Lifestyle Management Interventions Research Articles

Patient, facility, and environmental factors associated with obesity treatment in US Veterans.

Identifying patient-, facility-, and environment-level factors that influence the initiation and retention of comprehensive lifestyle management interventions (CLMI) for urban and rural Veterans could improve obesity treatment and reach at Veterans Affairs (VA) facilities. This study identified factors at these various levels that predicted treatment engagement, retention, and weight management among urban and rural Veterans. A retrospective cohort study of 631,325 Veterans was designed using VA databases to identify Veterans with class II and III obesity during 2015-2017. Primary outcomes were initiation of CLMI, bariatric surgery, or obesity pharmacotherapy within 1year of index date. Secondary outcomes included treatment retention and successful weight loss. Generalized linear mixed models were used to evaluate the relationships between factors and obesity-related outcomes, with rurality differences assessed through interaction terms. Patient characteristics associated with increased odds of initiating CLMI included female sex (p<0.001), black race (p<0.001), sleep apnea (p<0.001), mood disorder (p<0.001), and use of medications associated with weight loss (p<0.001) or weight gain (p<0.001). Facility use of telehealth was associated with greater odds of CLMI initiation in urban Veterans (p<0.001) but lower retention in both populations (p=0.003). Routine consideration of pharmacotherapy was associated with higher CLMI initiation. Environmental characteristics associated with increased odds of CLMI initiation included percent of population foreign born (OR=1.03 per 10% increase; p<0.001), percent black (p<0.001), and high walkability index (p<0.001). The relationship between total population and CLMI initiation differed by rurality, as greater population was associated with lower odds of CLMI initiation in urban areas (OR: 0.99 per 1000 population; p<0.001), but higher odds in rural areas (OR:1.01, p=0.01). Veterans in the south were less likely to initiate CLMI and had lower retention (p<0.001). Treatment and retention of CLMI among Veterans remain low, highlighting areas for improvement to expand its reach both urban and rural Veterans.

Responses of the Serum Lipid Profile to Exercise and Diet Interventions in Nonalcoholic Fatty Liver Disease.

This study aimed to assess the response patterns of circulating lipids to exercise and diet interventions in nonalcoholic fatty liver disease (NAFLD). The 8.6-month four-arm randomized controlled study comprised 115 NAFLD patients with prediabetes who were assigned to aerobic exercise (AEx; n = 29), low-carbohydrate diet (Diet; n = 28), AEx plus low-carbohydrate diet (AED; n = 29), and nonintervention (NI, n = 29) groups. Hepatic fat content (HFC) was quantified by proton magnetic resonance spectroscopy. Serum lipidomic analytes were measured using liquid chromatography-mass spectrometry. After intervention, the total level of phosphatidylcholine (PC) increased significantly in the AEx group ( P = 0.043), whereas phosphatidylethanolamine (PE) and triacylglycerol decreased significantly in the AED group ( P = 0.046 and P = 0.036, respectively), and phosphatidylserine decreased in the NI group ( P = 0.002). Changes of 21 lipid metabolites were significantly associated with changes of HFC, among which half belonged to PC. Most of the molecules related to insulin sensitivity belonged to sphingomyelin (40 of 79). Controlling for the change of visceral fat, the significant associations between lipid metabolites and HFC remained. In addition, baseline serum lipids could predict the response of HFC to exercise and/or diet interventions (PE15:0/18:0 for AED, area under the curve (AUC) = 0.97; PE22:6(4Z,7Z,10Z,13Z,16Z,19Z)/0:0 for AEx, AUC = 0.90; and PC14:1(9Z)/19:1(9Z) for Diet, AUC = 0.92). Changes of lipidome after exercise and/or diet interventions were associated with HFC reductions, which are independent of visceral fat reduction, particularly in metabolites belonging to PC. Importantly, baseline PE could predict the HFC response to exercise, and PC predicted the response to diet. These results indicate that a circulating metabolomics panel can be used to facilitate clinical implementation of lifestyle interventions for NAFLD management.

