Table. Randomized and Nonrandomized Diet and Physical Activity Intervention Studies in Adult African American Populations, January 2000 Through December 2011.
| Study Components | Description |
|---|---|
| Randomized Controlled Trials, Significant Results Reported | |
| West et al, 2008 ( 13 ) | |
| Sample | N = 508 African Americans (341 women, 167 men) aged ≥18 years with type 2 diabetes. Unable to determine mean age and standard deviation [SD] for participants because of inability to distinguish African American participants from other races. Three groups: metformin group, 163 women and 58 men who received standard lifestyle recommendations plus metformin; placebo group, 163 women and 57 men who received standard lifestyle recommendations plus placebo; lifestyle group, 154 women and 50 men who received intensive lifestyle modification. |
| Theory | None noted |
| Study outcome(s) | Weight |
| Intervention | Duration: 6 months. Location: various clinical centers. Design: individual or one-on-one sessions; consisted of 16 diet and lifestyle sessions using the NIH DPP over 4 months from initiation of intervention with two additional monthly follow up sessions. Education: diet and PA. Follow-up: at 6 months, 12 months, 18 months, 24 months, and 30 months. |
| Attendance and retention | Attendance: not reported. Retention: 91% women, 87% men. |
| Clinical outcomes and results | Weight loss: 4.8 kg, women, 2.1 kg, men. Results significant over 30 month (P < .05) in intensive lifestyle modification group with no significant difference between placebo or metformin groups. Results reported exclusive to the African American subgroup of study. |
| Goodpaster, et al, 2010 ( 14 ) | |
| Sample | 48 African American women and men aged 30–55 y (mean 46.8 y, SD, 6.4 y), BMI ≥35 kg/m2. Two groups: initial PA, delayed PA. |
| Theory | None noted |
| Study outcome | Weight, waist circumference. abdominal adiposity, visceral fat, body composition (DXA measure), BP. |
| Intervention | Duration: 12 months. Location: university. Design: group, individual, and telephone contacts (1st–6th month, 3 group and 1 individual contacts/month; 6th–12th month, 2 group sessions and 2 telephone contacts/month). Diet prescribed for both groups to achieve 8% to 10% weight loss over 12 months; meal replacements offered during first 6 months. PA goals for both groups to achieve 60 minutes, 5 days per week, moderate-intensity PA. Delayed PA group started PA at 6th month. Education: diet and physical activity. Follow-up: 6 months, and 12 months. |
| Attendance and retention | Attendance: not reported. Retention: initial group, 90% at 6 months, 73% at 12 months; delayed group, 90% at 6 months, 83% at 12 months. Study not African American- specific; however, no difference reported between white and African American participants. |
| Clinical outcomes and results | Weight: 12.1 kg decrease for initial group; 9.9 kg decrease for delayed group (P < .001). Loss in percentage body fat and waist circumference significant in both groups (P < .001); higher in initial group but not significant. SBP: approximately 15 mm Hg decrease at 12 months in initial and delayed groups (P < .001). DBP: approximately 6 mm Hg decrease in initial and delayed groups (P < .001). Insulin and HOMA-IR: significant decrease (insulin, approximately 4µU/mL; HOMA-IR, approximately 1.0 point, [P ≤ .01]); FG, total cholesterol, HDL, triglycerides: no significant differences. Study not African American specific; however, reported no difference between white and African American groups. Results based on 12–month follow up results compared with 0 month; trends similar at 6th month with exception of no significant change in BP. |
| Murrock et al, 2009 ( 6 ) | |
| Sample | Women (N = 70) with type 2 diabetes aged ≥18 years (mean, 62.8 y; SD, 10.1 y). Two groups: group 1 (n = 34), dance intervention plus usual care; group 2 (control group) (n = 36), usual care. |
| Theory | Social cognitive learning theory |
| Study outcome(s) | HbA1c, weight, BIA, BP |
| Intervention | Duration: 12 weeks. Location, community center. Design, group, 60-minute dance intervention 2 times per week, led by experienced African American instructor. Education: diet and physical activity. Follow up: 12th week. |
| Attendance, retention | Attendance: not reported. Retention: 84%. |
