Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial

Patricia A Hageman, Carol H Pullen, Melody Hertzog, Linda S Boeckner, Patricia A Hageman, Carol H Pullen, Melody Hertzog, Linda S Boeckner

Abstract

Background: Lifestyle modification is recommended for management of prehypertension, yet finding effective interventions to reach rural women is a public health challenge. This community-based clinical trial compared the effectiveness of standard advice to two multi-component theory-based tailored interventions, using web-based or print-mailed delivery, in reducing blood pressure among rural women, ages 40-69, with prehypertension.

Methods: 289 women with prehypertension enrolled in the Wellness for Women: DASHing towards Health trial, a 12-month intervention with 12-month follow-up. Women were randomly assigned to groups using a 1:2:2 ratio, comparing standard advice (30-minute counseling session) to two interventions (two 2-hour counseling sessions, 5 phone goal-setting sessions, strength-training video, and 16 tailored newsletters, web-based or print-mailed). Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure, healthy eating and activity, adjusted for age and baseline level. General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity.

Results: Mean blood pressure reduction ranged from 3.8 (SD = 9.8) mm Hg to 8.1 (SD = 10.4) mm Hg. The 24-month estimated marginal proportions of women achieving normotensive status were 47% for web-based, and 39% for both print-mailed and standard advice groups, with no group differences (p = .11 and p = .09, respectively). Web-based and print-mailed groups improved more than standard advice group for waist circumference (p = .017 and p = .016, respectively); % daily calories from fat (p = .018 and p = .030) and saturated fat (p = .049 and p = .013); daily servings of fruit and vegetables (p = .008 and p < .005); and low fat dairy (p < .001 and p = .002). Greater improvements were observed in web-based versus standard advice groups in systolic blood pressure (p = .048) and estimated VO2max (p = .037). Dropout rates were 6% by 6-months, 11.4% by 24 months, with no differences across groups.

Conclusions: Rural women with prehypertension receiving distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status.

Trial registration: ClinicalTrials.gov NCT00580528.

Figures

Figure 1
Figure 1
Participant Flow Diagram of theWellness for Women: DASHing towards HealthClinical Trial.

