Lifestyle Modification Program Research Articles

A pragmatic lifestyle intervention for overweight and obese women with gestational diabetes mellitus (PAIGE2): A parallel arm, multicenter randomized controlled trial study protocol.

The global epidemic of type 2 diabetes (T2D) and obesity has been translated into pregnancy, with approximately 18% of women being diagnosed worldwide with Gestational Diabetes Mellitus (GDM). Whilst preventive strategies have proven effective in the non-pregnant context, attrition rates are high and there is an urgent need to develop a customized, pragmatic lifestyle intervention for women both during and after pregnancy. Diet and exercise modification, behavioral support, and Commercial Weight Management Organizations have been strongly recommended to aid postpartum weight reduction for mothers with previous GDM, subsequently reducing their risk of developing obesity and T2D. This study, informed by a previous pilot study, aims to determine the effectiveness of a pragmatic pregnancy and postpartum lifestyle modification program for overweight women with previous GDM (PAIGE2) to reduce body weight at 12 months postpartum. This paper summarizes the protocol for the PAIGE2 study, which has been developed based on results from a pilot study (PAIGE). A six center, two parallel arm, 12-month, randomized controlled trial will be conducted across Northern Ireland and the Republic of Ireland (3 centers each), involving 340 women with GDM and body mass index ≥25 kg/m2 recruited during pregnancy. The lifestyle intervention involves a one-hour virtual educational program (to take place at 32-36 weeks gestation). Postpartum, the intervention will include monthly phone calls, weekly motivational text messages, weekly step counts, and referral for three months to a Commercial Weight Management Organization (Slimming World). The control arm will receive usual care as offered by the local maternity hospital. The primary outcome is weight loss at 12 months postpartum. Study visits for anthropometric and clinical measurements, fasting blood samples, questionnaires pertaining to health, wellbeing and physical activity will take place at 6 weeks, 6- and 12-months postpartum. Focus groups will be conducted with intervention mothers' post-intervention to determine the acceptability of the study design including utility of a Commercial Weight Management Organization, feasibility of remote patient contact, family involvement and patient satisfaction. The PAIGE2 study will address the gaps in previously conducted research and, if positive, has the potential to have major public health implications for the prevention of future GDM and subsequent T2D. https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1, identifier NCT04579016.

Implementation and Evaluation of an Automated Text Message-Based Diabetes Prevention Program for Adults With Pre-diabetes.

Despite the efficacy of diabetes prevention programs, only an estimated 5% of people with pre-diabetes actually participate. Mobile health (mHealth) holds promise to engage patients with pre-diabetes into lifestyle modification programs by decreasing the referral burden, centralizing remote enrollment, removing the physical requirement of a brick-and-mortar location, lowering operating costs through automation, and reducing time and transportation barriers. Non-randomized implementation study enrolling patients with pre-diabetes from a large health care organization. Patients were exposed to a text message-based program combining live human coaching guidance and support with automated scheduled, interactive, data-driven, and on-demand messages. The primary analysis examined predicted weight outcomes at 6 and 12 months. Secondary outcomes included predicted changes in HbA1c and minutes of exercise at 6 and 12 months. Of the 163 participants included in the primary analysis, participants had a mean predicted weight loss of 5.5% at six months (P < .001) and of 4.3% at 12 months (P < .001). We observed a decrease in predicted HbA1c from 6.1 at baseline to 5.8 at 6 and 12 months (P < .001). Activity minutes were statistically similar from a baseline of 155.5 minutes to 146.0 minutes (P = .567) and 142.1 minutes (P = .522) at 6 and 12 months, respectively, for the overall cohort. In this real-world implementation of the myAgileLife Diabetes Prevention Program among patients with pre-diabetes, we observed significant decreases in weight and HbA1c at 6 and 12 months. mHealth may represent an effective and easily scalable potential solution to deliver impactful diabetes prevention curricula to large numbers of patients.

