Lifestyle Behavior Change Program Research Articles

Abstract 12594: Comparison of Effects of Face-to-Face and Online Community-Based Healthy Lifestyle Behavior Change Programs on Life Simple 7 Score in the Elderly

Introduction: The Life Simple 7 (LS7) score, developed by the American Heart Association, is a powerful predictor of an individual's cardiovascular health. It consists of seven key cardiovascular health metrics, including cholesterol levels, blood pressure, blood sugar, body mass index, diet, smoking status, and physical activity levels. In-person behavior change programs that target LS7 may not be accessible to older people. Aims: Our aim was to compare the impact of face-to-face and online community-based programs on the LS7 score among elderly individuals. Methods: Elderly participants were recruited from local community centers and randomly assigned to either a face-to-face or online program group. The face-to-face group attended weekly sessions at the community center, while the online group received program content through a web-based platform. Changes in the LS7 score were measured at baseline and six weeks after the intervention. An analysis of covariance (ANCOVA) was used to compare outcomes. Results: A total of 114 elderly individuals, with an average age of 71.75 ± 10.39 and 70.8% males, participated in the study (face-to-face group, n=48; online group, N=66. The findings indicate significant improvements in blood pressure (p=0.048), cholesterol (p=0.021), exercise (p=0.000), and diet scores (p=0.001). However, no significant differences were observed between the two groups (F=0.16, p>.05). Conclusion: The findings suggest that both modes of intervention are effective in improving cardiovascular health, highlighting the potential of online programs during times such as the COVID-19 pandemic or in rural areas.

Understanding Primary Care Providers’ Experience with Lifestyle Behavior Change Recommendations and Programs to Prevent Chronic Disease

Prescribing lifestyle behavior change is a recommended strategy for both primary and secondary prevention of disease. Programs that support and encourage lifestyle behavior change are available to patients but are underutilized. The purpose of this study was to understand primary care providers (PCPs) experiences and barriers they experience with referring patients to lifestyle behavior change programs at one academic health care system. In-depth semi-structured interviews were conducted with 7 academic PCPs between November 2020 and January 2021. Qualitative analysis identified major themes. Four themes emerged: (1) guideline awareness and adherence, (2) barriers to lifestyle behavior change recommendations, (3) provider role with respect to lifestyle behavior change recommendations, and (4) suggestions to improve utilization of behavior change support. Specific strategies for improvement include revising referral process, educating providers about programs already offered, integrating a team-based approach, and systemizing healthy lifestyle behaviors interventions. The lessons identified through this study highlight the need for systematic prioritization of lifestyle behavior change to decrease certain barriers that providers face when attempting to integrate lifestyle change consistently into their practice.

Digital Intervention With Lifestyle Coach Support to Target Dietary and Physical Activity Behaviors of Adults With Nonalcoholic Fatty Liver Disease: Systematic Development Process of VITALISE Using Intervention Mapping.

