Healthy Lifestyle Program Research Articles

Cost-effectiveness of a community-based cardiovascular disease prevention intervention in medically underserved rural areas

BackgroundRural women experience health disparities in terms of cardiovascular disease (CVD) risk compared to urban women. Cost-effective CVD-prevention programs are needed for this population. The objective of this study was to conduct cost analysis and cost-effectiveness analyses (CEAs) of the Strong Hearts, Healthy Communities (SHHC) program compared to a control program in terms of change in CVD risk factors, including body weight and quality-adjusted life years (QALYs).MethodsSixteen medically underserved rural towns in Montana and New York were randomly assigned to SHHC, a six-month twice-weekly experiential learning lifestyle program focused predominantly on diet and physical activity behaviors (n = 101), or a monthly healthy lifestyle education-only control program (n = 93). Females who were sedentary, overweight or obese, and aged 40 years or older were enrolled. The cost analysis calculated the total and per participant resource costs as well as participants’ costs for the SHHC and control programs. In the intermediate health outcomes CEAs, the incremental costs were compared to the incremental changes in the outcomes. The QALY CEA compares the incremental costs and effectiveness of a national SHHC intervention for a hypothetical cohort of 2.2 million women compared to the status quo alternative.ResultsThe resource cost of SHHC was $775 per participant. The incremental cost-effectiveness ratios from the payer’s perspective was $360 per kg of weight loss. Over a 10-year time horizon, to avert per QALY lost SHHC is estimated to cost $238,271 from the societal perspective, but only $62,646 from the healthcare sector perspective. Probabilistic sensitivity analyses show considerable uncertainty in the estimated incremental cost-effectiveness ratios.ConclusionsA national SHHC intervention is likely to be cost-effective at willingness-to-pay thresholds based on guidelines for federal regulatory impact analysis, but may not be at commonly used lower threshold values. However, it is possible that program costs in rural areas are higher than previously studied programs in more urban areas, due to a lack of staff and physical activity resources as well as availability for partnerships with existing organizations.Trial registrationClinicalTrials.gov identifier NCT02499731, registered on July 16, 2015.

Evaluation of the Healthy Lifestyle Program on Cognitive Outcomes

Evaluation of the Healthy Lifestyle Program on Cognitive Outcomes

BOUNCE to Health: A Healthy Lifestyle Program

BOUNCE to Health: A Healthy Lifestyle Program

A qualitative exploration of barriers and enablers of healthy lifestyle engagement for older Australians with intellectual disabilities

Older Australians with intellectual disabilities experience high rates of lifestyle-related illness, yet generally have poor diets and participate in limited physical activity. Eliciting the perspectives of people with intellectual disabilities and support workers may inform interventions to support healthy lifestyles. A semi-structured focus group question framework was developed to investigate participants’ experiences of barriers and enablers of physical activity and healthy eating. Data from focus groups with paid support workers (n = 6) and people with intellectual disabilities (n = 8) aged 60 + years were analysed within this framework. Similarities and differences between perspectives were explored. Both groups perceived decreased physical activity as an inevitable aspect of ageing. Health problems and environmental constraints were also identified. Embedding physical activity into daily routines, providing choices, and viewing exercise as beneficial, were highlighted as enablers across groups. Support workers, but not people with intellectual disabilities, identified barriers to healthy eating including use of “junk” food to manage behaviour and lack of message consistency between care providers. Financial and human resource barriers were also highlighted by support workers. Both carers and people with intellectual disabilities may benefit from specialised support to adapt healthy lifestyle interventions for people as they age. Behavioural management strategies unrelated to food should be promoted. Organisational and policy-level commitment are needed to ensure that healthy lifestyle programs are adequately resourced to meet the needs of the ageing population with intellectual disabilities.

"With Every Step, We Grow Stronger": The Cardiometabolic Benefits of an Indigenous-Led and Community-Based Healthy Lifestyle Intervention.

