Lifestyle Change Program Research Articles

Randomized Trial for Weight Loss Using a Digital Therapeutic Application.

Smartphones present a near-ubiquitous channel through which structured lifestyle change can reduce risk or progression of the most common noncommunicable diseases. We explored whether a digital structured lifestyle program enhances weight loss. We randomized overweight and obese participants attending a four-month lifestyle change program to either standard weekly coaching sessions (controls), or standard treatment supplemented with a digital therapeutic mobile application (intervention). Changes in body mass index after four months were the main outcome measure. Odds ratios of achieving 5% weight loss were estimated with unconditional logistic regression. Of 234 eligible persons, 146 (62%) agreed to participate, were block-randomized, showed up for the baseline measures, and constituted the intention-to-treat (ITT) sample (n = 95 intervention group, n = 51 control group). In the intervention group, 70 (74%) downloaded the mobile application and completed the program (intervention per-protocol). Significant weight loss and BMI reduction were observed for both the intention-to-treat intervention group (P < 0.05, P = 0.01) and the per-protocol intervention group (P < 0.0001, P < 0.0001). For the intervention per-protocol group, the odds ratio of achieving 5% weight loss, compared to not treated per-protocol, was 3.3 (95% CI 1.3-8.2), adjusting for age and weight at baseline.Attendance to weekly coaching sessions decreased by 18% during the program in the control group while it increased by 3% amongst the per-protocol group (P = 0.004). These preliminary findings support the benefit of a digital therapeutic to enhance weight reduction and attendance in a structured lifestyle change program. Larger trials of longer duration are needed to confirm these findings.

Contemplation‐action‐maintenance model of behaviour change for persons with coronary heart disease: A qualitative study

To explore factors of health behaviour maintenance from the perspective of coronary heart disease (CHD) patients. The majority of CHD patients do not achieve appropriate theory-based intervention to maintain health behaviours. Previous health behaviour change theories give little importance to behaviour maintenance. A qualitative descriptive study. Thirty CHD patients were recruited purposively and interviewed from four hospitals in Beijing, China during January 2017-August 2019. Data were analyzed using template analysis methods. The COREQ checklist was used. Perceived enjoyment and perceived effectiveness from the newly adopted behaviours emerged as vital factors for maintaining health behaviour; contemplation-action-maintenance (CAM) model to explain the behaviour change and maintenance of CHD patients was constructed. The CAM model provides insight into the factors of health behaviour action and maintenance among CHD patients. Professionals can develop interventions from the perspective of patients' experiences to promote maintenance of behaviour. Relevance to clinical practice Professionals need to consider that the goal of behavioural intervention should initially and continuously target patients' perseverance. Interventions of health behaviour that bring enjoyment may aid long-term maintenance. Also, health care providers can enhance patients' perception of effectiveness to motivate their behaviour maintenance in lifestyle change programs.

Progression to diabetes by baseline glycemic status among middle-aged and older adults in the United States, 2006–2014

AimsPrimary prevention studies have indicated that structured lifestyle change programs in adults with an annual diabetes risk of 4.7% are cost-effective. However, few population-based studies have quantified the risk of diabetes among adults with prediabetes. MethodsWe used the nationally representative U.S. Health and Retirement Study to identify adults aged ≥ 52 years with prediabetes (A1c: 5.7% − 6.4%) in 2006 and followed them to 2014 to assess diabetes status defined by A1c ≥ 6.5% in 2010 or 2014 or by self-report of a diabetes diagnosis by various risk factors. ResultsAmong the 1,406 adults with prediabetes (average 4.7 years of follow-up), risk factors significantly associated with subsequent incident diabetes with adjusted annual risk of diabetes ≥ 4.7% were: male gender (4.8%); aged 52–64 years (5.0%); Black race (5.5%); obesity (body mass index (kg/m2) ≥ 30.0, 6.8%); large waist circumference (women: > 35 in.; men: > 40 in., 4.9%); C-reactive protein levels ≥ 3 ug/L (5.5%); treated for high cholesterol (4.7%); treated for hypertension (5.3%); and moderate mobility loss (4.8%). ConclusionsPrimary prevention interventions among adults with prediabetes who also have moderate mobility loss or well-known risk factors for diabetes are likely to be cost-effective.

