4 YEARS OF PRACTICE-BASED AND EXERCISE-SUPPORTED BEHAVIORAL MEDICINE IN ONE COMMUNITY OF THE GERMAN CINDI AREA

The main goal of the preventive intervention study in one community of the German CINDI (Countrywide Integrated Non-Communicable Diseases In tervention programme of the WHO) area was to improve cardiovascular he alth by reducing the risk factors smoking, hypertension, obesity, hype rcholesterolaemia, and by changing sedentary lifestyle. The interventi on was performed by using the special ''Three-Level-Strategy'', which is characterised by activities of primary care physicians in the usual consulting hour (1st level), with patient groups in their practices ( 2nd level), and at community level (3rd level) where a special work gr oup and a co-ordinating general practice are co-operating. To evaluate the occurrence of the risk factors in practice and the local populati on, four cross-sectional random samples (N-total = 4881) were carried out in seven practices from 1992 to 1995. On the community level, 23 s pecial exercise-based health groups (N-total = 600) were established a nd were investigated by means of a questionnaire, related to behaviour and health beliefs. A ''Local Health Information System'' facilitated the evaluation, the management of the data, and the organisation of t he health programme. The results of the practice samples showed a sign ificant reduction of smoking (-17.8%) and hypertension (-31.5%) (p<0.0 1). The exercise-based groups were combined with nutritional counselli ng or relaxation and were accepted very well by the participants (83.8 %). The participants considerably improved their health behaviour: 82% discussed health in their family, 37.3% stated an increase of healthy nutrition, 52% of relaxation; 86.2% intended to regularly increase ph ysical activity in leisure time and 82% could not imagine regular heal th training without exercise meetings. We conclude that the practice-b ased ''Three-Level-Strategy'' provides a strong support for successful long-term prevention of cardiovascular risk, particularly, when exerc ise-based health training sessions are performed in order to change se dentary lifestyle. When organised on community level, they might have a positive impact on the health behaviour of the whole community. Phys ical activity can be used as a ''pro-drug'' for health promotion in a holistic way.