| Clinical outcomes and results | HbA1c: decrease 0.5% in dance group (P < .05); increase 0.3% in control group (P < .05). Weight: decrease 10.8 kg in dance group (P < .01); increase 8.1 kg in control group (P < .01). Percentage body fat (BIA measure): decrease 2.8% in dance group (P < .01); no change in control group. SBP: 8.8 mm Hg decrease (P < .01) in dance group; 4.1 mm Hg increase in control group. DBP: 10.2 mm Hg decrease (P < .05) in dance group; 1.4 mm Hg decrease in control group. All results compared with baseline. |
| Yanek et al, 2001 ( 17 ) | |
| Sample | Women (n = 529) ≥40 y (mean, 53.1 y; SD, 9.3 y). Three groups: group without spirituality (n = 188); group 2, group with spirituality (n = 267); group 3, self-help group, no spirituality (n = 74). |
| Theory | None noted |
| Study outcome(s) | Weight, BMI, waist circumference, BP, blood lipids, FG, energy intake, smoking, PA |
| Intervention | Duration: 20 weeks. Location: 16 churches. Design: weekly group meetings of 30 to 45 minutes with nutrition education and 30 minutes moderate aerobic exercise. First 20 weeks, group led by research staff; thereafter, by church lay health leader. Education: diet and PA. Follow-up: 6 months, 12th months. |
| Attendance and retention | Attendance, 33%–50% overall. Retention: 71.2%. |
| Clinical outcomes and results | Weight: 0.5 kg decrease in without-spirituality and spirituality groups (P ≤ .001); 0.8 kg increase in self-help group (P < .01). BMI, 0.2 kg/m2 decrease in without-spirituality and spirituality groups (P = .02); 0.1kg/m2 increase in self-help group (not significant). Waist circumference: 1.7 cm decrease in without-spirituality and spirituality groups (P < .001); 0.02 cm decrease in self-help group (not significant). SBP: 1.6 mm Hg decrease in without-spirituality and spirituality groups (P < .001); 0.9 mm Hg decrease in self-help group (no significance). DBP: 0.4 mm Hg decrease in without-spirituality and spirituality groups; 0.2 mm Hg increase in self-help group. Results based on 12th month follow up. |
| Kennedy et al, 2005 ( 19 ) | |
| Sample | Overweight or obese women (n = 37) and men (n = 3), ≥20 y of age (mean, 44.0 y, SD, 10.0 y). Two groups: group intervention (n = 20), individual intervention (n = 20). |
| Theory | None noted |
| Study outcome(s) | PA, weight, body composition (DXA measure), blood lipids, FG, BP, quality of life |
| Intervention | Duration: 6 months. Location: church. Design: group and individual (or one-one-one). Intervention conducted by lay health educators with extensive training. Group intervention had 6 monthly meetings; individual intervention had 15 meetings over 6 months. Education: diet and PA. Follow-up: 6th month. |
| Attendance and retention | Attendance: not reported. Retention: 90%. |
| Clinical outcomes and results | Weight: mean loss 3.3 kg in both groups (P < .05); no significance between groups. BMI: 1.2 decrease in both groups; no significance compared with baseline or between groups. Percentage body fat: mean loss 0.5% in both groups (P < .05); no significance between groups. SBP: 1 mm Hg loss in both groups, no significance compared with baseline or between groups. DBP: 2 mm Hg loss in both groups; no significance compared with baseline or between groups. HDL, 3 mg/dL decrease. LDL: 4 mg/dL decrease (P < .05 at baseline); no significance between groups. Total cholesterol, triglycerides, FG: no significant differences from baseline or between groups. |
| Ard et al, 2000 ( 24 ) | |
| Sample | N = 56 (54 women, 2 men). Mean age, 40.4 y; SD, not reported. Two groups: intervention (n = 35); delayed (n = 22). |
| Theory | None noted |
| Study outcome(s) | Weight, BP, cholesterol |
| Intervention | Duration: 8 weeks. Location: university. Design: both groups led by African American instructor; both groups prescribed progressive diet (1st week, rice diet, 1,000 kcal, 7% fat; 3rd week, added animal protein (eggs, milk, cheese); 5th week, advanced animal protein (lean meat [chicken/fish], 1,200 kcal, 14% fat). Delayed group began intervention after 8 weeks. Participants paid $106 for university employees and $170/nonemployees to cover food costs. Education: diet and physical activity. Follow-up: 8 weeks. |
| Attendance and retention | Attendance: 79%. Retention: 77%. |
| Clinical outcomes and results | Weight: 32.6 kg mean loss (P < .01). BMI: 2.5 mean decrease (P < .01). SBP: 4.3 mm Hg mean decrease (P < .01). DBP: 2.5 mm Hg mean decrease (P < 0.05). Cholesterol: 13.7 mg/dL decrease (P < .01). |
