Home-based Lifestyle Intervention Research Articles

Exploring the Feasibility of Digital Voice Assistants for Delivery of a Home-Based Exercise Intervention in Older Adults With Obesity and Type 2 Diabetes Mellitus: Randomized Controlled Trial.

Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent-treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software ("Buddy Link"; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference -67, SD 23; 95% CI -113 to -21 min/d), which was represented by a medium to large effect size (d=-0.6). A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true.

A home-based lifestyle intervention program reduces the tumorigenic potential of triple-negative breast cancer cells

Translational research for the evaluation of physical activity habits and lifestyle modifications based on nutrition and exercise has recently gained attention. In this study, we evaluated the effects of serum samples obtained before and after a 12-week home-based lifestyle intervention based on nutrition and exercise in breast cancer survivors in terms of modulation of the tumorigenic potential of breast cancer cells. The home-based lifestyle intervention proposed in this work consisted of educational counselling on exercise and nutritional behaviors and in 12 weeks of structured home-based exercise. Triple-negative breast cancer cell line MDA-MB-231 was cultured in semi-solid medium (3D culture) with sera collected before (PRE) and after (POST) the lifestyle intervention program. Spheroid formation was evaluated by counting cell colonies after 3 weeks of incubation. Results show a slight but significant reduction of spheroid formation induced by serum collected POST in comparison to those obtained PRE. Moreover, statistical analyses aimed to find physiologic and metabolic parameters associated with 3D cell proliferation revealed the proliferative inducer IGF-1 as the only predictor of cell tumorigenic potential. These results highlight the importance of lifestyle changes for cancer progression control in a tertiary prevention context. Translational research could offer a useful tool to identify metabolic and physiological changes induced by exercise and nutritional behaviors associated with cancer progression and recurrence risk.

Home-based lifestyle intervention for breast cancer survivors: A surprising improvement in the quality of life during the first year of COVID-19 pandemic.

The COVID-19 pandemic induced an extraordinary impact on public mental health to a degree not completely understood, especially in vulnerable populations such as breast cancer (BC) survivors. In this study, we described the short- (after 3-month) and long- (after 12-month) term effects of a multidisciplinary home-based lifestyle intervention in Italian women BC survivors during the first year of COVID-19 pandemic. In total, 30 Italian BC survivors with risk factors for recurrence took part in the ongoing MoviS trial (protocol: NCT04818359). Between January 2020 and January 2021, a 3-month lifestyle intervention based on psychological counseling, nutrition, and exercise was carried out. Participants were asked to fill out psychological questionnaires for the assessment of quality of life (QoL) indicators (European Organization for Research and Treatment of Cancer QoL, EORTC-QLQ-C30) and psychological health measures such as fatigue (Brief Fatigue Inventory, BFI), distress (Distress Thermometer, DT and Psychological Distress Inventory, PDI), cancer-related fatigue (Verbal Rating Scale, VRS), and mood states (Profile of Mood States Questionnaire, POMS). IBM SPSS Statistical Software version 27.0 and R Project for Statistical Computing version 4.2.1 were used to process data. All participants were assessed at four time points: T0 (baseline), T1 (3-month), and follow-up at T2 and T3 (6- and 12-month, respectively) to measure primary (quality of life indicators) and secondary (psychological health) outcomes. Friedman non parametric test and Wilcoxon signed rank test (with Bonferroni correction) were conducted to investigate the statistically significant differences in psychometric scores and between assessment times. Compared to baseline (T0), at T1 most of the QoL indicators (i.e., symptoms of fatigue and general health) were improved (p < 0.017) with the exception of a worsening in participants' social functioning ability. Also, perception of severity of fatigue, distress, cancer-related fatigue, depression, and anger enhanced. Compared to baseline (T0), at T3 we mainly observed a stable condition with T0-T1 pairwise comparison, however other secondary outcomes (i.e., fatigue mood state, confusion, and anxiety) significantly improved. Our preliminary findings support the proposal of this lifestyle intervention for BC survivors. Despite the home-confinement due to the COVID-19 pandemic, the intervention surprisingly improved QoL indicators and psychological health of the participants.

Changes in gut microbiota composition after 12 weeks of a home-based lifestyle intervention in breast cancer survivors during the COVID-19 lockdown.

