Nurse-Supervised Workplace Program in Al-Diwaniyah, Iraq for Lifestyle Improvement and Cardiometabolic Risk Prevention: A 12-Month Randomized Controlled Trial

Abstract Administrative employees in Iraq face an elevated risk of cardiovascular and noncommunicable diseases due to pervasive sedentary work patterns. This study evaluated the effectiveness and long-term sustainability of a theory-based, nurse-led workplace lifestyle intervention among administrative staff in Al-Diwaniyah Governorate in Iraq. A 12-month prospective randomized controlled trial was conducted with 140 participants initially randomized (70 per group). The final per-protocol analytical sample comprised 120 participants (n = 60 per group) who completed all five longitudinal assessments (baseline, 2, 4, 6, and 12 months). Outcomes included Health-Promoting Lifestyle Profile-II scores, daily steps (accelerometer-measured), estimated VO2 max (Rockport walking test), systolic blood pressure, and total cholesterol. Data were analyzed using mixed-model repeated measures analysis of variance (group × time interaction), with Greenhouse–Geisser sphericity corrections, Tukey post-hoc comparisons, and partial eta squared (η2p) effect sizes. Significance was set at p ≤ 0.05. At the 12-month postintervention assessment, the intervention group demonstrated highly significant improvements across all primary outcomes. Mean daily steps increased from 5,200 ± 415 to 8,900 ± 595 (p < 0.001), while cardiorespiratory fitness (VO2 max) improved from 29.5 ± 2.1 to 33.8 ± 2.6 mL/kg/min (p < 0.001). Systolic blood pressure showed a clinically meaningful reduction from 126 ± 8.5 to 119 ± 6.9 mm Hg (a –7 mm Hg reduction; p = 0.004), compared to the control group, which remained stable at 125 ± 8.6 mm Hg. Total cholesterol decreased from 190 ± 15.2 to 178 ± 13.1 mg/dL (a –12 mg/dL reduction; p = 0.001), while the control group showed no improvement (188 ± 16.1 to 191 ± 16.0 mg/dL). The nurse-led workplace intervention is highly effective and sustainable for mitigating cardiometabolic risks and optimizing health behaviors among Iraqi administrative staff.