BackgroundNonalcoholic fatty liver disease (NAFLD) is linked to excessive calorie consumption, physical inactivity, and being overweight. Patients with NAFLD can halt or decelerate progression and potentially reverse their condition by changing their lifestyle behavior. International guidelines recommend the use of lifestyle interventions; however, there remains a discordance between published guidelines and clinical practice. This is primarily due to a lack of NAFLD-specific interventions to support weight loss and improve liver function.ObjectiveThis study aims to use intervention mapping to systematically develop a digital intervention to support patients with NAFLD to initiate and maintain changes in their dietary and physical activity behavior to promote weight loss.MethodsIntervention mapping consisted of 6 steps: step 1 involved a needs assessment with primary and secondary health care professionals (HCPs) and patients with NAFLD; step 2 involved identification of the social cognitive determinants of change and behavioral outcomes of the intervention; step 3 involved linking social cognitive determinants of behavioral outcomes with behavior change techniques to effectively target dietary and physical activity behavior; step 4 involved the development of a prototype digital intervention that integrated the strategies from step 3, and the information content was identified as important for improving knowledge and skills from steps 1 and 2; step 5 involved the development of an implementation plan with a digital provider of lifestyle behavior change programs to patients with NAFLD using their delivery platform and lifestyle coaches; and step 6 involved piloting the digital intervention with patients to obtain data on access, usability, and content.ResultsA digital intervention was developed, consisting of 8 modules; self-regulatory tools; and provision of telephone support by trained lifestyle coaches to help facilitate behavioral intention, enactment, and maintenance. A commercial provider of digital lifestyle behavior change programs enrolled 16 patients with NAFLD to the prototype intervention for 12 consecutive weeks. A total of 11 of the 16 participants successfully accessed the intervention and continued to engage with the content following initial log-in (on average 4 times over the piloting period). The most frequently accessed modules were welcome to the program, understanding NAFLD, and food and NAFLD. Goal setting and self-monitoring tools were accessed on 22 occasions (4 times per tool on average). A total of 3 out of 11 participants requested access to a lifestyle coach.ConclusionsIntervention mapping provided a systematic methodological framework to guide a theory- and evidence-informed co-design intervention development process for patients and HCPs. The digital intervention with remote support by a lifestyle coach was acceptable to patients with NAFLD and feasible to deliver. Issues with initial access, optimization of information content, and promoting the value of remote lifestyle coach support require further development ahead of future research to establish intervention effectiveness.

Clinically Meaningful Changes In Mobility After An Exercise Program For Older Adults

Aging is associated with a progressive decline in muscle strength and mass, eventually leading to reduced functional ability and disability. Regular physical activity can slow this inevitable decline and promote physical wellbeing, improve physical function and reduce risk of chronic diseases in older adults. However, meaningful improvements in physical function for individuals in response to a training stimulus are often missed when only group effects are considered. PURPOSE: to examine interindividual variation in changes in functional ability in response to a 10-week exercise intervention designed to improve physical function in older adults. METHODS: 97 older adults (age= 72.7 yrs+7.9); BMI=32.3+7.2) completed the 10-week Physical Activity for Seniors for Life (PALS) group exercise and lifestyle behavior change program. 6MW (distance covered in 6 minutes), and UGS (meters/second (m/s) to walk 6 m distance) were measured before and after the exercise program. RESULTS: There was a significant (p<.05) improvement in 6mw and UGS for the group (m=60.2 meters and 0.1045 m/s respectively). For 6mw, 27% did not improve more than 20 meters (>20 meters is small meaningful change), 23% improved between 20 and 50 meters, and 50% improved more than 50 meters (>50 meters is substantial meaningful change). For UGS 38% showed less than 0.05 m/s improvement (0.05 m/s is small meaningful change), 12% improved between 0.05 and 0.1 m/s, and 47% improved more than 0.1 m/s (0.1 m/s is substantial meaningful change). CONCLUSIONS: Consideration of individual variability is important in establishing the clinical meaningfulness of improvements in physical function in response to exercise programs designed for older adults.

App-technology to improve lifestyle behaviors among working adults - the Health Integrator study, a randomized controlled trial

