Lifestyle Coaching Research Articles

Recruitment and Retention in the National Diabetes Prevention Program Lifestyle Change Program in Two Federally Qualified Health Centers in Rural Hawai'i.

Prediabetes disproportionately affects racial and ethnic minority groups in Hawai'i. The National Diabetes Prevention Program lifestyle change program (National DPP LCP) decreases the risk of developing diabetes. However, enrolling and retaining participants is a challenge for program providers. This evaluation aimed to understand factors that influence racial and ethnic minority groups in Hawai'i to enroll in and complete the program. From 2018 through 2023, two federally qualified health centers (FQHCs) in rural Hawai'i administered 6 year-long cohorts. Trained lifestyle coaches, who were FQHC staff members, recruited participants and facilitated the evidence-based curriculum. In 2023, the evaluation team conducted semistructured interviews with 14 of the 40 enrolled participants (35%), all of whom were women aged 25 to 74 years. Six participants identified as Native Hawaiian or Other Pacific Islander and 3 as Filipino. Eight participants reported completing the program. We used qualitative methodology to analyze transcripts. We identified themes around motivators, barriers, facilitators, and suggestions for improvement. Recruitment by trusted individuals in their communities motivated participants to enroll. Caregiving and work obligations were attendance barriers for early withdrawers and graduates. Social support from lifestyle coaches and enrolled friends and family were facilitators for program completion. Suggestions included improving class availability and incorporating culturally relevant recipes. Barriers experienced by Native Hawaiian or Other Pacific Islander and Filipino participants were similar to those reported by racial and ethnic groups in other studies. Program providers in rural communities should use trusted individuals as lifestyle coaches and recruit family and friends, regardless of National DPP LCP eligibility, to reduce caregiving barriers and engage critical support systems to facilitate completion.

Empowering patients with heart failure: a digital health solution improved self-care and metabolic outcomes in a randomized controlled trial

Abstract Background/Introduction Heart failure is a common cause of morbidity and mortality and poses a significant burden on patients and healthcare providers. Purpose The aim of the study was to evaluate whether a digital health program improves quality of life and clinical outcomes for patients with heart failure. Methods A single-center, randomized controlled trial (RCT) was conducted with patients receiving standard of care (SoC) at a heart failure outpatient clinic. Patients were randomized (1:1) to receive either SoC alone or SoC with an additional six-month digital health program. The program consisted of remote patient monitoring (RPM) with symptom tracking, disease-specific education, and lifestyle coaching, designed to empower patients with heart failure. After the main program concluded, a six-month maintenance program was initiated, consisting of recurrent educational materials, with reduced coaching- and RPM frequency. The primary endpoint was the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at six months. Secondary endpoints included the European Heart Failure Self-care Behaviour Scale-9 (EHFScB-9), 6-question heart failure knowledge questionnaire, and metabolic outcomes. Here we report on the Intention-to-Treat (ITT) population analysis for the primary and significant secondary endpoints at six and 12 months. Results The ITT included 175 participants, 86 in the program group and 89 in the control. Program group: mean age (SD) 64.7 (13.2), 66.3% male, 87.2% with NYHA stages I-II. Control group: mean age (SD) 66.2 (11.1) years, 69.7% male, 87.6% with NYHA stages I-II. Median compliance with RPM was 93% and in-app retention was 80% at six months. Results for primary and secondary endpoints are presented in Table 1 and Figure 1. No statistical difference was observed in the KCCQ score between groups at six or 12 months. The program group had statistically significant improvements in EHFScB-9 score at six and 12 months and in heart failure knowledge at 12 months compared to the control group. Metabolic outcomes: a significant difference in glucose levels was also observed between groups at six months, and in HbA1c and triglycerides levels at 12 months. Conclusions The difference between groups in the primary endpoint of heart failure symptoms and quality of life, as measured by the KCCQ-12, was not statistically significant. However, significant differences were observed in self-care behaviour and heart failure knowledge, as well as metabolic outcomes at six and 12 months, when compared with standard care alone. These findings, along with good retention and engagement, indicate the value to patients of digital health interventions in the management of heart failure.

