Background
Methods
Context and intervention
Data collection
Study design
-
Phase 1 was a cross-sectional telephone survey administered by an independent survey research firm. The survey took approximately 30 min to complete and assessed lifestyle behaviours (eg. diet, physical activity, smoking), health status (including height and weight) and cognitive change (intentions).
-
Phase 2 involved physical measures of height, weight, waist and hip circumference and BP at a local measurement clinic. Participants were offered free transportation, light refreshments and a $20 CDN gift card to a local grocery store in exchange for participation. The clinics remained open 3–7 times per week (including evenings and weekends) over a 16-week period.
-
Phase 3 was conducted exclusively in Medicine Hat, and consisted of blood collection by a phlebotomist to measure fasting glucose, total cholesterol, high- and low-density lipoprotein cholesterol levels and triglycerides. The third phase of the study is not discussed further in this paper as findings have been published [28].
Participants
Parameters | Baseline n = 1554 | Follow-up n = 1808 |
---|---|---|
mean ± SEM | ||
Age, years | 50.0 ± 0.4 | 54.0 ± 0.3 |
Age categories | % (n) | |
18–39 years
| 27.9 (433) | 18.1 (322) |
20–39 years
| 27.5 (427) | 18.1 (321) |
40–59 years
| 42.7 (664) | 44.9 (797) |
60–79 years
| 27.2 (422) | 33.5 (595) |
≥ 80 years
| 2.3 (35) | 3.4 (61) |
Sex, female (%) | 69.0(1073) | 67.6 (1222) |
Education, completed College/University | 39.9 (619) | 38.1 (687) |
Employment status | ||
Employed full-time
| 42.1 (655) | 39.8 (720) |
Employed part-time
| 17.7 (275) | 16.1 (291) |
Homemaker
| 12.1 (188) | 9.4 (170) |
Retired
| 24.5 (380) | 30.4 (549) |
Student
| 3.8 (59) | 1.8 (33) |
Temporarily unemployed
| 4.5 (70) | 5.1 (92) |
Volunteer
| 7.7 (120) | 5.2 (94) |
Level of combined household income, above cut-off pointsa
| 84.8 (1223) | 87.8 (1490) |
Perceived health, excellent and very good | 54.0 (838) | 54.1 (978) |
Sense of belonging to local community, strong | 73.3 (1121) | 77.1 (1380) |
Fruit and vegetable intake, ≥ 5 servings/dayb
| 49.5 (751) | 46.9 (824) |
Physical activity index, activec
| 36.7 (570) | 22.4 (405) |
High blood pressure | 18.0 (279) | 21.5 (387) |
Use antihypertensive medication | 16.8 (261) | 19.5 (352) |
