Erik Ruland

Lifestyle factors of a five-year community-intervention program: the Hartslag Limburg intervention

BACKGROUND Community-based health promotion is a widely advocated strategy in public health to favorably alter lifestyle. The aim of this study was to investigate the net effect of a cardiovascular disease-prevention program (Hartslag Limburg) on lifestyle factors after 5 years of intervention (1998-2003). METHODS In a cohort study, 5-year mean changes in lifestyle factors (energy intake; fat intake; time spent on leisure-time physical activity; walking, bicycling, and sports; and smoking behavior) between subjects from the intervention area (n=2356) and the control area (n=758) were compared for men and women and for those with a low (less than intermediate secondary education) and a moderate (intermediate vocational or higher secondary education) or high (higher vocational education or university) educational level. Adjustments were made for age and the mean of the individual pre- and post-intervention measurement of the variable under study. When stratifying for gender, adjustments were made for educational level, and vice versa. RESULTS In general, lifestyle factors changed unfavorably in the control group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in lifestyle factors between the intervention group and the control group was significant (p<or=0.05) for energy intake (-0.2 megajoule per day among both women and those with a low educational level); fat intake (-2.5 grams per day [g/d] among women and -3 g/d among those with a low educational level); time spent walking (+2.2 hours per week [hrs/wk] among women and +2.3 hrs/wk among those with a low educational level); time spent on total leisure-time physical activity (+2.1 hrs/wk among women); and time spent bicycling (+0.6 hrs/wk among those with a low educational level). CONCLUSIONS The community intervention Hartslag Limburg succeeded in preventing age- and time-related unfavorable changes in energy intake, fat consumption, walking, and bicycling, particularly among women and those with low SES.

Costs of the 'Hartslag Limburg' community heart health intervention

BackgroundLittle is known about the costs of community programmes to prevent cardiovascular diseases. The present study calculated the economic costs of all interventions within a Dutch community programme called Hartslag Limburg, in such a way as to facilitate generalisation to other countries. It also calculated the difference between the economic costs and the costs incurred by the coordinating institution.MethodsHartslag Limburg was a large-scale community programme that consisted of many interventions to prevent cardiovascular diseases. The target population consisted of all inhabitants of the region (n = 180.000). Special attention was paid to reach persons with a low socio-economic status.Costs were calculated using the guidelines for economic evaluation in health care. An overview of the material and staffing input involved was drawn up for every single intervention, and volume components were attached to each intervention component. These data were gathered during to the implementation of the intervention. Finally, the input was valued, using Dutch price levels for 2004.ResultsThe economic costs of the interventions that were implemented within the five-year community programme (n = 180,000) were calculated to be about €900,000. €555,000 was spent on interventions to change peoples exercise patterns, €250,000 on improving nutrition, €50,000 on smoking cessation, and €45,000 on lifestyle in general. The coordinating agency contributed about 10% to the costs of the interventions. Other institutions that were part of the programmes network and external subsidy providers contributed the other 90% of the costs.ConclusionThe current study calculated the costs of a community programme in a detailed and systematic way, allowing the costs to be easily adapted to other countries and regions. The study further showed that the difference between economic costs and the costs incurred by the coordinating agency can be very large. Cost sharing was facilitated by the unique approach used in the Hartslag Limburg programme.

Effects of health counseling on behavioural risk factors in a high-risk cardiology outpatient population: a randomized clinical trial:

Background An evaluation study of an individual lifestyle advice intervention to reduce cardiovascular risk behaviours (high fat consumption, smoking, physical inactivity). Methods A randomized, controlled trial at the cardiology outpatient clinic of the University Hospital Maastricht. Participants were at high risk of incurring a cardiovascular event. Changes in risk behaviours and behavioural determinants were assessed with self-administered validated questionnaires. Results Questionnaires were completed by 1270 patients at baseline, 1169 after 4 months (92%), and 1032 after 18 months (81.3%). After 4 months, intention-to-treat analyses revealed a decrease in fat consumption (−5.6%, P=0.000), a reduction in the percentage of smokers [odds ratio (OR) 0.57, 95% confidence intervals (CI) 0.33–0.97] and a trend towards a maintained physical activity level (OR 1.28, 95% CI 0.97–1.70). No long-term effects were found. Conclusion The lifestyle advice intervention was potentially effective in changing cardiovascular risk behaviours, but should be further improved to be effective in secondary cardiovascular prevention. The main limitations of the study were related to the randomization procedure and the self-selection of patients and cardiologists.