Prediabetes screening intervention used to promote a lifestyle change program

BackgroundAccording to the 2020 Centers for Disease Control and Prevention (CDC) report on diabetes in the United States, an estimated 88 million Americans have prediabetes. A study found that those who were aware that they had prediabetes were more likely to engage in diabetes risk-reducing behaviors. There is no current literature supporting methods to promote a lifestyle change program (LCP), which were proven effective at lowering the risk of prediabetes. We theorized that the results of this study may be used to justify the screening intervention to promote this LCP. ObjectiveThe objective of this study was to describe the impact of a prediabetes risk–screening intervention on (1) increasing awareness of participants’ risk of prediabetes and (2) enrollment in the LCP. MethodsThe screening intervention consisted of informed consent, preintervention survey, intervention, and postintervention survey. The intervention included the CDC Prediabetes Screening Test, body mass index calculation, and brief risk counseling. Participants who had a CDC Prediabetes Screening Test score lower than 9 were released from counseling and the postintervention survey. Eligible participants were offered enrollment in the LCP. Preintervention and postintervention survey scores were compared using paired t tests, with significance set at P ≤ 0.05. ResultsOf the 53 total participants, 46 screened positive on the CDC Prediabetes Screening Test. Of these 46 participants, 33 met the CDC eligibility requirements for the LCP. Of these 33 participants, 12 enrolled in the LCP, which was the same number as a previous pilot study. Mean survey scores increased from 9.41 to 9.65 out of 10 (P = 0.002). Overall, 89.1% (N = 46) of participants reported that the intervention increased their awareness of the risk of prediabetes. ConclusionThe prediabetes screening intervention successfully increased awareness of risk of prediabetes, both quantitatively and according to participant report. The intervention led to equivalent enrollment in the LCP as the previous pilot year.

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.

Impact of lifestyle change plus dental care programme on stress levels and periodontal status in chronic periodontitis patients

Impact of lifestyle change plus dental care programme on stress levels and periodontal status in chronic periodontitis patients

A Feasibility Evaluation of an Employee-led Brief Health Promotion Program to Promote Lifestyle Change in the Workplace.

Background:In Japan, lifestyle-related diseases are a major issue. It is necessary to support employees in making lifestyle changes. As a result, this study intended to test and evaluate the feasibility of a brief lifestyle change program led by employees in the workplace.Methods:A 2-group before-and-after test design was used, with employees from a plant in Japan as participants. Intervention was carried out by healthcare specialists for the Standard Intervention Group, while employees who previously received the same intervention performed it for the Employee-run Group. Data were collected twice with a questionnaire, provided in the first and last program sessions. The conditions of the participants during the intervention were compared.Results:Of all the participants, 96 were in the Standard Intervention Group and 365 were in the Employee-run Group. The mean age did not differ significantly between the 2 groups. There was a significantly higher ratio of men and night shift workers in the Employee-run Group. Although a significantly smaller proportion of participants set shared behavioral goals for 3 people or self-monitored their lifestyle habits in the Employee-run Group, the lifestyle habits of self-checking, physical measurement, and other items for set goals did not differ.Conclusions:Participants in the Employee-run group completed components of the program to the same extent as those in the Standard Intervention Group, suggesting that this program is feasible. However, as the participation rate was lower in some components, improvements to the program and workbook are needed to make those components easier to complete.

Intermittent and continuous energy restriction result in similar weight loss, weight loss maintenance, and body composition changes in a 6 month randomized pilot study.

