Presentation Transcript

1. Effect of a fitness training/health education intervention on cardiovascular health of inmates in Kentucky state prisons Alison Connell, PhD, APRN

2. Biobehavioral Cardiovascular Health Promotion Intervention In A State Prison System

   Debra Moser, DNS, principal investigator Alison Connell, PhD, co-investigator Terrie Lennie, PhD, co-investigator Alison Bailey, MD, co-investigator Misook Chung, PhD, project director Funding: National Institutes of Health, NINR, RC2NR0119428
3. Background Leading cause of death in inmates is cardiovascular disease Adjusted risk of death among recently released inmates 3.5 times that of non-incarcerated Heart disease is the second most common cause of death in recently released inmates Lower education, income levels and worse health literacy 41 % of inmates in state and federal prisons have not completed high school or its equivalent, compared to 18.4 % for the non-incarcerated Wang EA, et al. Arch Intern Med. 2009;169:687-693. van Olphen J, et al. J Urban Health. 2006;83:372-381. Wolff N, et al. Psychiatr Serv. 2002;53:1469-1471. Binswanger IA, et al. N Engl J Med. 2007;356:157-165. MumolaC. Medical causes of death in state prisons. www.ojp.usdoj.gov/bjs/pub/pdf/mcdsp04.pdf
4. Study Purpose and Design The long-term objective of the study was to improve the cardiovascular (CV) health of inmates by implementation of a state-wide CV risk factor reduction program in prisons Specific aim: to determine the effect of a fitness training and health education intervention on: Cardiovascular health as measured by time to 85% of maximal heart rate using graded exercise treadmill test. Self-reported lifestyle behaviors pre- and post-intervention.
5. Methods Four prisons—4 groups in each prison, ~35 inmates per group Kentucky State Reformatory Luther Luckett Correctional Complex Eastern Kentucky Correctional Complex Little Sandy Correctional Complex Recruited via flyers in dorms and recreation areas Data gathered from inmates at four time points A multiple baselines design was used in which all participants receive the intervention, and all have a 3 month run-in period to establish their own baseline without intervention Baseline, pre-intervention, immediately post-intervention and 3 months post-intervention Intervention—12-week Health education with behavior change strategy sessions delivered by certified health educators—one hour once a week Aerobic exercise program led exercise specialists—one hour twice a week
6. Measures Submaximal treadmill test—85% of maximal heart rate Modified Bruce protocol Inmate Health Risk Assessment—self-report questionnaire Exercise How often moderate physical activity (0-1, 2-3, 4 or more days a week) How often vigorous physical activity (0-1, 2-3, 4 or more days a week) Diet Usual fruits and vegetables a day (<3, 3-4, 5 or more) Usual carbs a day Mostly white bread and few grains Some carbs from fiber and whole grain Mostly whole grain and high fiber Usual meat/dairy Cheese, whole milk, fried foods 5-7 days a week, 2% milk, fried food/chips 3-4 days a week No-fat dairy, lean meats, rare fried foods Social support Stress—how well cope Tobacco use—smoke cigarettes every day, some days, not at all
7. Intervention Participants Total attendance in education and fitness sessions = 36 sessions Education 12 sessions Fitness 24 sessions For analysis divided into tertiles of total attendance 0 - 6 sessions 7 – 31 sessions Over 31 sessions Age, education level and length of sentence were associated with participation. There was no difference in intervention participation by marital status (p = .96) or by self-report of level of health (p = .79).
8. Intervention Attendance Fewest fitness and education sessions (0-6 sessions) 19-34 years old Have less than high school, or high school diploma education Shorter sentence (less than 20 years) Most fitness and education sessions (> 31 sessions) Over 35 years Over 30 year sentence
9. Results: Time to 85% of maximal HR By third assessment n = 186 Those who attended more than 31 sessions of the total education and fitness improved their cardiovascular fitness as measured by the time to get to 85% of their maximal heart rate (p = .01) When analyzed using just the fitness sessions Highest tertile of fitness sessions attended (over 20 sessions) (p = .003)
10. Lifestyle Choices Inmate Health Risk Assessment Exercise How often moderate physical activity (0-1, 2-3, 4 or more days a week) How often vigorous physical activity (0-1, 2-3, 4 or more days a week) Diet Usual fruits and vegetables a day (<3, 3-4, 5 or more) Usual carbs a day Mostly white bread and few grains Some carbs from fiber and whole grain Mostly whole grain and high fiber Usual meat/dairy Cheese, whole milk, fried foods 5-7 days a week, 2% milk, fried food/chips 3-4 days a week No-fat dairy, lean meats, rare fried foods Social ties—no change ( p = .85) Stress—no change (p = .28) Tobacco use—smoke cigarettes every day, some days, not at all
11. Self-reported Changes in Behavior Exercise Inmates with the highest attendance (>31 sessions) reported that they continued to exercise on non-intervention days 26.8% who had been 3 or less days a week at baseline, reported exercising 4 or more days a week post intervention (p = < .001) Diet Increasing fruits and vegetables from less than 3 servings a day to over 3 servings a day No change in behavior Increasing fiber, whole grain from mostly white bread and few whole grain 30.9% of highest intervention group who ate almost all white bread added fiber through whole wheat or high fiber (p =.04) Decreasing fried/fatty foods and drinking 2% milk 31.9% of highest intervention group changed from whole milk to 2% and eating fried or fatty foods from 5-7 d/wkto 4 or less days a week (p = .04)
12. Cigarette Smoking Baseline 39.5% some or every day (N =378) 20.2% at KSR—tobacco-free prison (staff and inmates) 49.0% at other three prisons—smoking allowed outdoors Post-intervention 11.5% at KSR 41% at other three prisons 13 out of 180 (7.2%) who reported smoking “every day” or “some days” reported smoking "not at all" by end of study 8 were in highest attendance group and 5 were in the middle intervention group (7-31 sessions) 9 out of 180 (5%) who reported smoking “not at all” at baseline, reported smoking every day by 3rd assessment
13. Conclusion Inmates who participated in the most intervention sessions Demonstrated improved cardiovascular health as measured by the time to reach 85% of their maximal heart rate Made modifiable lifestyle changes such as Increasing exercise Decreasing fried foods, whole milk, and increasing fiber in their diets Inmates who had longer sentences, over age 35, and more educated were more likely to participate in the entire intervention Limitations Attrition: N = 378 at baseline and n = 180 by the third assessment