Increasing Physical Activity to Prevent Cardiovascular Disease

Cardiovascular disease (CVD) is a significant public health issue; it constitutes the major cause of death and disability globally.¹ The burden of this disease is significantly associated with societal concern.¹ Cardiovascular disease is very much affected by geographical area depending on the environment, economic, social and personal behavior (such as physical inactivity, smoking, unhealthy diet, and alcohol consumption) of the population in a particular geographic location.^{1, 2}   

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Detroit is the largest city in the Midwestern state of Michigan, it is also the largest city in the United States (US); it is an urban community with the total population of approximately 672,829.³ The city of Detroit has a very high rate of cardiovascular disease one of the highest in the United States.⁴ In 2013, approximately 34.6% of Michigan adult population were reported to have high blood pressure, 75.7% of adult with CVD are on blood pressure medication.⁵ It is estimated that by 2030 the cases of CVD in Detroit Michigan will rise from 600,000 to 2.9 million.⁵ Factors attributed to this high rate include an increased rate of fast-food consumption, lack or inadequate physical activity and poor access to health care. Detroit has a very high poverty rate (37.5%) compared to the US national rate of 12.7%, which is also a contributing factor to the high rate of CVD in Detroit; this is associated with poor access to health care services due to inability to pay.^{3, 4} Hence, it is essential for us to develop an effective program that will prevent CVD and that which will also significantly reduce the prevalence of CVD in Detroit. My proposed intervention for the prevention of CVD is increasing physical activity among the Detroit populations. Increase physical activity has been found to be very significant in the prevention of cardiovascular disease; a study shows that healthy physical activity is associated with reduced risk of cardiovascular disease.⁶

Another study by Lilly CL. et al., ⁷ demonstrated conclusively how the intervention of cardiovascular disease prevention behaviors among the three underserved populations of Colorado, North Carolina, and West Virginia was successful through the improvement in the problem-solving skill, stress, healthy feeding, physical activity, and steady weight gain. The study was based on the Social Cognitive Theory (SCT) and resulted in the significant increase in physical activity among the participants.⁷ Another study also demonstrated the effectiveness of lifestyle modification such as smoking cessation, improved physical exercise, healthy eating in the prevention of cardiovascular disease among patients who are on the intensive treatment of cardiovascular disease.⁸ The study was based on social cognitive theory and health belief model (HBM) and was effective in the risk reduction and secondary prevention of cardiovascular disease.⁸  

The use of technological application would also be applicable to the intervention of CVD; there is evidence of successful intervention of cardiovascular disease by increasing physical activity through the application of technology. An example is the use of web-based technology to promote physical activity in Latinas.⁹ The study focused on the use of the Transtheoretical Model (TTM) and social cognitive theory to achieve its goal, the program reported a significant increase in healthy physical activity among the participants.⁹

 I am recommending social cognitive theory for the improvement of physical activity among the Detroit population in this intervention of cardiovascular disease prevention. The social cognitive theory is one of the most valuable tools in the area of health behavior and has been successful in behavior change over the years.¹⁰ For this intervention, I would propose focusing on the following theoretical constructs: Awareness, knowledge, attitude, social influences, self-efficacy/ skill, goal setting and overcoming barriers to achieve a successful behavior change.

• Awareness: – the participants become aware of the risk associated with physical inactivity in the development of cardiovascular disease.
• Knowledge: – the participants gain an understanding of the benefit of engaging and maintaining healthy physical activity to prevent the risk of cardiovascular disease.
• Attitude: – The participants believe it is crucial to engage in regular physical activity to maintain a healthy weight to prevent the risk of cardiovascular disease.
• Social influences: – The participant describes how their job and stressful life would hinder their desire to engage in a regular physical activity and feel positive about how having a social support network will help in improving physical activity.
• Self-efficacy/skill: – The participants at this stage express the wiliness and are confident in maintaining regular healthy physical activity.
• Barriers: – Participants identifies situations that could result in relapses such as stress from their jobs, discouragement from peers, families, and friends. And believe they can overcome these barriers to achieve the desired goal of behavior change progressively.

However, I would like to identify that there might be some cultural and environmental factors that may impact the success of this intervention. Studies have shown that cultural, socioeconomic status and environmental factors are associated with physical activity in regards to progress and barriers.^{11, 12} Examples of the cultural factors are beliefs, customs, language barriers, and values. Hence, it is essential to put into consideration cultural competence in this coalition for the success of the intervention. These can be achieved by involving traditional leaders, religious leaders, and stakeholders who are familiar with the social norms as well as the cultural practices and needs of the various race/ethnic groups in Detroit.