Poor adherence is a barrier to successful weight control. Intermittent energy restriction (IER) provides an alternative approach to those for whom daily energy restriction is not ideal. This study assessed changes in weight, body composition, and macronutrient intake for an IER and a continuous energy restriction (CONT) approach within a multicomponent weight management intervention. We randomized 35 adults with overweight/obesity (BMI = 31.2 ± 2.4 kg/m2 ) to CONT or IER for 24 weeks (12-week weight loss intervention and 12 weeks of weight loss maintenance). Diets were delivered within a multimodal weight management program including weekly group meetings with a registered dietitian, increased physical activity, and a comprehensive lifestyle change program. Retention and adherence were similar for CONT and IER. Weight, BMI, fat mass, percentage body fat, waist circumference, hip circumference, blood pressure, and heart rate all decreased after 24 weeks (all, P < .01), but there were no main effects of group (all, P > .27). Weight loss was clinically relevant in both CONT (11.38 ± 7.9%) and IER (9.37 ± 9.7%), and the proportion of each group achieving 5% weight loss was 82 and 61% (P = .16), respectively. Participant satisfaction was high in both groups. The results from this study (a) support the feasibility of IER as an alternative for weight loss and weight loss maintenance, (b) indicate that IER is an effective alternative to CONT for weight control and improvements in body composition, and (c) emphasize the importance of intensive lifestyle interventions with ongoing support for effective behaviour modification.

Effectiveness of a Group-Based Lifestyle Change Program Versus Usual Care: An Electronic Health Record, Propensity Score–Matched Cohort Study

Translational lifestyle change programs for community and clinical settings have been available for a decade, yet there are limited data on their comparative effectiveness. This study examines the effectiveness of a Centers for Disease Control and Prevention-aligned lifestyle change program relative to usual care in clinical practice. This was an electronic health record-based retrospective cohort study conducted in a community-based healthcare system. Investigators identified adult program participants and usual-care patients in the electronic health record between 2010 and 2018 and defined their index date (baseline) as the first lifestyle change program encounter or a random encounter date, respectively. Participants were matched 1:2 to usual-care patients on baseline demographics and clinical characteristics using propensity-score methods. Changes in body weight and blood pressure were examined from baseline through 24 months. The authors identified 2,833 program participants and 438,432 usual-care patients meeting study eligibility criteria. A total of 2,833 program participants were matched to 4,776 usual-care patients; the average age was 54 years, and 80% of the participants were female. Program participation was associated with a 1.9- and 1.6-fold higher prevalence of clinically meaningful (≥5%) weight loss at 12- and 24-month follow-up than usual care and a higher prevalence of blood pressure control at 12 months but not at 24 months. Patients without type 2 diabetes at baseline had more pronounced outcomes than those with type 2 diabetes. This study demonstrates the effectiveness of an evidence-based, Centers for Disease Control and Prevention-aligned lifestyle change program in reducing cardiometabolic risk factors compared with usual care in clinical practice, with long-term reductions in weight and transient reductions in blood pressure.

Abstract 16831: Effect of a Virtual Cardiac Rehabilitation Program on Functional Capacity and Risk Factor Modification in Veterans With Ischemic Heart Disease

