate participants to live mindfully as they make choices about eating and physical activity.\\n\\nMEASURES: Height, weight, body mass index (BMI), waist circumference, blood pressure, confidence in ability to eat healthy and be physically active, changes in eating, and physical activity behaviors.\\n\\nANALYSIS: Descriptive statistics, t-tests, \u03c7(2) tests, and analyses of variance.\\n\\nRESULTS: Data are reported for 1341 participants in ESMMWL who completed the program, submitted an evaluation, and had not participated in the program in the past; 89% were female and mean age was 48.8 years. Average BMI and waist circumference decreased significantly. Confidence in eating healthfully and being physically active increased significantly. The percentage of participants with a BMI < 30 kg/m(2) increased from 40% to 45% and those with a normal blood pressure increased from 23% to 32.5%. Participants reported being more mindful of what and how much they ate (92%), being more mindful of how much daily physical activity they got (88%), and eating fewer calories (87.3%).\\n\\nCONCLUSION: This project demonstrated the feasibility of implementing a behavior change-based weight management program at the worksite to achieve positive outcomes related to weight, blood pressure, healthy eating, and physical activity behaviors. Programs such as this have the potential to provide health care cost savings.", "author" : [ { "dropping-particle" : "", "family" : "Dunn", "given" : "Carolyn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Whetstone", "given" : "Lauren Mackenzie", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kolasa", "given" : "Kathryn M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jayaratne", "given" : "K S U Jay", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "Cathy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Aggarwal", "given" : "Surabhi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Herget", "given" : "Casey", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rogers", "given" : "Anne B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American journal of health promotion : AJHP", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "378-83", "title" : "Delivering a behavior-change weight management program to teachers and state employees in North Carolina.", "type" : "article-journal", "volume" : "27" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "8,16", "plainTextFormattedCitation" : "8,16", "previouslyFormattedCitation" : "8,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }8,16 While stress reduction and smoking cessation are addressed; the extent and details of stress reduction may need to be clarified. Additionally, one of the goals of the program is to meet the CDC’s activity recommendations in regards to aerobic activity, however, the strength component of the recommendations are not addressed and may be important to incorporate.Another limitation is that potential participants may feel the length of time (20 weeks) is too long, which may deter recruitment and increase dropout rate. The program is free, which is a positive, but may also be a limitation. For example, if participants have not put forth any monetary value toward the program it may be easier to drop out, as they may not feel invested in the program. Also, it is unknown whether the current funding through the 3-year grant of the Health Promotion Program is sustainable, which may negatively impact the program’s future. ConclusionThe Health Promotion Program helps participants learn more about the risks of hypertension and benefits of exercise through education and promotes increasing activity in order to lower blood pressure in a targeted population of 45-60 year olds in Winston-Salem, NC and was developed by physical therapists to ultimately prevent secondary conditions, including, surgical procedures, stroke, and heart failure, which are caused by hypertension.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1002/14651858.CD003075.pub2", "ISBN" : "1469-493X (Electronic)\\r1361-6137 (Linking)", "PMID" : "19821300", "abstract" : "BACKGROUND: Peripheral arterial disease (PAD) causes considerable morbidity and mortality. Hypertension is a risk factor for PAD. Treatment for hypertension must be compatible with the symptoms of PAD. Controversy regarding the effects of beta-blockade for hypertension in patients with PAD has led many physicians to stop prescribing beta-blockers. Little is known about the effects of other classes of anti-hypertensive drugs in the presence of PAD. This is an update of a Cochrane review first published in 2003. OBJECTIVES: To determine the effects of anti-hypertensive drugs on cardiovascular events and death, symptoms of claudication, critical leg ischaemia, progression of PAD and revascularisation or amputation in people with hypertension and PAD SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched May 2009) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2). The authors studied abstracts of cardiology meetings. SELECTION CRITERIA: Randomised controlled trials of at least one anti-hypertensive treatment against placebo, or two anti-hypertensive medications against each other, with interventions lasting at least one month. Trials had to include patients