Learning by Doing: The Potential for Experiential Education in Health Promotion

Background: Rural populations face significant health disparities (e.g., high rates of chronic diseases) and unique accessibility barriers (e.g., limited healthcare facilities). Training higher education students to serve as facilitators for chronic disease prevention programs may address rural health promotion needs. Purpose: The purpose of this pilot, exploratory study was to create an experiential learning opportunity for students and examine their experiences. Methodology/Approach: Project leaders completed a Diabetes Prevention Program Lifestyle Coach training and, based on their experiences, created training program goals, content, and schedule. Undergraduate students in health-related programs or courses were recruited to participate. Four students completed a 4-week experiential training program and, at the end of the program, participated in an individual qualitative interview for researchers to understand their experiences. Findings/Conclusions: Data were analyzed through a qualitative-descriptive approach. The main theme, experiential learning, branched into two subthemes: (a) professional development and (b) program implementation and future program directions. Students’ experiential learning influenced their personal and programmatic views of prevention training. Implications: The benefits of experiential learning in prevention will enhance students’ education and future employment experiences. Future studies should improve upon training delivery and examine the acceptability of this method of delivery in the rural population.

Facilitators and barriers to implementing the Diabetes Prevention Program in rural church settings: A qualitative study using the Consolidated Framework for Implementation Research.

The CDC's Diabetes Prevention Program (DPP) is an effective lifestyle intervention to prevent type 2 diabetes (T2D). However, DPP implementation in rural areas is limited. This study sought to address this gap by implementing DPP in rural church settings through a community-academic partnership and identifying implementation facilitators and barriers. This was a cross-sectional qualitative study. Semistructured interviews guided by the Consolidated Framework for Implementation Research (CFIR) assessed church leaders' and lifestyle coaches' perceptions of implementing DPP in rural churches. Thematic analysis was used to identify key themes through an inductive approach; then, these emergent themes were deductively linked to CFIR constructs. COREQ guidelines were used to report study findings. Twenty-five stakeholders participated. Facilitators to implementing DPP included its evidence-based effectiveness in preventing T2D, as well as support from the academic partner in terms of funding, training, and communication. Additionally, DPP's alignment with community needs, along with the active engagement of pastors in participant recruitment, supported implementation. Several barriers hindered DPP implementation, including transportation and childcare issues, as well as program participants' medical conditions/disabilities limiting their participation. Furthermore, rural residents' reluctance to adopt lifestyle changes and loyalty to family churches posed challenges to their engagement in DPP. This study identified contextual factors influencing DPP implementation in rural communities. Findings highlight the importance of tailored strategies that leverage facilitators while proactively addressing barriers, including rural residents' reluctance to attend programs outside their church, resistance to lifestyle changes, and transportation issues to ensure successful DPP implementation in rural areas.

Implementation lessons learned from the University of California’s Diabetes Prevention Program Initiative

BackgroundThe University of California’s Diabetes Prevention Program (UC DPP) Initiative was implemented systemwide to address diabetes and obesity risk on all 10 campuses. As little is known about implementing lifestyle change programs in university settings, we examined implementation partners’ (i.e., UC DPP leaders and campus leads) perceptions of factors influencing program success on UC campuses.MethodsWe conducted qualitative interviews with UC DPP leaders and campus leads to examine challenges and opportunities with university-based DPP delivery models. Interviews were recorded, professionally transcribed, and reviewed in detail by the research team. Transcripts were analyzed using rapid qualitative analysis (RQA). The study was approved by the UCLA Institutional Review Board. All implementation partners provided verbal informed consent.ResultsTwenty-six implementation partners (8 UC DPP leaders and 18 campus leads) completed interviews in 2021. Seven themes were identified as critical for implementation, including (1) marketing and recruitment (i.e., market and recruit broadly through established channels as well as target at-risk populations); (2) enrollment (i.e., offer the program during convenient times and let participants know what to expect); (3) use an adaptable, evidence-based program; (4) secure funding for the program, participants, lifestyle coaches, and space; (5) hire experienced and dedicated staff and lifestyle coaches; (6) ensure leadership support; and (7) utilize campus linkages and resources. Perceptions of challenges faced with respect to these themes are also described.ConclusionsThis is one of the first studies to examine the challenges and opportunities of delivering an intensive lifestyle change program across 10 university sites. Understanding factors that enhance success of university-based diabetes prevention programs can facilitate UC DPP efforts and help inform delivery strategies of health and wellness programs across other university settings more broadly.

