Intensive Lifestyle Changes Research Articles

Digital Health–Supported Lifestyle Change Programs to Prevent Type 2 Diabetes

IN BRIEF Type 2 diabetes can be prevented or delayed in people with prediabetes through participation in an intensive lifestyle change program (LCP), particularly one based on the Diabetes Prevention Program research study. Digital health offers opportunities to extend the reach of such LCPs and possibly improve on these programs, which traditionally have been delivered in person. In this review, we describe the current state of evidence regarding digital health–supported LCPs and discuss gaps in research and opportunities for future efforts.

Weight Loss Achieved by Participants with Hypertension/Elevated Blood Pressure in a Diabetes Prevention Program

In light of new national guidelines by the AHA/ACC that recommend lifestyle intervention as the primary mode of treatment for adults with hypertension (HTN), we assessed weight loss achieved by adults that had a HTN diagnosis and/or a measured blood pressure (BP) ≥140/90 mm Hg in an intensive lifestyle change intervention provided by lifestyle coaches using the National Diabetes Prevention Program (DPP) curriculum. From 2008-2016, 6,418 participants enrolled in the Montana DPP, and 55.8% (n=3,582) had HTN/BP on enrollment. Participants with HTN/BP were significantly older, weighed more at baseline, had greater fasting glucose, and attended more sessions than did other participants (Table). After the 16-week core sessions four months), participants in both groups achieved significant weight loss. Results from the logistic regression model indicated that the factors independently associated with achieving 7% weight loss were being female [AOR 0.57, 95% 0.44-0.74], having low prediabetes risk score of 3-8 [AOR 0.60, 95% 0.40-0.89], meeting the physical activity goal [AOR 1.46, 95% 1.17-1.82], and self-monitoring fat for 7-13 weeks [AOR 5.66, 95% 4.10-7.81] and 14-16 weeks [AOR 12.81, 95% 8.87-18.49]. These data suggest, the DPP is likely an effective method to support adults with HTN/BP in making recommended lifestyle changes and decreasing an important blood pressure risk.Table. Participant baseline characteristics and outcomes during the 16-week core (four months), by hypertension/BP status, Montana DPP, 2008-2016.Hypertension/BP ≥140/90 (N = 3,582)No Hypertension/BP <140/90 (N = 2,828)Mean (SD)Mean (SD)Age (Years)55.8 (11.6)51.2 (12.5)*Baseline BMI (kg/m2)37.1 (7.3)35.2 (7.0)*Baseline fasting blood glucose (mg/dL)101.4 (13.7)98.5 (13.3)Sessions attended15.0 (6.1)14.7 (6.0)*Weight change (kg)-5.1 (5.3)-4.8 (5.3)*% (n)% (n)Sex (Female)79.1 (2,836)85.2 (2,406)*Prediabetes risk score (low 3-8)7.9 (108)12.7 (109)Met ≥150 min/week physical activity goal58.3 (1,867)57.7 (1,449)Self-monitored fat intake 14-16 weeks30.8 (1,015)26.0 (659)*Achieved ≥5% weight loss47.4 (1,701)46.0 (1,300)Achieved ≥7% weight loss goal31.7 (1,138)30.0 (848)*P≤0.05 Disclosure S.M. Brokaw: None. D. Carpenedo: None. S. Tysk: None. J. Fernandes: None. S.D. Helgerson: None. T.S. Harwell: None.

A protocol for the development and piloting of quality measures to support the Healthier You: The NHS Diabetes Prevention Programme.

BackgroundThe increasing prevalence of type 2 diabetes in the UK creates an additional, potentially preventable burden on health care and service providers. The Healthier You: NHS Diabetes Prevention Programme aims to reduce the incidence of type 2 diabetes through the identification of people at risk and the provision of intensive lifestyle change support. The provision of this care can be monitored through quality measurement at both the general practice and specialist service level.AimTo develop quality measures through piloting to assess the validity, credibility, acceptability, reliability, and feasibility of any proposed measures.Design & settingThe non-experimental mixed design piloting study consists of consensus testing and exploratory research with GPs, commissioners, and patients from Herefordshire, England.MethodA mixed-method approach will be used to develop and validate measures for diabetes prevention care and evaluate their performance over a 6-month pilot period consisting of consensus testing using a modified RAND approach with GPs and commissioners; four focus groups with 8–10 participants discussing experiences of non-diabetic hyperglycaemia (NDH), perceived ability to access care and prevent diabetes, and views on potential quality measures; and piloting final measures with at least five general practices for baseline and 6-month data.ResultsThe findings will inform the implementation of the diabetes prevention quality measures on a national scale while addressing any issue with validity, credibility, feasibility, and cost-effectiveness.ConclusionHealthcare professionals and patients have the opportunity to evaluate the reliability, acceptability, and validity of measures.