Smoking status, daily | 24.0 (254) | 20.4 (246) |
Ethical approval
Physical measurements
Blood pressure
Weight and height
Body mass index
Waist and hip circumference, waist-to-hip ratio
Statistical analyses
Results
Response rates and participant characteristics
Blood pressure
Parameter | Age categories | Interventiona
| Comparisonb
| Differential significance between changes in intervention and comparison groups p-value | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline (n
= 1554) | Follow-up (n
= 1808) | ∆ | Baselinec(n
= 3725) | Follow-upd(n = 3873) | ∆ | |||||||||||
Mean |
95 % Confidence interval
| Mean |
95 % Confidence interval
| Mean |
95 % Confidence interval
| Mean |
95 % Confidence interval
| |||||||||
from | to | from | to | from | to | from | to | |||||||||
Mean systolic blood pressure (mm Hg) | 20–39 | 108 |
107
|
109
| 106 |
105
|
107
| −2** | 106 |
104
|
107
| 105 |
103
|
107
| −1 | 0.006 |
40–59 | 115 |
114
|
116
| 112 |
111
|
113
| −3*** | 114 |
112
|
116
| 113 |
111
|
116
| −1 | 0.001 | |
60–79 | 126 |
124
|
128
| 123 |
121
|
125
| −3* | 125 |
124
|
126
| 124 |
122
|
125
| −1 | 0.087 | |
Mean diastolic blood pressure (mm Hg) | 20–39 | 71 |
70
|
72
| 68 |
68
|
69
| −3*** | 69 |
68
|
71
| 69 |
67
|
70
| 0 | <0.001 |
40–59 | 76 |
76
|
77
| 73 |
72
|
73
| −3*** | 75 |
74
|
76
| 74 |
73
|
76
| −1 | <0.001 | |
60–79 | 75 |
74
|
76
| 71 |
70
|
73
| −4*** | 73 |
72
|
73
| 72 |
71
|
73
| −1 | <0.001 | |
Normal blood pressuree (%) | 18–39 | 90.6 |
88.2
|
92.9
| 93.9 |
92.1
|
95.7
| 3.3* | 95.4 |
93.8
|
96.9
| 94.7 |
89.4
|
97.4
| −0.7 | 0.029 |
40–59 | 76.3 |
72.9
|
79.7
| 85.2 |
82.5
|
87.9
| 8.9*** | 82.4 |
78.8
|
85.9
| 82.7 |
77.4
|
86.9
| 0.3 | <0.001 | |
60–79 | 60.3 |
54.5
|
66.1
| 63.9 |
58.6
|
69.2
| 3.6 | 66.7 |
64.2
|
69.1
| 67.1 |
62.9
|
71.0
| −0.6 | 0.403 | |
18–79 | 79.1 |
77.0
|
81.1
| 84.7 |
83.0
|
86.5
| 5.6*** | 84.4 |
82.8
|
86.0
| 84.1 |
80.7
|
87.0
| −0.3 | <0.001 | |
High-normal blood pressuree (%) | 18–39 | 5.2 |
3.4
|
7.0
| 5.2 |
3.5
|
6.8
| 0 | 3.9 |
2.6
|
5.1
| n/a |
…
|
…
| … | … |
40–59 | 12.2 |
9.5
|
14.8
| 11.0 |
8.6
|
13.4
| −1.2 | 11.3 |
8.7
|
13.9
| 9.3 |
6.8
|
12.6
| −2.0 | 0.772 | |
60–79 | 16.6 |
12.2
|
21.0
| 19.7 |
15.3
|
24.1
| 3.1 | 15.7 |
12.8
|
18.6
| 17.9 |
14.5
|
21.9
| 2.2 | 0.466 | |
18–79 | 10.2 |
8.6
|
11.7
| 10.2 |
8.8
|
11.7
| 0 | 9.2 |
8.0
|
10.4
| 8.9 |
7.3
|