Background: Cardiac rehabilitation (CR) is a comprehensive lifestyle change program proven to reduce cardiovascular disease (CVD) risk and improve quality of life in patients with ischemic heart disease but remains highly underutilized (&lt;20% of eligible patients) due to the inconvenience and cost of attending a facility-based program. We evaluated the efficacy of a home-based, virtual CR program using mobile health (mHealth) in veterans with coronary artery disease (CAD) on improving functional capacity, CVD risk factors, and depressive symptoms. Methods: We enrolled 196 Veterans with a qualifying CR diagnosis between May 2016 and April 2020. All participants underwent baseline functional evaluation with a 6-minute walk test (6MWT), followed by a 12-week home-based, virtual CR program delivered via the Movn smartphone app (Movn by Moving Analytics). The Movn app featured daily alerts to exercise, a digital diary to record activity and vital signs, and connectivity with a health coach who remotely monitored participants through an integrated dashboard and scheduled weekly phone visits. We compared the risk factor profile pre-intervention versus post-intervention with paired t-tests. Results: Among enrolled Veterans, the mean (SD) age was 61 (9) years, 95% were male, and 50% were black. A majority (63%) completed the full 12-week virtual CR program including an exit visit. Participants completed an average of 10.4 ± 1.9 (range 3–13) phone visits with the coach. There were concurrent improvements in 6MWT distance (443.9 vs. 481.9 meters; mean difference [MD], 38 meters; 95% CI, 26.6 – 50.8, P&lt;0.001), low-density lipoprotein cholesterol (80 vs. 69 mg/dL, MD, -10.9; 95% CI, -17.9 to -3.9, P=0.003), body mass index (31.1 vs 30.8; MD, -0.33; 95% CI, -0.60 to -0.06; P=0.001), and PHQ-9 depression scores (7.4 vs. 6; MD, -1.4, 95% CI, -2.4 to -0.44; P=0.005) among program completers. Conclusions: Among veterans with ischemic heart disease, a virtual CR program results in moderate improvements in functional capacity, CVD risk factors, and mood. The durability of these effects and whether virtual CR improves longer-term outcomes such as readmissions, survival, and cost remain to be determined.

Adaptions to the National Diabetes Prevention Programme lifestyle change curriculum by Hawai‘i Federally Qualified Health Centers: a qualitative descriptive study

ObjectiveThe objective of this qualitative study was to describe the community-appropriate and culturally appropriate adaptations made by lifestyle change programme (LCP) coaches to the National Diabetes Prevention Programme curriculum for...

The effects of financial incentives on diabetes prevention program attendance and weight loss among low-income patients: the We Can Prevent Diabetes cluster-randomized controlled trial

BackgroundPenetration and participation of real life implementation of lifestyle change programs to prevent type 2 diabetes has been challenging. This is particularly so among low income individuals in the United States. The purpose of this study is to examine the effectiveness of financial incentives on attendance and weight loss among Medicaid beneficiaries participating in the 12-month Diabetes Prevention Program (DPP).MethodsThis is a cluster-randomized controlled trial with two financial incentive study arms and an attention control study arm. Medicaid beneficiaries with prediabetes from 13 primary care clinics were randomly assigned to individually earned incentives (IND; 33 groups; n = 309), a hybrid of individual- and group-earned incentives (GRP; 30 groups; n = 259), and an attention control (AC; 30 groups; n = 279). Up to $520 in incentives could be earned for attaining attendance and weight loss goals over 12 months. Outcomes are percent weight loss from baseline, achieving 5% weight loss from baseline, and attending 75% of core and 75% of maintenance DPP sessions. Linear mixed models were used to examine weight change and attendance rates over the 16 weeks and 12 months.ResultsThe percent weight change at 16 weeks for the IND, GRP, and AC participants were similar, at − 2.6, − 3.1%, and − 3.4%, respectively. However, participants achieving 5% weight loss in the IND, GRP, and AC groups was 21.5, 24.0% (GRP vs AC, P < 0.05), and 15.2%. Attendance at 75% of the DPP core sessions was significantly higher among IND (60.8%, P < 0.001) and GRP (64.0%, P < 0.001) participants than among AC (38.6%) participants. Despite substantial attrition over time, attendance at 75% of the DPP maintenance sessions was also significantly higher among IND (23.0%, P < 0.001) and GRP (26.1%, P < 0.001) participants than among AC (11.0%) participants.ConclusionsFinancial incentives can improve the proportion of Medicaid beneficiaries attending the 12-month DPP and achieving at least 5% weight loss.Trial registrationClinicalTrials.govNCT02422420; retrospectively registered April 21, 2015.

