High-intensity Program Research Articles

Regional morphological adaptations of vastus lateralis muscle in response to different progressive resistance training programs: A randomised controlled trial.

Resistance training often increases muscle size, a phenomenon known as muscle hypertrophy. These morphological adaptations were typically documented to occur in a non-uniform pattern. Investigating the specific morphological adaptations to different training programs was of interest. This study aimed to investigate two resistance training programs, a high-intensity program (HI) and a combined high-intensity with low-intensity blood flow restriction program (MIX), on morphological adaptations of vastus lateralis muscle in healthy young men. Eighteen active participants were recruited and randomly assigned to the HI (n = 10) or MIX (n = 8) groups, undergoing different 6-week resistance training programs. The training volume set was equated and progressively increased from three sets in weeks 1 and 2 to six sets, and eight sets in weeks 3-4 and 5-6, respectively. Three specific regions of vastus lateralis were assessed by magnetic resonance imaging (MRI) and ultrasound imaging (US) during pre-and post-intervention. Statistical analysis revealed statistically significant increases in muscle area at the proximal (HI: Δ12%, MIX: Δ9.2%), middle (HI: Δ8.7%, MIX: Δ9.0%), and distal (HI: Δ14%, MIX: Δ13%) regions. Additionally, both HI and MIX groups showed statistically significant increases in the sum of muscle thickness post-intervention (HI: Δ12%, MIX: Δ19%) and in the sum of fascia thickness post-intervention (HI: Δ27%, MIX: Δ54%). Despite the MIX group training with higher volume load, no statistical differences were observed between groups for any week. These findings suggested that both HI and MIX programs effectively induced increases in muscle area and sums of muscle and fascia thickness in healthy young men, allowing practitioners to choose either program based on individual preferences and constraints.

The effect on HIV transmission and cost-effectiveness of programmes for female sex workers in East, Central, and Southern Africa: a modelling study

HIV prevalence and incidence has declined in East, Central, and Southern Africa (ECSA), but remains high among female sex workers (FSWs). Sex worker programmes have the potential to considerably increase access to HIV testing, prevention, and treatment. We aimed to quantify these improvements by modelling the potential effect of sex worker programmes at two different intensities on HIV incidence and key health outcomes, and assessed the programmes' potential cost-effectiveness in order to help inform HIV policy decisions. Using a model previously used to review policy decisions in ECSA, we assumed a low-intensity sex worker programme had run from 2010 until 2023; this resulted in care disadvantages among FSWs being reduced, and also increased testing, condom use, and willingness to take pre-exposure prophylaxis (PrEP). After 2023, three policy options were considered: discontinuation, continuation, and a scale-up of the programme to high-intensity, which would have a broader reach, and higher influences on condom use, antiretroviral therapy (ART) adherence, testing, and PrEP use. Outputs of the key outcomes (the percentage of FSWs who were diagnosed with HIV, on ART, and virally suppressed; the percentage of FSWs with zero condomless partners, and HIV incidence) were compared in 2030. The maximum cost for a sex worker programme to be cost-effective was calculated over a 50-year time period and in the context of 10 million adults. The cost-effectiveness analysis was conducted from a health-care perspective; costs and disability-adjusted life-years were both discounted to present US$ values at 3% per annum. Compared with continuing a low-intensity sex worker programme until 2030, discontinuation of the programme was calculated to result in a lower percentage of FSWs diagnosed (median 88·75% vs 91·37%; median difference compared to continuation of a low-intensity programme [90% range] 2·03 [-4·49 to 10·98]), a lower percentage of those diagnosed currently taking ART (86·35% vs 88·89%; 2·38 [-3·69 to 13·42]), and a lower percentage of FSWs on ART with viral suppression (87·49% vs 88·96%; 1·17 [-6·81 to 11·53]). Discontinuation of a low-intensity programme also resulted in an increase in HIV incidence among FSWs from 5·06 per 100 person-years (100 p-y; 90% range 0·52 to 22·21) to 4·05 per 100 p-y (0·21 to 21·15). Conversely, comparing a high-intensity sex worker programme until 2030 with discontinuation of the programme resulted in a higher percentage of FSWs diagnosed (median 95·81% vs 88·75; median difference compared to discontinuation [90% range] 6·36 [0·60 to 18·63]), on ART (93·93 vs 86.35%; median difference 7·13 [-0·65 to 26·48]), and with viral suppression (93·21% vs 87·49; median difference 7·13 [-0·65 to 26·48]). A high-intensity programme also resulted in HIV incidence in FSWs declining to 2·23 per 100 p-y (0·00 to 14·44), from 5·06 per 100 p-y (0·52 to 22·21) if the programme was discontinued. In the context of 10 million adults over a 50-year time period and a cost-effectiveness threshold of US$500 per disability-adjusted life-year averted, $34 million per year can be spent for a high-intensity programme to be cost-effective. A sex worker programme, even with low-level interventions, has a positive effect on key outputs for FSWs. A high-intensity programme has a considerably higher effect; HIV incidence among FSW and in the general population can be substantially reduced, and should be considered for implementation by policy makers. Wellcome Trust.

