Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Public Health Research Center, Columbia, SC, USA.
Int J Gen Med. 2011 Jan 19;4:53-62. doi: 10.2147/IJGM.S15686.
Primary care facilities may be a natural setting for delivering interventions that focus on behaviors that improve cardiovascular disease (CVD) risk factors. The purpose of this study was to examine the 24-month effects of the Activity Counseling Trial (ACT) on CVD risk factors, to examine whether changes in CVD risk factors differed according to baseline risk factor status, and to examine whether changes in fitness were associated with changes in CVD risk factors. ACT was a 24-month multicenter randomized controlled trial to increase physical activity. Participants were 874 inactive men and women aged 35-74 years. Participants were randomly assigned to one of three arms that varied by level of counseling, intensity, and resource requirements. Because there were no significant differences in change over time between arms on any of the CVD risk factors examined, all arms were combined, and the effects of time, independent of arm, were examined separately for men and women. Time × Baseline risk factor status interactions examined whether changes in CVD risk factors differed according to baseline risk factor status. Significant improvements in total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol, the ratio of total cholesterol to HDL-C, and triglycerides were seen in both men and women who had high (or low for HDL-C) baseline levels of risk factors, whereas significant improvements in diastolic blood pressure were seen only in those men with high baseline levels. There were no improvements in any risk factors among participants with normal baseline levels. Changes in fitness were associated with changes in a number of CVD risk factors. However, most relationships disappeared after controlling for changes in body weight. Improvements in lipids from the ACT interventions could reduce the risk of coronary heart disease in people with already high levels of lipids by 16%-26% in men and 11%-16% in women. Interventions that can be implemented in health care settings nationwide and result in meaningful population-wide changes in CVD risk factors are needed. The ACT physical activity interventions produced substantial improvements among men and women with elevated CVD risk factors.
初级保健机构可能是提供干预措施的自然场所，这些干预措施侧重于改善心血管疾病（CVD）风险因素的行为。本研究的目的是检验活动咨询试验（ACT）在 24 个月内对 CVD 风险因素的影响，检验 CVD 风险因素的变化是否因基线风险因素状况而异，并检验身体适应力的变化是否与 CVD 风险因素的变化相关。ACT 是一项为期 24 个月的多中心随机对照试验，旨在增加身体活动。参与者为 874 名年龄在 35-74 岁之间不活跃的男性和女性。参与者被随机分配到三个不同的组中，这些组在咨询的水平、强度和资源需求上有所不同。由于在任何被检查的 CVD 风险因素方面，各个组之间在随时间的变化上没有显著差异，因此将所有组合并，并分别检查男性和女性中时间（独立于组）的影响。时间×基线风险因素状态的相互作用检验了 CVD 风险因素的变化是否因基线风险因素状况而异。在基线风险因素水平较高（或 HDL-C 较低）的男性和女性中，总胆固醇、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇、总胆固醇与 HDL-C 的比值以及甘油三酯都有显著改善，而只有基线水平较高的男性中舒张压有显著改善。在基线水平正常的参与者中，没有任何风险因素得到改善。身体适应力的变化与许多 CVD 风险因素的变化相关。然而，在控制体重变化后，大多数关系消失了。ACT 干预措施改善的血脂可使男性中已经高水平的血脂降低患冠心病的风险 16%-26%，女性中降低 11%-16%。需要在全国医疗保健机构中实施能够产生 CVD 风险因素的有意义的人群变化的干预措施。ACT 的身体活动干预措施使 CVD 风险因素升高的男性和女性获得了实质性的改善。