Effectiveness and Side Effect Incidence in a Real-World Digital Weight-Loss Service Using Compounded Semaglutide: A Retrospective Comparative Study

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were originally developed in the late 1980s as a class of antidiabetic medication. However, research over the past decade has found them to be a safe and effective weight-loss agent, which has led to the approval of GLP-1 RAs such as Semaglutide as a supplement to lifestyle obesity interventions in multiple countries. When Semaglutide has become commercially unavailable, digital weight-loss services (DWLSs) have prescribed a compounded form of the medication—a practice in which health professionals formulate a replica of the commercial medication to serve ongoing patient needs. Although compounding has been relatively common over the past century, prominent medical bodies have argued that compounding a relatively novel medication such as Semaglutide represents a major safety risk. This study retrospectively compared the weight and side effect outcomes of patients from a large Australian DWLS whose lifestyle coaching was supplemented with either compounded or pure Semaglutide (both groups following the same titration schedule). All data were extracted from the service’s central data repository. To be included in the weight loss analysis, patients needed to have received a minimum of four monthly medication orders between June 2023 and May 2024 and have submitted weight data between 90 and 150 days after the arrival of their first order. All patients who received at least one medication order within the same period were included in the side effect analysis. The mean four-month weight loss percentage was statistically lower in the compounded Semaglutide group (N = 923, M = 9.11, SD = ±5.76) compared to those in the pure Semaglutide group (n = 1858, M = 9.87, SD = ±6.46), t (2032) = −3.15, p = 0.0017. A statistically lower proportion of patients in the compounded Semaglutide group (71.61%) reported at least one side effect than patients in the pure Semaglutide group (77.40%) during the study period, X2 (1, N = 7683) = 32.32, p < 0.001. When side effects were disaggregated into severity categories, a statistical difference was only observed in mild side effects, X2 (1, N = 7683) = 59.16, p < 0.001. A significantly higher rate of patients from the pure Semaglutide group achieved the ten (50.54% vs. 44.64%), X2 (1, N = 7683) = 10.34, p < 0.001, and fifteen (21.42% vs. 12.78%), X2 (1, N = 7683) = 30.43, p < 0.001, percent weight loss thresholds than patients from the compounded Semaglutide group. The findings indicate that compounded Semaglutide can be used as a component of tightly controlled DWLSs with slightly less effectiveness and but with slightly lower side effect incidence when compared to pure Semaglutide.

The effectiveness and sustainability of health outcomes from a holistic digital weight-loss service with concomitant initiation of tirzepatide: A pragmatic randomized controlled trial in the UK.

To measure the effectiveness and sustainability of the Juniper UK digital weight-loss service (DWLS), which delivers 6 months of personalized, proactive lifestyle coaching supplemented with tirzepatide to patients through a multidisciplinary team (MDT). An observer-blinded randomized controlled trial (RCT) will be conducted on a cohort of non-diabetic patients of the Juniper DWLS in the UK. Participants in both the intervention and control groups will receive weekly subcutaneous injections of 2.5 mg tirzepatide for 4 weeks, uptitrating the dose to 5.0 mg from weeks 5 to 8, and by 2.5 mg every 4 weeks until reaching 15 mg in week 21, which they will maintain until the end of the intervention period at 6 months, when participants will be taken off the medication. The intervention group will receive personalized weeklylifestyle coaching with a focus on protein intake and resistance training for 6 months. Participants in the control group will attend a diet and exercise group counselling session at programme inception and will be sent a summary of the session's content at months 2 and 4. Aside from these events, health coaches will only interact with control group participants on a reactive basis. From month 6 to month 12, participants from both groups will no longer have access to their MDTs. The trial's co-primary endpoints include weight loss, fat-free to fat-mass ratio and composite strength measures at 12 months (6 months following the end of treatment), compared with baseline. Secondary endpoints include percentage change in weight, fat-free to fat-mass ratio, and composite strength from baseline to 6 months, side effect incidence, and change in cardiometabolic risk factors at 12 months. Quality of life and programme engagement represent the study's exploratory endpoints. A total of 688 participants enrolled in the study, with a mean age of 44.6 (± 11.4) years and a mean body mass index of 34.8 (± 7.5) kg/m2; 81.0% of participants are women, and 72.8% are of White ethnicity. More than three-quarters of participants have at least one co-morbidity, with dyslipidaemia (42.4%), hypertension (35.3%) and high cholesterol (31.8%) being the most prevalent conditions. This RCT will be the first to assess the effectiveness and sustainability of a real-world intensive, multidisciplinary DWLS, and it should highlight the potential of such a service for long-term obesity treatment compared with programmes that deliver standard health counselling.

