***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES We tested a community-based intervention design ed to reduce cardiovascular disease risk in sedentary midlife and older women who were overweight or obese . METHODS In a r and omized controlled trial conducted in 8 counties in Arkansas and Kansas , counties were assigned to the intervention ( a 12-week twice-weekly heart health program ) group or to the delayed-intervention control group .  Ten to fifteen women were selected from each site , and participants ' weight , waist circumference , diet , physical activity , and self-efficacy were measured before and after the intervention . Data were analyzed with multiple regressions . RESULTS Compared with the control group , participants in the intervention group had a significant decrease in body weight ( -2.1 kg ; 95 % confidence interval [ CI ] = -3.2 , -1.0 ) , waist circumference ( -2.3 in ; 95 % CI = -4.2 , -0.5 ) , and energy intake ( -390 kcal/day ; 95 % CI = -598 , -183 ) ; an increase in activity ( + 1637 steps/day ; 95 % CI = 712 , 2562 ) ; and an increase in self-efficacy for dietary and physical activity behaviors . CONCLUSIONS Our results suggest that a community-based program can improve self-efficacy , increase physical activity , and decrease energy intake , result ing in decreased waist circumference and body weight among at-risk women OBJECTIVE The objective of the present study was to evaluate the effectiveness of a minimal contact physical activity intervention that was maximally integrated into the existing structures of a women 's organization . METHODS The intervention included one group meeting , a self-help booklet , and five monthly reminder letters and was implemented in four units of a rural women 's organization . Two other units served as control group . Pretest and posttest measurements were completed by 81 women in the intervention group and 88 in the control group .  Physical activity was assessed at baseline and at 6 months with  accelerometers  and the International Physical Activity Question naire ( IPAQ ) .  RESULTS There was a significant interaction between time and group for the total accelerometer activity counts ( p = 0.007 ) . Total activity counts increased in the intervention group , whereas there was a decrease in the control group . No significant results were found with the IPAQ . CONCLUSIONS An intervention in a women 's organization was effective in increasing the objective ly measured physical activity levels of its members . These results indicate that women 's organizations can be valuable setting s for physical activity promotion programs . The minimal number of contact hours and the use of existing structures and communication channels are important strengths for later implementation Background : Unhealthy diet and lack of physical activity increase rural midlife and older women 's risk of chronic diseases and premature death , and they are behind urban residents in meeting Healthy People 2010 objectives . Objectives : The objective of this study was to compare a tailored intervention based on the Health Promotion Model with a generic intervention to increase physical activity  and  healthy eating  among rural women . Methods : In a r and omized-by-site , community-based , controlled , clinical trial , Wellness for Women , 225 women aged 50 to 69 years were recruited in two similar rural areas . Over 12 months , women received by mail either 18 generic newsletters or 18 newsletters computer tailored on Health Promotion Model behavior-specific cognitions ( benefits , barriers , self-efficacy , and interpersonal support ) , activity , and eating . Outcomes at 6 and 12 months included behavioral markers and biomarkers of physical activity and eating . Data were analyzed by repeated- measures analysis of variance and chi-square tests ( & agr ; < .05 ) . Results : Both groups significantly increased stretching and strengthening exercise and fruit and vegetable servings and decreased percentage of calories from fat , whereas only the tailored group increased moderate or greater intensity activity and decreased percentage of calories from saturated fat from baseline to 6 months . Both groups increased stretching and strengthening exercise , whereas only the tailored group increased moderate or greater intensity activity and fruit and vegetable servings and decreased percentage of calories from fat from baseline to 12 months . Both groups had several changes in biomarkers over the study . A higher proportion of women receiving tailored newsletters met Healthy People 2010 criteria for moderate or greater intensity activity , fruit and vegetable servings , and percentage of calories from fat at 12 months . Discussion : Mailed computer-tailored and generic print newsletters facilitated the adoption of change in both activity and eating over 6 months . Tailored newsletters were more efficacious in facilitating change over 12 months Background : Preventive guidelines on cardiovascular risk management recommend lifestyle changes . Support for lifestyle changes may be a useful task for practice nurses , but the effect of such interventions in primary prevention is not clear . We examined the effect of involving patients in nurse-led cardiovascular risk management on lifestyle adherence and cardiovascular risk . Methods : We performed a cluster r and omized controlled trial in 25 practice s that included 615 patients . The intervention consisted of nurse-led cardiovascular risk management , including risk assessment , risk communication , a decision aid and adapted motivational interviewing . The control group received a minimal nurse-led intervention . The self-reported outcome measures at one year were smoking , alcohol use , diet and physical activity . Nurses assessed 10-year cardiovascular mortality risk after one year . Results : There were no significant differences between the intervention groups . The effect of the intervention on the consumption of vegetables and physical activity was small , and some differences were only significant for subgroups . The effects of the intervention on the intake of fat , fruit and alcohol and smoking were not significant . We found no effect between the groups for cardiovascular 10-year risk . Interpretation : Nurse-led risk communication , use of a decision aid and adapted motivational interviewing did not lead to relevant differences between the groups in terms of lifestyle changes or cardiovascular risk , despite significant within-group differences Background — There is growing awareness of cardiovascular disease ( CVD ) as the leading cause of death in women , but whether this greater awareness is associated with increased action by women to lower their personal or family ’s risk is unknown . Methods and Results — A nationally representative sample of 1008 women selected through r and om-digit dialing were given a st and ardized question naire about history of CVD/risk factors , awareness of leading cause of death , knowledge of healthy and personal levels of CVD risk factors , self-reported actions taken to reduce risk  , and barriers to heart health . The rate of awareness of CVD as the leading cause of death has nearly doubled since 1997 ( 55 % versus 30 % ) was significantly greater for whites compared with blacks and Hispanics ( 62 % versus 38 % and 34 % , respectively ) and was independently correlated with increased physical activity ( odds ratio , 1.35 ; 95 % CI , 1.00 to 1.83 ) and weight loss ( odds ratio , 1.47 ; 95 % CI , 1.14 to 2.02 ) in the previous year in logistic regression models . Fewer than half of the respondents were aware of healthy levels of risk factors . Awareness that personal level was not healthy was positively associated with action . Most women took steps to lower risk in family members and themselves . The most frequently cited barriers for heart health were confusion in the media ( 49 % ) , the belief that health is determined by a higher power ( 44 % ) , and caretaking responsibilities ( 36 % ) . Conclusions — General awareness of CVD risk among women is associated with preventive action . Educational interventions need to be targeted at racial/ethnic minority women BACKGROUND This study assessed the effects of the Health Works for Women ( HWW ) intervention on improving multiple behaviors including nutrition and physical activity among rural female blue-collar employees in North Carolina . METHODS Nine small to mid-size workplaces were r and omly assigned to either intervention or delayed intervention conditions . After a baseline survey , an intervention consisting of two computer-tailored magazines and a natural helpers program was conducted over 18 months . Delayed worksites received one tailored magazine . Approximately 77 and 76 % of baseline respondents completed follow-up surveys at 6 and 18 months , respectively , and 538 women ( 63 % ) completed all three surveys . RESULTS At the 18-month follow-up , the intervention group had increased fruit and vegetable consumption by 0.7 daily servings compared to no change in the delayed group ( P < 0.05 ) . Significant differences in fat intake were observed at 6 months ( P < 0.05 ) but not at 18 months . The intervention group also demonstrated improvements in strengthening and flexibility exercise compared to the delayed group . The rates of smoking cessation and cancer screening did not differ between study groups . CONCLUSIONS The HWW project was a successful model for achieving certain health behavior changes among blue-collar women Physical activity is associated with health and reduced mortality risk , yet only15 % ofU.S. adults achieve adequate activity . This study is an experimental repeated measures nested design r and omizing two similar rural communities to investigate the effectiveness of the Heart and Soul Physical Activity Program ( HSPAP ) ( Peterson , 2002 ) in promoting physical activity in midlife women ( n = 42 ) aged 35 to 65 years . The HSPAP , an innovative church-based health promotion intervention , is conceptualized in social support and design ed to increase physical activity , energy expenditure ( EE ) , and cardiorespiratory fitness ( VO2 max ) , measured over time . A significant