Intensity matters in CLIL: Evidence from primary school learners’ receptive skills

The implementation of L2-medium education, exemplified by Content and Language Integrated Learning (CLIL), is becoming increasingly popular in primary schools (García Mayo, 2021). While previous research highlights CLIL's positive impact on linguistic competence (Jiménez-Catalán & Ruiz de Zarobe, 2009), differences in linguistic achievement are often associated with varying exposure hours (Pladevall-Ballester & Vallbona, 2016). Despite CLIL's growing popularity, studies examining linguistic achievement in varying-intensity CLIL programs remain scant. We address this gap by comparing low and high-intensity CLIL programs, alongside a standard English as a foreign language (EFL) program in primary schools. Focused on 11-year-olds' receptive skills, our results show that high-intensity programs significantly enhance proficiency in listening and reading when compared to their lower-intensity counterparts. Distinctions between low-intensity and EFL programs are non-significant. These findings underscore the critical role of the intensity of exposure in shaping the effectiveness of CLIL programs and contribute insights for refining CLIL program design guidelines.

Comparative Effects of High and Low Intensity Progress Resisted Exercises on Pain, Range of Motion and Functional Disability in Knee Osteoarthritis Patients with Sarcopenia: A Randomized Controlled Trial

Background: Osteoarthritis is the most common kind of arthritis, affecting millions of people. It develops because of the slow loss of the protective cartilage that cushions the ends of the bones over time. Although osteoarthritis may affect any joint, it is most often connected with joints in the hands, knees, hips, and spine. Objective: To compare the effects of high and low intensity progressive resisted exercises on pain, range of motion and functional disability in knee osteoarthritis patients with sarcopenia. Methods: It was a Randomized Controlled Trial. Data was collected from University of Lahore Teaching Hospital, physical therapy department. Group A- High Intensity Program and Group B- Low Intensity Program each had 42 patients in them. They were all male and female, between the ages of 35 and 65, and had osteoarthritis of different grades, according to Kallgren and Lawrence. The SARC-F questionnaire was used to find out if people had sarcopenia. The outcome measures were pain, functional disability, as well as range of motion. Results: Group A had a mean age of 58.47 years (SD = 4.22) and a mean symptom duration of 3.47 (SD = 1.82). In contrast, Group B had a slightly higher mean age of 58.8 years (SD = 3.11) and a mean symptom duration of 3.04 (SD = 1.68). At baseline, no significant differences were seen between Group A and Group B in terms of knee range of motion, KOOS pain, KOOS function, and KOOS quality of life. However, after 8 weeks, all variables showed significant differences (p>0.05) except for knee flexion (p>0.05). Conclusion: Low-intensity exercises showed greater improvements in pain, functional disability, quality of life, and range of motion compared to the high-intensity group among knee osteoarthritis patients with sarcopenia. Notably, knee flexion exhibited superior enhancement within the high-intensity exercise regimen.