Effect of an exercise intervention or combined exercise and diet intervention on health-related quality of life-physical functioning after kidney transplantation: the Active Care after Transplantation (ACT) multicentre randomised controlled trial

Robust evidence for interventions to improve health-related quality of life (HRQoL) in people who receive a kidney transplant is scarce. We aimed to assess the effects of a lifestyle intervention in this context. We conducted a multicentre, open-label, parallel-group, randomised controlled trial among people who have received a kidney transplant. Participants from six hospitals across the Netherlands were randomly assigned 1:1:1 by an independent company into: usual care, exercise, and exercise plus diet. The exercise intervention encompassed two phases, a 3-month supervised exercise programme (twice weekly) followed by 12months of lifestyle coaching, with 15months of additional dietary counselling (12 sessions) for the exercise plus diet group. The primary outcome was HRQoL-domain physical functioning, assessed using the 36-item Short Form Survey at 15months. From Oct 12, 2010to Nov 18, 2016, 221participants who had received a kidney transplant (138 [62%] male and 83 [38%] female, with a mean age of 52·5 [SD 13·5] years, who were a median of 5·5 [IQR 3·6-8·4] months post-transplant) were included and randomly assigned to usual care (n=74), exercise intervention (n=77), and exercise plus diet intervention (n=70). In the intention-to-treat analyses, at 15months post-baseline, no significant differences inHRQoL-domain physical functioning were found for the exercise group (5·3arbitrary units, 95% CI -4·2to 14·9; p=0·27), and the exercise plus diet group (5·9arbitrary units, -4·1to 16·0; p=0·25) compared with control. Safety outcomes showed no safety concerns. After 3months of supervised exercise intervention, HRQoL-domain physical functioning improved in the exercise group (7·3arbitrary units, 95% CI 1·2to 13·3; p=0·018) but not in the exercise plus diet group (5·8arbitrary units, -0·5to 12·1; p=0·072). A lifestyle intervention is safe and feasible in people who have received kidney transplants, paving the way for lifestyle intervention studies in other multimorbid populations with polypharmacy. However, improving HRQoL for people who have received a kidney transplant is challenging. The lifestyle interventions in the current study did not show significant improvements in HRQoL at the end of the study at the total group level. Dutch Kidney Foundation, Innovation Fund of the Dutch Medical Insurance Companies, and University Medical Center Groningen.

Adapting the National Diabetes Prevention Program: Learning from Lifestyle Coach strategies and adjustments during the COVID-19 pandemic in the United States

BackgroundThe National Diabetes Prevention Program (National DPP) is an evidence-based lifestyle intervention successfully disseminated across the United States. Some adaptations have been made to address real-world needs, including during the COVID-19 pandemic. This study aims to qualitatively describe adaptations Lifestyle Coaches made in response to the pandemic. MethodsBetween May and June 2021, Lifestyle Coaches (n = 300) from organizations across the United States answered open-ended survey questions about adjustments implemented during the pandemic. Survey responses were descriptively coded and codes were grouped into categories. ResultsNearly all coaches transitioned the format of their class from in-person to remote delivery (93.0 %; n = 279). Other commonly-reported strategies included adjusting contact with participants (48.0 %; n = 144), increasing support for participants (36.7 %; n = 110), and tailoring materials (28.3 %; n = 85). ConclusionsMaintaining these adaptations may address barriers to engagement in the National DPP and improve access to the program. Increased support for emotional symptoms and ensuring a patient-centered approach to care are particularly promising strategies.

