The primary prevention of cardiovascular disease in women with an emphasis on physical activity: A social marketing approach
The policies of the Welsh Assembly Government (WAG) regarding the health of the Welsh population are underpinned by a social marketing approach. This is where the individual is supported in their efforts to take personal responsibility for their health. Atherogenic cardiovascular disease (CVD) is a prevalent health problem for women who can take preventative steps through attention to major modifiable risk factors for the disease. There is a paucity of information about the experience of preventing CVD from the perspective of Welsh women and this was the stimulus for this project involving a profiling of apparently healthy women aged between 25 and 79 years living in the Vale of Glamorgan.
The thesis consisted of three exploratory studies the first of which utilised a 27-item questionnaire developed by the primary investigator to ascertain knowledge of CVD, preferred sources of health information, physical activity levels, prevalence of overweight and obesity, smoking status, perceptions of risk, and health screening behaviours of 724 women aged between 25 and 65 years. The second study of women aged between 25 and 65 years (n = 58) utilised a Chester Step test to measure womenâ€˜s aerobic fitness facilitating comparison with thresholds of CVD risk identified in the literature, and comparison of self-perceptions of aerobic fitness with measured aerobic fitness. Additionally, measured body-weight and stature enabled estimation of body mass index and this together with measured waist circumference allowed comparison with risk thresholds identified in the literature. The third study investigated and compared perceptions of exercise benefits and barriers of women aged between 25 and 79 years (n = 128) utilising an Exercise Benefits and Barriers Scale (Sechrist et al., 1987). Participants for the three studies were obtained by convenience sampling and this took place in various localities where women were known to meet for leisure or employment.
The results of study one highlighted gaps in womenâ€˜s knowledge base of CVD, a concerning prevalence of overweight and obesity, low levels of physical activity, poor uptake of screening for cholesterol and blood pressure, and misperceptions of personal CVD risk. Preferred sources of information about CVD were magazines and television and only 10.0% of women reported discussing CVD prevention with their General Practitioner. The results of study two suggested that women were moderately accurate regarding self-perception of their aerobic fitness and 75.8% reported partially meeting recommendations for physical activity. Fifty-seven percent were overweight or obese and 50.0% were over thresholds advised by the National Institute for Health and Clinical Excellence (2006) for risk of CVD and other long-term illness. Nineteen percent had an increased risk of all-cause mortality and cardiovascular events based on failure to achieve an aerobic threshold of 7.9 METs suggested by Kodama et al. (2009). The results of study three demonstrated that women in the sample perceived more exercise benefits than barriers. Physical performance and psychological outcome benefits were the most agreed with exercise benefits in women aged between 25 and 65 years but in women aged between 66 and 79 years social interaction was the most important. Preventative health benefits were not ranked highly across the age spectrum. The most agreed with barrier in women aged between 25 and 79 years was that of exercise as tiring or fatiguing, and restrictions caused by time and family responsibilities also ranked highly. The overall results indicated that interventions to increase exercise participation in women must account for possible negative perceptions of exercise as tiring and fatiguing and efforts to increase participation should focus on enjoyment. Furthermore, account should be taken of the time restrictions faced by women, and exercise opportunities should be easily accessible and convenient.
The prevention of CVD entails attention to major modifiable risk factors. The overall results of this thesis suggested that women might more readily take responsibility for CVD prevention if gaps in their knowledge base were addressed, they were supported in efforts at maintaining
a healthy body-weight, were engaged in talking with health professionals about prevention, and if more attention was paid to their perceptions of exercise benefits and barriers. Further research could capitalise on these findings adding to what is known about women and the prevention of CVD, particularly with regard to interventions to increase physical activity and for the management of body-weight.
- School of Sport and Health Sciences