| Staffileno et al, 2007 ( 26 ); Staffileno and Coke, 2006 ( 27 )a | |
| Sample | N = 24 women, aged 18 to 45 (mean, 39 y; SD, 5.5 y), sedentary, with normal BP or stage 1 hypertension. Two groups: group 1 (n = 13), exercise; group 2 (n = 10), no exercise. |
| Theory | None noted |
| Study outcome(s) | BP, PA |
| Intervention | Duration: 8 weeks. Location: participant’s home. Design: individual. Exercise group visited at home to encourage lifestyle PA (eg, walking, stair climbing) for 10 minutes, 3 times a day, 5 days a week following NIH-DPP program. Education: PA only. Follow-up: 8th week. |
| Attendance and retention | Attendance: not reported. Retention: 96%. |
| Clinical outcomes and results | SBP: 6.4 mm Hg decrease (P < .05) in exercise group; significantly different from no-exercise group (P = .04). DBP: 3.4 mm Hg decrease in exercise group, not significantly different from no-exercise group. |
| Wilbur et al, 2008 ( 29 ) | |
| Sample | N = 281 women, aged 40 to 65 y (mean, 48.6 y; SD, 6.0 y). Two groups: intervention (n = 156), control (n = 125). |
| Theory | None noted |
| Study outcome(s) | BMI, waist circumference |
| Intervention | Duration: 48 weeks. Location: community health centers. Design: intervention group, 4 targeted workshops followed by weekly telephone calls over 24 weeks. Education: PA only. Follow-up: week 24 and week 48. |
| Attendance and retention | Attendance: 58%, intervention; 25%, control. Retention: 42.7%. |
| Clinical outcomes and results | BMI: 0.7 decrease in intervention group; 0.2 decrease in control group; no significant difference between groups. Waist circumference: 1.1 cm decrease in intervention group (P < .05); 1.1 cm decrease in control group; not significant. Results based on 24th week and maintained at 48th week. |
| Samuel-Hodge et al, 2009 ( 31 ) | |
| Sample | N = 201 (128 women, 73 men) aged ≥20 y (mean, 59.2 y; SD, 1.1 y) with diabetes diagnosis. Two groups: special intervention (n = 117 [75 women, 17 men]); minimal intervention (n = 84 [53 women, 31 men]). |
| Theory | None noted |
| Study outcome(s) | Diet, PA, diabetes self-management |
| Intervention | Duration: 48 weeks. Location: community health centers. Design: special intervention group, 8-month intensive phase with 1 counseling visit, 12 group sessions, telephone calls, 3 postcards, and 4-month reinforcement phase with telephone calls; minimal intervention group, standard education pamphlets by mail. Education: diet and PA. Follow-up: 8th and 12th months. |
| Attendance and retention | Attendance: 67% special intervention group and 70%, minimal intervention group at 8th month; 68% special intervention group, 67% minimal intervention group at 12th month. Retention: 84.5%. |
| Clinical outcomes and results | HbA1c: 0.4% decrease in special intervention; no decrease in minimal intervention (P < .01). BP: nonsignificant change in both groups. DBP: 3.3 mm Hg lower in minimal intervention group than in special intervention group (P < .001). Results based on 8-month follow-up and were attenuated at 12 months. |
| Mayer-David et al, 2004 ( 32 ) | |
| Sample | N = 152 (123 women, 29 men with diabetes). Mean age, 60.3 y; SD, 8.6 y. Three groups: intensive-lifestyle intervention (n = 49); reimbursable-lifestyle intervention (n = 47); control (usual care) (n = 56). |
| Theory | None noted |
| Study outcome(s) | Weight |
| Intervention | Duration: 12 months. Location: community health centers. Design: intensive lifestyle intervention group met weekly with nutritionist for first 4 months, every other week for next 2 months, once monthly for remaining 6 months; reimbursable lifestyle intervention group had key elements of intensive lifestyle intervention group delivered in four 1-hour sessions (equivalent to the amount of allowable time to reimbursed for nutrition counseling by Medicaid) over 12 months with 3 group sessions and 1 individual session; program modeled after NIH DPP. Education: diet and PA. Follow-up: 3rd, 6th, and 12th months. |
| Attendance and retention | Attendance: not reported. Retention: 81%. |
