The Effect of Physical Activity on Decreasing Risk Level
Condition: CVD Risk; Physical Activity; Nurse's Role; Risk Reduction
Study type: Interventional

Summary: 
      Objective: The aim of the first part of this study with two stages is to determine prevalence
      of CVD risk and the associated variables in individuals aged 40-65 years registered in a
      Family Health Center (FHC) in city center of Antalya; the aim of the second one is to
      evaluate the effect of intervention to increase physical activity in individuals with
      moderate risk of CVD on decreasing the risk level.

      Methods: Stage 1 and Stage 2 were conducted as cross-sectional and Randomized Controlled
      Experimental Trial, respectively.

      In the first stage the CVD risk level was calculated using the HeartScore. In the second
      stage, 11 individuals with moderate CVD risk (2-<5%) found in the intervention group
      participated into a 12-week physical activity program (a moderate walk outdoor, with group 5
      days in a week, each lasting for 40 minutes) guided by nurse. CVD brochure and physical
      activity guide was distributed to 11 individuals in control group within the scope of routine
      practice of FHCs.
    

Detailed description: 
      The purpose of this study is to determine Cardiovascular Disease (CVD) risk level in 40-65
      year-old individuals coming to a FHC and to evaluate the effect of increasing the physical
      activity and interventions about the changeable risk factors on reducing the risk level in
      individuals with moderate CVD risk.

      Hypothesis; the 12-week group walking activity about changing CVD risk factors reduces the
      risk level more in intervention group compared to the control group (H1).

      It provides blood pressure control in the intervention group. It reduces cholesterol. It
      helps reducing the weight, BMI, and waist circumference values. This study was conducted in
      two stages. Stage 1: In order to determine the high risk prevalence of CVD, it was carried
      out in Akdeniz FHC located in Konyaalti Central District of Antalya between April and
      September 2016.

      Stage 2: In order to evaluate the effect of the interventions for the changeable risk factors
      (HeartScore 2-<5%) in individuals with moderate level of CVD risk, the study was conducted as
      a Randomized Controlled Experimental Trial between October-December 2016 in April 23 Park
      located near to FHC in the same region. There is a hiking trail around this park. This trail
      is 860-meter long, covered with rubber, and suitable for walking. In addition, there are two
      fields for exercise on apparatus in the east and west side of the park.

      Stage 1 Population and Sample The population of the study consisted of 2390 individuals aged
      between 40 and 65 years registered in the Akdeniz FHC. In the study, the sample size was
      calculated by considering the CVD moderate risk prevalence (27.4%) obtained by Ünal et al. in
      their study conducted with individuals living in Balcova region via the formula used in the
      cases of known population and the minimum sample size for this study was determined as 27012.
      However, 327 individuals were voluntary to participate in the study between the dates when
      the study was conducted and their risk levels were calculated by using HeartScore® program.

      Stage 2 Population and Sample Seventy two individuals who were found to have moderate risk as
      a result of the first stage of the study constituted the population of this stage. 22 people
      met the inclusion criteria of the study. When the sample size power was evaluated with Power
      and Sample Size Calculation program for determining the difference between two dependent
      numerical variables with the power of 80% and the error margin of 0.05 in Randomized
      Controlled Trials (RCT), it was determined that minimum 9 people is sufficient for each
      group.

      Preliminary preparation The content of the study was explained to the individuals meeting the
      inclusion criteria of the study in detail.

      Current CVD risks of the individuals determined as the intervention group were re-measured
      before the physical activity program and it was emphasized that their current risk can be
      reduced after the 12-week program.

      In order to encourage individuals to participate in physical activity programs, materials
      such as pedometer, hats, and t-shirts were distributed before starting the program.

      The feature of pedometer distributed to the individuals to keep time and distance of the
      conducted activity was used. The necessary technical settings for the pedometer were made by
      the researcher daily and weekly.

      Healthy Beverage Distribution

      •Individuals were asked to come with empty stomach and water was distributed before the walk
      so that they could meet their fluid needs. They were advised to drink at least 2.5-3 liters
      of water per day. In addition, in order to encourage the individuals to healthy diet, "ayran"
      (a drink made with yoghurt and water), milk and mineral water were regularly distributed in
      certain periods every day.

      Intervention: 12-Week Physical Activity Program Physical activity program was administered to
      all individuals in the experimental group whose risk was found as 2-<5% by evaluating their
      all risk factors using HeartScore® program. In this direction, International Physical
      Activity Questionnaire (IPAQ Short Form) was first applied to the individuals in order to
      determine again their physical activity levels. Individuals determined to be inactive and
      minimally active according to this measure were included in the physical activity program
      recommended by the Ministry of Health and International Guidelines as a nonpharmacological
      tool in primary prevention of CVD.

      Duration of moderate intensity physical activity or aerobic exercise which can reduce total
      and cardiovascular mortality are 2.5 - 5 hours a week; as the total period of the weekly
      physical activity prolonged, the observed benefits increased as well. For this reason,
      physical activity program was completed in such a way to complete minimum 150 minutes per
      week. It was explained that the time individuals need to walk per week should be minimum 150
      minutes. However, some individuals increased this time up to 200-250 minutes per week
      according to their availability and willingness statuses.

      With the pedometer distributed to the individuals, step, distance, pace and the calories
      burned were recorded and these records were taken daily with the table prepared specific for
      the individuals. The aim here was to increase their motivation by showing them the
      developments in their physical activity levels. In addition, thanks to the record feature of
      pedometer, the extra steps taken by individuals who wanted to continue to walk could be
      recorded, the steps taken by the individuals who could not continue to walk due to personal
      reasons (being sick, hospital appointment, etc.) and walked individually on that day were
      also recorded.

      In order to regularly determine the weight lost by the individuals and to increase their
      motivations, Mondays in each week were determined as "Scale Day" and weight and waist
      circumference values were measured and the obtained values were recorded.

      Application of WHO Smoking Cessation Algorithm After fagerström test was applied, the
      modified smoking cessation algorithm of World Health Organization (WHO) was applied to the
      individuals and those who decided to quit smoking were referred to smoking cessation
      outpatient clinics. For the individuals who decided to quit smoking, appointments were made
      from the smoking cessation outpatient clinic located in Cancer Early Detection, Screening and
      Education Center which provides free services.

      Routine Practice for Control Group As routine practice, a brochure provided from the Public
      Health Directorate on protection from CVD was delivered to the individuals in the control
      group.

      As the posttest to the individuals after applying the above-planned interventions;
      HeartScore® risk level assessment, implementation of IPAQ questionnaire, BMI, weight and
      waist circumference measurements were performed.
    

Intervention name(s): physical activity program; Routine Practice
Intervention type(s): Other; Other
Intervention description(s): The 12-week physical activity program was implemented under the guidance of nurse, in outdoors with the group, 5 days a week with warm up and cooling down for 10 minutes and normal walking tempo at a moderate pace for 30-45 minutes (3-6 km/hour).
Application of WHO Smoking Cessation Algorithm: After fagerström test was applied, the modified smoking cessation algorithm of WHO was applied to the individuals and those who decided to quit smoking were referred to smoking cessation outpatient clinics.; As routine practice, a brochure provided from the Public Health Directorate on protection from CVD was delivered to the individuals in the control group.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention