An entire community changes its diet and exercise habits in an effort to head off heart disease.
Pat Booker says she never could have imagined herself belly-dancing.
Nonetheless, the 58-year-old Minnesota Department of Corrections supervisor gave it a whirl -- along with Zumba, kettlebells, yoga, Pilates and the occasional 5K run -- as she adopted a new fitness regimen over the last few years.
"It doesn't look pretty,'' she said of the exotic dance form. "But it's a great workout.''
Booker's new exercise routine reflects a wider transformation taking place in New Ulm, which embarked five years ago on an ambitious experiment to improve an entire community's cardiovascular health by changing residents' diet and exercise habits.
"Heart of New Ulm,'' launched by the Minneapolis Heart Institute Foundation and Allina Health, is one of dozens of community wellness experiments unfolding across Minnesota and other states.
But it may be the first with data to demonstrate that changing habits can really change health outcomes.
New figures from the project show that the share of New Ulm residents with high blood pressure, high cholesterol and high triglycerides has gone down -- modestly but measurably. Rates of obesity have also stabilized, alongside a small weight decrease across the population, said Toby Freier, president of New Ulm Medical Center. In one sample of New Ulm residents, the share using aspirin -- which many doctors prescribe for heart health -- rose from 32 percent to 40 percent.
"We have been able to move the needle on community health," said Jackie Boucher, the project's leader.
The results are still early, said Abbey Sidebottom, senior scientific adviser with Allina. Heart health screenings will be conducted in 2014 and electronic health record trends will continue to be monitored. Researchers haven't yet completed an analysis of heart attack outcomes.
Even so, "the results are encouraging," said Dr. Thomas Knickelbine, a research cardiologist at the Minneapolis Heart Institute Foundation. The community has reduced smoking and increased exercise, and it has better control of its blood pressure and cholesterol, he noted.
Karen Moritz, director of Brown County Public Health, said the project has had a "significant impact" on the residents of the southern Minnesota city.
Salad, not fries
The Heart of New Ulm is a 10-year collaboration among Allina, the Minneapolis Heart Institute Foundation, New Ulm Medical Center and the community. One reason for its success is that more than 90 percent of the town's 13,000 residents get their health care through the Allina-operated New Ulm Medical Center, which uses electronic medical records to produce accurate health-tracking data.
Another reason for its success is broad buy-in. The project has "become a sort of a fabric of the community, with its impact being seen everywhere you go in New Ulm," Freier said.
Moritz said the parking lot at the New Ulm Recreation Center is nearly full most evenings; membership there has seen "steady increases," according to Cheryl Kormann, New Ulm's assistant park and recreation director.
During warmer weather, residents can be seen biking and walking in greater numbers than before, Moritz said. New Ulm also holds several running and walking events with large participation.
Restaurants, too, are getting on board. Many restaurants in New Ulm are family-owned small businesses, Boucher said, and at first they were hesitant to change their menus because there wasn't a demand for healthier food. But as lifestyles changed, healthier menu choices became more and more common. "Now residents need to ask for fries instead of a salad," Boucher said.
One local government office building, Moritz said, recently got rid of the soda machine because it was no longer generating a profit.
Beyond New Ulm
Five years into the program, Booker continues to monitor what she eats, something she called a "huge change." She has continued her fitness center membership and attends at least four days per week for cardio and strength training.
"There have been slips and slides along the way," Booker said. "There were many times that I had to scold myself."
But her tenacity paid off: She met her weight-loss goals and changed her daily habits.
Now the program has reached its midpoint, though its impact may linger long after its decade milestone has passed. Meanwhile, organizers are looking toward the future and beyond New Ulm.
Knickelbine said he hopes for additional funding to eventually eliminate heart attacks from the entire community and for more sophisticated testing to pinpoint those at highest risk.
"We also want to begin to understand how we can take what we learned in New Ulm and help other people," he said, including metropolitan areas.
But there's less funding available for community wellness projects across the state. Minnesota's Statewide Health Improvement Program, or SHIP, launched as part of a bipartisan health reform package in 2008, issued dozens of community grants aimed at promoting healthier diets, exercise and other habits. But its funding was slashed from $47 million in 2010-2011 to $15 million in 2012-2013, and the number of grants has dropped sharply.
While Heart of New Ulm has similarities to SHIP-funded projects, and even the "Blue Zones'' experiment taking place in Albert Lea, the New Ulm program is built entirely on private investments. When Brown County had SHIP funds, it partnered with the Heart of New Ulm to expand those activities beyond the town's limits. But Brown County did not receive SHIP funding in 2011, Moritz said.
With a new federal grant, however, the Minneapolis Heart Institute Foundation hopes to expand the work to the rest of Brown County.
What works in New Ulm can work other places, Boucher said.
"The reality is, it takes a community," she said.
Jeff Hargarten is a University of Minnesota student reporter on assignment for the Star Tribune.