Comprehensive Lifestyle Modification Research Articles

Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial

The main 6-month results from the PREMIER trial showed that comprehensive behavioral intervention programs improve lifestyle behaviors and lower blood pressure. To compare the 18-month effects of 2 multicomponent behavioral interventions versus advice only on hypertension status, lifestyle changes, and blood pressure. Multicenter, 3-arm, randomized trial conducted from January 2000 through November 2002. 4 clinical centers and a coordinating center. 810 adult volunteers with prehypertension or stage 1 hypertension (systolic blood pressure, 120 to 159 mm Hg; diastolic blood pressure, 80 to 95 mm Hg). A multicomponent behavioral intervention that implemented long-established recommendations ("established"); a multicomponent behavioral intervention that implemented the established recommendations plus the Dietary Approaches to Stop Hypertension (DASH) diet ("established plus DASH"); and advice only. Lifestyle variables and blood pressure status. Follow-up for blood pressure measurement at 18 months was 94%. Compared with advice only, both behavioral interventions statistically significantly reduced weight, fat intake, and sodium intake. The established plus DASH intervention also statistically significantly increased fruit, vegetable, dairy, fiber, and mineral intakes. Relative to the advice only group, the odds ratios for hypertension at 18 months were 0.83 (95% CI, 0.67 to 1.04) for the established group and 0.77 (CI, 0.62 to 0.97) for the established plus DASH group. Although reductions in absolute blood pressure at 18 months were greater for participants in the established and the established plus DASH groups than for the advice only group, the differences were not statistically significant. The exclusion criteria and the volunteer nature of this cohort may limit generalizability. Although blood pressure is a well-accepted risk factor for cardiovascular disease, the authors were not able to assess intervention effects on clinical cardiovascular events in this limited time and with this sample size. Over 18 months, persons with prehypertension and stage 1 hypertension can sustain multiple lifestyle modifications that improve control of blood pressure and could reduce the risk for chronic disease.

Effects of lifestyle modification on the progression of coronary atherosclerosis, autonomic function, and angina—The role of GNB3 C825T polymorphism

Given the multimodal medical and interventional treatment options in coronary artery disease, the additional value of intensified lifestyle modification is unclear. We have therefore examined the effects of lifestyle modification on top of current treatment and also associated with the GNB3 C825T polymorphism, which has established association to sympathetic activation and the precipitation of angina. One hundred one patients with established coronary artery disease were randomized to a 1-year lifestyle modification group (lifestyle group [LG]) or an advice group. Risk factors, coronary calcification (electron beam tomography), heart rate variability, baroreflex sensitivity, anginal symptoms, and quality of life (QOL) were assessed on entry and after 1 year. Patients in LG had excellent program adherence, but lifestyle modification had no impact on metabolic risk factors and coronary calcification. Changes in heart rate, heart rate variability, and blood pressure were only slightly favoring LG. Baroreflex sensitivity increased by 2 (0.79-3.13) ms/mm Hg in the LG but decreased by -0.10 (-1.11 to 0.92) in the advice group (P = .013). Lifestyle modification led to improved physical QOL, reductions of anginal attacks (-54% vs 11%, P = .01), and dose reductions in 30% of anti-ischemic medications (P = .004). *825T allele carriers had a more pronounced reduction of heart rate and improvement of angina and QOL. The beneficial effect on reduction of medication was seen in *825T allele carriers only. In the presence of modern treatments, comprehensive lifestyle modification provides no additional benefits on progression of atherosclerosis but improves autonomic function, angina, and QOL with concomitant reduced need of medication. These responses are more pronounced in GNB3*825T allele carriers.

Randomized Controlled Trial on Lifestyle Modification in Hypertensive Patients

The authors examined the effects of a comprehensive lifestyle modification intervention on blood pressure (BP) and other cardiovascular risk factors in hypertensive patients. A total of 70 participants were randomly placed into either a lifestyle intervention or a control group. Four education classes and individual counseling sessions were held for the intervention group. Participants in the control group were provided with routine outpatient services and were asked to maintain their usual lifestyle. Data were gathered at baseline and at the end of 6 months. At the end of 6 months, BP, body weight, body mass index, waist circumference, and fasting lipids, apart from high-density lipoprotein cholesterol, significantly declined in the intervention group. Healthpromoting lifestyle scores of the intervention group had increased significantly compared to those of the control group. In conclusion, the results demonstrate the feasibility of comprehensive lifestyle modification and show its beneficial effects.

