Comprehensive Lifestyle Intervention Research Articles

Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevenci\xf3n de la Diabetes Gestacional

BackgroundGestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence.MethodsThe principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1–3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks’ gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures.DiscussionThe Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks.Trial registrationClinicalTrials.gov NCT02763150. Registered on May 5, 2016

Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) is associated with improvement in weight and components of metabolic syndrome in men exposed to androgen deprivation therapy for prostate cancer.

Androgen deprivation therapy (ADT) for prostate cancer is associated with adverse effects, such as obesity and metabolic syndrome, which increase cardiovascular risk, the most common cause of non-cancer mortality in men diagnosed with prostate cancer. The Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) was created to determine the feasibility of conducing a comprehensive lifestyle modification intervention in men on ADT for prostate cancer and determine its early efficacy in reducing obesity and metabolic syndrome. A single-arm, open-label clinical trial was conducted by recruiting 31 men diagnosed with prostate cancer and exposed to ADT within the last 5 years. A multicomponent lifestyle modification program was delivered weekly for 16 weeks by a trained health coach. This was followed by 8 weeks of passive follow-up resulting in a total trial duration of 24 weeks. Feasibility was determined by calculating study recruitment, retention, and adherence rates. Weight and components of metabolic syndrome (waist circumference, triglycerides (TG), high-density lipoprotein (HDL), serum glucose, and blood pressure (BP)) were measured at baseline, 12, and 24 weeks. Recruitment, retention, and adherence rates were 47.1%, 90.3%, and 100%, respectively. Statistically significant improvements were noted between baseline and end of study measurements for weight (206.3 vs. 191.3 lbs, p < 0.001), waist (41.3 vs. 38.8 inches, p < 0.001), systolic BP (144.1 vs. 133.4 mm of Hg, p = 0.014), diastolic BP (83.3 vs. 76.2 mm of Hg, p = 0.0056), TG (146.0 vs. 113.8 mg/dl, p = 0.022), HDL (51.1 vs. 55.0 mg/dl, p = 0.012), and serum glucose (114.0 vs. 103.2 mg/dl, p = 0.013). CLIPP demonstrates feasibility and early efficacy of a multicomponent lifestyle modification intervention toward addressing obesity as well as components of metabolic syndrome in men on ADT for prostate cancer. This study provides strong preliminary data to develop future clinical trials in this population.

Role of Comprehensive Lifestyle Interventions in Managing Gastroesophageal Reflux Disease Complicating COPD-OSA Overlap Syndrome”

Although the term “lifestyle medicine” was first used as the title of a symposium in 1989 and of an article in 1990, its concept is not new. The towering figures in medicine: Huang Ti (2698-2598 BCE), Hippocrates (460-377 BCE) and Ibn Sina (980-1037CE) had the credit to link the natural effects of diet, lifestyle, emotion and environment with the preservation of health. Unhealthy lifestyle behaviors, a well proven primary source of the global burden of chronic diseases, are among the leading risk factors for increased disability-adjusted life years around the world. While, Gastroesophageal Reflux Disease and Chronic Obstructive Pulmonary Disease augument each other, COPD and Obstructive Sleep Apnea have a common pathophysiology and are known to coexist leading Flenley to coin the term “Overlap Syndrome” ,in 1985. Behavioral therapy on each modifiable item, including diet and weight management, physical activity, smoking, sleeping pattern, stress and mood states have all been evaluated in the present study.

Stress interventions and hypertension in Black women.

Hypertension is a risk factor for cardiovascular disease. Black women have high rates of hypertension compared to women of other racial or ethnic groups and are disproportionately affected by psychosocial stressors such as racial discrimination, gender discrimination, and caregiving stress. Evidence suggests that stress is associated with incident hypertension and hypertension risk. Stress management is associated with improvements improved blood pressure outcomes. The purpose of this review is to synthesize evidence on effects of stress management interventions on blood pressure in Black women. A comprehensive search of scientific databases was conducted. Inclusion criteria included studies that were: (1) primary research that tested an intervention; (2) in the English language; (3) included African-American women; (4) incorporated stress in the intervention; (5) included blood pressure as an outcome; and (6) were US based. Eighteen studies met inclusion criteria. Ten (56%) studies tested meditation-based interventions, two (11%) tested coping and affirmation interventions, and six (33%) tested lifestyle modification interventions that included stress management content. Thirteen of the studies were randomized controlled trials. Reductions in blood pressure were observed in all of the meditation-based interventions, although the magnitude and statistical significance varied. Comprehensive lifestyle interventions were also efficacious for reducing blood pressure, although the relative contribution of stress management versus behavior modification could not be evaluated. Coping and affirmation interventions did not affect blood pressure. Most of the reviewed studies included small numbers of Black women and did not stratify results by race and gender, so effects remain unclear. This review highlights the urgent need for studies specifically focusing on Black women. Given the extensive disparities in cardiovascular disease morbidity and mortality, whether stress management can lower blood pressure and improve primary and secondary cardiovascular disease prevention among Black women is an important question for future research.

Obesity Impact on Respiratory Function

Abstract Not so much emphasize in literature and studies, obesity consequences on respiratory function may influence chronic obstructive pulmonary disease COPD and asthma, triggering important healthcare issues. Pulmonary function is a mortality predictor. The largest populational study European Community Respiratory Health Survey shows the impact of overweight and obesity on pulmonary function by decreasing forced expiratory volume in first second FEV1 and forced vital capacity FVC. By the contrary, weight loss is decreasing both. Inflammatory and mechanical mechanisms should be considered in lung function impairment, as a consequence of obesity. Important aspect, lifestyle, will consider tobacco, physical activity, diet. Adopting a healthy lifestyle with a Mediterranean Diet MD will preserve a good pulmonary function on long term. We detailed below specific dietary recommendations, favorable nutrients or foods to be avoided. In conclusion comprehensive lifestyle interventions should become populational based interventions for a better prevention for pulmonary diseases and NCD’s and finally for a better health status.

Rationale and description of a lifestyle intervention programme to achieve moderate weight loss in women with non-metastatic breast cancer: the lifestyle intervention part of the SUCCESS C Study

ObjectiveThere is growing evidence from observational studies that lifestyle factors such as obesity, an unhealthy diet and lack of physical activity are associated with poor long-term outcome in women with...

Metabolic and Neurocognitive Changes Following Lifestyle Modification: Examination of Biomarkers from the ENLIGHTEN Randomized Clinical Trial.

Previous studies have demonstrated that aerobic exercise (AE) and the Dietary Approaches to Stop Hypertension (DASH) diet can improve neurocognition. However, the mechanisms by which lifestyle improves neurocognition have not been widely studied. We examined the associations between changes in metabolic, neurotrophic, and inflammatory biomarkers with executive functioning among participants from the Exercise and Nutritional Interventions for Neurocognitive Health Enhancement (ENLIGHTEN) trial. To examine the association between changes in metabolic function and neurocognition among older adults with cognitive impairment, but without dementia (CIND) participating in a comprehensive lifestyle intervention. ENLIGHTEN participants were randomized using a 2×2 factorial design to receive AE, DASH, both AE+DASH, or a health education control condition (HE) for six months. Metabolic biomarkers included insulin resistance (homeostatic model assessment [HOMA-IR]), leptin, and insulin-like growth factor (IGF-1); neurotrophic biomarkers included brain derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF); and inflammatory biomarkers included interleukin-6 (IL-6) and C-Reactive Protein (CRP). Participants included 132 sedentary older adults (mean age = 65 [SD = 7]) with CIND. Results demonstrated that both AE (d = 0.48, p = 0.015) and DASH improved metabolic function (d = 0.37, p = 0.039), without comparable improvements in neurotrophic or inflammatory biomarkers. Greater improvements in metabolic function, including reduced HOMA-IR (B = -2.3 [-4.3, -0.2], p = 0.033) and increased IGF-1 (B = 3.4 [1.2, 5.7], p = 0.004), associated with increases in Executive Function. Changes in neurocognition after lifestyle modification are associated with improved metabolic function.