Environmental factors such as social cohesion, deprived neighborhood, safety, recreation facilities, affordability, etc. can influence the effectiveness of the intervention. Hence, a partnership with stakeholders is crucial to overcoming these barriers.

My evaluation measures will be tailored towards collecting data to evaluate the success of the intervention program, to refine the delivery of the program and to ensure that the program is appropriate for the target population of Detroit in Michigan. The evaluation will be done in three stages.

1. In the initial stage, I will collect data for the baseline study of my health condition that will enable me with a prior assessment of the program to ensure that the proposed intervention is developed, disseminated and implemented in a consistent and standardized manner.
2. In the second stage, I will collect data to evaluate the process, impact, and outcome of the intervention. For the process evaluation, I will collect data to assess if the program was carried out as designed. Measures will include gathering list of how frequent participants engage in physical activity, recording blood pressure of those who are already on blood pressure medication. These will enable me to identify areas of weakness and needed improvement. To measure the impact of the program, I will carry our qualitative and quantitative study via interviews, surveys, and questionnaire to assess any behavior change in regards to physical activity brought by the intervention. The outcome measure will involve collecting data necessary to determine the effectiveness/success of the program such as reduction in the prevalence of cardiovascular disease in Detroit, and to determine if more people are physically active and if these people have achieved the maintenance of behavior change.  
3. My final stage of evaluation includes the dissemination and report of evolution to stakeholders. It would further promote support for the program if it were successful. 

In summary, improved physical activity will significantly help to prevent or reduce the risk associated with cardiovascular disease, and contribute to maintaining a healthy weight among the obese population at risk of cardiovascular disease. I am relating this proposed intervention to an existing body known as National Coalition for Promoting Physical Activity (NCPPA). NCPPA runs a membership organization program; the organization, which was established in 1996, aimed at inspiring and empowering Americans to live a healthy physically active lifestyle.¹³  

References

1. Roth GA, Johnson C, Abajobir A, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol 2017;70(1):1-25. doi:10.1016/j.jacc.2017.04.052.
2. Healthy People 2020. Determinant of health. Available at: https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health. Accessed September 15, 2018.
3. Detroit, MI/DATA USA: Available at https://datausa.io/profile/geo/detroit-mi/. Accessed September 8, 2018.
4. Burden of Cardiovascular Disease. Michigan Department of Health and Human Services (MDHHS). Available at: https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_2959_3208-80201–,00.html. Accessed October 15, 2018.
5. Cardiovascular disease in Michigan- State of Michigan. Available at: https://www.michigan.gov/documents/mdch/CVH_fact_sheet_update-_Final_3.4.15__483077_7.pdf. Accessed October 15, 2018.
6. Carnethon MR. Physical activity and cardiovascular disease: How much is enough? Am J Lifestyle Med. 2009; 3(1 Suppl): 44S-49S. doi:10.1177/1559827609332737.
7. Lilly CL, Bryant LL, MSHA, et al. Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009. Prev Chronic Dis. 2014; 11:E32. doi: 10.5888/pcd11.130249.
8. IJzelenberg W, Hellemans IM, van Tulder MW, et al. The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomized controlled trial. BMC Cardiovasc Disord. 2012;12:71. doi:10.1186/1471-2261-12-71.
9. Benitez TJ, Cherrington A, Joseph RP, et al. Using web-based technology to promote physical activity in Latinas: Results of the Muévete Alabama pilot study. Comput Inform Nurs : CIN. 2015;33(7):315-324. doi:10.1097/CIN.0000000000000162.
10. DiClemente R, Salazar L, Crosby R. Health Behavior Theory for Public Health: Principles, Foundations, and Applications, Burlington, MA: Jones and Bartlett Publishers, 2013
11. Keller C, Coe K, and Moore N. Addressing the demand for cultural relevance in intervention design. Health Promot Pract. 2014;15(5):654-663. https://doi.org/10.1177/1524839914526204. Accessed October 15, 2018.
12. Watts P, Phillips G, Petticrew M, Harden A, Renton A. The influence of environmental factors on the generalizability of public health research evidence: physical activity as a worked example. Int J Behav Nutr Phys Act. 2011;8:128. doi:10.1186/1479-5868-8-128. Accessed October 15, 2018.
13. National Coalition for Promoting Physical Activity. Available at: http://www.ncppa.org/membership Accessed October 15, 2018.