The Medicine Wheel as a public health approach to lifestyle management interventions for indigenous populations in North America.

This analytic essay intends to elevate Medicine Wheel, or generally "four directions" teachings, to encourage a more comprehensive alignment of lifestyle intervention components with traditional ecological knowledge systems of Indigenous cultures in North America. North American Medicine Wheels provided people with a way to orient themselves both within their traditional belief systems and to the seasonal changes in their areas, improving survivability. The wheel or circle is a sacred symbol, indicating the continuity and perpetuity of all of life. The four directions are iconized in many Indigenous cultures across North America with different directions representing different aspects of our world and of ourselves, different seasons of the year and of our lives, different beings of the earth and tribes of humans with a balance among those necessary for health and wellbeing. In the context of public health, teachings of the four directions warn that a lack of balance limits our ability to achieve optimal health. While there is much public health success in lifestyle interventions, existing practice is limited by a siloed and one size fits all approach. Medicine Wheel teachings lay out a path toward more holistic and Indigenous-based lifestyle intervention that is modifiable depending on tribal teachings and needs, may appeal to a variety of Indigenous communities and is in alignment with health behavior change theory. It is a public health imperative that lifestyle management interventions are fully optimized to rigorously determine what can be achieved when interventions are implemented in a holistic and Indigenous-based manner, and in alignment with an Indigenous model of health. This more complete alignment would allow for a stronger foundation to further explore and develop social determinants (i.e., housing, employment, etc.) and structural intervention enhancements to inform public health practice and promote health equity.

Social Media-Delivered Lifestyle Interventions Among Individuals Living with Diabetes and Prediabetes: A Scoping Review.

There is a lack of synthesized evidence on social media-delivered lifestyle interventions for managing and preventing diabetes. This scoping review aims to evaluate recently reported lifestyle interventions delivered on social media for individuals with diabetes and prediabetes. Twelve studies were included in this review. A team of multidisciplinary healthcare professionals coordinated most interventions, half of which lasted for 6months, and used a combination of videos, texts, images or audio to deliver the educational materials. The glycosylated hemoglobin (HbA1c) level improved in most of the studies, followed by diabetes self-care and fasting plasma glucose. The dietary intakes were only assessed in two interventions among the individuals with prediabetes and showed promising improvements. This scoping review provides a holistic overview of the recent designs of lifestyle interventions for diabetes management and prevention on social media. This is essential for various healthcare professionals and stakeholders to formulate and implement population-based, cost-effective interventions in combating diabetes using social media.

Online exercise program for men living with obesity: Experiences, barriers, and enablers

The prevalence of obesity is increasing among men, and this population remains under-represented in lifestyle and weight management interventions. The current study aims to explore the experiences of men living with obesity (body fat ≥25 %) toward a 12-week supervised online exercise platform. Ten men were interviewed for this qualitative study. Semi-structured, open-ended phone interviews were conducted, and the transcripts were thematically coded using the qualitative data analysis Nvivo QSR software package. The research findings are illustrated using quotes from participants. The results were organized into two main themes: those that removed barriers to exercise and those that improved the enablers of exercise. Eliminating barriers included not purchasing specialized equipment or travelling to a gym facility. The enablers to their success with the program included the structured format of the circuit program and having supervised sessions. By removing barriers and enhancing enablers, the 12-week online exercise circuit program increased compliance to and success of the exercise program for men living with obesity. Future research should explore the long-term effects of an online program for men living with obesity and its appeal beyond COVID-19.

Epidemiological impact of public health interventions against diabetes in Qatar: mathematical modeling analyses.