Outcomes of Physiotherapy Exercises After Total Knee Replacement Surgery

Introduction: Total knee replacement (TKR) surgery is a common procedure for severe knee osteoarthritis, improving the quality of life for many patients. Despite surgical success, optimal recovery heavily relies on effective post-operative rehabilitation. This systematic review aimed to evaluate the effectiveness of various physiotherapy exercises in enhancing recovery outcomes following TKR, focusing on knee function, pain reduction, and patient satisfaction. Methods: A comprehensive search of PubMed, Scopus, Cochrane Library, and Web of Science was conducted, focusing on interventional studies and clinical trials published in the last five years up to 2022. Studies included were those evaluating physiotherapy interventions post-TKR, with clear measures on efficacy regarding patient outcomes. Exclusion criteria encompassed non-exercise-based rehabilitations, observational studies, and non-English publications. Data extraction focused on intervention types, sample sizes, and outcome measures. Results: Twelve studies were included, with sample sizes ranging from 30 to over 200 participants. Interventions varied from in-person physiotherapy, home-based exercises, high-intensity training, to tele-rehabilitation. High-intensity physiotherapy programs were associated with a 40% greater improvement in knee function compared to standard care. Tele-rehabilitation provided comparable outcomes in terms of pain management and mobility improvements, with patient satisfaction exceeding 80% in some studies. However, adherence and exercise intensity were noted challenges in remote settings. Conclusions: The review highlights physiotherapy's pivotal role in post-TKR recovery, with high-intensity programs showing significant benefits in knee function. Tele-rehabilitation emerges as a promising alternative, potentially increasing access to care. These findings support the integration of structured physiotherapy into rehabilitation protocols to maximize recovery outcomes. Future research should explore strategies to enhance adherence and effectiveness of tele-rehabilitation services.

Extremely Low-Volume Burpee Interval Training Equivalent to 8 Minutes Per Session Improves Vertical Jump Compared with Sprint Interval Training in Real-World Circumstances.

Pérez-Ifrán, P, Magallanes, CA, de S. Castro, FA, Astorino, TA, and Benítez-Flores, S. Extremely low-volume burpee interval training equivalent to 8 minutes per session improves vertical jump compared with sprint interval training in real-world circumstances. J Strength Cond Res XX(X): 000-000, 2023-The aim of this study was to compare the cardiometabolic and physical effects of 2 time-matched high-intensity programs in a real-world environment. Forty-three active and healthy adults (sex = 31 men and 12 women; age = 27 ± 5 years; peak heart rate [HR peak ] = 190.7 ± 10.6 beat·min -1 ) were randomized to 2 very low-volume protocols (∼8 minutes): sprint interval training (SIT) ( n = 15), burpee interval training (BIT) ( n = 15), and control (CON) ( n = 13). Subjects in SIT and BIT performed 5 days of 10 × 4 second "all-out" efforts with 30 seconds of recovery. Body composition, blood pressure, countermovement jump (CMJ), 10-m sprint, shuttle run test (SRT), autonomic modulation , self-efficacy, and intention were evaluated before and after training. Sprint interval training elicited a higher %HR peak , energy expenditure, rating of perceived exertion category ratio 10 scale, and feeling scale than BIT ( p < 0.05). SRT distance was significantly improved in SIT ( p = 0.03, d = 0.62), whereas CMJ height was significantly enhanced in BIT ( p = 0.0014, d = 0.72). Self-efficacy progressively worsened for SIT than for BIT as sessions increased, and significant differences were found in 5× a week frequency between protocols ( p = 0.040, d = 0.79). No differences in intention to engage were detected between the regimens ( p > 0.05). No changes were observed in body composition, blood pressure, 10-m sprint, SRTV̇O 2max , or autonomic variables with training ( p > 0.05). Results exhibit that extremely low-volume SIT improved running performance, whereas BIT increased the vertical jump.