Exercise And Nutrition Patterns Of Pregnant Women Self-Selecting For Participation In A Lifestyle Intervention

Exercise and healthy eating are integral parts of a comprehensive healthy lifestyle intervention during pregnancy. Women who volunteer to participate in such an intervention in early to mid-pregnancy may already be practicing healthy lifestyle habits such as walking 10,000 steps/day (active), and consuming 1800-2252 kilocalories/day (kcal), whereas most pregnant woman walk on average 3000-7000 steps/day (sedentary to low active) and consume 1882-2789 kcal/day. As such, intervention participants may not be representative of the general population of pregnant women, especially relating to exercise. PURPOSE: To assess the baseline exercise and nutrition patterns of pregnant women who enrol in a healthy lifestyle intervention in London, Canada. METHODS: Pregnant women who had self-selected to participate in a nutrition and exercise intervention completed a baseline (12-18 weeks gestation) 3-day step count log and 3-day food intake record (3dFR). Step counts were recorded over 3 consecutive days using a hip-worn pedometer or a wrist-worn activity tracker, and an average was calculated. The 3dFR was completed over the same 3 consecutive days and was analyzed for average energy intake (kcal) using Nutritionist Pro (NP; Axxya Systems). Measured height and self-reported pre-pregnancy weight were used to calculate pre-pregnancy body mass index (BMI). Gestational age at study entry and maternal age were also collected. RESULTS: Ninety-seven pregnant women chose to participate in a healthy lifestyle intervention study and completed both the 3-day step count log and 3dFR at baseline. At study entry, mean daily steps were 7399±2741 (low to above normal range) and energy intake was 2305±634 kcal/day (within to above normal range). Pre-pregnancy BMI was 26.2±5 kg/m2 (overweight), gestational age was 15±3 weeks, and maternal age was 32±4 years. CONCLUSION: Many pregnant women who self-select to participate in a lifestyle intervention in early to mid-pregnancy may already have healthy patterns of exercise and to a lesser extent nutrition. To achieve a more representative sample of pregnant women, interventions could be performed in a clinical setting, which may allow for better identification of effective behaviour change strategies to promote and maintain healthy exercise and nutrition patterns during pregnancy.

O22 BOUNCE: A Comprehensive Healthy Lifestyle Summer Program for Minority Adolescents and Parents

Background Low-income Latino and African American youth compared to their Caucasian counterparts are at increased risk for obesity. Objective The purpose of this study was to assess fidelity and efficacy of a summer community and family-based summer healthy lifestyle intervention named BOUNCE to reduce percent body fat by promoting healthy and mindful eating and physical activity engagement among Latino and African American youth. Study Design, Setting, and Participants We utilized a quasi-experimental pre-post group design. Ninety-four low-income Latio and African American boys and girls (M age = 10.6, SD age = 1.6) and primarily their mothers participated. Participating youth received 20 nutrition education sessions including cooking demonstrations, 20 psychoeducational sessions, and 60 exercise sessions (eg, yoga, kickboxing, and circuit training). In addition, parents were asked to participate in a 2-hour health workshop “platica” once per week. This workshop included nutrition basic education, cooking demonstration, and tips for parents to be more active as a family. University-based elementary school facilities (gym, classrooms, and cafeteria) were used to implement this intervention. Analysis Pre-and post-intervention participants completed demographic, physical activity, food frequency questionnaires, and wore an accelerometer for 7 days. Participants also had their body height measured using a stadiometer Seca 210 and body weight and percent body fat measured using a Tanita (TBS 310). Repeated ANCOVA was conducted to analyze the main effects of the intervention over time. Results At post-intervention, 60% exhibited a reduction of at least 0.5 cm of waist circumference. These children lost an average of 2.2% (SD = 1.6%) body fat, and 1.6 cm in waist circumference (SD = 3.6 cm). There was a 10% decrease in percent of time spent in sedentary behavior. Conversely, there was a 5% increase in percent of time spent in moderate to vigorous physical activity. That is, on average, 46 minutes converted from sedentary behavior to moderate physical activity. Conclusion This study provides valuable information about the feasibility and efficacy of a summer comprehensive healthy lifestyle intervention targeting minority youth. Funding Aetna Foundation, United Health Foundation.