Breast cancer (BC) is the second-leading cause of cancer-related death worldwide. This study aimed to investigate the effects of a 12-week home-based lifestyle intervention (based on nutrition and exercise) on gut microbial composition in twenty BC survivors of the MoviS clinical trial (protocol: NCT04818359). Gut microbiota analysis through 16S rRNA gene sequencing, anthropometrics, Mediterranean Diet (MD) adherence, and cardiometabolic parameters were evaluated before (Pre) and after (Post) the lifestyle intervention (LI). Beneficial effects of the LI were observed on MD adherence, and cardiometabolic parameters (pre vs post). A robust reduction of Proteobacteria was observed after LI, which is able to reshape the gut microbiota by modulating microorganisms capable of decreasing inflammation and others involved in improving the lipid and glycemic assets of the host. A significant negative correlation between fasting glucose and Clostridia_vadinBB60 (r = -0.62), insulin and homeostatic model assessment (HOMA) index and Butyricicoccus genera (r = -0.72 and -0.66, respectively), and HDL cholesterol and Escherichia/Shigella (r = -0.59) have been reported. Moreover, positive correlations were found between MD adherence and Lachnospiraceae_ND3007 (r = 0.50), Faecalibacterium (r = 0.38) and Butyricimonas (r = 0.39). These data suggest that adopting a healthy lifestyle, may contribute to ameliorate several biological parameters that could be involved in the prevention of cancer relapses through the modulation of gut microbiota.

Associations between exercise training characteristics and change in peak oxygen consumption in patients with chronic ischaemic heart disease and type 2 diabetes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovationsfonds des Gemeinsamen Bundesausschusses. Introduction Exercise interventions are well established in the treatment of chronic ischaemic heart disease (CIHD) and type 2 diabetes mellitus (T2DM). Yet, there remains a significant research gap when it comes to patients which suffer from both diseases. Purpose The aim of this study was to investigate the associations of training characteristics (average minutes of endurance training per week, average endurance training sessions per week and mean intensity) and change in peak V̇O2 following 6 months of a telemedicine supported exercise intervention in patients with CIHD and T2DM. Methods Among 251 intervention group patients of a randomised controlled trial that evaluated the effects of an individual home-based lifestyle intervention compared to usual care (N=502 patients), those who completed the 6-month follow-up (N=201) were included in this analysis. All patients received an individual exercise training plan via a smartphone application, which recorded training duration and heart rates (HR, utilizing a connected heart rate sensor, Polar H7, Polar, Finland). Patients also had the possibility to perform additional sessions without prescribed intensity zones. All recorded sessions were evaluated with a customized software and manually checked for plausibility. Intensities were calculated as the average % heart rate reserve (HRR) of all endurance exercise sessions. If HR measurements were classified as invalid/unreliable (e.g. very strong fluctuations), these sessions were excluded from the average HRR calculation but still included in the average minutes and sessions of endurance training per week. Associations between training characteristics and change in peak V̇O2 were evaluated via univariate regression analysis. Results Of the 201 patients (16% female, 68±8 years), 81 (40%) were classified as adherent to the exercise intervention (defined as having performed the prescribed training duration in ≥ 50% of the weeks and ≥ 66.7% of the recommended duration). On average, patients performed 78±94 minutes of endurance training per week across 3.26±3.13 sessions at an average of 51.6±18.2% HRR. Peak V̇O2 improved by a mean (SD) of 0.94±2.74 ml/kg/min. Change in peak V̇O2 was significantly associated with the average duration and number of sessions per week (p &amp;lt; 0.01), but not with mean intensity (p = 0.10) (Fig. 1). Conclusions Mean changes in peak V̇O2 were low, likely due to low overall adherence. Accordingly, we found a significant positive association between the average minutes as well as the average sessions of endurance training per week and change in peak V̇O2, whereas change in peak V̇O2 was not significantly associated with mean exercise training intensity. Therefore, future telemedical exercise interventions need to find ways to improve adherence of patients towards the provided exercise recommendations.

1075-P: Racial/Ethnic Differences in the Association between Frailty and Depression among Adults with Diabetes

Individuals with diabetes are at increased risk of developing depression. The prevalence of depression in non-Hispanic Blacks (NHB) with diabetes is about 25%, higher than the prevalence among non-Hispanic Whites (NHWs) . Frailty, a measure of biological age and one’s increased susceptibility to negative health outcomes and has been found to be associated with disability and dependency. The aim of this study was to examine the association between depression and frailty and to understand whether this association differs by race/ethnicity among adults with diabetes. Data on 3792 adults with diabetes from NHANES (2003-2005) were analyzed. Depression was assessed using scores from the 9-item Patient Health Questionnaire (PHQ-9) . Frailty index composed of 46 variables (comorbidities, disability, symptoms, labs, general health) was created ranging from 0 - 1 (frail&amp;gt;=0.21; not frail&amp;lt;0.21) . Unadjusted and adjusted linear regression models were used to assess the association between depression and frailty. Covariates included age, sex, education, income-to-poverty ratio, marry, insurance, employment, smoke, physical activity, and body mass index. All models were stratified by race/ethnicity. Unadjusted models showed an association depression and frailty across all racial/ethnic groups with those who were frail having significantly higher PHQ9 scores (NHW: b 2.63; 95%CI:1.36, 3.89; NHB: b 3.26; 95%CI:2.23, 4.23; Hispanic/Other (H/O) : b 1.33; 95%CI:0.52, 2.14) . The association remained significant across all groups in adjusted models (NHW: b 4.5; 95%CI:1.9, 7.1; NHB: b 6.3; 95%CI:4.2, 8.4; H/O: b 2.1; 95%CI:0.5, 3.7) .While depression was associated with frailty across all racial/ethnic groups, NHBs who were frail had the highest mean PHQ9 score. Additional research is needed to identify the key drivers of this relationship and potential targets for home-based lifestyle intervention to improve care provided to and outcomes for frail patients with diabetes. Disclosure L.E.Egede: None. A.Z.Dawson: None. J.A.Campbell: None. R.J.Walker: None. Funding American Diabetes Association (1-19-JDF-075) ; National Institute of Diabetes and Digestive and Kidney Diseases (grant K24DK093699, R01DK118038, R01DK120861, Principal Investigator (PI) : Leonard Egede, MD) National Institute on Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker)

Effects of a telemedically supported home-based lifestyle intervention in patients with chronic ischaemic heart disease and type 2 diabetes mellitus

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Federal Joint Committee Germany Background Ischaemic heart disease is the leading cause of global mortality and when accompanied by type 2 diabetes mellitus (T2DM), prognosis is even worse. Lifestyle (LS) interventions are recommended, however, evidence in patients with both chronic ischaemic heart disease (CIHD) and T2DM is scarce. Furthermore, LS interventions were generally performed in a resource intensive supervised setting. Therefore, this study examined whether an individualised telemedically supported home-based LS intervention has a different effect on changes in glycosylated haemoglobin (HbA1c) compared to usual care (UC) in patients with CIHD and T2DM. Methods Eligible patients (ICD-10: I20-25; HbA1c≥6.5% or anti-diabetic drugs) were randomly assigned (1:1) to LS or UC at 11 sites. LS intervention consisted of home-based exercise training (ET) and nutritional recommendations following 7-day nutrition diaries. ET was based on the results of a cardiopulmonary exercise test (CPET), i.e. ventilatory thresholds and peak oxygen consumption, and was provided and recorded by a smartphone application. Intensities varied and volume was gradually increased to reach at least 150 min/week. Every 2-4 weeks, patients were contacted by telephone to receive feedback and adjust the training (if necessary). CPETs and nutrition diaries were analysed by a core laboratory, which also provided the feedback to the patients. Primary endpoint was the change in HbA1c after 6 months. Secondary endpoints included change in weight, waist circumference, HDL, LDL, triglycerides and quality of life (QoL). The main analysis included all patients with baseline and follow-up (FU) measures (full analysis). In a per-protocol analysis (PPA), patients randomised to LS who performed less than 2/3 of the scheduled exercise time or filled less than 2 out of 3 nutrition diaries were excluded. Results Among 499 enrolled patients (mean age, 68 years; 16% female; mean HbA1c, 6.9%), 402 (81%) completed the 6-month FU. From 201 patients who completed FU in the LS group, 76 (38%) were included in the PPA [81 (40%) adhered to ET, 144 (72%) filled at least 2 nutrition diaries]. In the full analysis, mean change in HbA1c was significantly different between LS and UC (-0.1% [95% CI, -0.2 to 0.0], p=0.04). Furthermore, significant differences were found for changes in weight (p&amp;lt;0.001) and the QoL mental component score (MCS) of the Short-Form-36 questionnaire (p=0.006, Table 1). In the PPA, mean changes in HbA1c (p=0.002), weight (p&amp;lt;0.001), waist circumference (p&amp;lt;0.001), triglycerides (p=0.03) and the QoL MCS (p=0.004) were significantly different between groups (Table 1). Conclusion In patients with CIHD and T2DM, a telemedically supported home-based LS intervention significantly reduced HbA1c as compared to UC. However, only in the per-protocol analysis, change in HbA1c met a clinically meaningful difference of 0.3% between groups. Therefore, future studies should aim at increasing adherence to such interventions.