References

    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green L, Izzo JL, Jr, Jones DW, Materson BJ, Oparil S, Wright JT, Jr, Roccella E. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–1252. doi: 10.1161/01.HYP.0000107251.49515.c2.
    1. Liska HA, Mainous AG, 3rd, King DE, Egan BM. Prehypertension and cardiovascular morbidity. Ann Fam Med. 2005;3:294–299. doi: 10.1370/afm.312.
    1. Vasan R, Larson M, Leip E, Evans J, O’Donnell C, Kannel W, Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291–1297. doi: 10.1056/NEJMoa003417.
    1. Mosca L, Mochari H, Christian A, Berra K, Taubert K, Mills T, Burdick KA, Simpson SL. National study of women’s awareness, preventive action, and barriers to cardiovascular health. Circulation. 2006;113(4):525–534. doi: 10.1161/CIRCULATIONAHA.105.588103.
    1. Hsia J, Margolis KL, Eaton CB, Wenger NK, Allison M, Wu L, LaCroix AZ, Black HR. Prehypertension and cardiovascular disease risk in the Women’s Health Initiative. Circulation. 2007;115(7):855–860. doi: 10.1161/CIRCULATIONAHA.106.656850.
    1. Feresu SA, Zhang W, Puumala SE, Ullrich F, Anderson JR. The frequency and distribution of cardiovascular disease risk factors among Nebraska women enrolled in the WISEWOMAN screening program. J Womens Health (Larchmt) 2008;17(4):607–617. doi: 10.1089/jwh.2007.0438.
    1. Hageman PA, Pullen CH, Walker SN, Boeckner LS. Blood pressure, fitness, and lipid profiles of rural women in the wellness for women project. Cardiopulm Phys Ther J. 2010;21(3):27–34.
    1. Fahs PS, Grabo TN, James GD, Neff-Smith M, Spencer GA. A comparison of the cardiovascular risks of rural, suburban, and urban women. Online J Rural Nurs Health Care. 2001;2(1):6–16.
    1. Befort CA, Nazier N, Perri MG. Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005–2008) J Rural Health. 2012;28:392–397. doi: 10.1111/j.1748-0361.2012.00411.x.
    1. Trivedi T, Liu J, Probst JC, Martin AB. The metabolic syndrome: are rural residents at increased risk? J Rural Health. 2013;29:188–197. doi: 10.1111/j.1748-0361.2012.00422.x.
    1. Eberhardt MS, Ingram DD, Makuc DM, Pamuk ER, Freid VM, Harper SB, Schoenborn CA, Xia H. Health, United States, 2001: Urban and Rural Health Chartbook. Hyattsville, Maryland: National Center for Health Statistics; 2001.
    1. Fahs PS, Pribulick M, Williams IC, James JD, Rovynak V, Seibold-Simposon SM. Promoting heart health in rural women. J Rural Health. 2013;29:248–257. doi: 10.1111/j.1748-0361.2012.00442.x.
    1. Casey MM, Thiede Call K, Klingner JM. Are rural residents less likely to obtain recommended preventive healthcare services? Am J Prev Med. 2001;21(3):182–188. doi: 10.1016/S0749-3797(01)00349-X.
    1. Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, Ganiats TG, Gomes AS, Gornik HL, Gracia C, Gulati M, Haan CK, Judelson DR, Keenan N, Kelepouris E, Michos ED, Newby LK, Oparil S, Ouyang P, Oz MC, Petitti D, Pinn VW, Redberg RF, Scott R, Sherif K, Smith SC, Jr, Sopko G, Steinhorn RH, Stone NJ, Taubert KA, Todd BA, Urbina E, Wenger NK. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007;115(11):1481–1501. doi: 10.1161/CIRCULATIONAHA.107.181546.
    1. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin P, Karanja N. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336(16):1117–1124. doi: 10.1056/NEJM199704173361601.
    1. Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin P, Svetkey LP, Young DR. Effects of comprehensive lifestyle modification on blood pressure standard advice: Main results of the PREMIER clinical trial. J Am Med Assoc. 2003;289(16):2083–2093.
    1. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, Lin PH, Champagne C, Harsha DW, Svetkey LP, Ard J, Brantley PJ, Proschan MA, Erlinger TP, Appel LJ, PREMIER Collaborative Research Group Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure standard advice: 18-month results of a randomized trial. Ann Intern Med. 2006;144(7):485–495. doi: 10.7326/0003-4819-144-7-200604040-00007.
    1. Walker SN, Pullen CH, Boeckner L, Hageman PA, Hertzog M, Oberdorfer MK, Rutledge MJ. Clinical trial of tailored activity and eating newsletters with older rural women. Nurs Res. 2009;58(2):74–85. doi: 10.1097/NNR.0b013e31818fcee1.
    1. Walker SN, Pullen CH, Hageman PA, Boeckner LS, Hertzog M, Oberdorfer MK, Rutledge MJ. Maintenance of activity and eating change after a clinical trial of tailored newsletters with older rural women. Nurs Res. 2010;59(5):311–321. doi: 10.1097/NNR.0b013e3181ed6695.
    1. Kreuter M, Farrell D, Olevitch L, Brennan L. Tailoring Health Messages. New Jersey: Lawrence Erlbaum Associates; 2000.