Improvement in binge eating and alexithymia predicts weight loss at 9-month follow-up of the lifestyle modification program

PurposeThe aim of this longitudinal study was to examine the extent to which improved levels of binge eating (BE) behaviors, alexithymia, self-esteem, and psychological distress would predict a reduction in body mass at 9-month follow-up, following a lifestyle modification program for weight loss in obese or overweight patients. MethodsA convenience sample of 120 obese or overweight patients were recruited. Body mass index (BMI), binge eating (BES), levels of alexithymia (TAS-20), perceived stress (PSS), depressive symptoms (SDS), and self-esteem (RSE) were assessed during their first medical examination (T1), and after a weight-loss treatment period of 9 months (T2).ResultsCompared with unimproved patients, improved patients reported a significant decrease in binge eating (p = 0.04) and perceived stress symptoms (p = 0.03), and a significant improvement in self-esteem (p = 0.02) over time. After controlling for gender, self-esteem, depressive symptoms, and perceived stress, baseline BMI (OR = 1.11, 95% CI [1.04,1.19]), ΔBES (OR = 0.99, 95% CI [0.98,0.99]), and ΔTAS-20 (OR = 1.03, 95% CI [1.01,1.05]) significantly and independently predicted a ≥ 5% reduction in body mass from baseline.ConclusionsOur finding supports the suggestion to consider psychological outcomes such as emotional aspects and dysfunctional eating behaviors when planning a weight loss programs to prevent a negative outcome.Level of evidence: Level III, case–control analytic study.

Evaluating Statin Knowledge-Perceptions and Receptivity Following a Comprehensive Lifestyle Modification Program

Background Though clinical guidelines for cholesterol-lowering therapies advocate for both a trial of lifestyle modification and the initiation of statin medication when appropriate, the extent to which lifestyle modification may alter a patient’s knowledge-perceptions and receptivity towards statins remains unclear. Methods Following completion of a 6-month comprehensive lifestyle modification program, perceived changes in knowledge and receptivity towards statins were examined across prespecified subgroups of age, sex, and statin eligibility using a mixed-methods questionnaire. Quantitative and qualitative analyses incorporated binomial tests, McNemar’s test, and thematic analyses. Results Among 192 patients who completed the program and exit questionnaire between December 15, 2020 and July 2, 2021, 88.4% of patients indicated a perceived improvement in cholesterol and/or statin knowledge (P &lt; . 0001). 48.2% of patients acknowledged that their receptivity towards taking statins increased (P = . 61). Changes in receptivity were attributed to several identified program themes including improvements in health knowledge and awareness, motivation and empowerment. Patients who noted improvements in their mental health also reported significantly increased receptivity towards statins (P &lt; . 001). Conclusions Patients’ perceived knowledge and receptivity towards statins may improve following participation in a comprehensive therapeutic lifestyle modification program. Future research must evaluate the impact of these programs on statin uptake, compliance and outcomes.

Mindfulness skills and experiential avoidance as therapeutic mechanisms for treatment-resistant depression through mindfulness-based cognitive therapy and lifestyle modification.

The COVID-19 pandemic and consequent physical distancing has made it difficult to provide care for those with Treatment-Resistant Depression (TRD). As a secondary analysis of a clinical trial, the aim of this study was to explore potential mechanisms through which three online-delivered approaches, added to treatment as usual, improve depressive symptoms in TRD patients. The three approaches included (a) Minimal Lifestyle Intervention (MLI), (b) Mindfulness-Based Cognitive Therapy (MBCT), and (c) Lifestyle Modification Program (LMP). Sixty-six participants with TRD completed assessments pre-post intervention (mindfulness skills [FFMQ]; self-compassion [SCS]; and experiential avoidance [AAQ-II]) and pre-intervention to follow-up (depressive symptoms [BDI-II]). Data were analyzed using within-subjects regression models to test mediation. Mindfulness skills mediated the effect of MBCT on depressive symptoms (ab = -4.69, 95% CI = -12.93 to-0.32), whereas the lack of experiential avoidance mediated the effect of LMP on depressive symptoms (ab = -3.22, 95% CI = -7.03 to-0.14). Strengthening mindfulness skills and decreasing experiential avoidance may promote recovery in patients with TRD, MBCT, and LMP have demonstrated that they may help increase mindfulness skills and decrease experiential avoidance, respectively. Future work will need to unpick the components of these interventions to help isolate active ingredients and increase optimization.