Effects Of Moderate Versus Vigorous Intensity Exercise Training In Older Adults With Prediabetes

PURPOSE: Aerobic exercise is recommended to improve glycemic control; however, the optimal intensity of exercise for older adults with prediabetes is unknown. The objective of this pilot study was to compare the effects of moderate vs. vigorous intensity aerobic exercise on glycemic control and non-exercise physical activity (NEPA). METHODS: 19 older adults (14F; 68.1 ± 5.8 yrs) with prediabetes (HbA1c 5.7-6.4% or fasting glucose 100-125 mg/dl) were randomized to 12-weeks of supervised aerobic exercise (45-min sessions 4 days/wk) at either moderate (MOD: 60-65% HRmax) or vigorous (VIG: 80-85% HRmax) intensity. Free-living glycemic control (24h mean; percent of day ≥140 mg/dL) was measured using continuous glucose monitors (CGM, Dexcom). NEPA (>1.5 METs, excluding exercise sessions) was assessed using a thigh worn accelerometer (ActivPAL v4). A 3h Oral glucose tolerance test (OGTT, 75g) was performed at baseline and following the exercise intervention (72-96h following the last exercise bout) to compare to free-living CGM and as measure of insulin sensitivity (Matsuda Index). Data are presented as mean±SE. RESULTS: Adherence rates to the exercise interventions were 85±9% and 89±3% in MOD and VIG with mean heart rates during exercise of 99±1 bpm (65% HRmax) and 123±4 bpm (79% HRmax), respectively. Mean 24h glucose (-8.4±6.4 vs. -2.2±6.7 mg/dl) and percent of day >140 mg/dL (-9.7±11.0% vs. 0.7±4.6%) did not significantly change in MOD or VIG, respectively. However, there was a significant group by time interaction (p=0.05) for change in insulin sensitivity in MOD (+2.4±1.1) and VIG (-0.6±0.8).There were no differences between groups for change in NEPA, fasting glucose, or 2h glucose. Changes in free-living CGM were not significantly correlated with changes in OGTT outcomes. CONCLUSION: In older men and women with prediabetes, both MOD and VIG had minimal effects on free-living glycemic control, but MOD induced greater improvements in insulin sensitivity. These preliminary results suggest that a more comprehensive lifestyle intervention combining dietary intervention and exercise may be needed to improve glycemic control in this population.

840-P: An Internet-Based Interventional Study in a Real-World Setting Improves Metabolic Control in Patients with Hyperglycaemia

Objective: Strictly designed clinical trials have shown benifit of lifestyle Intervention on the prevention of type 2 diabetes (T2DM). Translational data in real-world setting, however, is still limited. Methods: In December 2015, a Multi-Disciplinary Team (MDT), consisting of endocrinologist, dietitian, certified exercise instructor, psychotherapist and clinical nurses was built to conduct comprehensive life-style intervention on 65 volunteers with hyperglycaemia (43 with T2DM and 22 with prediabetes) based on a WeChat group. At baseline, the patients had mean age of 48.2±4.1 yrs. Each patient was requested to upload pictures of daily meals, FPG and 2hPG, and exercise logs recorded by wearable device and the MDT experts would comment in the group. In addition, a half-day event was held at enrollment, week 4, and week 8, in which patients received face to face instructions, as well as measurements of body weight, FPG, 2hPG, HbA1c, serum triglyceride (TG) and total cholesterol (TC). Data before and after the intervention were compared by using paired T-test. Results: A total of 59 patients accomplished intervention. The follow-up rate was 90.7%. At week 8, BMI (26.06 vs. 24.91kg/m2), FPG (8.56 vs. 6.7mmol/L), 2hPG (17.54 vs. 12.75mmol/L), HbA1c (7.28 vs. 6.53%), and TC (5.12 vs. 4.60mmol/L) were significantly decreased (all p-values &amp;lt; 0.01) among T2DM subgroup. Similar Figure was seen for BMI (27.86 vs. 26.57Kg/m2), FPG (6.21 vs. 5.89mmol/L), 2hPG (9.04 vs. 8.10mmol/L), HbA1c (5.98 vs. 5.78%), and TC (5.43 vs. 4.74mmol/L) among prediabetes subgroup. TG was also decreased in both subgroups but the difference did not reach statistical significance. The proportion of patients who simultaneously achieved goals of HbA1c (&amp;lt;7%), BMI (&amp;lt;26.0 Kg/m2) and TC (&amp;lt;4.50mmol/L) increased 16.3%. Conclusion: In a real-world setting, well designed online plus offline intervention approach improves metabolic control in patients with hyperglyceamia. Disclosure L. Zhang: None. X. Chen: None. C. Dong: None. H. Wang: None. N. Wu: None. Y. Yang: None.