10.9
| −0.3 | 0.895 | |
Stage 1 hypertensione (%) | 18–39 | 3.7 |
2.2
|
5.2
| 0.6 |
0
|
1.1
| −3.1*** | n/a |
…
|
…
| n/a | … | … | … | … |
40–59 | 8.8 |
6.5
|
11.1
| 2.7 |
1.5
|
.0
| −6.1*** | 5.3 |
4.0
|
6.6
| 6.5f
|
3.9
|
10.6
| 1.2 | <0.001 | |
60–79 | 16.7 |
12.3
|
21.2
| 13.9 |
10.1
|
17.8
| −2.8 | 13.8 |
11.6
|
15.9
| 10.5 |
8.2
|
13.5
| −3.3 | 0.638 | |
18–79 | 8.2 |
6.8
|
9.7
| 4.0 |
3.0
|
4.9
| −4.2*** | 5.1 |
4.5
|
5.8
| 5.4 |
3.8
|
7.5
| 0.3 | <0.001 | |
Mean body weight (kg) | 20–39 | 77.5 |
75.9
|
79.2
| 79.4 |
77.8
|
81.0
| 1.9 | 76.0 |
74.2
|
77.7
| 75.6 |
72.5
|
78.7
| −0.4 | 0.111 |
40–59 | 82.4 |
80.9
|
83.9
| 84.0 |
82.4
|
85.6
| 1.6 | 79.2 |
77.4
|
80.9
| 79.8 |
77.7
|
81.8
| 0.6 | 0.231 | |
60–79 | 81.9 |
79.7
|
84.1
| 82.9 |
79.7
|
84.1
| 1.0 | 77.5 |
76.4
|
78.6
| 78.0 |
76.0
|
80.1
| 0.5 | 0.585 | |
Mean BMI(kg/m2) | 20–39 | 26.69 |
26.17
|
27.21
| 26.68 |
26.23
|
27.13
| −0.01 | 26.20 |
25.64
|
26.77
| 25.87 |
25.09
|
26.65
| −0.33 | 0.848 |
40–59 | 28.56 |
28.09
|
29.04
| 28.79 |
28.32
|
29.26
| 0.23 | 27.69 |
27.18
|
28.19
| 28.02 |
27.38
|
28.66
| 0.33 | 0.711 | |
60–79 | 29.24 |
28.60
|
29.88
| 29.62 |
29.00
|
30.23
| 0.38 | 28.23 |
27.85
|
28.62
| 28.43 |
27.75
|
29.12
| 0.20 | 0.486 | |
Normal weightg (%) | 18–39 | 44.7 |
40.7
|
48.7
| 43.2 |
39.5
|
46.9
| −1.5 | 48.2 |
42.8
|
53.7
| 49.7 |
43.3
|
56.2
| 1.5 | 0.532 |
40–59 | 29.6 |
25.9
|
33.3
| 28.7 |
25.2
|
32.1
| −0.9 | 32.7 |
28.0
|
37.4
| 32.2 |
27.2
|
37.6
| −0.5 | 0.777 | |
60–79 | 20.4 |
15.6
|
25.1
| 20.6 |
16.1
|
25.0
| 0.2 | 27.9 |
22.5
|
33.3
| 25.6 |
19.9
|
32.3
| −2.3 | 0.850 | |
18–79 | 34.0 |
31.5
|
36.4
| 33.1 |
30.9
|
35.4
| −0.8 | 37.9 |
33.3
|
42.4
| 37.6 |
33.1
|
42.3
| −0.3 | 0.674 | |
Overweightg(%) | 18–39 | 32.3 |
28.5
|
36.1
| 32.0 |
28.5
|
35.4
| −0.4 | 29.7 |
25.4
|
33.9
| 28.4 |
24.0
|
33.3
| −1.3 | 0.978 |
40–59 | 35.9 |
32.0
|
39.8
| 36.5 |
32.8
|
40.2
| 0.6 | 41.4 |
38.0
|
44.8
| 37.4 |
31.1
|
44.1
| −4.0 | 0.573 | |
60–79 | 40.2 |
34.4
|
46.0
| 35.8 |
30.5
|
41.0
| −4.4 | 41.2 |
37.2
|
45.3
| 38.8 |
34.0
|
43.9
| −2.4 | 0.368 | |
18–79 | 35.3 |
32.8
|
37.7
| 34.5 |
32.2
|
36.8
| −0.8 | 36.7 |
33.7
|
39.7
| 34.2 |
30.9
|
37.7
| −2.5 | 0.906 | |
Obese, class Ig (%) | 18–39 | 11.4 |
8.8
|
13.9
| 13.5 |
11.0
|
16.1
| 2.1 | 11.3 |
9.8
|
12.7
| 11.3 |
8.5
|
14.9
| 0 | 0.286 |
40–59 | 20.6 |
17.4
|