To predict the epidemiological impact of specific, and primarily structural public health interventions that address lifestyle, dietary, and commuting behaviors of Qataris as well as subsidies and legislation to reduce type 2 diabetes mellitus (T2DM) burden among Qataris. A deterministic population-based mathematical model was used to investigate the impact of public health interventions on the epidemiology of T2DM among Qataris aged 20-79 years, which is the age range typically used by the International Diabetes Federation for adults. The study evaluated the impact of interventions up to 2050, a three-decade time horizon, to allow for the long-term effects of different types of interventions to materialize. The impact of each intervention was evaluated by comparing the predicted T2DM incidence and prevalence with the intervention to a counterfactual scenario without intervention. The model was parameterized using representative data and stratified by sex, age, T2DM risk factors, T2DM status, and intervention status. All intervention scenarios had an appreciable impact on reducing T2DM incidence and prevalence. A lifestyle management intervention approach, specifically applied to those who are categorized as obese and ≥35 years old, averted 9.5% of new T2DM cases by 2050. An active commuting intervention approach, specifically increasing cycling and walking, averted 8.5% of new T2DM cases by 2050. Enhancing consumption of healthy diets including fruits and vegetables, specifically a workplace intervention involving dietary modifications and an educational intervention, averted 23.2% of new T2DM cases by 2050. A subsidy and legislative intervention approach, implementing subsidies on fruits and vegetables and taxation on sugar-sweetened beverages, averted 7.4% of new T2DM cases by 2050. A least to most optimistic combination of interventions averted 22.8-46.9% of new T2DM cases by 2050, respectively. Implementing a combination of individual-level and structural public health interventions is critical to prevent T2DM onset and to slow the growing T2DM epidemic in Qatar.

Design and methods of a translational, community-based, lifestyle weight management pilot intervention trial in breast cancer survivors with overweight or obesity

BackgroundBreast cancer survivors (BCS) with overweight or obesity are at heightened risk of cancer recurrence, cardiometabolic disease, and compromised quality of life. Given the prevalence of significant weight gain during and following breast cancer treatment, there is growing recognition of the need to develop efficacious, widely-accessible, weight management programs for BCS. Unfortunately, access to evidence-based weight management resources for BCS remains limited and little is known of the optimal theoretical basis, program components, and mode of delivery for community-based interventions. The primary aim of the Healthy New Albany Breast Cancer (HNABC) pilot trial was to determine the safety, feasibility, and preliminary efficacy of delivering a translational, evidence-based, and theory-driven lifestyle weight management intervention to BCS with overweight or obesity in the community setting. MethodsHNABC was a single-arm, pilot trial evaluating a 24-week, multi-component intervention leveraging exercise, dietary modification, and group-mediated cognitive behavioral (GMCB) counseling components designed to facilitate lifestyle behavior change and promote sustained independent adherence. Assessments of various objectively-determined and patient-reported outcomes and theory-derived determinants of behavioral adoption and maintenance were obtained at baseline, 3- and 6-month follow-up. Measures of trial feasibility were calculated prospectively throughout the study. ConclusionFindings from the HNABC pilot trial will provide evidence demonstrating the feasibility and preliminary efficacy of a multi-component, community-based, GMCB lifestyle weight management intervention for BCS. Results will inform the design of a future, large-scale, randomized controlled efficacy trial. If successful, this approach could offer a widely accessible, community-based intervention model for weight management programs in BCS.

Antipsychotics in Treatment of Schizophrenic Patients with Past Medical History of Coronary Artery Disease

Antipsychotic use in schizophrenia has been linked with a myriad of negative cardiovascular outcomes including the recurrence of coronary artery disease. This article evaluates the pathological mechanisms that correlate the relationship between antipsychotic use in schizophrenia and coronary artery disease in a patient predisposed to the condition. The study hypothesizes that certain atypical antipsychotics can increase the risk of recurrence of CAD accompanied by the development of metabolic syndrome, diabetes mellitus, and lipid disorders in a chronic schizophrenia patient. Additionally, it is essential to address the problem of the knowledge gap due to insufficient data and limitations of the undertaken study group. Extending the research on specific disorders such as metabolic syndrome and exploring the topic of medication compliance with patients is vital. Lifestyle management and pharmacological intervention significantly reduce mortality and morbidity due to CAD in schizophrenia patients.