Evaluation of overweight control applications with cognitive-behavioral therapy approach: A systematic review.

Overweight and obesity lead to the development of physical diseases. Cognitive factors play a vital role in controlling one's weight. Currently, cognitive-behavioral therapy (CBT) interventions are recognized as a subcategory of lifestyle modification programs that can be implemented to control weight and modify eating patterns as well as physical activity. Nowadays, smartphone-based applications are utilized to implement behavioral interventions. The main purpose of this study is to evaluate the quality of CBT-based smartphone applications available on Google Play and the App Store in the field of overweight control. Smartphone-based utility applications available on Google Play and App Store were identified in March 2021. Weight control smartphone applications were obtained based on inclusion and exclusion criteria. The app name, platform, version, number of downloads, password protection, affiliations, and features of retrieved apps were tabulated. The Mobile Application Rating Scalewas utilized to evaluate the quality of the identified apps. Seventeen CBT-based weight control smartphone apps were retrieved. The average engagement, functionality, aesthetics, and information quality scores were 3.65, 3.92, 3.80, and 3.91, respectively. Also, the average score in an aspect containing the usefulness of the app, frequency of using the application, cost, and user satisfaction was 3.5. Future applications related to this field can be improved by providing a personalization program according to the needs of users and the possibility of online chatting with the therapist. Further improvements can be achieved by improving the areas of engagement, aesthetics, and subjective quality as well as having appropriate privacy policies.

The Metabolic and Reproductive Effect of Exercise and Diet in Obese PCOS Women : Let the Evidence Guide Us

One of the most strongly related reproductive diseases in obese women is a polycystic ovarian syndrome. PCOS also suffer other comorbidities, such as insulin resistance. This review focus on identifying the metabolic and reproductive effect of diet and exercise in obese PCOS women. We searched for articles published from January 2004 to February 2022 and used electronic databases. We used the purposive sampling method then these articles were selected by inclusion and exclusion criteria. Lifestyle modification programs with an emphasis dietary and exercise interventions have been successful in reducing the risk of comorbidities in the general population and improving reproductive and metabolic features in PCOS. Lifestyle modification should be incorporated in treating obese PCOS patients to reduce their long-term risks for diabetes, hypertension, dyslipidemia, and cardiovascular disease and to increase the probability of spontaneous pregnancy. However, the specific guideline for lifestyle modification emphazising in diet and exercise for PCOS patients requires the large size of clinical trial research to find the best type of interventions in lifestyle modifications with the same outcome parameters.

