Study shows community-based interventions help residents make nutrition and physical activity improvements

Findings published in Preventive Medicine Reports are first to integrate patient-reported and electronic health record-based data

MINNEAPOLIS / February 21, 2019: According to new research published in the March 2019 online issue of Preventive Medicine Reports, a community-based health intervention may significantly improve lifestyle risk factors for cardiovascular disease (CVD) across an entire community, particularly with regard to increased physical activity and increased daily servings of fruits and vegetables. 

Researchers from the Minneapolis Heart Institute Foundation® (MHIF) and Allina Health found that over the first six years of a population health demonstration project in the rural community of New Ulm, Minn., achievement of adequate physical activity increased from 63 percent to 71 percent, and consumption of at least five servings of fruits and vegetables per day nearly doubled.

Lifestyle significantly influences development of CVD, but up until now, limited data has existed to demonstrate lifestyle improvements in community-based interventions,” said Gretchen Benson, MHIF population health manager and the study’s lead author. “Our study is the first we are aware of that has integrated patient-reported and electronic health record-based data to provide population-level estimates of changes in lifestyle risk factors for CVD.”

From 2009 to 2018, MHIF and Allina Health conducted Hearts Beat Back®: The Heart of New Ulm Project (HONU) to identify and deliver the best interventions to reduce cardiovascular disease at a population level. Project leaders employed an integrated array of evidence-informed health improvement practices in community settings, health care and worksites. HONU also instituted changes at the policy, systems and environmental levels to promote food and built environments that would support the ability for residents to initiate and sustain lifestyle improvements.

“For example, through HONU’s restaurant program, owners were encouraged to offer more fruits and vegetables, while safety improvements to streets helped make it easier and safer for people to walk or bicycle,” said Benson. “Our observations from this study seem to confirm these had positive impacts.”

Researchers examined data from HONU heart health screenings held from 2009 to 2014 — which provided an opportunity to assess lifestyle risk factors in the community, including smoking, physical activity, fruit/vegetable consumption, alcohol use and stress — in addition to the ongoing assessment of biometric risk factors through electronic health record (EHR) data. All screenings were documented in the EHR at Allina Health’s New Ulm Medical Center. Changes at the community level for the target population (age 40–79) were estimated using weights created from EHR data and modeled using generalized estimating equation models.

“Although smoking, alcohol consumption and stress levels remained statistically unchanged, the study findings were largely consistent with our prior published HONU studies, which showed that improvements in biometric risk factors such as blood pressure and lipid profiles appear to be accelerated in the New Ulm population,” said Abbey Sidebottom, PhD, MPH, a principal scientist for Care Delivery Research at Allina Health and a study author.

As much as 50 percent of morbidity and mortality is attributed to lifestyle behaviors, which strongly reinforces the need for health record systems to systematically track lifestyle information, so it can be adequately documented and followed up on,” said Benson. “By leveraging local EHR data and integrating it with patient-reported outcomes, health care systems and public health entities can forge meaningful partnerships to surveil changes in the health of the communities they serve.”

The journal article, “Population-level changes in lifestyle risk factors for cardiovascular disease in the Heart of New Ulm Project,” is available online.

About HONU

From 2009 to 2018, Hearts Beat Back®: The Heart of New Ulm Project was a 10-year population-based prevention demonstration project designed to reduce the number of heart attacks that occur in New Ulm, Minn. The project was a collaborative partnership of the Minneapolis Heart Institute Foundation, Allina Health and the New Ulm community. The project continues in New Ulm as a community-owned health initiative focused on three significant and widespread health issues: 1) Healthy lifestyles across the lifespan, 2) Mental health and 3) Addiction and risky use of substances.

About the Minneapolis Heart Institute Foundation®

The Minneapolis Heart Institute Foundation (MHIF) strives to create a world without heart and vascular disease. To achieve this bold vision, it is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education.

  • Scientific Innovation and Research — MHIF is a recognized research leader in the broadest range of cardiovascular medicine and population health initiatives. Each year MHIF leads more than 175 active research projects and publishes more than 175 peer-reviewed abstracts. Cardiologists, hospitals and communities around the world adopt MHIF protocols to save lives, improve care and create healthier living opportunities.
  • Education and Outreach — MHIF provides more than 10,000 hours of education each year putting its research into practice to improve outcomes. And, MHIF leads cutting-edge, transformative population health research to connect, engage, inform and empower individuals and communities to improve their health.

The Minneapolis Heart Institute Foundation’s work is funded by generous donors and sponsors and supports research initiatives of Minneapolis Heart Institute® at Abbott Northwestern Hospital. Minneapolis Heart Institute® physicians provide care for patients at Abbott Northwestern Hospital in Minneapolis and at 38 community sites across Minnesota and western Wisconsin. More information can be found at

About Allina Health
Allina Health is dedicated to the prevention and treatment of illness and enhancing the greater health of individuals, families and communities throughout Minnesota and western Wisconsin. A not-for-profit health care system, Allina Health cares for patients from beginning to end-of-life through its 90+ clinics, 12 hospitals, 15 retail pharmacies, specialty care centers and specialty medical services, home care, home oxygen and medical equipment and emergency medical transportation services.