The Dutch heart health community intervention “Hartslag Limburg”: evaluation design and baseline data

Hartslag Limburg, a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high‐risk strategy. The present paper presents the evaluation design for, and baseline data from, the community intervention. The conceptual framework of the community intervention and its evaluation study were based on programme planning and evaluation models. Within this framework, community organization principles and methods and health education theories and methods were applied. Pre‐test/post‐test control group designs were used to study changes at the individual and the organizational level. The baseline results confirm the need to carry out a comprehensive CVD prevention community project, and the appropriateness of the conceptual model that is used for the development of interventions.

Effects of a brief cardiovascular prevention program by a health advisor in primary care; the 'Hartslag Limburg' project, a cluster randomized trial.

OBJECTIVE To determine in primary care patients at high risk for a cardiovascular event, the effects on biomedical risk factors for and incidence of cardiovascular events, of a brief cardiovascular prevention program executed by a health advisor. METHOD DESIGN cluster randomized controlled trial with 1275 patients (24 general practices) in and around Maastricht, the Netherlands (1999-2004). INTERVENTION health advisors were to complete computerized cardiovascular risk profiles, provide multi-factorial tailored health education and advice, and communicate with GPs to optimize treatment. OUTCOME differences in changes in risk factors between baseline and follow up at 6, 18, and 36 months and incidence of cardiovascular events at 36 months. RESULTS PROCESS Because of logistic reasons risk profiles were put on paper instead of in the computerized patient files. On average patients attended 2.3 counseling sessions. Interaction with GPs was less productive than expected. OUTCOME Effect after six months on BMI (-0.20 kg/m(2) (95% CI -0.38 to -0.01, p=0.039), Cohens d: -0.18), and after 18 months on HDL-cholesterol (+0.05 mmol/l (95% CI +0.01 to +0.09, p=0.014), Cohens d: 0.14). No other (subgroup) effects were found. CONCLUSION Given the lack of clinically meaningful effects, implementation of this intervention in its present form is not justified.

Lifestyle Factors of a Five-Year Community-Intervention Program

BACKGROUND Community-based health promotion is a widely advocated strategy in public health to favorably alter lifestyle. The aim of this study was to investigate the net effect of a cardiovascular disease-prevention program (Hartslag Limburg) on lifestyle factors after 5 years of intervention (1998-2003). METHODS In a cohort study, 5-year mean changes in lifestyle factors (energy intake; fat intake; time spent on leisure-time physical activity; walking, bicycling, and sports; and smoking behavior) between subjects from the intervention area (n=2356) and the control area (n=758) were compared for men and women and for those with a low (less than intermediate secondary education) and a moderate (intermediate vocational or higher secondary education) or high (higher vocational education or university) educational level. Adjustments were made for age and the mean of the individual pre- and post-intervention measurement of the variable under study. When stratifying for gender, adjustments were made for educational level, and vice versa. RESULTS In general, lifestyle factors changed unfavorably in the control group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in lifestyle factors between the intervention group and the control group was significant (p<or=0.05) for energy intake (-0.2 megajoule per day among both women and those with a low educational level); fat intake (-2.5 grams per day [g/d] among women and -3 g/d among those with a low educational level); time spent walking (+2.2 hours per week [hrs/wk] among women and +2.3 hrs/wk among those with a low educational level); time spent on total leisure-time physical activity (+2.1 hrs/wk among women); and time spent bicycling (+0.6 hrs/wk among those with a low educational level). CONCLUSIONS The community intervention Hartslag Limburg succeeded in preventing age- and time-related unfavorable changes in energy intake, fat consumption, walking, and bicycling, particularly among women and those with low SES.