The Risk Factors of Prediabetes in Adolescents: A Systematic Review

Background: Pre-diabetes is a risk state for the future development of type 2 diabetes. The risk factors for prediabetes have been categorized as modifiable and non-modifiable. However, conclusive evidence regarding the risk factors associated with pre-diabetes in adolescence is still lacking. This study aims to answer the question of: which risk factors are most associated with the incidence of prediabetes in adolescents? Methods: This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A systematic search was conducted in PubMed, ScienceDirect, Scopus and Web of Science electronic databases using the keywords of “modifiable risk factors”, “non-modifiable risk factors”, “pre-diabetes” and “adolescent” in the time frame of 2010 to 2021. Eligibility criteria were determined based on the (population, intervention, comparison and outcomes) PICOS guidelines. Reference list from identified studies was used to augment the search strategy. Two authors assessed the quality and risk of bias of the studies using National Institute of Health (NIH) Quality assessment tool. Qualitative analysis method was used to review the articles. Based on this, components such as purpose, methodology, risk factors, measurement method and main findings were extracted. Results: As a result of the initial search, 3982 studies were obtained. All duplicates, case reports, reviews and non-English studies were excluded. A total of ten articles that met the pre-defined eligibility criteria were included in this review. The quality of included studies was mostly in the good category. Overall, the association between risk factors and adolescents’ prediabetes appeared to be strongest among modifiable factors such as physical activity, poor diet, smoking, and cardiometabolic factors. The most significant modifiable factor was body mass index (BMI) and the most significant non-modifiable factor was gender. Conclusion: Considering the prominent role of modifiable risk factors in the occurrence of prediabetes in adolescents, it seems necessary to include lifestyle modification programs for this age group. It is also important to pay attention to gender as a non-modifiable factor in the development of prediabetes in adolescents.

The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial

BackgroundMany lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM).MethodsWe conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model.ResultsThe sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05).ConclusionsOver 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide.Trial registrationRegistered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569

Lifestyle medicine approach in managing pemphigus vulgaris: A case report

A 58-year-old female presented to a lifestyle medicine clinic in 2019 with a one-year history of pemphigus vulgaris (PV) and having itching, burning sensations, and bulla formation all over her body. She further had a recent diagnosis of type 2 diabetes mellitus and also complained of malaise, indigestion, and anxiety due to her skin condition. She was on methyl prednisolone, metformin, and other herbal supplements for 1 year to control her PV and diabetes. Laboratory investigations revealed the presence of autoantibodies Desmoglein 1 and 3 with titers of 3.26 and 3.5, respectively.The patient underwent a yoga & naturopathy-based lifestyle modification program for a period of 53 days in 2019, followed by 10 days in 2020 and 15 days in 2021, and subsequent follow-up measures. This included hydrotherapy, yoga, a vegetarian diet, herbal preparations, massage, etc. By the end of 2020, the patient was tapered from all medications, and there was complete remission from PV. Given the multidimensional impact of PV, a holistic, patient-centered lifestyle approach as described in this case may be beneficial in managing PV. Further research is warranted in this area.

The effectiveness of magnetic resonance imaging (MRI) iron corrected T1 in monitoring metabolic dysfunction-associated steatohepatitis in obesity following bariatric surgery and lifestyle modification: a prospective cohort study.

Bariatric surgery and lifestyle modification are important treatments for obesity, a risk factor for metabolic dysfunction-associated steatohepatitis (MASH). Studies have related weight reduction with changes in MASH, however, few have used imaging to investigate effects on liver health. We evaluated differences in liver response to obesity treatment using disease activity iron corrected T1 (cT1) and proton density fat fraction (PDFF) in patients with both obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). Thirty-four patients with obesity and MASLD were recruited between March 2019 to February 2022 from a tertiary hospital in this longitudinal study; 13 underwent laparoscopic sleeve gastrectomy (LSG) alongside intraoperative liver biopsy, and 21 underwent a 4-month lifestyle modification program (LMP). All patients had multi-parametric magnetic resonance imaging (MRI) at baseline and 4-months. Diagnostic accuracy to identify MASH was assessed using the area under receiver operating characteristic (AUROC) curve. Four (31%) of patients in the LSG group had MASH [non-alcoholic steatohepatitis (NAS) activity score ≥4] on liver biopsy. PDFF and cT1 correlated with the NAS activity score [r=0.81, 95% confidence interval (CI): 0.453 to 0.943, P<0.001] and (r=0.70, 95% CI: 0.228 to 0.907, P=0.008, respectively). There was good AUROC curve for cT1 (0.89, 95% CI: 0.67 to 1.00, P=0.031) and PDFF (0.83, 95% CI: 0.57 to 1.00, P=0.064) to identify MASH. At follow-up, weight reduction -22.8% (P=0.013) vs. -1.3% (P=0.262) resulted in cT1 reduction of -8.04% (864 ms, P=0.025) vs. -3.87% (907 ms, P=0.083) in the LSG vs. LMP group, respectively. Significant differences between interventions were observed for percentage PDFF decrease (-64.52% vs. -29.16%, P=0.001). Both biomarkers were significantly reduced in the LSG group (cT1 by -8.04%, P=0.025, PDFF by -64.52%, P=0.012), while only PDFF (-29.16%, P=0.012) was significantly reduced in the LMP group. MRI biomarkers may have some utility to monitor MASH following intervention in patients with obesity allowing objective comparison between intervention strategies. Compared to LMP, LSG was more effective in improving liver health.

