Bulletin of the World Health Organization

Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran

Nizal Sarrafzadegan, Roya Kelishadi, Ahmad Esmaillzadeh, Noushin Mohammadifard, Katayoun Rabiei, Hamidreza Roohafza, Leila Azadbakht, Ahmad Bahonar, Gholamhossein Sadri, Ahmad Amani, Saeid Heidari & Hossein Malekafzali

Objective

To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities.

Methods

Within the framework of the Isfahan Healthy Heart Program, a community trial was conducted in two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak). Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak. In each community, a random sample of adults was selected yearly by multi-stage cluster sampling. Food consumption, physical exercise and smoking behaviours were quantified and scored as 1 (low-risk) or 0 (other) at baseline (year 2000) and annually for 4 years in the intervention areas and for 3 years in the control area. The scores for all behaviours were then added to derive an overall lifestyle score.

Findings

After 4 years, changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points versus –1.2 points, respectively; P < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% versus –2.0%, respectively; P < 0.001). Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant. Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women. Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (–68 metabolic equivalent task (MET) minutes per week versus –114 MET minutes per week, respectively; P < 0.05). Leisure time devoted to physical activities showed an increasing trend in all areas. A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score, even after controlling for age, sex and baseline values.

Conclusion

The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting.

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