Targeting physical activity in a low socioeconomic status population: observations from the Norwegian “Romsås in Motion” study

Abstract

Objective: To summarize the main results of a community-based study on physical activity promotion -"Romsås in Motion". Methods:We assessed changes in physical activity, body mass and psychosocial mediators of physical activity from a pseudo-experimental cohort study involving two districts with low socio-economic status in Oslo, Norway. In 2000, baseline investigation included 2,950 30-67 year olds -48% of those invited. At follow-up in 2003 we measured 1,776 subjects (67% of those eligible). A set of theoretically informed strategies targeting individuals, groups and the environment were implemented, tailored towards groups with different psychosocial readiness for change. We report net changes (the difference between changes in the intervention and control districts) and results of mediation analyses related to the effect of the intervention. Results:The increase in physical activity measured by two questionnaires was 9.5% (p=0.008) and 8.1% (p=0.02), respectively. The proportion who increased their body mass was reduced by 50% compared with the control district. Participation in walking and aerobic exercise groups, having seen the "Walk the stairs"-poster and used the walk path were particularly effective intervention components. The most promising psychosocial mediators of forward transition in stages of change were physical activity identity, perceived control, support from friends and family, and self-efficacy when facing psychological barriers. Conclusion:Through a theoretically informed, low-cost, population-based intervention program we observed an increase in physical activity levels and a reduced weight gain.Mediation findings regarding forward transition in stages of change enhance our understanding of psychosocial mechanisms of behaviour change, and may prove helpful in guiding implementation and evaluation of future interventions. 3In western societies today low socio-economic status (SES) at the individual, group and regional level represents a risk factor for premature cardiovascular disease (CVD), 1-2 a sedentary lifestyle and is linked to the world-wide increase in obesity and type 2 diabetes. [3][4][5] Although lifestyle interventions may be highly effective in high risk individuals, [6][7] very few community-based interventions have addressed behavioural risk factors for type 2 diabetes, and most study designs are flawed. 8 Even small improvements in one or more risk factors, if achieved in a large proportion of the population, 9 can provide considerable impact on public health. Thus, such interventions are needed, especially in low-income communities. 8 The determinants of physical activity behaviour are multi-factorial. 10-17The most promising theories and models hypothesize that behaviour change is mediated by change in proximal psychological factors such as attitudes, efficacy, control beliefs and identity.Further, influencing also more distal social and physical environmental factors comprising family support and social networks, organizations, communities and societies to reinf...

Promoting Physical Activity among Underserved Populations

“…There was no indication of whether the intervention was modified in some way to fit this population; however, attendance in the low SES group was roughly equal to that of the higher SES group, and the intervention was equally effective for both low and high SES groups. Similarly, a comprehensive PA intervention program in Norway used a variety of individual, group, and community-wide approaches in two low SES communities and found that, while the low SES individuals had a slightly less positive view of the intervention, they reported a greater effect on daily active lifestyle than higher SES individuals (41). The authors found that simple elements such as posters to increase stair use were among the most effective.…”

Pilot intervention in an economically disadvantaged community: The back‐to‐basics after‐school healthy lifestyle program

“…The burden of obesity is experienced disproportionally by minority groups and low‐income families in developed countries . Socioeconomic status (SES) is a risk factor for premature cardiovascular disease at the individual, group and regional levels . Studies in Australia have shown that body mass index (BMI) increases linearly with socioeconomic disadvantage, decreasing maternal education and family income .…”

“…Current recommendations suggest that to address the growing issue of obesity, structured treatment and prevention programs that target the parent as the agent of change and focus on nutrition and physical activity in socioeconomically disadvantaged communities should be prioritised . However, it has been recognised that changing behaviours in these groups can be challenging . Studies in low SES community settings have been predominantly conducted in the USA, including ethnic minority groups such as African‐American and/or Hispanic populations .…”

“…Studies in low SES community settings have been predominantly conducted in the USA, including ethnic minority groups such as African‐American and/or Hispanic populations . The effectiveness of interventions in low SES communities for improving weight‐related, diet and physical activity outcomes have been demonstrated, at least in the short‐term . Long‐term lifestyle behaviour change may be achievable, if provided with culturally appropriate programs that have a sense of local ownership .…”

“…3 Socioeconomic status (SES) is a risk factor for premature cardiovascular disease at the individual, group and regional levels. 4 Studies in Australia have shown that body mass index (BMI) increases linearly with socioeco-nomic disadvantage, decreasing maternal education and family income. 5 In addition, children from lower-income families are more likely to have inadequate intakes of fruits and vegetables and lower physical activity levels than children from families with medium-to-high incomes.…”