BackgroundMobile health, mHealth is recognized as a strategy to improve lifestyle behaviors. Research targeting specific lifestyle behaviors has shown that interventions using smartphones can be effective. However, few studies have evaluated solutions with multicomponent interventions, tailoring the intervention to the specific needs of the participant using a combination of mHealth and conventional treatment. To accomplish this, we developed Health Integrator, an mHealth platform with services and offers in the areas of diet, physical activity, sleeping habits, stress, alcohol and tobacco use. In the system, the user selects an area of intervention together with a health coach and set weekly goals. This study protocol presents the design and methodology of the Health Integrator Study, a randomized controlled trial to promote improved lifestyle behaviors.MethodsA three-arm parallel randomized controlled trial (1:1:1) is conducted in the Stockholm County, Sweden. In total, 209 employees at a four different companies representing both white and blue collar workers, have been recruited.Participants are randomized to either a control group or to one of two intervention groups receiving a 3-month lifestyle behavior change program including either 1) use of Health Integrator and monthly health coaching sessions or 2) only Health Integrator.At baseline and follow-up after 3- and 6-months, all participants answer questionnaires assessing lifestyle behaviors and quality of life. At baseline and the 3-month follow-up (end of intervention period), weight, height, waist circumference and blood pressure are measured, and all participants wear an Actigraph accelerometer for 7 days to assess physical activity. Blood lipid profile and HbA1c are measured among all participants at baseline. If baseline measures fall outside the normal range, a second measurement is done after 3 months.DiscussionThe Health Integrator Intervention Study will evaluate if a personalized intervention combining mHealth and conventional programs for lifestyle change, with or without additional health coach sessions, can improve lifestyle behaviors and quality of life. Based on the results from this trial, Health Integrator can easily be implemented within a broad public.Trial registrationClinicalTrials.gov Identifier: NCT03579342. Retrospectively registered, first submitted May 8, 2018.

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

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

Effect of a Gender-Tailored eHealth Weight Loss Program on the Depressive Symptoms of Overweight and Obese Men: Pre-Post Study.

BackgroundObesity and depression are of two of the largest contributors to the global burden of disease in men. Although lifestyle behavior change programs can improve participants’ weight and depressive symptoms, the evidence is limited by a lack of male participants and a reliance on face-to-face treatment approaches, which are not accessible or appealing for many men.ObjectiveThis study examined the effect of a gender-tailored electronic health (eHealth) program on the depressive symptoms of a community sample of overweight and obese men with or without depression. A secondary aim was to determine whether the eHealth, self-directed format of the program was a feasible and acceptable treatment approach for the subgroup of men with depression at baseline.MethodsIn total, 209 overweight/obese men from the Hunter Region of Australia were assessed before and after completing a self-administered eHealth weight loss program over 3 months. To increase engagement, most program elements were socio-culturally targeted to appeal specifically to men and included printed materials, a DVD, motivational text messages, online- or app-based self-monitoring, and other weight loss tools (eg, pedometer). Depressive symptoms were measured with the validated 8-item Patient Health Questionnaire (PHQ-8). Program feasibility and acceptability were assessed with a process questionnaire plus recruitment and retention rates. Changes in depressive symptoms and weight were examined using intention-to-treat linear mixed models, adjusted for the centered baseline score and other covariates. Effect sizes were estimated with Cohen’s d.ResultsAt baseline, the mean weight and age of the sample was 105.7 kg (standard deviation [SD] 14.0) and 46.6 years (SD 11.3), respectively. Overall, 36 men (36/209, 17.2%) were experiencing depression (PHQ-8 score ≥10). Retention rates were comparable between men with and without depression (32/36, 88.9% vs 145/173, 83.8%; P=.44). At posttest, depressive symptoms had reduced by 1.8 units (95% CI 1.3 to 2.3; P<.001; d=0.5) for the whole sample. These improvements were particularly notable in the subgroup of men with depression (-5.5 units; P<.001; d=1.0) and 72.2% (26/36) of this subgroup no longer met the criterion for depression at posttest. A corresponding, albeit smaller, intervention effect on depressive symptoms was also observed in men without depression (-1.0 units; P<.001; d=0.4). The overall intervention effect on weight was -4.7 kg (d=1.3), which did not vary significantly by depression status. Program acceptability, feasibility, and online engagement metrics were also comparable between men with and without depression.ConclusionsA gender-tailored eHealth lifestyle program generated short-term improvements in the mental health of overweight and obese men, particularly for men with depression at baseline. Despite receiving no personalized support, men with depression reported high levels of satisfaction and engagement with the program. As such, a longer-term controlled trial testing an adapted version of the program for this subgroup is warranted.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12612000749808; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=362575 (Archived by WebCite at http://www.webcitation.org/6wJvbRsNW)

Using a Self Regulation Physical Activity Intervention to Improve Physical Function