    1. Brug J, Campbell M, van Assema P. The application and impact of computer-generated personalized nutrition education: A review of the literature. Patient Educ Couns. 1999;36(2):145–156. doi: 10.1016/S0738-3991(98)00131-1.
    1. Broeckhuizen K, Kroeze W, van Poppel MNM, Oenema A, Brug J. A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: an update. Ann Behav Med. 2012;44:259–286. doi: 10.1007/s12160-012-9384-3.
    1. Bock C, Jarczok MN, Litaker D. Community-based efforts to promote physical activity: a systematic review of interventions considering mode of delivery, study quality and population subgroups. J Sci Med Sport. 2014;17(3):276–282. doi: 10.1016/j.jsams.2013.04.009.
    1. Kroeze W, Werkman A, Brug J. A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Ann Behav Med. 2006;31(3):205–223. doi: 10.1207/s15324796abm3103_2.
    1. Bavikati VV, Sperling LA, Salmon RD, Faircloth GC, Gordon TL, Frankling BA, Gordon FN. Effect of comprehensive therapeutic lifestyle changes on prehypertension. Am J Cardiology. 2008;102:1677–1680. doi: 10.1016/j.amjcard.2008.08.034.
    1. Dorough AE, Winett RA, Anderson ES, Davy BM, Martin EC, Hedrick V. DASH to wellness: emphasizing self-regulation through E-Health in adults with prehypertension. Health Psychol. 2012;33(3):249–254. doi: 10.1037/a0030483.
    1. Watson AJ, Singh K, Myint-U K, Grant RW, Jethwani K, Murachver E, Harris K, Lee TH, Kvedar JC. Evaluating a web-based self-management program for employees with hypertension and prehypertension: a randomized clinical trial. Am Heart J. 2012;164:625–631. doi: 10.1016/j.ahj.2012.06.013.
    1. Vogt RJ, Cantrell RR, Johnson BB, Tomkins AJ: Rural Nebraska: Looking back at a decade of change and progress. Publications from the Center for Applied Rural Innovation (CARI) 2005, Paper 19. Available at
    1. Pullen CH, Hageman PA, Boeckner L, Noble Walker S, Oberdorfer MK. Feasibility of internet-delivered weight loss interventions among rural women ages 50–69. J Geriatr Phys Ther. 2008;31(3):105–112. doi: 10.1519/00139143-200831030-00006.
    1. Melvin CL, Corbie-Smith G, Kumanyika SK, Pratt CA, Nelson C, Walker ER, Ammerman A, Ayala GX, Best LG, Cherrington AL, Economos CD, Green LW, Harman J, Hooker SP, Murray DM, Perri MG, Ricketts TC, The Workshop Working Group on CVD Prevention in High-Risk Rural Communities Developing a research agenda for cardiovascular disease prevention in high-risk rural communities. Am J Publ Health. 2003;110(6):1011–1021.
    1. Smedley BD, Syme SL, Committee on Capitalizing on Social Science and Behavioral Research to Improve the Public’s Health. Division of Health Promotion and Disease Prevention, Institute of Medicine Promoting health: intervention strategies from social and behavioral research. Am J Health Promotion. 2001;15(3):149–166. doi: 10.4278/0890-1171-15.3.149.
    1. Pender N, Murdaugh CL, Parsons MA. Health Promotion in Nursing Practice. 5. Upper Saddle River, NJ: Pearson Education Inc; 2006.
    1. United States Department of Health and Human Services, National Institutes of Health, and National Heart, Lung, and Blood Institute. Your guide to lowering your blood pressure with DASH. 2010. Available at: .
    1. Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelly GA, Ray CA. American College of Sports Medicine position stand: exercise and hypertension. Med Sci Sports Exerc. 2004;36:533–553. doi: 10.1249/01.MSS.0000115224.88514.3A.
    1. Health Resources and Service Administration, Federal Office of Rural Health Policy (ORHP) and US Department of Agriculture, Economic Research Service: Rural-urban Commuting Area Codes (RUCAs). Available at: .
    1. Cardinal BJ, Esters J, Cardinal MK. Evaluation of the revised physical activity readiness questionnaire in older adults. Med Sci Sports Exerc. 1996;28(4):468–472. doi: 10.1097/00005768-199604000-00011.
    1. Whitlock E, Orleans C, Pender N, Allan J. Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med. 2002;22(4):267–284. doi: 10.1016/S0749-3797(02)00415-4.
    1. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hil MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. Recommendations for blood pressure measurement in humans and experimental animals, part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45:142–161. doi: 10.1161/01.HYP.0000150859.47929.8e.
    1. Boeckner LS, Pullen CH, Walker SN, Abbott GW, Block T. Use and reliability of the World Wide Web version of the Block Health Habits and History Questionnaire with older rural women. J Nutr Educ Behav. 2002;34(Suppl 1):S20–S24. doi: 10.1016/S1499-4046(06)60307-2.