Community-based and Indigenous-led health and wellness approaches have been widely advocated for Indigenous peoples. However, remarkably few Indigenous designed and led interventions exist within the field. The purpose of this study was to evaluate an Indigenous-led and community-based health and wellness intervention in a remote and rural Indigenous community. This protocol was designed by and for Indigenous peoples based on the aspirations of the community (established through sharing circles). A total of 15 participants completed a 13-week walking and healthy lifestyle counselling program (incorporating motivational interviewing) to enhance cardiometabolic health. Measures of moderate-to-vigorous physical activity (MVPA; 7-day accelerometry and self-report), predicted maximal aerobic power (VO2max; 6-min walk test), resting heart rate and blood pressure, and other health-related physical fitness measures (musculoskeletal fitness and body composition) were taken before and after the intervention. The intervention led to significant (p < 0.05) improvements in VO2max (7.1 ± 6.3 % change), with the greatest improvements observed among individuals with lower baseline VO2max (p < 0.05, r = -0.76). Resting heart rate, resting systolic blood pressure, and resting diastolic blood pressure decreased significantly (p < 0.05) after the intervention. Self-reported and accelerometry-measured frequency of MVPA increased significantly (p < 0.05), and the total MVPA minutes (~275 min/week) were above international recommendations. Change in VO2max was significantly correlated with change in self-reported (r = 0.42) and accelerometry-measured (r = 0.24) MVPA minutes. No significant changes were observed in weight, body mass index, waist circumference, body fat (via bioelectrical impedance), grip strength, and flexibility. These findings demonstrate that a culturally relevant and safe, community-based, Indigenous-led, health and wellness intervention can lead to significant and clinically relevant improvements in cardiometabolic health and physical activity behaviour, with the greatest changes being observed in the least active/fit individuals.

Differences in cardiometabolic risk markers among ethnic groups in Queensland, Australia.

Very little is known about the cardiometabolic risk of migrants who settle in Australia. This study investigated differences in cardiometabolic risk markers among ethnic groups attending a tailored healthy lifestyle program in Queensland, Australia; and differences in these markers between those living in Australia for shorter versus longer periods of time. Baseline data collected between October 2014 and June 2017 from the Living Well Multicultural-Lifestyle Modification Program were used. People living in ethnic communities in Queensland who were ≥18years old, and not underweight were eligible to participate. Independent variables were ethnicity and length of time in Australia. Outcomes were cardiometabolic risk markers including BMI, waist circumference, weight-to-height ratio (WHtR) and hypertension. Analyses were done separately for each independent variable. Linear and logistic regressions were run for continuous and binary outcomes with differences/Odds ratios reported respectively. Multivariable analyses showed that Burmese/Vietnamese had an average BMI lower than Afghani/Arabic (3.7 points), Somalian/Sudanese (4.7 points) and Pacific Islander (11.6 points) (p<0.001) respectively. Differences in waist circumference between Burmese/Vietnamese with Sri Lankan/Bhutanese, Afghani/Arabic, Somalian/Sudanese and Pacific Islander were 6.3, 8.4, 9.1 and 24.0cm (p<0.01) respectively. Although Burmese/Vietnamese also had lower average WHtR compared to the others, the differences were not significant for Somalian/Sudanese. Moreover, Sri Lankan/Bhutanese and Pacific Islander were more likely to be hypertensive compared to Burmese/Vietnamese (p<0.05). Immigrants living in Australia >5years had on average 1.2 points higher BMI, 2.4cm larger waist circumference, and 0.02 points higher WHtR (p<0.05) compared to those living for ≤5years. Long-stay immigrants were also more likely to be hypertensive than short-stay immigrants (p<0.01). In conclusion, cardiometabolic risk is significantly different among ethnic groups in Queensland with Pacific Islanders having the highest risk. Immigrants living in Australia >5years had higher risks compared to those living in Australia for shorter periods of time.

Integrating Local Knowledge into a National Programme: Evidence from a Community-Based Diabetes Prevention Education Programme.