Service evaluation of a digital behavioural change programme

The purpose of this service evaluation was to analyse the -efficacy of OurPath, a UK-based digital behavioural change programme, based on real-world data gathered in a commercial setting. In total, 98 potential participants with a mean body mass index of 31 kg/m2 (obese) paid money to enrol on OurPath, a digital behavioural change programme that combines a private online social network, daily structured educational content, health coaching, wireless scales and an activity tracker. Participants underwent a core 6-week intensive lifestyle change intervention and moved onto OurPath's Sustain programme, with follow-ups after 3 and 6 months. A total of 77 participants met the inclusion criteria for the core programme and achieved a significant weight loss from baseline of 5.3% in 6 weeks (p<0.01). At the date of data analysis, 69 participants were over 3 months from their start date. Of these 69 participants, 42 (61%) had submitted a weight reading after 3 months and had achieved a mean weight loss of 6.7% (p<0.01). Data available for 15 participants after 6 months (52% of participants who had passed the 6-month mark at the date of analysis) demonstrated a mean weight loss of 8.2% (p<0.01). Weight loss data were not available for all participants at the 3 and 6-month mark. The OurPath online behavioural change programme achieved clinically significant weight loss results in a real-world setting. Online delivery platforms like OurPath could therefore offer an effective and scalable solution to tackle the UK's obesity and diabetes epidemics.

Interdisciplinary Management of Pediatric Obesity: Lessons Learned in the Midsouth.

The Healthy Lifestyle Clinic (HLC) is an interdisciplinary weight management clinic conceived to address alarming rates of pediatric obesity and related comorbidities in the midsouth region of the United States. The clinical cohort presented is a subset of the 609 patients evaluated during the first 2 years of the HLC and comprises 380 patients with a minimum of 6 months of follow-up. The primarily non-Hispanic black (67.1%) cohort presented with severe obesity ( MzBMI = 2.52 ± 0.41) and particularly high rates of insulin resistance, among other comorbidities. This article offers insight into the challenges of intervening with a cohort of youth and their families, many with limited resources to support intensive behavioral and lifestyle changes. Our experiences implementing a weight management clinic with a diverse clinical cohort provide guidance for emerging programs and impetus to investigate environmental and cultural factors that contribute to high attrition in the treatment of pediatric obesity.

American College of Lifestyle Medicine Expert Panel Discussion: Implementing Intensive Therapeutic Lifestyle Change Programs.

American College of Lifestyle Medicine Expert Panel Discussion: Implementing Intensive Therapeutic Lifestyle Change Programs.

Management of diabetic neuropathy: the ADA's latest statement fleshes out NICE guidance

Management of diabetic neuropathy: the ADA's latest statement fleshes out NICE guidance

A Comprehensive Clinical Lifestyle Medicine Specialty Fellowship Program: What Intensive Lifestyle Treatment Can Do.

Lifestyle medicine (LM) is recognized as an essential component of evidence-based medical treatment, particularly for chronic diseases. Multiple studies have shown that intensive therapeutic lifestyle change can arrest and reverse disease, including heart disease, type 2 diabetes, essential hypertension, metabolic syndrome, and autoimmune and inflammatory conditions. While more modest lifestyle changes can slow the onset or prevent disease, studies reveal that intensive therapeutic changes are required to arrest and reverse disease. As increasing numbers of clinicians have learned about the powerful treatment effects of intensive lifestyle interventions, interest in LM has greatly increased. This, in turn, has led to the need for evidence-based clinical LM training in how to effectively provide intensive LM interventions that can arrest and reverse disease. As with all clinical training, such training must include actual patient care guided by knowledgeable expert LM clinicians. The purpose of this article is to (1) describe the need for and function of clinical LM specialists, (2) describe the key components in the training of clinical LM specialists to treat and reverse chronic disease, and (3) describe the steps/components in establishing and implementing a clinical LM specialty-training program.

