Outcomes from Walk the Talk: a nursing intervention for Black women.

Abstract: Objective: Explore changes in walking behavior, blood pressure, and weight over the course of a pilot intervention designed to increase physical activity. Design: A pre/post single group design was used to examine outcomes of a 12-month group intervention with 6-month follow-up. Sample: Twenty-one sedentary hypertensive African American women residing in Mid-Missouri with a mean age of 50.3 years. Intervention: A 3-hour monthly meeting was paired with an at-home walking component. Results: Mean steps per day taken by participants were 3857 at baseline, 4060 at the end of the group intervention, and 5282 at the end of the follow-up period. Mean systolic blood pressure was 142 mmHg at baseline, 123 mmHg at intervention end, and 130 mmHg at 18 months. Mean diastolic blood pressure at baseline was 87 mmHg, 80 mmHg at 12 months, and 78 mmHg at the end of the follow-up period. Mean weight decreased from 206 lbs at baseline to 188 lbs at the end of the intervention. However, mean weight had increased to 213 lbs by the end of the 6-month follow-up. Conclusions: Outcomes from this pilot study are encouraging with respect to the potential of group level interventions as a strategy for promoting cardiovascular health among hypertensive African American women. It is particularly noteworthy that women maintained decreases in systolic blood pressure and further decreased diastolic blood pressure despite regaining weight during the follow-up period. Replication of this study with a larger sample size and control group will significantly enhance our ability to evaluate whether the unusual pattern of change in walking behavior noted in this pilot was a fluke or indicative of a slower pattern of change in this population. Key Words: Physical Activity, Pilot Studies, Intervention Studies, African American Women, Group Interventions, Cardiovascular Health Promotion Reducing risk factors for cardiovascular disease (CVD) among African American women is integral to improving the health of this population. Approximately 71.3 million adults in the United States have CVD. Among women, CVD claimed more lives in 2003 than the combined total of the next five leading causes of death. This same year estimated direct and indirect total cost of CVD and stroke within our country was a staggering $403.1 billion (Thomas et al., 2006). A continuous relationship between blood pressure and CVD, independent of other risk factors has been documented (Chobanian et al., 2003). Hypertension is a greater risk factor for acute myocardial infarction among women globally as compared to men (Yusuf et al., 2004). It is a particularly powerful predictor of coronary heart disease among African American women. The age-adjusted hazard rate ratio (HRR) for coronary heart disease among hypertensive African American women is 5.3 as compared to 2.7, 2.0, and 1.8 among hypertensive White women, African American men, and White men respectively (Jones et al., 2002). Conversely, the HRR for coronary heart disease was only 1.6 among African American women without hypertension. Mounting evidence indicates that a lack of PA (Harrell & Gore, 1998; Whelton, Chin, Xin, & He, 2002) increases the potential of developing hypertension and CVD (Hu, Stampfer, & Colditz, 2000; Kohl, 2001; Lee, Rexrode, Cook, Manson, & Buring, 2001; Li et al. 2006; Williams, 2001 ). Relative risk of heart disease secondary to physical inactivity ranges from 1.5-2.4, an increase in risk equivalent to that associated with high blood pressure, cigarette smoking, or high blood cholesterol (Pate et al. 1995; Thomas et al., 2006). It has been well established that routine PA can reduce blood pressure (Whelton et al., 2002), and decrease the risk of developing hypertension or CVD (Bassett, Fitzhugh, Crespo, King, & McLaughlin, 2002; Thomas et al., 2006). A global study of potentially modifiable risk factors for acute myocardial infarction found that PA has a greater protective effect among women than men (Yusuf et al. …