The Evaluation of Smart Speaker Skills for Chronic Disease Management of Older Adults

A voice-activated smart speaker is an emerging technology that presents unique opportunities to support the chronic disease management of older adults. We identified the available health-related smart speaker skills in Amazon Alexa platform that support chronic disease management and assessed their functionalities to inform the development of a home-based lifestyle intervention program for older adults with cardiovascular disease and type 2 diabetes. From January to March 2021, we searched Alexa Skills using keywords related to diabetes, medication, blood pressure and nutrition management. Our search produced total 156 potentially relevant skills (63 diabetes, 57 medication, 11 blood pressure and 25 nutrition related), of which 22 skills met inclusion criteria. Apps were excluded if it was only informational, not relevant to the topic, had zero user rating, available in language other than English, and required an external device or a subscription to a specific health plan or service. 22 skills (4 diabetes, 8 medication, 3 blood pressure and 7 nutrition) were evaluated with Echo Show 8 device. The skills were evaluated using the modified version of IMS Institute for Healthcare Informatics app functionality scores and the score (0 to 11) was calculated accordingly. The median number of functionalities was 3.5 and 68% of skills (15/22) had 4 or fewer functions. The highest rated skill was a medication management app named myNurseBot having 6 out of 11 functionalities. The poor functionality score highlights a need for a more robust and comprehensive smart speaker skill to support the health management of older adults.

Effects of a Home-Based Lifestyle Intervention Program on Cardiometabolic Health in Breast Cancer Survivors during the COVID-19 Lockdown.

This study aimed to evaluate the cardiometabolic effects of a home-based lifestyle intervention (LI) in breast cancer survivors (BCSs) during the COVID-19 lockdown. In total, 30 BCSs (women; stages 0–II; non-metastatic; aged 53.5 ± 7.6 years; non-physically active; normal left ventricular systolic function) with a risk factor for recurrence underwent a 3-month LI based on nutrition and exercise. Anthropometrics, Mediterranean diet adherence, physical activity level (PAL), cardiorespiratory fitness (VO2max), echocardiographic parameters, heart rate variability (average standard deviation of NN intervals (ASDNN/5 min) and 24 h very- (24 hVLF) and low-frequency (24 hLF)), and metabolic, endocrine, and inflammatory serum biomarkers (glycemia, insulin resistance, progesterone, testosterone, and high-sensitivity C-reactive protein (hs-CRP)) were evaluated before (T0) and after (T1) the LI. After the LI, there were improvements in: body mass index (kg/m2: T0 = 26.0 ± 5.0, T1 = 25.5 ± 4.7; p = 0.035); diet (Mediet score: T0 = 6.9 ± 2.3, T1 = 8.8 ± 2.2; p < 0.001); PAL (MET-min/week: T0 = 647 ± 547, T1 = 1043 ± 564; p < 0.001); VO2max (mL·min−1·kg−1: T0 = 30.5 ± 5.8, T1 = 33.4 ± 6.8; p < 0.001); signs of diastolic dysfunction (participants: T0 = 15, T1 = 10; p = 0.007); AS-DNN/5 min (ms: T0 = 50.6 ± 14.4, T1 = 55.3 ± 16.7; p = 0.032); 24 hLF (ms2: T0 = 589 ± 391, T1 = 732 ± 542; p = 0.014); glycemia (mg/dL: T0 = 100.8 ± 11.4, T1 = 91.7 ± 11.0; p < 0.001); insulin resistance (HOMA-IR score: T0 = 2.07 ± 1.54, T1 = 1.53 ± 1.11; p = 0.005); testosterone (ng/mL: T0 = 0.34 ± 0.27, T1 = 0.24 ± 0.20; p = 0.003); hs-CRP (mg/L: T0 = 2.18 ± 2.14, T1 = 1.75 ± 1.74; p = 0.027). The other parameters did not change. Despite the home-confinement, LI based on exercise and nutrition improved cardiometabolic health in BCSs.