Obesity: An important predictor of metabolic syndrome

Background/Aim: The leading avoidable cause of mortality in the world is obesity. It modifies how the body reacts to insulin, which might result in insulin resistance and an elevated risk of type 2 diabetes. Recent investigations have revealed a link between obesity and the metabolic syndrome. Therefore, it was intended for the current study to look at the prevalence of obesity and how it relates to the metabolic syndrome. Methods: 120 healthy males between 30-50 years of age were chosen from the general population of Kota District, Rajasthan, India and screened for obesity and divided in three groups: normal, overweight and obese. Each group comprised of forty subject. Serum was separated and run in department of biochemistry , GMC Kota. Anthropometric parameters were taken. The completely automated analyser ERBA EM 360 performed lipid profile and blood sugar analyses on serum. Result: Obesity increased metabolic syndrome prevalence. In comparison to overweight and normal weight people, obese subjects exhibited considerably lower levels of high-density lipoprotein (HDL) cholesterol and significantly higher levels of blood glucose, triglycerides, total cholesterol and low-density lipoprotein (LDL) cholesterol. Additional coronary artery disease (CAD) risk prediction ratios, such as total cholesterol/HDL, LDL/HDL and triglycerides/ HDL ratios that have gradually increased from the normal to obese group, show that obese subjects have a relatively higher risk of developing cardiovascular diseases (CVD) than do those in the overweight and normal groups. Conclusion: One of the key elements of metabolic syndrome, which is a collection of clinical and metabolic anomalies including abdominal obesity, insulin resistance, hypertension and dyslipidaemia, is obesity. Each of these conditions raises the risk of CVD and diabetes mellitus type 2 directly. The progression towards diabetes and CVD can be prevented by lifestyle modification programmes and regular health checks (to explore the risk factors of metabolic syndrome).

Correlational study to identify the barriers to physical activity and healthy diet among adolescents in selected school of Kashmir with a view to develop a lifestyle modification programme

Correlational study to identify the barriers to physical activity and healthy diet among adolescents in selected school of Kashmir with a view to develop a lifestyle modification programme

Diabetes, A Global Epidemic

The International Diabetes Federation notes that diabetes is a global epidemic affecting approximately 537 million adults (20-79 years) worldwide. The total number of people living with diabetes is projected to rise to 643 million by 2030 and 783 million by 2045. In the United States, 37.3 million people (about 1 in 10) have diabetes, and the incidence is 1.4 million every year. 38.0% (96 million) aged 18 and above have prediabetes (National diabetes statistics report, 01/2020). More than 8 in 10 do not know they have prediabetes (About Prediabetes and Type 2 Diabetes | National Diabetes Prevention Program | Diabetes | CDC, 2022). The estimated cost of care in 2012 was $ 240 billion, which increased to $327 billion in 2017 (Economic Costs of Diabetes in the U.S. in 2017 | Diabetes Care | American Diabetes Association, n.d.). It has been the seventh leading cause of death in the U.S. since 2019 (Statistics About Diabetes / ADA, n. d.). Epidemiological research to assess the effect of lifestyle modification on the development of T2DM produced evidence that a structured lifestyle modification program can cut the risk of developing T2DM by 58% for people under 60 and 71% for people over 60 years old (CDC - About the Program - National Diabetes Prevention Program - (Diabetes DDT, 2021). Lifestyle intervention is a safe, cost-effective, and efficacious way of diabetes prevention (Glechner et al., 2018). It is recommended that early screening of patients with prediabetes that exhibit risk for T2DM and implementing lifestyle modifications or referral to the National Diabetes Prevention Program will help address this public health issue. More training and an increased workforce are needed to open conversation in T2DM prevention strategies.