INFN-LNS facility upgrade for the Nuclear Physics Renaissance

A broad range of Nuclear Physics research activities have been carried out at INFN-LNS until the summer 2020, when the accelerators were stopped for the upgrade. The upgrade of LNS is a project mainly funded by a PON-FESR (National Program for Research and Innovation) strategic line for boosting the research infrastructures, having its own goals, time-schedule and deadlines. In addition to such an action promoted by the Italian Ministry of Research, further funds have been made available from INFN budget. The end of the phase supported by the PON for procurement and tenders is currently set for the end of 2023. A series of actions will therefore be implemented to improve scientific opportunities for users. In particular, the focus is on the commissioning of the Tandem and Superconducting Cyclotron with the new set-up, completed by the renewal of the experimental areas and the commissioning of the new fragment separator FRAISE, also financed under the PON. The high-intensity program, including the determination of the nuclear matrix elements (NME) for the double beta decay and the study of EOS for nuclear matter with large neutron content, will be made feasible by these improvements to accelerators, beamlines and detectors. Some highlights of the whole activity as well as of the Applied Physics perspectives and the Astroparticle Physics multi-messenger program, strictly connected to the Nuclear Physics program, are given.

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program.

Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.

Migrants With Schizophrenia in Forensic Psychiatric Hospitals Benefit From High-Intensity Second Language Programs

Background: As a result of migration, an increasing number of patients in forensic psychiatric hospitals show poor skills in the national language, which can affect their treatment. Improving the second language (L2) of inpatients with schizophrenia may help to enable effective psychotherapy and thus reduce the risk of criminal recidivism and facilitate reintegration into society, for example because of a language-related higher degree of social functioning. For this purpose, a Hessian forensic psychiatric hospital established a ward specialized in L2 acquisition. The ward accommodates up to 21 patients with schizophrenia, who attend an L2 program consisting of 800–900 lessons within 1 year.Aims: The study aimed to evaluate whether patients on the specialized ward (experimental group) achieve at least Common European Framework of Reference (CEFR) level A2 in the L2 program. Additionally, it examined whether language acquisition is better among participants in the experimental group than among those on regular wards (control group).Methods: Achievements in the L2 were assessed by an L2 test 3 times: at the beginning of the program, after 6 months, and after 1 year. The impact of intelligence on achievements in L2 was evaluated using Raven's Standard Progressive Matrices.Results: The experimental group showed significantly better improvement than the control group. Literacy was a significant predictor of improvement in the L2. The majority of the experimental group reached at least CEFR level A2 after 1 year.Conclusions: High-intensity L2 programs are an effective way to improve the L2 of inpatients with schizophrenia in forensic psychiatric hospitals.

The role of Legal Aid NSW in addressing the civil legal needs of participants in High Intensity Units (HIPUs) in prisons

ABSTRACT Legal Aid NSW civil lawyers provide community outreach clinics and civil legal assistance to address the civil legal needs of participants in High Intensity Program Units (HIPUs) in prisons in New South Wales (NSW), Australia. Semi-structured interviews were conducted with Legal Aid NSW staff to explore their work in HIPUs. Interviews focused on the types of civil legal issues faced by HIPU participants, the value of providing such services in the HIPUs and the challenges and barriers associated with this work. The findings indicated that HIPU participants have a range of civil legal needs including issues relating to housing and tenancy, outstanding debts, welfare payments, victims’ compensation, driver disqualification, tort claims and family law matters. Successful resolution of these matters can be critical for ensuring the best chance of post-release desistance from crime. However, provision of civil legal services in prisons can be adversely impacted by practical and operational issues attributable to the time- and resource-intensive nature of this work. Some of these barriers include considerable travel times to prison, delays upon arrival at the prison and unexpected lockdown procedures.

The Distributional Impacts of Active Labor Market Programs for Indigenous Populations

We evaluate the distributional impacts of active labor market programming for indigenous peoples in Canada. Using administrative data and an empirical strategy that compares participants in high-intensity programs--skills interventions, job-creation partnerships, or wage subsidies--to those in low-intensity programs, such as employment assistance or job counseling, reveals large returns to high-intensity programming for above-median earnings. Returns are largest for women at the mean, suggesting that high-intensity programming may reduce gender gaps in earnings among participants, who represent 10 percent of all indigenous people in Canada. Larger returns at the top of the distribution indicate that overall inequality among participants could increase.

Programming Interval Training to Optimize Time-Trial Performance: A Systematic Review and Meta-Analysis.