Limitations in physical function are risk factors for subsequent disability, institutionalization, and loss of independence for older adults and are directly caused or exacerbated by physical inactivity. Getting older adults to adopt and maintain physical activity (PA) is a challenge. Use of self-regulation (SR) strategies may be useful, especially for overweight and obese older adults. PURPOSE: To examine the effect of a 10-week group exercise and lifestyle behavior change program on physical function in older community-dwelling adults. METHODS: Fifty two older adults (mean age= 72.34 yrs ± 8.0, mean BMI=31.68 ± 6.53) completed the 10-week Physical Activity for Life for Seniors (PALS) group exercise and lifestyle behavior change program. Ten exercises were performed in a circuit in 1 minute intervals over 40 minutes 3 days/week. The 30 minute lifestyle behavior change class included self-regulation problem solving strategies for staying active. Physical function was measured via the Physical Function Questionnaire (PFQ, 0=unable to do to 100=no difficulty in performing 6 functional tasks), Timed Up and Go (TUG, time in seconds to rise from a chair, walk 3 meters, return to chair and sit), 6 Minute Walk (6MW, feet) and Usual Gait Speed (UGS, meters/second to walk 6 m distance); PA via the CHAMPS questionnaire and SR via the Self-Regulation for Exercise Scale (1=never to 5=very often). Paired t-tests were used to examine mean differences in the variables pre and post intervention. RESULTS: In this population of overweight and obese older adults, significant improvements (p=.000) were noted in physical function (PFQ: 72.85 ± 21.12 vs 79.31 ± 18.47; TUG: 10.89 sec ± 2.67 vs 9.45 sec ± 2.52; UGS: 1.19 m/s ± .22 vs 1.26 m/s ± .22; 6MW: 1112.06 ft ± 410.21 vs 1337.92 ft ± 361.04); PA (total PA: 2143.31 ± 2153.24 vs 4092.99 ± 2635.78; moderate PA: 742.84 ± 1476.00 vs 2366.96 ± 2112.94); and SR (1.55 ± .61 vs 2.67 ± .62). CONCLUSIONS: These results suggest that a 10-week group exercise intervention that includes a SR behavior change component was effective in improving physical function and moderate intensity and total PA in this population of older adults. Participants indicated they liked the socialization the group format provided.

Role Of Self-regulation In A Community-based Physical Activity Intervention For Older Adults

Regular physical activity can reduce the risk of falls, hypertension, osteoporosis, stroke, and diabetes, yet only 27.3-44.3% of older adults meet recommended physical activity (PA) guidelines. Use of self-regulation (SR) techniques may increase compliance in a group-based behavior change PA intervention for older adults, yet it is unclear which SR strategies are effective in older adults to increase PA level and stay active. PURPOSE: The purpose of this study is to examine change in PA, and improvement in the use of SR techniques employed by individuals in a 10-week exercise and lifestyle behavior change program. METHODS: Fifty-two older adults (age = 72.3, yrs±8.0) completed a 10-week group exercise and lifestyle behavior change program called Physical Activity for Life for Seniors (PALS). Three days/week over 40 minutes, participants completed ten exercises in a circuit, at 1 minute intervals. The 30-minute lifestyle behavior change class included SR problem solving techniques for staying active. SR was measured using the Self-Regulation for Exercise Scale (1=never to 5=very often), which examined SR techniques for self-monitoring, goal setting, social support, reinforcement, relapse prevention and time management. PA was measured using the CHAMPS questionnaire (caloric expenditure/week). Significant differences (p<0.05) in response to the intervention were identified using paired t-tests. RESULTS: In this population of older adults, significant improvements (p<.000) were noted in SR techniques (SR self-monitoring: 1.573± .72 vs 3.19 ±.91; SR goal setting: 1.55±.75 vs 3.02±.88; SR social support: 1.35±.55 vs 2.09±.67; SR reinforcement: 1.92±.76 vs 2.77±.67; SR relapse prevention: 1.45±.56 vs 2.17 ±.63; SR time management: 1.45±.80 vs 2.80±1.01) and total PA energy expenditure: 2143.31±2153.24 vs 4092.99±2635.78; moderate to vigorous energy PA expenditure: 742.84±1476.00 vs 2366.96±2112.94). CONCLUSIONS: These results suggest that including SR strategies in a 10-week group exercise and lifestyle behavior change intervention can lead to an increase in total PA, especially the moderate to vigorous PA in this population. Goal setting, self-monitoring and time management were used most frequently following the intervention.