The Walking and Lifestyle Coaching (WALC) Program for University Students: A Pilot Study

Background: The purpose of this study was to evaluate the implementation of the 3-week Walking and Lifestyle Coaching (WALC) program with university college students to promote health behavior change and reduce chronic disease risk. Methods: During the 3-week WALC program, students received weekly peer health and wellness coaching while engaging in a 30-minute walk throughout campus. Each week, physical activity was directly measured using pedometers, and self-report physical activity behavior, steps, and daily reflections were reported using a self-monitoring journal. At baseline and follow-up, students completed biometrics screening, mental health questionnaires, and the Cooper 1.5 mile walk test to evaluate cardiovascular fitness. Results: A total of 35 college students participated in the WALC program. The mean daily steps number of steps during the WALC program was 6315 ( SD = 2073.16). Only 25/35 participants reported steps for the entire WALC program (71.43%). There was not a statistically significant difference in generalized anxiety, perceived stress, depression, quality of life, or self-compassion. There was a slight decline in body fat percentage, although not statistically significant. There was an average improvement of 89 seconds on the 1.5-mile walk/run test. Discussion: The WALC program was developed to be inclusive, feasible, and a mechanism to synergize campus resources to collaborate on behalf of student wellness. It is necessary for this program to be utilized on university campuses in diverse geographical regions (i.e., rural, urban, or suburban), with diverse students (i.e., racially, ethnically, gender-identity, and religious affiliation.), and with universities of all sizes and funding levels. Future research could consider the use of a control group as well as an online self-monitoring journal.

Peer support for people with dementia: an exploratory study of two peer support models

In this article, perceived benefits, facilitators and challenges of peer support offered for and by people living with dementia are explored by comparing peer support provided by Dementia Lifestyle Coach (DLC) and Dementia Alliance International (DAI). Semi-structured interviews were conducted with interviewees from DLC and DAI. Interview recordings were transcribed verbatim and thematically analysed. Peer support offered by DLC and DAI provided connection and emotional and informational support and promoted living well with dementia. Each programme had unique barriers and facilitators. The article concludes that peer support for and by people living with dementia should be considered in post-diagnostic dementia support programmes.

Does Health Coaching Reduce the Risk of Type 2 Diabetes?

Even with decades of medical advancements and the National Diabetes Prevention Program, the incidence obesity and type 2 diabetes mellitus (T2DM) continues to rise. This pilot study explored the effect of lifestyle coaching on weight and engagement in care among adults with or at risk for prediabetes. It used a virtual, group health coaching program called Aligning Nutrition, Exercise and Wellbeing (ANEW-AP), facilitated by board-certified health coaches. Weight loss varied, yet no participants gained weight, and overall engagement in care slightly increased.

A multidomain lifestyle intervention to maintain optimal cognitive functioning in Dutch older adults—study design and baseline characteristics of the FINGER-NL randomized controlled trial

BackgroundEvidence on the effectiveness of multidomain lifestyle interventions to prevent cognitive decline in older people without dementia is mixed. Embedded in the World-Wide FINGERS initiative, FINGER-NL aims to investigate the effectiveness of a 2-year multidomain lifestyle intervention on cognitive functioning in older Dutch at risk individuals.MethodsMulti-center, randomized, controlled, multidomain lifestyle intervention trial with a duration of 24 months. 1210 adults between 60–79 years old with presence of ≥ 2 modifiable risk factors and ≥ 1 non-modifiable risk factor for cognitive decline were recruited between January 2022 and May 2023 via the Dutch Brain Research Registry and across five study sites in the Netherlands. Participants were randomized to either a high-intensity or a low-intensity intervention group. The multidomain intervention comprises a combination of 7 lifestyle components (physical activity, cognitive training, cardiovascular risk factor management, nutritional counseling, sleep counseling, stress management, and social activities) and 1 nutritional product (Souvenaid®) that could help maintain cognitive functioning. The high-intensity intervention group receives a personalized, supervised and hybrid intervention consisting of group meetings (on-site and online) and individual sessions guided by a trained lifestyle coach, and access to a digital intervention platform that provides custom-made training materials and selected lifestyle apps. The low-intensity intervention group receives bi-monthly online lifestyle-related health advice via the digital intervention platform. Primary outcome is 2-year change on a cognitive composite score covering processing speed, executive function, and memory.ResultsWithin 17 months, participant recruitment has been successfully completed (N = 1210; mean age: 67.7 years (SD: 4.6); 64% female). Modifiable risk factors commonly present at baseline were physical inactivity (89%), low mental/cognitive activity (50%), low social engagement (39%), hypertension (39%) and high alcohol consumption (39%). The mean body mass index of participants was 28.3 (SD: 4.2) and the total serum cholesterol was 5.4 mmol/L (SD: 1.2).ConclusionsBaseline lifestyle and clinical measurements showed successful recruitment of participants with sufficient potential for prevention. Results of FINGER-NL will provide further insight into the efficacy of a multidomain lifestyle intervention to prevent cognitive decline in older adults.Trial registrationClinicalTrials.gov (ID: NCT05256199)/2022–01-11.

