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August 15, 2001
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Church-Based Programs Lower Heart Disease Risk For African-American Women

Church-based nutrition and exercise programs can move African-American women to adopt healthier habits, according to a study led by Johns Hopkins researchers.

Programs set up by Hopkins scientists in partnership with 16 Baltimore churches encouraged more than 500 participants to lose weight and choose healthier foods over a year-long period, according to a report of the study published in the Summer 2001 issue of the journal Public Health Reports.

Women who participated in on-site exercise and dietary activities did much better than those assigned to self-help groups. One year after the program’s start, researchers found a statistically significant reduction in 11 of 13 risk factors for heart disease in 10 percent of the women.

"Urban African-American women age 40 and up bear a marked excess risk of obesity and death from heart disease," says Diane M. Becker, Sc.D., M.P.H., an author of the study and director of Hopkins’ Center for Health Promotion. "This study demonstrates that church-based interventions can greatly improve their cardiovascular health."

Women who weighed the most at the study’s start lost an average of nearly 20 pounds during the program. Overall, participants lost two-thirds of an inch off their waists, and reduced systolic blood pressure (the upper number) by 1.6 mmHg, daily calories by 117, daily fat by eight grams, and daily salt by 145 milligrams.

Becker and her team worked with community members and local pastors to design three strategies to encourage healthier lifestyles; each church’s participants were randomly assigned to one of the groups. In the first group, female African-American health educators, assisted by church lay leaders with health training, led weekly nutrition and physical activity sessions at the church. Each session included a weigh-in and group discussion, a taste test or cooking demonstration, and 30 to 45 minutes of moderate aerobic activity such as brisk walking, water aerobics or kick-boxing.

The second group added spiritual content and prayer to the regimen. Physical activities included aerobics to gospel music or worship dance.

In the third group, participants were simply given self-help handouts and other materials on diet, exercise and smoking cessation tailored to their needs. They attended no support groups or education sessions but had a hotline phone number to call a project health educator for additional guidance.

Of the 529 who enrolled, 267 (50.5 percent) were in the spiritual group; 188 (35.5 percent) were in the standard group; and 74 (14 percent) were in the self-help group.

Researchers gave all participants a full health screening at the study’s start, recording medical history, weight and body mass index, blood pressure and heart rate, cholesterol and glucose (sugar) levels, diet, smoking status and level of physical activity. Retreats to kick off the programs were held for each church after the women were screened but before the start of weekly sessions. Interventions began in each church within a month of the retreat.

Women were encouraged to exercise for at least 30 minutes, five to seven days a week, and to consume 1,200 to 1,800 calories per day, including at least five servings of fruits and vegetables, 25 grams of fiber, less than 40 grams of fat, and less than 2,400 milligrams of sodium. Stopping smoking also was recommended.

The biggest weight loss among the self-help group was seven pounds, compared to 20 pounds in the active intervention groups. The greatest change among self-help participants was a 5 percent increase in the number of women who consumed less salt.

Other authors of the study were Lisa R. Yanek, M.P.H.; Taryn F. Moy, M.S., R.D.; Joel Gittelsohn, Ph.D., of Hopkins; and Dyann Matson Koffman, Dr.P.H., M.P.H., C.H.E.S., of the Centers for Disease Control and Prevention, Atlanta.

Yanek, L.R., Becker, D.M., et al., "Project Joy: Faith Based Cardiovascular Health Promotion for African American Women," Public Health Reports, Summer 2001, Vol. 116: pp. 68-82.

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