| Clinical outcomes and results | Weight: 2.2 kg loss in intensive lifestyle intervention group; significant compared with baseline (P < .05) and control (P = .05). No significant difference between reimbursable lifestyle intervention group and control group. BMI: 0.97 decrease in intensive lifestyle intervention group; 0.16 decrease in control group; significant from baseline (P < .001) and control (P < .01). HbA1c, triglycerides, HDL, LDL, SBP, DBP: no significant difference between reimbursable lifestyle intervention, intensive lifestyle intervention, and control. Results based on 12th month. |
| Fitzgibbon et al, 2005 ( 30 ) | |
| Sample | N = 59 overweight/obese women. Mean age 48.5 y; SD, 21.9 y. Two groups: faith-based weight-loss intervention (n = 30), weight-loss intervention (n = 29). |
| Theory | SCT |
| Study outcome(s) | Weight, dietary fat consumption, PA |
| Intervention | Duration: 12 weeks. Location: hospital. Design: Groups met 2 times per week; weight-loss group received culturally tailored intervention; faith-based group received same intervention with addition of a faith/spirituality component. Education: diet and PA. Follow-up: 12th week. |
| Attendance and retention | Attendance: 54% faith-based weight-loss group; 54%, weight-loss group. Retention: 77%, faith-based weight-loss group; 79% weight-loss group. |
| Clinical outcomes and results | Weight loss: 2.6 kg, faith-based weight-loss group (P < .01); 1.6 kg, weight-loss group (P < .05). BMI: 1.0 decrease in faith-based weightloss group (P < .01); 0.6 kg decrease in weight-loss group (P < .05). Results compared with baseline; no significant differences between treatment groups. |
| Zoellner et al, 2011 ( 12 ) | |
| Sample | N = 269 (229 women, 40 men). Mean age, 43.8 y; SD, 12.1 y. |
| Theory | Community-based participatory research, transtheoretical model |
| Study outcome(s) | BP, PA |
| Intervention | Duration: 18 months. Location: community. Design: trained and paid community coach-led groups participated in intervention with monthly 90-minute group education and PA sessions; used pedometers and diaries. Education: PA only. Follow-up: 3rd, 6th, 12th, and 18th months. |
| Attendance and retention | Attendance: 33.6%. Retention: 84%. |
| Clinical outcomes and results | SBP: 6 mm Hg decrease (P < .001). DBP: 3 mm Hg decrease (P < .001). Results based on 3-month follow-up (no other follow-up currently available) and compared with baseline. |
| Duru et al., 2010 ( 28 ) | |
| Sample | N = 71 women aged ≥60 years (mean, 72.8 y; SD, 7.7 y). Two groups: intervention (n = 37); control (n = 34). |
| Theory | None noted |
| Study outcome(s) | Weight, BP, PA, chronic pain |
| Intervention | Duration: 6 months. Location: church. Design: Both groups received 45 minutes PA per week for 8 weeks and then once monthly for 4 months. Intervention group had additional 45 minutes PA faith-based curriculum; both groups used pedometer. Education: diet and PA. Follow-up: 6th month. |
| Attendance and retention | Attendance: 85% (75% of classes). Retention: 87%. |
| Clinical outcomes and results | Weight: 1.0 kg decrease, intervention group; 0.7 kg decrease, control group; no significant difference between groups. BMI: not reported. SBP: 12.5 mm Hg decrease, intervention group; 1.5 mm Hg decrease control group (P < .01). DBP: 5.9 mm Hg decrease, intervention group; 3.8 mm Hg decrease, control group; no significant difference between groups. |
| Randomized Trials, Nonsignificant Results Reported | |
| McCarthy et al, 2007a ( 20 ), Yancey et al, 2006b ( 21 ) | |
| Sample | N = 366 women. Mean age, 45.5 y; SD, 10.5 y. Two groups: intervention group: (n = 188); control group, (n = 178). |
| Theory | SCT, socio-ecological model |
| Study outcome(s) | Diet quality (fiber, fruits and vegetables), body fat percentage (BIA measure), waist circumference, fitness |
| Intervention | Duration: 8 weeks. Location: local gym. Design: group; 1 hour PA, 1 hour nutrition lectures and activities; participants given 1 year free gym membership; administered food frequency questionnaire; recorded 1 mile run/walk; waist circumference, percentage body fat (BIA measure). Education: diet and PA. Follow-up: 2nd, 6th, 12th month. |
| Attendance and retention | Attendance: 80%–95% 1 or more sessions. Retention: >70%. |
| Clinical outcomes and results | BMI: marginal decrease (P = .06) with no sustained results |
| Nonrandomized Trials, Significant Results Reported | |
| Stolley et al, 2009 ( 22 ) | |
| Sample | N = 20 overweight women. Mean age, 51.4 years; SD, 8.9 y. |
| Theory | SCT, health behavior theory |