with symptomatic PAD. DATA COLLECTION AND ANALYSIS: Data were extracted by one author (DAL) and checked by the other (GYHL). Eligible studies were excluded when results presentation prevented adequate extraction of data and enquiries to authors did not yield raw data. MAIN RESULTS: Four studies were included. Two compared ACE inhibitors against placebo. In the HOPE study there was a significant reduction in the number of cardiovascular events in 168 patients receiving ramipril (OR 0.72, 95% confidence interval 0.58 to 0.91). In the second trial using perindopril in a small numbers of patients, there was a marginal increase in claudication distance but no change in ankle brachial pressure index (ABPI) and a reduction in maximum walking distance.The third trial in patients undergoing angioplasty suggested that the calcium antagonist verapamil reduced restenosis, although this was not reflected in the maintenance of a high ABPI. Another small study demonstrated no significant difference in arterial intima-media thickness with men receiving the thiazide diuretic hydrochlorathiazide compared to those receiving the alpha-adrenoreceptor blocker doxazosin. AUTHORS' CONCLUSIONS: Evidence on various anti-hyperten\u2026", "author" : [ { "dropping-particle" : "", "family" : "Lane", "given" : "D a", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lip", "given" : "G Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cochrane Database Syst Rev", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "CD003075", "title" : "Treatment of hypertension in peripheral arterial disease", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2015", "10", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Staff", "given" : "Mayo Clinic", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "title" : "High blood pressure (hypertension) - Mayo Clinic", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "9,10", "plainTextFormattedCitation" : "9,10", "previouslyFormattedCitation" : "9,10" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }9,10 The Health Promotion Program makes a strong case for the need of this program. There are many strengths of this program, like using proven behavioral models to target and influence multiple constructs of individual participants for maximal influence, using rewards, making it free to participants for increased appeal, using groups to influence motivation, and using goals and activity tracking. Also, it should be pointed out the ‘break’ is unique to this program and is considered a strength because it should allow the participants to experience some of the struggles and possible barriers, which can be addressed during the second session. Recommendations for program adaptation and advancement include: using text messages and email blasts to participants for increased motivation and support, both of which have been shown to be effective enablers for increasing activity.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2519/jospt.2014.0301", "ISSN" : "1938-1344", "PMID" : "24787328", "abstract" : "The increases in preventable chronic diseases and the rising costs of health care are unsustainable. The US Army Surgeon General's vision to transition from a health care system to a system of health requires the identification of key health enablers to facilitate the adoption of healthy behaviors. In support of this vision, the US Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled \"Incentives to Create and Sustain Change for Health.\" Members of government and academia participated to identify key health enablers that could ultimately be leveraged by technology. The key health enablers discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior-change intervention, and (5) the role of peer and social networks on change. 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The results of the current survey will be analyzed once all are received and added to our current recommendation. Overall, we have deemed the quality of this program to be moderate-high (6/10 rating), it appears to be feasible, and the obvious need for the implementation of this program is undoubtedly worth the investment. APPENDIXA. Chart showing the heavy economic cost of hypertension in the U.S. in billions, stressing the need for this preventative health program.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1161/CIR.0000000000000152", "ISBN" : "0000000000000", "ISSN" : "0009-7322", "author" : [ { "dropping-particle" : "", "family" : "Mozaffarian", "given" : "D.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Benjamin", "given" : "E. J.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Go", "given" : "a. 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Blood Pressure Normal: 120mmHg/80mmHgPrehypertensive: >120mmHg/80mmHg-139.9mmHg/89.9mmHgHypertension defined:ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1056/NEJMsa1406751", "ISSN" : "0028-4793", "author" : [ { "dropping-particle" : "", "family" : "Moran", "given" : "Andrew E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Odden", "given" : "Michelle C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thanataveerat", "given" : "Anusorn", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tzong", "given" : "Keane Y.