Strong Hearts, Healthy Communities (StrongPeople Healthy Hearts)

Strong Hearts, Healthy Communities (also known as StrongPeople Healthy Hearts) is a multilevel, multicomponent program that targets individual, social, and built environment levels of behavior change. It is designed to improve diet and physical activity behaviors, assess and improve local food and physical environment resources, and shift social norms about active living and healthy eating through civic engagement through a community-identified project of interest. Experiential classes, with groups of 10-15 participants, meet twice weekly for 24 weeks for one hour. Leaders attend an online training to learn how to facilitate classes and are provided with leader toolkits and participant toolkits. Classes include strength training, aerobic exercise, healthy eating skill-building, social support via homework with family members or friends, and a civic engagement project where participants follow a stepwise process to make a change in their community's food or physical activity environment that will make it easier to live healthy lives.

SHHC targets individual, social, and built environment levels of behavior change and is designed to improve diet and physical activity behaviors, assess and improve local food and physical environment resources, and shift social norms about active living and healthy eating through civic engagement and capacity building.

First randomized controlled trial (Montana and New York): 16 rural towns: 8 intervention towns, 8 education-only control towns. 194 overweight or obese, sedentary women, age 40+.
Second randomized controlled trial (New York): 11 rural towns: 5 intervention towns, 6 delayed intervention towns. 182 women who were 1) overweight and sedentary or 2) obese. Age 40+.

Example peer-reviewed publications and results are listed below:
Seguin RA, Paul L, Folta SC, Nelson ME, Strogatz D, Graham ML, Diffenderfer A, Eldridge G, Parry SA. Strong Hearts, Healthy Communities: a community‐based randomized trial for rural women. Obesity. 2018 May;26(5):845-53.
Results: Within-group and between-group multivariate analyses revealed that only intervention participants decreased BMI (20.85 units; 95% CI: 21.32 to 20.39; P50.001) and weight (22.24 kg; 95% CI: 23.49 to 20.99; P50.002). Compared with controls, intervention participants decreased BMI (difference: 20.71 units; 95% CI: 21.35 to 20.08; P50.03) and weight (1.85 kg; 95% CI: 23.55 to 20.16; P50.03) and improved C-reactive protein (difference: 21.15 mg/L; 95% CI: 22.16 to 20.15; P50.03) and Simple 7, a composite CVD risk score (difference: 0.67; 95% CI: 0.14 to 1.21; P50.01).

Pullyblank K, Strogatz D, Folta SC, Paul L, Nelson ME, Graham M, Marshall GA, Eldridge G, Parry SA, Mebust S, Seguin RA. Effects of the Strong Hearts, Healthy Communities intervention on functional fitness of rural women. The Journal of Rural Health. 2020 Jan;36(1):104-10.
Results: The SHHC program was associated with increased strength and endurance, as represented by greater improvement in the chair stand (difference between changes in intervention group and control group: +4.2, CI: +1.5, +7.0) and step test (+21.7, CI: +10.2, +33.1) ; and with increased physical function, as represented by the SF-36 PF (+8.1, CI: +1.2, +14.9)

Folta SC, Paul L, Nelson ME, Strogatz D, Graham M, Eldridge GD, Higgins M, Wing D, Seguin-Fowler RA. Changes in diet and physical activity resulting from the Strong Hearts, Healthy Communities randomized cardiovascular disease risk reduction multilevel intervention trial. International Journal of Behavioral Nutrition and Physical Activity. 2019 Dec 1;16(1):91.
Results: Compared to the control group, the intervention group realized significant improvements in intake of fruit and vegetables combined (difference: 0.6 cup equivalents per day, 95% CI 0.1 to 1.1, p = .026) and in vegetables alone (difference: 0.3 cup equivalents per day, 95% CI 0.1 to 0.6, p = .016). By self-report, the intervention group experienced a greater increase in walking MET minutes per week (difference: 113.5 MET-minutes per week, 95% CI 12.8 to 214.2, p = .027).

Seguin-Fowler RA, Strogatz D, Graham ML, Eldridge GD, Marshall GA, Folta SC, Pullyblank K, Nelson ME, Paul L. The Strong Hearts, Healthy Communities Program 2.0: an RCT examining effects on Simple 7. American Journal of Preventive Medicine. 2020 Jul 1;59(1):32-40.
Results: Compared with control participants, the intervention group had greater improvements in Simple 7 score (a composite measure of cardiovascular disease risk) (difference=1.03, 95% CI=0.44, 1.61, p<0.001) and 3 of the Simple 7 components (physical activity, healthy diet score, and BMI).