Black Americans who have a sibling <60 years of age with premature coronary artery disease (CAD) have an increased risk of developing CAD themselves, and a marked excess prevalence of all cardiovascular risk factors, particularly the metabolic syndrome, which is a potent CAD precursor in this high-risk population. Sedentary lifestyle is associated with the metabolic syndrome and its vascular disease substrate. Moderate- intensity exercise is known to abolish metabolic syndrome risk factors in well-controlled research settings. However, habitual moderate intensity exercise is difficult to achieve among high-risk Black Americans. We propose a community-based coach-mediated intervention to achieve regular resistance and aerobic activity of sufficient intensity to ameliorate risk factors and reduce the prevalence of the metabolic syndrome. We will test a strategy to engage participants exercise based on: 1) an effectiveness hypothesis, that one year of a guided exercise program provided in the community and implemented by a trained coach from the community will result in a significant improvement in physical fitness and exercise adherence, and 2). an efficacy hypothesis that the community intervention will result in a significant reduction in individual CAD risk factors, particularly metabolic risk factors, and will be accompanied by improvement in """"""""vascular health"""""""" in Black American non-CAD nondiabetic individuals with the metabolic syndrome. We will use a randomized trial of the community-based exercise intervention (C-FIT) compared to a self-help exercise (SELF) control intervention using culturally sensitive materials and referral to community exercise sites. The sample will be comprised of 200 already identified <65 year old unaffected brothers and sisters of premature CAD patients accrued within the past 10 years. The outcomes at 6 months, 1- and 2-years include changes in habitual physical activity and aerobic and strength fitness, body composition, insulin resistance syndrome, high sensitivity C-reactive protein, blood pressure and lipids levels. Endpoints also include a proxy for improved vascular health and conversion from having the metabolic syndrome to normal. The analysis will use regression adjustment for the baseline level of the dependent variables using mixed-model analysis of covariance (MM-ANCOVA). The integration of biological and social cognitive science frameworks allows translation of exercise efficacy research findings to the """"""""real world"""""""" to achieve exercise of sufficient intensity to moderate metabolic risk factors that are prevalent in high risk Black American families. This study is designed to determine the impact of a community-based personal trainer model over a year of moderate intensity aerobic fitness and strength training on the metabolic syndrome and its components in high risk people from African Americans with premature coronary disease. Outcomes will include changes in factors that affect cardiovascular risk. Long term-outcomes will be examined at 1 and 2 years.
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