Interval training has become an essential component of endurance training programs because it can facilitate a substantial improvement in endurance sport performance. Two forms of interval training that are commonly used to improve endurance sport performance are high-intensity interval training (HIIT) and sprint interval training (SIT). Despite extensive research, there is no consensus concerning the optimal method to manipulate the interval training programming variables to maximize endurance performance for differing individuals. The objective of this manuscript was to perform a systematic review and meta-analysis of interval training studies to determine the influence that individual characteristics and training variables have on time-trial (TT) performance. SPORTDiscus and Medline with Full Text were explored to conduct a systematic literature search. The following criteria were used to select studies appropriate for the review: 1. the studies were prospective in nature; 2. included individuals between the ages of 18 and 65years; 3. included an interval training (HIIT or SIT) program at least 2weeks in duration; 4. included a TT test that required participants to complete a set distance; 5. and programmed HIIT by power or velocity. Twenty-nine studies met the inclusion criteria for the quantitative analysis with a total of 67 separate groups. The participants included males (n = 400) and females (n = 91) with a mean group age of 25 (range 19-45) years and mean [Formula: see text] of 52 (range 32-70) mL·kg-1·min-1. The training status of the participants comprised ofinactive (n = 75), active (n = 146) and trained (n = 258) individuals. Training status played a significant role in improvements in TT performance with trained individuals only seeing improvements of approximately 2% whereas individuals of lower training status demonstrated improvements as high as 6%. The change in TT performance with HIIT depended on the duration but not the intensity of the interval work-bout. There was a dose-response relationship with the number of HIIT sessions, training weeks and total work with changes in TT performance. However, the dose-response was not present with SIT. Optimization of interval training programs to produce TT performance improvements should be done according to training status. Our analysis suggests that increasing interval training dose beyond minimal requirements may not augment the training response. In addition, optimal dosing differs between high intensity and sprint interval programs.

Meta-analysis of the effects of smoking prevention programs for young adolescents.

PurposeThis meta-analysis aimed to analyze the effects of smoking prevention programs for young adolescents at early smoking stages to identify the appropriate characteristics of prevention programs for this population.MethodsSearches of health-related databases and Google Scholar were conducted, and 23 randomized studies were included in the analysis. The main outcome variable was smoking behavior. The analysis was conducted using Comprehensive Meta-Analysis software (version 3.0).ResultsSmoking prevention programs significantly reduced smoking behaviors (OR=0.85, 95% CI=0.77-0.93). School-based programs (OR=0.79, 95% CI=0.75-0.83), programs by trained teachers or educators (OR=0.77, 95% CI=0.71-0.83), high-intensity programs (OR=0.82, 95% CI=0.75-0.91), and programs in an in-school setting (OR=0.82, 95% CI=0.74-0.90) had the most significant effect on reducing smoking behavior.ConclusionFor young adolescents, smoking prevention programs are most effective when they are school-based or highintensity programs, and when conducted by teachers or educators with proper training. Further studies are required since there was insufficient research to explore the effect of web-based programs or family-centered programs on adolescent smokers.

Recovery trajectories over six weeks in patients selected for a high-intensity physiotherapy program after Total knee Arthroplasty: a latent class analysis

BackgroundRecovery trajectories differ between individual patients and it is hypothesizes that they can be used to predict if an individual patient is likely to recover earlier or later. Primary aim of this study was to determine if it is possible to identify recovery trajectories for physical functioning and pain during the first six weeks in patients after TKA. Secondary aim was to explore the association of these trajectories with one-year outcomes.MethodsProspective cohort study of 218 patients with the following measurement time points: preoperative, and at three days, two weeks, six weeks, and one year post-surgery (no missings). Outcome measures were performance-based physical functioning (Timed Up and Go [TUG]), self-reported physical functioning (Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS-ADL]), and pain (Visual Analogue Scale [VAS]). Latent Class Analysis was used to distinguish classes based on recovery trajectories over the first six weeks postoperatively. Multivariable regression analyses were used to identify associations between classes and one year outcomes.ResultsTUG showed three classes: “gain group” (n = 203), “moderate gain group” (n = 8) and “slow gain group” (n = 7), KOOS showed two classes: “gain group” (n = 86) and “moderate gain group” (n = 132), and VAS-pain three classes: “no/very little pain” (n = 151), “normal decrease of pain” (n = 48) and “sustained pain” (n = 19). The” low gain group” scored 3.31 [95% CI 1.52, 5.09] seconds less on the TUG than the “moderate gain group” and the KOOS “gain group” scored 11.97 [95% CI 8.62, 15.33] points better than the “moderate gain group” after one year.Patients who had an early trajectory of “sustained pain” had less chance to become free of pain at one year than those who reported “no or little pain” (odds ratio 0.11 [95% CI 0.03,0.42].ConclusionThe findings of this study indicate that different recovery trajectories can be detected. These recovery trajectories can distinguish outcome after one year.