Randomized nutrient bar supplementation improves exercise-associated changes in plasma metabolome in adolescents and adult family members at cardiometabolic risk.

Poor diets contribute to metabolic complications of obesity, insulin resistance and dyslipidemia. Metabolomic biomarkers may serve as early nutrition-sensitive health indicators. This family-based lifestyle change program compared metabolic outcomes in an intervention group (INT) that consumed 2 nutrient bars daily for 2-months and a control group (CONT). Overweight, predominantly minority and female adolescent (Teen)/parent adult caretaker (PAC) family units were recruited from a pediatric obesity clinic. CONT (8 Teen, 8 PAC) and INT (10 Teen, 10 PAC) groups randomized to nutrient bar supplementation attended weekly classes that included group nutrition counseling and supervised exercise. Pre-post physical and behavioral parameters, fasting traditional biomarkers, plasma sphingolipids and amino acid metabolites were measured. In the full cohort, a baseline sphingolipid ceramide principal component composite score correlated with adiponectin, triglycerides, triglyceride-rich very low density lipoproteins, and atherogenic small low density lipoprotein (LDL) sublasses. Inverse associations were seen between a sphingomyelin composite score and C-reactive protein, a dihydroceramide composite score and diastolic blood pressure, and the final principal component that included glutathionone with fasting insulin and the homeostatic model of insulin resistance. In CONT, plasma ceramides, sphinganine, sphingosine and amino acid metabolites increased, presumably due to increased physical activity. Nutrient bar supplementation (INT) blunted this rise and significantly decreased ureagenic, aromatic and gluconeogenic amino acid metabolites. Metabolomic changes were positively correlated with improvements in clinical biomarkers of dyslipidemia. Nutrient bar supplementation with increased physical activity in obese Teens and PAC elicits favorable metabolomic changes that correlate with improved dyslipidemia. The trial from which the analyses reported upon herein was part of a series of nutrient bar clinical trials registered at clinicaltrials.gov as NCT02239198.

An Examination of Gender Differences in the National Diabetes Prevention Program's Lifestyle Change Program.

The purpose of the study was to examine how gender was related to enrollment and number of sessions attended in the National Diabetes Prevention Program's Lifestyle Change Program (DPP LCP). To better understand program uptake, a population of those who would be eligible for the LCP was compared to those who enrolled. Estimates of those eligible were computed using data from the National Health and Nutrition Examination Survey, whereas enrollment and sessions attended were computed using data from the Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program. Results revealed that although similar numbers of males and females were eligible for the program, only 39 321 males versus 121 007 females had enrolled in the National DPP LCP by the end of 2017 (odds ratio = 3.20; 95% CI, 3.17-3.24). The gender differences persisted even when stratifying by age or race/ethnicity. In contrast, no significant gender differences were found between the average number of sessions attended for males (14.0) and females (13.8). Results of the study can help inform efforts to market and tailor programs to appeal more directly to men and other groups that are underrepresented in the National DPP LCP.

Patient Preferences in Surveillance: Findings From a Discrete Choice Experiment in the "My Follow-Up" Study.

Approximately 800 000 people die globally from colorectal cancer (CRC) every year. Prevention programs promote early detection, but for people with precancerous lesions, tailoring surveillance to include lifestyle-change programs could enhance prevention potential and improve outcomes. Those with intermediate or high-risk polyps removed during CRC screening colonoscopy within the Northern Ireland CRC Screening Programme were invited to complete 8 discrete choice questions about tailored surveillance, analyzed using random-parameters logit and a latent class modeling approach. A total of 231 participants (77% male) self-reported comorbid hypertension (53%), high cholesterol (48%), and mean body mass index of 28.7 (overweight). Although 39% of participants were unaware of their CRC risk status, 30.9% indicated they were already making changes to reduce their risk. Although all respondents were significantly risk- and cost-averse, the latent class analysis identified 3 segments (classes): 1. Class 1 (26.8%) significantly favored phone or email support for a lifestyle change, a 17-month testing interval, and noninvasive testing. 2. Class 2 (48.4%) preferred the status quo. 3. Class 3 (24.7%) significantly favored further risk reduction and invasive testing. This is the first documented preference study focusing on postpolypectomy surveillance offering lifestyle interventions. Although current care is strongly preferred, risk and cost aversion are important for participants. Latent class analysis shows that some respondents are willing to change diet and lifestyle behaviors, reflecting a teachable moment, with opportunities to personalize and optimize surveillance. Significant discordance between perceived and known risk of recurrence and limited recall of risk information provided within current practice suggest necessary improvements to surveillance programs.