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rasmussen", "given" : "Petra W.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Guzman", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Williams", "given" : "Lawrence", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bibbins-Domingo", "given" : "Kirsten", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coxson", "given" : "Pamela G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Goldman", "given" : "Lee", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "New England Journal of Medicine", "id" : "ITEM-1", "issue" : "5", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "447-455", "title" : "Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines", "type" : "article-journal", "volume" : "372" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "36", "plainTextFormattedCitation" : "36", "previouslyFormattedCitation" : "39" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }36dic Stage 1: > 140 mmHg/90 mmHgStage 2: >160 mmHg/100 mmHgC. Main goal is Prevention, targeting Middle-Aged Adult (45-60 years) prior to the accumulation of chronic health conditions which will increase health costs (see “Health Policy in Perspective” below).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1080/09593980802668027", "ISBN" : "1532-5040 (Electronic)\\r0959-3985 (Linking)", "ISSN" : "1532-5040", "PMID" : "19842862", "abstract" : "Part I of this two-part introduction to this Special Issue on the practice of physical therapy in the 21st century outlines the epidemiological basis and rationale for evidence-informed physical therapy practice for addressing contemporary health priorities. This evidence emanates from the definition of health by the World Health Organization (WHO) and the International Classification of Functioning (ICF), and WHO and other international databases on the prevalence of lifestyle conditions. Lifestyle conditions include ischemic heart disease, smoking-related conditions, hypertension and stroke, obesity, diabetes, and cancer. Epidemiological data combined with evidence supporting the effectiveness of noninvasive interventions related to physical therapy to address these priorities (e.g., health education and exercise) are highly consistent with the promotion of health and wellness and the ICF. Given their commitment to exploiting effective noninvasive interventions, physical therapists are in a preeminent position to focus on prevention of these disabling and lethal conditions in every client or patient, their cure in some cases, as well as their management. Thus, a compelling argument can be made that clinical competencies in 21st century physical therapy need to include assessment of smoking and smoking cessation (or at least its initiation), basic nutritional assessment and counseling, recommendations for physical activity and exercise, stress assessment and basic stress reduction recommendations, and sleep assessment and basic sleep hygiene recommendations. The physical therapist can then make an informed clinical judgment regarding whether a client or patient needs to be referred to another professional related to one or more of these specialty areas. The prominence of physical therapy as an established health care profession and its unique pattern of practice (prolonged visits over prolonged periods of time) attest further to the fact that physical therapists are uniquely qualified to lead in the assault on lifestyle conditions. Evidence-based physical therapy practiced within the context of epidemiological indicators (i.e., evidence-informed practice) maximally empowers clinicians to promote lifelong health in every person and in turn, the health of communities. This vision of physical therapy's leading role in health promotion and health care in the 21st century holds the promise of reducing the need for invasive health interventions (drugs and su\u2026", "author" : [ { "dropping-particle" : "", "family" : "Dean", "given" : "Elizabeth", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Physiotherapy theory and practice", "id" : "ITEM-1", "issue" : "5-6", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "330-353", "title" : "Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions.", "type" : "article-journal", "volume" : "25" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "37", "plainTextFormattedCitation" : "37", "previouslyFormattedCitation" : "40" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }37References:ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Rossi A, Dikareva A, Bacon SL, Daskalopoulou SS. The impact of physical activity on mortality in patients with high blood pressure. J Hypertens. 2012;30(7):1277-1288. doi:10.1097/HJH.0b013e3283544669.2. Chandrasekaran B, Arumugam A, Davis F, et al. Resistance exercise training for hypertension (Protocol). Cochrane Database Syst Rev. 2010;(11). doi:10.1002/14651858.CD008822.3. Mozaffarian D, Benjamin EJ, Go a. S, et al. Heart Disease and Stroke Statistics--2015 Update: A Report From the American Heart Association. Vol 131. 2015. doi:10.1161/CIR.0000000000000152.4. Wen CP, Wu X. Stressing harms of physical inactivity to promote exercise. Lancet. 