Plasma GSH as Independent Antioxidant Factor of Metabolic Syndrome Lowering by a Lifestyle Modification Program

Introduction: Metabolic syndrome (MetS) is accompanied by pro-oxidative processes that might be reversed or attenuated by the physical exercise. Objective: To investigate the impact of a lifestyle modification program (LiSM) on antioxidant status and redox processes in MetS. Methodology: It was analyzed data from participants of the ongoing dynamic coort-study "Move for Health" during the period of 2009-2012. Fifty-seven subjects full filed the inclusion criteria of attending the 20wk-LiSM with nutritional counseling and supervised aerobic exercises. Assessment at baseline and end of LiSM were undetaken for anthropometric, clinical, dietary, cardiorespiratory fitness (CRF) and plasma-biochemistry data. Plasma hydrophilic total antioxidant performance (TAP) along with malondialdehyde (MDA) and total and oxidized (GSSG) glutathione were measured and reduced (GSH) glutathione was estimated. MetS was defined by NCEP(2005) criteria. Statistical significance was set at p &lt;0,05. Findings: Primary outcomes after LiSM were the decreasing of BMI, WC and body fat and the increasing of HEI, CRF, HDL-c, GSH and plasma TAP. These changes were similar in both groups, MetS and non-MetS. MetS decreased by 16.4%. In the MetS group, the TAP variation during 20wk-LiSM correlated significantly with WC (r=-0.47), fasting blood glucose (r=-0.48) and MDA (r=-0.45) and, in non-MetS group TAP correlated with HDL-c (r=0.38) and GSH (r=0.45). After LiSM, the TAP-responsive (≥3% increased) subjects differed from the non-TAP-responsive (≤3%) by presenting increased values of CRF, HDL-c, uric acid and GSH, and decreased SBP, GSSG and GSSG/GSH ratio. The multiple-adjusted regression analysis pointed out the increased GSH as the only independent risk factor for TAP changes, during LiSM, either in presence or absence of MetS. Conclusion: Thus, this 20-wk LiSM changed the pro-antioxidant balance by modifying GSH redox status irrespective to the presence or absence of MetS.

Leisure-time physical activity is more strongly associated with cardiometabolic risk than occupational physical activity: Results from a workplace lifestyle modification program

BackgroundRegular physical activity (PA) plays a key role in the management and prevention of numerous chronic diseases. However, recent studies have suggested that occupational physical activity (OPA) may not always have health benefits. The aim of the present study was to examine the respective contributions of OPA vs. leisure-time physical activity (LTPA) to the variation in the cardiometabolic profile, including cardiorespiratory fitness (CRF), of employees involved in a workplace lifestyle modification program. Our study hypothesis was that LTPA would show a stronger association with indices of cardiometabolic health than OPA. MethodsA mobile health assessment unit was used to assess 5145 workers (3397 men and 1748 women) on site at their workplace. Assessments included lifestyle questionnaires (overall diet quality, type of OPA and level of LTPA), blood pressure measurements, blood tests, anthropometric measurements, and a submaximal treadmill exercise test to assess CRF. Results were adjusted for education, household income and age. ResultsWhen workers were classified on the basis of their OPA (sedentary work, standing work, physical work, and heavy manual work), only a few significant differences in the cardiometabolic profile were observed in men, with those in the physical work category having more favorable values than sedentary workers. However, substantial and significant differences were observed among employees classified on the basis of their LTPA, these differences being observed in both men and women. For instance, waist circumference, the cholesterol/HDL cholesterol ratio, triglyceride concentrations and resting heart rate were lower in active individuals compared to inactive and moderately inactive individuals (p < 0.01). Furthermore, irrespective of whether or not employees were sedentary at work, a high level of LTPA was associated with a greater CRF (p < 0.001). Finally, we found that the lowest prevalence of hypertriglyceridemic waist (p < 0.01) and the highest score of overall diet quality (p < 0.001) were observed in active individuals, irrespective of their OPA category. ConclusionLevels of LTPA were more strongly associated with cardiometabolic health than OPA in a cohort of blue- and white-collar employees. Furthermore, high levels of LTPA were found to counteract the potentially deleterious effects of a sedentary work on cardiometabolic health.