The Effects of a Comprehensive Life Style Modification Program on Glycemic Control and Stress Response in Type 2 Diabetes

This study was to evaluate the effects of a comprehensive life style modification program on glycemic control and stress response in type 2 diabetes. The participants(n=34) with type 2 diabetes were divided into either a usual care(control) or treatment(experimental) group. The experimental group(n=21) received a program that was based on a comprehensive life style modification protocol at a weekly meeting for 16 weeks. They also participated in individually prescribed exercise and diet along with stress management and self monitoring. The participants were followed for 6 months, during which postprandial glucose, HbA1C, and stress response inventory were measured. The experimental group showed a significant lower postprandial glucose and stress response compared to those of the control group. However, there was no significant change in the HbA1C value in either group. These results suggest that a type 2 diabetes comprehensive lifestyle modification program may lead to clinical improvement in glycemic control and reduce the stress response.

Psychological and Quality-of-Life Outcomes from a Comprehensive Stress Reduction and Lifestyle Program in Patients with Coronary Artery Disease: Results of a Randomized Trial

Background: Stress reduction and comprehensive lifestyle modification programs have improved atherosclerosis and cardiac risk factors in earlier trials. Little is known about the impact of such programs on quality-of-life (QoL) and psychological outcomes. Given recent significant improvements in cardiac care, we evaluated the current benefit of stress reduction/lifestyle modification on QoL and emotional distress in patients with coronary artery disease (CAD). Methods: 101 patients (59.4 ± 8.6 years, 23 female) with CAD were randomized to a 1-year lifestyle/stress management program (n = 48) or written advice (n = 53). QoL and psychological outcomes were assessed with the SF-36, Beck Depression, Spielberger State/Trait Anxiety, Spielberger State/Trait Anger and Perceived Stress Inventories. Group repeated-measures analyses of variance were performed for all measures. Results: Adherence to the program was excellent (daily relaxation practice 39 ± 5vs. 5 ± 8 min, respectively; p < 0.001). Both groups improved comparably in most dimensions of QoL, and significantly greater improvements for the lifestyle group were found for physical function and physical sum score (p = 0.046 and p = 0.045). Depression, anxiety, anger and perceived stress were reduced similarly in both groups. However, intervention × gender interaction effects revealed greater benefits among women in the lifestyle intervention vs. advice group for depression and anger (p = 0.025 and p = 0.040), but no effects for men. Conclusions: A comprehensive lifestyle modification and stress management program did not improve psychological outcomes in medically stable CAD patients. The program did appear to confer psychological benefits for women but not men. Further trials should investigate gender-related differences in coronary patient responses to behavioral interventions.

Outcomes of comprehensive lifestyle modification in inpatient setting

Objective To examine the effectiveness of a 4-week inpatient non-pharmacological risk factor modification programme for individuals with the metabolic syndrome. The aim of the program was to reduce patients’ over risks for stroke and myocardial infarction. Methods A prospective clinical study including 2468 patients – 1096 men and 1372 women – with and average age of 50 ± 10 years. The patients were referred to the programme from primary care units and hospitals where treatment options were exhausted. Results All risk factor levels for stroke and myocardial infarction decreased. The reduction of weight among men was 4.7 ± 2.6 kg and 3.8 ± 1.8 kg among women from an initial weight of 96 ± 17 kg and 85 ± 16 kg, respectively. The patients systolic and diastolic blood pressure decreased by15/10 mm Hg for men and 14/9 mm Hg among women from initial average for the whole population of 148/90 ± 19/11 mm Hg and 146/87 ± 19/12 mm Hg, respectively. The greatest decrease in weight and blood pressure occurred in men and women with an initial body mass index of ≥30 and with a diastolic blood pressure of ≥90; in this group, the average reductions in weight were 5.8 ± 2.4 kg for men and 4.4 ± 1.7 kg for women; the reductions in systolisk/diastolisk blood pressure were 22/15 ± 16/9 mm Hg ( p < 0.001) for both men and women. A reduction of medication (DDD) although not a goal was also achieved. Conclusion The results prove the value of a comprehensive and highly structured inpatient approach to lifestyle modification. Practice implications The results should give cause to trials with half-way strategies integrating features from the inpatient programme into the design of risk factor interventions.