Type 2 diabetes prevention is a major priority for healthcare services and public health. This study aimed to evaluate how a local authority in England piloted a diabetes prevention programme. The South Gloucestershire Diabetes Prevention (Pilot) Programme (SGDPP) comprised a group health education course over six weeks with subsequent support provision up to six months post-enrolment. Of the 300 patients invited onto the programme, 32% enrolled and 29% completed the full six-month programme. There was an attendance rate of 84% throughout group sessions and at a six-month follow-up. There were significant improvements across most measures at six months, including a 4 kg mean weight loss and a 3.45 mmol/mol mean HbA1c reduction. Clear goals, high quality organization and personal qualities of educators were identified as central for the programme’s success. The unit costs were similar to pilots of other healthy lifestyle programmes. The evaluation found evidence of reduced type 2 diabetes risk markers, positive impacts for dietary and physical activity, and potential cost-effectiveness for this format of group-based diabetes prevention intervention. Feedback from multiple stakeholders provided insight on how to successfully embed and scale-up delivery of diabetes prevention work. This evidence enables the integration of learning in local service delivery and provides a basis to support development of the national diabetes prevention programme.

Abstract P144: The Effect of a Community-Based Healthy Lifestyle Behavior Change Program on Simple 7 Score Among Rural Women

Objective: The objective of this study was to evaluate the effects of a multilevel healthy lifestyle behavior change program for women living in rural areas where higher rates of cardiovascular disease are influenced by poverty, reduced access to health care and unique social and built environment challenges. Methods: In eleven medically underserved rural towns in New York, 182 overweight and obese sedentary women 40 years and older enrolled in a community-randomized trial. Communities randomized to Group 1 (intervention) participated in six months of hour-long, twice weekly experiential learning classes that included progressive strength training, aerobic exercise and skill-based nutrition education (individual level), and a civic engagement curriculum focused on healthy food and physical activity environments (social, community and policy levels); classes were facilitated by local health educators trained by the research team. Communities randomized to Group 2 (delayed intervention control) received the intervention immediately following the completion of intervention activities for Group 1. All components of the Simple 7 score were recorded at baseline (prior to randomization) and at six months (post-intervention for Group 1, pre-intervention for Group 2). Weight, height, blood pressure, blood cholesterol and blood glucose were measured directly and smoking status, diet and physical activity were self-reported. Multivariate regression analyses were used to examine change in Simple 7 score from baseline to outcome. Initial models controlled for study site, baseline Simple 7 score, education and age, and were based on the 107 participants with complete data. Results: Simple 7 scores were similar for both groups prior to randomization (7.91 for Group 1, 7.83 for Group 2). At the end of the six month intervention period for Group 1, the Simple 7 score for Group 2 was unchanged (7.85) but increased to 8.98 for Group 1 participants (p=0.02 for the difference between groups in Simple 7 change). The percentage of Group 1 participants in the optimal range of scores (10-14) rose from 14.8% to 37.0%. The Simple 7 components showing the greatest improvement were BMI, physical activity and healthy diet score. Additional analyses will assess potential bias associated with incomplete data and will examine evidence for the validity of self-reports on physical activity and diet. Conclusion: The multilevel healthy lifestyle program is feasible for implementation in rural settings with limited resources and showed promise for reducing cardiovascular disease risk in midlife and older rural overweight and obese women.