Offering a lifestyle intervention to women of premenopausal age as primary prevention for cardiovascular disease? – assessing its cost-effectiveness

BackgroundThere is limited evidence of cost-effective primary prevention interventions for cardiovascular disease (CVD) in young women. This study aimed to assess the value for money of primary prevention of CVD in this population.MethodsA Markov microsimulation model consisting of both first-ever and recurrent CVD events was developed to simulate the lifetime intervention impact on cost and health outcomes in women of premenopausal age (30 to 54 years) from the Australian healthcare system perspective. The latest wave of the Australian National Health Survey defined the modelled population’s characteristics. The intervention effectiveness of a lifestyle modification program involving changes in diet and physical activity demonstrated to be effective in this population was sourced from a systematic review and meta-analysis. The first-ever and recurrent CVD probabilities were derived from the CVD risk calculators accounting for socio-demographic and clinical characteristics. Costs and utility weights associated with CVD events and long-term management post-CVD were informed by national statistics/published literature. Sensitivity analyses were undertaken to examine the robustness of base case results.ResultsThe lifestyle modification program was associated with both higher costs and benefits (in terms of quality-adjusted life years, QALYs) as a primary prevention measure of CVD in premenopausal women, with an ICER of $96,377/QALY or $130,469/LY. The intervention led to fewer first-ever (N = −19) and recurrent CVD events (N = -23) per 10,000 women over the modelled life horizon. The avoided cost due to reduced hospitalisations (−$24) and management (−$164) of CVD could partially offset the cost associated with the intervention ($1560). Sensitivity analysis indicated that time horizon, starting age of the intervention, discount rate, and intervention effectiveness were the key drivers of the results. If the intervention was scaled up to the national level (N = 502,095 at-risk premenopausal women), the total intervention cost would be $794 million with $95 million in healthcare cost-savings.ConclusionOffering a lifestyle modification program to premenopausal women in Australia as primary prevention of CVD is not cost-effective from a healthcare system perspective. We should continue to search for new or adapt/optimise existing effective and cost-effective primary prevention measures of CVD for women.

Efficacy of an adjuvant non-face-to-face multimodal lifestyle modification program for patients with treatment-resistant major depression: A randomized controlled trial

BackgroundThe high prevalence of depression is partly attributable to the poor response of patients to first-line antidepressants. Multimodal programs that promote a healthy lifestyle are successful in treating depression when used as a complementary therapy, but their medium- and long-term benefits have not been demonstrated for patients with treatment-resistant depression (TRD). The main aim of this study was to compare the effectiveness of a lifestyle modification program (LMP) with mindfulness-based cognitive therapy (MBCT) and a placebo-control (written suggestions for lifestyle changes) in Spanish patients with TRD. MethodsThis controlled clinical trial randomized 94 patients with TRD into 3 arms. The primary outcome was the Beck Depression Inventory-II (BDI-II) score at baseline, 2, 6 and 12 months. The secondary outcomes were changes in scores that evaluated quality-of-life, adherence to the Mediterranean diet, physical activity, and social support. ResultsRelative to the placebo group, the LMP and MBCT groups had significantly better quality of life (p = 0.017; p = 0.027), and the LMP group had significantly better adherence to the Mediterranean diet (p<0.001) and reduced use of antidepressants (p = 0.036). However, the three groups showed no significant differences in BDI-II score. LimitationsOnly about half of the planned 180 patients were recruited, in part due to the COVID-19 pandemic. ConclusionsThere was no evidence that the LMP treatment significantly reduced symptoms of depression relative to the other groups during the COVID-19 lockdown.