Effect van 5 jaar community interventie Hartslag Limburg op risicofactoren voor hart- en vaatziekten

Samenvatting‘Hartslag Limburg’ is een integraal preventieprogramma gericht op het bevorderen van een gezonde leefstijl, met als doel om hart- en vaatziekten in de regio van Maastricht terug te dringen.1 Dit artikel is de vijfde in de serie en beschrijft het effect van Hartslag Limburg op leefstijl en risicofactoren voor hart- en vaatziekten na vijf jaar interventie (1998-2003). Van 2414 mensen uit de interventiepopulatie en 758 mensen uit de controlepopulatie is complete follow up informatie beschikbaar (31-70 jaar). Deze studie, gebaseerd op de follow up gegevens, laat een gunstig interventie effect zien op body mass index, middelomtrek, diastolische en systolische bloeddruk bij mannen en vrouwen. Verder is bij vrouwen een gunstig effect gevonden op bloedglucose, tijd besteed aan wandelen, totale activiteit in vrije tijd, energie-inneming en vetconsumptie en een ongunstig effect op serum cholesterol. Er is geen effect gevonden op het rookgedrag. De veranderingen in biologische risicofactoren sluiten goed aan bij de gevonden effecten op de leefstijlfactoren. In Hartslag Limburg is het hiermee gelukt om de aan leeftijd en periode gerelateerde verandering in risicofactoren voor hart- en vaatziekten gedeeltelijk tegen te gaan.AbstractEffect of five year community intervention ‘Hartslag Limburg’ on cardiovascular risk factors ‘Hartslag Limburg’ or Heartbeat Limburg is a cardiovascular community intervention programme aimed at promoting a healthy lifestyle in Maastricht, a town in the South of the Netherlands. This article is the fifth in the series and presents the effects of Hartslag Limburg on lifestyle and risk factors for cardiovascular disease after five year intervention (1998-2003). Complete follow up information was available for 2414 subjects of the intervention region and 758 subjects of the reference region (age range 31-70). This study, based on follow up, shows a favourable intervention effect on body mass index, waist circumference, diastolic and systolic blood pressure among men and women. In addition, in women favourable effects were observed on non fasting serum glucose, time spent on walking and total leisure time physical activity, energy intake and fat consumption and an unfavourable effect on serum cholesterol. There is no intervention effect on smoking behaviour. Changes in biological risk factors are consistent with the changes observed in the lifestyle factors.‘Hartslag Limburg’ succeeded in reducing and in some cases even preventing the age and time related increased risk of cardiovascular diseases.

The effects on lifestyle factors of a five year community intervention program in the Netherlands: The Hartslag Limburg intervention.

BACKGROUND Community-based health promotion is a widely advocated strategy in public health to favorably alter lifestyle. The aim of this study was to investigate the net effect of a cardiovascular disease-prevention program (Hartslag Limburg) on lifestyle factors after 5 years of intervention (1998-2003). METHODS In a cohort study, 5-year mean changes in lifestyle factors (energy intake; fat intake; time spent on leisure-time physical activity; walking, bicycling, and sports; and smoking behavior) between subjects from the intervention area (n=2356) and the control area (n=758) were compared for men and women and for those with a low (less than intermediate secondary education) and a moderate (intermediate vocational or higher secondary education) or high (higher vocational education or university) educational level. Adjustments were made for age and the mean of the individual pre- and post-intervention measurement of the variable under study. When stratifying for gender, adjustments were made for educational level, and vice versa. RESULTS In general, lifestyle factors changed unfavorably in the control group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in lifestyle factors between the intervention group and the control group was significant (p<or=0.05) for energy intake (-0.2 megajoule per day among both women and those with a low educational level); fat intake (-2.5 grams per day [g/d] among women and -3 g/d among those with a low educational level); time spent walking (+2.2 hours per week [hrs/wk] among women and +2.3 hrs/wk among those with a low educational level); time spent on total leisure-time physical activity (+2.1 hrs/wk among women); and time spent bicycling (+0.6 hrs/wk among those with a low educational level). CONCLUSIONS The community intervention Hartslag Limburg succeeded in preventing age- and time-related unfavorable changes in energy intake, fat consumption, walking, and bicycling, particularly among women and those with low SES.