Mobility Improvement After an Exercise Program for Older Adults

Basic mobility tasks are often used to assess improvement in response to physical activity interventions for older adults. However, it can be argued that if strength and endurance capacities are adequate prior to engaging in a program of exercise, further increases in capacity are not expected to alter basic tasks. Usual Gait Speed (UGS), 6 Minute Walk (6MW), and Timed Up and Go (TUG) are often used in research evaluate the efficacy of an exercise training program for older adults. However, the change in these measures has not been evaluated in relation to initial mobility. PURPOSE: To evaluate the improvement in basic mobility tasks in response to a ten-week community based exercise program for older adults with high or low functional ability. METHODS: Sixty-one older adults (age= 72.7 yrs+7.9); BMI=32.3+7.2) completed the 10-week Physical Activity for Seniors for Life (PALS) group exercise and lifestyle behavior change program. TUG (time in seconds to rise from a chair, walk 3 meters, return to chair and sit), 6MW (distance covered in 6 minutes), and UGS (meters/second to walk 6 m distance) were measured before and after the exercise program. Participants were divided into upper and lower functional groups based on the median for each mobility task. Repeated measures ANOVA and Effect Size (Cohen’s d) were used to examine mean differences within the two groups. RESULTS: After the exercise program, the lower functional group showed significant improvement in all basic mobility tasks (p<0.001). The upper functional group showed significant improvement in 6MW (p<0.001) and TUG (p=0.006), with no significant change in UGS (p=0.816). Importantly, the lower functional group demonstrated much higher effect sizes in all three tests (6MW: 763 vs 1121 feet, d=0.936; TUG: 13.3 vs 11.2 seconds, d=0.858; UGS: 6.3 vs 5.4 seconds d=0.800), pre, post respectively, while the higher functional group showed only moderate or low effect sizes, 6MW (1414 vs 1522 feet, d=0.562), TUG (9.1 vs 8.3 seconds d=0.577), UGS (4.65 vs 4.62 seconds d=0.041) pre, post respectively. CONCLUSION: These results suggest that UGS may be better suited for use with a frail population, while TUG and 6MW may be useful across a wider range of functional ability in older adults.

The EPIC Kids Study: a randomized family-focused YMCA-based intervention to prevent type 2 diabetes in at-risk youth.

BackgroundIt is well established that behavioral lifestyle interventions resulting in modest weight reduction in adults can prevent or delay type 2 diabetes mellitus; however in children, successful weight management interventions are rarely found outside of controlled clinical settings. The lack of effective community-based programs is a barrier to reducing obesity prevalence and diabetes risk in children. The objective of our study is to develop and test a group-randomized family-centered community-based type 2 diabetes prevention intervention targeting at-risk children, 9- to 12-years-old.Methods/DesignUsing participatory methods, the adult-focused YMCA Diabetes Prevention Program was adapted for families, creating a novel lifestyle behavior change program focused on healthy eating, physical activity, and a supportive home environment. The program will be tested in sixty 9- to 12-year-old children at risk of diabetes and sixty parents over 12 consecutive weeks with two intervention formats randomized by location: a face-to-face instructor-led program, or a hybrid program with alternating face-to-face and mobile technology-delivered content. Anthropometric, behavioral, psychosocial and physiological outcomes will be assessed at baseline, post-intervention (12 weeks), and follow-up (24 weeks). Secondary outcomes are participant acceptability, feasibility, and adherence. The RE-AIM framework (reach, efficacy, adoption, implementation, and maintenance) will guide intervention implementation and evaluation. Changes at 12 weeks will be assessed using a paired t-test combining both delivery formats. Exploratory models using linear regression analysis will estimate the magnitude of the difference between the face-to-face and hybrid format. The sample size of 60 children, informed by a previous YMCA intervention in which −4.3 % change in overweight (SE = 1.1) was observed over 6 months, will give us 80 % power to detect an effect size of this magnitude, assuming a one-sided test at alpha = 0.05.DiscussionThe proposed study capitalizes on a partnership with the YMCA, a popular and widespread community organization, and uses mobile technologies to extend program reach while potentially reducing burden associated with weekly attendance. The long-term goal is to create a scalable, replicable, and sustainable pediatric “diabesity” prevention program that overcomes existing barriers to the translation of efficacious interventions into effective community programs.Trial registrationClinicalTrials.gov, NCT02421198 on April 15, 2015