Stoffwechselflexibilität – eine wichtige Grundlage des Behandlungserfolgs: Prospektive Kohortenstudie über den Einfluss der osteopathischen Lebensstilberatung auf die metabolische Flexibilität

Metabolic flexibility is the ability of the metabolism to efficiently adapt to the food supply and energy requirements. It is ensured by healthy mitochondria and a balanced hormone system, and it is important for osteopaths as it is essential for the healthy interplay of bodily functions. A loss of metabolic flexibility leads to insulin resistance and is linked to many conditions that we treat in practice on a daily basis. By means of lifestyle advice, osteopaths can increase the effect of their treatments. An adapted lifestyle prevents the circulation of pro-inflammatory cytokines and obesogenic and pathogenic concentrations of certain hormones, leading to improved self-healing powers.Based on a prospective study, we show that lifestyle counseling by osteopaths, accompanied by lifestyle coaches, has positive effects on metabolic flexibility and thus on metabolic health. We osteopaths can ensure a healthy metabolism and are well advised to point out the health-promoting effects of carbohydrate restriction and fasting to our patients.

Barriers, facilitators, and other factors associated with health behaviors in childhood, adolescent, and young adult cancer survivors: A systematic review.

Healthy behaviors are paramount in preventing long-term adverse health outcomes in childhood, adolescent, and young adult (CAYA) cancer survivors. We systematically reviewed and synthesized existing literature on barriers, facilitators, and other factors associated with health behaviors in this population. MEDLINE and PsycInfo were searched for qualitative and quantitative studies including survivors aged 16-50 years at study, a cancer diagnosis ≤25 years and ≥2 years post diagnosis. Health behaviors included physical activity, smoking, diet, alcohol consumption, sun exposure, and a combination of these behaviors (defined as health behaviors in general). Barriers, facilitators, and other factors reported in ≥2 two studies were considered relevant. Out of 4529 studies, 27 were included (n = 31,905 participants). Physical activity was the most frequently examined behavior (n = 12 studies), followed by smoking (n = 7), diet (n = 7), alcohol (n = 4), sun exposure (n = 4), and health behavior in general (n = 4). Relevant barriers to physical activity were fatigue, lack of motivation, time constraints, and current smoking. Relevant facilitators were perceived health benefits and motivation. Influence of the social environment and poor mental health were associated with more smoking, while increased energy was associated with less smoking. No relevant barriers and facilitators were identified for diet, alcohol consumption, and sun exposure. Barriers to healthy behavior in general were unmet information needs and time constraints whereas lifestyle advice, information, and discussions with a healthcare professional facilitated healthy behavior in general. Concerning other factors, women were more likely to be physically inactive, but less likely to drink alcohol and more likely to comply with sun protection recommendations than men. Higher education was associated with more physical activity, and lower education with more smoking. This knowledge can be used as a starting point to develop health behavior interventions, inform lifestyle coaches, and increase awareness among healthcare providers regarding which survivors are most at risk of unhealthy behaviors.

The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial.

Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)-based lifestyle coaching program on achieving BP control among adults with hypertension. Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI -7.1 to -4.2; P<.001) and 3.8 mm Hg (95% CI -4.7 to -2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI -12.2 to -6.9; P<.001) and 5.7 mm Hg (95% CI -7.6 to -3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI -10.1 to -6.1; P<.001) and 5.1 mm Hg (95% CI -6.2 to -3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI -17.7 to -10.7; P<.001) and 8.1 mm Hg (95% CI -10.4 to -5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks. The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734.

