Low income ethnic minority women, many with reduced literacy skills, are at elevated risk for cardiovascular disease (CVD) and non-insulin- dependent diabetes mellitus. Recent NHANES data showed more women than men, especially Mexican-American women (46 percent), reported no leisure time physical activities. Exceedingly little research has been conducted evaluating methods for enhancing adherence to current physical activity recommendations in this highly sedentary and underserved population. This proposal is designed to encourage sustained increases in physical activity (PA) in a multiethnic, low income population of 180 health women (mean age 31 years). Women attending adult education classes will be recruited for the study. Twelve classes from 3 adult education sites will be randomly allocated to receive the intervention or to participate in an assessment-only control group. The intervention will combine class-based and home-based approaches to improve PA knowledge, attitudes, and PA levels. Participants will attend 8, one-hour weekly preparatory classes held in conjunction with their existing adult education courses (e.g., GED, job training). These classes, based on our previous experience with a similar population, will include didactic lectures, interactive discussions, group activities, and resource materials tailored to the women's literacy, social, and economic circumstances. The classes will teach behavioral skills that prepare women to increase their PA. At the end of the preparatory class, women from the class will be randomized to one of two home-based interventions. Women in the usual care intervention will receive standard print materials for initiating and maintaining physical activity. The experimental intervention will include telephone counseling and mailed materials that provide feedback on progress and incentives for initiating, increasing, and maintaining PA. Evaluation will consist of baseline and follow-up assessment at 10 weeks, 6 months, and 12 months. The primary outcomes will be measured on-site at the adult education sites. They will include reported PA levels and heart rate during a submaximal exercise test. Secondary outcomes include adherence to the exercise regimens, body mass index, blood pressure, waist-to-hip ratio, fasting serum lipids, and fasting glucose. Portable heart rate/activity monitors will be worn to validate adherence. This study will serve as a model for the design and dissemination of risk reduction programs for underserved populations in this and similar community settings.