| Study outcome(s) | Social support, food intake, weight, BMI, PA |
| Intervention | Duration: 6 months. Location: community center. Design: 2 weekly group classes: 1st hour, education; 2nd hour, exercise. Education: diet and PA. Follow-up: 6th month. |
| Attendance and retention | Attendance: 55% (75% of classes). Retention: 87%. |
| Clinical outcomes and results | Weight: 14.5 kg loss (P = .001). BMI: 1.0 decrease (P = .001). |
| Boltri et al, 2008 ( 25 ) | |
| Sample | N = 46 (26 women, 20 men) aged ≥18 years at risk for diabetes. Mean age, 52.1 y; SD not reported. |
| Theory | None noted |
| Study outcome(s) | Weight, BP, FG |
| Intervention | Duration: 4 months. Location: church. Design: individual; 16 NIH DPP sessions. Education: diet and PA. Follow-up: 6th, 12th month. |
| Attendance and retention | Attendance: not reported. Retention: 65%. |
| Clinical outcomes and results | Weight: 2.5 kg loss at 6 months, significant compared with baseline (P < .05). BMI: 0.9 decrease at 6 months, significant compared with baseline (P < .05). SBP: 9 mm Hg decrease; DBP, 6 mm Hg decrease; FG, 4.0 mg/dL decrease at 6 months compared with baseline (P < .05). Results maintained significance at 12 months; SBP, DBP, FG improved. |
| Hollis et al, 2008 ( 15 ) | |
| Sample | N = 736 African American (540 women, 196 men) aged ≥ 25 years (mean, 52.3 y; SD, 9.5 y); BMI 25–45 kg/m2. Phase I trial. |
| Theory | SCT, transtheoretical model |
| Study outcome(s) | Weight, PA |
| Intervention | Duration: 20 weeks. Location: 4 clinical research centers. Design: group conducted by nutrition and behavioral counselors with goals of achieving ≥4 kg weight loss and 180 minutes per week moderate-intensity PA (need to enter Phase II trial). Education: diet and PA. Follow-up: 0, 20 weeks (participants achieving goals were entered into Phase II). |
| Attendance and retention | Attendance: 71% (not African American specific). Retention: 92% (not African American specific). |
| Clinical outcomes and results | Weight: men, 5.4 kg mean loss; women, 4.1 kg mean loss (P < .01). BMI: men, 1.7 decrease; women, 1.4 decrease. |
| Davis-Smith 2007 ( 18 ) | |
| Sample | N = 10 (7 women, 3 men) aged ≥18 years (mean and SD note reported) with prediabetes (FG 100–125mg/dl). |
| Theory | None noted |
| Study outcome(s) | Attendance, changes in FG, weight, BMI |
| Intervention | Duration: 6 weeks. Location: church. Design: 6-session group program (nutrition, PA, behavior change) derived from 16-session intensive lifestyle arm of NIH DPP. Education: diet and PA. Follow-up: 6 weeks, 6th month, 12th month. |
| Attendance and retention | Attendance: 78% overall sessions and participants. Retention: 90%. |
| Clinical outcomes and results | Weight: 4 kg loss. BMI: 1.7 decrease. FG: 7 mg/dL decrease. SBP: 3 mm Hg decrease. DBP: 5 mm Hg decrease. Results significant compared with baseline (P < .05) post-intervention and were maintained at 6th and 12th months. |
| Wilson et al, 2005 ( 23 ) | |
| Sample | N = 22 breast cancer survivors, women. Mean age, 55.0 years; SD, not reported. |
| Theory | Health behavior theory, SCT. |
| Study outcome(s) | Weight, BP, FG |
| Intervention | Duration: 2 months. Location: church. Design: individual; 16 sessions on exercise behaviors. Education: diet and PA. Follow-up: 3rd month. |
| Attendance and retention | Attendance: not reported. Retention: 65%. |
| Clinical outcomes and results | BMI: 0.38 decrease (P < .01). Weight: 0.9 kg decrease (P < .01). Waist circumference: 4.6 cm decrease (P = .04). SBP: 10.1 mm Hg decrease (P < .001). DBP: 6.2 mm Hg decrease (P < .01). Results post-intervention compared with baseline. |
Abbreviations: BIA, bioelectrical impedance analysis; BMI, body mass index; BP, blood pressure; DBP, diastolic blood pressure; DXA, dual energy X-ray absorptiometry; FG, fasting plasma glucose; HbA1c, hemoglobin A1C; HDL, high-density lipoprotein; HOMA-IR, homeostasis model assessment-estimated insulin resistance; NIH DPP, National Institute of Health Diabetes Prevention Program; LDL, low-density lipoprotein; PA, physical activity; SBP, systolic blood pressure.
a
References refer to the same study. Intervention results were published separately from attendance rates, retention rates, and strategies.
b
References refer to the same study. Data were divided by physical activity- and diet-related content and were published separately.