Vietnam Physical Activity and Nutrition Project: A community-based physical activity and nutrition intervention for adults with metabolic syndrome in Vietnam

The intervention strategies for this community-based program are designed to inform participants of the benefits of being physically active and maintaining a healthy diet as a means of preventing chronic disease (outcome expectation). Positive reinforcement (incentives and motivation), by way of encouragement and feedback, will be facilitated through the trained community group leaders. The setting of realistic and personal physical activity goals, as well as opportunities to learn about and practice new skills (e.g. education and walking groups) will be provided. Observational learning (seeing others being active) and environmental supports via the involvement of family, friends and peers in the program, will further enhance positive behavioural changes. The communes provide an ideal environment to observe the adoption of healthy lifestyle behaviours and build social and physical environmental supports. This community-based intervention will include the following strategies. All components will be conducted within the same commune where the participant resides to minimise subject burden. a. Education sessions The participants (n=100) in each intervention commune will be divided into four groups, i.e. 25 participants per group. Each group will attend four 2-hour education sessions on healthy diet and physical activity in months 1, 2, 3, 4 of the program held at the local commune health centres. Sessions will be participatory and interactive, rather than didactic. Small group activities will foster problem solving, social support, and program ownership. b. Booklet At the first education session, each participant will be provided with a booklet (in Vietnamese) designed to inform and support improvements in nutritional intake and physical activity behaviours. This booklet will be adapted from previously developed materials used in the Physical Activity and Nutrition for Seniors (PANS) project and modified to ensure suitability for the Vietnamese context. The educational materials will be simple, short, and easy to understand. The first section will introduce the program as well as the benefits of physical activity and a healthy diet. The second section will focus on various modes of physical activity, and contain illustrations and tips on how to perform physical activity (e.g. brisk walking) correctly and resistance, weight training and stretching exercises safely. The third section will comprise suggested meal plans, recipes, and tips for healthy eating, encouraging a higher consumption of fruits and vegetables and fibre while reducing intake of saturated fat, salt, and sugar. The last section will provide information on the barriers to physical active and healthy eating and how to overcome them. c. Walking groups and walk leaders Three walking groups per commune will be established immediately after the first education session. The walking groups serve to mobilise the participants, supporting them to meet and walk together in order to achieve the physical activity guidelines for health benefits. A walk leader in each walking group will be identified, who will be either a local middle-aged volunteer or the village health worker within the commune. The walk leaders are required to be enthusiastic, demonstrate leadership qualities, and respected by other people in the commune. A 25-week prescriptive progressive physical activity program will be provided by the 9 group leaders, supported by clear explanations and illustrations of stretching and resistance exercises. The weekly walking will be increased gradually from only 5 minutes per day in the first week to 40 minutes per day in the weeks of 6th month. The walk leaders will guide the participants but have the flexibility to modify the prescribed program to suit individual needs, such as walking less or more, within their group. d. Resistance exercises Each participant will be provided with a resistance band. Simple gym equipment such as light free-weights, skipping ropes and gym balls will be placed in the commune health centres to foster group training. Detailed instructions on using such equipment, warming up and exercise techniques, as well as how to develop their own personal physical activity goals and plan will be disseminated during the education sessions. It is not intended to be a strenuous weight training program. To encourage participation in the exercise component, the walk leaders will endeavour to take their entire group to the commune health centre once a week. Regular maintenance and checking of the gym equipment will be assured by local research assistants to enable long term sustainability of the exercise program