title: Efficacy of a Community-Based Physical Activity Program KM2H2 for Stroke and Heart Attack Prevention among Senior Hypertensive Patients: A Cluster Randomized Controlled Phase-II Trial.
abstract: OBJECTIVE
  To evaluate the efficacy of the program Keep Moving toward Healthy Heart and Healthy Brain (KM2H2) in encouraging physical activities for the prevention of heart attack and stroke among hypertensive patients enrolled in the Community-Based Hypertension Control Program (CBHCP).
  
  
  METHODS
  Cluster randomized controlled trial with three waves of longitudinal assessments at baseline, 3 and 6 months post intervention.
  
  
  METHODS
  Community-based and patient-centered self-care for behavioral intervention in urban settings of China.
  
  
  METHODS
  A total of 450 participants diagnosed with hypertension from 12 community health centers in Wuhan, China were recruited, and were randomly assigned by center to receive either KM2H2 plus standard CBHCP care (6 centers and 232 patients) or the standard care only (6 centers and 218 patients).
  
  
  METHODS
  KM2H2 is a behavioral intervention guided by the Transtheoretical Model, the Model of Personalized Medicine and Social Capital Theory. It consists of six intervention sessions and two booster sessions engineered in a progressive manner. The purpose is to motivate and maintain physical activities for the prevention of heart attack and stroke.
  
  
  METHODS
  Heart attack and stroke (clinically diagnosed, primary outcome), blood pressure (measured, secondary outcome), and physical activity (self-report, tertiary outcome) were assessed at the individual level during the baseline, 3- and 6-month post-intervention.
  
  
  RESULTS
  Relative to the standard care, receiving KM2H2 was associated with significant reductions in the incidence of heart attack (3.60% vs. 7.03%, p < .05) and stroke (5.11% vs. 9.90%, p<0.05), and moderate reduction in blood pressure (-3.72 mmHg in DBP and -2.92 mmHg in DBP) at 6-month post-intervention; and significant increases in physical activity at 3- (d = 0.53, 95% CI: 0.21, 0.85) and 6-month (d = 0.45, 95% CI: 0.04, 0.85) post-intervention, respectively.
  
  
  CONCLUSIONS
  The program KM2H2 is efficacious to reduce the risk of heart attack and stroke among senior patients who are on anti-hypertensive medication. Findings of this study provide solid data supporting a formal phase-III trial to establish the effectiveness of KM2H2 for use in community settings for prevention.
  
  
  BACKGROUND
  ISRCTN Register ISRCTN12608966.
authors.affiliation: Department of Chronic Diseases, Wuhan Center for Disease Prevention and Control, Wuhan, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of Chronic Diseases, Wuhan Center for Disease Prevention and Control, Wuhan, China; Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America.
authors.forename: Xinguang
authors.initials: X
authors.lastname: Chen
authors.affiliation: School of Nursing, Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Sijian
authors.initials: S
authors.lastname: Li
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D016022:Case-Control Studies; D055812:Community-Based Participatory Research; D018479:Early Intervention, Educational; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000959:Antihypertensive Agents