A randomised controlled intervention trial to study the effect of a personalised lifestyle programme on cancer-related fatigue among colorectal cancer survivors: protocol for the SoFiT study.

Observational studies suggest that a healthy diet in combination with ample physical activity is associated with a lower prevalence of cancer-related fatigue. The SoFiT trial (SoFiT: Study on Fatigue: a lifestyle intervention among colorectal cancer survivors) will assess the effect of a personalised lifestyle programme on cancer-related fatigue in a randomised study. We designed a programme that aims to increase adherence to lifestyle recommendations on diet and physical activity. The programme was person-centred with regard to the lifestyle and personal characteristics of participants, to the determinants of behaviour of that participant, and to the preferences, opportunities and barriers of the participant. The effect of the programme was tested in the SoFiT trial: a two-armed, parallel, randomised controlled trial among adult stage I-III colorectal cancer survivors, who experience cancer-related fatigue after treatment completion; intended sample size n=184. Participants randomised to the intervention group received the personalised lifestyle programme. During 6 months, participants in the intervention group had individual sessions with a lifestyle coach of which four sessions were face-to-face and eight sessions were remote. After 6 months, participants randomised to the control group had access to two lifestyle coaching sessions and to the same materials that the intervention group also received. The primary endpoint of the trial is cancer-related fatigue. Secondary endpoints are sleep quality and duration, health-related quality of life, physical performance, depression and anxiety, skeletal muscle echo intensity and cross-sectional area, and gut microbiota composition. This trial will show the effects of a personalised lifestyle programme on cancer-related fatigue and on an extensive set of secondary outcomes. Clinicaltrials.gov: NCT05390398.

Liraglutide (Saxenda) Combined with Lifestyle Coaching for Weight Loss in a Bariatric Center

Introduction: Overweight and obesity should be viewed as chronic diseases, for which liraglutide (Saxenda) might be a treatment option. The aim of the current study is to describe a real-world experience with the use of liraglutide combined with lifestyle coaching in a bariatric center. Methods: A retrospective study including all patients (n=124) who enrolled in our lifestyle coaching program combined with the use of liraglutide. Discussion: Liraglutide was well tolerated. After 1 year of treatment, median Total Weight Loss (TWL) was 11.5% and decrease in total body weight at 4-, and 6-months post initiation were 8.7% and 9.9%, respectively. At 6 months after start of the treatment, 89% had lost at least 5% of their body weight and 52% of participants lost at least 10%. Disappointment in weight loss or effect on satiety are reasons to stop using liraglutide. Conclusion: The use of liraglutide is well-tolerated and associated with clinically meaningful weight loss in a cohort with a mean BMI of 36 kg/m2 . Gastrointestinal symptoms are not the main reason to stop using liraglutide. Reasons for patients to stop treatment with liraglutide are disappointment in weight loss or effect on satiety and appetite, predominantly after 6 months of use.

Abstract P290: Telephone Lifestyle Coaching - Sex Differences in Referrals and Enrollment During National Implementation