Abstract P051: College Students’ Perception and Beliefs Regarding Cardiovascular Risk Factors: A Mixed-Methods Study

Background: Many college students underestimate their cardiovascular risk while engaging in high-risk behaviors such as consumption of high-fat foods, smoking, alcohol abuse, and sedentary lifestyle. Objective: To explore the perceptions and beliefs regarding cardiovascular risk factors and lifestyle modifications among college students who have been identified as high risk for cardiovascular disease (CVD). Methods: Using a mixed-methods design, quantitative data was collected to identify participants with high CVD risk. Participants with a Framingham 30-year CVD risk of 10% or higher were invited to participate in the qualitative interviews. Of 148 college students who completed the quantitative portion, 16 were high risk and invited to participate in qualitative interviews. A conventional content analysis was used to analyze interview data. Results: Ten participants completed the interviews (mean 30-year CVD risk was 19.0% (ranges 10% to 39%). All participants were overweight or obese, 70% consumed alcohol, 60% had elevated blood pressure, 50% had a family history of heart disease, and 20% were current smokers while none had diabetes or hyperlipidemia. Analysis of the in-depth interviews revealed a thematic structure consisting of five primary categories: 1) recognizing risk, 2) lifestyle trajectories, 3) factors influencing lifestyles, 4) ideal healthy lifestyle modifications, and 5) perceived benefits of healthy lifestyles. Recognizing risk, participants had varied responses to the news that they were at risk for CVD, some were not surprised to learn of their cardiovascular risk status while others found this information to be unexpected. Lifestyle trajectory, participants often used their previous lifestyle and behaviors as a context for their current lifestyles. The influencing factors, both facilitators and barriers, are categorized as environmental, relational, financial, work/life/school balance, and internal/intrinsic motivation. Participants described their conceptualizations of an ideal healthy lifestyle modification program and the necessary components for success. The benefits and results of a healthy lifestyle were clearly described as feeling better and experiencing improved physical tolerance, looking better, reaping the rewards of experiencing results, positive feedback from others, and social acceptance and validation. Conclusions: Understanding high-risk college students’ beliefs and perceptions regarding CVD risk factors, barriers, facilitators, and strategies for implementing a healthy lifestyle, is the first step to assessing the problem facilitating early intervention which may result in improved long-term cardiovascular health outcomes in the young population.

Rugby Fans in Training New Zealand (RUFIT-NZ): a pilot randomized controlled trial of a healthy lifestyle program for overweight men delivered through professional rugby clubs in New Zealand

BackgroundHealthy lifestyle programs that are designed specifically to appeal to and support men to improve lifestyle behaviors and lose weight are needed. The Rugby Fans in Training-New Zealand (RUFIT-NZ) program is delivered by professional rugby clubs and inspired by the successful Football Fans In Training program (FFIT), a gender sensitized weight loss program for obese middle-aged men delivered by professional football clubs in Scotland. RUFIT-NZ required development and evaluation for feasibility.MethodsTo develop the intervention we reviewed content from the FFIT program and evidence-based physical activity, dietary and weight management guidelines, and undertook a series of focus groups and key informant interviews. We then evaluated the feasibility of the intervention in a two-arm, parallel, pilot randomized controlled trial in New Zealand. Ninety-six participants were randomized to either the 12-week RUFIT-NZ intervention (N = 49) or a control group (N = 47). The intervention was delivered through professional rugby clubs and involved physical activity training and classroom sessions on healthy lifestyle behaviors. Pilot trial outcomes included body weight, heart rate, blood pressure, cardiorespiratory fitness, and lifestyle behaviors. Feasibility was assessed by recruitment and retention rates, and acceptability of the intervention.ResultsAt 12 weeks the mean difference in body weight was 2.5 kg (95% CI -0.4 to 5.4), which favored the intervention. Statistically significant differences in favor of the intervention group were also observed for waist circumference, resting heart rate, diastolic blood pressure, cardiorespiratory fitness, and the proportion of participants that were adherent to 3 or more healthy lifestyle behaviors. The intervention was considered feasible to test in a full trial given the good recruitment and retention rates, and positive feedback from participants.ConclusionsA pilot study of a healthy lifestyle intervention delivered via professional rugby clubs in New Zealand demonstrated positive effects on weight and physiological outcomes, as well as adherence to lifestyle behaviors. Feasibility issues in terms of recruitment, retention, and participant acceptability were assessed and findings will be used to inform the design of a definitive trial.Trial registrationThe trial was prospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12616000137493, 05/12/2016.