Developing a Culturally Sensitive Lifestyle Behavior Change Program for Older Latinas.

Despite the burgeoning U.S. Latino population and their increased risk of chronic disease, little emphasis had been placed on developing culturally sensitive lifestyle interventions in this area. This article examines older Latinas' sociocultural context relative to health with the goal of developing a culturally sensitive health behavior intervention. Photo-elicitation indicated two emerging themes that influenced lifestyle choices: family caregiving and religion. Researchers partnered with a faith-based organization to develop and implement a 6-month lifestyle intervention for Latinas ages 50 and older: Abuelas en Acción (AEA). At completion, interviews were conducted to understand women's experiences and the influence AEA had on their lifestyles and health. Findings suggest that religious content empowered and deeply affected women; however, the intergenerational content presented significant challenges for instruction, retention, and implementation. We discuss findings in relation to the health intervention literature and provide suggestions for future interventions drawing on religion, family, and health behavior change.

Life style factors in common ailments reported by working women

This cross sectional exploratory sample survey on working women (N: 35) from urban areas uses a need based ‘Life Style Questionnaire’ (LSQ) comprising of two parts: (a) listing of 32 common ailments; and, (b) 25 statements on frequency and adherence to various life style practices. The respondents were instructed to answer these questions based on their recent experience of the symptomatic occurrence and frequency of the listed ailments vis-a-vis their related life style practices during the past three months. Results indicate a statistically significant mean difference in terms of frequency and magnitude of the common ailments by the respondent working women and also the risky life style behavioral practices indulged by them. These findings are true across all the studied co-variables like respondent age, job type, educational qualifications, family type or size, marital status, etc. The findings invite attention towards the need to plan life style behavior change programs for the affected population of at risk urban working women in the country.

Using lifestyle medicine in U.S. health care to treat obesity: too many bariatric surgeries?

More than one-third of Americans are classified as obese. Many clinicians perform bariatric surgery (BSx) when it is said that lifestyle intervention failed. However, BSx is medically complex, with extremely variable success, certain failures, major complications, and sometimes death. Although many studies declare BSx as more effective for producing weight loss than nonsurgical lifestyle management, these conclusions are flawed when lifestyle management between cohorts are not identical. Lifestyle behavior change is essential to success for both surgical and nonsurgical weight loss, as over 50% of BSx patients regain weight without lifestyle modification. Indeed, programs that include self-reward and reinforcement are extremely effective. It is therefore possible that successful BSx is simply an intrinsic reward for an intensive change in lifestyle behavior. Accounting for the costs and risks associated with BSx, providing state and federal resources for lifestyle behavior change programs could provide a key opportunity for the war against obesity.