2012;380(9838):192-193. doi:10.1016/S0140-6736(12)60954-4.5. Johnson MP, Abrams SL. Historical perspectives of autonomy within the medical profession: considerations for 21st century physical therapy practice. J Orthop Sports Phys Ther. 2005;35(10):628-636. doi:10.2519/jospt.2005.2085.6. Ornish D. Intensive lifestyle changes and health reform. Lancet Oncol. 2009;10(7):638-639. doi:10.1016/S1470-2045(09)70175-5.7. Ornish D. Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Am J Cardiol. 1998;82(10B):72T - 76T. doi:10.1016/S0002-9149(98)00744-9.8. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280(23):2001-2007. doi:10.1097/00008483-199905000-00016.9. Staff MC. High blood pressure (hypertension) - Mayo Clinic. 2015. . Accessed October 8, 2015.10. Lane D a, Lip GY. Treatment of hypertension in peripheral arterial disease. Cochrane Database Syst Rev. 2009;(4):CD003075. doi:10.1002/14651858.CD003075.pub2.11. Murray CJL, Kulkarni SC, Michaud C, et al. Eight Americas: Investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006;3(9):1513-1524. doi:10.1371/journal.pmed.0030260.12. QuickFacts. . Accessed November 7, 2015.13. Bellamy J. Vision Statement for the Physical Therapy Profession and Guiding Principles to Achieve the Vision. . Accessed October 10, 2015.14. Rhodes RE, Fiala B. Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence. Physiother Theory Pract. 2009;25(5-6):424-441. doi:10.1080/09593980902835344.15. Ornish D, Brown SE, Billings JH, et al. Can lifestyle changes reverse coronary heart disease? Lancet. 1990;336(8708):129-133. doi:10.1016/0140-6736(90)91656-U.16. Dunn C, Whetstone LM, Kolasa KM, et al. Delivering a behavior-change weight management program to teachers and state employees in North Carolina. Am J Health Promot. 2013;27(6):378-383. doi:10.4278/ajhp.120221-QUAN-101.17. Dunn C, Kolasa KM, Vodicka S, et al. Eat Smart, Move More, Weigh Less a weight management program for adults-revision of curriculum based on first-year pilot. J Ext. 2011;49(6):9-14. 18. Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. Heal Behav Heal Educ Theory Res Pract. 2008;4:465-482. doi:465-482.19. McLeroy KR, Bibeau D, Steckler a, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351-377. doi:10.1177/109019818801500401.20. Robinson T. Applying the socio-ecological model to improving fruit and vegetable intake among low-income African Americans. J Community Health. 2008;33(6):395-406. doi:10.1007/s10900-008-9109-5.21. Casey MM, Eime RM, Payne WR, Harvey JT. Using a socioecological approach to examine participation in sport and physical activity among rural adolescent girls. Qual Health Res. 2009;19(7):881-893. doi:10.1177/1049732309338198.22. Strecher VJ, Rosenstock IM. The health belief model. Cambridge Handb Psychol Heal Med. 2008:113-117. 23. Cleland CL, Hunter RF, Tully M a, et al. Identifying solutions to increase participation in physical activity interventions within a socio-economically disadvantaged community: a qualitative study. Int J Behav Nutr Phys Act. 2014;11(1):68. doi:10.1186/1479-5868-11-68.24. Russell H a., Rufus C, Fogarty CT, Fiscella K, Carroll J. “You need a support. When you don”t have that . . . chocolate looks real good’. Barriers to and facilitators of behavioural changes among participants of a Healthy Living Program. Fam Pract. 2013;30(4):452-458. doi:10.1093/fampra/cmt009.25. Wilcox S, Parrott A, Baruth M, et al. The Faith, Activity, and Nutrition Program. Am J Prev Med. 2013;44(2):122-131. doi:10.1016/j.amepre.2012.09.062.26. Mick Cornett: How an obese town lost a million pounds | TED Talk | . . Accessed October 5, 2015.27. Needs for Adults | Physical Activity | DNPAO | CDC. . Accessed October 10, 2015.28. Teyhen DS, Aldag M, Centola D, et al. Key enablers to facilitate healthy behavior change: workshop summary. J Orthop Sports Phys Ther. 2014;44(5):378-387. doi:10.2519/jospt.2014.0301.29. Mission: Feet First Fittings & Shoe Donations - Fleet Feet Winston-Salem. . Accessed November 9, 2015.30. Centers for Disease Control and Prevention. Framework for Program Evaluation in Public Health. Vol 48. 1999. 31. Koplan JP, Registry D, Milstein RL. Framework for program evaluation in public health. MMWR Recomm Rep. 1999;48:1-40. 32. Kashfi SM, Khani Jeihooni a, Rezaianzadeh a, Amini S. The effect of health belief model educational program and jogging on control of sugar in type 2 diabetic patients. Iran Red Crescent Med J. 2012;14(7):442-446. 33. Simek EM, McPhate L, Haines TP. Adherence to and efficacy of home exercise programs to prevent falls: A systematic review and meta-analysis of the impact of exercise program characteristics. Prev Med (Baltim). 2012;55(4):262-275. doi:10.1016/j.ypmed.2012.07.007.34. Yancey AK, McCarthy WJ, Harrison GG, Wong WK, Siegel JM, Leslie J. Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention. J Womens Health (Larchmt). 2006;15(4):412-429. doi:10.1089/jwh.2006.15.412.35. Populations of North Carolina (NC) Cities - ranked by Population Size. . Accessed December 3, 2015.36. Moran AE, Odden MC, Thanataveerat A, et al. Cost-Effectiveness of Hypertension Therapy According to 2014 Guidelines. N Engl J Med. 2015;372(5):447-455. doi:10.1056/NEJMsa1406751.37. Dean E. Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother Theory Pract. 2009;25(5-6):330-353. doi:10.1080/09593980802668027. ................
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