A Simple Home-Based Lifestyle Intervention Program to Improve Cardiac Autonomic Regulation in Patients with Increased Cardiometabolic Risk

Lifestyle modification programs (LMP) represent a new approach to cardiometabolic/oncologic risk reduction. Successful LMP in clinical practice must be feasible, cost effective, efficacious and consider home-based exercise. Likewise, multiple mechanisms implied in cardiometabolic risk reduction such as cardiac autonomic regulation (CAR) should be easily evidenced, in spite of the computational complexity involved. This goal could be facilitated by employing novel, friendlier, simpler techniques, such as the Autonomic Nervous System Index (ANSI), which can be treated as a proxy of CAR. In this observational study, we introduce a simple LMP (based on cognitive behavioral strategies and patient-tailored prescription of nutrition and home-based exercise, managed by a single physician) into the currently existing clinical practice of secondary cardiometabolic prevention. In 26 subjects, we assessed CAR (autoregressive spectral analysis of cardiovascular variabilities), body mass composition (bioelectrical impedance analysis) and stress perception (questionnaires). After LMP, ANSI and lipid profile were improved; % of fat mass, waist circumference and stress perception were reduced. We conclude that this preliminary, proof of concept study provides significant evidence in favor of the hypothesis that it is possible to introduce a convenient, cost effective LMP into the currently existing clinical practice of secondary cardiometabolic prevention. Findings suggest a successful comprehensive behavioral change, possibly facilitated by the simplified approach employed in this study, capable of improving cardiac autonomic regulation in addition to body mass composition and stress perception.

Randomized Controlled Trial of Home-Based Lifestyle Therapy on Postpartum Weight in Underserved Women with Overweight or Obesity.

This study aimed to assess the efficacy of a home-based lifestyle intervention delivered through Parents as Teachers (PAT), a national home-visiting organization, designed to minimize excessive weight gain through 12 months post partum in socioeconomically disadvantaged (SED) African American women with overweight or obesity. This randomized controlled trial was conducted at a single center as part of the Lifestyle Interventions for Expectant Moms (LIFE-Moms) consortium. Analysis was conducted with 185 SED African American women (BMI 25.0-45.0 kg/m2 at pregnancy onset) retained from an original sample of 267 randomized to standard PAT or PAT+Lifestyle, which embedded lifestyle therapy within standard PAT delivered prenatally and for 12 months post partum. Compared with standard PAT, the PAT+Lifestyle group gained less weight (2.5 kg vs. 5.7 kg; P=0.01) and were more likely to return to their baseline weight (38.0% vs. 21.5%; P=0.01) from baseline to 12 months post partum. There were no differences between groups in cardiometabolic outcomes, indices of glycemic control and insulin sensitivity, and plasma lipid profile. The estimated cost of PAT+Lifestyle was $81 more to deliver per family than standard PAT. PAT+Lifestyle decreases weight gain during pregnancy through 12 months post partum in SED African American women with overweight or obesity at the start of pregnancy with minimal additional cost.

Effect of a Home-Based Lifestyle Intervention on Breastfeeding Initiation Among Socioeconomically Disadvantaged African American Women with Overweight or Obesity.

Socioeconomically disadvantaged (SED) African American women with overweight or obesity are less likely to breastfeed. To test whether a home-based lifestyle intervention impacts breastfeeding initiation rates in SED African American women with overweight or obesity. This was a secondary analysis of a randomized controlled trial from October 2012 to March 2016 at a university-based hospital within the LIFE-Moms consortium. SED African American women with overweight or obesity and singleton gestations were randomized by 16 weeks to Parents as Teachers (PAT)-a home-based parenting support and child development educational intervention-or PAT+, PAT with additional content on breastfeeding. Participants completed a breastfeeding survey. Outcomes included breastfeeding initiation and reasons for not initiating or not continuing breastfeeding. One hundred eighteen women were included: 59 in PAT+; 59 in PAT. Breastfeeding initiation rates were similar in each group (78.00% in PAT+; 74.58% in PAT). On a one to four scale, with four denoting "very important," women in PAT+ and PAT were equally likely to rate their beliefs that formula was better than breast milk or breastfeeding would be too inconvenient as the most important reasons to not initiate breastfeeding. On the same scale, women similarly rated their difficulty latching or concern for low milk supply as the most important reasons for breastfeeding cessation. SED African American women with overweight or obesity who received a home-based educational intervention had higher breastfeeding rates than is reported nationally for black women (59%). However, the intervention with more breastfeeding content did not further increase breastfeeding rates or impact reasons for breastfeeding cessation. ClinicalTrials.gov : NCT01768793.