Effects Of Rebound After Weight Loss On Coronary Heart Disease Risk Factors

Many studies have revealed that comprehensive lifestyle therapy, involving diet, exercise, and behavioral modification, can lead to weight losses of 2 to 10 kg over 10 to 20 weeks and reduce coronary heart disease (CHD) risk factors. To sustain the effects of lifestyle therapy, long-term maintenance of the reduced weight would be required. However, many persons experience weight gain after relapsing toward their pre-intervention lifestyle. Few reports are currently available to indicate how much weight gain will reverse the effects on CHD risk factors. PURPOSE To examine longterm weight changes and correlative changes in CHD risk factors. METHODS One hundred fourteen overweight and obese women (age 46.5 ± 8.0 years, BMI 27.6 ± 2.8 kg/m2) were assigned to 2 groups: diet only (n = 35) and diet and exercise (n = 79). The women had participated in a 14-week weight-loss program and were retested 2 to 5 (3.6 ± 1.4) years later. RESULTS The mean weight before and after the program, and at follow-up was 67.7 ± 7.5 kg, 59.1 ± 7.0 kg, and 63.2 ± 8.0 kg, respectively. With the moderate rebound of weight, total cholesterol (219 ± 32 mg/dl, 197 ± 29 mg/dl, 218 ± 35 mg/dl), triglycerides (109 ± 84 mg/dl, 68 ± 29 mg/dl, 95 ± 57 mg/dl), and low-density lipoprotein cholesterol (133 ± 29 mg/dl, 120 ± 26 mg/dl, 134 ± 32 mg/dl) rebounded completely, while systolic blood pressure (132 ± 18 mmHg, 121 ± 15 mmHg, 123 ± 17 mmHg) and diastolic blood pressure (82 ± 10 mmHg, 76 ± 9 mmHg, 76 ± 11 mmHg) did not change after the program. Moderate rebounds were found in fasting plasma glucose (98 ± 25 mg/dl, 88 ± 13 mg/dl, 92 ± 15 mg/dl) and visceral fat (94.7 ± 49.5 cm2, 58.9 ± 34.5 cm2, 68.3 ± 41.1 cm2). No significant group differences in terms of rebound were found, although systolic blood pressure significantly regained in the diet only group, and visceral fat significantly regained in the diet and exercise group. CONCLUSIONS Weight gain (+3.9 kg) after weight loss (−8.6 kg) may reverse effects on CHD risk factors. Greater efforts to maintain reduced weight are needed for preventing CHD. Supported partly by Uehara Memorial Foundation, the 21st century COE program, and Tsukuba Advanced Research Alliance (TARA).

Obesity and impaired fibrinolysis: role of adipose production of plasminogen activator inhibitor-1.

Obesity is the central promoter of the metabolic syndrome which also includes disturbed fibrinolysis in addition to hypertension, dyslipidaemia and impaired glucose tolerance/type 2 diabetes mellitus. Plasminogen activator inhibitor-1 (PAI-1) is the most important endogenous inhibitor of tissue plasminogen activator and uro-plasminogen activator, and is a main determinant of fibrinolytic activity. There is now compelling evidence that obesity and, in particular, an abdominal type of body fat distribution are associated with elevated PAI-1 antigen and activity levels. Recent studies established that PAI-1 is expressed in adipose tissue. The greater the fat cell size and the adipose tissue mass, the greater is the contribution of adipose production to circulating PAI-1. Experimental data show that visceral adipose tissue has a higher capacity to produce PAI-1 than subcutaneous adipose tissue. Studies in human adipocytes indicate that PAI-1 synthesis is upregulated by insulin, glucocorticoids, angiotensin II, some fatty acids and, most potently, by cytokines such as tumour necrosis factor-alpha and transforming growth factor-beta, whereas catecholamines reduce PAI-1 production. Interestingly, pharmacological agents such as thiazolidinediones, metformin and AT(1)-receptor antagonists were found to reduce adipose expression of PAI-1. In addition, weight loss by dietary restriction or comprehensive lifestyle modification is effective in lowering PAI-1 plasma levels. In conclusion, impaired fibrinolysis in obesity is probably also due to an increased expression of PAI-1 in adipose tissue. An altered function of the endocrine system and an impaired auto-/paracrine function at the fat cell levels may mediate this disturbance of the fibrinolytic system and thereby increase the risk for cardiovascular disease..