The Effect Of Aerobic Training In Rheumatoid Arthritis Patients: A Literature Study

To evaluate the effectiveness of aerobic training on pain in Rheumatoid arthritis. Methods Asystematic literature search was carried out using the Pubmed, Embase, and Cochrane databases untilNovember 2016 and abstractly presented at a scientific meeting of rheumatology for 3 years. Randomizedcontrolled trials (RCTs) comparing resistance exercise-based therapy with interventions withoutresistance exercise for RA patients' treatment were included. Six literature studies, including 547 patients,met the study inclusion criteria. Patient characteristics and exercise did not affect the outcome. Subgroupanalysis revealed a trend toward higher effectiveness associated with high-intensity programs. There isevidence with a low risk of bias that an aerobic exercise program effectively reduces fatigue amongpatients with RA, especially in the short term. An RCT should be performed in patients with RA who areselected for fatigue to strengthen the evidence.

Comparison of two different models of rehabilitation programs following total knee replacement operations

BackgroundTotal knee replacement operation (TKR) is the treatment of choice in severe knee osteoarthritis (OA). Rehabilitation post-TKR is still not well studied. The aim of this study was to compare between the high-intensity (HI) rehabilitation program and the low-intensity (LI) rehabilitation program following TKR.ResultsAt 1 month following the TKR operations, significant improvements were found in the first group compared to the second group in all the measured parameters except for the knee range of motion (ROM). At 3 and 12 months follow-up periods, there were statistically significant differences between both groups in all the evaluated parameters except for the numeric pain rating scale and the knee ROM.ConclusionsBoth high-intensity and low-intensity rehabilitation programs are effective; however, HI program had superior functional gain and patient-reported outcomes compared to the LI program. Moreover, HI group has a long-term functional gain.

Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

PurposeFew evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity.MethodsA single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation and exploratory measures of program adoption and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interviews. We evaluated elements of the RE-AIM model (reach, adoption) to assess staff barriers to success for future scalability.FindingsThere were 27 patients and 8 staff completing measures. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation.ConclusionsThe need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity.Trial registrationClinicaltrials.gov NCT03309787. Registered on 16 October 2017.

Weight Loss in Underserved Patients — A Cluster-Randomized Trial

BackgroundEvidence of the effectiveness of treatment for obesity delivered in primary care settings in underserved populations is lacking.MethodsWe conducted a cluster-randomized trial to test the effectiveness of a high-intensity, lifestyle-based program for obesity treatment delivered in primary care clinics in which a high percentage of the patients were from low-income populations. We randomly assigned 18 clinics to provide patients with either an intensive lifestyle intervention, which focused on reduced caloric intake and increased physical activity, or usual care. Patients in the intensive-lifestyle group participated in a high-intensity program delivered by health coaches embedded in the clinics. The program consisted of weekly sessions for the first 6 months, followed by monthly sessions for the remaining 18 months. Patients in the usual-care group received standard care from their primary care team. The primary outcome was the percent change from baseline in body weight at 24 months.ResultsAll 18 clinics (9 assigned to the intensive program and 9 assigned to usual care) completed 24 months of participation; a median of 40.5 patients were enrolled at each clinic. A total of 803 adults with obesity were enrolled: 452 were assigned to the intensive-lifestyle group, and 351 were assigned to the usual-care group; 67.2% of the patients were Black, and 65.5% had an annual household income of less than $40,000. Of the enrolled patients, 83.4% completed the 24-month trial. The percent weight loss at 24 months was significantly greater in the intensive-lifestyle group (change in body weight, −4.99%; 95% confidence interval [CI], −6.02 to −3.96) than in the usual-care group (−0.48%; 95% CI, −1.57 to 0.61), with a mean between-group difference of −4.51 percentage points (95% CI, −5.93 to −3.10) (P<0.001). There were no significant between-group differences in serious adverse events.ConclusionsA high-intensity, lifestyle-based treatment program for obesity delivered in an underserved primary care population resulted in clinically significant weight loss at 24 months. (Funded by the Patient-Centered Outcomes Research Institute and others; PROPEL ClinicalTrials.gov number, NCT02561221.)