Weight Control Program and Gestational Weight Gain in Disadvantaged Women with Overweight or Obesity: A Randomized Clinical Trial.

ObjectiveTo evaluate the efficacy of a home-based lifestyle intervention delivered through Parents as Teachers (PAT) to reduce excessive GWG.MethodsThis was a single-blinded, randomized controlled trial conducted as part of the LIFE-Moms consortium at a single university-based tertiary care institution, from October 2012 to March 2016. There were 267 SED African-American women with overweight or obesity (BMI 25.0–45.0 kg/m2) before pregnancy. Participants were randomized to therapy with standard PAT alone (n=134) or PAT+ a lifestyle intervention program embedded within the standard PAT program (PAT+, n=133). Both interventions were delivered in 10-biweekly home visits during pregnancy. The primary outcome was percentage of women whose GWG exceeded IOM guidelines, and secondary outcomes included both weekly and total GWG.ResultsCompared with the standard PAT group in the intent-to-treat analysis, the PAT+ group gained less weekly (0.4 kg v. 0.5 kg per week, P=0.04) and total (8.0 kg v. 9.6 kg, P=0.02) weight during gestation. Fewer participants in the PAT+ group had excessive total GWG (36.1% vs 45.9%), but the difference between groups was not statistically significant (P=0.11).ConclusionsPAT+ reduced weekly and total GWG in SED African-American women with overweight or obesity at the start of pregnancy.

891: Does a home-based lifestyle intervention improve breastfeeding rates in socioeconomically disadvantaged (SED) obese women?

SED, obese women are comparatively less likely to breastfeed. Prior studies suggest the highest increases in breastfeeding (BF) occur from individual-level BF education and support interventions available during pregnancy and after delivery. However, data remain limited on the effectiveness on these interventions among SED women. We aimed to test the efficacy of an antepartum and postpartum home-based lifestyle intervention on BF rates in this population. This prospective study was nested within a randomized control trial occurring at a single university-based tertiary care center from 2013-2016 as part of the LIFE-Moms consortium (NCT01768793). SED, obese women with singleton gestations were randomized by 15 weeks to Parents as Teachers (PAT)—a parenting support and child development intervention—or PAT+, PAT with behavior interventions to decrease excessive weight gain and increase BF rates. Consenting women completed a well-validated BF survey at 6-12 months postpartum. The primary outcome was BF initiation. Secondary outcomes were reasons for not initiating or stopping BF. 118 women completed the survey: 59 in PAT+ and 59 in PAT. BF initiation rates were similar in each group. On a 1-4 scale with higher scores denoting more importance, there were no statistically significant differences among reasons for not initiating BF. On the same scale, women in PAT+ and PAT similarly rated their difficulty latching, concern for low milk supply, or pain during BF as the most important reasons for BF cessation. Comparatively, those in PAT+ were less likely to rate their desire to leave their baby for several hours, their medication use, or their desire to return to prior diet as important reasons for BF cessation (1.49 vs 1.98, aOR 0.39 (95% CI 0.16-0.98); 1.40 vs 1.86; aOR 0.33 (95% CI 0.12-0.93); 1.29 vs 1.72, aOR 0.32 (95% CI 0.11-0.95), respectively). Among SED, obese women, a home-based lifestyle intervention did not improve BF initiation rates or impact views on BF initiation or common reasons for BF cessation. Other educational interventions are needed to improve BF rates in this at-risk population.

