Risk for cardiovascular disease (CVD) increases in women as they traverse the menopause, independently of aging. In a 15-year longitudinal study of women undergoing the menopause, we have shown that menopause increases in the predominance of testosterone in the hormonal milieu which promotes the development of visceral fat, an important CVD risk factor. Although menopause cannot be modified, we have shown that sedentary lifestyle and chronic stress are also independently associated with high levels of visceral fat. Thus, we hypothesize that an intervention that is successful in producing a sustained increase physical activity and reduction in chronic stress could reduce the menopause-related development of visceral fat and, as such, reduce early cardiovascular risk in women. This proposal aims to develop a multi-level intervention targeting simultaneously the individual, the social network, and the community, for the purpose of producing a sustained increase in physical activity and reduction in chronic stress. The targeted community is the same community from which the epidemiologic data were obtained. Thus providing the opportunity to give back by improving health. The research team features expertise in the disciplines of psychology, epidemiology, physical medicine, biostatistics, endocrinology, communications, and health economics. The community partners include participants in the 15-year epidemiologic study and community- based organizations. Development of the intervention has been informed by theory concerned with sustained change, namely Self-Determination Theory, Social Cognitive Theory, Diffusion of Innovation Theory, Community-Based Participatory Research, Communications Theory, and Utility Theory. It will be developed in 3 phases. The first explore psychological and social characteristics in individuals who have been successful at sustaining physical activity over 9 years, determine the best way to prevent drop-outs in the early phase of change, and exploring qualitatively potential activities that would be included in a treatment tool box. The second is a """"""""proof of concept study"""""""" aimed at determining optimum length and the value of community support. The third is a controlled pilot study of the refined intervention which will generate estimates needed for the design of a subsequent clinical trial.

Public Health Relevance

There is an urgent need to find treatments to reduce risk for CVD in women which is their number one killer.
We aim to develop an intervention to reduce early risk for developing visceral fat in pre-menopausal women by producing a sustained increase in physical activity and reduction in chronic stress. The setting is in a community that has partnered with us over the past 15 years to provide the epidemiologic data that form the basis of this work.
We aim to give back to this community by partnering to develop a program that could improve their health.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZHL1-CSR-H (S1))
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Czajkowski, Susan
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Rush University Medical Center
Public Health & Prev Medicine
Schools of Medicine
United States
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