An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial.

BackgroundElectronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children.ObjectiveThis study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy.MethodsThe Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection.ResultsA total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes.ConclusionsThe trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power.Trial RegistrationAustralian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ).

A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI).

Weight gain is prevalent among people with traumatic brain injury (TBI) and may be attributable to environmental or injury-specific factors such as mobility impairment, endocrine dysfunction, behavioral and emotional disorders, and sensory loss. Few weight management programs exist to meet the unique needs of this population. Researchers modified a nationally recognized, evidence-based weight-loss program, Group Lifestyle Balance™ (GLB), to address the needs of over-weight and obese people post TBI (GLB-TBI). This current randomized controlled trial (RCT) examines the efficacy of the GLB-TBI on weight and secondary outcomes compared to an attention control educational support group. Furthermore, researchers have developed a mobile technology app to further engage participants in the program. This RCT will enroll and randomize 66 participants over a two-year period. It is anticipated that findings from this current RCT will contribute to the knowledge and evidence for an effective weight-loss intervention among this underserved population, with a goal of achieving full recognition by the Centers for Disease Control and Prevention-National Diabetes Prevention Program and subsequent Center for Medicare and Medicaid Services reimbursement for participation.

Effect of Healthy Lifestyle Educational Programs on Happiness and Life Satisfaction in the Elderly: A Randomized Controlled Trial Study

Objectives Like the global population, the Iranian population is aging rapidly. Measures should be taken to maintain aging population healthy and happy. The present study evaluated the effects of active education of healthy lifestyle on happiness and life satisfaction of the elderly people. Methods & Materials In this randomized controlled trial, 96 elderly people aged 60-70 were conveniently recruited from a health center in Isfahan Province, Iran. The subjects were randomly allocated to an intervention and a control group. Participants in the intervention group were provided with lifestyle educations in 4 two-hour sessions. Happiness and life satisfaction were assessed before and 2 months after the intervention. Study data were analyzed by SPSS using the Independent samples t-test and Paired t-test, Mann Whitney U test, Wilcoxon signed-rank test, Chi-squared test and Pearson correlation analysis. Results The lifestyle education program significantly improved happiness scores from 36.80 to 43.11 and life satisfaction scores from 12.96 to 16.02 (P < 0.001). Happiness was positively correlated with life satisfaction (r=0.719; P < 0.001). Conclusion Active participation in healthy lifestyle education programs can improve happiness and life satisfaction among elderly people.

Development of a Healthy Eating and Lifestyle Program (HELP) Online Website for Filipinos: A Case Report

Background and Purpose: Non-communicable diseases (NCDs) are a major public health problem in the Philippines and around the world. Preventive measures to reduce its continuous rise require improvement in the health system. Utilization of information and communication technology-(ICT)-based tools will allow dissemination of evidenced-based information in the population. This case report contains the description of the development process of a Web-based nutrition Website. Case Description: ICT-based tools were explored as means of communicating nutrition information to the public because of the increasing access and usage of the Internet among Filipinos. An iterative process with five major phases were followed in the development. Outcome: The Website HELP Online can be accessed through (http://i.fnri.dost.gov.ph/helponline). There is integration of two modules: one for the general public and the other for registered nutritionist dietitians (RND) of the Food and Nutrition Research Institute (FNRI). The first module contained the nutrition counseling platform that connects and records all interactions of online and walk-in clients with their RNDs. The second module contained nutrition calculators, a health tracker, and nutrition education materials. Discussion: The developed HELP Online Website was used for online users to easily access nutrition information and services offered by Department of Science and Technology (DOST)-FNRI. The user-centered design focus in combination with a responsive Web platform resulted in improved user satisfaction. In terms of content, use of the current and accepted scientific information translated to simpler and easier messages were found to be more effective among the target group. Although many issues exist with the continuous use of ICT-based tools, the main purpose is to improve the delivery of evidence-based information to the public.