Changes in Physical Functioning in the Active Living Every Day Program of the Active for Life Initiative®

Physical activity can prevent or delay the onset of physical functional limitations in older adults. There are limited data that evidence-based physical activity interventions can be successfully translated into community programs and result in similar benefits for physical functioning. The purpose of this study is to measure the effects of the Active Living Every Day program on physical functioning and physical functional limitations in a diverse sample of older adults. As a part of the Active for Life initiative, the Council on Aging of Southwestern Ohio implemented Active Living Every Day (ALED), a group-based lifestyle behavior change program designed to increase physical activity. Performance-based physical functioning tests (30-s Chair Stand Test, eight Foot Up-and-Go Test, Chair Sit-and-Reach Test, 30-Foot Walk Test) were administered to participants at baseline and posttest. Baseline to post-program changes in physical functioning and impairment status were examined with repeated measures analysis of covariance. Interactions tested whether change over time differed according to race/ethnicity, body mass index (BMI), and baseline impairment status. Participants significantly increased their performance in all four physical functioning tests. The percentage of participants classified as "impaired" according to normative data significantly decreased over time. Physical functioning improved regardless of BMI, race/ethnicity, or baseline impairment status. ALED is an example of an evidenced-based physical activity program that can be successfully translated into community programs and result in significant and clinically meaningful improvements in performance-based measures of physical functioning.

Active for Life: Final Results from the Translation of Two Physical Activity Programs

Most evidence-based programs are never translated into community settings and thus never make a public health impact. Active for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008. Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white). In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4. Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure. Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites. Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adult's health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

Evaluation of a community-based weight control program

Overweight and obesity result from a complex interaction of behavioral, environmental, and genetic factors. The present study reports on the efficacy of a community-based weight control program in 31 overweight and obese adults. TrymGym® is a multi-dimensional lifestyle behavior change program for improving both diet and physical activity (PA) related behavior with education and cognitive behavioral training. The program was evaluated using nutritional, physiological, and physical activity-related psychological factors before and after the 12 week program. Paired sample t-tests were conducted to identify significant changes. Body weight (BW) and diastolic blood pressure decreased by 3.6 and 6.4% respectively in completers of the study. Waist and hip circumferences decreased by 4.1 and 5.7% respectively. Caloric intake decreased from 1994 ± 146 at baseline to 1768 ± 144 in completers of the study. There was also a significant 5.2% decrease in the percentage of calories derived from fat and a 4% increase in percent of calories from protein. Although intake of vitamin C was increased at the end of the study, intake of several other micronutrients at baseline did not meet Dietary Reference Intake recommendations and were further compromised at week 12. Despite a trend toward increased participation in leisure-time and strenuous PA there was a decrease in behavioral intention to participate in future PA. Overall, this community-based weight control program was effective in fostering a significant improvement in BW, anthropometric measurements, participation in PA, and nutritional intake.

Efficacy of lifestyle behavior change programs in diabetes

Evidence that a comprehensive lifestyle behavior change program targeting eating and physical activity, and ultimately weight loss, can alter the course of diabetes progression is growing. This report summarizes data from major clinical trials primarily, describes key features of behavior change programs, and comments on existing challenges regarding the adequacy, sustainability, and feasibility of behavior change programs for weight loss and diabetes prevention.

Multifactorial Evaluation of a Program for Lifestyle Behavior Change in Rehabilitation and Secondary Prevention of Coronary Artery Disease

A comprehensive, multifactorial lifestyle behavior change program was developed for rehabilitation and secondary prevention of subjects with coronary artery disease. The purpose of the present report is to describe this intervention model and to analyze results achieved in a first group of consecutive participants. Main inclusion criteria for the 292 subjects were a recent history of acute myocardial infarction, coronary artery bypass surgery, or percutaneous transluminal coronary angioplasty. The program commenced with a 4-week residential stay, with the focus on health education and the achievement of behavior change in major lifestyle areas. During the year of follow-up a systematic maintenance program included regular contact with a nurse. Morbidity and mortality was low. Self-reported quality of life improved and there were significant improvements in blood lipids, exercise capacity and body mass index. There were also significant changes both in psychological variables such as Type A behavior, anger, hostility, and in major lifestyle areas such as stress reactions, diet, exercise and smoking. These changes compared favorably with data from relevant samples from the Swedish normal population. This program had a considerable effect on a number of important factors for rehabilitation and secondary prevention of coronary artery disease.