The influence of lifestyle modification on carotid artery intima-media thickness in a suburban Japanese population

<h2>Abstract</h2> To evaluate the influence of lifestyle modification with and without lipid-lowering drug therapy on the carotid arterial wall, we did a 2 year prospective ultrasound study of carotid intima-media thickness (IMT) in 1390 male and female residents of a suburban Japanese town. According to total cholesterol (TC) level at baseline, subjects were classified into a lifestyle modification alone group (TC≥220mg/dl, <i>n</i>=437), a lifestyle modification with lipid-lowering drug group (TC≥220mg/dl, <i>n</i>=159), and a control group (TC<220mg/dl, <i>n</i>=794). After 2 years of follow-up, both sexes of both treatment groups showed significant reductions of TC, low-density lipoprotein cholesterol (LDL-C), and IMT, although TC continued over 220mg/dl in some subjects in the lifestyle modification group. The reduction of TC and LDL-C was significantly higher in the lifestyle modification with lipid-lowering drug group than in the lifestyle modification alone group. Although the IMT reduction was not statistically different between the treatment groups of either sex, the reduction of IMT was greater in the lifestyle modification with lipid-lowering drug group than in the lifestyle modification alone group. Our results indicate that comprehensive lifestyle modification can reduce carotid IMT in the general population, with or without the use of lipid-lowering drugs and that cholesterol reduction is of benefit even when TC level remain above the recommended level.

The influence of lifestyle modification on carotid artery intima-media thickness in a suburban Japanese population

To evaluate the influence of lifestyle modification with and without lipid-lowering drug therapy on the carotid arterial wall, we did a 2 year prospective ultrasound study of carotid intima-media thickness (IMT) in 1390 male and female residents of a suburban Japanese town. According to total cholesterol (TC) level at baseline, subjects were classified into a lifestyle modification alone group (TC≥220 mg/dl, n=437), a lifestyle modification with lipid-lowering drug group (TC≥220 mg/dl, n=159), and a control group (TC<220 mg/dl, n=794). After 2 years of follow-up, both sexes of both treatment groups showed significant reductions of TC, low-density lipoprotein cholesterol (LDL-C), and IMT, although TC continued over 220 mg/dl in some subjects in the lifestyle modification group. The reduction of TC and LDL-C was significantly higher in the lifestyle modification with lipid-lowering drug group than in the lifestyle modification alone group. Although the IMT reduction was not statistically different between the treatment groups of either sex, the reduction of IMT was greater in the lifestyle modification with lipid-lowering drug group than in the lifestyle modification alone group. Our results indicate that comprehensive lifestyle modification can reduce carotid IMT in the general population, with or without the use of lipid-lowering drugs and that cholesterol reduction is of benefit even when TC level remain above the recommended level.

Lifestyle recommendations reduced blood pressure in patients with above optimal blood pressure

(2003) JAMA 289, 2083. Appel LJ, Champagne CM, Harsha DW, et al. . Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. ....