Is enneagram personality system able to predict perceived risk of heart disease and readiness to lifestyle modification?

Background:Studying personality traits and patterns is of significant importance in adopting healthy behaviors. Therefore, the current study investigates the relationship between Enneagram personality types and perceived risk of heart disease and readiness to lifestyle modification.Methods:In this cross-sectional study, 190 noncardiac patients (82.3% female) in an outpatient clinic in western Iran were selected using a simple random sampling method to fill out standard questionnaires. The obtained data were analyzed using Pearson's correlation coefficient and linear regression analysis.Results:The findings show that the performer personality (Type 3) can directly predict increasing readiness to lifestyle modification (P < 0.001). In contrast, there is a reverse significant relationship between the challenger personality (Type 8) and readiness to lifestyle modification (P = 0.019). Moreover, the helper personality (Type 6) is able to directly predict increasing the perceived risk of heart disease (P = 0.012).Conclusions:In the Enneagram system, unique personality types possess a unique risk perception and readiness to adopt healthy behaviors. The results of the current study can provide valuable information for healthy lifestyle programs professionals with regard to preventing cardiovascular diseases.

A review of the sustainability and impact of a healthy lifestyles programme in primary schools 2-5 years after the intervention phase.

There has been an emphasis on schools to promote healthy lifestyles and many intervention programmes have attempted this. Most programmes are evaluated at the time and/or shortly afterwards. This is a review of the impact and sustainability of the Health for Life programme 2-5 years after the initial phase. It captures the experiences of the senior school staff who delivered the programme through semi-structured interviews. Senior teachers recognized the importance of promoting healthy lifestyles in primary schools. They reported positively on aspects of the programme, in particular its flexibility and how it enabled schools to develop a new relationship with parents and how schools have sustained the initial programme. They discussed the main barriers to intervention and how they could be mitigated. Delivering a sustainable healthy lifestyle primary schools programme which has an impact is feasible but challenging for school staff. To maximize the likelihood of delivery, interventions must be championed by a member of the Senior Leadership Team, embedded in the curriculum, hands-on, easy to manage, and flexible to the needs of individual schools but requires support (financial, training and advisory). With these conditions the sustainability and impact of the programme was significant.

Evaluation of the Effectiveness of a 3-Year, Teacher-Led Healthy Lifestyle Program on Eating Behaviors Among Adolescents Living in Day School Hostels in Malaysia.

Independence gained during adolescence may be associated with unhealthy eating behaviors. Although malnutrition among adolescents is evident, studies on eating behaviors among adolescents are scarce. To determine the effectiveness of a teacher-led Healthy Lifestyle Program on eating behaviors among adolescents in Malaysia. This was a cluster randomized controlled trial (conducted in 2012 to 2014), with 100 schools randomly selected from 721 schools, then assigned to 50 intervention schools and 50 control schools. A Healthy Eating and Be Active among Teens (HEBAT) module was developed for pretrained teachers to deliver a Healthy Lifestyle Program on eating behaviors among adolescents. Eating behaviors of the respondents was determined using Eating Behaviors Questionnaire. Linear Mixed Model analysis and χ2 test were used to determine within- and between-group effects of studied variables. A total of 4277 respondents participated in this study, with 2635 samples involved in the final analysis, comprised of 921 intervention and 1714 control respondents. There were 32.4% (36.4%) males and 67.6% (63.6%) females in the intervention (control) group. Mean age was comparable between the groups (intervention = 12.98 years; control = 12.97 years). Majority of the respondents skipped meals at baseline (intervention = 74.7%; control = 79.5%). After the program, intervention respondents had higher consumption frequency of lunch, dinner, and mid-morning snack but a lower consumption frequency of late-evening snack and meal skipping behaviors than their control counterparts. The teacher-led Healthy Lifestyle Program was effective in reducing meal-skipping behaviors among Malaysian adolescents.

Longitudinal Associations of the Healthy Lifestyle Index Score With Quality of Life in People With Multiple Sclerosis: A Prospective Cohort Study.