Bradford beating diabetes through an intensive lifestyle change programme

Bradford beating diabetes through an intensive lifestyle change programme

NICE quality standards: driving improved care?

NICE quality standards: driving improved care?

Testosterone and depressive symptoms among men in the Diabetes Prevention Program

ObjectiveWe examined associations between intensive lifestyle intervention (ILS) and changes in testosterone and associations with mood among middle-aged men. DesignSecondary analysis of men (n=886) participating in the Diabetes Prevention Program which randomized glucose-intolerant, overweight men to ILS, metformin, or placebo between 1996 and 1999. Main outcome measuresChanges in testosterone between baseline and 1-year follow-up asnd associations of these changes with mood measures (Beck Depression Inventory [BDI-II], Beck Anxiety Inventory [BAI]). ResultsMedian baseline testosterone was 10.98nmol/l and 44% (n=385) had testosterone<10.41nmol/l or 300ng/dl. Testosterone increases were greater among men randomized to ILS vs. metformin vs. placebo (1.15nmol/l vs. −0.12nmol/l vs. −0.27nmol/l, p<0.001). The association between changes in testosterone and mood differed by study arm (p<0.001 for interaction); there were no significant associations between changes in testosterone and mood changes among men in the ILS or placebo arms. Among men in the metformin arm, increases in testosterone were significantly associated with decreases in BDI-II (improved depressive symptoms) (β-coefficient −0.2336, p=0.0002) indicating a 0.23 decrease in BDI-II for every 1nmol/l increase in testosterone and decreases in BAI (improved anxiety symptoms) (β-coefficient −0.2147, p=0.0014). Similar patterns were observed for bioavailable testosterone. ConclusionsAmong overweight middle-aged men with glucose-intolerance, ILS increased endogenous testosterone slightly but without significant improvements in mood. Metformin did not increase testosterone, but among metformin users, testosterone increases were associated with improvements in mood. Thus, interventions that increase endogenous testosterone may not also improve mood.

Obesity: epigenetic aspects.

Epigenetics, defined as inheritable and reversible phenomena that affect gene expression without altering the underlying base pair sequence has been shown to play an important role in the etiopathogenesis of obesity. Obesity is associated with extensive gene expression changes in tissues throughout the body. Epigenetics is emerging as perhaps the most important mechanism through which the lifestyle-choices we make can directly influence the genome. Considerable epidemiological, experimental and clinical data have been amassed showing that the risk of developing disease in later life is dependent on early life conditions, mainly operating within the normative range of developmental exposures. In addition to the 'maternal' interactions, there has been increasing interest in the epigenetic mechanisms through which 'paternal' influences on offspring development can be achieved. Nutrition, among many other environmental factors, is a key player that can induce epigenetic changes not only in the directly exposed organisms but also in subsequent generations through the transgenerational inheritance of epigenetic traits. Overall, significant progress has been made in the field of epigenetics and obesity and the first potential epigenetic markers for obesity that could be detected at birth have been identified. Fortunately, epigenetic phenomena are dynamic and rather quickly reversible with intensive lifestyle changes. This is a very promising and sustainable resolution to the obesity pandemic.

Apical Resection Mouse Model to Study Early Mammalian Heart Regeneration.

Cardiovascular disease plagues the whole world due to intensive lifestyle changes. Heart regeneration holds great promise for repairing and restoring cardiomyocytes lost due to injury and disease. In contrast to the robust cardiac regeneration of certain lower vertebrates, adult mammalian hearts typically show minimal capacity for heart regeneration and repair. However, recent studies have sparked considerable scientific interest with the finding that, between postnatal day 1 to 7 (P1 to P7), the neonatal mouse heart retains significant regenerative potential after apical resection (i.e., surgical amputation and exposure of left ventricular apex). One major controversy over this finding might be due to the diverse surgery-related procedures used in efforts to replicate or expand upon this important finding. These instructions dynamically present the materials and methodology for apical resection in a mouse model. The salient steps of this rodent survival surgery involve hypothermia anesthesia, thoracotomy, surgical amputation of heart ventricular apex, and suture and recovery of mice. The approach described could expand the application of the apical resection mouse model for cardiovascular research.