Analysis of Recent Papers in Hypertension

Analysis of Recent Papers in Hypertension

P.1.134 Association study of a G-protein beta3 subunit gene polymorphism and major depressive disorders, symptomatology, and treatment response

Given the multimodal medical and interventional treatment options in coronary artery disease, the additional value of intensified lifestyle modification is unclear. We have therefore examined the effects of lifestyle modification on top of current treatment and also associated with the GNB3 C825T polymorphism, which has established association to sympathetic activation and the precipitation of angina.One hundred one patients with established coronary artery disease were randomized to a 1-year lifestyle modification group (lifestyle group [LG]) or an advice group. Risk factors, coronary calcification (electron beam tomography), heart rate variability, baroreflex sensitivity, anginal symptoms, and quality of life (QOL) were assessed on entry and after 1 year.Patients in LG had excellent program adherence, but lifestyle modification had no impact on metabolic risk factors and coronary calcification. Changes in heart rate, heart rate variability, and blood pressure were only slightly favoring LG. Baroreflex sensitivity increased by 2 (0.79-3.13) ms/mm Hg in the LG but decreased by −0.10 (−1.11 to 0.92) in the advice group (P = .013). Lifestyle modification led to improved physical QOL, reductions of anginal attacks (−54% vs 11%, P = .01), and dose reductions in 30% of anti-ischemic medications (P = .004). *825T allele carriers had a more pronounced reduction of heart rate and improvement of angina and QOL. The beneficial effect on reduction of medication was seen in *825T allele carriers only.In the presence of modern treatments, comprehensive lifestyle modification provides no additional benefits on progression of atherosclerosis but improves autonomic function, angina, and QOL with concomitant reduced need of medication. These responses are more pronounced in GNB3*825T allele carriers.

Effect of comprehensive lifestyle modification on blood pressure control

Effect of comprehensive lifestyle modification on blood pressure control

Dietary treatment and long-term weight loss and maintenance in type 2 diabetes.

Increasing body weight, particularly abdominal weight, is associated with increasing risk for type 2 diabetes, and 80% of people with type 2 diabetes are overweight or obese. Weight loss and maintenance are challenging in the obese population without diabetes, and data suggest that this may be more difficult in obese people with diabetes. Various weight-loss strategies with follow-up for at least 1 year have been evaluated in people with diabetes with mixed results. Diet is most effective in promoting initial weight loss. Energy restriction will improve glycemic control within days of initiation, independent of weight loss. There is deterioration of the effects of dietary therapy on glycemic control over time, even with partial weight maintenance, because of the relaxation of energy restriction. Diet composition has little effect on glycemic control independent of total calories. Very-low-calorie diets lead to better initial weight loss and glycemic control but yield no better long-term results than more moderate treatment. The initial results from studies using prepared meals and liquid meal replacements show that weight loss and glycemic control are comparable with conventional dietary treatment. Comprehensive lifestyle therapies, involving diet, exercise, and behavioral modification, can lead to weight losses of approximately 2 to 10 kg over 10 to 20 weeks, with regain over 1 year of one-third to one-half of weight initially lost. The net improvement on glycemic control is usually small 1 year after weight loss. Creative strategies using these and other modalities are needed to improve long-term weight loss, weight maintenance, and glycemic control in patients with type 2 diabetes. Greater efforts in primary prevention are also needed because of the increasing prevalence of obesity and type 2 diabetes.