Clustering of Lifestyle Cardiovascular Risk Factors Among Healthy Government Servants in Kuala Terengganu: Who And What to Target

Cardiovascular disease is the leading cause of death and disability among men and women in nearly all nations, including Malaysia. Lifestyle cardiovascular risk factors such as dietary habits, physical inactivity and smoking are considered fundamental risk factors for cardiovascular disease. Previous studies showed that the clustering of cardiovascular risk factors significantly increase the risk of developing cardiovascular events. Surveillance of these key modifiable risk factors, including its clustering and study of factors associated is needed to monitor the magnitude of the problem and effects of our interventions. This study aimed to determine the prevalence and factors associated with clustering of lifestyle cardiovascular risk factors among government servants in Kuala Terengganu, Malaysia. This was a cross-sectional study conducted between June and September 2013 among 121 government servants, selected using simple random sampling from all servants asymptomatic of cardiovascular disease at a multi-department government center in the capital of Terengganu. A questionnaire, which consisted of socio-demographic data, International Physical Activity Questionnaire (IPAQ) and the dietary component of WHO STEPs, were used as the research tools. Clustering of lifestyle cardiovascular risk was defined as the presence of two or more of the lifestyle risk factors. Prevalence of clustering of lifestyle risks in this study was 57% (95% CI: 0.47, 0.67). Respondents with income less than RM3, 000 was significantly associated with clustering of lifestyle cardiovascular risks (p=0.032, OR 2.57, CI: 1.08, 6.07). This study provides evidence of clustering of lifestyle risks in the local asymptomatic healthy subjects. Therefore, comprehensive lifestyle interventions may be an effective strategy for controlling CVD risk factors, especially among those with low socioeconomic status where affordable interventions should be suggested. A more effective approach should be identified to promote affordable healthier diet and healthy lifestyle activities.&#x0D; &#x0D; Keywords: Clustering; Lifestyle; Cardiovascular Risk Factors; low socioeconomic status.

The Impact of Health Promotion Interventions on Telomere Length: A Systematic Review.

The aim of this study was to evaluate the effectiveness of health promotion interventions in delaying telomere shortening (a biomarker for aging). PubMed, PsychINFO, EMBASE, CINAHL, and Cochrane Library databases. Inclusion criteria: (1) empirical studies involving human subjects; (2) health promotion intervention studies including both randomized control trials (RCTs) and non-RCTs.; (3) measured telomere length as an intervention outcome; and (4) were written in English. Exclusion criteria: (1) observational studies without any health promotion intervention practices and (2) did not report intervention effects. Data extraction was performed by two reviewers following the preferred reporting items for systematic reviews and meta-analysis guidelines. Substantial heterogeneity in intervention type and study design in the included studies precluded a meta-analysis. We conducted a narrative synthesis instead. Thirty studies were included in the review, of which 16 were RCTs. One-third of the included studies reported significant intervention impacts in delaying telomere shortening, with relatively consistent significant results emerged from weight-loss interventions and interventions involving multiple lifestyle modification components (eg, diet and exercise). Most of supplement intervention studies observed null effects in telomere length. Weight-loss and comprehensive lifestyle intervention strategies show encouraging impacts in delaying telomere shortening. More rigorous studies targeting populations at different age stages through life span are needed.