Home-based lifestyle intervention for rural adults improves metabolic syndrome parameters and cardiovascular risk factors: A randomised controlled trial

The presence of metabolic syndrome (MetS) increases the risk of developing type 2 diabetes and cardiovascular disease. Targeted interventions to reduce MetS for high risk populations are crucial for the prevention of these chronic diseases. This study evaluated the effectiveness of a 6-month home-based physical activity and diet intervention for rural adults with, or at risk of MetS. The randomised controlled trial was conducted in Albany and surrounding towns, Western Australia, 2014–2015. Participants were screened for MetS using the International Diabetes Federation criteria, and eligible participants were randomly assigned to the intervention (n=201) or control (n=200) group. The intervention group received printed and online programme materials and motivational support, and the control group was waitlisted to receive the programme after post-test data collection. Anthropometry, lipid profiles, glycaemic status, and blood pressure were measured at baseline and 6-months post-test. In total, 312 (77.8%) participants completed post-test data collection and were included in the anthropometric analysis, and 274 (68.3%) participants were included in the blood sample analysis. After controlling for confounders, the intervention group significantly improved their triglyceride (−0.10mM, p=0.002), total cholesterol (−0.09mM, p=0.02), and non-HDL cholesterol (−0.08mM, p=0.02) concentrations compared to the control group. Waist circumference (−2.11cm, p=0.03), waist-to-hip ratio (−0.01, p=0.04), weight (−0.70kg, p=0.01), and body mass index (−0.20kg/m2, p<0.001) were also improved. These findings suggest that comprehensive home-based prevention programmes that include a combination of dietary and physical activity interventions are a promising means to prevent the onset of chronic disease in rural adults.Trial registration:anzctr.org.au Identifier: ACTRN12614000512628

Adapted physical activity and diet (APAD) during adjuvant breast cancer therapy: Design and implementation of a prospective randomized controlled trial

Exercise practice and appropriate nutrition have been advanced as non pharmacological supportive care to reduce side effects related to cancer and its treatment, but large sample-sized randomized controlled trials are needed to confirm such results. The Adapted Physical Activity and Diet counseling (APAD) study is a prospective randomized controlled trial designed to evaluate the effectiveness of a 26-week hospital- and home-based lifestyle intervention on cancer-related fatigue in women receiving breast cancer adjuvant treatment (chemotherapy and radiotherapy). The aim of this paper is to describe the APAD study protocol. Study recruitment goal is 264 adult breast cancer women with newly, histologically proven, incident and non metastatic breast cancer scheduled for 6cycles of adjuvant chemotherapy followed by radiotherapy. Patients are randomized either in the experimental arm with tailored exercise training and diet counseling program or in the control arm without any lifestyle intervention (usual care). Outcome measures are collected at baseline, and at 15weeks (i.e., mid-intervention), 26weeks (i.e., immediately post-intervention), and at 12-month and 18-month of follow-up. Intervention effect is assessed on fatigue (emotional, cognitive, physical), quality-of-life, anxiety, depression, body weight and composition. In addition, levels of physical activity, dietary intakes and adjuvant therapy observance are measured and a cost–utility analysis will be performed. If improvements in fatigue, quality-of-life and a better weight control are observed, the APAD study could demonstrate the feasibility and the effectiveness of such exercise and nutrition supportive care with limited additional cost in patients receiving adjuvant breast cancer therapy.

A 2‐Year Follow‐Up of a Lifestyle Physical Activity Versus a Structured Exercise Intervention in Older Adults

To evaluate the long-term effects of a lifestyle intervention and a structured exercise intervention on physical fitness and cardiovascular risk factors in older adults. Controlled trial with randomization between the intervention groups. Belgium, Vlaams-Brabant. One hundred eighty-six sedentary but healthy men and women aged 60 to 83. Participants in the lifestyle intervention were stimulated to integrate physical activity into their daily routines and received an individualized home-based program supported by telephone calls. The structured intervention consisted of three weekly supervised sessions in a fitness center. Both interventions lasted 11 months and focused on endurance, strength, flexibility, and postural and balance exercises. Cardiorespiratory fitness, muscular strength, functional performance, blood pressure, and body composition were measured before (pretest), at the end (11 months, posttest), and 1 year after the end (23 months, follow-up) of the interventions. The results from pretest to posttest have already been published. The current study analyzed the results from posttest to follow-up. There was a decrease in cardiorespiratory fitness, muscular fitness, and functional performance from posttest to follow-up in the structured intervention group but not in the control group or the lifestyle intervention group. At 23 months, participants in both groups still showed improvements in cardiorespiratory fitness. In addition, the structured group showed long-term improvements in muscular fitness, whereas the lifestyle group showed long-term improvements in functional performance. No long-term effects were found for blood pressure or body composition. These results highlight the potential of a structured fitness center-based intervention and a home-based lifestyle intervention in the battle against inactivity in older adults. Lifestyle programs are especially valuable because they require fewer resources and less time from health institutions and health practitioners.