23.9
| 21.4 |
18.3
|
24.5
| 0.8 | 15.9 |
12.8
|
19.0
| 17.3 |
14.1
|
21.0
| 1.4 | 0.897 | |
60–79 | 26.4 |
21.2
|
31.6
| 27.2 |
22.3
|
32.1
| 0.8 | 21.0 |
16.1
|
25.8
| 23.1 |
20.4
|
26.1
| 2.1 | 0.968 | |
18–79 | 18.0 |
16.0
|
19.9
| 19.3 |
17.4
|
21.2
| 1.3 | 15.1 |
13.3
|
16.9
| 16.2 |
14.0
|
18.7
| 1.1 | 0.646 | |
Obese, class IIg (%) | 18–39 | 5.5 |
3.6
|
7.3
| 6.0 |
4.2
|
7.7
| 0.5 | 5.0 |
3.4
|
6.5
| 4.8f
|
2.8
|
8.1
| −0.2 | 0.686 |
40–59 | 9.0 |
6.7
|
11.4
| 7.3 |
5.3
|
9.3
| −1.7 | 6.3f
|
4.2
|
8.5
| 8.1f
|
5.2
|
12.5
| 1.8 | 0.189 | |
60–79 | 8.1 |
4.9
|
11.4
| 11.7 |
8.1
|
15.2
| 3.6 | 6.5 |
4.5
|
8.5
| 5.9 |
4.5
|
7.8
| −0.6 | 0.126 | |
18–79 | 7.4 |
6.1
|
8.8
| 7.6 |
6.3
|
8.8
| 0.2 | 5.8 |
4.7
|
7.0
| 6.3 |
4.6
|
8.7
| 0.5 | 0.985 | |
Obese, class IIIg (%) | 18–39 | 3.5 |
2.0
|
5.0
| 2.4 |
1.2
|
3.5
| −1.1 | 2.8f
|
1.6
|
4.0
| 2.7f
|
1.5
|
4.6
| −0.1 | 0.286 |
40–59 | 4.3 |
2.7
|
6.0
| 5.8 |
4.0
|
7.6
| 1.5 | 3.2 |
2.2
|
4.2
| 4.2f
|
2.8
|
6.1
| 1.0 | 0.427 | |
60–79 | 4.5 |
2.1
|
7.0
| 4.2 |
2.0
|
6.5
| −0.3 | 3.0f
|
1.9
|
4.1
| 4.6f
|
2.8
|
7.5
| 1.6 | 0.645 | |
18–79 | 4.0 |
3.0
|
5.1
| 4.1 |
3.2
|
5.1
| 0.1 | 3.0 |
2.3
|
3.7
| 3.7 |
2.8
|
4.8
| 0.7 | 0.671 | |
Mean waist circumference (cm) | 20–39 | 86.6 |
85.2
|
88.0
| 88.4 |
87.3
|
89.6
| 1.8* | 86.9 |
85.5
|
88.4
| 85.7 |
83.6
|
87.7
| −1.2 | <0.001 |
40–59 | 93.7 |
92.4
|
94.9
| 95.6 |
94.4
|
96.9
| 1.9* | 93.4 |
91.9
|
94.9
| 93.8 |
92.1
|
95.6
| 0.4 | 0.062 | |
60–79 | 97.9 |
96.1
|
99.8
| 99.3 |
97.6
|
101.0
| 1.4 | 97.6 |
96.2
|
98.9
| 97.3 |
95.4
|
99.1
| −0.3 | 0.255 | |
Mean hip circumference (cm) | 20–39 | 103.6 |
102.6
|
104.6
| 105.0 |
104.1
|
105.9
| 1.4* | 102.7 |
101.5
|
103.8
| 102.1 |
100.5
|
103.7
| −0.6 | 0.030 |
40–59 | 105.6 |
104.7
|
106.6
| 106.7 |
105.8
|
107.7
| 1.1 | 104.3 |
103.3
|
105.3
| 104.5 |
103.1
|
105.8
| 0.2 | 0.139 | |
60–79 | 107.2 |
105.9
|
108.6
| 108.0 |
106.8
|
109.3
| 0.8 | 105.1 |
104.3
|
105.9
| 105.1 |
103.8
|
106.4
| 0 | 0.402 | |
Mean waist/hip ratio | 20–39 | 0.83 |
0.82
|
0.84
| 0.84 |
0.83
|
0.84
| 0.01 | 0.84 |
0.84
|
0.85
| 0.86 |
0.85
|
0.86
| 0.02*** | 0.807 |
40–59 | 0.88 |
0.88
|
0.89
| 0.89 |
0.89
|
0.90
| 0.01 | 0.89 |
0.89
|
0.90
| 0.91 |
0.90
|
0.92
| 0.02*** | 0.518 | |
60–79 | 0.91 |
0.90
|
0.92
| 0.92 |
0.91
|
0.93
| 0.01 | 0.93 |
0.92
|
0.94
| 0.93 |
0.93
|
0.94
| 0 | 0.206 |