Change in adiponectin explains most of the change in HDL particles induced by lifestyle intervention but not metformin treatment in the Diabetes Prevention Program

ObjectiveIn addition to slowing diabetes development among participants in the Diabetes Prevention Program (DPP), intensive lifestyle change and metformin raised HDL-cholesterol (HDL-C) compared to placebo treatment. We investigated the lifestyle and metabolic determinants as well as effects of biomarkers of inflammation, endothelial dysfunction and coagulation and their changes resulting from lifestyle and metformin interventions on the increase in HDL-C in the DPP. MethodsThe effects of a 1year period of intensive lifestyle change aimed at achieving 7% weight loss or metformin 850mg twice daily versus placebo on HDL-C were assessed in 3070 participants with impaired glucose tolerance, and on HDL particle concentration (HDL-P) and size in a subgroup of 1645 individuals. Treatment-associated changes in lifestyle and metabolic factors as well as in novel biomarkers were investigated for their associations with change in HDL-C using multiple regression analysis. ResultsAfter adjusting for BMI, insulin resistance, glycemia, dietary saturated fat, alcohol intake, physical activity and nine different biomarkers, only adiponectin accounted for the effect of intensive lifestyle change on HDL-C via an increase in large HDL-P. By contrast baseline and change in BMI and tissue plasminogen activator levels attenuated the effect of metformin on HDL-C, with adiponectin having no specific effect. ConclusionWhile both lifestyle and metformin interventions used to prevent diabetes increase HDL-C, the mechanisms involved differ between the two treatments and may have consequences for future risk of cardiovascular disease.

Head-to-head comparison of intensive lifestyle intervention (U-TURN) versus conventional multifactorial care in patients with type 2 diabetes: protocol and rationale for an assessor-blinded, parallel group and randomised trial

IntroductionCurrent pharmacological therapies in patients with type 2 diabetes (T2D) are challenged by lack of sustainability and borderline firm evidence of real long-term health benefits. Accordingly, lifestyle intervention remains the...

Perceptions of Adolescents with Overweight and Obesity for the Development of User-Centered Design Self-Management Tools within the Context of the Chronic Care Model: A Qualitative Study

BackgroundThe Chronic Care Model (CCM) is helpful to illustrate multiple levels of influence in the management of chronic disease, such as overweight and obesity in adolescents. Unfortunately, various constraints create gaps in the management process activities performed within the CCM. Consumer health technologies (CHT) may serve as a linkage between adolescents with overweight or obesity, their parents, and their pediatricians. ObjectiveTo conduct formative research to qualitatively identify views of adolescents with overweight and obesity on use of consumer health technologies to manage weight loss across chronic care management settings. DesignAs part of a multi-perspective qualitative study, 10 focus groups were conducted with adolescents with overweight and obesity. Participants/settingForty-eight adolescents (15 male, 33 female) aged 12 to 17 years who were current participants of an intensive lifestyle change camp in the summer of 2012 participated in focus groups. All adolescents were classified as overweight (21%) or obese (79%) according to body mass index (BMI) for age charts published by the Centers for Disease Control and Prevention. AnalysisAll focus groups were recorded, transcribed verbatim, and checked for accuracy. Predefined and open coding were used to analyze transcripts for emerging themes. ResultsAdolescents perceive CHT, with its functional requirements of assistance with restaurant food selection, teaching cooking skills, and providing encouragement and motivation, to be helpful with overweight and obesity self-management. Desired features to carry out these functional requirements included avatars, self-monitoring capabilities, social networking, and rewards. ConclusionOur findings largely agree with previously reported parental perceptions of the benefit of CHT for adolescent overweight and obesity self-management and strengthen support for the design and implementation of CHT within the CCM.