RESULTS OF A COMPREHENSIVE OBESITY TREATMENT PROGRAM

Methods: We developed a program designed to treat high-risk obese individuals using a multi-disciplinary approach. Our model combines nutrition education, exercise, behavioral therapy and physician supervision. Criteria for entry include Body Mass Index (BMI) ≥ 30 kg/m2, or ≥ 27 kg/m2 with two or more risk factors. Eight co-morbid conditions were represented, including hypertension, hyperlipidemia, diabetes, asthma, sleep apnes, gastroesophageal reflux, depression and coronary artery diseae. Our 15-month prospective study includes a 12-week treatment phase followed by a one-year maintenance program. Results: 25/30 subjects, 12 men and 13 women, completed the initial 12-week program. The 12-week results included the following: weight lost, 10.63 lbs; reduction in systolic blood pressure, 10.96 mmHg; reduction in diastolic blood pressure, 4.4 mmHg; average cholesterol was reduced from 202 mg/dl to 192 mg/dl; HDL cholesterol did not increase significantly (43.71 mg/dl to 44 mg/dl); LDL cholesterol decreased from 124 mg/dl to 114 mg/dl; triglycerides decreased from 187 mg/dl to 148 mg/dl; and HbA1c decreased in diabetics from 8% to 5.6%. Individuals were divided into three groups based on their compliance. High compliers missed 0–4 visits (N = 13), moderate compliers missed 5–9 visits (N = 8), and poor compliers missed greater than 10 visits (N = 4). High compliers as a group had BMIs ranging from 27 to 61. They lost an average of 14 pounds, 14 inches in total circumference, and 4% body fat. Beck Depression Scores improved from averages of 9 to 3. Quality of Life Scores improved from averages of 45 to 67 (range: 0 worst to 90 best). Moderate compliers had BMIs ranging from 32 to 58. They lost an average of 9 pounds, 14.5 inches, and 1% body fat. Beck Depression Scores improved from averages of 13 to 3. Quality of Life Scores improved from averages of 48 to 69. Utilization of medications was decreased. Of 8 hypertensive subjects, 1 reduced and 4 discontinued anti-hypertensive medication by week 12. Of the 3 diabetic patients (DM II), 2 reduced medication by over 50% by week 12. A fourth patient newly diagnosed with DM II did not require medication as a result of intervention. Of 4 patients with gastroesophagcal reflux disease (GERD), 1 patient reduced and 2 discontinued prescription medication by week 12. Of 7 patients with asthma/allergy, 3 decreased and 1 discontinued prescription medication by week 12. Conclusion: Obesity is associated with other costly and chronic diseases. The intervention of a comprehensive lifestyle modification program can cause sufficient weight loss to reduce or discontinue medication and improve co-morbid conditions and quality of life measurements over a 12-week period. This translates into healthcare cost savings. The ability to maintain clinical improvement will be the focus of the maintenance phase of this study.

Medical therapy versus coronary angioplasty in stable coronary artery disease: a critical review of the literature

The recent publication of the Atorvastatin Versus Revascularization Treatment (AVERT) trial has renewed debate on the optimal management strategy for relatively stable patients with coronary artery disease. Currently, coronary angiography and percutaneous coronary intervention are often performed in stable patients with good exercise tolerance who have not been treated with proven medications such as aspirin, statins and beta-adrenergic blocking agents in conjunction with comprehensive lifestyle modification. We review the results of prior trials comparing medical therapy with angioplasty and assess their strengths and limitations and then make conclusions about the aggregate data. Next, we describe the ongoing Clinical Outcome Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, which will be the largest of the studies comparing optimal medical therapy and percutaneous revascularization. This study will employ intensive medical management in all patients with coronary disease, and the incremental benefit of state of the art revascularization techniques in terms of clinical event reduction, quality of life issues and cost-effectiveness will be addressed. For now, aggressive medical therapy and revascularization should be viewed as complementary rather than opposing strategies. All patients with coronary heart disease should receive proven medical and lifestyle prescriptions to favorably alter the atherosclerotic process. Percutaneous revascularization without comprehensive risk factor modification is a suboptimal therapeutic strategy.

Comprehensive lifestyle interventions in the community: A preliminary analysis

In a 6-month prospective study designed to retard the aging process, we examined the effects of comprehensive lifestyle modifications in 52 participants aged 31 to 78 years, who were free of clinically overt disease. The group adhered to a low-fat vegetarian diet supplemented with antioxidant nutrients, engaged in regular aerobic exercise (power-walking or jogging), and received motivational support. Statistical analysis of objective data shows a trend of optimization of weight and lipid values. Overall, the group lost an average of 2.95 kg, or 4.4% of starting weight; total cholesterol (TC) decreased 7.7%; LDL-C, 12%; and TC/HDL-C ratio, 9%. Analysis by age and gender shows no significant differences in trends. When grouped by objective parameter, maximal effect is found in those with greatest deviation from a normal value at baseline. Subjective assessments showed significant improvement in energy levels and physiological functioning. Although more well-defined studies are needed, we conclude that lifestyle modifications can optimize health status and level of physiologic functioning, and may be instituted by adults of all age groups with prior medical approval.