Calcium intake is inversely associated with body fat in postmenopausal women

Calcium intake seems to be inversely associated with body fat in several populations; however, little is known about this relationship in postmenopausal women. This study aimed to associate calcium intake with body fat mass in postmenopausal women. A cross-sectional study was performed with 107 postmenopausal women who entered in a lifestyle change program. The dietary intake was estimated through three 24-h food recalls. Body fat mass was evaluated by dual-energy X-ray absorptiometry (DXA). Linear regression analyzes were performed associating body fat variables (total fat mass, body fat percentage, trunk fat, gynoid and android fat mass; and body mass index) with calcium intake. After adjustments for age; carbohydrate, protein, lipids and fiber intakes; and physical activity, it was observed that calcium intake (mg/day) was inversely associated with total fat mass (kg and percentage), trunk fat mass (kg), gynoid and android fat mass (kg). Calcium intake was not associated with body mass index, although a tendency was observed (p=0.062). Calcium intake was inversely associated with body fat mass in postmenopausal women.

Retention Among Participants in the National Diabetes Prevention Program Lifestyle Change Program, 2012-2017.

To assess retention in the National Diabetes Prevention Program (DPP) lifestyle change program, which seeks to prevent type 2 diabetes in adults at high risk. We analyzed retention among 41,203 individuals who enrolled in Centers for Disease Control and Prevention (CDC)-recognized in-person lifestyle change programs at organizations that submitted data to CDC's Diabetes Prevention Recognition Program during January 2012-February 2017. Weekly attrition rates were typically <1-2% but were between 3.5% and 5% at week 2 and at weeks 17 and 18, where session frequency typically transitions from weekly to monthly. The percentage of participants retained through 18 weeks varied by age (45.9% for 18-29 year olds, 53.4% for 30-44 year olds, 60.2% for 45-54 year olds, 66.7% for 55-64 year olds, and 67.6% for ≥65 year olds), race/ethnicity (70.5% for non-Hispanic whites, 60.5% for non-Hispanic blacks, 52.6% for Hispanics, and 50.6% for other), mean weekly percentage of body weight lost (41.0% for ≤0% lost, 66.2% for >0% to <0.25% lost, 72.9% for 0.25% to <0.5% lost, and 73.9% for ≥0.5% lost), and mean weekly physical activity minutes (12.8% for 0 min, 56.1% for >0 to <60 min, 74.8% for 60 to <150 min, and 82.8% for ≥150 min) but not by sex (63.0% for men and 63.1% for women). Our results demonstrate the need to identify strategies to improve retention, especially among individuals who are younger or are members of racial/ethnic minority populations and among those who report less physical activity or less early weight loss. Strategies that address retention after the first session and during the transition from weekly to monthly sessions offer the greatest opportunity for impact.

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.