43 Real time longitudinal monitoring of patient diet, exercise and weight loss has substantial positive effects on metabolic syndrome parameters

Background Intensive lifestyle change programs are utilised in cardiovascular disease prevention, but their efficacy is variable. Real-time monitoring of patients is feasible. Purpose To evaluate the efficacy of real-time adherence monitoring of patient diet and exercise, in targeting metabolic syndrome parameters of bmi, blood pressure (bp) and total cholesterol (tc), in overweight/obese (owo) individuals. Methods 28 owo (bmi >25 and 140/90), 12 elevated tc (>5 mmol/l). Baseline resting metabolic rate (rmr) and bmi was calculated. Participants had a reduced daily calorie intake (~300–500 kcal below rmr) and increased daily exercise (10 3 –12.5 3 steps). Phone app training tracked caloric intake, while a wireless weighing- scale and pedometer, enabled daily weight tracking and exercise adherence monitoring. Non-adherents received motivational emails, sms or phonecall. Participants were met weekly, face to face or via video-link. The primary aim was to assess the effects on weight loss. Secondarily, bp and tc were analysed. Results Significant weight loss was achieved at weeks 4, 8 and 12 with an average weight reduction of 5.6%, 9.6% and 10.1% (p Conclusion Intense lifestyle and behavioural intervention, coupled with real-time remote monitoring of patients diet, exercise and weight has a substantial positive effect on metabolic syndrome parameters and may have a seminal role to play in cardiovascular disease prevention.

Intensive Therapeutic Lifestyle Change Programs

Intensive therapeutic lifestyle change (ITLC) programs have been shown to consistently achieve improved biologic markers for cardiac heart disease risk in short periods of time. We propose a standard definition of ITLC and discuss the specifics that are critical to their success. We include a discussion of our experiences with delivering ITLC programs in large health care systems and use that to illustrate opportunities for ITLC implementation in the future. Finally, we discuss the current drivers of change in the US health care reform movement and comment on their predictable effects on the current health care landscape.

Prevention Of Coronary Heart Disease And Stroke Complications In Type 2 Diabetes Mellitus: An Observational, Prospective Study

Abstract Background and Aims: We assessed the effect of intensive therapy on modifiable cardiovascular (CV) risk factors and CV risk as compared to conventional therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Material and Methods: This was an observational, prospective study, conducted in Romania. During 1-year follow-up period the enrolled participants received either multi-factorial pharmacotherapy associated with intensive therapeutic education (Intensive group), or conventional therapy (Control group). Current analysis included data (anthropometric measurements, blood pressure and biochemical parameters) recorded at months (M) 0, 6 and 12. CV risk was calculated at M1 and M12 using the UK Prospective Diabetes Study Risk Engine. Results: 138 patients aged 57.02±10.05 years were included in this analysis (69 in each group). At M6 and M12 a significant improvement of the majority of the modifiable risk factors in the Intensive group compared to the Control group was observed. At M12, coronary heart disease (CHD)/fatal-CHD risks were significantly lower in the Intensive (7.5%/3.1%) than in the Control (17.95%/10.3%) group (p&lt;0.05). A similar trend was observed for the stroke/fatal-stroke risks. Conclusions: CHD/fatal-CHD and stroke/fatal-stroke risk burden decreased in newly diagnosed diabetic patients following multi-factorial pharmacotherapy association with intensive lifestyle changes during 1-year follow-up.

Weight loss increases follicle stimulating hormone in overweight postmenopausal women [corrected

Structured ObjectiveTo examine the impact of a weight loss intervention upon follicle stimulating hormone (FSH) levels in postmenopause.Design and MethodsParticipants were postmenopausal, overweight, glucose-intolerant women not using exogenous estrogen (n=382) in the Diabetes Prevention Program. Women were randomized to intensive lifestyle change (ILS) with the goals of weight reduction of at least 7% of initial weight and 150 minutes per week of moderate intensity exercise, metformin 850 mg, or placebo administered twice a day.ResultsRandomization to ILS led to small increases in FSH between baseline and 1-year follow-up vs. placebo (2.3 IU/l vs. -0.81 IU/l, p<0.01). Increases in FSH were correlated with decreases in weight (r=-0.165, p<0.01) and E2 (r=-0.464, p<0.0001) after adjustment for age, race/ethnicity, and randomization arm. Changes in FSH were still significantly associated with changes in weight even after adjustment for E2 levels. Metformin users had reductions in weight but non-significant changes in FSH and E2 levels vs. placebo.ConclusionsWeight loss leads to small increases in FSH among overweight, postmenopausal women, potentially through pathways mediated by endogenous estrogen as well as other pathways.