Strong Hearts, Healthy Communities: A Community-Based Randomized Trial for Rural Women

OBJECTIVE: To evaluate a multilevel cardiovascular disease (CVD) prevention program for rural women. METHODS: This six-month community-based randomized trial enrolled 194 sedentary rural women aged 40 or older, with a BMI ≥ 25 kg/m(2). Intervention participants attended six months of twice-weekly exercise, nutrition, and heart health classes (48 total) that included individual-, social-, and environment-level components. An education-only control program included didactic healthy lifestyle classes once a month (6 total). The primary outcome measures were change in BMI and weight. RESULTS: Within group and between group multivariate analyses revealed that only intervention participants decreased BMI (−0.85 units; 95% CI 1.32, −0.39; p=0.001) and weight (−2.24 kg; −3.49, −0.99; p=0.002); compared to controls, intervention participants decreased BMI and weight (difference: −0.71 units; −1.35, −0.08; p=0.03 and 1.85 kg; −3.55, −0.16; p=0.03, respectively) and improved C-reactive protein (difference: −1.15; −2.16, −0.15; p=0.03) and Simple 7, a composite CVD risk score (difference=0.67; 0.14, 1.21; p=0.01). Cholesterol decreased in controls but increased among intervention (−7.85 versus 3.92; difference=11.77; 0.57, 22.96; p=0.04). CONCLUSIONS: The multilevel intervention demonstrated modest but superior and meaningful improvements in BMI and other CVD risk factors compared to the control program.