Objectives: Telephone Lifestyle Coaching (TLC) is an evidence-based program providing individualized telephone coaching and self-management support to Veterans working on personalized, healthy living SMART goals. Given the flexibility of telephone support, we explored sex differences in TLC referrals and enrollment. We focus on sex to identify potential opportunities with virtual/telephone prevention programs in VA. Methods: Since March 2019, 44 VA sites have implemented TLC nationwide. Under VA’s QUERI rapid response evaluation program, we examined sex differences in referrals and enrollment with logistic regression controlling for demographics, mental and physical health, prior participation in a VA Whole Health Program and VA’s MOVE! Weight Management Program, and site-level clustering. The sample included all Veterans with at least one primary care visit one year prior to starting TLC. Results: As of 12/31/22, a total of 11,719 Veterans had at least one TLC referral, with 9,514 enrolled (82%), totaling 122,233 encounters. For both referrals and enrollment, mean age was 54, with 33% female, 29% Black, 7% Hispanic, and 34% with rural residence. In adjusted models, female Veterans had increased odds of being referred (OR=2.40, CI:1.89-3.05) and enrolling (OR=1.27, CI:1.13-1.42) compared to male Veterans. Odds of referral were higher for younger Veterans (OR=0.98, CI:0.97-0.98), those with depression (OR=1.62, CI:1.46-1.81), PTSD (OR=1.45, CI:1.21-1.73), overweight/obesity (OR=2.38, CI:1.58-3.57), at least one cardiovascular (CV) risk (OR=1.94, CI:1.63-2.30), and prior participation in Whole Health (OR=2.46, CI:1.74-3.51) or MOVE! (OR=6.40; CI:4.02-10.19). Similar associations with enrollment were observed, except Veterans with depression had decreased odds of enrollment (OR=0.84, CI:0.750.93), and effects for PTSD and CV risks were not significant. Conclusions: TLC demonstrated success in reach and engagement of female Veterans at rates above their national proportions in VA care. Referrals targeted weight and CV risk consistent with Veteran clinical needs. Our findings suggest that prior participation with MOVE! and Whole Health may facilitate engagement. Mental health diagnoses were not a barrier to referral, but depression status may reduce patient participation. Impact: TLC and virtual modalities of lifestyle coaching may have broader application for reaching and engaging female Veterans, as well as Veterans with mental health and CV risks who can benefit from health behavior change to optimize care.

Abstract MP17: Sustained Improvements in Liver Fat Reduction and Cardiometabolic Health at Nine Months After a 12 Week Digital Health Program in Individuals With Non-Alcoholic Fatty Liver Disease - A Feasibility Study

Introduction: Behavioral changes can improve health outcomes, but maintaining improvements can be challenging. A 12-week digital health program for Non-Alcoholic Fatty Liver Disease (NAFLD) was previously shown to be feasible in terms of patient engagement, program retention, and improvements in clinical markers of liver and cardiometabolic health. Here, we report on retention and clinical measurements after a 6-month maintenance program. Hypothesis: We hypothesized that improvements in cardiometabolic health can be sustained six months beyond an active program’s duration. Methods: A prospective, open label, single arm, 12-week long study was first conducted, where a digital health program was delivered through the Sidekick app with emphasis on disease education, lowering dietary carbohydrates, increasing activity levels, reducing stress and lifestyle coaching. Individuals with either BMI&gt;30, metabolic syndrome or type 2 diabetes were screened for NAFLD with a FibroScan assessment. Data collection included demographics, anthropometric and clinical measurements, MRI-PDFF for liver fat content, dual-energy X-ray absorptiometry for body composition and blood tests. Measurements were done at baseline, 12 weeks and nine months. Once the 12-week program concluded, a six-month maintenance program was initiated with no new educational materials and the health coaching ceased. During the maintenance program the participants retained access to the app with recurring educational content. Summary statistics were calculated for all participants who started the health program. Missing values at follow-up were imputed using baseline observation carried forward. Results: In total, 38 individuals were included in the study and 34 (89%) completed the 12-week program, of which 28 (83%) attended the third and final follow-up visit at nine months. The median population age was 59.5 [IQR 46.3,68.8] years and 23 (60.5%) were females. At month nine the mean weight loss compared to baseline was 4.0 kg (SD=5.0) (p&lt;0.001) with 5.2% (SD=10.0) reduction in fat mass (p&lt;0.001). The average relative liver fat reduction was 18.4% (SD=30.5) (p&lt;0.001). Systolic blood pressure decreased by 8.3 mmHg on average (SD=13.4) (p&lt;0.001), diastolic blood pressure by 2.5 mmHg (SD=6.0) (p=0.015) and waist circumference by 4.7 cm (SD=7.1) (p&lt;0.001). According to a sensitivity analysis the observed changes were not explained by changes in medication. Previous changes in triglyceride levels were not maintained. In the final week, 50% (19/38) of the users were retained in the app. Conclusion: This study suggests that improvements after a 12-week digital health program can be sustained at nine months despite coaching cessation. We observed sustained improvements for weight loss, liver fat, blood pressure and body composition. This approach could provide a new tool to obtain and maintain improvements in NAFLD.