What lifestyle management interventions are needed for atrial fibrillation?

What lifestyle management interventions are needed for atrial fibrillation?

An integrated approach for obesity management: the effectiveness of glucagon-like peptide 1 agonist and life-style interventions for obesity management

Background. The obesity is found in 24.8% (approximately 10 million people) and overweight in 34.3% of the population of Ukraine, mainly in females. Obesity is associated with hereditary factors, overeating as well as a sedentary lifestyle. An integrated approach is applied to treat obesity such as combination of adequate eating behavior, high physical activity and administration of pharmacological correction, including glucagon-like peptide 1 agonist (GLP-1). Currently, the little is known about utility and effectiveness of GLP-1 in combination with adequate physical activity for obesity management among Ukrainian patients. The purpose of this study was to determine and evaluate the role of GLP-1 in combination with high physical activity for weight loss in obese patients and to compare with obese patients receiving treatment with metformin and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Materials and methods. A prospective study included 155 obese patients, and follow-up data were available of 49 patients. The study group GLP-1 consisted of 30 patients receiving combination therapy GLP-1 liraglutide in daily doses of 1.2 to 3 mg per day. The control group consisted of 19 patients receiving complex therapy with metformin in daily doses from 500 to 2000 mg, and SGLT2i in daily doses from 10 to 12.5mg. Body mass index (BMI), waist circumference (WC), hip circumference (HC), and WC/HC ratio were evaluated. Number of daily steps was determined using pedometers built into smartphones or smartwatches. Evaluation of the obtained data was performed using non-parametric statistical methods. Results. In study group GLP-1 the mean weight before the treatment was 104.6kg, after treatment 96.36 kg (p=0.000007), the mean weight lost was 7.8% (range 1–23.71%) of initial body weight. Mean BMI before treatment was 37.1 kg/m2, after treatment 34.11kg/m2 (p=0.000006). In the control group, the mean weight before the treatment was 99.4 kg, after treatment 91.74 kg (p=0.000196), the mean weight lost was 7.73% (range 0–16.9%) of initial body weight. Mean BMI before treatment was 35.6kg/m2, after treatment 34.11 kg/m2 (p=0.000196). Analyses of the entrie chorot showed that before treatment, the daily number of steps &gt;5000/day was determined in 25 (51%) patients, after treatment in 48 (98%); the daily number of steps &gt;10,000/day before treatment was determined in 6 (11%) patients, after treatment it was 5 times more frequent in 31 (63%) patients. These results indicate a significant intensification of physical activity, and high motivation for weight loss in both study groups. Conclusions. Our findings suggest that weight loss in obese people is effective in case of administration of GLP-1, metformin, SGLT2i in combination with high physical activities of daily steps &gt;5000, which is part of life style intervention.

The Effectiveness of Santri’s Life Style Management on Santri’s Coping Mechanisms

BACKGROUND: Santri is someone who is studying to deepen knowledge about Islam seriously in boarding school. Life changes will be experienced by Santri. Santri who is used to living at home and living dependent on their parents is then required to live in Islamic boarding schools so that Santri must accept unexpected conditions. Santri must change their previous life habits and have to adapt back to everyday life that is already different, for example, in making decisions, solving problems, and completing responsibilities as a student, when Santri has been given a choice, the Santri is expected to be able to accept it. AIM: The purpose of this study was to analyze the effect of lifestyle management on the coping mechanisms of Santri. METHODS: The design of this research is quasi-experimental (pre-and post-test control group design). The samples in this study were Santri in Islamic boarding schools in Surabaya and Sidoarjo which were taken by probability sampling (multi stage sampling) with 78 treatment groups and 75 control groups. Data analysis used t test with a significance value of p &lt; 0.05. This research questionnaire uses that the coping mechanism (Jalowiec Coping Scale) has reliability (r = 0.8) and the validity test gets that the Cronbach alpha value is 0.7. RESULTS: The Santri’ coping mechanisms in the intervention group were 68.6 (adaptive coping mechanisms) and 45.7 in the control group (maladaptive coping mechanisms) with p = 0.00. The results of the paired t-test statistical test obtained p = 0.000 in the intervention group and obtained p = 0.35 in the control group, p &lt; 0.05, it can be concluded that there is a significant change in the coping mechanisms of Santri before and after being given lifestyle management interventions in intervention group and control group. CONCLUSION: Lifestyle management is effective in improving Santri’ coping mechanisms in dealing with a problem.