interaction ( p < .001 ) was found for EE in one HSPAP group increasing their EE by 1,010 kcals/week . HSPAP participants increased their VO2 max level by 75 % ( p < .001 ) and 10 % ; comparison groups stayed the same or declined 16 % . Study results provide preliminary support for the HSPAP intervention as an effective treatment to improve physical activity levels in sedentary , rural , midlife women OBJECTIVES This intervention was implemented to reduce the prevalence of cigarette smoking among women . METHODS We used community organization approaches to create coalitions and task forces to develop and implement a  multicomponent intervention in 2 counties in Vermont and New Hampshire , with a special focus on providing support to help women quit smoking . Evaluation was by pre-intervention and post-intervention r and om-digit-dialed telephone surveys in the intervention counties and the 2 matched comparison counties . RESULTS In the intervention counties , compared with the comparison counties , the odds of a woman being a smoker after 4 years of program activities were 0.88 ( 95 % confidence interval = 0.78 , 1.00 ) ( P = .02 , 1-tailed ) ; women smokers ' perceptions of community norms about women smoking were significantly more negative ( P = .002 , 1-tailed ) ; and the quit rate in the past 5 years was significantly greater ( 25.4 % vs 21.4 % ; P = .02 , 1-tailed ) . Quit rates were significantly higher in the intervention counties among younger women ( aged 18 to 44 years ) ; among women with household annual incomes of $ 25,000 or less ; and among heavier smokers ( those who smoked 25 or more cigarettes daily ) . CONCLUSIONS In these rural counties , community participation in planning and implementing interventions was accompanied by favorable changes in women 's smoking behavior Background : Walking can significantly increase cardiorespiratory fitness and thereby reduce the incidence of heart disease in women . However , there is a paucity of research aim ed at increasing walking in rural women , a high-risk group for heart disease and one for which exercise strategies may pose particular challenges . Purpose : This study tested Heart-to-Heart ( HTH ) , a 12-week walking program , design ed to increase fitness through walking in rural women . Heart-to-Heart integrated individual-oriented strategies , including motivational interviewing , and group-based strategies , including team building . Methods : Forty-six rural women were r and omized to either HTH or a comparison group . The primary outcome of cardiorespiratory fitness and secondary outcomes of self-efficacy and social support were measured preintervention and postintervention . Group differences were analyzed with repeated- measures analysis of variance . Results : Women in HTH group had a greater improvement in cardiorespiratory fitness ( P = .057 ) and in social support ( P = .004 ) compared with women in the comparison group . Neither group of women experienced a change in exercise self-efficacy ( P = .814 ) . Conclusions : HTH was effective in improving cardiorespiratory fitness in a sample of rural women . Further research is needed to refine HTH and determine the optimal approach in rural women to increase their walking OBJECTIVES To evaluate Cookin ' Up Health , a computer-based interactive nutrition intervention . METHODS After r and omization to intervention and control groups , 262 women in rural clinics in West Virginia completed both a baseline and 3-month follow-up survey . RESULTS Compared to the control group , the intervention group had significantly improved scores on knowledge of dietary fats , food label reading , and readiness to eat 5 fruits and vegetables a day and foods lower in fat . CONCLUSIONS This brief interactive nutrition intervention shows potential as a strategy to begin the process of change , but follow-up may be needed for actual behavior change to occur Cardiovascular disease mortality rates have decreased in men during the past 20 years , but have steadily increased in women . In the United States , > 500,000 women die of coronary artery disease ( CAD ) every year . Although many factors can influence an individual 's risk for CAD , some factors are unique to women , including reproductive status . Menopause is associated with significant elevations in serum cholesterol levels and a 3-fold increase in the risk of CAD . It has been suggested that these changes result from a reduction in the 
    Output:
    
While there were decreases in blood pressure at 6 months , studies with a 5-year follow up found no decreases for both systolic and diastolic blood pressure .
Overall results of studies into dietary modification programs also did not sustain an effect over a longer period of time .
The results of this review suggest that in rural areas , lifestyle interventions delivered by primary care providers in primary care setting s to patients at low risk appeared to be of marginal benefit .
Re sources and time in primary care might be better spent on patients at higher risk of cardiovascular disease , such as those with diabetes or existing heart disease