Physical fitness and activity changes after a 24-week soccer-based adaptation of the U.S diabetes prevention program intervention in Hispanic men

PurposeOne third of the U.S. adult population is estimated to have prediabetes. Hispanics have a 50% higher type 2 diabetes (T2DM) death rate compared to non-Hispanic whites, yet low participation in lifestyle change programs, making this subgroup an important target for prevention efforts. The purpose of this study was to determine the effects of an exercise intervention implementing the Center for Disease Control and Prevention National Diabetes Prevention Program (NDPP) plus recreational soccer (RS) in Hispanic men. MethodsOverweight and obese Hispanic men, aged 30–57 years with prediabetes at screening were recruited from the community. Trained soccer coaches led 30-min facilitated discussion of the NDPP modules after each RS session, with two weekly sessions delivered over 12 wks, then once a wk until 24 wks. The 1-h RS sessions followed the Football Fitness curriculum structure. Standardized study assessments included objectively measured physical activity via fitness tracker, physical fitness via validated field tests, global positional system soccer specific metrics and behavior change questionnaires. Mixed models assessed the outcomes as a function of time and cohort and incorporated an unstructured covariance structure to examine the difference between baseline, 12 and 24 wks. All analyses were conducted as intent-to-treat and generated using SAS v 9.4. RESULTS: Hispanic males (n = 41; mean age 41.9 [6.2 SD] years) were obese at baseline (mean BMI 32.7, standard error [0.7]). After 24 wks of the NDPP+RS intervention, there were significant beneficial changes in vertical jump (2.8 [1.3] cm; p = 0.048), agility and lower extremity muscular power (figure 8-run) at 12 wks (−4.7% change; p = 0.001) and 24 wks (−7.2% change; p < 0.0001), predicted VO2 max (12 wks: 1.9%; p = 0.007; 24 wks 1.0%; p = 0.036), modified push-ups increased 22% (p < 0.0001) at 12 wks and 31% (p < 0.0001) at 24 wks, dynamic sit-ups increased 10% (p = 0.005) at 12 wks and 15% (p < 0.0001) at 24 wks. CONCLUSION: Among middle-aged Latino men, broad-ranging significant improvements in physical fitness were observed after 24 wks participating in lifestyle education plus RS in a single arm feasibility trial.

2238-PUB: A Diabetes Prevention Evaluation Model for Health Care Organizations: Pilot Results for Target Population

Health care organizations play a critical role in diabetes prevention by identifying and managing individuals with prediabetes. This project piloted a systematic diabetes prevention evaluation ’M.A.P. model’. The framework’s key components includes the ’M’ related to ’measuring accurately’ by identifying adults with prediabetes; the ’A’ related to ’acting rapidly’ by initiating treatment specifically, referral to a National Diabetes Prevention Program (DPP) lifestyle change program (LCP); and the ’P’ related to ’partnering with patients’ to support treatment participation in a LCP. The model was implemented at 3 grantee sites focused on building capacity to address diabetes prevention in a target disparate population of women who identify as Black and/or Hispanic. Aggregate data for a 12-month baseline period for the ’M’ metric found that the total number of adults at risk for abnormal glucose with laboratory tests ordered averaged only 57% (39-69%) of those eligible and 61% (39-69%) for those sites participating in the intervention. Documentation of a prediabetes diagnosis with an ICD-10 code was 51% (42-65%) for the total and 58% (42-65%) among the participating sites. The ’A’ metric submitted by 2 sites to date found only 8% (7-9%) of all patients and 10% (9-42%) of target population patients eligible for the LCP had a clinical referral order. Data for the ’P’ metric submitted by 1 site to date reported a 25% enrollment rate, of which 86% consisted of the target population, and 91% were referred from a primary care provider rather than a self-referral. The findings highlight that tracking metrics related to diabetes prevention in health care organizations is feasible. The initial results suggest that a structured evaluation model can help organizations and clinical care teams identify opportunities for improvement and guide targeted activities to increase prediabetes patient identification, National DPP LCP referrals, and program enrollment and completion rates. Disclosure T. Khan: None. A. Hughes: None. N. Sachdev: None. A. Balan: None. D. Pere: None. Funding Centers for Disease Control and Prevention (6NU38OT000289-01-01)