1255Associations between select lifestyle behaviours and quality of life based on MS phenotype

Abstract Background Multiple sclerosis (MS) comprises progressive and non-progressive phenotypes, both presenting with symptoms that may reduce quality of life (QoL). Lifestyle behaviours, including diet, exercise, and wellness activities, are associated with higher QoL, however little is known about differences by MS phenotype. We assessed associations between lifestyle behaviours and QoL, between progressive vs non-progressive MS. Methods Self-reported cross-sectional data from the iConquerMS study (n = 1,109) were analysed. Lifestyle behaviours were queried via tick-box options for diet-type, supplement use, and wellness activities; and physical activity via Godin-Shephard Leisure-Time Physical Activity Questionnaire. QoL was queried via Neuro-QoL. Linear regression, adjusted for age, sex, BMI, education, disability, and MS duration, was used to assess associations and moderation analyses to assess differences between MS phenotypes. Results Diet-type, physical activity, and wellness activities were associated with specific QoL subdomains. Only associations between diet and physical activity, with QoL subdomains, differed between phenotypes. Anti-inflammatory diets were associated with a 1.5-point increase in mobility in progressive MS. In non-progressive MS, high physical activity was associated with a 3.6-point decrease in depression, and a 4.2-, 2.3- and 3.0-point increase in positive affect, fine motor skills, and social participation, respectively. Conclusions Specific lifestyle behaviours were associated with QoL subdomains. Associations between diet and physical activity with QoL differed between MS phenotype. Key messages Specific lifestyle behaviours are associated with higher QoL. Lifestyle interventions for MS management should consider disease course.

Culturally tailored lifestyle interventions for the prevention and management of type 2 diabetes in adults of Black African ancestry: a systematic review of tailoring methods and their effectiveness.

To evaluate the cultural tailoring methods used in type 2 diabetes (T2D), prevention and management interventions for populations of Black African ancestry and to examine their effectiveness on measures of glycaemia. Three databases were searched in October 2020; eligible studies used a randomised controlled trial (RCT) design to evaluate the effectiveness of culturally tailored lifestyle interventions compared with usual care for the prevention or management of T2D in adults of Black African ancestry. Cultural tailoring methods were evaluated using the Facilitator-Location-Language-Messaging (FiLLM) framework, whereby facilitator refers to delivery by individuals from the target community, language focuses on using native language or language appropriate to literacy levels, location refers to delivery in meaningful settings, and messaging is tailoring with relevant content and modes of delivery. Sixteen RCT were identified, all from USA. The mean age of participants was 55 years, majority female. Six of fifteen RCT reported significant improvements in glycated haemoglobin (HbA1c) at 6 and 8 months; one, in prediabetes, reported significantly improved fasting plasma glucose. Diabetes knowledge improvement (5/7 studies) was associated with HbA1c improvement. The majority tailored to location (12/16), facilitators (11/16), messaging (9/16) and language (6/16) domains of FiLLM. Those with ethnically matched facilitators and those which tailored to more than one domain showed the greatest HbA1C benefits. This evidence supports the effectiveness of culturally tailored lifestyle interventions for T2D management in populations of Black African ancestry, with further RCT needed to evaluate interventions for T2D prevention and for communities outside of the USA.