Two-year weight, risk and health factor outcomes of a weight-reduction intervention programme: Primary prevention for overweight in a multicentre primary healthcare setting

Objective: To study the long-term effects of weight reduction, quality of life and sense of coherence in a primary health care (PHC)-based programme with two different intensities.Design: Prospective two-armed randomised intervention.Setting: Three PHC centres in south west of Sweden.Subjects: In total, 289 women and men aged 40-65 years with a BMI of 28-35 were recruited for a two-year weight-reduction programme. Participants were randomized to high-intensity or low-intensity groups. Blood samples, physical measurements and questionnaires were analysed. Participants received cookbooks and dietary lectures. The high-intensity group also received Motivational interviewing (MI), dietary advice on prescription (DAP- advice), a grocery store lecture, a website and weekly e-mails.Main outcome measures: Weight, quality of life, risks and health factors.Results: In total, 182 (64%) participants completed the 2-year follow-up. The total sample reduced their weight by 1 kg (p = 0.006). No significant differences regarding weight were found between the groups. Anxiety/depression decreased in EQ5-D (p = 0.021), EQ5-D VAS (p = 0.002) and SOC (p = 0.042). Between the groups, there were significant differences in EQ5-D usual activities (p = 0.004), anxiety/depression (p = 0.013), pain/discomfort (p = 0.041), fruit and vegetables (p = 0.005), HLV anxiety (p = 0.005), and visits to nurses (p = 0.012).Conclusion: The total population lost weight, and the high-intensity and low-intensity programmes did not result in significant differences in terms of weight. The high-intensity programme reported health benefits linked to lower levels of anxiety and depression, increased activity and intake of greens and reduced visits to physicians and nurses.Key pointsBoth groups had a consisting weight- reduction after two years.High intensity did not lead to a significant difference in weight reduction between the groups.The high-intensity group reported more health effects, such as better quality of life, reduced anxiety, and increased greenery intake. It is unknown how much support patients in a weight- reduction programme in PHC require to succeed with weight loss and a healthy lifestyle

Lifestyle modification approaches for the treatment of obesity in adults.

The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight and Obesity in Adults (hereafter, Obesity Guidelines) as a framework, this article reviews the principal components of comprehensive lifestyle modification, which include diet, physical activity, and behavior therapy. To lose weight, the Obesity Guidelines recommend participation for 6 months in high-intensity programs that provide 14 or more counseling sessions with a trained interventionist. When provided face-to-face individual or group treatment, participants lose up to 8 kg (8% of weight) in 6 months and experience improvements in cardiovascular disease risk factors and quality of life. To prevent weight regain, the Obesity Guidelines recommend participation for 1 year in weight-loss-maintenance programs that provide at least monthly counseling. High levels of physical activity, frequent monitoring of body weight, and consumption of a reduced-calorie diet are associated with long-term weight loss. Investigators currently are seeking to increase the availability of lifestyle modification by delivering it in community-based programs, as well as on digital platforms (e.g., Internet and Smartphone). Digitally delivered programs lower costs and expand treatment reach; their efficacy is likely to improve further with the addition of new technologies for monitoring food intake, activity, and weight. Ultimately, to improve long-term weight management, individual lifestyle counseling must be joined with collective and institutional efforts to improve the nation's eating and activity environments. (PsycINFO Database Record (c) 2020 APA, all rights reserved).