"Worth the Walk": Culturally Tailored Stroke Risk Factor Reduction Intervention in Community Senior Centers

J Am Heart Assoc. 2019 Mar 19;8(6):e011088. doi: 10.1161/JAHA.118.011088.

Abstract

Background Racial/ethnic minority older adults have worse stroke burden than non-Hispanic white and younger counterparts. Our academic-community partner team tested a culturally tailored 1-month (8-session) intervention to increase walking and stroke knowledge among Latino, Korean, Chinese, and black seniors. Methods and Results We conducted a randomized wait-list controlled trial of 233 adults aged 60 years and older, with a history of hypertension, recruited from senior centers. Outcomes were measured at baseline (T0), immediately after the 1-month intervention (T1), and 2 months later (T2). The primary outcome was pedometer-measured change in steps. Secondary outcomes included stroke knowledge (eg, intention to call 911 for stroke symptoms) and other self-reported and clinical measures of health. Mean age of participants was 74 years; 90% completed T2. Intervention participants had better daily walking change scores than control participants at T1 (489 versus -398 steps; mean difference in change=887; 97.5% CI, 137-1636), but not T2 after adjusting for multiple comparisons (233 versus -714; mean difference in change=947; 97.5% CI, -108 to 2002). The intervention increased the percent of stroke symptoms for which participants would call 911 (from 49% to 68%); the control group did not change (mean difference in change T0-T1=22%; 99.9% CI, 9-34%). This effect persisted at T2. The intervention did not affect measures of health (eg, blood pressure). Conclusions This community-partnered intervention did not succeed in increasing and sustaining meaningful improvements in walking levels among minority seniors, but it caused large, sustained improvements in stroke preparedness. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02181062.

Trial registration: ClinicalTrials.gov NCT02181062.

Keywords: Community‐based participatory research; aging; minority health; walking.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Ethnicity*
  • Exercise Therapy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Quality of Life*
  • Retrospective Studies
  • Risk Factors
  • Risk Reduction Behavior*
  • Senior Centers*
  • Single-Blind Method
  • Stroke / ethnology
  • Stroke / prevention & control*
  • Survival Rate / trends
  • Treatment Outcome
  • United States / epidemiology
  • Walking / physiology*

Associated data

  • ClinicalTrials.gov/NCT02181062