Yoga-based Lifestyle Intervention for Prevention and Management of Type 2 Diabetes Mellitus and Associated Complications: A Clinical Research Review

Yoga-based Lifestyle Intervention for Prevention and Management of Type 2 Diabetes Mellitus and Associated Complications: A Clinical Research Review

Results of a Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Healthy Eating and Lifestyle after Stroke

ObjectivesAlthough healthy lifestyle practices mitigate recurrent stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a occupational therapy-based lifestyle management intervention, Healthy Eating And Lifestyle after Stroke (HEALS), to improve stroke survivors’ self-management skills relating to diet and physical activity and evaluated it in a diverse safety-net population. Materials and MethodsOne hundred English- or Spanish-speaking participants with stroke or transient ischemic attack were randomized to a 6-week occupational therapist-led group lifestyle intervention vs. usual care. Each of the six 2-h group sessions included didactic presentations on diet and physical activity, peer exchange, personal exploration with goal setting, and direct experience through participation in a relevant activity. Primary outcomes at 6 months were change in body mass index, fruit/vegetable intake, and physical activity. Secondary outcomes included change in waist circumference, smoking, blood pressure, high-density lipoprotein, low-density lipoprotein, triglyceride, total cholesterol, glycosylated hemoglobin levels, quality of care, and perceptions of care. Effect sizes were determined in preparation for a larger randomized controlled trial powered to detect a difference in primary outcomes. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and intervention adherence. ResultsThere were no significant changes in primary or secondary outcomes at 6 months. Effect sizes for all outcomes were small (< 0.2). Focus group participants recommended extending the intervention program duration with more sessions, additional information on stroke and vascular risk factors, an interdisciplinary approach, additional family involvement, and incentives. Providers recommended longer program duration, more training, fidelity checks to ensure standardized program delivery, and additional incentives for participants. ConclusionsThe HEALS intervention was feasible in a safety-net setting, but effect sizes were small. A longer-duration intervention, with intervener fidelity checks may be warranted. Trial RegistrationNCT01550822.

Stress and cancer-related lifestyle factors among African American heterosexual couples.

Intimate partners can have a profound influence on individuals’ health behaviors. In this exploratory research, we investigated the concordance of cancer-related lifestyle factors including smoking, body mass index, physical activity, fruit and vegetable intake, red meat intake, and alcohol use within African American heterosexual couples. We also examined whether females’ stress is associated with their own (actor effect) and males’ cancer-related lifestyle factors (partner effect), and vice versa. We analyzed a total of 216 heterosexual couples (i.e., N = 432 individuals) recruited from black churches. Intraclass correlation coefficients (ICCs) were calculated and multilevel modeling in which individuals are nested within couples was conducted. Results showed that there was high concordance of body mass index (ICC = 1.68, p < .001), fruit and vegetable intake (ICC = 1.62, p < .001), red meat intake (ICC = 1.50, p = .001), and alcohol use (ICC = 1.74, p < .001) between spouses. A multilevel analysis showed that there were actor and partner effects of stress on females’ BMI; females’ stress was positively associated with their own BMI (actor effect; β = .42, p = .006) and males’ stress was positively associated with females’ BMI (partner effect; β = .39, p = .026). Also, females’ stress was positively associated with their own red meat intake (actor effect; β = .20, p = .019). In conclusion, high concordance of cancer-related lifestyle factors (BMI, fruit and vegetable intake, red meat intake and alcohol use) exists between African American spouses. Given the identified actor and partner effects of stress on females’ BMI, a couple-based lifestyle or weight management intervention that targets both male and female spouses’ stress and coping will be promising, particularly to enhance African American women’s health behaviors. Future studies need to investigate mechanisms underlying concordance and discordance of cancer-related lifestyle factors in African American couples. Also, factors that explain African American male spouses’ health behaviors need to be uncovered.

Lifestyle interventions after ablation for atrial fibrillation: a systematic review.