The Effect Of A Two Year Lifestyle Intervention On Glycemic Control In Patients With Type 2 Diabetes

PURPOSE: Available resources currently limit the widespread application of supervised lifestyle interventions for patients with type 2 diabetes (T2DM). The aims of this study were to determine the effects of a two-year predominantly home-based lifestyle intervention on glycemic control in patients with T2DM and investigate the characteristics of patients who respond the best. METHODS: Patients were randomised into usual care (n=112) or lifestyle intervention (n=111) for 2 years. The lifestyle intervention was delivered in two stages; a one month of gym-based training (stage 1) followed by 23 months of home-based training with dietary advice (stage 2). Glycemic control (HbA1c), blood lipid profile, VO2max and body mass index (BMI) were assessed at baseline, one and two years. All data were analyzed as intention to treat. RESULTS: Compared to controls, the intervention group significantly (p<0.05) prevented deterioration in HbA1c over two years, maintained the first year decrease in blood glucose, continued to increase VO2max, but failed to maintain reductions in BMI and waist circumference (Table). The improvement in HbA1c was significantly (p<0.05) correlated to (r=-0.42) and independently associated with (beta=-0.39) baseline HbA1c, as well as VO2max (r=0.24, beta=0.17 respectively). ROC analysis revealed that patients with a baseline HbA1c greater than 7.7% (AUC=0.73, p<0.01) would have a greater improvement in glycemic control from the intervention. CONCLUSION: The second year of home-based intervention maintained first year improvements in glycemic control and further increased cardiorespiratory fitness, despite failing to maintain BMI and waist circumference in patients with type 2 diabetes compared to usual care.Table

A One-Year Home-Based Lifestyle Intervention is Effective in Improving Glycemic Control in Patients with Type 2 Diabetes

PURPOSE: Supervised exercise training improves glycemic control in patients with type 2 diabetes. Available resources currently limit the widespread application of supervised exercise training for patients with type 2 diabetes meaning that more practical and economical solutions need to be developed. The aims of this study were to determine the effects of a one-year predominantly home-based lifestyle intervention on glycemic control in patients with type 2 diabetes and investigate the characteristics of patients who respond better to the training. METHODS: A randomized controlled trial was conducted in 176 patients with type 2 diabetes. The lifestyle intervention (n=88) comprised individualized and gym-based exercise training for one month followed by dietary advice and home-based training monitored by telephone exercise counselling for 11 months. Control subjects (n=88) received usual care. Glycemic control (HbA1c, blood glucose), body composition, insulin sensitivity (insulin, QUICKI) and VO2max were assessed at baseline and one year. RESULTS: Compared to controls, the intervention group showed significant (p<0.05) changes in BMI (-1.9kg/m2), waist circumference (-2.8cm), percentage fat mass (-2%), resting blood glucose (-1.1mmol/L), HbA1c (-0.7%), insulin sensitivity (+6%) and VO2max (+2.2ml/kg/min). The improvement in HbA1c was significantly (p<0.05) correlated to baseline VO2max (r=0.27), change in waist circumference (r=0.31) and change in VO2max (r= -0.19). Furthermore change in HbA1c was significantly (p<0.05) independently predicted by baseline VO2max (β=0.26, p<0.01) and change in waist circumference (β=0.26, p=0.02). ROC analysis revealed that patients with a baseline VO2max of less than 21.5ml/kg/min (AUC=0.65, p<0.01) would benefit more from the intervention. CONCLUSION: A one-year, predominantly home-based lifestyle intervention improved glycemic control, body composition and cardiorespiratory fitness in patients with type 2 diabetes compared to usual care. Patients with low levels of cardiorespiratory fitness could be prioritised for treatment.

140 A one-year home-based lifestyle intervention is effective in improving insulin sensitivity and glycaemic control in patients with type 2 diabetes

140 A one-year home-based lifestyle intervention is effective in improving insulin sensitivity and glycaemic control in patients with type 2 diabetes