BACKGROUND Women living in rural areas face unique challenges in achieving a heart-healthy lifestyle that are related to multiple levels of the social-ecological framework. The purpose of this study was to evaluate changes in diet and physical activity, which are secondary outcomes of a community-based, multilevel cardiovascular disease risk reduction intervention designed for women in rural communities. METHODS Strong Hearts, Healthy Communities was a six-month, community-randomized trial conducted in 16 rural towns in Montana and New York, USA. Sedentary women aged 40 and older with overweight and obesity were recruited. Intervention participants (eight towns) attended twice weekly exercise and nutrition classes for 24 weeks (48 total). Individual-level components included aerobic exercise, progressive strength training, and healthy eating practices; a civic engagement component was designed to address social and built environment factors to support healthy lifestyles. The control group (eight towns) attended didactic healthy lifestyle classes monthly (six total). Dietary and physical activity data were collected at baseline and post-intervention. Dietary data were collected using automated self-administered 24-h dietary recalls, and physical activity data were collected by accelerometry and self-report. Data were analyzed using multilevel linear regression models with town as a random effect. RESULTS At baseline, both groups fell short of meeting many recommendations for cardiovascular health. Compared to the control group, the intervention group realized significant improvements in intake of fruit and vegetables combined (difference: 0.6 cup equivalents per day, 95% CI 0.1 to 1.1, p = .026) and in vegetables alone (difference: 0.3 cup equivalents per day, 95% CI 0.1 to 0.6, p = .016). For physical activity, there were no statistically significant between-group differences based on accelerometry. By self-report, the intervention group experienced a greater increase in walking MET minutes per week (difference: 113.5 MET-minutes per week, 95% CI 12.8 to 214.2, p = .027). CONCLUSIONS Between-group differences in dietary and physical activity behaviors measured in this study were minimal. Future studies should consider how to bolster behavioral outcomes in rural settings and may also continue to explore the value of components designed to enact social and environmental change. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02499731. Registered 16 July 2015.

中文翻译：

---

强心、健康社区随机降低心血管疾病风险多层次干预试验导致饮食和身体活动发生变化。

背景技术生活在农村地区的妇女在实现心脏健康的生活方式方面面临着独特的挑战，这与社会生态框架的多个层面相关。本研究的目的是评估饮食和体力活动的变化，这是针对农村社区妇女设计的基于社区的多层次心血管疾病风险降低干预措施的次要结果。方法“坚强的心，健康的社区”是一项为期六个月的社区随机试验，在美国蒙大拿州和纽约州的 16 个乡村城镇进行。招募了 40 岁及以上、超重和肥胖的久坐女性。干预参与者（8 个城镇）每周参加两次运动和营养课程，为期 24 周（总共 48 周）。个人层面的组成部分包括有氧运动、渐进式力量训练和健康饮食习惯；公民参与部分旨在解决社会和建筑环境因素，以支持健康的生活方式。对照组（八个城镇）每月参加健康生活方式教育课程（总共六次）。在基线和干预后收集饮食和身体活动数据。使用自动自我管理的 24 小时饮食回忆来收集饮食数据，并通过加速测量和自我报告收集身体活动数据。使用多级线性回归模型对数据进行分析，其中城镇为随机效应。结果 在基线时，两组均未达到心血管健康的许多建议。与对照组相比，干预组的水果和蔬菜综合摄入量（差异：每天 0.6 杯当量，95% CI 0.1 至 1.1，p = 0.026）和单独蔬菜摄入量（差异：0.3 杯当量）显着改善每天，95% CI 0.1 至 0.6，p = .016）。对于体力活动，基于加速度测量的组间差异不存在统计学意义。根据自我报告，干预组每周步行 MET 分钟数显着增加（差异：每周 113.5 MET 分钟，95% CI 12.8 至 214.2，p = .027）。结论 本研究中测量的饮食和身体活动行为的组间差异很小。未来的研究应考虑如何增强农村环境中的行为结果，并可能继续探索旨在实现社会和环境变化的组成部分的价值。试验注册 ClinicalTrials.gov 标识符：NCT02499731。2015 年 7 月 16 日注册。