Risk factors of atrial fibrillation include diabetes, obesity and physical inactivity. Positive effects such as decreased atrial fibrillation burden have been reported for atrial fibrillation patients who have participated in lifestyle changing interventions after atrial fibrillation ablation treatment. The aim of this study was to assess the evidence on the benefits and harms of lifestyle and risk factor management interventions in patients undergoing atrial fibrillation ablation. Our systematic review searched MEDLINE, EMBASE, CINAHL, Psychinfo, Web of Science and CENTRAL using key terms related to atrial fibrillation and lifestyle, including interventional trials. The primary outcomes were mortality and serious adverse events. Random effects meta-analyses of outcomes were conducted when appropriate. Two randomised controlled trials and two non-randomised interventional trials with a total of 498 patients were included. Six primary events were reported for the intervention groups and five events for the control groups (relative risk of 1.03, 95% confidence interval (CI) 0.3 to 3.1, I2 0%, P = 0.537). Effects in favour of the intervention groups were found for atrial fibrillation frequency (0.82 points, 95% CI -1.60 to -0.03, I2 87.3%, P = 0.005), atrial fibrillation duration (-0.76 points, 95% CI -1.64 to 0.12, I2 89.1%, P = 0.002) and body mass index (-5.40 kg/m2, 95% CI 6.22 to -2.57, I2 83.9%, P = 0.013). Risk of bias in the four studies was judged to be low to moderate. Lifestyle changing interventions seem to have a positive effect on outcomes relevant to patients undergoing atrial fibrillation ablation, but the included studies were small, interventions were inhomogeneous, and the quality of evidence was low to moderate. More studies are warranted.

Secondary-prevention behaviour-change strategy for high-risk patients: Benefits for all classes of body mass index.

Research is needed to support the long-term benefits of lifestyle interventions for management of high-risk patients with different BMI classifications. This prospective multicentre study assessed two-year outcomes of hospital-referred patients (BMI 25-61 kg/m2 ) attending a dietitian-led multidisciplinary Healthy Eating and Lifestyle Behaviour-Change Program in group or individual formats in hospital outpatient settings. Bodyweight, quality of life (Short Form-12) and intuitive eating (Intuitive Eating Scale) data were collected at pre-intervention, post-intervention and 2 years. Outcomes were reported in BMI classes. At pre-intervention (n = 493), 11% had pre-obesity, 25% obesity class I, 30% obesity class II and 34% obesity class III. Characteristics of participants with available data at post-intervention (n = 290) and 2 years (n = 178) were comparable (P > .05). Significant mean weight loss was seen at post-intervention (-2.0 ± 0.4 kg, P < .001, n = 290) and 2 years (-4.3 ± 0.5 kg, P < .001, n = 178). All BMI classes had significant weight losses (P < .05). Participants with higher obesity (classes II and III) had greater improvements in mental quality of life (P < .05) and initial weight reductions (P < .05) than those with lower classes. However, those with obesity class I had the greatest long-term weight reductions and significant improvements in physical quality of life at 2 years (P < .05). All BMI classes reported similar improvements in intuitive eating. No effect was found for differences in intervention format, duration or setting (P > .05). The results support dietitian-led multidisciplinary lifestyle interventions for multidisciplinary management of high-risk patients of all BMI classes.

A Mobile Lifestyle Management Program (GlycoLeap) for People With Type 2 Diabetes: Single-Arm Feasibility Study.

BackgroundSingapore’s current prevalence of diabetes exceeds 13.6%. Although lifestyle modification can be effective for reducing the risks for complications of type 2 diabetes mellitus (T2DM), traditional lifestyle interventions are often difficult to administer in the primary care setting due to limited resources. Mobile health apps can address these limitations by offering low-cost, adaptable, and accessible platforms for disseminating lifestyle management interventions.ObjectiveUsing the RE-AIM evaluation framework, this study assessed the potential effectiveness and feasibility of GlycoLeap, a mobile lifestyle management program for people with T2DM, as an add-on to standard care.MethodsThis single-arm feasibility study recruited 100 patients with T2DM and glycated hemoglobin (HbA1c) levels of ≥7.5% from a single community health care facility in Singapore. All participants were given access to a 6-month mobile lifestyle management program, GlycoLeap, comprising online lessons and the Glyco mobile phone app with a health coaching feature. The GlycoLeap program was evaluated using 4 relevant dimensions of the RE-AIM framework: (1) reach (percentage who consented to participate out of all patients approached), (2) effectiveness (percentage point change in HbA1c [primary outcome] and weight loss [secondary outcome]), (3) implementation (program engagement as assessed by various participatory metrics), and (4) maintenance (postintervention user satisfaction surveys to predict the sustainability of GlycoLeap). Participants were assessed at baseline and at follow-up (≥12 weeks after starting the intervention).ResultsA total of 785 patients were approached of whom 104 consented to participate, placing the reach at 13.2%. Four were excluded after eligibility screening, and 100 patients were recruited. Program engagement (implementation) started out high but decreased with time for all evaluated components. Self-reported survey data suggest that participants monitored their blood glucose on more days in the past week at follow-up compared to baseline (P<.001) and reported positive changes to their diet due to app engagement (P<.001) (implementation). Primary outcome data were available for 83 participants. Statistically significant improvements were observed for HbA1c (–1.3 percentage points, P<.001) with greater improvements for those who logged their weight more often (P=.007) (effectiveness). Participants also had a 2.3% reduction in baseline weight (P<.001) (effectiveness). User satisfaction was high with 74% (59/80) and 79% (63/80) of participants rating the app good or very good and claiming that they would probably or definitely recommend the app to others, respectively (maintenance).ConclusionsAlthough measures of program engagement decreased with time, clinically significant improvements in HbA1c were achieved with the potential for broader implementation. However, we cannot rule out that these improvements were due to factors unrelated to GlycoLeap. Therefore, we would recommend evaluating the effectiveness and cost effectiveness of GlycoLeap using a randomized controlled trial of at least 12 months.Trial RegistrationClinicalTrials.gov NCT03091517; https://clinicaltrials.gov/ct2/show/NCT03091517 (Archived by WebCite at http://www.webcitation.org/77rNqhwRn)

Abstract WP229: H ealthy E ating and L ifestyle After S troke (HEALS): A Pilot Trial of a Lifestyle Intervention for Stroke Survivors in the Safety-Net

Background: Although healthy lifestyle practices mitigate stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a lifestyle management intervention, HEALS, to improve stroke survivors’ diet and physical activity and tested it in a diverse population receiving care at a safety-net county facility. Methods: One hundred English- or Spanish-speaking participants with stroke or TIA were randomly assigned to a 6-week weekly occupational therapist-led group lifestyle intervention vs. usual care. Each 2 hour session included didactics, goal setting, activities, and peer exchange. Primary outcomes measured at baseline and 6 months were body mass index, abdominal obesity, fruit/vegetable intake, and physical activity. Secondary outcomes were blood pressure, high-density lipoprotein cholesterol, and glycosylated hemoglobin. Outcomes were compared with repeated measures analysis. Effect sizes for continuous variables were determined using partial eta-squared. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and adherence to the intervention. Results: Mean age was 60 years, 62% were men, 68% were Hispanic, 60% were Spanish-speaking, 35% had ≤8 th grade education, 31% were working at enrollment, and 69% had modified Rankin scale &lt;3. Seventy-three percent participated in at least one HEALS session. Over one third (37%) attended all 6 sessions. There were no significant changes in primary or secondary outcomes at 6-months, even after adjusting for number of sessions attended. Effect sizes for primary outcomes were small (&lt;0.05). Focus group participants recommended more sessions for a longer treatment duration, additional information on diet and physical activity, and monetary incentives for participation. Providers agreed with a need for a longer treatment duration and suggested more robust provider training and fidelity checks to ensure standardized program delivery. Conclusions: The HEALS intervention was feasible in a safety-net setting, but the effect sizes were small. An RCT of a longer-duration intervention, with more formal provider training, may be warranted.