Objective: To explore the association between combined lifestyle risk factors with quality of life in people with multiple sclerosis (MS) over 2.5 years.Methods: People with MS were recruited to participate in a comprehensive online survey regarding their demographic and clinical characteristics, health-related quality of life (HRQOL), and lifestyle behaviors including physical activity, alcohol consumption, cigarette smoking, body mass index, and dietary habits measured at baseline and 2.5-year follow-up. A combined healthy lifestyle index score (HLIS) was constructed by assigning scores of 0–4 to each of the lifestyle risk factors, for which higher values indicate healthier lifestyle behavior. Multivariable linear regression modeling was used to assess whether the HLIS at baseline was associated with the physical and mental HRQOL over the study period in this sample of people with MS.Results: Of 2,466 participants with confirmed MS, 1,401 (57%) completed the follow-up. Multivariable linear regression analyses demonstrated that every 5-point increase (of a possible total of 20) in the baseline HLIS was associated with 1.7 (95% CI: 0.2–3.2) and 2.5 (95% CI: 1.0–4.0) higher scores in the change in physical and mental HRQOL components from baseline to follow-up respectively.Conclusion: Findings suggest the importance of healthy lifestyle behavior in quality of life in MS. A healthy lifestyle program focusing on these behaviors has the potential to positively influence health-related quality of life for people with MS.

The combination of storybook and children’s activity: “The seven basic principles of a clean and healthy lifestyle"

Currently, the Government of Indonesia is promoting the activities of the community movement about clean and healthy life, one of the Ministry of Health programs that are Clean and Healthy Behavior (Lifestyle). Benefits of the program are learning to habituate behavior that includes the cleanliness of the environment around us, such as homes, schools, food and beverage sanitation that aims to avoid infectious diseases, such as diarrhea, types, cough, skin diseases, etc. Obviously, this will be effective if applied too early childhood, but the constraints are sometimes less optimal delivery. This is usually due to several things namely, lack of understanding, the form or manner of delivery is not appropriate, the use of language that is less appropriate, the media used less interesting. With the method of simplifying the program in a picture book that accompanied interactive activities that are easy to be done by the child, so the delivery of the message more interesting and easier to understand. After doing the design test for the students of PAUD KAYYIS kindergarten school, Ciledug Tangerang on May 15-16, 2018, and the result all enthusiastic respondents read the story and the spirit of doing the exercises correctly and understand the information submitted. In conclusion, the delivery of the Clean and Healthy Lifestyle program is easily accepted and understood if it is delivered in a picture storybook accompanied by interactive activities that are easy to work on by children.

Impact of a Community-Based Healthy Lifestyle Program on Individuals With Traumatic Brain Injury.

To examine adherence with and effect of an evidence-based healthy lifestyle intervention modified for individuals with traumatic brain injury (TBI). Pre-/postintervention without control. Community. Eighteen individuals with TBI: primarily male (61%), white (67%), with private insurance (50%). Mean age was 45.6 ± 12.3 years, weight 210 ± 42.6 lb, and body mass index 31.8 ± 4.6 (obese category) at baseline. The primary goal of the Diabetes Prevention Program Group Lifestyle Balance program is 5% to 7% weight loss through increased physical activity and improved dietary behaviors. Adherence (ie, session attendance and self-monitoring of dietary behaviors), physiologic changes (ie, weight loss, blood pressure; waist and arm circumference; and lipid profile), and quality of life (ie, self-reported health, quality of life, and step count). Average participant attendance (85% over 12 months) and self-monitoring (90% over 6 months) were high. Significant decreases were observed in diastolic blood pressure and waist and arm circumference from baseline through 12 months and from baseline to 3 months only for weight and total cholesterol. No significant changes were observed in self-reported health, quality of life, or step count. Participants demonstrated high adherence with the program, suggesting that individuals with TBI are able to successfully engage in the program and achieve significant weight loss and changes in key physiologic outcomes.