Lifestyle Modification Program for Cardiovascular Risk Patients in Indonesia

Purpose: Unhealthy lifestyle leads to an increased risk of contracting cardiovascular disease (CVD). This study aimed to determine the effectiveness of the LIFESTYLE modification program developed by the researcher. The program was designed in response to the needs of Indonesian patients. LIFESTYLE is an acronym for L-ose weight, I-dentify your risk, F-ood choice, E-xercise frequently, S-top smoking and alcohol, T-hink positive, Y-es to a healthy lifestyle, L-et’s control regularly, and E-veryone is supporting you.&#x0D; Method: This study employed the quasi-experimental design, specifically pretest-posttest method along with time series. Fifty-eight (58) participants were purposively chosen and given a 12-week LIFESTYLE modification program in a community health center called Puskesmas in Indonesia. CVD risk and physiological parameters such as blood pressure, waist circumference, total blood cholesterol, and body mass index (BMI) were observed before, during, and after the intervention. CVD risk was estimated using Framingham 10-year CVD risk score of non-laboratory-based test.&#x0D; Results: The mean for CVD risk and physiological parameters decreased after the participants underwent the LIFESTYLE modification program. The analysis of variance (ANOVA) revealed that there was a significant difference in the participants’ systolic blood pressure and total cholesterol (p&lt;.001) before, during, and after the intervention.&#x0D; Conclusion: The 12-week LIFESTYLE modification program is effective in increasing knowledge of cardiovascular risk and observing a healthy lifestyle. Also, this program facilitates early identification of risks for CVD and improves selected physiological parameters.

Weight regain after behavioural weight management programmes and its impact on quality of life and cost effectiveness: Evidence synthesis and health economic analyses.

We used data from a recent systematic review to investigate weight regain after behavioural weight management programmes (BWMPs, sometimes referred to as lifestyle modification programmes) and its impact on quality-of-life and cost-effectiveness. Trial registries, databases and forward-citation searching (latest search December 2019) were used to identify randomized trials of BWMPs in adults with overweight/obesity reporting outcomes at ≥12 months, and after programme end. Two independent reviewers screened records. One reviewer extracted data and a second checked them. The differences between intervention and control groups were synthesized using mixed-effect, meta-regression and time-to-event models. We examined associations between weight difference and difference in quality-of-life. Cost-effectiveness was estimated from a health sector perspective. In total, 155 trials (n > 150 000) contributed to analyses. The longest follow-up was 23 years post-programme. At programme end, intervention groups achieved -2.8kg (95%CI -3.2 to -2.4) greater weight loss than controls. Weight regain after programme end was 0.12-0.32 kg/year greater in intervention relative to control groups, with a between-group difference evident for at least 5 years. Quality-of-life increased in intervention groups relative to control at programme end and thereafter returned to control as the difference in weight between groups diminished. BWMPs with this initial weight loss and subsequent regain would be cost-effective if delivered for under £560 (£8.80-£3900) per person. Modest rates of weight regain, with persistent benefits for several years, should encourage health care practitioners and policymakers to offer obesity treatments that cost less than our suggested thresholds as a cost-effective intervention to improve long-term weight management. The review is registered on PROSPERO, CRD42018105744.