    1. Block G, Woods M, Potosky A, Clifford C. Validation of a self-administered diet history questionnaire using multiple diet records. J Clin Epidemiol. 1990;43:1327–1336. doi: 10.1016/0895-4356(90)90099-B.
    1. Mares-Perlman JA, Klein BE, Klein R, Ritter LL, Fisher MR, Freudenheim JL. A diet history questionnaire ranks nutrient intakes in middle-aged and older men and women similarly to multiple food records. J Nutr. 1993;123:489–501.
    1. Hellman EA, Williams MA, Thalken L. Modifications of the 7-day activity interview for use among older adults. J Appl Gerontol. 1996;15(1):116–132. doi: 10.1177/073346489601500108.
    1. Hellman EA, Williams MA, Thalken L. Construct validity of the modified 7-day activity interview used with older adults with cardiac problems. Rehabil Nurs Res. 1996/1997;5(4):126–133.
    1. Kline GM, Procari JP, Hintermeister R, Freedson PS, Ward A, McCarron RF, Ross J, Rippe JM. Estimation of VO2max from a one-mile track walk, gender, age, and body weight. Med Sci Sports Exerc. 1987;19(3):253–259. doi: 10.1249/00005768-198706000-00012.
    1. Fenstermaker F, Plowman S, Looney M. Validation of the Rockport walking test in females 65 years and older. Res Qtr Exer Sport. 1992;63:322–327. doi: 10.1080/02701367.1992.10608749.
    1. Hageman PA, Walker SN, Pullen CH, Pellerito P. Test-retest reliability of the Rockport Fitness Walking Test and other fitness measures in women ages 50–69 years. Issues Aging. 2001;24(2):6–11.
    1. U.S. Department of Health and Human Services . Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults - the Evidence Report. 1998.
    1. U.S. Department of Health and Human Services . The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. 2000.
    1. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002;48(3):436–472.
    1. Sallis JF, Pinski RB, Grossman RM, Patterson TL, Nader PR. The development of self-efficacy scales for health-related diet and exercise behaviors. Health Educ Behav: Theory Pract. 1988;3(3):282–292.
    1. Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise behaviors. Prev Med. 1987;16(6):825–836. doi: 10.1016/0091-7435(87)90022-3.
    1. Mainous AG, III, Everett CJ, Liszka H, King DE, Egan BM. Prehypertension and mortality in a nationally representative cohort. Am J Cardiol. 2004;94:1496–1500. doi: 10.1016/j.amjcard.2004.08.026.
    1. Peels DA, Bolman C, Golsteijn RH, de Vries H, Mudde AN, van Stralen MM, Lechner L: Long-term efficacy of a printed or a web-based tailored physical activity intervention among older J Behav Nutr Phys Act 2013, 2(10):104.
    1. Greaney ML, Puleo E, Bennett GG, Haines J, Viswanath K, Gillman MW, Sprunck-Harrild K, Coeling M, Rusinak D, Emmons KM. Factors associated with choice of web or print intervention materials in the healthy directions 2 study. Health Educ Behav. 2014;41(1):52–62. doi: 10.1177/1090198113486803.
    1. Artinian NT, Fletcher GF, Mozaffarian D, Kris-Etherton P, Van Horn L, Lichtenstein AH, Kumanyika S, Kraus WE, Fleg JL, Redeker NS, Meininger JC, Banks J, Stuart-Shor EM, Fletcher BJ, Miller TD, Hughes S, Braun LT, Kopin LA, Berra K, Hayman LL, Ewing LJ, Ades PA, Durstine JL, Houston-Miller N, Burke LE. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation. 2010;122:406–441. doi: 10.1161/CIR.0b013e3181e8edf1.
    1. Svetkey LP. Management of prehypertension. Hypertension. 2005;45:1056–1061. doi: 10.1161/01.HYP.0000167152.98618.4b.
    1. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E. 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (JNC 8) JAMA. 2014;311(5):507–520. doi: 10.1001/jama.2013.284427.
    1. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleinjne JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003;42:878–884. doi: 10.1161/.
    1. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: at meta-analysis of randomized controlled trials. Ann Intern Med. 2002;136:838–843. doi: 10.7326/0003-4819-136-7-200204020-00006.
    1. Barone BB, Wang N-Y, Bacher AC, Stewart KJ. Decreased exercise blood pressure in older adults after exercise training: contributions of increased fitness and decreased fatness. Br J Sports Med. 2009;43:52–56. doi: 10.1136/bjsm.2008.050906.
    1. Duncan GE, Sydeman SJ, Perri MG, Limacher MC, Martin AD. Can sedentary adults accurately recall the intensity of their physical activity. Prev Med. 2001;33(1):18–26. doi: 10.1006/pmed.2001.0847.
    1. Eysenbach G, CONSORT-EHEALTH Group: CONSORT-EHEALTH: improving and standardizing evaluation reports of web-based and mobile health interventions.J Med Internet Res 2011, 13(4):e126.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe