Not all of the 220 women from rural Nebraska enrolled in Susan Noble Walker’s research project, Wellness for Women, have met goals for incorporating healthy eating and physical activity into their lifestyle, but many have made extensive changes over the past two years.
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Susan Noble Walker |
Dr. Walker is the principal investigator of the research project, which began in 2001 when she received a $1.6 million grant from the National Institute of Nursing Research, National Institutes of Health.
She is joined by an interdisciplinary team of investigators including Patricia Hageman, Ph.D., professor and director of Physical Therapy Education at UNMC; Linda Boeckner, Ph.D., professor at the University of Nebraska-Lincoln Department of Nutrition and Health Sciences; Carol Pullen, Ed.D., R.N., professor and assistant dean for Distance Education and Technology in the UNMC College of Nursing.
Project staff includes Maureen Oberdorfer, M.P.A., project coordinator, Matthew Rutledge, M.A., instructional technologist, and research nurses Cathy Vasko, B.S.N. in Scottsbluff and Dawn Garcia, B.S.N. in Norfolk. Both research nurses are graduates of the UNMC College of Nursing.
The goal of the research project is to evaluate the effectiveness of an intervention program that encourages midlife and older women living in rural areas to adopt the health-related behaviors of healthy eating and physical activity.
“The study is designed so the women could work toward their lifestyle change goals at home rather than in organized groups,” Dr. Walker said.
Two groups of 110 women, ages 50 to 69, were recruited from Scottsbluff and Norfolk by random digit dialing conducted by the University of Nebraska-Lincoln Bureau of Sociological Research. One group received tailored newsletters and the other standard newsletters.
The intervention lasted for one year with participants receiving newsletters every two weeks for six months, then only once a month.
All of the women came to the research office in their community every three months in the first year of the study and every six months in the second year. The offices were located at the Cooperative Extension Office in Scottsbluff and Northeast Community College in Norfolk. Follow-up visits were then scheduled for 18 and 24 months to evaluate whether or not the women were able to sustain any positive behavior changes.
Participants were given a pedometer when they started the study, and a research nurse helped them to complete an assessment of activity and eating patterns on a computer at each office visit. The nurses also assessed the women’s fitness level and drew blood for cholesterol levels.
The data was used to create a tailored newsletter that gave specific advice to each participant selected to be in the tailored group. The advice was based on participants’ answers to various questions.
The remaining group of participants received a standard newsletter that gave helpful tips on healthy eating, exercising and basic facts about fruits and vegetables, but was not based on each woman’s data.
“Feedback is motivating,” Dr. Walker said. “We hoped that by providing detailed advice concerning areas in which study group participants needed to make changes in activity and eating, it would prompt them to make those changes.”
For example, she said, if a participant’s data indicated that she ate fewer than the recommended minimum of two servings of fruit a day, that person’s tailored newsletter would have a paragraph explaining how to incorporate more fruit into her diet, give examples of what a serving size is as well as include a recipe.
“We not only told women what they should do, but how to do it and how to overcome barriers and get greater interpersonal support from friends and family,” Dr. Walker said.
The women also were educated about how much exercise they need every day based upon national guidelines, which recommends at least 30 minutes of moderate or greater intensity exercise.
“We told the women how fast to walk in order to meet the national physical activity guidelines,” said Dr. Walker. “The idea behind moderate physical activity is that you are using most of the major muscles in your body, giving you a sensation of being warm.”
Each participant’s progress was measured not only by their reports of their own behavior but also by biological markers, such as cholesterol levels, fitness level and weight.
So far, all of the women have completed 18 months in the study, said Dr. Walker, and a few have completed the entire 24 months. Some made few changes and some surpassed expectations.
“One woman diagnosed with type II diabetes has lost 10 percent of her body fat and was able to go off of her medications,” said Maureen Oberdorfer.
Oberdorfer said the feedback the research team has received thus far has been extremely positive. “Most of the women have said that they have learned a lot about how to eat and the importance of daily physical activity,” she said.
Many of the women chose walking as a way to increase their level of physical activity, she said. In addition, all of the women were given resistance bands and instructional videotape for strength training developed by the team, and encouraged to do those exercises for 30 minutes, two to three times each week.
In order to ensure the success of the research project, Dr. Walker and her colleagues met with a community advisory council in each geographic area.
Dr. Walker said the advisory council acted as consultants and their input was invaluable in making sure the research team had realistic expectations for the participants.
“We relied on the advisory council to recommend locations where the participants could go to exercise, especially during the winter months,” Dr. Walker said.
One of the many tips the advisory council suggested was that some local high schools be asked to open their gym after hours so that participants could go there to walk.
“Our hope is that long after the study ends all of the participants will continue to be physically active and eat healthier,” she said.
Dr. Walker said that rural women were targeted for the research project because they have higher rates of obesity and chronic illnesses than their urban counterparts. “National data show that rural women are more sedentary than urban, yet are less likely to receive counseling from their health care providers on the importance of maintaining a healthy lifestyle,” Dr. Walker said.
Dr. Walker chose women between the ages of 50 and 69 because this is the time when a woman’s health risks increase.
“After menopause women are at risk for such chronic diseases as diabetes, osteoporosis and cardiovascular disease,” she said. “Many of these diseases are preventable or can at least be delayed by healthy eating and daily moderately intense physical activity.”