Short and long term effect of treatment non-pharmacological and lifestyle in patients with metabolic syndrome

BackgroundMetabolic syndrome (MS) is a complex disorder represented by a set of cardiovascular risk factors usually related to central fat deposition, insulin resistance, hypertension and dyslipidemia. It is associated with accelerated atherosclerosis in response to chronic inflammation and vascular endothelial dysfunction, increasing overall mortality. The objective to evaluate the short and long term effect of the comprehensive cardiac rehabilitation program and intensive lifestyle intervention in metabolic syndrome patients.MethodsThis is longitudinal interventional study. All patients underwent a 20-session cardiac rehabilitation program with aerobic and resisted exercises as well as an educational program for lifestyle changes and follow up 1 year.ResultsForty seven patients participated in the present study, but only 28 concluded the follow up. 77.7% were females and the majority was older than 60 years (63.1%). After cardiac rehabilitation, the percentage of overweight (0.04) patients who controlled the SBP (0.04) increased, and obesity levels I and II were reduced, as well as a significant reduction in total cholesterol and triglycerides (0.01 and 0.05), all of these variables remained similar after 1 year of follow-up. After cardiac rehabilitation all participants were practicing the five factors of healthy lifestyle, and reduced to 73% after follow up.ConclusionA comprehensive cardiac rehabilitation program and lifestyle change is an effective approach in the treatment of patients with MS mainly, it has positive short and long term effects on weight control, reducing total cholesterol and triglycerides.

JOIN for ME: Testing a Scalable Weight Control Intervention for Adolescents.

Background: The goal of this randomized controlled trial was to compare the relative effectiveness of a comprehensive lifestyle intervention delivered through the YMCA, JOIN for ME, with an enhanced version of this program that included on-site supervised group physical activity and opportunities for peer support, in decreasing adolescent weight status. Methods: Sixty-six adolescents with BMI >85th percentile and absolute BMI <50 were randomly assigned to the JOIN for ME or the JOIN for ME enhanced program. Teens in both conditions attended 16 weekly, in-person group sessions, followed by four biweekly and four monthly maintenance sessions. The enhanced condition also included weekly, group-based physical activity sessions and challenges. Group sessions were led by YMCA coaches. Results: Groups did not differ at baseline by age (14.7 + 1.6 years), sex (60.6% female), racial/ethnic minority status (37.7%), or weight (53.0% with severe obesity). Retention was 91% at 16 weeks and 82% at 10 months. Controlling for minority status and sex, there were no significant group differences over time for BMI (p = 0.15), BMI z-scores for age and sex (BMIz, p = 0.07), or percent overweight (p = 0.15). Across all participants, on average, BMI decreased by 1.4 kg/m2, BMIz decreased by 0.12, and percent overweight decreased by 8.8% at four months. Conclusions: There were no significant differences observed in primary outcomes for adolescents randomized to the standard and enhanced versions of the JOIN for ME program. Although the absence of a control condition precludes attribution to the intervention, teens in both conditions demonstrated greater decreases in weight status than what was observed in an open trial of the original program.

Patients' reasons for weight loss and their relations to clinical weight loss outcomes in a comprehensive lifestyle intervention.

SummaryObjectiveResearch suggests that individuals seeking weight loss treatment do so for a variety of reasons. Limited work has explored relations of reasons for weight loss to patient characteristics or to weight loss outcomes. The current study examined these relations.MethodsThe sample consisted of 588 patients in a 15‐week fee‐for‐service weight loss programme. Prior to the intervention, patients completed questionnaires including items on reasons for weight loss, demographic characteristics, and a variety of weight‐based characteristics. Patients' weight change outcomes were expressed as percent weight loss and also categorized into one of three previously described weight loss trajectories.ResultsThe results of chi‐squared and t‐test analyses suggested that endorsement of health concerns, mobility concerns, or another person's recommendation was associated with higher body mass index (BMI) and older age. These reasons were more likely to be endorsed by White patients than Black patients and by male patients than female patients. Endorsement of doctor recommendation was more likely to be seen among Black patients than White patients. There was no significant relation of any weight loss reason with weight loss outcome.ConclusionsWhile certain reasons for weight loss were more often cited by certain patient groups, no specific reason predicted a better or worse outcome.

Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss.

The current obesity epidemic is staggering in terms of its magnitude and public health impact. Current guidelines recommend continuous energy restriction (CER) along with a comprehensive lifestyle intervention as the cornerstone of obesity treatment, yet this approach produces modest weight loss on average. Recently, there has been increased interest in identifying alternative dietary weight loss strategies that involve restricting energy intake to certain periods of the day or prolonging the fasting interval between meals (i.e., intermittent energy restriction, IER). These strategies include intermittent fasting (IMF; >60% energy restriction on 2–3 days per week, or on alternate days) and time-restricted feeding (TRF; limiting the daily period of food intake to 8–10 h or less on most days of the week). Here, we summarize the current evidence for IER regimens as treatments for overweight and obesity. Specifically, we review randomized trials of ≥8 weeks in duration performed in adults with overweight or obesity (BMI ≥ 25 kg/m2) in which an IER paradigm (IMF or TRF) was compared to CER, with the primary outcome being weight loss. Overall, the available evidence suggests that IER paradigms produce equivalent weight loss when compared to CER, with 9 out of 11 studies reviewed showing no differences between groups in weight or body fat loss.

A Critical Review of Exercise Training in Hemodialysis Patients: Personalized Activity Prescriptions Are Needed.

Exercise training appears to have modest or inconsistent benefits in hemodialysis patients. This may be due to the low volume and intensity of exercise often prescribed. To address this, research is needed to evaluate the efficacy of individualized exercise prescriptions as a component of a comprehensive lifestyle intervention strategy that gives patients more autonomy to choose preferred types of physical activity.

Long term management of obstructive sleep apnea and its comorbidities

Obstructive sleep apnea (OSA) is a worldwide highly prevalent disease associated with systemic consequences, including excessive sleepiness, impairment of neurocognitive function and daytime performance, including driving ability. The long-term sequelae of OSA include and increase risk for cardiovascular, cerebrovascular and metabolic syndrome disorders that ultimately lead to premature death if untreated. To ensure optimal long-term outcomes, the assessment and management of OSA should be personalized with the involvement of the appropriate specialist. Most studies have demonstrated inmediate improvement in daytime somnolence and quality of life with CPAP and other therapies, but the effect of long-term treatment on mortality is still under debate. Currently, the long-term management of OSA should be based on a) identifying physiological or structural abnormalities that are treatable at the time of patient evaluation and b) comprehensive lifestyle interventions, especially weight-loss interventions, which are associated with improvements in OSA severity, cardiometabolic comorbidities, and quality of life. In long-term management, attention should be paid to the clinical changes related to a potential reoccurrence of OSA symptoms and it is also necessary to monitor throughout the follow up how the main associated comorbidities evolve.

Comprehensive Lifestyle Interventions in Obstructive Sleep Apneea

Abstract There is a complex link between obesity and obstructive sleep apneea (OSA), and there are new guidelines for comprehensive lifestyle interventions (CLI) for weight loss, with beneficial results on obese patients with OSA. A structured algorithm is proposed, step by step, according to BMI. All these recommendations are evidence based, a large meta-analysis is further discussed as an evidence base. Implications in clinical practice outline: the effectiveness of lifestyle changes in reducing OSA outcomes, higher efficiency for complex interventions on male patients with severe OSA, duration of the intervention and combination with CPAP usage are not statistically correlated with lifestyle interventions effects on OSA. Different types of food affect sleep quality, high fat diets and processed meat are correlated with OSA. Higher adherence to Mediterranean Diets, that is very common used in CLI is a predictor for OSA outcomes improvement. Metabolic bariatric surgery MBS, indicated for a specific group of patients will ameliorate OSA. Building a long term partnership with the patients with OSA and obesity will ensure adherence to therapeutically measures and finally good results in improving quality of life.